Evolving Trainee Participation in Radiologists' Workload: A National Medicare-Focused Analysis From 2008 to 2020

Purpose: Increasing volumes and productivity expectations, along with practice type consolidation, may be impacting trainees' roles in the work effort of radiologists involved in education. We assessed temporal shifts in trainee participation in radiologists' workload nationally.

Methods: All US radiologists interpreting noninvasive diagnostic imaging for Medicare fee-for-service beneficiaries were identified from annual 5% Research Identifiable Files from 2008 to 2020 (n = 35,595). Teaching radiologists were defined as those billing services using Medicare's GC modifier, indicating trainee supervision. Billed work relative value units were used to determine the percentage of teaching radiologists' total workload with trainee participation. Mean trainee participation in workload was calculated for teaching radiologists overall and stratified by radiologist and practice characteristics determined using National Downloadable Files.

Results: The percentage of radiologists involved in teaching increased from 13.6% (2008) to 20.4% (2020). Among teaching radiologists, mean total workload increased 7% from 2008 to 2019 and decreased in 2020 to 2% below 2008's level; mean teaching workload decreased 19% from 2008 to 2019 and decreased in 2020 to 31% below 2008's level. Mean trainee participation in teaching radiologists' total workload decreased from 35.3% (2008) to 26.3% (2019) and 24.5% (2020). Teaching radiologists showed decreased mean trainee participation when stratified by gender, experience, subspecialty, geography, practice type, and practice size.

Conclusions: The percentage of US radiologists involved in resident teaching has increased, likely reflecting academic practice expansion and academic-community practice consolidation. However, a declining percentage of teaching radiologists' total workload involves trainees; this dispersion effect could have implications for education quality.