Workforce shortages in clinical radiology are increasing year-on-year, resulting in delayed diagnoses and lower-quality patient care, according to the latest annual census from the UK Royal College of Radiologists (RCR). Shortages of interventional and breast radiologists are of particular concern, the “Clinical Radiology UK Workforce Census 2019 Report” states.
“The 2019 clinical radiology workforce census findings are grave,” Mark Callaway, lead author of the workforce report and the RCR’s medical director of professional practice for clinical radiology, writes in the forward. “Once again, they highlight the continued growth in demand for diagnostic and interventional radiology (IR) services, alongside further increases in workforce shortages. These are issues we have raised for many years and, worryingly, the continuing workforce shortages are impacting the cost and quality of patient care.
“The 2019 census report demonstrates unequivocally that our current imaging and interventional radiology services are unsustainable; governments and policy makers from across the sector and from all four nations must take action. Otherwise, patients are at risk.”
Costs have risen as radiology departments struggle to meet the demand for complex imaging, and consultant radiologists are feeling overworked and undervalued, noted the report, which was released on 14 April.
The key findings from the 61-page report were as follows:
- National Health Service (NHS) hospitals spent £193 million last year on outsourcing, overtime, and locums to cover radiologist shortages. UK outsourcing costs rose 32% in 2019. In Scotland, expenditure on outsourcing shot up by 73%.
- Only 1% of NHS trusts (hospital groups) and health boards are able to report all scans within radiologists’ contracted hours.
- 70% of clinical directors of radiology departments feel they do not have enough radiology consultants to deliver safe care. Additionally, 46% of trusts and boards do not have the staff or transfer arrangements required for safe 24/7 IR services.
- Demand for CT and MRI scans is growing at 9% a year, which is three times the speed of the radiologist workforce.
- In 2020, approximately 200 doctors will qualify as radiology consultants—not enough to fill even half of the estimated 466 vacancies. Also, in the 12 months to September 2019, 196 consultant clinical radiologists (equivalent to 161 whole-time equivalents) left the workforce, equal to 4% attrition.
- The UK radiologist workforce is now 33% short-staffed; without more consultants in training and better staff retention and recruitment, the shortfall will hit 43% by 2024.
- Importantly, the document was finalised before the escalation of novel coronavirus management, and it underlines the precarious state of many hospital imaging services and the unprecedented challenge that lies ahead, stated an accompanying RCR press release.
“The global coronavirus pandemic brings a sustained period of uncertainty and demand for the NHS,” Callaway comments. “Our most recent report underlines how our staffing crisis, which has been evident and escalating for the past five years, is having an undeniable, direct impact on the cost and quality of patient care.”
He hopes politicians and health leaders will seriously consider how the ongoing shortage of radiologists limits patient care and poses a threat to patient safety and commit to improving trainee numbers and focusing on specialty-specific retention measures.
“Due to our consistent 100% completion rate for the workforce census, these powerful but concerning data can be used by the RCR to lobby government, health education bodies, and policy-makers for increased training numbers and improved working practices for clinical radiologists,” Callaway adds.
Questions concerning the provision of IR services in the UK included for the first time
This year’s report is the first to include questions about the provision of IR services across the UK. Minimally invasive therapy is vital for the delivery of safe patient care and avoiding unnecessary surgery, says Callaway, before opining: “The results make disappointing reading from a patient’s perspective; only half of trusts and health boards can provide a comprehensive 24-hour service, and there is a severe shortage of experts to provide both vascular and non-vascular IR procedures.”
The report concludes that IR provision is “patchy and puts patients at unacceptable risk”, explaining that trusts and health boards need a minimum of six whole-time equivalent interventional radiologists to provide an effective and sustainable 24 hour IR service, or that formal transfer arrangements need to be in place 24/7. This was not the case for all trusts. Specifically pertaining to IR service provision, the key findings of the report were:
- In 2019, almost half of the trusts/ health boards (46%, n=79) did not provide adequate IR services, with insufficient radiologists on their rotas or no rota at all and no formal transfer arrangements for patients needing IR procedures. This pits patients at unacceptable risk.
- Census data indicate that 386 additional interventional radiologists are currently needed in the UK to meet IR guidelines; this equates to an IR workforce shortfall of 37%.
Generalists versus specialists
In 2019, 73% of consultant radiologists were classified as generalists. Variations were seen across the UK, with generalists being more common in Northern Ireland, Scotland, and Wales (84% to 85% of the consultant workforce) than in England (71% of the consultant workforce).
“The proportion of specialist radiologists in England has increased gradually over the past five years, from 25% of the consultant workforce in 2014 to 29% in 2019. In comparison, there has been no shift from generalists to specialist consultant radiologists in Northern Ireland, Scotland and Wales, where specialist radiologists account for 15% to 16% of the consultant workforce,” the report noted.
Most generalists across the UK have one main area of specialty interest (57%), a third have two (33%), and a small number (10%) have none. The majority of specialists across the UK have one main area of specialty interest (83%), though some (17%) have two or more areas of specialty interest.
The most common specialty areas of practice are musculoskeletal, gastrointestinal, breast, vascular IR, and chest/lung. Together, these account for 53% of all specialty interests.
Breast radiology has slipped from 13% of all specialty interests in 2014 to 11% in 2019. Similarly, vascular IR has dropped from 12% of all specialty interests in 2014 to 10% in 2019. Shortages of breast radiologists and vascular interventional radiologists are an area of concern, the report stated.