What the data show
A recent study by the Harvey L. Neiman Health Policy Institute looked at insurance claims data (commercial, Medicaid, and Medicare Advantage) from 2016 to 2023. AuntMinnie+3DOTmed+3AJMC+3
They defined “pediatric radiologists” as radiologists whose work relative value units (wRVUs) were ≥50% for pediatric imaging. Alternative thresholds (≥25%, ≥75%) were also tested. DOTmed+2Newswise+2
Among about 109,077 unique radiologists during that period, about 9,198 (≈8.4%) met the ≥50% threshold at some point. Newswise+2AuntMinnie+2
But, crucially, the number of pediatric radiologists (≥50% pediatric work) declined from 2,190 in 2016 to 2,032 in 2023, a drop of ~7.2%. AJMC+2Newswise+2
Their share of all radiologists also dropped: from 6.4% of all radiologists in 2016 to 4.6% in 2023. DOTmed+1
Other findings: fellowship positions in pediatric radiology have fallen, for example from 88 accredited positions in 2013 to only 54 in 2023. AuntMinnie+1
Also, many pediatric radiologists plan to retire in the next decade (≈38% in one survey).
What are the possible causes
The study & related literature suggest several drivers:
Reduced fellowship training & recruitment interest
Fewer trainees are entering pediatric radiology fellowships. SpringerLink+2AuntMinnie+2
Inadequate exposure to pediatric radiology during residency – many programs (especially smaller or non-pediatric hospitals) don’t provide sufficient rotations at children’s hospitals. SpringerLink
Perceptions about compensation, workload, and lifestyle
Pediatric radiology is often perceived as having lower compensation relative to some adult subspecialties. SpringerLink+2AuntMinnie+2
Heavier call burdens and expectations of working non-standard hours may deter some. SpringerLink+1
Aging workforce & retirements
Many active pediatric radiologists are nearing typical retirement age. Several surveys indicate high proportions planning to retire within 5-10 years. AuntMinnie+1
Supply vs. demand mismatch increasing
While demand for pediatric imaging is generally increasing (children need imaging for various reasons, technological advances, etc.), the number of specialists is not keeping up. DOTmed+2AuntMinnie+2
Some imaging services for children are being done by non-pediatric specialists (general radiologists) or non-radiologist clinicians. While this helps, there are concerns about quality, consistency, specialization. AuntMinnie+1
Structural/Training constraints & policies
Accreditation limits, funding for graduate medical education (GME), and the availability of pediatric hospitals for training are all constraints. SpringerLink+2AuntMinnie+2
A recent initiative: The American Board of Radiology approved a 15-month pathway for pediatric radiology subspecialty certification (March 2025), potentially lowering barriers. But certification remains optional, and its uptake/impact is yet unknown. AJMC+1
Implications of the decline
Access to specialized children’s imaging: Fewer pediatric specialists means in many regions (especially rural or non-metropolitan), children may have less access to radiologists with expertise in pediatric imaging. Interpretations by general radiologists might miss nuances. DOTmed+2AuntMinnie+2
Quality and safety: Pediatric imaging requires specific skills (e.g. lower radiation doses, pediatric anesthesia, imaging protocols suited to children). A decline in specialist capacity risks errors, delays, or suboptimal imaging. Radiology Business+1
Workforce stress & burnout: With fewer pediatric radiologists, existing ones often have heavier workloads, more on-call responsibilities, less ability to take leave or balance work/life. Burnout is reported. JACR+1
Training & future pipeline: Reduced exposure for trainees, fewer fellowship slots, and fewer mentors means future capacity may decline further. It becomes harder to reverse the trend.
What is being done / possible solutions
New certification pathways: The ABR’s 15-month subspecialty pathway (from March 2025) is intended to create more flexibility. AJMC+1
Increasing fellowship slots and making training more accessible: Encouraging more hospitals (especially those that currently don’t have robust pediatric departments) to offer pediatric rotations, giving funding/support. SpringerLink
Policy & incentives: Possibly better compensation for pediatric radiologists; recognizing the extra training or burdens; loan forgiveness or grants; subsidies.
Using non-physician providers: Some practices are using advanced practitioners (PA, NP) or radiologic technologists with specialized training to take on some tasks, under supervision, to relieve pressure. AuntMinnie+1
Telemedicine / teleradiology models: Remote reading by pediatric specialists might help in underserved areas.
Improving recruitment & awareness: Early exposure in medical school / residency; mentoring; emphasizing the importance and rewards of pediatric radiology; dispelling myths about workload or compensation.
Challenges and uncertainties
The optional nature of the new certification pathway may limit uptake if perceived value isn’t high.
Compensation may still lag compared to adult subspecialties, especially where reimbursement for pediatric imaging is lower.
Geographic maldistribution: even if total numbers stabilize, regions far from major children’s hospitals may continue to be underserved.
Funding constraints (for GME, for licensing, for pediatric hospitals) could limit expansion of training.
Conclusion
The decline in U.S. pediatric radiologists over the 2016-2023 period is concerning, especially as demand for pediatric imaging continues to grow. The issue is multifactorial: trainee interest, compensation, retirement, training opportunities, and structural policy/institutional constraints all play roles. Without targeted interventions (training pathway changes, incentives, improved working conditions, improving access), the trend could worsen, with consequences for care quality, access, and children’s health outcomes.
