erewitz The Practice of Radiolog y • Original Research

nd Sunshine
hortage of
ediatric
adiologists

A C E N T U
R Y O F

A Portrait of Pediatric Radiologists

MEDICAL IMAGING
in the United States
Leonard Merewitz1 OBJECTIVE. In recognition of the importance of pediatric radiology and the apparent
Jonathan H. Sunshine2,3 shortage of radiologists in the field, the purpose of this study was to provide an extensive and
detailed portrait of pediatric radiologists, their professional activities, and the practices in
which they work.
MATERIALS AND METHODS. We tabulated data from the American College of Ra-
diology’s 2003 Survey of Radiologists, a stratified random sample survey that achieved a 63%
response rate with a total of 1,924 responses. Responses were weighted to make them repre-
sentative of all radiologists in the United States. We compare information about pediatric radi-
American Journal of Roentgenology 2006.186:12-22.

ologists with that for other radiologists.

RESULTS. Approximately 3% of radiologists, some 800–900 physicians, are pediatric radi-
ologists. Depending on how pediatric radiologist is defined, two thirds to three quarters of them
spend 70% or more of their clinical work time doing pediatric radiology. Unlike other radiolo-
gists, a greater percentage of pediatric radiologists desire a reduction in workload (with a corre-
sponding reduction in income) than desire an increase in workload. Pediatric radiologists who
spend 70% or more of their clinical work time in their field are older than radiologists in general
(average age, 55 vs 51 years), and the fraction of pediatric radiologists younger than 45 years is
lower than for other subspecialists (≈ 20% vs 37%). Pediatric radiologists are disproportionately
women (one third or more, depending on definition, are women, vs 19% for other subspecialists
and 15% for nonsubspecialists), hospital-based, in academic practices (approximately half vs one
fifth for other subspecialists), and in the main cities of large metropolitan areas.
CONCLUSION. A shortage of pediatric radiologists exists and is likely to intensify. Ac-
cess to pediatric radiologists is probably a problem except for children in large metropolitan
areas who connect readily to academic hospitals. Means to overcome these problems need to
be actively sought.

ediatric radiology is an important radiologists. The survey’s special focus on pe-

Keywords: pediatric imaging, practice of radiology

DOI:10.2214/AJR.05.0615 P subspecialty within radiology and

Received April 15, 2005; accepted after revision
April 19, 2005.
1LAMA Consulting, Chevy Chase, MD 20815-3940
(merewitz@post.harvard.edu).
2Research Department, American College of Radiology,
1891 Preston White Dr., Reston, VA 20191.
Address correspondence to J. H. Sunshine
(jsunshine@acr.org).
3Department of Diagnostic Radiology, Yale University
School of Medicine, New Haven, CT.
AJR 2006; 186:12–22
0361–803X/06/1861–12
© American Roentgen Ray Society
one particularly concerned about
a shortage of well-qualified per-
sonnel. As well, pediatric radiology suffers a
financial handicap because the very low pay-
ment rates characteristic of Medicaid apply to
a greater proportion of children than to any
other age group.
The American College of Radiology (ACR),
as part of its mission of providing important
and useful information to the professions it
serves, periodically conducts large-scale,
multitopic surveys of the members of these
professions and their practices [1–12].
In response to the concerns of pediatric ra-
diology, the ACR’s 2003 Survey of Radiolo-
gists, the most recent of these periodic surveys,
was designed with a special focus on pediatric
diatric radiologists consisted of having a de-
sign that included more ways of recognizing
and defining pediatric radiologists than almost
any other field within radiology. This article,
an in-depth portrait of pediatric radiologists, is
one of the first full-scale papers to be produced
from the 2003 survey.
This article first shows how many pediatric
radiologists there are under each of many pos-
sible definitions of who is a pediatric radiolo-
gist, the relationship among these definitions
of pediatric radiologists, and the demographics
of pediatric radiologists (Tables 1–3 and
Table S1). It then details the work activities of
pediatric radiologists, such as types of proce-
dures performed and work hours (Tables 4–6
and S2–S5), and the characteristics of the prac-
tices in which pediatric radiologists work

