Rethink Imaging

EP 33 • December 4, 2025

The U.S. Is 1,500 Radiologists Short: What It Means for Imaging Workloads

Featured Guest

Dr. Ian Weissman, DO, FACR

Radiologist • Milwaukee VA Medical Center

Listen Now41 min

Also on:

Let's Talk

Beyond dose

Ask us what your imaging data can actually show you.

Start a Conversation

Share This Episode

Subscribe to Rethink Imaging

The United States has about 38,000 practicing radiologists and, by Dr. Ian Weissman’s read of Medicare data, is short roughly 1,500 of them. That gap is colliding with relentless demand: emergency departments alone order about 100 million CT scans a year, a number that grows by roughly 11 million each decade. Chris St. John and Dr. Weissman walk through what the shortage looks like on the ground, from cancer studies that no longer get same-day reads to a health system that closed its outpatient imaging centers for two weeks just to clear its inpatient and ICU backlog.

The second half turns prescriptive. Weissman explains why telling radiologists to read more studies produces moral injury rather than throughput, and why younger physicians are leaving employed roles for 1099 work with whoever pays best. He lays out what leaders can do right now: servant leadership, peer learning instead of punitive peer review, and honest communication that brings patients onto the care team. Longer-term fixes get airtime too, including more residency slots, better visa pathways for international physicians, and AI that handles measurement work without replacing the radiologist. He closes with a case for optimism built on collaboration.

Host

Chris St. John

Host, Rethink Imaging • Imalogix

Featured Guest

Dr. Ian Weissman, DO, FACR

Radiologist • Milwaukee VA Medical Center

Watch the Episode

Key Takeaways

The U.S. has about 38,000 practicing radiologists and is short roughly 1,500, a figure Weissman derives from Medicare data and calls a best guess that may run higher as older colleagues cut hours or retire.
Demand keeps outrunning supply: U.S. emergency departments alone order about 100 million CT scans a year, growing by roughly 11 million per decade, before counting ICU, inpatient, or outpatient volume.
Backlogs are now severe enough that one health system closed its outpatient imaging centers for two weeks just to catch up on inpatient and ICU reads, something Weissman had never seen before.
Moral injury is widespread: in a colleague’s survey, most radiologists said they are asked to read more studies than they believe they safely can, and 11 percent looked for a different job last year.
Retention is a leadership problem with available fixes: servant leadership, peer learning instead of punitive peer review, and transparency with patients, while AI currently helps most with tasks like lung nodule measurement rather than interpretation.

Full Transcript

[00:00:01] Ian Weissman: There was a healthcare system, I think it was Illinois, and they were so backed up with studies that need to be read, patients, inpatients, patients in the ICU, that they actually closed our outpatient imaging centers. They said we’re gonna close our patients’ imaging centers for a couple of weeks so we can catch up.

[00:00:17] Chris St John: Welcome to Frame by Frame Rethink Imaging, a podcast by Imologix. Here, we explore the intricate of medical imaging, aiming to dissect the field and inspire both professionals and curious minds alike. I’m your host, Chris St. John. Welcome back to Frame by Frame Rethink Imaging. I am Chris St. John. Today, I am joined by doctor Ian Weisman, a radiologist at the Milwaukee VA Medical Center and a nationally recognized leader in radiology. He has held leadership roles with the American College of Radiology, including chairing the Veterans Affairs Committee and the Patient and Family Centered Care Outreach Committee. He has served on the ACR’s council steering committee and currently serves on the RSNA government relations committee. He’s a speaker for the ACR’s Radiology Leadership Institute. Doctor Weissman is a strong advocate for patient centered care, clinician wellness, and workforce mitigation strategies. He was the first physician to achieve the designation of leadership mastery through the Radiology Leadership Institute. Doctor Weissman is a fellow of the ACR, and his national recognitions include the RLI’s Impact in Leadership Award and the ACR’s advocate of the year. Now that I’m through that quite lengthy intro, welcome to the show, doctor Weissman. It’s great to have you here.

[00:01:33] Ian Weissman: Hey, Chris. It’s a great pleasure. You can call me Ian. That’s fine. Let’s we’ll keep this casual. So

[00:01:37] Chris St John: Well, Ian, you know, we’re I wanted to talk to you today to talk about the workforce shortage going on today in the world of medical imaging. So can we just start with the big picture? How would you describe the current radiology workforce shortage to folks outside of the field, and what’s, like, a rough snapshot of where we’re at right now?

