Another Perspective on Radiology Worklist Delay Assertions from the Royal College of Radiologists
Other factors such as burnout, extraneous imaging orders and increasingly non-clinical tasks are key considerations when assessing reported backlogs with radiology worklists.
Scott Adams, a podcaster whom I have referred to a few times in this blog, coined the term, half-pinion, which means half an opinion. It refers to the unfortunately common practice of excessively simplifying an issue to the point that your opinion on it sounds like the only reasonable conclusion. That can happen when one is genuinely unaware of relevant details that weaken a particular position or because the person knows the details but disingenuously omits them.
Health care is rife with half-pinions and radiology is no exception. One that we routinely see pertains to the imbalance of imaging studies versus the capacity of rads to read them. A recent iteration came from the United Kingdom. The Royal College of Radiologists (RCR) announced that, in 2024, a record 976,000 scans lingered on worklists for more than a month before being read. That was a 28 percent increase from 2023 and a “stark failure against the National Health Service (NHS) target of zero scan results taking longer than a month."1
This news included talk about the “radiology shortage,” the amount of money being spent on outsourcing excess work to telerads, a proclaimed need to boost productivity, and training “the workforce we need” (interesting that they said “workforce” instead of radiologists).
Completely missing from their half-pinion was where all this imaging volume is coming from. Would you expect an economist to be taken seriously if he or she spoke only about demand, but offered not a word regarding supply?
I mentioned that half-pinions can result from innocent naivete/ignorance or more sinister machinations. It gets harder to charitably assume the former when the half-pinion’s expresser has sufficient experience and resources to know better.
To put this another way, if you are the CEO of a large corporation, a high-ranking government official or a professional body like the Royal College of Radiology (over 17,000 fellows and members, plus nearly 300 employees), you have no excuses to be unaware of the many factors influencing any topic of import to you. Proceeding to talk about only one side of an issue therefore screams out that you are pursuing an agenda.
It is not necessarily a bad thing to have lopsided interests. I wouldn’t expect a labor union to be “fair” in safeguarding a business owner’s interests rather than getting everything possible for the union’s members, nor would I expect a political party to push for election reforms that they knew would diminish their candidates’ chances of winning office.
If you are trying to maintain the appearance of impartiality, however, and want people to respect you as the trusted authority on something like the oversight of diagnostic imaging, you don’t want people to see you dealing in half-pinions. They are liable to come away with the idea that your words and actions are with your, not their, best interests at heart.
I have no idea about the politics surrounding the RCR nor what agenda they might be pursuing. I might also be giving them too much credit for being organized and savvy. For all I know, they are the radiological Keystone Cops.
If one were to assume the contrary, and that they have genuine concerns about the supply and demand of diagnostic imaging, one might imagine their announcement to reference a couple of other relevant details. Key questions on this topic may include the following considerations.
• How has imaging utilization trended relative to the radiology workforce? Has the number of scans increased disproportionately to the number of interpreting radiologists and/or the patient population?
• Under what circumstances is this extra imaging volume occurring? Is it like the USA, where an ever increasing number of non-physicians have gained the ability to order studies? How many of those studies turn out to be inappropriate, exams that an actual doctor seeing the patient would not have ordered? How much of that imaging was done as result of physicians and their extenders being overtaxed to the point where it is easier to order a study as a triaging tool?
• How much of that imaging, when all is said and done, turns out to be relevant and/or impactful? Has the proportion of studies that are “normal” or “no significant change” disproportionately contributed to the volume of excess scans that the radiology workforce is now being blamed for failing to keep up with? How many of these needless studies propagate themselves with “follow-ups” that would otherwise never have occurred?
• Are there any mechanisms whereby radiologists can meaningfully say no to some of this excessive utilization? Alternately, would a rad spend 10 times the amount of time and effort saying no as he or she would have by just allowing the study to happen and reading it out? Do rads take their career in their hands by blocking a study, or is there a basic assumption that their professional opinion should be held harmless?
• Has the radiology workforce in fact declined, whether it is via overall numbers or hours of clinical work? Have factors like stress, reduced compensation, etc., been considered as contributing factors? More importantly, has anything been done about such factors, or has there only been lip service? Has there been any examination of the clerical and other non-doctorly responsibility forced on the rads, such that they are pulled away from their workstations more than they need to be?
Reference
1. The Royal College of Radiologists. Radiology delays worst on record despite spend on private providers soaring. Available at https://www.rcr.ac.uk/news-policy/latest-updates/radiology-delays-worst-on-record-despite-spend-on-private-providers-soaring/ . Published May 19, 2025. Accessed June 2, 2025.
What if Radiology Turns Out Exactly the Way We Predict it Will?
May 19th 2025Whether it is reimbursement cuts or continued attempts to push non-radiologist image interpretation, where do we draw the line between inspired protest and misspent energy criticizing things that are doomed to fail or things we have no control over?