12 AJR:186, January 2006


TABLE 1: Number of Pediatric Radiologists
Unweighted
Definition of Pediatric Radiologist No. of Responses
Pediatric radiologist in AMA Masterfile
Have pediatric CAQ
Did pediatric fellowship
Subspecialty society highly important
Pediatric is primary specialty
Pediatric is secondary specialty
Does any pediatric radiology 135
Pediatric is ≥ 30% of clinical time
Pediatric is ≥ 40% of clinical time
Pediatric is ≥ 50% of clinical time
Pediatric is ≥ 70% of clinical time
Note—CAQ = certificate of added qualification.
(Tables 7–9 and S6–S10). (Tables S1–S10 ap-
pear in the electronic supplement to the AJR
and provide more detail than the tables in this
American Journal of Roentgenology 2006.186:12-22.
hard-copy version.) Throughout, comparisons
with other categories of radiologists are made.
The Society for Pediatric Radiology (SPR)
has conducted a number of in-depth, highly in-
formative surveys of its members and has pub-
lished data from one ([13]; Jennifer Boylan,
personal communication, February 2005). Re-
searchers have also published results of sur-
veys of SPR members [14–16]. The advan-
tages of this article relative to those studies are
that it has more recent information, contains
systematic comparisons with other radiolo-
gists, and is based on a systematic sample of all
radiologists in the United States, meaning that
it includes radiologists active in the pediatric
field who are not SPR members.
Materials and Methods
Data Source and Survey Methods
Data are from the ACR’s 2003 Survey of Radiol-
ogists (hereinafter referred to as the “2003 survey”).
The survey and its methods have been described in
detail elsewhere [17, 18]. In brief, the 2003 survey
was similar to its predecessor, the ACR’s 1995 Sur-
vey of Radiologists and Radiation Oncologists
[1–5], but it incorporated important improvements
throughout the survey process. These ranged from
more thorough canvassing of all ACR leadership to
identify issues of importance and ascertain priorities
among them, through use of a multifaceted “tailored
design method” [19] to maximize the response rate,
to use of an expanded and more intensive array of
steps to improve data quality.
The questionnaire for the 2003 survey consisted
of 36 items; many items in turn contained multiple
subitems. Questionnaire items and topics were elic-
AJR:186, January 2006
Shortage of Pediatric Radiologists
Weighted
% of Radiologists No. of Radiologists
31 2.3 650
46 3.4 900
44 3.4 900
23 1.7 450
39 3.0 800
6 0.5 150
13.1 3,500
33 3.3 900
32 3.2 850
30 3.0 800
26 2.6 700
ited from two rounds of canvassing ACR physician
and staff leaders, winnowed according to priorities
indicated by top leadership, and pretested in two
large pretests conducted in autumn 2002, with re-
finements made after each pretest.
The survey sample, a stratified random sample
composed of four strata, was taken primarily from
the American Medical Association’s (AMA) Phy-
sician Masterfile [20], a reasonably complete list-
ing of all allopathic physicians in the United
States, whether or not AMA members, but also in-
cluded a sample of osteopathic radiologists ob-
tained from the American Osteopathic College of
Radiology. The sample included residents, fel-
lows, and retirees, not merely posttraining, profes-
sionally active physicians.
The survey was administered by our contractor,
the Center for Survey Reasearch, University of Vir-
ginia, by mail between March and August 2003,
with nonrespondents being sent up to four remail-
ings as necessary and other steps taken to boost the
response rate. The response rate achieved was 63%,
with 1,924 usable responses. Responses were
weighted so that the weighted statistics would be
representative of the answers that would have been
received if all physicians in the United States in the
four strata had been surveyed and had responded.
Our leading tool to minimize data deficiencies
was the designation of the 12 items on the ques-
tionnaire judged most crucial as core questions.
When questionnaires were returned, our contrac-
tor checked that these 12 items were indeed an-
swered and made three designated consistency
checks involving them. If any problems were
found with the core items, the Center telephoned
the respondent to obtain the missing response(s)
or to resolve the consistency problems. In addi-
tion, data used in this article have been cleaned
and edited to further minimize deficiencies.
Definition of Variables
The definition of most variables has been de-
tailed in a previous article [18] and also is apparent
from the Results section and the tables. We detail
here only the definitions of pediatric radiologists
that we used.
To provide the fullest picture of pediatric radiol-
ogists, this article contains information on a large
number of definitions of who is a pediatric radiolo-
gist. The definitions are as follows:
• Physicians who have listed their main specialty
as pediatric radiology in the AMA Masterfile.
This definition presumably underreports the
number of pediatric radiologists and particularly
omits older physicians in the field because radi-
ology subspecialty designations generally be-
came available in the Masterfile only relatively
recently. Most likely, many pediatric radiolo-
gists who started in the field earlier never
changed their self-designated specialty listing in
the Masterfile.
• Respondents who reported in the 2003 survey
having a certificate of added qualification
(CAQ) from the American Board of Radiology
in pediatric radiology.
• Respondents who reported they did a fellowship
in pediatric radiology.
• Respondents who reported that the SPR, the
most prominent subspecialty society in the field,
is one of the two most important professional or-
ganizations to which they belong.
• Respondents who reported that they subspecial-
ize to at least a small extent and report that pedi-
atirc radiology is their main or secondary sub-
specialty.
• Respondents who reported spending any of their
clinical work time performing pediatric radiol-
ogy. Although this is obviously an overly broad
definition of pediatric radiologist, it is a category
of interest.
• Respondents who reported that they spend at least
a specified fraction of their clinical work time per-
forming pediatric radiology. Thresholds used for
this criterion were 30%, 40%, 50%, and 70%.
Analysis Methods
All information presented in the remainder of
this article, unless otherwise noted, is based on
weighted data and refers to physicians from all
strata combined. Where numbers of physicians are
given (in Table 1), an adjustment was made for item
nonresponse— that is, for the failure of a limited
percentage of respondents to answer each ques-
tion— so that the numbers are, as always, represen-
tative of what the answers would have been if all
physicians of interest in the country had responded.
Reported standard errors (SEs) and tests of
statistical significance are calculated taking into
13

