Professional and economic factors affecting access to mammography: a crisis today, or tomorrow? Results from a national survey.
BACKGROUND
Objective data and anecdotal reports have suggested that access to mammography may be declining because of facility closures and difficulty in recruiting and retaining radiologists and radiologic technologists. To gain insight into the practice patterns, use of emerging technologies, and concerns of breast imagers in current practice, the Society of Breast Imaging (SBI) conducted a national survey of breast imaging practices in the U.S.


METHODS
Between October 2003 and April 2004, the SBI conducted a survey of the SBI membership database, and received completed surveys from 575 breast imaging practices in the U.S. Responses to the survey regarding practice characteristics, the utilization of standard and emerging technologies, staffing, malpractice, finance, and morale were analyzed.


RESULTS
Job vacancies for radiologists who read mammograms were reported in 163 practices (29%), 59 of which (10%) had 2 or more openings. A higher proportion of practices with job openings had long appointment waiting times for asymptomatic women when compared with fully staffed practices. Unfilled fellowship positions also were common, with 41 of 65 practices that offer fellowships reporting 47 openings. Among 554 responding practices, 55% reported that someone in their practice was sued because of a mammography related case within the past 5 years, and 50% of practices reported that the threat of lawsuits made radiologist staffing "moderately" or "a lot" more difficult. Of 521 responding practices, 35% reported financial losses in 2002. One in 5 respondents reported that they would prefer to spend less time in mammography, and fewer than 1 in 3 would recommend a breast imaging fellowship to a relative or friend. Emerging technologies, such as breast magnetic resonance imaging and screening ultrasound, currently are being performed in many practices.


CONCLUSIONS
The survey results provide support for anecdotal reports that breast imaging practices face significant challenges and stresses, including shortages of key personnel, a lack of trainees, malpractice concerns, financial constraints, increased workload due to emerging technologies, low appeal of breast imaging as a career specialty, and the steady rise in the population of women of screening age.
Department of Radiology-Breast Imaging, Washington University School of Medicine, St. Louis, Missouri, USA.
Dione M
DM
Farria
Maria E
ME
Schmidt
Barbara S
BS
Monsees
Robert A
RA
Smith
Charles
C
Hildebolt
Roberta
R
Yoffie
Debra L
DL
Monticciolo
Stephen A
SA
Feig
Lawrence W
LW
Bassett
D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000191:economics*; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006302:Health Services Research; D006306:Health Surveys; D006801:Humans; D008327:Mammography / Q000191:economics*; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D013679:Technology, Radiologic / Q000191:economics / Q000706:statistics & numerical data; D014850:Waiting Lists; D000078329:Workforce