Staffing crisis looms, radiologists warn

Radiologists don't need to use any of their expensive equipment to see how serious their specialty's staffing problems are becoming. A conservative estimate is that there is now a shortage of 105 radiologists in Canada, meaning that about 4% of the estimated total of 2500 positions are vacant. But with 12% of radiologists at retirement age and another 10% considering retirement, says Normand Laberge, that shortage could reach as high as 26%.

Waiting lists are already growing longer, says Laberge, CEO at the Canadian Association of Radiologists (CAR). Depending on the province, patients can wait between 3 and 9 months for an MRI scan. "Any waiting period over a month and a half is unacceptable," he says.

To alleviate the shortage in some areas, foreign-trained radiologists are being hired temporarily. One Alberta group recently hired 8 foreign graduates.

Exacerbating the physician shortage is a dearth of up-to-date radiology equipment. Given the 2 problems, says CAR President John Radomsky, things are "going to deteriorate rapidly into a crisis situation." FIGURE

Figure. A crisis is imminent: Dr. John Radomsky

The CAR is determined to prevent that crisis. This summer Radomsky sent a letter to federal Health Minister Allan Rock asking him to take "rigorous measures" immediately, and Laberge met with Rock's staff. The CAR is now planning a forum for February 2000 that will involve all provincial radiology associations, 16 academic heads from the country's medical schools, and the federal government.

"It's time for the entire radiology community to make a unified and very strong statement to the minister that we are descending to a Third World level of service," says Radomsky, who practises in Red Deer, Alta.

Meanwhile, Dr. Brian Lentle says radiologists are trying to cover the staffing deficit by working overtime and deferring holidays and retirement. Lentle, past president of the CAR and a professor of radiology at the University of British Columbia, says the key to solving the problem lies in having more doctors in the training pipeline. Surveys conducted for the CAR in 1994/95 and 1997/98 indicate that the number of unfilled positions in Canada rose from 59 in 1995 to 105 in 1998, while the number of new radiologists being produced declined from 87 in 1994 to 69 in 1998. The radiologist-patient ratio is already well above the recommended ratio of 1:13 000. In 1994 it stood at 1:15 607, and the 1998 estimate was 1:16 763. Lentle says the situation will not improve unless the number of radiology graduates increases immediately, from about 70 per year to 135 to 150 annually.

Lentle would also like to see changes to re-entry rules to allow practising doctors to enter the field, and a "reversal of the disincentives that drive people to the US." These include poor equipment and limited research opportunities. Most equipment is between 12 and 15 years old, and some is as old as 20 years. "Downtime is high and quality of diagnosis is not the best," says Laberge.

He says the CAR is also considering delegating certain duties to other professionals, such as technologists. In the United Kingdom, for example, technologists do colorectal exams and first readings of the results; radiologists do a second reading.

Several factors have converged to create the shortage. As in medicine generally, the number of residency slots assigned to the specialty was cut in the early 1990s. Meanwhile, the demographic surge involving seniors meant there were more and sicker patients to treat as well as an aging workforce to treat them; the average radiologist is now 51 years old. "There's no one around to replace them," says Laberge.

There's also more demand for radiologists' services because of the proliferation of new tests. "Patients who used to be in the OR are now in radiology because testing is cost-effective," says Lentle. This economic factor is also driving the demand for tests.

Some areas have been hit more heavily by the shortage than others. In Quebec, for example, the number of practising radiologists has dropped from 507 at the end of 1996 to 477 by mid-1999. A survey of heads of radiology departments indicated a current need for 59 radiologists in the province, which has responded by doubling the number of first-year residency positions from 16 to 32; Newfoundland and the Northwest Territories also have above-average shortages. The situation is compounded by a similar escalating shortage in the US. "They're hundreds short," says Lentle.

Laberge maintains that the real crisis lies ahead. "The shortage is not jeopardizing safety, but it will if we don't act now."