[00:01:56] Ian Weissman: Yeah. You know, it’s a excellent question. And and certainly, I think, at the national level, we’re all very concerned. I think as a patient, for the patients out there, I would tell you all that I think we’re holding our own. A lot of my colleagues were working really, really hard as many of you in your jobs as well to keep things moving. I know colleagues who work long hours, uh, to make sure we get the reports out to patients in a timely fashion. I, myself, because I’m I understand what’s happening in in our supply chain in a sense. We’ll actually call patients at night once it’s past business hours to speed up their care. So I will call a patient just to make sure that they their care is expedited. Patients are very appreciative of that. And these are things I’m trying to do and I know some of my colleagues are doing similar things. But looking overall with the what we’re faced with, you know, there’s currently about 38,000 radiologists practicing in the in the country. And we know by taking a look at data, like Medicare data, things we can track because we know how many radiologists are practicing. So we’re short probably around 1,500 radiologists. That may be a little bit more, a little bit less. So that’s that’s a lot. And that’s our best guess. It’s possible the numbers may even be higher because we know a lot of our colleagues do the challenges. Some are getting older. There’s certainly more stress in the profession. We can talk about that as well. That some of our colleagues are moving to part time, and that’s hard to track. So we know radiologists are working, but we don’t know necessarily how many have moved to part time. So the numbers may actually be greater in terms of the work store shortages that we’re dealing with. And I think we’re starting to see cracks in what’s happening around us. And again, not just in radiology, but in different specialists as well. I’m sure many of you have are starting to to see when you call your primary care doctor, if you have children, you’re calling your pediatrician, it’s hard to get in. There’s longer delays than trying to get in to see your your clinician. And the same is true for radiology. And and we’re starting to see things which I’ve never seen before. There was a health care system, I think it was Illinois, and they were so backed up with studies that need to be read, patients, inpatients, patients in the ICU, that they actually closed our outpatient imaging centers. They said we’re gonna close the outpatient’s imaging centers for a couple of weeks so we can catch up. And that’s something I haven’t seen before. So it’s letting me know that we really have some severe challenges, but we’re finally looking at the national level to try to find solutions. We we can kinda dig into that. I can tell you what I think will help us and I have some other and I’d like to hear your thoughts as well because, obviously, we’re in this together. Whether you’re a radiologist or you’re working in, you know, as a teacher or you’re working as a cashier someplace. I mean, we’re all dealing with workforce shortages right now. So

[00:04:32] Chris St John: Yeah. So, actually, I’m I’m curious. You said you said that was in Illinois that they shut down their outpatient for a few weeks?

[00:04:38] Ian Weissman: I think it was in Illinois. I think it was a health care system in Illinois is my recollection.

[00:04:43] Chris St John: And, I mean, I can’t help but ask, how how did that go for them? Right? Like, did they how, like, how is it returning to adding outpatient back in? Did they just have this even larger backup? It it feels like they’re it almost you know, it’s like an ouroboros, like they’re they’re gonna catch themselves there.

[00:04:59] Ian Weissman: They were transparent. They they put information out to their referred clinicians. They put information out to their patients. You know, patients now have access to their phones so they can send a message to patients saying this is what’s happening or patients try to schedule. They try to be as transparent as possible. I’ll give you an example of how one of my colleagues is having a similar thing. They didn’t close their outpatient imaging center, but I have a colleague who works at an excellent academic center in Virginia. And they’re facing the same thing whether in an academic center, whether you’re in a private center. I mean, we know by looking at data that about seventy percent of radiologists when we survey them, they say we’re short. And academics probably a bit higher, seventy five percent. And with this patient with this well, my colleague did, who’s a radiologist and worked from the academic center, he realized what was happening. And what he was very concerned about is patients who are getting cancer imaging because that’s very serious. You know, when a patient goes in for cancer imaging, their stress level is quite high. You can imagine. And they wanna make sure the treatment’s working. They wanna make sure it’s not progressing. I mean, that can be really, really stressful. And he realized that they may not be able to interpret the studies in the in a timely fashion. You know, we typically like to finish the study the same. We do the study the same day, we interpret the same day. But we know now that we’re starting to see delays. In addition, when I told you about that health care system closing their outpatient imaging center for a couple of weeks, I’ve known and I’ve heard for quite some time that some academic centers may be backed up two weeks to turn on their studies. I mean, they’re not closing anything. Right. But it may be a two week delay. So you’re waiting for your cancer imaging, a two week delay. So what he did is somebody what I told you, he talked to the his referring doctors. He put out notes to the patients, letting them know this is what’s happening. We have a he you know, in a sense, he said we have a workforce shortage, and there may be a delay in getting your imaging studies, but we haven’t forgotten about you. We will be getting up. We just want you to know. And so we’re we’re trying to do things we can to try to let patients know and include them in that because when you include patients in in the situation, you kinda bring them along with you and you’re all together on the same team, things work better. So that’s kinda what’s happening. I mean, they in that sense, they didn’t they didn’t close the the place, but they they’re informing people. That’s why they did with the Illinois Center as well. So

[00:07:14] Chris St John: Right. And so, I mean, you have said before. Right? And, you know, it it it might be obvious to folks, like, that this didn’t happen overnight. Can you walk us through a bit of the timeline and how we ended up here? You know, is it is it just about rising imaging volumes? Is it about supply and training pipeline? Is it, you know, is