account not only the weighted nature of the data but
also the complex survey design— that is, the fact
that responses come from distinct strata. The SEs
are calculated with the Statistical Analysis System
software procedure “surveymeans” (SAS Institute).
All data analysis was conducted with SAS soft-
ware, release 9.0 (SAS Institute). Because most
comparisons are made between pediatric radiolo-
gists and five comparison groups of radiologists
(Tables 3 and S1), we use a two-tailed z-test with a
p value of 0.01 or less as the criterion of statistical
significance, in keeping with the Bonferroni
inequality [21]. In two instances in which visual in-
spection of the data showed relatively large differ-
ences between pediatric radiologists and other radi-
ologists but the differences were not significant at
p ≤ 0.01, we applied the more common criterion of
p ≤ 0.05; these instances are explicitly noted in the
text. SEs for percentages in the tables can be ap-
proximated by the formula:
p(1 – p)
SE = 1.2 × ---------------------
American Journal of Roentgenology 2006.186:12-22.
n
where p = percentage / 100 and n = unweighted
number of observations (from Table 1 or 3). The
factor of 1.2 approximates the effects of the com-
plex survey design and item nonresponse.
Results
Number, Characteristics, and
Demographics of Pediatric Radiologists
Among useful definitions of who is a pe-
diatric radiologist, the highest estimate of
the number of pediatric radiologists, approx-
imately 950 or 3.5% of all radiologists, re-
sults from defining as pediatric radiologists
those who reported that pediatric radiology
is their primary or secondary subspecialty
(Table 1). The lowest estimate, approxi-
mately 700 or 2.6% of radiologists, results
from defining pediatric radiologists as those
who spend 70% or more of their clinical
work time in the field. Those who report pe-
diatric radiology is their secondary specialty
are few—approximately 150 persons, or
0.5% of all radiologists.
Table 2 shows the relationship between
pairs of characteristics of pediatric radiolo-
gists. Each row of the table refers to those ra-
diologists with the characteristic listed at the
left of the row, and each cell tells what per-
centage of these radiologists also have the
characteristic listed at the top of the column
in which the cell appears. For example, the
table shows, in its third row, that of those
who did a fellowship in pediatric radiology,
approximately 70% have the CAQ, a similar
percentage spend 30% or more of their clin-
14
Merewitz and Sunshine
ical work time performing pediatric proce-
dures, and approximately half spend 70% or
more of their clinical work time in the field.
But one sixth are not currently doing any pe-
diatric radiology. Other highlights of the ta-
ble include the following: Of those who re-
ported on the 2003 survey that pediatric
radiology was their primary specialty, five
sixths have a CAQ, four fifths did a fellow-
ship in the field, four fifths spend 30% or
more of their clinical work time performing
pediatric procedures, and two thirds spend
70% or more of their clinical work time in
the field. Of those who spend 30% or more
of their clinical work time in pediatric radi-
ology, five sixths have the CAQ, 70% did a
pediatric fellowship, and four fifths spend
70% or more of their clinical work time in
the field. Of the half dozen respondents who
reported pediatric radiology as their second-
ary specialty, only one third reported spend-
ing as much as 30% of their clinical work
time in the field and none reported having
done a fellowship, having the CAQ, or
spending 40% or more of their clinical work
time in the field.
Tables 3 and S1 present the demographic
characteristics of pediatric radiologists and
the corresponding demographics of five com-
parison groups of radiologists. Pediatric radi-
ologists in general are, on average, about
51–53 years old, not significantly different
from other specialists or radiologists overall.
But those practicing 70% or more of their
time in the field are significantly older (aver-
aging 55 years) than other subspecialists.
Also, although more than one third of all ra-
diology subspecialists are younger than 45
years, the fraction is considerably smaller for
pediatric radiologists. Specifically, the per-
centage of pediatric radiologists who are
35–44 years old is generally smaller than for
comparison categories, but the difference is
significant only at the level of p ≤ 0.05.
More than 40% of radiologists who spend
more than 30% of their clinical work time in
pediatric radiology are women, compared
with half that percentage or less for other
subspecialists and for nonsubspecialized ra-
diologists. As is true for radiologists in gen-
eral, more than 95% of pediatric radiologists
are board-certified. The proportion of pedi-
atric radiologists in the Northeast is some-
what lower than the proportion of nonpedi-
atric radiologists, and the proportion of
pediatric radiologists in the Midwest is cor-
respondingly elevated (results significant
only at p ≤ 0.05).
The Work of Pediatric Radiologists
Pediatric radiologists average performing
approximately four and one half of the seven
major types of procedures (mostly technique
categories) into which we have divided radi-
ology (Tables 4 and S2). This is about the
same as for other radiologists. Pediatric radi-
ologists are more likely to perform CT than
other radiologists, more likely to perform ra-
diography or fluoroscopy and (to some ex-
tent) sonography than other subspecialists,
and much less likely to do breast imaging.
Pediatric radiologists work at an average of
two distinct locations versus an average of al-
most three for other subspecialists and for
nonsubspecialists (Tables 5 and S3). On aver-
age, full-time radiologists who are pediatric
specialists report working approximately
56–57 hours in a typical full week, not signif-
icantly different from other radiologists. Sim-
ilarly, the percentage of pediatric radiologists
who are part-timers is not significantly differ-
ent from the percentage for other radiologists.
With an average of 25 or fewer vacation days
by a number of definitions of who is a pediat-
ric radiologist, full-time pediatric radiologists
have less vacation than other full-time radiol-
ogists, who average approximately 35 vaca-
tion days. In contrast, both full-time pediatric
radiologists and other full-time radiologists
average approximately 10 days annually for
professional education and society meetings.
By most definitions of who is a pediatric
radiologist, approximately 15% of pediatric
radiologists would like less work, even
though that means their income would de-
crease proportionately, and a smaller percent-
age would like more work with a correspond-
ing increase in income (Tables 5 and S4). In
contrast, although the difference is not signif-
icant, largely because of the limited number
of pediatric radiologists in our survey, for
other radiologists, the percentages desiring
more and less work are more even. Pediatric
radiologists are like other radiologists in re-
porting, on average, a level of enjoyment of
their work approximately halfway between
“enjoy very much” and “enjoy somewhat.”
Virtually all pediatric radiologists report
spending part of their work time in clinical
practice at hospitals, although only about
90% of subspecialists who are not pediatric
radiologists and 86% of nonsubspecialists do
so (Tables 6 and S5). Conversely, only ap-
proximately one fourth of pediatric radiolo-
gists do clinical work at nonhospital sites
compared with half of other subspecialists
and half of nonsubspecialists.
AJR:186, January 2006
 TABLE 2: Relationship Among Characteristics of Pediatric Radiologists
AJR:186, January 2006

% of Row Having the Column Characteristic

Pediatric Subspecialty
Radiologist Has Did Society Pediatric Is Pediatric Is Does Any Pediatric Pediatric Pediatric Pediatric
in AMA Pediatric Pediatric Highly Primary Secondary Pediatric ≥ 30% of ≥ 40% of ≥ 50% of ≥ 70% of
Characteristic Masterfile CAQ Fellowship Important Specialty Specialty Radiology Clinical Time Clinical Time Clinical Time Clinical Time
Pediatric radiologist in AMA Masterfile 100.0 79.2 75.0 45.9 87.3 0.0 94.9 80.7 80.7 77.3 68.6
Has pediatric CAQ 54.8 100.0 68.9 44.7 79.4 0.0 92.9 84.7 84.7 79.2 70.9
Did pediatric fellowship 54.4 70.7 100.0 42.6 77.7 0.0 83.1 71.9 71.9 66.4 54.1
Subspecialty society highly important 61.8 88.0 81.7 100.0 78.0 4.8 95.0 90.5 90.5 86.1 81.4
Pediatric is primary specialty 63.6 84.1 79.2 42.9 100.0 0.0 96.3 82.5 82.5 77.0 64.8
Pediatric is secondary specialty 0.0 0.0 0.0 16.1 0.0 100.0 53.4 32.6 0.0 0.0 0.0
Does any pediatric radiology 19.3 23.2 21.5 14.4 24.2 1.6 100.0 25.5 24.5 23.1 20.0
Pediatric is ≥ 30% of clinical time 64.4 83.1 70.8 54.9 81.5 3.9 100.0 100.0 96.1 90.7 78.6
Pediatric is ≥ 40% of clinical time
American Journal of Roentgenology 2006.186:12-22.

67.1 86.4 73.6 57.2 84.8 0.0 100.0 100.0 100.0 94.4 81.8
Pediatric is ≥ 50% of clinical time 68.2 85.6 72.1 57.8 83.9 0.0 100.0 100.0 100.0 100.0 86.7

Shortage of Pediatric Radiologists

Pediatric is ≥ 70% of clinical time 70.2 88.5 67.8 63.3 81.4 0.0 100.0 100.0 100.0 100.0 100.0
Note—CAQ = certificate of added qualification.

