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Health Policy and Practice |
1 From the Research Department, American College of Radiology, 1891 Preston White Dr, Reston, VA 20191 (R.S.L., M.B., J.H.S.); and Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (J.H.S.). Received February 14, 2006; revision requested April 18; revision received May 9; final version accepted July 7. Address correspondence to R.S.L. (e-mail: rlewis{at}acr.org).
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONADVANCES IN KNOWLEDGEReferences |
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Materials and Methods: The authors analyzed nonindividually identified data from the ACR's 2003 Survey of Radiologists, a stratified random sample survey that guaranteed respondents confidentiality. A cover letter assured respondents that no individually identifiable information would be disseminated; to further enhance confidentiality, survey operations were conducted by a contractor rather than by the ACR itself. There was a 63% response rate, with a total of 1924 responses. Responses were weighted to make them representative of all radiologists in the United States. Two-tailed z tests of percentages and means and multiple regression analysis were used to compare information for women radiologists with that for men radiologists.
Results: Twenty-four percent of radiologists in training (residents and fellows) and 18% of posttraining, professionally active radiologists were women. Forty-one percent of posttraining, professionally active women were younger than 45 years in comparison with 29% of men (P = .004). Women radiologists were more likely to have fellowship training than men (69% vs 60%, P = .007), although they were less likely than men to have a subspecialty certificate (16% vs 27%, P < .001). Thirty-nine percent of women and 16% of men worked part-time (P < .001). Women were more concentrated in academia (22% vs 14%, P = .009) and breast imaging (27% vs 6%, P < .001) than their male peers but were underrepresented in interventional radiology (2% vs 13%, P < .001) and neuroradiology (3% vs 10%, P < .001). In situations where radiologists are likely to be practice owners, fewer women than men were owners (75% vs 91%) (P = .011). Women reported the same level of enjoyment of radiology as did men.
Conclusion: Women radiologists differ from men in regard to age, fellowship training, full- versus part-time employment, academic versus nonacademic practice, subspecialty practice, and practice ownership.
© RSNA, 2007
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONADVANCES IN KNOWLEDGEReferences |
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The American College of Radiology (ACR), as part of its mission of providing important and useful information to the professions it serves, periodically conducts large-scale, multitopic surveys of the members of these professions and the practices in which they work. In 2003, the ACR conducted a survey of radiologists. The purpose of our study was to retrospectively evaluate data from the ACR's 2003 Survey of Radiologists with regard to characteristics of women radiologists, their professional activities, and the practices in which they work.
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MATERIALS AND METHODS |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONADVANCES IN KNOWLEDGEReferences |
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Parameters Evaluated
Trends were studied through comparisons with published data (2,6,7) and new tabulations from earlier (1990, 1995, and 2000) ACR surveys. These earlier surveys are very similar to the 2003 survey and have been reported on in detail (2,6,7). Parameters so evaluated (R.S.L.) included the percentage of women among trainees, posttraining professionally active radiologists, age groups, diagnostic subspecialists, those working full-time, those working part-time, each practice type, and practice owners. In addition, for the 2003 survey, parameters evaluated (R.S.L.) were as follows: current work status, posttraining professionally active radiologists by age group, professional and practice characteristics, the five most common subspecialties, breast and women's imaging subspecialization, percentage of clinical time spent in breast imaging, number of mammography studies performed annually, work satisfaction and reasons associated with dissatisfaction, work hours, and annual vacation days.
Statistical Analysis
Data analysis was conducted with statistical software (SAS, release 9.1; SAS Institute, Cary, NC) by using survey-specific procedures (proc surveymeans and proc surveylogistic). These procedures estimate variances, taking account of the "complex" (stratified, weighted) survey sample design, by using the Taylor expansion approximation (8,9). Differences in percentages and means were evaluated with a two-tailed z test. Because we made multiple comparisons, which increases the likelihood of type I error (false-positive result), in the text we used P < .01 as the criterion of a statistically significant difference. Tables 1–8 provide more extensive information on significance levels and allow readers to make their own choices of criteria. The definitions of most variables have been detailed in a previous article (5) and also are apparent from the Results section and Tables 1–8.
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RESULTS |
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Geographically, women and men radiologists were, in part, distributed differently. The Northeast region had the most women (33% of all women radiologists, but only 20% of men; P < .001), while the South had the highest number of men (35% of all men radiologists, but only 31% of women; P = .334).
Of posttraining, professionally active radiologists, 38% of women were ages 35–44 years (vs 26% of men), and 43% of women were ages 45–54 years (vs 33% of men). There were proportionately fewer women ages 55–64 years (13% vs 25%) and age 65 years and older (4% vs 14%). There was no significant difference in percentages of women and men younger than 35 years (P = .91). Forty-one percent of posttraining, professionally active women were younger than 45 years in comparison with 29% of men (P = .004; not shown in tables).
