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The mission of the Harvey L. Neiman Health Policy Institute® is to establish foundational evidence for health policy and radiology practice that promotes the effective and efficient use of health care resources and improves patient care.

January 9, 2019

The Decline of Radiology Trainee Exposure to Invasive Procedures

As interventional radiology (IR) evolves as a distinct specialty from diagnostic radiology (DR), the central and ongoing role of diagnostic radiologists in performing certain invasive radiological procedures could have important patient access implications. This study, published online in the Journal of American College of Radiology (JACR), characterizes longitudinal changes in radiology trainees’ exposure to invasive image-guided procedures.

“Using national Medicare claims data over two decades as a surrogate measure of the changing relative distribution of services rendered by radiology trainees overall, we observed that radiology trainees now spend a smaller fraction of their overall work effort performing invasive procedures than in the past,” said Andrew Rosenkrantz, MD, MPA, professor and director of health policy in the department of radiology at NYU Langone Health and a Neiman Institute affiliate research fellow. “Previously, a variety of invasive procedures accounted for approximately one third of radiology trainees’ relative work effort. Trainees’ relative invasive procedural work effort has now declined to approximately one half of that.”

Dr. Rosenkrantz and team used Physician/Supplier Procedure Summary Master Files from 1997 to 2016, and identified Medicare services performed by radiology trainees in approved programs by extracting information on services billed by diagnostic radiologists and interventional radiologists reported with “GC” modifiers. Services were categorized as (1) invasive procedures, (2) noninvasive diagnostic imaging services, or (3) clinical evaluation and management (E&M) services. Relative category trainee work effort was estimated using service level professional work relative value units.

Nationally from 1997 to 2016, invasive procedures declined from 34.2% to 14.3% of relative work effort for all Medicare-billed radiology trainee services. Radiology trainees’ non-invasive diagnostic imaging services increased from 65.1% to 85.4%. Clinical E&M services remained uniformly low (0.7% to 0.3%). DR and IR faculty supervised 81.0% and 19.0%, respectively, of all trainee invasive procedures in 1997, vs. 68.3% and 31.7%, respectively, in 2016. Despite declining relative procedural work, trainees were exposed to a wide range of both basic and complex invasive procedures in both 1997 and 2016.

“Radiology trainees’ relative invasive procedural work effort has declined over time as their work increasingly focuses on CT and MRI,” stated study senior author Richard Duszak, MD, FACR, professor and vice chair for health policy and practice in the department of radiology and imaging sciences at Emory University and senior affiliate research fellow at the Neiman Institute. “As DR and IR/DR residency curricula begin to diverge, it is critical that both DR and IR residents receive robust training in basic image-guided procedures to ensure broad patient access to these services.”

To obtain a copy of the study or to arrange an interview with a Neiman Institute spokesperson, contact Nichole Gay at (703) 648-1665 or


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 and follow us on Twitter, LinkedIn and Facebook.


Nichole Gay
Harvey L. Neiman Health Policy Institute