Those unsung providers of patient care-hospital radiologists and pharmacists-are taking a page from the book of those who are addressing the widely publicized nursing shortage.
Although most patients hardly notice them, the number of allied health professionals is failing to keep up with demand. The timing of this shortfall couldn't be worse, coming just as technologies such as diagnostic and therapeutic radiology and new drug treatments have come on line.
In radiology, the general population undergoes about 130 diagnostic imaging procedures annually per 100 people. By 2020, the annaul number of imaging procedures is expected to grow by 140%, according to the American Society of Radiologic Technologists, Albuquerque, which cited a study published in the January-February 2001 issue of Imaging Economics.
The demographic problem was identified at the December 2002 annual meeting of the Radiological Society of North America, Chicago. Even with 280,000 registered radiologic technologists in the U.S.-the people who operate the X-ray and ultrasound machines, CTs and PETs-hospitals still have a 15% vacancy rate, according to the American Hospital Association. That was the highest vacancy rate for the job categories surveyed by the AHA. By 2010, the U.S. Bureau of Labor Statistics estimates that there will be a need for 75,000 new technicians.
Radiation therapy departments, likewise, are facing a staffing crisis, according to a new study in the June issue of the American Society for Therapeutic Radiology and Oncology's International Journal of Radiation Oncology, Biology and Physics. Based on a survey of 1,400 radiation oncology practice centers, the nation is in need of approximately 1,800 more therapists-an 18.3% vacancy rate. That translates to a shortage of 2.6 radiation oncology professionals for each private practice, which averages 12 professionals on staff.
This has huge financial implications for hospitals. The ASRT says a 2001 study found that the average full-time radiologic technician generates $750,000 annually for an employer, according to Allied Consulting, a Dallas-based recruitment firm. The average sonographer generates $1.1 million and the average nuclear medicine technician generates $1.8 million.
"We're going to have to rethink who we are and what we do," Lynn May, the ASRT's chief executive officer, says of the shortages.
The demand is greater at larger university hospitals and rural-based health centers, according to the RSNA's own survey. Of the university hospitals surveyed, 88% said they had a shortage, compared with only 17% of the outpatient centers that responded.
Good pay, benefits
The shortage dismays Patricia Soto, administrator of the Department of Radiology at Memorial Sloan-Kettering Cancer Center in New York. Sloan-Kettering fortunately is not experiencing a shortage and still is able to recruit and retain its staff of about 90 technologists with only about a 1% vacancy rate, she says. "It's a great profession," says Soto, who worked her way up the ladder at hospitals that paid almost entirely for her education right through her master's in business administration. "Guidance counselors just are not aware of the options."
Nationwide, radiologic technologists earn an average of $21.26 per hour, according to a survey conducted by the ASRT in 2001. Fueled at least in part by the shortage, salaries increased an average 20% from 1997 to 2001, the group says.
May says the shortage's roots can be traced to the 1990s when schools training the technicians cut back on the number of students in response to an anticipated lower demand. But patient demand actually was increasing as imaging capabilities expanded and as they continue to expand, he says. More students are choosing the profession, but it is unclear if it will be enough to meet the demand.
The profession can't do much about the number of patients, the number of procedures or the aging population, but it is focusing efforts on recruiting more people and improving retention rates. The ASRT has led initiatives that include a videotape, brochure and media campaign. In 2001, it launched a scholarship program for minority students.
But in the belief that real change won't occur without fundamental changes in the workforce and workplace, the ASRT in the long term is investigating the expansion of the career ladder, proposing the development of a new career option called the radiologist assistant. The position would create an entirely new option for advancement in the clinical area of radiology, which historically has lost front-line workers to management or education.
Unlike a physician assistant, the idea is to create a "physician extender" rather than a "physician substitute," May says. Working under the supervision of a radiologist, the radiologist assistant will take a leading role in patient management and assessment, perform selected radiology exams and evaluate image quality.
The ASRT Education and Research Foundation recently awarded four $25,000 grants to help four colleges launch programs for radiologist assistants. The four schools are Loma Linda (Calif.) University; Midwestern State University, Wichita Falls, Texas; the University of Medicine & Dentistry of New Jersey, Newark; and the University of North Carolina at Chapel Hill. Students in the programs will complete a standardized curriculum at the baccalaureate level or higher.
Borrowing from the Nurse Reinvestment Act, which became law last year, the ASRT also has joined the Association of Schools of Allied Health Professions, Washington, to develop federal legislation called the Allied Health Reinvestment Act. The bill would fund allied health recruitment grants to perform outreach at the elementary- and secondary-school levels, provide scholarships, create grants for programs to expand allied health education, develop best practices in the field and establish a loan program for allied health faculty. The ASRT and the ASAHP are seeking a sponsor for the legislation.
Pharmacists easier to come by
Although still a problem, the hospital pharmacist shortage appears to be easing, says Mick Hunt, senior director of pharmacy for Irving, Texas-based group purchaser Novation. Hunt says hospitals are beginning to offer salaries that are competitive with those in the retail sector. As with other healthcare professions, schools are churning out more workers, but they still aren't keeping up with demand.
Hospital pharmacist vacancy rates fell from 8.9% in 2000 to 6.9% in 2002, says Douglas Scheckelhoff, director of the division of practice leadership and management for the American Society of Health-System Pharmacists in Bethesda, Md. Hospital pharmacists probably account for about 25% of the 200,000 pharmacists in the workforce, he says.
The profession also is making greater use of pharmacy technicians who assist on the drug distribution side, freeing up pharmacists to concentrate more on providing clinical services, Hunt says. Most technicians are trained on the job, and there are now more than 100,000 certified pharmacy technicians. But that creates its own set of problems: There is a shortage of these technicians, who tend to be needed more in hospitals than in retail pharmacies, as well as a constant turnover, Hunt says. The vacancy rate for pharmacy technicians was 4.6% in 2002, the first year the position was surveyed by the ASHP, Scheckelhoff says.
Regardless, all things being equal, pharmacists seem to get greater gratification working on the clinical side than in drug distribution areas. In 2002, the ASHP quizzed pharmacists on what workplace issues mattered most to them and found that pharmacists were more concerned with lifestyle considerations, professional practice considerations and general work environment than they were with salary and staff development.
"Pharmacists see opportunities for patient involvement in the hospital setting," Scheckelhoff says. "If hospitals are at least competitive with the local market, (the competition) won't stand a chance with recruitment."
That was the experience at four-hospital Inova Health System in Falls Church, Va. The system only has 2.7 vacant pharmacist positions, a 2% vacancy rate, says Lisa Wolfington, an Inova spokeswoman. That compares with an 11% vacancy rate for radiologic technicians, 13% for respiratory therapists and 5.1% in nursing.
The pharmacist vacancy rate has plummeted in the last year-from a high of 15%-simply by "creating a stronger orientation program," says Maureen Murphy, Inova's senior director of recruitment. Retail pays more, but "hospital work is more interesting for pharmacists," she says. The system only had to make sure retail pharmacists knew that.