A significantly higher percentage of posttraining, professionally active women radiologists than men radiologists worked in an academic practice (22% vs 14%) (P = .009). This difference persisted across all age groups except for those younger than 35 years; in this group, there were too few respondents to facilitate meaningful comparison.
A smaller percentage of women than men worked in private nonacademic single-specialty radiology practices (labeled as "private radiology" in Table 2) (26% vs 44%, P = .009), and a higher percentage of women than men worked in multispecialty practices. By controlling for age, age squared (to show any nonlinear effect of age), region, and practice locality by using logistic regression, we found that women were more likely than men to be in multispecialty practice (P = .006) and less likely than men to be in private single-specialty practice (P < .001).
An analysis was performed of full-time radiologists who were working in private nonacademic radiology or multispecialty practices and who had been at their current practice for 4 years or longer—that is, radiologists likely to be practice owners. Results showed that women were less likely than men to be practice owners (75% vs 91%), but the difference was only marginally significant (P = .011). For those age 45 years and older, the corresponding statistics were 70% versus 93% (P = .005), and for those younger than 45 years, the corresponding statistics were 93% versus 89%, but the sample size was small (only 14 women; not shown in tables).
Subspecialization
The five fields most frequently self-reported by women as main subspecialties were breast imaging (27%), body imaging (9%), pediatric radiology (6%), abdominal imaging (5%), and nuclear medicine (3%) (Table 3). The five fields most frequently self-reported by men were interventional radiology (13%), neuroradiology (10%), body imaging (7%), breast imaging (6%), and nuclear medicine (5%). Two percent of women subspecialized in interventional radiology and 3% subspecialized in neuroradiology (data not shown).
Higher percentages of women than men reported having a fellowship in breast imaging (11% vs 1%, P < .001) and reported breast imaging or women's imaging as their primary specialty (29% vs 6%, P < .001) (Table 4). In addition, proportionately more women than men reported spending 50% or more of their clinical time in breast imaging (22% vs 3%, P < .001). Results of logistic regression analysis, controlling for age (in years), age squared, gender, and other variables, supported our findings that women were more likely than men to have a fellowship in breast imaging, report breast imaging as their primary specialty, report breast or women's imaging as their primary specialty, and spend 50% or more of their clinical time in breast imaging (for all findings, P < .001). Of those radiologists who interpreted mammograms, women on average interpreted 55% more mammograms per year than did men (3364 vs 2113; P < .001).
Enjoyment of Radiology and Work Satisfaction
There was no significant difference between percentages of women and men who reported that they enjoy radiology very much, enjoy radiology somewhat, or are less pleased with their profession (P = .561, .250, and .293, respectively) (Table 5). There was also no significant difference between percentages of women and men who reported that they enjoy radiology the same as, more than, or less than they did 5 years ago (P = .149, .690, and .987, respectively). Results of ordinal logistic regression analysis indicated that, controlling for the effects of age, age squared, and other factors, gender did not cause a statistically significant difference in either current satisfaction (P = .037) or satisfaction relative to that 5 years ago (P = .519).
After restricting analysis to those who reported enjoying radiology less than they did 5 years ago, the five most frequent reasons associated with this response reported by women and men included medicolegal climate, workload, lifestyle/work hours, and shortage of radiologists (Table 6). However, reimbursement/financial pressures, the second-most frequent reason for men, was not included in the top five reasons for women.
When respondents were asked how the amount of work they have compares with the amount of work that they would like to have, if a change in workload proportionately affected income, a larger percentage of women (75%) than men (66%) (P = .009) reported that their work amount/income was about right. A smaller percentage of women (11%) than men (17%) (P = .009) reported that they would like their work amount and income increased. Results of logistic regression analysis showed that, after controlling for age, age squared, and other factors, women were marginally significantly less likely than men to want more work (P = .014).
Work and Vacation Time
Women who were full-time radiologists worked, on average, fewer hours per week than did men (49 vs 53 hours per week, respectively; P < .001) (Table 7). This pattern was maintained across the main types of practices in which women work, although the difference was statistically significant only for academic practices (P = .007). For those radiologists working full-time, there was no significant difference in number of vacation days according to gender for academic and nonacademic practices (P = .389 and .157, respectively).
