The number of pediatric radiologists in the U.S. is in decline, according to a report from the Harvey L. Neiman Health Policy Institute (HPI).
A team led by Tatiana Morales-Tisnés, MD, of the Children's Hospital of Philadelphia used data from a national private payor claims database that included approximately 414 million unique covered lives and found that the pediatric radiology workforce decreased between 2016 and 2023, even as demand for imaging services grew. The results were published September 8 in the Journal of the American College of Radiology.
"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," said co-author Casey Pelzl in a statement released by the HPI. Pelzl is a principal economics and health services analyst at the Neiman Institute.
For more than 20 years, researchers have warned of a continued shortage of pediatric radiologists, exacerbated perhaps by not only a decline in the number of pediatric radiology residents but also an aging workforce, the group explained. Although the overall number of radiology residents has increased, the number of pediatric radiology residents decreased from 88 in 2013 to 54 in 2023 -- according to the Accreditation Council for Graduate Medical Education (ACGME) -- and a report from the American College of Radiology (ACR) workforce survey noted that 38% of active pediatric radiologists intend to retire within the next decade.
The team sought to investigate the current state of pediatric radiology via a study that analyzed more than 52 million radiology claims from the Inovalon Insights database (which includes Medicaid, Medicare Advantage, and commercial payers). It defined pediatric radiologists as those with at least 50% of their annual work relative value units (wRVUs) attributed to imaging children. Across the study period, 9,198 (8.4%) out of 109,077 unique radiologists met this threshold.
Overall, Morales-Tisnés and colleagues reported that the number of unique pediatric radiologists declined from 2,190 in 2016 to 2,032 in 2023. On further testing of the data via alternative thresholds for pediatric wRVUs, the group found the following:
- When the threshold was raised to ≥ 75%, the number of unique pediatric radiologists decreased by 18.9%.
- When the threshold was lowered to ≥ 25%, the number of identified pediatric radiologists increased by 47.1%.
- As a proportion of all radiologists, the percentage of pediatric radiologists identified using the 75% threshold dropped from 9.1% of all radiologists in 2016 to 6.2% in 2023.
- As a proportion of all radiologists, the percentage of pediatric radiologists identified using the 50% threshold dropped from 6.4% in 2016 to 4.6% in 2023 across the same period.
Study senior author Hansel Otero, MD, also of Children's Hospital of Philadelphia, noted that "many radiologists are delivering pediatric imaging services without formal subspecialty certification," which 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."
But the investigators also wrote that the research illuminates "the potential impact of recent policy changes," noting that in March 2025, the American Board of Radiology (ABR) approved a new 15-month pathway to pediatric subspecialty certification. This initiative could help address workforce shortages, but whether it actually will remains unclear, as "certification is not required for clinical practice and may be foregone due to cost or perceived value," they said in the statement.
One of the study's strengths is that it used claims data to identify pediatric radiologists and track workforce trends over time, Morales-Tisnés explained.
"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," she said.
The authors called for more research that would focus on investigating the geographic distribution of the pediatric radiology workforce and its demographics, as well as identifying the number of trained pediatric radiologists that may not meet the "practical definition" but should be part of the discussion on possible solutions to current workforce shortages for pediatric radiology.
"These findings [could] help inform planning efforts around workforce distribution and training needs by providing more accurate understanding of who is delivering pediatric imaging services," they concluded.
The complete study can be found here.