TABLE 3: Demographics of Radiologists

Unweighted Age (yr) Distribution by Census Region (%)
No. of % % % % %
Category Responses Mean ≤ 35 35–44 45–54 55–64 ≥ 65 % Women Northeast Midwest South West
Comparison category
All radiologists 1,337 51.0 2.9 28.3 34.4 22.5 11.9 17.8 22.5 23.9 34.1 19.5
Subspecialists I: those who subspecialize even slightly 784 49.1 2.9 33.3 36.9 18.5 8.3 19.3 25.0 25.0 29.7 20.3
Subspecialists II: those who spend ≥ 50% clinical time in one field 494 49.1 3.2 34.4 36.3 16.4 9.7 23.6 28.4 25.1 27.6 18.9
Subspecialists I except pediatric radiologists 740 49.0 3.1 33.9 36.4 18.8 7.8 18.6 25.5 24.7 29.4 20.4
Nonsubspecialists 503 53.6 3.1 21.7 30.2 27.6 17.4 15.4 18.9 22.0 40.5 18.5
Definition of pediatric radiologist
Has pediatric radiology CAQ 44 53.4 2.3 17.1 43.5 17.2 19.9 30.4 13.9 29.2 35.3 21.6
Did pediatric radiology fellowship 42 51.2 0.0 27.7 41.4 17.1 13.8 35.7e 12.5c 35.3 33.7 18.6
Subspecialty society highly important 22 53.1 0.0 19.1 40.6 21.1 19.2 43.3e 16.1 42.3 26.2 15.5
Pediatric radiology is primary specialty 38 51.9 0.0 20.0 50.2 15.4 14.4 33.3 15.1 30.7 35.6 18.6
Pediatric radiology is ≥ 30% of clinical time 32 52.5 0.0 19.6 47.2 16.6 16.6 42.3a,d,e 20.1 36.7 26.2 17.1
Pediatric radiology is ≥ 50% of clinical time 29 53.4 0.0 14.0 49.3 18.4 18.4 43.8a,b,d,e 17.8 40.4 28.9 12.9
Pediatric radiology is ≥ 70% of clinical time 25 54.9b,c,d 0.0 8.9 51.9 18.0 21.3 41.9e 20.5 43.1 26.5 9.8
Note—CAQ = certificate of added qualification.
a Statistically significantly different from all radiologists, p < 0.01.
b Statistically significantly different from subspecialists I, p < 0.01.
c Statistically significantly different from subspecialists II, p < 0.01.
d Statistically significantly different from subspecialists I except pediatric radiologists, p < 0.01.
e Statistically significantly different from nonsubspecialists, p < 0.01.
15
 Merewitz and Sunshine
Practices in Which Pediatric Radiologists Work
Radiography or

100.0a,b,c,d,e

100.0a,b,c,d,e

100.0a,b,c,d,e
Fluoroscopy

95.8b,c,d
95.3b,c,d

Approximately half of pediatric radiolo-

93.8c,d
90.5c

gists work in primarily academic practices

85.9
82.7
73.7

90.5
82.0

(Tables 7 and S6). Surprisingly, this is greater

than the 6% for radiologists who do not sub-
specialize, but it is also far greater than the
16.9a,b,c,d,e

19.7a,b,c,d,e
15.5a,b,c,d,e
12.6a,b,c,d,e
32.1a,b,d,e
39.2a,b,d,e

36.7a,b,d,e

20% for other subspecialists. Conversely, ap-

Imaging
Breast

proximately 20% of pediatric radiologists are

61.6
67.6

45.2

76.6
63.4

in private single-specialty radiology prac-

tices, which is about half the level for other
subspecialists and for radiologists who do not
Sonography

89.6b,c,d
88.8b,c,d
91.4b,c,d
90.1b,c,d

subspecialize. Two thirds of radiologists who

84.4c
87.3c
90.6c
74.6

spend at least 30% of their clinical work time

61.1
78.3

83.9
74.0

doing pediatric radiology work in practices

% Who Perform

located primarily in the main cities of large

metropolitan areas (area population > 1 mil-
lion), a much higher percentage than is true
MRI

69.0

69.6
63.5
52.1
70.1
63.7
62.8
65.6
62.8
67.6

66.6
69.0

for other subspecialists (Tables 8 and S7).

Like radiologists generally, about two
thirds of pediatric radiologists work in prac-
98.0a,b,c,d,e

96.4a,b,c,d,e
95.8a,b,c,d,e

100.0a,b,c,d,e
95.3a,b,c,d

95.3a,b,c,d

tices that serve both hospital and nonhospital

88.5c
82.2
73.0
82.5

83.4
81.5
CT

sites (Tables 7 and S8). The rest of pediatric

radiologists work in hospital-only practices,
whereas, in contrast, some 10% of other radi-
ologists work in nonhospital-only practices.
Interventional
Radiology

The practices in which pediatric radiolo-

47.2

35.1

39.3
33.4
29.3
45.4

42.4

34.3
44.4

35.3
39.7
47.8

gists work are significantly less likely to per-

form breast imaging than the practices in
which other radiologists work (Tables 9 and
S9). These tables refer to the categories of
Medicine
Nuclear

procedures performed by the practices in

50.6

52.2

56.4
41.1
42.3
34.8

52.3

49.4
54.4

48.6
59.9
50.3

which radiologists work, not to the work of

TABLE 4: Major Categories of Procedures Performed by Radiologists

the individual radiologists themselves, which

d Statistically significantly different from subspecialists I except pediatric radiologists, p < 0.01.

is shown in Tables 4 and S2.

No. of Major
Categories
Performed

Pediatric radiologists work in practices with

Mean

4.8c

4.8c
4.7

4.3
4.3
4.0

4.7

4.5
4.8

4.4
5.0
4.7

an average size of 21–28, larger than the size of

12 for nonsubspecialists but similar to that for
other subspecialists (Tables 9 and S10). De-
pending on the definition of who is a pediatric
Subspecialists II: those who spend ≥ 50% clinical time in one field

radiologist, about 75–90% of pediatric radiolo-

e Statistically significantly different from nonsubspecialists, p < 0.01.

c Statistically significantly different from subspecialists II, p < 0.01.
b Statistically significantly different from subspecialists I, p < 0.01.
gists have coverage from a member of their

a Statistically significantly different from all radiologists, p < 0.01.

group who is in the same subspecialty when
Subspecialists I: those who subspecialize even slightly

they are away, which, at the upper end, is higher

than the percentage for other subspecialists.
By most definitions, 30–40% of pediatric
Subspecialists I except pediatric radiologists

Pediatric radiology is ≥ 30% of clinical time

Pediatric radiology is ≥ 50% of clinical time
Pediatric radiology is ≥ 70% of clinical time
Note—CAQ = certificate of added qualification.
radiologists are in practices entirely owned by

Pediatric radiology is primary specialty

members of the practice. This is less than the

Subspecialty society highly important

Category

65% for other subspecialists and the 69%

Did pediatric radiology fellowship

Definition of pediatric radiologist
characteristic of nonsubspecialists.

