Keystone state story capturesradiology's painful transition

It's rare for us to focus closely on medical trends in a particular state. We made an exception with this edition's look at Pennsylvania, in part because it's an interesting story, but also because it represents a cautionary tale for all of radiology.

Pennsylvania has some unique characteristics that could soon find their way into other states and regions, particularly as the population ages and reimbursement rates are forced down further.

Much of the concern about trends in Pennsylvania is reflected in an annual report compiled by the Pennsylvania Medical Society. Among its findings:

• The mean age of physicians in Pennsylvania is 50. Radiologists, as a whole, are the oldest of the bunch: 85% are older than 50, and half are older than 55. The percentage of physicians who are under the age of 35 has dropped to between 6% and 7.8%, down from nearly 15% in 1991.

• The aging of the physician workforce is more than matched by the aging of the population. Nationally, 12% of the population is 65 or older. By 2030, that figure will reach 18%. Currently in Pennsylvania, 16% are 65 and older. By 2030, that figure will reach 21%.

• Although Pennsylvania has quite a few residency programs, retention rates are low and falling. From 1992 to 2006, the percentage of physicians-in-training who stayed in Pennsylvania for active practice declined from nearly 60% to 20%, according to the report.

A close look at the numbers and interviews with experts in Pennsylvania suggest that what ails medicine as a whole in the state also ails radiology: Reimbursements are low relative to other states, malpractice is often a burden, and residents come and train and then leave for sunnier or more lucrative climates. What's distinctive about Pennsylvania is the aging population of radiologists and the fact that in the next five to 10 years, many of them could be ready for retirement.

What will happen then? Recall that early in this decade, radiology was slammed with a workforce shortage that has abated somewhat. In the interim, however, radiologists became more efficient and worked harder, and new businesses like teleradiology sprang up to fill the void.

A perennial concern whenever a radiologist workforce shortage occurs is that other medical specialists step up their interest in obtaining imaging equipment and interpreting the scans themselves.

We can't say what the medical market's response to a localized or more widespread shortage of radiologists will be next time, but we know that it inevitably provokes changes. Radiologists need to be aware of this and to plan accordingly.