While the technology behind CT scanners has greatly improved over the past decade, he said the reality is that most of the issues with imaging and low-quality exams are due to the humans behind the technology. This highlights the importance of retaining well-trained staff to keep image quality consistent. 

Understanding the cardiac CT staffing challenges

Williamson emphasized that most healthcare professionals, whether cardiologists, radiologists or technologists, enter the medical field with a primary focus on patient care, not on the business aspects of healthcare or how to maintain adequate staffing levels. He highlights that there are two critical aspects to consider. The first is having professionals who can interpret scans and the second is having allied health professionals who can operate the scanning equipment effectively.

In the context of cardiac CT, the shortage of allied health professionals, particularly technologists, poses a significant challenge. Williamson pointed out that the shortage of imaging staff is a pressing issue, especially in rural areas, where even if imaging equipment is available, there may not be individuals trained to operate it. This shortage has led to healthcare facilities reducing the number of scanning slots and workdays to prevent overburdening their existing staff.

"I think all of us feel stretched a little thin today, but out in more rural areas that the issue is huge. And there are frequently, even if there are adequate imagers who've been trained, even if there is adequate equipment and frequently there is, there's frequently not somebody who knows how to operate that equipment. And so the Allied Health staffing shortage has hit us really hard in cardiac CT. We definitely feel that every day. I know I've talked to plenty of my colleagues and we are closing scanners, closing time slots, and shortening workdays just so that we can keep from burning out our allied health staff colleagues," Williamson said.

The cardiac CT staffing crisis

The staffing crisis in cardiac CT is further exacerbated by a broader shortage of physicians and technologists in the medical field. Williamson said there is a persistent shortage of cardiologists and radiologists, with the number of positions exceeding the number of qualified professionals produced each year. This imbalance has significant consequences for patient care.

Furthermore, the shortage of technologists is even more pronounced. Williamson pointed out that there are approximately 25,000 open positions for allied health staff across various medical imaging specialties. This shortage affects not only cardiac CT, but also other imaging modalities like echocardiography, nuclear medicine, and MRI.

"We've tracked these statistics for a while. There are about a hundred fewer cardiology fellows produced every year than there are jobs. So in one year we're a hundred cardiology cardiologists in practice behind, and in two years, we're 200 behind. Just the effect magnifies. And the same problem is true within radiology. We're actually about 200 radiologists short every year over our existing positions that are open and ready to be filled. And this is a huge problem, and we all feel it," Williamson explained.

He said the CT community really needs to do a better job of training the technologists who currently exist to do cardiac imaging and needs to find ways to attract more technologists fresh out of training programs into CT and the subspecialty of cardiac CT.

"We've also got to hold onto them," he said. 

This includes making their current positions attractive enough to stay where they are. He said it is not uncommon for someone to leave an imaging department and then try to poach good techs from their old facility when they run into staffing shortages at their new hospital. But, he said there are strategies to do this. 

Recruitment and retention strategies for retaining cardiologists and technologists

To address the staffing shortages in cardiac CT and other medical imaging specialties, Williamson suggested a multi-pronged approach:

   • Training: Healthcare institutions need to take responsibility for training technologists in cardiac CT. They should offer specialized training programs to equip technologists with the skills necessary to operate advanced CT scanners.

   • Attraction: It is essential to attract technologists to the field of cardiac CT. Healthcare facilities should actively promote the benefits of working in cardiac imaging and offer opportunities for subspecialty training.

   • Automation: As a response to the staffing shortage, increased automation, including the use of artificial intelligence (AI), is necessary to enhance productivity. Automation can help healthcare professionals work more efficiently and make up for fewer staff, allowing them to meet the growing demand for cardiac CT services.

   • Acknowledgment and respect: Williamson said one of the most crucial factors in retaining healthcare professionals is showing respect and providing acknowledgment. He said money is nice, but often it is acknowledgment of a job well done that is a primary reward and helps keep staff from leaving. Williamson underscored the importance of recognizing the hard work and contributions of technologists and building a sense of belonging within the workplace. He said this can sometimes be difficult in a busy imaging department, but it is important for the cardiologists or radiologists to go and acknowledge their staff in person so they understand the important role they play on the care team. 

The issue of using traveling technologists to augment staff

The staffing shortage has also led to bringing in temporary, traveling technologists that make much higher salaries than full-time employees. This hiring of what many staff consider "mercenaries" in the field does not always sit well with others in the industry. 

"Bringing somebody in from outside into your institution and paying them a premium for a short period of time is not maybe the most enabling, supportive thing that you can do for your existing folks who've been there for years doing the job and now kind of feel like, 'how did this happen? So one of the things that we really have tried to do in our CT operations group at Mayo is ... talk to our existing technologists before the travelers show up and say, 'look, this is a temporary thing,'" Williamson said.

The staff has to understand that bring in outside help is a band-aid, but the ultimate intention is not to bring in traveling techs or to minimize the current staff in any way. He said managers should encourage staff to work with them so they can better understand how to create a better environment.