Very few radiologists work exclusively in siloed subspecialties. As other areas of medicine specialize and subspecialize, it becomes increasingly important for radiologists to increase their range and grow more nimble across many specialties. Dr. David Youmans of Princeton Radiology Associates says that “multispecialty radiologists are…likely to become even more valuable as more referrals originate from less rigorously trained providers.”
Historically, a generalist was defined as a non-fellowship trained radiologist. This is no longer the case. Now, a generalist is “a practitioner for whom no single specialty represents a majority of their billed relative value units (RVU’s).”1
Over 55% practicing radiologists meet the definition of a radiology generalist. However, the term “general radiologist” may be antiquated. This is because, among general radiologists, over 85% of them derive their billable work from two or more distinct subspecialty areas.
Multispecialists are the way of the future. About 98% of radiologists are fellowship trained. Because of the trend towards multispecialists, most radiology programs offer 4-6 month mini-fellowships in the 4th year of residency. This illustrates academic centers’ recognition that a single fellowship is, likely, not enough for today’s radiologist to succeed. This shift towards multispecialists may be especially important in rural and underserved areas because multispecialty radiologists can cover many different types of common exams and lower complexity procedures.
A number of factors contributed to the increase in multispeciality radiologists.
Workload and volume have massively increased, resulting in massive shortages nationwide for mammographers, pediatric radiologists, cardiothoracic radiologists and more. To keep up with volumes, radiologists have to practice beyond their core specialty because hiring additional FTE and even outsourcing is no longer viable.
After a decades-long focus on increasing subspecialization, many of today’s radiologists are caught off-guard by the need to be a multi-specialist. That is why we must now undertake two changes:
In 2020, the American College of Radiology passed Resolution 47. Resolution 47 established a taskforce to explore the concept of the “Multispecialty Radiologist.” The taskforce discovered that radiologists do not care about the title of multispecialty radiologist, nor do they agree upon an exact definition.2 That said, there is no debate as to whether there is an ever increasing trend towards radiologists as jacks-of-all-trades. As a result, it is imperative that the broader radiology community embrace this concept and all of the doctors who fall into this category.
Once that occurs, the next thing that has to happen to curtail massive burnout, resignation, and discontent among radiologists today is to support this new reality. To do this, we must maximally equip multispecialty radiologists with the tools that they need to be confident, competent, and efficient reading across specialties. Because this is a shift in how we think about radiologists and their training needs, an appropriate shift in how we train and equip them needs to follow suit.
This shift cannot be slow. We need to invest now in new and innovative ways of training radiologists so that they can read across specialties. These investments include digital microlearning, peer-to-peer mentoring, classic CME across a range of subspecialties, and conference opportunities. When this happens radiologists reading across specialties will become more facile, confident, and competent. The downstream impacts of this will be at the practice level. As more radiologists become more competent and confident, more practices will become more profitable, nimble, and successful at retaining and recruiting top talent.
[1] https://vulcanimaging.com/wp-content/uploads/2021/08/Value-of-the-New-General-Radiologist-in-Private-Practice.pdf
[2] The definition used in this document is one of many others. The author feels that this definition accurately describes the concept being discussed.