Comparison with Previous Survey Findings
In the 2003 survey, women made up 24% of residents and fellows and 18% of all posttraining, professionally active radiologists (Fig 1). In the ACR's 2000 survey (2), women made up 22% of residents and fellows and 16% of all posttraining, professionally active radiologists. Neither percentage showed a statistically significant increase (P = .599 and .129, respectively). However, the percentage of women among posttraining, professionally active radiologists in 2003 (18%) was significantly higher than that in 1995 and in 1990 (14% and 13%, respectively; P < .01 for both) (Table 8) (6,7). There were proportionately more women ages 40–54 years in 2003 than in 1995 and in 1990 (P < .01 for both comparisons) (6,7) and proportionately more women ages 55 years and older in 2003 than in 1990 (P < .01) (6). The percentage of women who were practice owners was not significantly different from that reported in the 1995 survey (P = .759) (7).
Of the 2000 survey, Sunshine et al (2) noted that "in general, we found that the younger the age group in question, the higher the percentage of women." In 2003, this was true only for respondents older than about 50 years of age (Table 8); below that cutoff, irrespective of age, women composed about one-fourth of radiologists. Also of the 2000 survey, Sunshine et al (2) noted that part-time work was fairly common among men ages 55–74 years, while part-time work among women in this age range was rare. In contrast, we found that there was no significant difference between percentages of women (38%) and men (31%) working part-time in this age group (55–74 years, P = .231; not shown in tables), but overall, significantly greater percentages of women than men were working part-time (P < .001).
The percentage of radiologists in 2003 in nonacademic private practice who were women was relatively unchanged compared with the 2000 and 1995 surveys (16% vs 15% and 14%, respectively; P = .713 and .267, respectively) (2,7). Also compared with the 2000 and 1995 surveys, there was no change in the percentage of academic radiologists who were women (25% vs 25% and 22%, respectively; P = .433 and .842, respectively). More than a decade ago, Owen et al (10) found that women were less likely than men to work in nonacademic or multispecialty groups.
As in previous studies (2,7,10), we found that women were more concentrated in academics than were men. Our findings on the relatively high percentages of women choosing breast imaging and pediatric radiology and the relatively low percentages of women choosing interventional radiology and neuroradiology are consistent with those from earlier time periods (1,7,10). In reference to radiologists in 1995, Potterton et al (1) observed that women "clustered in certain subspecialties of radiology, such as mammography, pediatrics, and sonography, and avoided others, such as interventional and vascular radiology." More than a decade ago, Owen et al (10) noted that "women were represented in mammography, pediatric radiology, and sonography at a higher rate than in the profession as a whole but were less represented in interventional-vascular radiology," and Deitch et al (7) similarly found "some tendency for women to subspecialize or report expertise in mammography, sonography, and pediatric radiology ... and that women were rare in interventional radiology."
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONADVANCES IN KNOWLEDGEReferences |
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Limitations include those common to sample surveys: sampling variability (with the size of the resulting uncertainties estimated by means of the standard errors), possible nonresponse bias (but only with respect to characteristics not considered in the weighting), and incorrect responses (some still remain despite the data quality assurance procedures). Also, the percentage of radiologists reporting that they were in private, nonacademic, multispecialty groups was a good deal larger than that in the ACR's previous survey (in 1995) (7), 36% versus 27%, which casts doubt on the reliability of this information.
Practice Ownership
Among radiologists likely to be owners of their practice, women were less likely than men to be practice owners in 2003, and the percentage of women who were practice owners was not significantly different from that reported in the 1995 survey (7). Our data suggest, however, that the gender difference for ownership was not present for those younger than 45 years. Because ownership implies control in the way in which practices are run, women are likely to have more control of practice methods in the future as this cohort ages.
If practice ownership becomes more common among women radiologists, women's issues such as pregnancy policies and flexible work hours are likely to receive more attention. With the increasing demand for imaging and increasing workloads for radiologists, all practices must be on the lookout for the best radiologists they can hire—male or female. Having more women in positions of power and authority in practices might result in changes that are more effective at attracting women to the profession.
Percentage of Women among Radiologists
The relatively low percentage of women in radiology is of concern. The percentage of women in radiology as reported in the 2003 survey and by the American Medical Association (11) is considerably lower than the percentage of women in more traditional (for women) specialties, such as internal medicine (30%), pediatrics (51%), obstetrics-gynecology (39%), and dermatology (36%), although the percentage of women in radiology is higher than the percentage of women in general surgery (13%) and cardiology (9%), which are specialties largely and/or historically dominated by men (11). Of greater importance, since 1990, the percentage of women in training in radiology has stayed at about 25%, while (since 1990–1991) the percentage of women in U.S. medical schools has increased from 38.5% to 50% (12). Unless this pattern changes, the percentage of women in radiology will "top out" at about 25%.