Has pediatric radiology CAQ

Discussion
Comparison with Other Information Sources
Comparison category

Nonsubspecialists
For approximately 25 years, surveys of
All radiologists
SPR members have been providing informa-
tion about pediatric radiologists. Because
these surveys included only pediatric radiolo-
gists, they could, unlike our survey, easily ask
numerous pediatric-radiology-specific ques-
16 AJR:186, January 2006
American Journal of Roentgenology 2006.186:12-22.
 Shortage of Pediatric Radiologists
tions, and thus they have additional detail that
Enjoyment
Score
Mean

we lack. On the other hand, the limitations in-

1.5

1.4

1.5
1.4
1.6
1.4
1.6
1.6
1.7
1.5

1.6
1.5

herent in using an organization’s membership

as a basis for surveying a subspecialty have
been noted earlier in this article.
43.2a,e
Mean %

Desired
More
Work

27.6

24.4

35.1
41.5
39.9
41.5
41.5
41.5
26.4

26.4
27.2

More than 25 years ago (in a 1979 survey),

a prominent concern was that pediatric radiol-
ogists were lagging other radiologists in using
Note—Enjoyment scores: 2 = enjoy very much, 1 = enjoy somewhat, 0 = neither enjoy nor dislike, –1 = dislike somewhat, –2 = dislike very much. CAQ = certificate of added qualification.
% Who

new imaging techniques (which then were CT

More
Want

Work

16.5

15.3

10.0
11.7
15.4
7.8
10.6
11.8
13.6
15.9

19.3
17.1

and sonography) [14]. A decade later, pediat-

ric radiologists were found to be more in-
volved in newer techniques [15], and this was
Practice Want Less Less Work
Mean %

Desired

19.4

23.0

18.7
22.9
16.6
20.9
20.5
20.5
20.5
21.2

21.3
19.4

even more true in 1998 [16]. In this study, we

have presented the first systematic compari-
son of the average number of techniques pe-
diatric radiologists and other radiologists per-
% Who

Work

14.9

19.1

11.1
15.3
11.5
17.6
14.7
16.2
18.8
16.5

11.7
14.8

form. We find equality.

The surveys of SPR members confirm our
finding that pediatric radiologists are heavily
1.8a,b,c,d,e
1.8a,b,c,d,e
2.0a,b,c,d,e
Full-Timers Locations

2.0a,b,d,e
2.1a,b,d
No. of
Mean

hospital-based. Only roughly 10% report some

2.2d
2.9

2.2
2.9

2.6

2.8
2.9

other main location of their practice [13, 16].

(Because questions on our survey did not have
Professional

the wording of those on earlier surveys, find-

Days of
Mean

ings on this point and subsequent ones are not

9.8

10.3
9.8
10.7
10.2

9.4
9.9
9.4

9.9

8.7

9.1
9.8

fully comparable.) Recent surveys of SPR

members conducted in 1998, 1999, and 2002
report that almost half of SPR members are
Full-Timers

22.9a,b,c,d,e
Vacation

24.9a,b,d,e

24.2a,b,d,e
24.0a,b,d,e
Days of

based in freestanding children’s hospitals ([13,

Mean

26.0e

16]; Jennifer Boylan, personal communication,

33.5

27.8
34.1

30.3

35.3

25.8
33.9

February 2005). In addition, about one third are

based in nonchildren’s academic hospitals [13].
% Part-
Timers

As we do, Forman et al. [16] and Goske et

16.5
19.7

24.4
23.3

31.3

27.6
18.4

21.0
23.1
23.5
17.2
15.9
TABLE 5: Work Arrangements and Work Satisfaction of Radiologists

al. [13] find high percentages of pediatric ra-

d Statistically significantly different from subspecialists I except pediatric radiologists, p < 0.01.

diologists have the CAQ (74–81%) or did a

Full-Timers

pediatric radiology fellowship ( 85%).

Hours of

57.8a,e
Weekly
Mean

53.0
52.7

53.4

52.4

57.5
56.2
56.3

57.0
57.2
56.6
52.8

Goske et al. [13], as we do, find pediatric

radiologists spend a high percentage of their
time doing pediatric work. They report an av-
erage of 82% of time, but note that this aver-
Subspecialists II: those who spend ≥ 50% clinical time in one field

age may be biased upward because the re-

e Statistically significantly different from nonsubspecialists, p < 0.01.

c Statistically significantly different from subspecialists II, p < 0.01.
b Statistically significantly different from subspecialists I, p < 0.01.
sponse rate to their survey was only 37%

a Statistically significantly different from all radiologists, p < 0.01.

(because of budget constraints, there were no
Subspecialists I: those who subspecialize even slightly

remailings) and responses came dispropor-

tionately from pediatric radiologists at chil-
dren’s hospitals, where the statistic was 96%
Subspecialists I except pediatric radiologists

Pediatric radiology is ≥ 30% of clinical time

Pediatric radiology is ≥ 50% of clinical time
Pediatric radiology is ≥ 70% of clinical time
of time. At the other end of the spectrum, in

Pediatric radiology is primary specialty

community hospitals with only a small pedi-

Subspecialty society highly important

Category

atric practice, they found the statistic was

Did pediatric radiology fellowship

Definition of pediatric radiologist
19% of time. The unpublished 2002 SPR sur-

Has pediatric radiology CAQ

vey, which possibly has the same bias, shows
that approximately 70% of pediatric radiolo-
gists have more than 75% of their practice in
Comparison category

Nonsubspecialists
pediatric radiology.
All radiologists Goske et al. [13] and Forman et al. [16]
both report, as we do, that a relatively large
fraction of pediatric radiologists—about one
third—are women. Goske et al. find that the
women are, on average, younger than the
AJR:186, January 2006 17
American Journal of Roentgenology 2006.186:12-22.
 Merewitz and Sunshine
men, and Forman et al. report that the younger
Report > 0
for Those
Mean %

Who

half of respondents are almost half women

11.1
11.4
11.5

10.1
10.9
8.6
10.7
9.3
9.3
9.3
9.0
11.6

and the older half are almost three fourths

Research

men. Thus, both find that the heavy represen-

45.5a,b,d,e
Report > 0

tation of women in the field is increasing

% Who

32.5a,e

36.0a,e
41.7a,e
23.2e

30.3e
32.6e

rather than decreasing.

10.9
16.6
23.5

2.6
15.7
% of Time in

Goske et al. [13] and we both find approx-

imately half of pediatric radiologists practice
Report > 0
for Those
Mean %

at more than one location. Forman et al. [16]

Who

12.1
12.2
14.1

14.4
11.7
14.1
13.8
15.4
16.4
16.6
12.2
12.1

find subspecialization within pediatric radiol-

Teaching

ogy is fairly common, both based on organ

system and based on imaging technique. We
86.4a,b,c,d,e

80.8a,b,c,d,e
81.9a,b,c,d,e
84.2a,b,c,d,e
68.7a,b,c,d,e
Report > 0

59.8a,b,d,e

60.8a,b,d,e
% Who

gathered no information on this phenomenon.