[00:07:32] Ian Weissman: it a sicker population? Yeah. Those are all excellent points, and that’s exactly what you said. It’s a combination of many, many things. And in the profession, we’ve been watching this for many years. And this give you some data so we kind of all know we’re faced with. This is a a surprising number. You know, when you think about and I’m just gonna talk about the ER now. So people get CT scans or CAT scans. When you think about the number of CTs ordered in the ER each year, uh, and this is just in the ER. I’m not talking about ICU, inpatient, things like the outpatient. So just in the ER, there’s a 100,000,000 CTs ordered every year, a 100,000,000 CTs, and every decade increases by about 11,000,000 CTs. That’s why the CTs, and that’s just in the ER and on the other things. So so certainly, we have more imaging. Uh, we, you know, radiologists have always, uh, in a sense, thought of ourselves as a doctor’s doctor. You know, we’re we can look at the patients, what’s happening inside the patient’s body. It can be very helpful, uh, for situations where the clinical history may not be as evident, uh, or on the physical exam may be challenging. You get a CT scan or you get an MRI and you look inside and you try to get a sense of what’s happening. So referring doctors rely on us to to help them in the interpretation. The growth of imaging has also been increasing about one to five percent every year, ultrasound, CT, MRI for the reasons I talked about. I think that well, we know for sure that we have an aging population in this country. Right? There was a time where maybe twelve percent of patients were on Medicare maybe ten years ago. Now we’re approaching thirty percent of patients on on on Medicare, you know, maybe in the next five, ten years. So an increasing elderly population. We have younger patients who we know are we’re either diagnosing them sooner or we’re seeing increased incidence of more serious things. And we hear it on the news all the time. We hear about colon cancer. Now in patients under the 50, that’s their leading cause of, uh, of cancer, which is colon cancer. And we don’t know what’s causing that. You know, there’s obviously lots of environmental challenges, but we’re having younger patients who are who are who are sicker. You also mentioned, do we have enough people that we’re training? And we know that that’s probably not the case. We don’t have enough funding for in our profession for radiology residents to go through their training, and we’re, you know, working on that. And then there’s other things too. We’ve been following this, you know, we’ve been found what we called, you know, burnout, you know, in in the profession. We’ve we’ve we’ve been seeing that. And and we’ve been trying to find solutions to try to mitigate that. And and we know that this has been happening for quite some time. And as early as 2018, 2019, there were lots of organizations, including in radiology, working on trying to mitigate that, trying to find strategies to help, uh, clinicians. And then as we’re making progress and we had even in the American College of Radiology, we had a well-being committee, which I served on. What happened in 2020? We had COVID. Mhmm. So we’re trying to build things up. Suddenly, in 2020, it just kind of the house of cards crumbled, and we’ve lost a lot of people. So it’s all these compounding factors, I think, which is leading to this.

[00:10:39] Chris St John: Yeah. I mean, it was interesting. On a on a previous episode, I was talking with a psychologist actually about radiologist burnout, and it was so interesting doctor Elizabeth Kropinski. She she had pointed out, like, the shift of film to digital in terms of reading images as this massive turning point because all of the sudden that the time baked in to develop the images themselves, like, that was rest time for the radiologists. And all of a sudden, you just have this unending, incessant wave of image after image after image. And then, of course, like you just talk about, it just it like, the story never stopped.

[00:11:15] Ian Weissman: Yeah. That’s exactly right. I mean, that’s exactly right. And I when I was younger, it’s like you said, we had films on hard copy. You’d throw them up on this on this viewing board. It would take time to put them up. It would take time to take them down.

[00:11:27] Chris St John: Right.

[00:11:27] Ian Weissman: You had a little bit of a break. But as you said, it’s on a computer now. It’s like we’re, you know, you’re you’re scrolling, and it is nonstop. I mean, I, you know, I work long days along with a lot of my colleagues. And I look back at until this week, and you sit in your chair, and it’s nonstop all day. It’s film after film for film. And when you take a look at CT scans, which may have had less images in the past, CAT scans, you may have thousands of images now that you have to review and and go through them and make sure you’re not missing things. And you find strategies to try to get you through it, but you’re still looking at lots and lots and lots of images. And that’s kind of image overload. Right? And it’s a challenge.

[00:12:05] Chris St John: Well and then I I feel like you also have the the driving force of, a, trying to read as many images as possible for your patients, but also just trying to turn over RVUs and, you know, get paid and do your job and, you know, make money for the facility. Like, there is this undercurrent of capitalism, and I you know, I’m I’m not trying to bash that, but I’m just saying, like, it to me, it seems ever present as a factor in in trying to get through images as fast as possible.

[00:12:35] Ian Weissman: Yeah. The economics, unfortunately, is a big part of it. And I think that’s why I think radiologists and I don’t think again, it’s not just radiologists. It’s all our colleagues and all the medical specialties are facing similar things with our views.

[00:12:47] Chris St John: Right.

[00:12:48] Ian Weissman: But there’s, you know, we talk about this thing called moral injury. Right? Where, uh, you you know the right thing to do, but because of the constraints of the situation as you mentioned, you may not be able to do it. And they actually one of my colleagues, Seward, who’s out on the East Coast and she’s kinda specialized in this area of moral injury and and and things like that. She’s surveyed radiologists. And the majority of them say exactly what you said, that they’re all have this moral injury. Mhmm. Because they’re being asked to read more films than they feel they really can do because it’s increasing so rapidly. And when they talk to their administrator to tell them the issue, their administrator says, just read more films. Okay? Right. That’s why we have, as you say, people who are getting older or even younger people who are just saying, look, I can’t do this. I can’t practice like I need to practice. And I’m seeing a lot of young people actually moving toward things which I’ve never seen before. You know, typically, the old older guys like me, you know, we’re used to a certain thing. We work for a company or we work for, um, you know, VA as I work for the VA. You know, you it’s a certain thing. You’re kinda used to that to show up in the morning, leave in the evening. A lot of younger people are saying, you know what? This is not for me. I’m gonna become a ten nine nine employee. And I’m gonna decide who I wanna work for, what I wanna work for. As you mentioned, the economics, who’s gonna pay me the most amount of money? And you have actually radiologists who are working from competing health care organizations, which is unheard of. To have someone working for one, you know, health care organization a, which competes against health or k organization b in the working for them. But the organizations are so they need physicians so much that they don’t put in non compete clauses and things like that. It’s okay. Work for us. And if you can work for us, you can read for us, We’re fine. So this is a situation we’re in. These are things we’ve just we have not seen before. So we’re paving new ground, I think, every day. So

