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DOI: 10.1148/radiol.2241011150
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(Radiology 2002;224:193-198.)
© RSNA, 2002

Health Policy and Practice

Data from a Professional Society Placement Service as a Measure of the Employment Market for Physicians1

Jonathan H. Sunshine, PhD, Rebecca S. Lewis, MPH, Barbara Schepps, MD and Howard P. Forman, MD

1 From the Research Department (J.H.S., R.S.L.) and Committee on Radiologist Resources (B.S.), American College of Radiology, 1891 Preston White Dr, Reston, VA 20191; Department of Diagnostic Imaging, Brown University Medical School, Providence, RI (B.S.); Department of Diagnostic Imaging, Rhode Island Hospital, Providence (B.S.); and Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (H.P.F.). Received July 3, 2001; revision requested August 20; revision received October 9; accepted November 12. Address correspondence to J.H.S. (e-mail: jonathans@acr.org).


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 MATERIALS AND METHODS
RESULTS
DISCUSSION
 REFERENCES
 
PURPOSE: To determine whether data from a professional society placement service—the Professional Bureau of the American College of Radiology—are a valid measure of the employment market.

MATERIALS AND METHODS: For the United States from 1990 to 1998, the authors compared three placement service measures—the annual number of job listings, job seekers, and listings per seeker—with two presumably valid measures of the employment market—annual total jobs available (which was ascertained from surveys of hiring) and radiologist median income relative to the all-physician median. For the comparisons, both graphic displays of the data and correlation were used.

RESULTS: In graphs, patterns of change were similar. The correlation of job listings, which measure demand, with total jobs, which also measure demand, was 0.84 (P = .04). The correlation of (a) job seekers, a measure of supply, and (b) listings per seeker, which involve both supply and demand, with total jobs was substantial but lower: 0.58 (P = .23) and 0.76 (P = .08), respectively. Correlation of the three placement service measures with relative income, which presumably depends on both supply and demand, was 0.80–0.88 (P < .05 for each measure).

CONCLUSION: The statistical significance levels of the correlations and the pattern of findings—namely, stronger correlations among measures of the same aspect of the employment market—indicate that these placement service data are valid and reasonably accurate measures of the employment market.

© RSNA, 2002

Index terms: Economics, medical • Radiology and radiologists, socioeconomic issues


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
MATERIALS AND METHODS
RESULTS
DISCUSSION
 REFERENCES
 
For more than 30 years, major forecasts in the United Sates have often projected large national surpluses or shortages of physicians; the forecasts sometimes engendered major responses and were often proved mistaken (1–7). Most recently, for example, the Council on Graduate Medical Education in 1994 projected a 30% surplus of physicians by the year 2000, with the supply of primary-care physicians expected to approximate the need but the supply of non–primary-care physicians expected to be in excess by 60% (8–10). Contrary to the prediction, physician unemployment in 2000 was in the same 0.5%–1.0% range it had been in throughout the 1990s, a level far lower than the lowest-in-a-generation 4% unemployment rate for all U.S. workers in 2000. (Careful reading of the Council on Graduate Medical Education report shows it conceptualized surplus as unemployed physicians or physicians without enough work to be occupied full time.) Moreover, there is a serious shortage of radiologists, the non–primary-care specialty we study (11,12). Nonetheless, in response to the specialty-differentiated nature of the predictions of the Council on Graduate Medical Education, the Department of Veterans Affairs, which is by far the nation’s largest single provider of residency training, instituted an 18% reduction in non–primary-care residency positions, with a largely offsetting increase in primary care positions. The reduction in radiology residency positions was 20%, which presumably will exacerbate the radiologist shortage.

