Temporal Shifts in Trainee Participation in Radiologists’ Workload: A National Medicare-Focused Analysis from 2008 to 2020

Purpose: Increasing case volumes and productivity expectations, as well as consolidation of various practice types, may be impacting the role of trainees in the work effort of radiologists involved in education. We assessed temporal shifts in trainee participation in radiologists’ workload nationally.

Methods/Materials: Annual 5% Research Identifiable Files from 2008 to 2020 were used to identify all U.S. radiologists who interpreted noninvasive diagnostic imaging for Medicare Part B fee-for-service beneficiaries. Teaching radiologists were defined as those radiologists who billed services using Medicare’s GC modifier, indicating trainee supervision. For teaching radiologists, the percentage of their total workload (quantified using billed work RVUs) with trainee participation was determined. Mean trainee participation in workload was determined 1) for teaching radiologists overall and 2) for teaching radiologists stratified by radiologist and practice characteristics, as determined using Physician Compare data sets.

Results: The sample size included 35,595 radiologists nationally. The percentage of all radiologists involved in teaching increased from 13.6% in 2008 to 20.4% in 2020. Among teaching radiologists, however, mean trainee participation in their total workload decreased from 35.3% in 2008 to 24.5% to 2020. A decrease in mean trainee participation in total workload was observed for teaching radiologists stratified across workload, gender, years of experience, subspecialty, geographic region, practice type, and practice size.

Conclusions: In recent years, the percentage of all U.S. radiologists involved in resident teaching has increased, likely reflecting both academic practice expansion and academic-community practice consolidation. Among teaching radiologists, however, a declining percentage of their total workload involves trainees. This dispersion effect could have implications for the quality of education efforts. For teaching radiologists, increasingly independent work likely diminishes unique differentiators between academic and community practice, possibly augmenting burnout and adversely impacting job satisfaction and the long-term sustainability of a robust academic radiologist workforce.