The aging population in the U.S. is growing and memory disorder specialists can’t keep up with the workload. Radiologists, neuroradiologists, and neurologists are all experiencing national shortages, delaying access to critical care, starting with Alzheimer’s testing.
Deadly Alzheimer’s Epidemic in the U.S.
An estimated 6.7 million people, age 65 and older, are living with Alzheimer’s Dementia in the U.S. This number will increase as the U.S. population ages in the next 20 years.
Deaths from Alzheimer’s Dementia increased by more than 145% from 2000 to 2023. Without medical breakthroughs to prevent, slow, or cure Alzheimer’s Dementia, the number of deaths can more than double to 13.8 million by 2060.
Our Aging Population Needs More MRIs
As the U.S. population grows and grows older, the need for more MRI scans also grows. By 2032, the U.S. population is projected to increase by 10%. MRI scans are roughly 5x more frequent for older patients, making them the #1 users of MRIs.
Why MRI for Alzheimer’s Disease?
MRIs are considered to be the preferred imaging test method for Alzheimer’s and other dementias. When making the decision between an MRI and a CT scan, it often comes down to the urgency of a patient’s medical condition.
CT scans are also leveraged for brain scans but are typically used for emergency medical situations such as brain trauma and strokes. Although they are a quicker type of scan, taking about 5 minutes vs. up to 2 hours it takes for an MRI, CT scans are less detailed and expose patients to harmful radiation.
MRI images provide a more detailed picture when identifying dementia progression, enabling the evaluation of advanced areas, such as blood vessel abnormalities, and therefore, give more certainty to the diagnosis.
What is the Burden of Care for Providers Ordering and Interpreting Brain MRIs?
Neurologists, neuroradiologists, and radiologists are among the healthcare providers responsible for the diagnostics, care, and follow-up of dementia and mental degeneration patients in various care settings.
Neurologists
The states with the highest burden of neurologists’ care include Texas, Iowa, N. Carolina, Oklahoma, and New Mexico. Neurologists in these states have less time and more patients, making it hard for older patients to receive the care they need.
We calculate the burden of care as the number of patients per medical provider, neurologist, licensed in this state.
See top ten states with the highest burden of care for neurologists in Table 1 below.
Due to high patient loads, more than half of neurologists are experiencing burnout. 62% of them identify too many hours at work as the cause, with administration and paperwork being a major cause of extra hours at work.
The paperwork alone, specifically charting and completing prior authorization and step therapy forms, takes an average of 17.6 hours a week for neurologists.
Radiologists
Radiologists primarily work within imaging centers (46.7%) and hospitals (14.2%). For the purpose of this article, VUNO has analyzed the burden of care for imaging centers.
The Southwest has the highest burden of care, with 35,727 patients per imaging center, followed by the Southeast, with 19,497 per center. See the full analysis in Table 2 below.
When there are not enough radiologists to support the aging population’s demand for brain MRI, delays in diagnostics and treatments persist, especially for complex cases.
Neuroradiologists
The acute shortage of neuroradiologists has further increased the burden of care for busy radiologists working at imaging centers.
As more neuroradiologists flock to academic institutions (read more below), general radiologists experience a higher demand for brain MRIs. As non-specialists in brain images, radiologists risk making more mistakes.
The American Society of Neuroradiology (ASNR) consists of only 6,000 physicians. Considering that there are 50,137 active radiologists in the U.S. as of 2024, only 11% have specialized training for interpreting brain imaging.
The current shortage of neuroradiologists stems from several factors, including efforts made within the neuroradiology community between 1996-1997 to decrease the number of neuroradiology fellowship programs.
Ripple effects traveled across the industry, with the National Neuroradiology Fellowship Matching Program (NRMP) indicating only 156 fellowship slots available in 2002. Of these, only 22% of the open slots were filled.
AJNR Editorial Board Member, Dr. James N. Dreisbach mentioned in his 2001 paper, Where Have All the Neuroradiologists Gone?, that “The decreased number of radiologists going into neuroradiology could have a significant impact on the future of our specialty.”
Dr. Dreisbach’s prediction 20+ years ago has proven to be accurate.
Today, the majority of neuroradiologists are not seeking employment by traditional healthcare institutions and imaging centers.
Academic institutions lead in terms of neuroradiologist hiring (60%). However, they have a lower patient volume and less pressure to cut time per case than hospitals (24%) and imaging centers (8%).
Based on this effect, it is no surprise that radiologists struggle to keep up with the high demand for brain MRI interpretations.
How Can AI Help Busy Providers Quickly and Accurately Diagnose and Monitor Alzheimer’s?
Considering that patients face significant barriers in obtaining and attending appointments (on average, patients wait up to 35 days to see a neurologist), providers must optimize their own time to support the earliest possible diagnosis and intervention for patients.
VUNO spoke to multiple neurologists, neuroradiologists, and radiologists regarding challenges with MRI-based diagnostics and what they anticipate for the future.
Skyrocketing Caseload of Brain MRI Cases
A Radiologist in New England, stated that “Radiology right now is at an inflection point, and there is a struggle with volume vs. staffing. Double-digit growth of workloads is expected next year.”
According to this Radiologist, cases in the past typically had 20-40 images. Today, cases can have thousands of images to read, in addition to patient history and other test results.
To support this increased workload, the Radiologist foresees AI imaging as a solution. “With this predicted workload growth, AI imaging tools will become more important for interpreting MRI scans.”
Fluctuating Accuracy and Consistency in Neuroradiology Reports
Dr. Weinman, a veteran neurologist from Brown Neurology, also shared that accuracy is a major challenge in the diagnostic imaging field. She expressed concern that there can be much variability in neuroradiologists’ interpretations of brain MRI scans regarding the degree and pattern of atrophy associated with Alzheimer’s disease.
Readings and the quality of readings vary when being done manually by neuroradiologists. Dr. Weinman shared that the neuroradiologists at the imaging centers she often refers patients to sometimes under-read or under-emphasize atrophy, and she doesn’t always agree with their readings. This speaks to the nature of the work; it is somewhat subjective and the neurologist should always also review the images.
Dr. Weinman believes AI would be not only in evaluating degree and pattern of atrophy, but also as a research tool, particularly for neurologists studying white matter hyperintensities.
Using an AI imaging tool can increase the accuracy of images, decrease the case read time needed, and provide greater detail.
Learn more about how AI can support workload challenges to deliver results to patients at a more rapid pace.
Sources:
- Alzheimer’s Disease
- The Neurosurgeon Shortage.
- MRI and a CT scan,
- Medscape Log in
- Medscape Registration
- radiologists in private practice
- The American Society of Neuroradiology (ASNR)
- Number of active physicians in U.S.
- AJNR: American Journal of Neuroradiology
- Radiology Fellowship Match
- Predictors of No-Show in Neurology Clinics
- Brown Neurology