[00:14:38] Chris St John: Yeah. And this is not just like, this this shortage does not apply just to radiologists. Right? I mean, inside the hospital, we have shortages of technologists and nurses, even referring physicians. Like, do you think patients have a solid understanding of what this shortage is looking like, you know, outside of just getting their exam scheduled?

[00:15:00] Ian Weissman: I think patients are seeing this. Uh, I think patients are realizing what’s happening. And and, again, that’s why it’s important of the strategies that my colleague at this academic academic center was doing to be transparent, to send information out to patients, to make them part of the team, also make you referring doctors part of the team so I know what’s happening. I think you’re absolutely right. I think patients are seeing it. And I’ve seen some surveys which have come out. There was a survey which came out a few years ago, and they asked patients, are you experiencing delays in in getting your care? And in just a few months, because it it was separated by a few months in the survey, it increased from eighty five percent from it went up to eighty five percent. And before it was seventy five percent seventy five percent of patients saying, I just don’t think I can get in to see my clinician in time. Right? And there was another study which came out, talked to patients who are Medicare, and they asked them, what about getting their imaging studies? Are you experiencing the Langmuir imaging studies? And about half of them said, yes, we are. Yeah. It’s just not like it used to be, like, if I need to get a follow-up, I can’t get in. So I think they’re seeing it. And certainly in radiology, for sure, they’re experiencing and they’re seeing the primary care physician or their specialty, their dermatologist. I need to go see have a follow-up for an appointment. And before maybe a couple of weeks. Now it may have maybe a few months. Right? Because they’re also short staffed. And as tough as it is here in The United States, and I think we’re gonna see more and more challenges as we move forward, we’re still doing pretty well relative to other countries. So Canada, which has universal health care, which is which is fantastic. And I and I think having a safety net like that safety net like that is very important. Of course, we realize there’s there’s many times two tiers. You have the universal health care, but then if you wanna pay a certain amount of money, you get a second health care, uh, which allows you to see collisions a little bit faster. So it’s not quite universal health care, but everyone still is within the safety tent. They’re not obligated to go to the ER if they don’t have insurance. So that’s a good thing that’s certainly we’re looking at across the world as to what systems work the best. But in Canada, if you’re trying to get an imaging study, let’s say, in British Columbia, there’s hundreds of thousands of patients ahead of you. Hundreds of thousands of patients, which is just staggering, you know, to think about that. So if you’re a woman and let’s say you find a mass in your breast and you need to get in to have, uh, this, you know, ultrasound or the to get a mammogram and an ultrasound, and then they say, yes, you know, there something there that’s taking you time to get in, and then you have to get a biopsy of that mass, it may take you weeks, you know, to get in. In contrast to in this country where they still will try to expedite patients, try to triage them so they come a bit faster. So Right. You know, we’re seeing major challenges. And in Canada, I I mentioned in Canada, of course, it tells us. In The UK, similar thing. You know, I told you that we’re short about 1,500 radiologists in this country roughly out of about 38,000. In The UK, they’re sure about 2,000 radiologists. 2,000 radiologists for a much much smaller country. So, you know, we’re still a lot better, I think, than a lot of countries, but we’re moving in that direction. And we have to find strategies to to try to help us, you know, as as we move forward.

[00:18:06] Chris St John: I mean, I’ve even noticed that just, you know, personally, my my mother is, uh, she’s now, like, a couple years post heart transplant, actually. But, you know, pre transplant, she needed to get regular heart caths. And, you know, she was in rough, rough state. And even just to get, like, a right heart catheterization was sometimes, like, pulling teeth. Like, it was crazy. I wanna touch back because you were saying a minute ago, you were talking about different kinds of strategies. And I’m curious, what what kinds of broad strategies are really on the table to address the shortage, whether it’s increasing residency slots or recruiting internationally or even, you know, the the the talk of the town, like, bringing AI into the game.

[00:18:46] Ian Weissman: Yeah. AI is a is a an important thing. And and, certainly, the RSNA, the the our big radiology conference, Radiological Society of North America, which is gonna mean a couple of weeks. I I know you’re gonna be there, and your college are gonna be there.

[00:18:57] Chris St John: Ten days.