Although pediatric radiologists are approxi-
27.5
36.6
44.9

14.2
34.9

mately 3% of all radiologists (Table 1), Saket-

khoo et al. [22] find 4.6% of all radiology job
Report > 0
for Those
Mean %
% of Time in Practice

Professional Society
Work, and so forth

advertisements in 1999–2002 in the two lead-

Who

12.1
12.6
13.1

13.8
13.8
11.5
15.3
16.2
16.2
16.2
10.9
12.4
Management,

ing radiology journals were for pediatric radi-

ologists. For 2003–2004, the corresponding
statistic was 3.6% (Nwanze C, personal com-
Report > 0
% Who

55.0e
32.6
36.9
34.9

46.4
44.5

39.4
40.1
44.4
51.4
26.1
36.7

munication, January 2005). These findings that

advertisements for pediatric radiologists were
more frequent than expected (4.6% vs an ex-
23.0a,b,c,d,e
Report > 0
for Those

pected 3%) reinforce our conclusion, based on

Mean %
% of Time in Clinical Practice of Radiology at

Nonhospital Sites

Who

there being more pediatric radiologists who

45.9
44.1

36.9
35.1
30.9

36.4
30.5
30.5
51.6

48.1
44.8

feel overworked than there are pediatric radiol-

ogists who would like less work, that there is a
19.2a,b,c,d,e
18.1a,b,c,d,e
Report > 0

26.4a,b,d,e

26.3a,b,d,e

21.0a,b,d,e
% Who

relative shortage of pediatric radiologists.

49.5
47.9

35.3

29.6
39.8

51.8
49.3

Substantive Findings
Our best estimate is that about 800–900 ra-
Report > 0
for Those

67.0a,e
Mean %

67.4e

66.5e

diologists in the United States, or 3% of all ra-

Who

76.6
73.8

73.4

73.2
70.3
69.7
73.2

80.6
73.8

diologists in the country, are pediatric radiol-

d Statistically significantly different from subspecialists I except pediatric radiologists, p < 0.01.
Hospitals

ogists. Thus, pediatric radiology is a relatively

98.1a,b,c,d,e
100.0a,b,c,d,e
100.0a,b,c,d,e
100.0a,b,c,d,e
100.0a,b,c,d,e
100.0a,b,c,d,e

small subspecialty.
Report > 0
% Who

Its practitioners differ from other subspe-

97.2a,e
88.8
91.0
89.1

86.4
90.5

cialists in a number of ways. A far greater per-

centage of pediatric radiologists are women.
TABLE 6: Distribution of Work Time of Radiologists

A far greater percentage of pediatric radiolo-

Subspecialists II: those who spend ≥ 50% clinical time in one field

gists are in academic practices. Probably as a

e Statistically significantly different from nonsubspecialists, p < 0.01.

c Statistically significantly different from subspecialists II, p < 0.01.
b Statistically significantly different from subspecialists I, p < 0.01.
result, pediatric radiologists are more hospi-

a Statistically significantly different from all radiologists, p < 0.01.

tal-centered and more concentrated in the
Subspecialists I: those who subspecialize even slightly

main cities of large metropolitan areas.

The Shortage of Pediatric Radiologists
Subspecialists I except pediatric radiologists

Pediatric radiology is ≥ 30% of clinical time

Pediatric radiology is ≥ 50% of clinical time
Pediatric radiology is ≥ 70% of clinical time
Note—CAQ = certificate of added qualification.
Our findings cast light on two important

Pediatric radiology is primary specialty

problems facing pediatric radiology. One,

Subspecialty society highly important

Category

we find evidence there currently is some-

Did pediatric radiology fellowship

Definition of pediatric radiologist
thing of a shortage of pediatric radiologists.

Has pediatric radiology CAQ

Moreover, an analysis of the 2003 survey
that is focused on the radiologist shortage
Comparison category found more of a shortage of pediatric radiol-

Nonsubspecialists
ogists than of other subspecialists or nonsub-

All radiologists
specialists [23]. However, because of the
small sample size, the differences generally
were not statistically significant.
More troubling, we find indications that
this problem is likely to become worse in the
18 AJR:186, January 2006
American Journal of Roentgenology 2006.186:12-22.
 Shortage of Pediatric Radiologists
future. The workload of the radiology pro-
Nonhospital
Hospital &

fession is increasing rapidly, fueled largely

Type(s) of Site(s) Served by Practice (%)

66.9

60.6
71.1
70.0
67.8
61.8
62.1
56.1
63.9

62.4

59.2
66.9

by scientific advances (new imaging tech-

niques and advances in existing techniques)
that allow radiology to do more for patients
0.0a,b,c,d,e
0.0a,b,c,d,e
0.0a,b,c,d,e
0.0a,b,c,d,e
0.0a,b,c,d,e
0.0a,b,c,d,e

[17]. Our findings indicate the number of pe-

Nonhospital

diatric radiologists is not likely to expand to

2.7e
Only

7.9
9.8

7.9

11.9
8.4

meet this growing need. To be more specific,

the finding that relatively few pediatric radi-
ologists are young means that newly trained
radiologists are entering the pediatric sub-
Hospital

specialty in less-than-proportionate num-

Only

25.3

36.7
28.9
30.0
32.2
38.2

43.9
37.9
26.3

29.6

28.8
24.8

bers. And the finding that those working

70% or more of time in the field are rela-
tively old (average age, 55 years) means that
12.1a,b,c,d,e

12.1a,b,c,d,e
Multispecialty

a disproportionate number of those who cur-

rently do the most work in the field will be
28.4

20.1
22.6
19.7
26.0

10.4
27.8

26.7

26.7
28.5

retiring relatively soon.

Radiologists for whom pediatric radiology
0.0a,b,c,d,e

0.0a,b,c,d,e
0.0a,b,c,d,e
0.0a,b,c,d,e

0.0a,b,c,d,e

is a secondary specialty are not a promising

reservoir from which to fill the gap. They are
1.9e
Solo

2.2
5.0

2.2

0.0
9.1
2.4

few in number and few of them have the ad-

vanced credentials—the CAQ or a fellow-
ship—that are generally indicative of the de-
Practice Type (%)

Locum Tenens

0.0a,b,d,e

0.0a,b,d,e
0.0a,b,d,e
0.0a,b,d,e

0.0a,b,d,e

sired skill level of a subspecialist.

Nor is increasing the percentage of their
2.1e
1.4
3.6

1.2

0.0
6.3
1.5

work time that pediatric radiologists spend on

pediatric radiology, a large potential reservoir.
Most radiologists who report pediatric radiol-
11.9a,b,c,d,e
21.0a,b,d,e
20.6a,b,d,e

18.0a,b,d,e
17.9a,b,d,e

15.5a,b,d,e

ogy is their primary specialty are already spend-

Note—Data are based on numbers of radiologists, not practices. CAQ = certificate of added qualification.
Private

ing 70% or more of their clinical work time in

39.4
41.0

28.6

16.6
43.9
40.6

pediatric radiology, and the same is even more

TABLE 7: Type and Location of Practices in Which Radiologists Work

true for radiologists who report spending 30%

d Statistically significantly different from subspecialists I except pediatric radiologists, p < 0.01.

or more of their time doing pediatric radiology.

