Cardiac nuclear imaging workforce: Trends from Medicare Part B (2013-2022)

Cardiac positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are widely used for the assessment of coronary artery disease. While SPECT remains more available, workforce shortages and training demands contribute to geographic disparities in PET availability, impacting patient access to advanced imaging. Therefore, we assessed trends in the U.S. cardiac nuclear imaging workforce.

Data from Medicare Part B (2013-2022), provided by the Centers for Medicare & Medicaid Services, were analyzed to assess trends in cardiac nuclear imaging services billed by physicians. The analysis focused on the number of readers, their gender, specialty, geographic distribution, and workload.

From 2013 to 2022, the proportion of SPECT procedures declined from 95.8% (2,303,194 scans; 4393 per 100,000 Medicare beneficiaries) to 86.3% (1,386,358 scans; 2130 per 100,000 Medicare beneficiaries) of total nuclear cardiology procedures, while the proportion of PET procedures increased from 4.2% (99,861 scans; 190 per 100,000 Medicare beneficiaries) to 13.7% (220,366 scans; 339 per 100,000 Medicare beneficiaries). The majority of studies were interpreted by readers performing 50 or more studies annually. From 2013 to 2022, the number of SPECT-only readers declined from 17,013 to 13,491, while PET-only readers increased from 66 to 386. Readers interpreting both SPECT and PET doubled from 822 to 1643. Only 1 in 10 nuclear imaging readers were women and the majority were cardiologists. The median (interquartile range) number of studies per reader was higher for cardiologists compared to those of other specialties. Geographic disparities were evident, with most nuclear imaging readers practicing in Texas, Florida, and California, while the fewest were in Wyoming, Alaska, Vermont, and Washington, D.C.

While SPECT remained the most commonly used modality in 2022, its use has declined, whereas PET use has increased, accompanied by similar trends in the number of readers. Gender and geographic disparities persist in the distribution of nuclear cardiology imaging specialists. Addressing these gaps is essential to ensuring equitable access to nuclear imaging expertise.