[00:18:58] Ian Weissman: Yeah. Ten days. That’s a big thing, and we’re health we’re hopeful that AI will help us. You know, there’s interpretive AI, and there’s non interpretive AI. Right. So interpretive AI is where it helps us actually get through the images a little bit faster. Non interpretive AI is where perhaps it triages certain studies to the top of our list so we know which studies we have to read fast and and other things, you know, gets very detailed. I can tell you that certain countries, like The UK, I mentioned the short 2,000 radiologists, in contrast, our 1,500 radiologists, but they’re a much smaller country than we are, much smaller population. They have different regulatory systems and and things like that we that we do in this country, but they’re already starting to to think outside the box if you wanna think of it that way. Some people may agree with this or not agree with what they’re doing. But they are already working on AI algorithms that will read chest radiographs or chest x rays as we call them, in in the absence of radiologists even looking at it. So the AI will just analyze a chest radiograph, a chest x-ray, and just make the interpretation. And I I’m not even sure the radiologist will necessarily be involved in that because they don’t have enough radiologists to read what they need to read because there’s radiographs, x rays, which are a lot of imaging, but then you also have ultrasounds, CT scans, MRIs, very complex imaging, which AI could not read yet with any sophistication. So we’re working on things like chest radiographs to at least not miss a lung nodule Mhmm. Or not miss a lung collapse. You know, big things, uh, training algorithms to do that. And I was talking with my colleagues about that. And he said, yeah. He said, they’re doing the same thing as South Korea. So whether we will do that in The United States, we may be moving toward that point where I see it being used now for the immediate future is it will be something of an aid for us. And so now we have AI at my place of work, and it takes a look at lung nodules, and it measures them for me and compares it to prior a prior study. Now it I don’t think it’s there yet. I I’m starting not to rely on it so much. I look at it myself rather than relying on the AI, but I do use it for measurements. Because I said I so I’m having to measure the thing with a cursor on the computer, which takes me time, I rely on this measurement, which which does save me time. So we’re gonna be we’re gonna be seeing things like that with AI. I mean, that’s one thing. You mentioned another thing which is increasing residency spots. K. That’s that’s a big thing. And it’s not again, it’s not just radiology which is short. We have primary care physicians. We we don’t have enough primary care physicians. We don’t have enough mental health professionals. K. A lot of people are are are suffer with mental health challenges in today’s environment. With everything that’s happened around the world, we we need people to be well. Right? So when when you when people go through medical school, they have to go then and do postgraduate training for residency. And that has to be funded through someone. And it’s been historically funded through CMS, Centers for Medicare and Medicare Services, which provides funding for them to do this. Uh, there’s other sources of funding as well. The VA, the Veterans Administration, also funds, uh, postgraduate trainees. Private hospitals will sometimes do it themselves. Private groups will sometimes do it themselves. But we just don’t have enough funding positions. So and we know that we’re we’re moving toward the shortage. So there have been some strategies which have come out, which have been proposed to Congress. One of them was an act that Congress approved 200 more funded positions through Medicaid for the next five, six years, 200 more per year. Uh, but taking a look at radiology of those 200 that were approved per year, only six one to radiology. Six one to radiology for some more radiology positions and three one to interventional radiology because the bulk of the positions are going toward primary care and mental health. Mhmm. So in radiology, we’re not gonna get there very fast through this route. Now they’re actually proposing another act through Congress where they would approve 2,000 more funded positions per year. That would be tremendous. But with everything that’s happening now with government cuts and government funding and we all hear the news every day, I’m not convinced that’s gonna happen anytime soon. So that’s a second route that we are looking at. And it may come to the fact that groups will have to fund their own positions. If they want more trainees, they may have to do it themselves. They have to pay for themselves out of their own hospital, you know, funding. Right? They may have to do it privately. And then the third thing that you mentioned, uh, which is very important is what about you know, we have people who come and train from out from a different country and they train in The United States. And once they train, many times they have to go back to their country. But many of them wanna stay here and work. Can we keep these people here which are very valuable, uh, clinicians working in this country? And and there are certain things that we’ve been working on they’ve been working on Congress to do that. But of course, the latest thing that you probably heard the news is the current administration is thinking of imposing a fee, increasing the fee on their visas for people from different countries that work here. And we’ve heard that in the tech industry. Mhmm. That if you bring someone from outside the country to work in the tech industry, they want the company to pay a $100,000 for the privilege of this person working in this country. Well, we heard the same thing in medicine too. A visa may have been several thousand dollars before. Is it gonna be a 100 for a clinician from outside this country to practice doing primary care someplace or reality, we all know yet. But all these things that we’re thinking of as strategies, we’re having lots of challenges now.

[00:24:20] Chris St John: Yeah. And so, obviously, these different strategies are gonna take time and years to to actually yield results. I’m curious. What do you prioritize in terms of these strategies, or what would you prioritize so that patients and providers could see relief, you know, sooner rather than later?

