One of the most troubling developments in radiology in the last two years has been the radiology workforce shortage. Generally, scarcity of a service is a good thing for those who control the supply, and there have been some salutary effects. These include higher starting salaries, a variety of job openings from which radiology residents can pick and choose, and more leverage for hospital-based radiologists in their negotiations with hospital administrators.

But many radiologists are also familiar with the considerable downside: a crushing workload that never seems to abate and stresses and squabbles within practices over how to meet the burgeoning demand for image interpretations. Probably the worst effect is far more subtle and insidious. When radiologists and nuclear medicine physicians are unable to supply image interpretations, medical specialists will look for other solutions. That often means lost turf that is never regained.

Dr. David Levin, radiology chair at Thomas Jefferson University and a turf expert, outlined a doomsday version of this scenario at a radiology economics conference last fall: Demand will continue to exceed supply, while advances will make imaging technology easier to use, other physicians will progressively take over a greater share of imaging, and radiology as a specialty will eventually cease to exist.

Solutions are not easy. They commonly involve increasing the supply of radiologists, but that takes time in a marketplace that is impatient for action. Even then, as the ACR's Dr. Jonathan Sunshine observed during the same conference, with the growth and aging of the U.S. population, various strategies to increase the number of radiologists would still leave demand outstripping supply for several years to come.

thus it is with pleasure that we report this month on an innovative approach to a workforce shortage problem: using technology and incentives to create a seventh "virtual radiologist" in a six-member practice. In one respect, the circumstances here are unique. The West Texas imaging practice has historically experienced recruiting and retention challenges due to the region's hot climate and distance from major population centers. But if you consider that the workforce shortage has made recruiting and retaining good radiologists a challenge for practices throughout the U.S., the experience of the Southwest Medical Imaging Group offers some valuable lessons.

One lesson is that digital imaging technology-PACS and teleradiology-is a vital part of any strategy to meet workload challenges. Being able to ship out digital images for remote interpretations provides a comforting pressure relief valve for the Texas practice. Digital imaging technology also makes it easier for practice members to take part of the overload via remote reads when the opportunity arises.

Another lesson is that how a practice structures its incentives, in this case paying extra to those members of the practice who want to take on added work, can make the group happier, healthier, and more productive.

How well has it worked? You can find out more in the article on page 31, but the standard workday has dropped from 10 to nine hours, and the group is considering adding new volume without adding new radiologists.

Obviously, this is not a one-size-fits-all solution, but it is something many will want to consider. Imaginative solutions like this one can help radiology better cope with the workforce shortage even though training programs are not producing enough radiology residents.

What are your thoughts on this topic? Please e-mail me at jhayes@cmp.com