IR workload narrows across U.S. radiologist workforce

Interventional radiology-related work has become more concentrated among a smaller share of U.S. radiologists, according to a Medicare claims analysis published in the Journal of Vascular and Interventional Radiology.

The study analyzed nationwide Medicare fee-for-service claims from 2008 to 2023 using a 5% representative sample. Researchers extrapolated the findings nationally and included 46,533 unique radiologists.

Radiologists performing any IR-related work declined from 70% in 2008 to 50% in 2023. Among radiologists performing IR procedures, the share with majority IR workloads increased from about 13% to nearly 19%.

Higher-concentration IR practice also grew. Radiologists with super-majority IR workloads increased from about 4% to nearly 9% over the study period.

“Together, these findings demonstrate a clear shift in the distribution of IR-related work toward a smaller subset of radiologists,” the authors wrote.

Male radiologists, radiologists between 35 and 44 years old, and those practicing in metropolitan areas were more likely to perform majority IR work. Majority IR workloads were also more common among physicians in multispecialty groups and practices with fewer than 10 radiologists.

The pattern was consistent across multiple physician and practice characteristics. Compared with 2008 to 2011, radiologists in 2020 to 2023 had higher odds of having super-majority IR workloads.

Mixed IR/DR work remained common, the authors noted. They wrote that this continued presence of hybrid workloads suggests integrated practice models remain relevant in many settings.

Training implications were a major part of the discussion. The authors said the IR/DR pathway was designed to preserve dual competency in imaging interpretation and procedural care, and that workforce planning should account for both predominantly IR-focused and hybrid IR/DR practice patterns.

Age-related trends may also reflect changes in training. Older radiologists were less likely to have majority or super-majority IR workloads, while younger radiologists showed the greatest growth in majority IR practice.

Practice environment, institutional structure, diagnostic imaging demand, procedural coverage needs, and market forces may be contributing to the trend, according to the authors.

The declining share of radiologists performing any IR-related work raises questions about procedural coverage, especially for lower-volume services in smaller practices. Greater concentration may also reflect increased specialization, continuity of care, and IR’s movement toward a more clinically oriented specialty.

The authors noted that the benefits and risks of these shifts are likely to vary by practice setting.