[00:24:38] Ian Weissman: Well, I think that and this is my thought on this, you know. And as you mentioned, I I lecture with the Radiology Leadership Institute, and I’m lecturing nationally on on workforce strategies. How can we mitigate the workforce shortage? What strategies can we use? And my thoughts on this is, yes, we need AI. We need to increase residency spots. We need to see if we can bring people who wanna live in this country from different countries to help us with patient care. But that will take some time. But I think there are strategies that we can do ourselves to try to keep people in the profession. So when I was on the council steering committee of the ACR, American Radiology, I put together an initiative called RETAIN, which I work with some of my colleagues who are interested in this across the country. And the RETAIN initiative is sharing leadership and organizational strategies with our colleagues to let them know what works. Uh, and the way I I and I’ve published it just was just was released in health management a few weeks ago. So if you wanna Google it, you could take a look at it. But the strategy to this is, you know, we have articles have been written. We have books have been written on this topic, but people are so busy. So I put together this in I put together this initiative where we record a sixty second video because people like to look at they like to take a look at little tiny videos on YouTube or TikTok and things like that. So I put that in a six second video, which talks about, you know, what’s what’s an effective way to keep someone retained in your organization because it’s so expensive when people leave and a lot of people are moving around. You know, 11% radiologists look for a different job last year. They’re looking for a place which may be better. Yeah. But all places have similar challenges. So I I put a six we we put out a six second video. So I talked about something called servant leadership, and I did that in sixty seconds. And the principle of servant leadership is if you can work for a leader who really is concerned about your professional development, who is who is concerned about you as an individual, who’s gonna inquire, inform, develop, recognize you, do these type of things, you’re much less likely to leave the organization. Mhmm. It’s so important. And it doesn’t have to be in radiology. It can be in any profession. It can be if you’re working for a manager, uh, at a target and you have a manager who really cares about you and and takes the time to know you. You’re much less likely to leave the organization. So I’ve put a video about that. Someone in sixty seconds talked about how important building a positive culture is, because that’s so important. And in fact, when we take a look at organizations like the National Academy of Medicine and The US Surgeon General, who have studied this in in detail, who have brought in real thought leaders across this country, they find out that the most important things are exactly that. Serving leadership, building a culture, building a positive culture, positive community. And we all know what works best in our place of work. We can always find solutions for that. If we can do those kind of things, we’re less much less likely to lose people. So that’s my thought on this, that we have to, in a sense, be good to each other. We have to we have to work together collaboratively at a systems level, at a local level to make sure that people look forward to coming to work to the best of our ability. You know, it’s gonna be hard. Right? It’s gonna be hard. We’re gonna be reading lots of films all day. But but can you have leaders who really care about their people? Because otherwise, people are gonna leave. Right? I mean, to 11% people seeking new employment last year, that’s a lot. Very disruptive to the individual, very disruptive to the organization. And it can cost millions of dollars, $3,000,000 to recruit a new radiologist because loss of revenue, you gotta recruit new people. So can we can we self manage? And that’s what I’ve been lecturing on and articles I’ve been writing. And now on the Radiological Society of North America, we have a a committee that I I serve on at the national level called WE, which has focused on workforce and also education. And it’s a new, uh, committee. And I’m gonna be leading some initiatives with my colleagues to try to do this because we have to, in a sense, do it ourselves, I think, as we hope AI will get there and other things. By the moment, we we gotta do it ourselves. So this is this is what I think will work.

[00:28:44] Chris St John: Yeah. Breaking character for a second. I want to follow-up and hear about the workforce and education committee at RSNA. But briefly before we touch on that, you know, you were talking about investing in your in your team and your people and having, you know, these striving for more positive workplaces, it may be a bit self evident, but do you have any advice for small but meaningful changes organizations can make that don’t lots of money or new legislation, but can help to improve retention and morale?

[00:29:18] Ian Weissman: Yes. I do. In fact, you have one of my colleagues on your podcast person I really respect highly. We work together at the national level for the ACR. We have strategic retreats. Uh, his name is Dave Larson. And I think Dave Larson, in my opinion, is one of our greatest thought leaders in radiology today. He’s a real leader in quality and safety issues. Uh, he’s he’s working on AI now at Stanford where he is. And I think he was just on your podcast, and he was talking about he was talking about peer review Yeah. And how important this is. So and and he’s been a leader in developing this along with his colleagues across the nation. So I wanna reinforce what I’m sure he talked about in this podcast because I’ve I’ve heard him speak because he heads a quality and safety meeting that we have through the American College of Radiology. So the concept is peer review versus peer learning. K? And we all do this in whenever especially we are in, whether in medicine or engineering, outside of medicine, you have to have some type of quality control built into your process. And we’ve done historically, medicine is what’s called peer review. And what that is is someone will review review your case, and they’ll they’ll give it a score, say, one to four or one to three, whatever your your system is. And if you get a let’s say it’s one to three, you get a three, that’s not good. K. So you’ll many times have to appear in front of a peer review committee, and they’ll and they’ll and they’ll ask you to talk about what happened. And it can be very stressful because many times there’s not a lot of transparency. There can be a lot of fear associated with this because you don’t know what the consequences are gonna be. They always say it’s protected and but you never know. And many times you don’t even hear about it until suddenly you get this letter from them saying you need to appear in front of this peer review committee. Well, that’s a problem. And and can there be consequences? Can people lose their sense of can they lose their employment? Well, if that’s the case, if there’s this fear or this perception of fear built in the system, then people are not gonna disclose. People are not gonna share things. They’re not gonna share things they’ve seen with different colleagues for fear of maybe someone doing it to them. I mean, they’re it’s not gonna work, which is, by the way, very different than engineering. In engineering, their system is to disc is to disclose, is to fail. They wanna fail quickly and then succeed. And and Elon Musk is a good example of that with his rockets. He failed brilliantly. I mean, he’d have rockets explode on their on their launch pad. But to him, that was always a success. Clearly, we’re not dealing with human lives here, so a little bit more challenging than medicine, I think. But he said, okay, my rocket exploded. Great. We’re gonna build another rocket, which will be better. Well, the same thing is true in medicine. We have to we have to identify issues so that that we could we can get better. So peer review, we know historically in medicine has not worked as well as we’d like. So what Dave Larson and his colleagues did is they developed they developed a a new strategy, a new paradigm called peer learning peer learning, which is still peer review, but it’s on a different fashion. The culture of peer learning is quite different. So peer learning is going to a colleague and saying, okay. And this is in a protected environment again. I came across this case you saw well, first of all, you go to the storeroom. Thank you for everything you’re doing. I value you. We’re all working hard. I appreciate you. I value you. I came across this case, you know, see what you think. You know, I came across this article I read a few months ago. Take a look at it. I I found helpful. Alright. See what you think. You know, I hope this helps. And then not just doing that, not just being collaborative, supporting people, but also telling someone, hey, great pickup. Wow. You picked up this amazing thing on this case. Wow. I saw this and you picked it up and fantastic. I mean, building this positive culture.

