September 9, 2025
Decline in U.S. Pediatric Radiology Workforce Revealed in Large Study of Private Insurance Claims
A new Harvey L. Neiman Health Policy Institute study published in the Journal of the American College of Radiology (JACR) reveals a concerning decline in the number of U.S. radiologists dedicating most of their clinical effort to pediatric imaging. Using a large, national private payor claims database including approximately 414M unique covered lives, researchers found that the pediatric radiology workforce shrank between 2016 and 2023, even as demand for imaging services grew.
The study analyzed over 52 million radiology claims from the Inovalon Insights, LLC database, which includes Medicaid, Medicare Advantage, and commercial payers. Pediatric radiologists were defined as those with at least 50% of their annual work relative value units (wRVUs) attributed to imaging children. Across the study period, 9,198 unique radiologists met this threshold, but the number of unique pediatric radiologists declined from 2,190 in 2016 to 2,032 in 2023.
“This is the first study to use claims data to systematically identify pediatric radiologists and track workforce trends over time,” said Casey Pelzl, MPH, Principal Economics and Health Services Analyst at the Neiman Institute. “Our findings show that, while the overall radiology workforce has grown, the number of pediatric-focused radiologists has declined, which raises concerns about access to specialized care for children.”
The researchers also tested alternative thresholds for pediatric wRVU effort. When the threshold was raised to 75%, the number decreased by 18.9%. When lowered to 25%, the number of identified pediatric radiologists increased by 47.1% overall. As a proportion of all radiologists, the percentage of pediatric radiologists identified using the 75% threshold dropped from 9.1% of all radiologists in 2016 to only 6.2% in 2023. At the 50% threshold, the proportion declined from 6.4% to 4.6% across the same period.
“Many radiologists are delivering pediatric imaging services without formal subspecialty certification,” said Hansel J. Otero, MD, Vice-Chair for Clinical Research at Children’s Hospital of Philadelphia (CHOP) and study senior author. “This suggests that traditional self-reported estimates, which were last collected through the ACR’s 2003 Survey of Radiologists, may significantly undercount the true pediatric radiology workforce.”
The study also highlights the potential impact of recent policy changes. In March 2025, the American Board of Radiology approved a new 15-month pathway to pediatric subspecialty certification. While this initiative may help address workforce shortages, the authors note that certification is not required for clinical practice and may be foregone due to cost or perceived value.
“Our methodology provides a utilization-based lens to evaluate workforce trends and can be used to inform policy like the recently proposed changes in requirements for training and certification,” said Tatiana Morales-Tisnés, MD, Radiology research scholar at CHOP and lead author. “Understanding who is delivering pediatric imaging services is essential for planning training programs and ensuring equitable access to care.”
The authors emphasize that claims-based methods can support more accurate workforce planning and help identify gaps in pediatric imaging coverage. Future research will explore geographic distribution, workforce demographics, and possible solutions to the current pediatric radiology workforce shortages.
To arrange an interview with a spokesperson, contact Nichole Gonzalez at ngonzalez@neimanhpi.org.
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About the Harvey L. Neiman Health Policy Institute
The Harvey L. Neiman Health Policy Institute is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care. Visit us at www.neimanhpi.org and follow us on X, LinkedIn and Facebook.