RSNA2023 Leading Through Change
Daily Bulletin

Radiology Workforce Shortage Hits Hard in Rural Systems

Monday, Nov. 27, 2023

By Richard Dargan

A committed effort from radiologists—and, in some cases, an injection of private equity funds—is needed to expand radiology access to U.S. rural and underserved areas, according to experts who spoke at a session Sunday.

The immediate picture for rural radiology access is bleak, in part due to the nationwide physician shortage and a spate of hospitals closures. Between 2013 and 2023, 131 rural hospitals closed, said presenter Danny Hughes, PhD, an economist and professor at Arizona State University's College of Health Solutions.

Making a practice work as a business in this environment is especially challenging, Dr. Hughes said. Practices need large enough patient volumes to spread costs, but the rural population is declining. Recruitment and retention of radiologists in the face of professional isolation, potentially lower pay and increasing subspecialization is difficult.

"If you're part of the group of younger radiologists who are increasingly subspecialized, it's not very attractive to want to be a rural practitioner because you're going to spend most of your time doing general diagnostic services," Dr. Hughes said.

Though often regarded warily by physicians, private equity investment can improve access for patients in rural areas, according to Catherine Joyce Everett, MD, MBA, a private practice radiologist in North Carolina.

(Left to right) Everett, Duszak, Hughes and Jha

Attracted by government subsidies and real estate value, among other things, private equity investors buy into radiology practices with a hope of realizing an increase in value. In return, radiology practices get cash, personnel, management and operations support.

This support can be critical in rural areas. Dr. Everett shared a story of a mass casualty event that occurred when a tornado hit Kentucky in December 2021. With local hospitals overwhelmed, radiologist Bruce Burton, MD, called in RP Matrix, the internal remote reading division of Radiology Partners.

"Over two days, they read over 650 trauma cases, which is pretty amazing," Dr. Everett said.

Boasting Access in Rural Areas

With or without private investment, running a radiology department that services a rural region requires a unique blend of business savvy and cultural competency.

Richard Duszak, MD, has seen this firsthand in his position as professor and chair of the Department of Radiology at University of Mississippi Medical Center (UMMC) in Jackson, MS.

In a little over a year, Dr. Duszak and UMMC leaders have driven major improvements in access. Average wait times at UMMC have improved to zero to two days for most modalities. Interventional radiology procedures by month rose from 380 in July 2022 to 676 in August 2023.

The department has been able to reduce the number of no-shows by connecting people with agencies that provide reliable transportation and using face-to-face meetings and telephone calls to combat high levels of illiteracy. Building trust through cultural competency also has increased the chances that patients follow recommendations and return for appointments.

"We are striving to create a workforce that is representative of the people we take care of, but it's going to take a multi-decade journey to get there," Dr. Duszak said.

After the presentations, session moderator Saurabh Jha, MD, associate professor of radiology at the University of Pennsylvania in Philadelphia, asked about the challenges of recruiting radiologists to rural areas.

"How do you get people who are on the fence to move and practice in rural communities?" he asked.

"Looking at the data, radiologists in rural areas have so much more variety in their workload and that is going to be very attractive to a lot of folks," Dr. Hughes responded.

Access the presentation, "Radiology Workforce Shortage: Considerations for Rural and Sprawling Systems," (S2-CNPM20) on demand at