[00:32:54] Chris St John: Mhmm.

[00:32:54] Ian Weissman: Because, again, we’re all active learners. We’re all clinicians. We all wanna get better. We’re all constantly going to RSNA. We’re gonna be in ten days. We’re all trying to learn. So how can you build a culture? How can you build a community which is gonna be much more productive? So people feel they wanna share. And, actually, when they there was a, uh, I I believe this is at Boston University, one of the leaders in pure learning did this. She found out that the number of people actually were disclosing, who were sharing cases with each other, went up exponentially. And before a very low percentage, uh, it went up to a very high percentage of people actually sharing cases so that everyone will learn collectively together, like they do in engineering, like they do outside of medicine. And this is what David’s been working on and and our colleagues outs in in this very important initiative. And the good news is that it’s supported by the American Board of Radiology, which is our when you take your boards, it’s it’s it’s that’s how you you get certification, you know, through the American Board of Radiology. They support it. The American College of Radiology supports it. Other organizations are doing it, but not everyone’s doing it. K? People are still reticent not to go with this peer learning, which is we know works, but moving with, you know, peer review. And again, it’s building a culture. Right? Right. Building a positive culture because we know that’s so important.

[00:34:04] Chris St John: Yeah. I’m curious to hear about this RSNA. You said workforce and education committee. When did that committee get started, and and what have y’all been up to?

[00:34:13] Ian Weissman: Yeah. So it’s a new committee. It’s actually part of the RSA has started a government relations committee. And within government relations, we’re working on on several things. One is AI, one is fostering research, and then initially, education, informing our our colleagues at the RSNA of of initiatives and things like that. But at our last strategic retreat, uh, that just happened a few months ago, uh, and I must say I was a big proponent of this because I’m I’m so concerned about workforce and this is what I lecture on now across the country. And I’ve and I’m very concerned. It’s what keeps me up at night knowing that we don’t have enough clinicians moving in the future. Because I said, look, we gotta talk about workforce. K. I mean, that’s that’s what in fact, when we survey our colleagues and we ask them what’s the biggest threat to radiology, workforce comes up and has come up for the past few years. It used to be burnout, but, of course, burnout has moved to the next level. Next level, that’s what’s work for it. Right. People are just leaving the profession. Right? Yeah. So we we kind of knew it was coming. COVID came. Now for the last three years, and the survey just came out from AdMini. Again, this year, what’s the biggest threat to reality? Workforce. Again, it was up there. That’s why I did the RETAIN initiative when I was on the American InterContinentality Council steering committee to share these sixty second videos with people. And at the beginning, I said, we gotta talk about workforce. And we were all in agreement. And I said and we gotta have a catchy name a catchy name like RETAIN, how do we RETAIN our colleagues? And so we came up with we. You know, that that we are working together to we hear you, we hear your concerns, and we’re gonna work on solutions to basically make sure that we can that we can fight solutions whether it’s govern ourselves from within, with with leadership and organizational strategies, or contend to foster research to help AI development, try to get more trading positions, trying to bring people to this country. I talked about the challenges with that. But it stands for we workforce and e education. And I’m very hopeful. And we just, you know, we just met on this several months ago, so I think things are gonna start to move quickly. And and I’m serving on this committee now for another few years, and I’m gonna work very hard to do everything I can to help our colleagues. So Okay.

[00:36:17] Chris St John: Cool. I like hearing that from you that you’re feeling very hopeful, at least relating to this committee in general. But I maybe this is too silly of a question, but I’m curious, like, what what else is making you hopeful right now? Not to not to end on a sour note. Let’s, you know, let’s end on a on a more optimistic note if that’s okay.