The only data regularly available to show whether predictions like those of the Councilon Graduate Medical Education are proving to be true have been the all-physician unemployment rates (U.S. Bureau of Labor Statistics, unpublished data, quarterly). This statistic contains no specialty-specific information, although such information is critical, given the specialty-differentiated character of the forecasts of the Council on Graduate Medical Education and some of its predecessors, such as the Graduate Medical Education National Advisory Committee (4,13). To remedy this information deficit, the American College of Radiology (ACR) and subsequently the American Medical Association undertook a series of annual surveys that provided detailed specialty-specific information (11,14–37). The ACR surveys dealt with radiology, and the American Medical Association surveys dealt with all sizable specialties. The surveys proved expensive, however, and because of the cost, both organizations discontinued them.

The purpose of this study was to determine whether data from a professional society placement service—the Professional Bureau of the ACR—are a valid measure of the employment market.


   MATERIALS AND METHODS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
DISCUSSION
 REFERENCES
 
Data
The Professional Bureau of the ACR (hereafter, the professional bureau) has been in existence since 1980, with electronic Internet-based operation available since 1996. We believe it is the largest single employment service for radiologists, and it functions much like employment services conducted by many other professional societies. Job seekers post their resumes, and employers seeking to hire radiologists (virtually all employers are physician practices) list their vacancies. Use of the professional bureau is free to both job seekers and employers if they are ACR members; in practice, the issue of paying to use the professional bureau scarcely arises. In surveys, recently graduated residents and fellows rate the professional bureau highly for usefulness in job finding (20,23).

The busiest period for the professional bureau each year is the last week of November during the annual scientific assembly and meeting of the Radiological Society of North America (RSNA), the largest radiology meeting in the world, when the professional bureau operates on site, and many face-to-face interviews take place. For our study, we used the data on the number of job seekers and jobs listed with the professional bureau at the RSNA meetings. These data provide a relatively clean point-in-time snapshot. In contrast, month-to-month data from the professional bureau are relatively convoluted because listings are for 6 months, are often not removed when a job is found or filled, and can be renewed. The professional bureau pledges confidentiality of name and address to those who use it. In keeping with that pledge, the professional bureau not only did not provide names and addresses for this study but also provided no individual-level information. We were given only the aggregate data on listings and job seekers shown in Table 1.


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  		TABLE 1. Data for the Employment Market from the ACR Bureau

 
Data for the annual total number of radiologists that physician groups sought to hire came from ACR surveys of the hiring activities of physician groups, which were conducted for 1991 and for each year from 1994 through 1998 and have been reported in detail elsewhere (11,17,19,22,27,29). As explained in these reports, although these were sample surveys, results were carefully weighted to show the findings that would have been obtained if all physician groups in the United States with radiologists had been surveyed and had responded. The surveys cover all types of groups in which radiologists practice, including academic groups, departments of government facilities, and private practices.

Data on physician incomes are taken from the annual Socioeconomic Monitoring Survey of the American Medical Association (38). As a measure, we used the ratio of the median income of radiologists to the median income of all physicians.

Analysis
The comparison of professional bureau annual statistics with actual total jobs available annually is an obvious means to ascertain whether the statistics of the professional bureau accurately measure the employment market; therefore, we made this comparison. Standard economics holds that when the supply of a good or service—such as radiologist services—becomes scarcer relative to demand, its price increases, and vice versa. Therefore, we compared annual professional bureau statistics with changes in radiologist incomes as another means to determine whether the former genuinely parallel changes in the employment market, as measured by the latter. However, because the predictions of economics are not always reliable, we first compared radiologist incomes with actual total jobs available to see if changes in radiologist incomes do, in fact, track known changes in the radiologist employment market.

We carried out comparisons of professional bureau statistics with the two presumably valid measures of the job market (a) first with graphing and accompanying descriptive analysis and (b) then with systematic quantitative analysis with standard statistical techniques. For reasons presented in the Discussion, we expected that each 1% change in total jobs available might be associated with a larger change—2% or 3%—in professional bureau statistics. Therefore, in the systematic quantitative analysis, we fit a model that assumes each 1% change in the independent variable (total jobs or radiologist incomes) is accompanied by a constant percentage change—which may be either larger or smaller than 1%—in the dependent variable (the professional bureau statistic). This is called measuring elasticity, which is a standard technique in economics that involves fitting a regression equation of the following form: logn (dependent variable) = b0 + b1logn (independent variable) + error. In this formulation, b1 is the elasticity and is the percentage change in the dependent variable associated with each 1% change in the independent variable.