68.4a,b,c,d,e

60.5a,b,c,d,e

68.7a,b,c,d,e
53.0a,b,c,d,e
43.5a,b,d,e

45.5a,b,d,e
Academic

Thus, there is little opportunity for pediatric ra-

6.3
21.8
15.5

33.5

62.5
20.4

diologists to cut back on nonpediatric clinical

work to make time for more pediatric work.
This situation of very widespread near-full-
time work in one’s main subspecialty is not true
Subspecialists II: those who spend ≥ 50% clinical time in one field

of all subspecialties [18].

e Statistically significantly different from nonsubspecialists, p < 0.01.

c Statistically significantly different from subspecialists II, p < 0.01.
b Statistically significantly different from subspecialists I, p < 0.01.
A more promising reservoir from which to

a Statistically significantly different from all radiologists, p < 0.01.

fill the gap consists of the one sixth of those
Subspecialists I: those who subspecialize even slightly

who did a pediatric fellowship who report

they currently are not doing any pediatric ra-
diology. Relatively brief refresher training for
Subspecialists I except pediatric radiologists

Pediatric radiology is ≥ 30% of clinical time

Pediatric radiology is ≥ 70% of clinical time

Pediatric radiology is ≥ 50% of clinical time
them might sharpen rusty skills and teach

Pediatric radiology is primary specialty

needed new skills so that they would be well

Subspecialty society highly important

Category

qualified to function as pediatric radiologists.

Did pediatric radiology fellowship

Definition of pediatric radiologist
It is not surprising that a sixth of those who

Has pediatric radiology CAQ

did a pediatric radiology fellowship are not
currently doing pediatric radiology. Radiolo-
gists may have done their fellowship 20 or
Comparison category

Nonsubspecialists
more years ago, and a considerable number of
All radiologists radiologists change their field of emphasis
over a time span that long. We found a broadly
similar fraction not practicing at all in their
fellowship field for radiologists who trained
as interventionalists [18].
AJR:186, January 2006 19
American Journal of Roentgenology 2006.186:12-22.
 Merewitz and Sunshine
Speculation suggests two reasons relatively
Nonmetropolitan Area

few residents enter pediatric radiology. The first

0.0a,b,c,d,e
0.0a,b,c,d,e
0.0a,b,c,d,e
0.0a,b,c,d,e
0.0a,b,c,d,e

one is financial. With a relatively large part of

2.7a,e
2.0a,e

the work of pediatric radiologists paid for by

% in

14.2
6.3
3.4

26.9
6.7

Medicaid, the low payment levels characteristic

of Medicaid mean pediatric radiologists pro-
duce less practice revenue than other radiolo-
gists. Moreover, with a relatively large part of
the work of pediatric radiologists consisting of
0.0a,b,c,d,e
0.0a,b,c,d,e
0.0a,b,c,d,e
0.0a,b,c,d,e
0.0a,b,c,d,e
0.0a,b,c,d,e
0.0a,b,c,d,e

radiography and sonography, pediatric radiolo-

% in Suburb

gists produce fewer relative value units (RVUs),

7.2
6.2
5.0

9.0
6.6

and therefore again less revenue, than most ra-

Small Metropolitan Area

diologists [24, 25]. As a consequence of this

double financial handicap, in practices in which
pay is at least partly by revenue produced or by
RVUs produced, pediatric radiologists are rela-
tively low-paid. This is not an attractive situa-
% in Main City

tion. In practices that do not differentiate pay by

revenue or RVUs produced, pediatric radiolo-
29.4
32.0

35.8
38.1
32.6
33.8
33.4
36.9
32.1
29.9

26.3
31.8

gists may be resented for taking a full share of

pay although they do not generate a full share of
income. Again, this situation is not attractive.
Second, disproportionately few women enter
radiology— to be specific, approximately half
2.9a,b,c,d,e
0.0a,b,c,d,e
0.0a,b,c,d,e

of current U.S. medical school graduates are

% in Suburb

women, but only one fourth of radiology resi-

18.8

16.4
16.3

19.1
19.0

17.9

18.8
18.9

7.8

dents are women [7]. To the extent sex role ste-

Large Metropolitan Area

reotyping has an effect, the relatively large frac-

tion of women among pediatric radiologists (≈
one third) may make pediatric radiology a rela-
Note—Data are based on numbers of radiologists, not practices. CAQ = certificate of added qualification.

tively unattractive choice for the three fourths of

radiology residents who are men.
67.9a,b,c,d,e
% in Main City

63.8a,b,d,e
63.1a,b,d,e

If reasons such as these are important in res-

d Statistically significantly different from subspecialists I except pediatric radiologists, p < 0.01.
TABLE 8: Degree of Urbanness of Practice Location of Radiologists

59.6a,e
45.1e
41.6e

47.0e

idents’ tendency not to choose pediatric radiol-

35.6
28.9

42.8

17.8
34.7

ogy, much work will be necessary to attract

larger numbers of them to pediatric radiology
and to attract back into the field that sixth of ra-
diologists with pediatric fellowship training
who are not now practicing in the field.
Subspecialists II: those who spend ≥ 50% clinical time in one field

e Statistically significantly different from nonsubspecialists, p < 0.01.

c Statistically significantly different from subspecialists II, p < 0.01.
b Statistically significantly different from subspecialists I, p < 0.01.
Access to Pediatric Radiology
a Statistically significantly different from all radiologists, p < 0.01.
Our findings that pediatric radiologists are
Subspecialists I: those who subspecialize even slightly

concentrated in large cities and in academic

practices indicate that access to pediatric radiol-
ogy services is likely a problem for children
Subspecialists I except pediatric radiologists

Pediatric radiology is ≥ 30% of clinical time

Pediatric radiology is ≥ 50% of clinical time
Pediatric radiology is ≥ 70% of clinical time
who do not live in large metropolitan areas and
Pediatric radiology is primary specialty
for children in such areas who do not readily
Subspecialty society highly important
Category

connect to academic medical centers. The prob-

Did pediatric radiology fellowship
Definition of pediatric radiologist
lem is not merely one of expertise in interpret-
Has pediatric radiology CAQ
ing images, a problem that might be overcome
through teleradiology. Expertise in patient man-
agement, particularly in sedation and minimi-
Comparison category

