There are not enough radiologists in the Lehigh Valley.
It’s a reality that isn’t unique to the region: There is a global shortage of radiologists due to factors such as older radiologists retiring, burnout among existing radiologists and not enough new people entering the field fast enough.
To bring more radiologists to the Lehigh Valley, both of the region’s major health networks have decided that part of the solution is to train their own radiologists, right here. St. Luke’s has its program up and running and LVHN is in the early stages of establishing its own.
Dr. Pallav Shah, director of St. Luke’s diagnostic radiology residency program, said getting new blood into the field is critical because it, like many other medical specialties, has an aging workforce — 53% of radiologists are over the age of 55 and 82% are over the age of 45. At the same time, the volume of radiology studies radiologists need to complete is increasing each year.
“There’s an increase in workload and probably a decrease in projected manpower just because people are going to age out of practice,” Shah said. “The other thing I would say is that we only have a certain number of residency programs in this country to train residents and the number has not significantly increased over the years.”
The in the U.S. as of 2013 was 1,356, which is 65% higher than it was in in 1991, according to analysis of national resident match program data by by Dr. Francis Deng, a professor at Johns Hopkins University School of Medicine. But the majority of that growth has happened in recent years.
The end result is that hospitals are competing for a limited pool of radiologists, and working radiologists are taking on an extra load. Dr. Devang Gor, chair of radiology and diagnostic medical imaging for Lehigh Valley Health Network, said this has led to increased burnout among radiologists, which can have the effect of worsening the shortage if radiologists leave the field or choose to work less.
“Because of the job market you are able to cut down and work less and make the same amount of money,” Gor said. “But the ones in the workforce that are not able to do so are facing increased burnout.”
Shah said these factors also lead to patients waiting longer for results.
“We’re seeing a backlog in studies because there’s only so much time in a day, but when we push that number and expect radiologists to read faster they tend to make more mistakes because they’re forced to read more over the same period of time. We’re trying to open up slots for patients so that there isn’t a backlog in scheduling,” Shah said.
Shah said St. Luke’s has had successful recruitment seasons, but the rising demand has always outstripped those gains in manpower. Several years ago, rather than waiting and hoping for things to get better, St. Luke’s began setting the stage for its own local solution. It received certification for its own radiology residency program from the Accreditation Council for Graduate Medical Education in 2022.
The program is composed of two types of residencies: a four-year diagnostic radiology residency with six slots per year and a five-year integrated interventional and diagnostic radiology program, which only has room for one new resident per year. Once residents from all four years are in the program, the number of working residents will total 28. However, the network shouldn’t have problem filling those spots. St. Luke’s saw immediate success when it opened for applications for its first class, which started last July. There were 750 applicants, of which 82 were interviewed and seven were accepted.
In the four-year diagnostic program, trainees learn the skills needed to become competent and successful radiologists. Shah added that these residents also will work closely with St. Luke’s vascular surgeons and learn how to use artificial intelligence-driven tools that already are assisting radiologists within the network.
The residents in the integrated interventional and diagnostic radiology program will spend three years focusing on diagnostic work and then receive two additional years performing procedures such as biopsies, catheterizations and angiograms.
However, Shah added that even residents in the other program will gain some experience with interventional radiology.
LVHN still is in the process of establishing its own residency program. Gor said the network has hired a residency program director to apply to the Accreditation Council for Graduate Medical Education. The network will apply to the council this month, hoping to have approval by the end of this year.
“If everything goes as planned we would expect to start teaching residents in 2025 or 2026,” Gor said.
He added that LVHN is also looking to establish anesthesia and orthopedics residencies.
Jefferson Health, with which LVHN plans to merge, already has its own radiology residency programs.
Role of technology in addressing radiologist shortage
Artificial intelligence is another component both networks are using to ease the workload of radiologists and decrease the time patients wait before getting results.
“We use AI in a lot of different ways, some from a workflow standpoint, some from an image evaluation and interpretation standpoint,” Shah said.
Radiologists already take advantage of AI tools that help detect brain bleeds and certain types of stroke during CT scans and CT angiograms. Different AI tools help with the detection and interpretation of other conditions and the network is continuing to expand these capabilities to help detect conditions such as emphysema.
On the workflow optimization side of things, St. Luke’s radiologists are using a text and voice recognition product called PowerScribe One, which automatically generates alerts and prompts for us radiologists when reports involve significant and/or critical’ findings.
Another major tool directly imports measurements taken on ultrasound machines into radiology reports. Shah said this reduces workload for the radiologist and improves accuracy in reporting by reducing voice recognition software errors.
LVHN began using AI at all radiology departments across the network last year, some of which it finished implementing earlier this year. This technology includes tools that detect certain potentially serious conditions and then sends those studies to the top of the list for radiologists to look at helping patients in need of immediate care get seen soon.
It also includes a tool that helps radiologists generate reports for patients based on the radiologist’s dictation when the results don’t require immediate attention. The newest tool LVHN has adopted helps manage follow-up appointments and treatment when results don’t require immediate attention by sending reminders to patients and care providers.
“There are certain tasks that radiologists can delegate to them and we are making sure they are delegating appropriately. With AI you want to make sure to decrease their fatigue in a day and increase their efficiency,” Gor said.
