Radiologist Turnover in the United States

Purpose: To estimate the turnover rate and its association with workload and radiologist and practice characteristics given the detrimental aspects of turnover on radiology practices. Methods: This retrospective study (2013-2022) examined practice turnover rates (leaving one practice to join another) of radiologists by year (radiologist-years). Radiologist and practice characteristics were obtained from CMS (Medicare Data on Provider Practice and Specialty and National Downloadable Files). Radiologists’ workload was estimated based on 5% sample of CMS Medicare fee-for-service claims and Inovalon Insights, LLC (Bowie, MD), claims (commercial, Medicaid, and Medicare Advantage). Radiologists’ total workload was extrapolated from these claims based on the population represented in these data. Turnover odds by radiologist and practice characteristics and workload were estimated by logistic regression. Results: Between 2013 and 2022, 280,692 radiologist-years (39,439 radiologists) met the selection criteria. Turnover increased from 5.3% to 8.5% (from 2013 to 2022). Adjusted turnover odds were 1.96 (95% confidence interval [CI]: 1.83-2.10) in 2022 versus 2013, were higher for female versus male (odds ratio [OR]: 1.06; 95% CI: 1.02-1.10) and metropolitan versus nonmetropolitan (OR: 1.12; 95% CI: 1.05-1.20), and were lower for academic versus nonacademic (OR: 0.91; 95% CI: 0.86-0.97) radiologists and decreased with years of practice (YOP). The turnover rate decreased as workload increased until reaching a minimum rate—an inflection point—and then increased. This inflection point was lower for academic versus nonacademic radiologists and with more YOP. Conclusions: Factors associated with higher turnover included excessive workload, nonacademic practices, females, lower YOP, and metropolitan setting. Practices should consider these factors as they design retention efforts.