How to address the shortage of interventional radiologists
There is a growing shortage of interventional radiologists (IRs), particularly in small towns and rural areas. Physician organizations such as the Society of Interventional Radiology (SIR) and American College of Radiology (ACR) are advocating for changes in payment models, loan forgiveness programs and increasing residency positions to try and address the shortages.
Health Imaging spoke with Elizabeth Ann Ignacio, MD, FSIR, FACR, the chair of SIR Small and Rural Practices Committee, president of the Hawaii Medical Association, and an ACR board member, who outlined the problems, numbers of IRS needed, and ways to make these positions more attractive. As a diagnostic and interventional radiologist in Hawaii and president of the Hawaii Medical Association, Ignacio brings firsthand experience and a deep understanding of the challenges facing this critical specialty.
"Overall, there is a shortage of 124,000 physicians. It's going to be worsening up through 2034. And for interventional radiologists, specialty medicine in general is struggling, particularly in small and rural practices in the underserved areas," Ignacio explained. "A recent study found that only 347 of 3,142 counties in the United States have a practicing interventional radiologist, and only 869 of those counties had a radiologist at all to perform any image-guided procedures. If you think 300 out of 3,000, that is pretty remarkable that a lot of people don't have access to standard minimally invasive procedures.
She said IRs provide a variety of image-guided, catheter-based procedures that include vascular access, oncology services, biopsies, drainages, treating tumors and trauma patients.
The growing shortage of interventional radiologists
Interventional radiology, a specialty at the intersection of imaging and minimally invasive procedures, is crucial for a wide range of medical interventions, including oncology, gynecology, and surgery. However, the field is experiencing a significant shortage of professionals, particularly outside of major urban centers.
"Patients in rural regions often have to travel long distances to receive even basic procedures like biopsies or drainages," said Ignacio. "More complex services, such as those related to oncology or trauma, are even harder to access."
She said the shortage has profound implications for patient care, particularly in underserved areas. Most states have vast expanses of rural areas that require patients to drive long distances for receive IR services. In Ignacio's home of Hawaii they water separating the islands that make up the state, which further compounds patient access issues.
Factors contributing to the shortage of interventional radiologists
Several factors contribute to the shortage of interventional radiologists. One significant issue is the limited number of residency positions available for training in the field. While IR is a popular and growing specialty, she said the number of training spots has not kept pace with demand. Furthermore, the high cost of medical education and the burden of student loans for the longer training period deter many prospective radiologists from entering the field, especially in less lucrative, rural areas.
Ignacio also highlighted the particular challenges faced by smaller hospitals in recruiting and retaining interventional radiologists.
"In smaller hospitals, where there are fewer beds and a lack of multi-specialty care, it can be challenging to attract and keep IRs," she explained. "The combination of lower compensation, fewer resources, and professional isolation makes it difficult to draw specialists to these areas."
Strategies for addressing the IR shortage
To combat this shortage, Ignacio emphasized the need for a multi-faceted approach. One promising strategy is loan forgiveness programs, which are already in place for primary care physicians in some states. These programs offer financial incentives to medical graduates in exchange for service in underserved areas. She pointed to the SPARC Act (Specialty Physicians Advancing Rural Care, H.R.2761) as a federal initiative that could significantly impact the shortage. She said the act proposes loan forgiveness for specialty medicine physicians, including interventional radiologists, who commit to working in rural or underserved areas for a set period.
In addition to federal initiatives, Ignacio mentioned that some private practices are taking matters into their own hands by offering signing bonuses, stipends, and other financial incentives to attract young physicians.
"These practices are reaching out directly to medical schools, offering support through medical school and residency in exchange for a commitment to practice in less densely populated areas. It's an innovative approach that could make a real difference," she explained.
While addressing the shortage of interventional radiologists will require time and coordinated efforts, Ignacio remains optimistic. She called for continued advocacy at both the state and federal levels, including reforms to the Medicare payment system and increasing the number of graduate medical education (GME) slots, to help alleviate the shortage. She said higher Medicare payments for IRs serving rural areas and places with known health disparities would make a big impact in changing where the specialists chose to practice.
"We need to ensure that our compensation systems reflect the reality of living and working in different parts of the country," she stressed.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com