Decline in US Pediatric Radiology Workforce Raises Concerns About Specialized Imaging Access

The number of radiologists dedicating most of their clinical effort to pediatric imaging in the US has declined over the past decade, even as demand for imaging continues to grow, according to a study published in Journal of the American College of Radiology.¹

Researchers from the Harvey L. Neiman Health Policy Institute in Virginia analyzed more than 52 million radiology claims from between 2016 and 2023 using the Inovalon Insights database, which covers approximately 414 million unique lives across Medicaid, Medicare Advantage, and commercial plans. Pediatric radiologists were defined as those with at least 50% of their annual work relative value units (wRVUs)—a component of the Medicare Physician Fee Schedule—attributed to interpreting imaging studies for children.

Shrinking Workforce Despite Growing Need

The study identified 9198 unique pediatric radiologists over the 8-year period. The annual count dropped 7.2%, from 2190 pediatric radiologists in 2016 to a total of 2032 in 2023. To account for variability in practice, researchers also applied alternative thresholds, looking at radiologists who spent at least 25% and 75% of their time interpreting pediatric imaging studies. Compared with those who spent 50% or more of their time (study threshold), the number of pediatric radiologists in the workforce increased to 13,532 with the looser wRVU threshold and decreased to 7456 with the stricter one.

Despite overall growth in the radiology workforce—from 34,231 total radiologists to 44,524—the proportion of pediatric radiologists specifically decreased from 6.4% to 4.6% from 2016 to 2023. All 3 subgroups saw a noticeable drop between 2019 and 2020.

Nonpediatric radiologists had near-zero pediatric wRVU contributions. | Image credit: Svitlana – stock.adobe.com

“This is the first study to use claims data to systematically identify pediatric radiologists and track workforce trends over time,” Casey Pelzl, MPH, principal economics and health services analyst at the Neiman Institute, said in a news release.² “Our findings show that, while the overall radiology workforce has grown, the number of pediatric-focused radiologists has declined, which raises concerns about access to specialized care for children.”

Defining Pediatric Radiology Effort

At the 50% threshold, most pediatric radiologists practiced nearly exclusively in the subspecialty, with median pediatric effort ranging from 95.3% to 100.0% across years.¹ Again looking at other thresholds, the median percentage of wRVUs ranged from 69.7% to 90.1% among those spending at least a quarter of their time on imaging and consistently stayed at 100% for those spending the most time on pediatric imaging.

On the other hand, nonpediatric radiologists had near-zero pediatric wRVU contributions, underscoring the reliance on a relatively small pool of specialists.

“Many radiologists are delivering pediatric imaging services without formal subspecialty certification,” said study author Hansel J. Otero, MD, vice chair for clinical research at Children’s Hospital of Philadelphia (CHOP).² “This suggests that traditional self-reported estimates, which were last collected through the ACR’s 2003 Survey of Radiologists, may significantly undercount the true pediatric radiology workforce.”

Policy and Training Implications

The study comes at a time of heightened workforce challenges in pediatrics. Pediatric radiology fellowship positions accredited by the Accreditation Council for Graduate Medical Education have declined from 88 positions in 2013 to just 54 in 2023.¹ Additionally, a 2021 American College of Radiology survey found nearly 40% of active pediatric radiologists plan to retire within the next decade.³

In an effort to help with this shortage, the American Board of Radiology approved a 15-month training pathway for pediatric radiology subspecialty certification in March 2025.⁴ Although this offers a flexible alternative to traditional fellowships and clinical practice pathways, its impact is currently unknown.

“Our methodology provides a utilization-based lens to evaluate workforce trends and can be used to inform policy like the recently proposed changes in requirements for training and certification,” said lead author Tatiana Morales-Tisnés, MD, radiology research scholar at CHOP.² “Understanding who is delivering pediatric imaging services is essential for planning training programs and ensuring equitable access to care.”

The researchers emphasized that claims-based data offer a more accurate and scalable way to estimate workforce supply than self-reported surveys, which may underrepresent radiologists who focus on children without pursuing subspecialty certification. Future studies will explore geographic distribution, demographic trends, and strategies to mitigate shortages.

References

1. Morales-Tisnés T, Pelzl CE, Christensen EW, Rula EY, Otero HJ. Defining the pediatric radiology workforce in the United States using insurance claims data. J Am Coll Radiol. 2025:S1546-1440(25)00448-X. doi:10.1016/j.jacr.2025.07.029
2. Decline in U.S. pediatric radiology workforce revealed in large study of private insurance claims. News release. Harvey L. Neiman Health Policy Institute. September 9, 2025. Accessed September 9, 2025. https://www.neimanhpi.org/press-releases/decline-in-u-s-pediatric-radiology-workforce-revealed-in-large-study-of-private-insurance-claims/
3. Farmakis SG, Tarrant J, Parris D, Markovich D, Rubin E, Barth RA. The 2021 ACR and radiology business management association workforce survey: subspecialty focus on pediatric radiology. J Am Coll Radiol. 2024;21(5):836-839. doi:10.1016/j.jacr.2023.06.047
4. Simoneaux SF, Wagner B. New 15-month pathway offers flexibility for pediatric radiology training and certification. American Board of Radiology. April 16, 2025. Accessed September 9, 2025. https://www.theabr.org/beam/focus-on-dr-april-2025