In reporting results of the quantitative analysis, we emphasized the Pearson correlation coefficient. This is the most commonly used single measure of the strength of the association of two variables and, thus, should be familiar to a relatively large number of readers. The measure of association perhaps most prominent in regression analysis, R2 is the square of the Pearson correlation coefficient.

Because the professional bureau data are from near the end of the calendar year and, to a large extent, involve placements of residents and fellows completing their training in June of the following calendar year, we compared them with data for the following year. For example, 1990 professional bureau data are compared with 1991 total jobs available and relative income.


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
DISCUSSION
 REFERENCES
 
Descriptive Findings
As Table 1 and the Figure show, the annual total number of jobs for radiologists decreased from its level at the beginning of the decade to a relatively flat trough in 1994–1996 and then increased. Its lowest point, reached in 1995, was approximately one-fourth less than its beginning-of-decade level. The ratio of the median income of radiologists to the median for all physicians followed the same pattern of decline to a shallow trough in 1994–1996, with a minimum occurring in 1995, and then it recovered.



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  		Graph shows data for the employment market. Professional bureau data show the same pattern of changes as do presumably valid measures of the employment market, and they precede by 1 year.

 
The number of jobs listed with the professional bureau followed a similar pattern. It declined from its beginning-of-decade level to a relatively flat trough in 1993–1995, with the lowest point reached in 1994, and then increased. With the appropriate 1-year shift described in Materials and Methods, the timing of the trough and of the minimum number of professional bureau job listings was the same as those of the two presumably valid measures of the job market. The lowest level of professional bureau listings was approximately one-third of its beginning-of-decade level, which is a larger decline than was seen for the actual number of jobs. Similarly, its increase after its lowest point was larger than those for the actual number of jobs: 157% for listings over 3 years versus 67% for actual total jobs.

The number of radiologists seeking jobs through the professional bureau showed the same temporal pattern as the number of jobs listed with the professional bureau but with the opposite direction of change. That is, it peaked in 1994 rather than reaching a minimum. The number of professional bureau job listings per job seeker showed the same temporal pattern as the number of listings; it reached a minimum in 1994. However, it was more volatile, decreasing to approximately one-seventh of its beginning-of-decade level at its minimum, and then it nearly quadrupled over the next 3 years.

Quantitative Analysis
The correlation of the annual total number of jobs with radiologist relative income was 0.97 (P < .01) for the 5 years for which data are available for both variables.

The comparison of professional bureau job listings with annual total jobs shows an elasticity of 1.94, that is, listings changed by approximately 2% for every 1% change in actual total jobs (R2 = 0.84, P = .04) (Table 2). Professional bureau listings per job seeker showed a slightly weaker correlation with annual total jobs (R2 = 0.76; P = .08, which represents marginal statistical significance), but they were more elastic, changing by approximately 2.7% for every 1% change in annual total jobs. The relationship of job seekers who used the professional bureau to annual total jobs was substantial, but it was considerably weaker (R2 = 0.58, P = .23).


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  		TABLE 2. Results of Regression Analysis of ACR Bureau Data

 
The relationship of the three professional bureau measures to radiologist relative incomes was strong (R2 = 0.80– 0.88, P < .05) for all three measures (Table 2).


   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
DISCUSSION
REFERENCES
 
The very strong correlation between radiologist relative income and total jobs available adds credence to the belief that the former is a valid measure of the employment market and that both measures track essentially the same phenomenon. Without such a correlation, one might be somewhat skeptical of the predictions of standard economics that changes in radiologist relative income reflect changes in supply and demand for radiologists (39).