While an examination of the causes of women's seemingly low preference for radiology relative to specialties such as pediatrics and obstetrics-gynecology is beyond the scope of our article, other authors have been examining the causes (1,13). In an ongoing survey of medical students' choice of radiology (or of another specialty), factors cited as important with respect to radiology were lack of direct patient contact, role as a consultant physician, physics requirement, and competitiveness of the residency program. Work hours and salary were not important (Julia Fielding, MD, written communications, March 6, 2005, and November 4, 2005).
Subspecialties
Our data indicate that women are not selecting subspecialties that are commonly perceived as "high tech" (interventional radiology and neuroradiology) as much as are men. Stereotypes about gender differences in interest in technology may be involved, although the actual practice of these subspecialties may not, in fact, involve more technology than some others. The concentration of women in pediatric radiology may also reflect gender role patterns. However, lifestyle (call hours) and other issues may also be factors in various of these choices.
Women are attracted to breast imaging, a subspecialty in which patients are overwhelmingly of their own gender. This phenomenon is also seen, at the level of specialty (rather than subspecialty), in the high percentage of women in obstetrics-gynecology and the very high percentages of men in urology.
Demographic changes in the radiology profession have implications not only for the future workforce but also for patient care. If the long-standing pattern in residency persists, women will eventually make up approximately one-fourth of all radiologists, which is an increase from the 18% levels of 2003. The supply of radiologists in the subspecialties in which women concentrate is likely to increase as a result. Pediatric radiology is one field in which there currently appears to be a shortage (14). The future increase in the percentage of posttraining radiologists who are women should provide important relief in this subspecialty.
Results of recent studies have indicated that experience and/or training may be important factors in the accuracy of interpretation of mammograms (15–18). Currently there are concerns about accuracy, with suggestions frequently made to increase the federally required minimum number of interpretations above the current number of 960 every 2 years. Women who interpret mammograms interpret 55% more mammograms than men, on average, and women are almost 20 times as likely as men to have had a breast imaging fellowship. The increase of women to 25% of the radiologist workforce should improve mammography quality.
Work Satisfaction
A study published in 1995 (19) found that age and salary status, rather than gender, affected satisfaction. As reported in the Results section of our article, we found that, on the basis of results of ordinal logistic regression analysis, controlling for effects of age and other factors, women and men did not differ in current enjoyment of radiology or satisfaction relative to 5 years ago—a finding that is in keeping with the negative finding, with respect to gender, of the study from 1995 (19).
Among radiologists who reported enjoying radiology less than they did 5 years ago, reimbursement/financial pressures was a leading reason for enjoying radiology less than 5 years ago among men but not among women. This suggests that women radiologists attach less importance to income than men, which is probably not because women are indifferent to income but because other factors—for example, lifestyle—are more important for women than for men and push income further down on women's priority list. Bickel (13) found that women were less likely than men to consider income when choosing specialties.
Implications of Findings
A diverse workforce in radiology reflecting both the patient population and the U.S. professional workforce is desirable. As the percentage of women in the radiology profession increases, there are more female role models for potential residents. However, the past increase, from 13% to 18%, in the percentage of posttraining practicing radiologists who are women has not produced more women residents. Rather, the fraction of residents who are women has remained fairly constant at about one-fourth despite the increase in the percentage of U.S. medical students who are women (to 50%). Hence, the growth of women in radiology seems likely to top out at about 25%.
Women and men radiologists differ in important professional respects and, thus, even if the percentage of posttraining, professionally active radiologists who are women does not increase beyond the approximately 25% we anticipate, the increase to 25% (from approximately 18% currently) is likely to have beneficial effects on some specialty-specific shortage and quality problems.
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ADVANCES IN KNOWLEDGE |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONADVANCES IN KNOWLEDGEReferences |
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ACKNOWLEDGMENTS |
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FOOTNOTES |
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Abbreviations: ACR = American College of Radiology
Authors stated no financial relationship to disclose.
Author contributions: Guarantors of integrity of entire study, all authors; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; manuscript final version approval, all authors; literature research, R.S.L.; statistical analysis, R.S.L.; and manuscript editing, all authors
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References |
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TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONADVANCES IN KNOWLEDGEReferences |
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This article has been cited by other articles:
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  T. L. Angtuaco, K. J. Macura, A. M. Lewicki, M. L. Rosado-de-Christenson, and C. M. Rumack Radiologic History Exhibit: The American Association for Women Radiologists (AAWR): 25 Years of Promoting Women in Radiology RadioGraphics, March 1, 2008; 28(2): 573 - 582. [Abstract] [Full Text] [PDF]
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