Disadvantage Of Academic Emergency Radiologist Promotion Compared To Other Diagnostic Radiology Subspecialties

Purpose: Academic Emergency Radiology divisions are growing in popularity, particularly to assist in staffing after-hours shifts. Non-radiology literature has suggested that hospitalists who focus on after-hours work may be disadvantaged in the current promotion system. We sought to evaluate academic rank differences between academic emergency (ER) vs. other subspecialty diagnostic radiologists (non-ER).

Methods/Materials: Radiology departments which could possibly contain emergency divisions were identified using Doximity’s top 20 radiology programs, the top 20 NIH ranked radiology departments, and all departments offering emergency radiology fellowships. All the identified institutions were reviewed via their websites looking for the presence of the emergency division and ER. ERs were matched to a same-institutional non-emergency diagnostic radiologist (non-ER).

Results: Of 36 institutions, 11 lacked ER entirely or sufficient information for analysis, yielding 283 ER faculty from 25 institutions, resulting in 112 career length and gender matched pairs. Assistant, associate, and full professors in ER vs. non-ER groups were 90, 17, 5 and 62, 32, 18 respectively. Average career length was 16 years and 23% were female. Mean number of publications for ERs and non-ERs were 12.34 ± 20.83 and 52.98 ± 79.15 (p < 0.001). Mean h-index for ERs vs. non-ER was 3.96±5.60 and 12.81±13.55, respectively (p < 0.0001). Non-ERs were twice as likely as ERs (0.21 vs. 0.11) of being an associate professor at h-index < 5. Men had nearly 3 times the odds of advanced rank compared to women (OR=2.91; [1.02 – 8.26]; p=0.045). Each additional year of practice increased the odds of advancing rank by 14% (OR=1.14; [1.08 – 1.21]; p< 0.001)

Conclusions: Academic emergency radiologists are less likely to achieve advanced rank compared to career length- and gender-matched faculty in non-ER subspecialties; this persists even after adjusting for h-index, suggesting that academic ERs may be disadvantaged in current promotion systems. Longer-term implications for staffing and pipeline development merit further attention as do parallels to other non-standard subspecialties like community radiology.