Assessing the state of the global radiology workforce involves a number of factors, including regional differences in who can call themselves radiologists and the number of public versus private radiology practices, according to radiologists from around the globe who gathered for an “International Trends” meeting at RSNA 2012.
Latin America, comprising 20 diverse countries with a total population of nearly 586 million, is “the most unequal region of the world,” said Gloria Soto Giordani, M.D., a radiologist with the Department of Radiology, Clinica Alemana de Santiago, Chile. Physicians per 1,000 inhabitants in each country range from just 0.25 in Nicaragua to 3.5 in Uruguay and 6 in Cuba.
Radiologists in Latin American countries are scarcer, with the radiologist per 100,000 inhabitants ratio ranging from 89 in Honduras and 96 in El Salvador to 5.7 in Cuba and 4.99 in Argentina. “There are great differences among and within countries in issues related to radiology,” Dr. Soto Giordani said.
Radiology workforce information was obtained from a survey sent by e-mail to the presidents of the national radiology societies of the countries that make up the Colegio Interamericano de Radiologia, (Inter-American College of Radiology), all Latin American countries except Paraguay.
“Many countries don’t know the exact number of radiologists they have,” Dr. Soto Giordani said. Confusion is created because of non-associated members and physicians performing as radiologists with no formal training. In most countries, radiologists work both in private and public practice, although Cuba has no private practice, Dr. Soto Giordani added.
Of note is the fact that many public practices have no radiologists at night, Dr. Soto Giordani said. “In those that have a residency program, residents do the night work, which is validated by a staff the next morning,” she said.
In Europe, the European Society of Radiology is “trying to harmonize training” across countries, said Luís Donoso-Bach, M.D., director of the Centre de Diagnòstic per la Imatge Clínic at the University of Barcelona. Included in that effort is the European Training Charter for Clinical Radiology and European Diploma in Radiology (EDiR).
Yves Menu, M.D., meanwhile, noted that while there are between 80,000 and 100,000 radiographers in Europe, few are members of a national or international society. Radiographers from the north are more likely to join a society than those from the south, added Dr. Menu, a professor and chairman of radiology at Saint Antoine Hospital, Pierre and Marie Curie University, Paris. That same latitudinal boundary seems to drive differences in extending sonography responsibilities to radiographers, he said—radiologists in some countries strongly favor such an expanded role, while in other countries there is strong opposition.
“There is a debate based on the training curriculum that poorly prepares technologists to perform extended tasks today, at least in Southern Europe,” Dr. Menu said. “Some countries have organized university training while others have a vocational organization. Finally, the question of the balance between radiologists and radiographers and the equilibrium seems to be different from one country to another.”
In the U.S., the ratio of technologists to radiologists is seven to one (225,000 technologists to 32,000 radiologists), according to Edward I. Bluth, M.D., chairman of the Department of Radiology at Ochsner Health System in New Orleans, La.
“The U.S. offers a very significant educational system that is very robust for technologists,” Dr. Bluth said. That system includes accredited, educational programs by recognized organizations that offer competency-based educational programs and certification exams, Dr. Bluth said.
Turf battles with other specialties over image-guided interventional procedures and vascular/interventional radiology, as well as diagnostic imaging of coronary CT, are occurring in Asia, said Sachio Kuribayashi, M.D., of Keio University of Medicine in Tokyo. E. Stephen Amis, Jr., M.D., professor and chairman of the Department of Radiology at the Einstein College of Medicine/Montefiore University Hospital in Bronx, N.Y., talked of similar conflicts in the U.S., with radiology performed by non-radiologists.
“We’re losing the battle,” Dr. Amis said, noting that radiologists are now paid less than non-radiologists for noninvasive imaging, a figure of $4.8 billion as opposed to $4.6 billion annually.
“A lot of people who aren’t radiologists claim imaging as part of their practice,” Dr. Amis said. “It’s very competitive. It’s a tough turf. As the reimbursement goes down, doctors will do things to try and keep their income level stable.”
Free-standing clinics and private practices are losing ground, according to Dr. Amis. “It’s not uncommon for other doctors to get first preference over radiologists,” he said.
Richard L. Baron, M.D., who served the RSNA Board of Directors as liaison for education from 2009 to 2012, is the new Board Liaison for International Affairs. Valerie P. Jackson, M.D., replaces Dr. Baron as education liaison.
Dr. Baron is dean for clinical practice and a professor of radiology at the University of Chicago Pritzker School of Medicine. In his new position with the RSNA Board, he will have responsibility for the development of a comprehensive international strategy and will facilitate Board direction and oversight of all international related activities. In this capacity, Dr. Baron will chair the Board Committee on International Affairs, and will serve as Board Liaison to the Committee on International Radiology Education and the International Advisory Committee.
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