Overall Conclusions
Findings in our study indicate that professional bureau data are valid and reasonably accurate measures of the employment market. One strong body of evidence pointing to this conclusion consists of the strong relationship—shown in the Figure, the descriptive analysis, and the quantitative analysis—between the professional bureau measures and the two presumably valid measures of the employment market. Another strong line of evidence lies in the specific form of this relationship.

The total number of jobs available is, obviously, a measure of the demand side of the employment market. Thus, it is expected that, as observed, its correlation would be strongest with the demand-side professional bureau measure, namely, job listings; weakest with the supply-side measure, namely, job seekers; and intermediate with the measure involving both supply and demand, namely, listings per job seeker. In contrast, radiologist relative income is a measure that presumably involves both supply and demand. Accordingly, it shows less difference in the strength of its relationship to the different professional bureau measures.

Most likely, the reason that changes in professional bureau listings are greater in percentage than are changes in total jobs—that is, the reason the elasticity is greater than 1—is as follows: As the total number of jobs available increases, then, other things equal, it becomes more difficult on average to fill a job, and employers have to exert more efforts to succeed in hiring. They therefore, on average, make use of a greater number of employee-finding techniques, which means the probability of their using any given technique—such as the professional bureau—increases. In support of this view, the data in Table 1 show that when the total number of jobs was lowest, 6% of the total jobs for the year were listed with the professional bureau at the RSNA meeting, but 3 years later, when the total number of jobs had increased by two-thirds, 9% of the total for the year were listed with the professional bureau at the RSNA meeting. Presumably, a similar phenomenon takes place on the supply side of the employment market, with job seekers more likely to use the professional bureau—or any other job-finding technique—when jobs are more difficult to obtain. Lacking a direct measure of seekers, we have no direct evidence on this point. However, it seems fairly certain that the three-to-one variation in job seekers using the professional bureau at the RSNA meeting in the 1990s (Table 1) is larger than the change in the total number of job seekers because the largest identifiable group of job seekers, the residents and fellows completing training each year, was nearly constant in size throughout the decade.

Techniques for Obtaining Employment Market Information
Various methods for obtaining information about the employment market have different advantages and disadvantages. Surveys can provide the most detailed information, including information not otherwise available that is of major concern, for example, the number of retirements (11,40). They can directly obtain information that is, by definition, valid, for example, the actual number of jobs available. However, they are slow, which means their information is available only with a serious lag, and they have proved so costly as to be feasible in only times of severe alarm regarding the employment situation. Finally, surveys are subject to sampling variability and nonresponse bias.

We have shown in this study that summary data from a professional society placement service are valid indicators of the employment market and can be leading indicators—that is, show what will happen in the near future—or, at least, coincident indicators. Given that a placement service is operating, such data are available at almost no cost in addition to the cost of operating the service. Currently produced summary data of the professional bureau contain no detail, but it would be feasible, with modest cost, for the professional bureau to tabulate listings and resumes to produce information about the number of listings and job seekers in specific subfields of radiology, the breakdown of jobs by region and between academic and nonacademic positions, the experience level of job seekers, and so on. However, the limited number of employers and job seekers using a placement service may limit the accuracy of disaggregated data.

One datum from a placement service—namely, the ratio of job listings to job seekers—incorporates information from both the supply and demand sides of the employment market and, therefore, is probably well insulated against a difficulty common to measures derived from nonsurvey sources. This difficulty is the likelihood that, as techniques used for job-finding and employee-finding change—for example, as electronic techniques to some extent displace print media—changes in the measures will reflect changes in the use of techniques rather than actual changes in the employment situation. At the extreme, however, if other techniques eventually almost completely displace use of a placement service, its data are likely to become unreliable because they would be based on very few listings and job seekers.