[00:36:36] Ian Weissman: I think human beings have a tremendous ability to overcome challenges. Right? And I think the thing which makes you hope hopeful is and this is something I do as a strategy. So I think it’s very important to share information with patients, population health strategies, things that I know work. So and I sent I think social media can be a force for good. You know, we know that social media can be used in different ways, but I’ve always thought it was a force for good where we educate people. We educate where you learn from people. So when I was trying the patient family centered care, uh, committee through the ACR, I put together a strategy over ten years ago. And every day, I share about five population health strategies for patients. And by that, I mean, uh, you know, go out there and walk in the woods, exercise, you know, kind of do some tree bathing, you know, that’ll help you. Right? I I tend to talk a bit of a lot about vaccines. I know there’s been a lot of pluralization on that. Mhmm. But I still think it works. I’m a physician. I get my vaccinations. I, you know, we didn’t have measles measles. Now we have measles. K? So vaccinations work. I put out there. Sometimes it’s popular, sometimes unpopular, depends who hears it. And I do things like that every day. I put out five strategies from articles. I don’t get my opinion. I put the article out there because I want people to educate themselves. I’ll just put out what I think will work. Read it if you agree with it, use it. If you don’t, I’m still gonna put it out there. And in doing that, I’m hearing from patients as well. I’m hearing from clinicians. I’m hearing from patients because they respond. I do this on x. I do this on blue sky, uh, because two different kind of population groups really.

[00:38:12] Chris St John: Right. Yeah.

[00:38:13] Ian Weissman: And right. And I put the same stories. And and I I just am hopeful because I hear these great ideas coming from patients, coming from clinicians. Uh, and in fact, on the week committee, uh, subcommittee that I’m working on, that’s gonna be one of our strategies to actually reach out to patients. Of course, I have experienced doing that for the ACR because I did that for many years. Uh, but can we collaborate with patients? Can we collaborate with patient groups? Patient groups that are concerned with Alzheimer’s, patient groups that worry about, you know, another condition. Can we work with them together collaboratively to find solutions, to go together as a team shoulder to shoulder to congress, to our hospital leaders? Because if if I talk to a hospital leader, they may listen to me. But if I have a patient by my side, that’s the client. That’s the customer. If we go shoulder to shoulder to our hospital leader and say, look, we need this program for this patient, I think we’re gonna have better luck. So I’m hopeful because I I see so much positive information coming out of patients every day, and I do this every day. And that kinda keeps me going too because I don’t feel like I’m isolated in my own little place. I I hear what people are saying and then I put out there. They they give an opinion. I put out there for other people to read. So I think if we can do this, if we can do this collaborative as a community, uh, I think we will find we will make progress. And I know at the national level, whether it’s the RSNA or the ACR or the we have about 50 radiology organizations or the multiple other organizations. We have really passionate leaders like Dave Larson and myself and other people. I think if we continue doing this, we will make progress. I I know we will. We have to. Right? Because if we don’t, what’s the alternative? Right? So that’s why I’m optimistic.

[00:39:58] Chris St John: Well, well, thank you so much. I feel like that’s a beautiful place to end, but is there anything else you’d like to touch on before we let you go today?

[00:40:06] Ian Weissman: Yeah. I would say just do the best you can. It’s challenging times, but I would say for those of you on the social media and those of you who are working in your jobs, just keep on doing what you’re doing. Reach out to your legislatures, reach out to your hospital leaders, support your colleagues, you know, build a positive culture in your workplace. We know it’s so important. If you’re a leader, be a servant leader. That’s so important. And we these are things we can do ourselves, your strategies we knew ourselves, and just keep I mean, that’s what makes the human race so fantastic. We’re always moving forward. We’re always getting better. We’re always finding strategies. We’re always problem solving. I think if we do this, we’ll be fine. So

[00:40:43] Chris St John: Well, Ian, thank you so much for joining me today.

[00:40:46] Ian Weissman: Thank you, Chris. It’s a great pleasure.

[00:40:48] Chris St John: This has been Frame by Frame Rethink Imaging. Doctor Ian Weisman is a radiologist at the Milwaukee VA Center, and, Ian, it’s just been so great talking to you today. Thank you so much.

[00:40:58] Ian Weissman: Thank you, Chris. Great pleasure.

[00:41:01] Chris St John: Frame by Frame, Rethink Imaging is brought to you by Imalogix. Here, you’ll find engaging interviews with thought leaders, experts, and patients sharing stories that showcase the transformative power of medical imaging. To discover how is rethinking imaging in health care, visit

Questions from This Episode

How short is the U.S. radiologist workforce?
About 1,500 radiologists out of roughly 38,000 practicing, based on Medicare data and workforce tracking. Weissman calls that a best guess and says the real number may be higher, since many colleagues are aging out or reducing their hours.
Are patients actually feeling the shortage?
Yes. Same-day reads for cancer imaging are no longer guaranteed, which adds real anxiety for patients waiting to learn whether treatment is working. Weissman cites a patient survey in which reports of care delays jumped from 75 percent to 85 percent within a few months, and one health system closed outpatient imaging for two weeks to clear its backlog.
What can imaging leaders do about it right now?
Weissman points to strategies that cost culture change, not capital: servant leadership that invests in each clinician’s development, peer learning that treats errors as shared teaching rather than punishment, and transparent communication that brings patients onto the team. Longer term, he backs more residency slots, better visa pathways, and AI that supports radiologists without replacing them.