Nonsubspecialists
zation of radiation dose, is also a problem.
All radiologists

Given the limited number of pediatric radiolo-

gists, which means there will never be a pediat-
ric radiologist in most practices, solutions seem
to lie in the direction of more links between pe-
diatric radiologists on the one hand and physi-
20 AJR:186, January 2006
American Journal of Roentgenology 2006.186:12-22.
 Shortage of Pediatric Radiologists
cians outside their practices and their hospitals
Physicians in the Group
% of Radiologists in
Practices in Which

on the other hand. Such links might include

All Owners Are

40.9a,b,d,e

41.3a,b,d,e
33.9a,b,d,e
31.4a,b,d,e
32.7a,b,d,e

minifellowships in pediatric radiology for radi-

44.9a,e
41.3e

ologists from other practices, increased refer-

66.0
63.6

65.0
69.4
51.2

rals to pediatric radiologists, and telephone ad-

vice by pediatric radiologists to radiologists in
other practices who have a pediatric case that
presents challenges. With such links enhanced,
% of Radiologists with

it might be useful to further centralize pediatric

Radiologist in Same

Within the Practice

Subspecialty from
Coverage from a

96.6a,b,c,d,e

radiology interpretation to more efficiently use

87.3a,b,d,e

89.4a,b,d,e
87.7a,e

pediatric subspecialty expertise.

73.3e
80.0e
74.1e
69.0
72.9

72.8
50.1
84.0

Study Strengths and Limitations

Like other studies, ours has both strengths
and limitations. These have been discussed
in detail elsewhere with respect to the over-
Mean Practice Size

all 2003 survey [17, 18]. In brief, major

strengths include the following: The data are
21.5e
22.2e

22.3e
28.1e
28.2e
28.1e

from a large, carefully conducted survey that

18.2
21.9

23.1
21.8
12.5
25.2

achieved a high response rate through inten-

sive follow-up. Weighting adjusted for non-
response bias—that is, differences between
respondents and nonrespondents—in the
characteristics used in the weighting. Multi-
% of Radiologists in
Practices Providing

64.1a,b,c,d,e

52.4a,b,c,d,e

59.2a,b,c,d,e
54.7a,b,c,d,e
47.1a,b,c,d,e

ple steps were taken to improve data quality.

Breast Imaging

67.8a,b,d,e

65.8a,b,d,e

Multiple definitions of who is a pediatric ra-

90.5
90.0

91.4
91.8
84.1

diologist are used to present a rounded and

in-depth portrait of the subspecialty.
Nonetheless, as with almost any survey, sta-
tistics drawn from our survey may have inaccu-
Note—Data are based on numbers of radiologists, not practices. CAQ = certificate of added qualification.

racies from at least three sources: sampling

Procedures Provided by

variability (the likely size of these inaccuracies

Mean No. of Major
Categories of

is measured by the SE); nonresponse bias (but

the Practice

d Statistically significantly different from subspecialists I except pediatric radiologists, p < 0.01.
6.6c,e

only with respect to characteristics not consid-

6.3
6.4

6.2

6.4
6.4
6.2
6.4
6.2
6.1

6.3
6.3

ered in the weighting); and incorrect or illogi-

cal responses (some still remain despite careful
TABLE 9: Other Characteristics of Practices of Radiologists

and extensive data cleaning). Sampling vari-

ability is particularly a problem in this study.
Subspecialists II: those who spend ≥ 50% clinical time in one field

Because pediatric radiologists are only approx-

imately 3% of all radiologists, the survey had a

e Statistically significantly different from nonsubspecialists, p < 0.01.

c Statistically significantly different from subspecialists II, p < 0.01.
b Statistically significantly different from subspecialists I, p < 0.01.
small sample of pediatric radiologists, and

a Statistically significantly different from all radiologists, p < 0.01.

modest-sized phenomena therefore often do
Subspecialists I: those who subspecialize even slightly

not attain statistical significance.

Also, as with any survey, aspects of the
questions on our survey affect the answers
Subspecialists I except pediatric radiologists

Pediatric radiology is ≥ 30% of clinical time

Pediatric radiology is ≥ 50% of clinical time
Pediatric radiology is ≥ 70% of clinical time
given and hence the findings. Most notably,

Pediatric radiology is primary specialty

this is true for the question about how respon-

Subspecialty society highly important

Category

dents divide their clinical work time among ra-

Did pediatric radiology fellowship

Definition of pediatric radiologist
diology fields. This question included as an-

Has pediatric radiology CAQ

swer options both technique-defined fields,
such as interventional radiology, and fields de-
fined by organ system or patient population,
Comparison category

Nonsubspecialists
All radiologists such as pediatric radiology. Respondents were
instructed that the reported percentages should
total 100. If there had been one question for
techniques and another for organ systems and
patient categories, with directions that each
was to total 100%, then the number of radiolo-
AJR:186, January 2006 21
American Journal of Roentgenology 2006.186:12-22.

gists reporting time spent in any field and the
reported amounts of time spent would have
been larger. This is unlikely to have produced
substantial bias with respect to radiologists
who spend large amounts of time in a field, and
these are the radiologists on whom this study
concentrates. However, the number of radiolo-
gists who, in fact, perform small amounts of
pediatric radiology may be twice or more the
number reported [18].
The involvement of representatives of indi-
vidual subspecialties in the design of the sur-
vey was limited and, because our survey was
a survey of all types of radiologists, it neces-
sarily had fewer questions relevant only to pe-
diatric radiology than a survey of only pediat-
ric radiologists would have had.
Conclusions
Our detailed portrait of pediatric radiolo-
gists shows that theirs is a small subspecialty
and that most practitioners of this subspecialty
American Journal of Roentgenology 2006.186:12-22.
spend most of their clinical time doing pediat-
ric work. Something of a shortage of radiolo-
gists exists, the shortage is likely to grow worse
over time, and ready remedies to the shortage
are not at hand. Thus, the problem of a shortage
needs concentrated attention. Similarly, the
problem of access to pediatric radiology ser-
vices needs thoughtful action to resolve.
Acknowledgments
Stuart A. Royal, president of the SPR, and
David C. Kushner, chair of the board of the SPR,
provided valuable insights and suggestions and
made SPR information available to us. Jennifer
Boylan, executive director of the SPR, assem-
bled and transmitted to us the studies the SPR
has conducted. We thank all those who re-
sponded to the 2003 Survey of Radiologists. By
contributing the time needed to complete the
questionnaire, they have helped make important
information available to the entire profession.
F O R YO U R I N FO R M AT I O N
A data supplement containing Tables S1–S10 can be viewed in the online version of the article at
www.ajronline.org. These more detailed tables have been designed to augment the tables in the article.
22
Merewitz and Sunshine
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