Some of us (H.P.F., J.H.S.) have recently demonstrated that an index based on help-wanted advertising in leading journals is a valid and valuable measure of the radiology employment market (41). Seifer et al (42) previously used such indexes (without validation) to effectively illuminate relative trends in market demand for primary care and specialist physicians. Production of such indexes is less costly by an order of magnitude than the conduction of surveys; the indexes yield data more rapidly; and they offer a good deal of detail, although the information is not as extensive as that produced by surveys. On the other hand, their cost is not negligible, and the indexes will be biased downward over time if electronic employee-finding techniques gradually partially displace journal advertisements.

Limitations of the Study
Both of our presumably valid measures of the employment market have limitations. The total number of jobs available was measured with annual sample surveys. Like all sample surveys, these are subject to sampling variability and nonsampling bias. However, if there is a systematic nonsampling bias in our surveys—for example, if our survey findings were routinely 20% too small—that would matter little because our analysis studied proportional year-to-year changes and not actual levels. Our surveys omit solo practices, which probably constitutes only a systematic downward bias. When groups report in the survey that they are recruiting, they may not all be working with equal vigor to hire radiologists.

The income data also came from sample surveys, with the limitations that implies. Moreover, it might, in the abstract, be preferable to use an absolute measure of radiologist income rather than their income relative to that of other physicians, the measure used in this study. However, Medicare payment changes and the advent of managed care have affected physician incomes in ways not related to changes in the surplus or shortage situation. In economist terminology, we think of these as shocks that consist of the use of market power in ways it had not been used before rather than changes in supply and demand. Thus, we used the relative measure. The relative measure, however, could be affected by changes in average supply of and demand for nonradiologist physicians that are extraneous to the phenomena we were trying to study.

Other limitations of our study include the following. For both total jobs available and radiologist income, data were available for only a limited number of years, which makes relatively strong correlations sometimes carry only modest statistical significance. Also, our study involved data from only one physician specialty. Although we have no reason to think that the employment market for radiologists operates differently from that for other specialties (contrary to a common impression, very few radiologists outside of academia are hospital employees), the generalizability of our results to other specialties has not been demonstrated. Finally, our study dealt with only the specific question of whether data from a professional society placement service are good measures of the employment markets rather than with the broad question of what factors affect the employment market. That question, and possibly relevant factors, such as retirement patterns, managed care, growth of workload, and number of graduates of training programs, have been the subject of other studies (5,11,43–45).

Overall, however, we believe findings in this study demonstrate that data from a professional society employment service can be valid, reasonably accurate, and virtually costless measures of the employment market for a specialty.


   ACKNOWLEDGMENTS
 
We thank Mythreyi Bhargavan, PhD, of the American College of Radiology, for helpful advice and suggestions about statistical issues.


   FOOTNOTES
 
Abbreviations: ACR = American College of Radiology, RSNA = Radiological Society of North America

Author contributions: Guarantor of integrity of entire study, J.H.S.; study concepts, J.H.S., H.P.F.; study design, J.H.S.; literature research, J.H.S.; data acquisition and analysis/interpretation, J.H.S., R.S.L.; statistical analysis, R.S.L.; manuscript preparation, J.H.S.; manuscript definition of intellectual content, editing, revision/review, and final version approval, J.H.S., B.S., H.P.F.


   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
DISCUSSION
 REFERENCES
 

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J. H. Sunshine, C. D. Maynard, J. Paros, and H. P. Forman
Update on the Diagnostic Radiologist Shortage
Am. J. Roentgenol., February 1, 2004; 182(2): 301 - 305.
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D. D. Saketkhoo, J. H. Sunshine, A. M. Covey, and H. P. Forman
Findings in 2002 from a Help Wanted Index of Job Advertisements: Is the Job-Market Shortage of Diagnostic Radiologists Easing?
Am. J. Roentgenol., August 1, 2003; 181(2): 351 - 357.
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M. Bhargavan and J. H. Sunshine
Workload of Radiologists in the United States in 1998-1999 and Trends Since 1995-1996
Am. J. Roentgenol., November 1, 2002; 179(5): 1123 - 1128.
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