Gender Differences in Modality Interpretation Among Radiologists: An Exploratory Study of Occupational Horizontal Segregation

      Rationale and Objectives

      Occupational “horizontal segregation,” defined as disparity in the distribution of responsibilities between genders, could discourage women from seeking careers in radiology, as well as impact women within radiology in terms of compensation, promotion, and career advancement. We aimed to explore the existence of horizontal workplace segregation in radiology, as potentially manifested as intergender differences in the distribution of clinical work effort among imaging modalities for radiologists.

      Materials and Methods

      Medicare-participating general radiologists, neuroradiologists, abdominal, cardiothoracic, and musculoskeletal radiologists were identified from the 2016 Medicare Physician and Other Supplier Public Use File. Work effort in radiography, ultrasound, CT, and MRI was stratified by gender. Univariable and multivariable analyses were performed.


      22,445 radiologists were included (19.0% female; 19.6% in academic practices). At univariable analysis, female (vs. male) generalists had lower work effort in MRI (10.2% vs. 13.2%) (p < 0.001); abdominal radiologists had higher work effort in ultrasound (27.1% vs. 21.9%), with lower work effort in CT (53.7%. vs. 56.0%) and MRI (8.1%. vs. 9.4%) (p < 0.001); and musculoskeletal radiologists had higher work effort in radiography (41.6% vs. 34.8%) and less in MRI (44.8% vs. 49.6%) (p = 0.007). In multivariable analyses, female gender was independently associated with lower work effort in advanced imaging (CT and MRI) for generalists (coefficient, −0.020; p < 0.001), abdominal radiologists (coefficient, −0.042; p < 0.001), and neuroradiologists (coefficient −0.010; p = 0.035).


      Horizontal occupational segregation exists in radiology with female radiologists devoting lower work effort to advanced imaging modalities. Further investigation is warranted to better understand the sources and downstream implications of such variation.

      Key Words


      CT (computed tomorgraphy), MRI (magnetic resonance imaging), NITOS (Neiman imaging types of service), POSPUF (physician and other supplier public use file), wRVU (work relative value units)
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        • Baker S.R.
        • Barry M.
        • Chaudhry H.
        • et al.
        Women as radiologists: are there barriers to entry and advancement?.
        J Am Coll Radiol. 2006; 3: 131-134
        • Cater S.W.
        • Yoon S.C.
        • Lowell D.A.
        • et al.
        Bridging the gap: identifying global trends in gender disparity among the radiology physician workforce.
        Acad Radiol. 2018; 25: 1052-1061
        • Grimm L.J.
        • Lowell D.A.
        • Cater S.W.
        • et al.
        Differential motivations for pursuing diagnostic radiology by gender: implications for residency recruitment.
        Acad Radiol. 2017; 24: 1312-1317
        • Heitkamp D.E.
        • Norris C.D.
        • Rissing S.M.
        The illusion of choice: gender segregation and the challenge of recruiting women to radiology.
        J Am Coll Radiol. 2017; 14: 991-994
        • Zener R.
        • Lee S.Y.
        • Visscher K.L.
        • et al.
        Women in radiology: exploring the gender disparity.
        J Am Coll Radiol. 2016; 13 (e1): 344-350
        • Rafnsdottir G.L.
        • Weigt J.
        Addressing the horizontal gender division of labor: a case study of support and obstacles in a heavy industry plant in Iceland.
        Sex Roles. 2019; 80: 91-104
        • Cohen P.
        The persistence of workplace gender segregation in the US.
        Sociol Compass. 2013; 7: 889-899
      1. Weeden KA, Newhart M, Gelbgeider D. State of the union 2018: occupational segregation. Stanford Center on Poverty and Inequality. Available at: Accessed April 29, 2019.

        • Rosenkrantz A.B.
        • Wang W.
        • Hughes D.R.
        • et al.
        Academic radiologist subspecialty identification using a novel claims-based classification system.
        Am J Roentgenol. 2017; 208: 1249-1255
        • Rosenkrantz A.B.
        • Wang W.
        • Bodapati S.
        • et al.
        Private practice radiologist subspecialty classification using medicare claims.
        J Am Coll Radiol. 2017; 14: 1419-1425
        • Rosenkrantz A.B.
        • Wang W.
        • Hughes D.R.
        • et al.
        Generalist versus subspecialist characteristics of the U.S. radiologist workforce.
        Radiology. 2018; 286: 929-937
      2. Centers for Medicare & Medicaid Services. Physician and other supplier data CY2016. Avaialbel at: Accessed April 29, 2019.

      3. Harvey L.Neiman Health Policy Institute. Neiman imaging types of service (NITOS). Available at: Accessed April 29, 2019.

        • Rosman D.A.
        • Duszak Jr., R.
        • Wang W.
        • et al.
        Changing utilization of noninvasive diagnostic imaging over 2 decades: an examination family-focused analysis of medicare claims using the neiman imaging types of service categorization system.
        Am J Roentgenol. 2018; 210: 364-368
        • Rosenkrantz A.B.
        • Ayoola A.
        • Duszak Jr., R.
        Abdominal imaging ordering patterns by referring provider specialty.
        Abdom Radiol (NY). 2017; 42: 2363-2368
        • Harkey P.
        • Duszak Jr, R.
        • Gyftopoulos S.
        • et al.
        Who refers musculoskeletal extremity imaging examinations to radiologists?.
        Am J Roentgenol. 2018; 210: 834-841
        • Jarman J.
        • Blackburn R.M.
        • Racko G.
        The dimensions of occupational gender segregation in industrial countries.
        Sociology. 2012; 46: 1003-1019
        • Pearlman J.
        Gender differences in the impact of job mobility on earnings: the role of occupational segregation.
        Soc Sci Res. 2018; 74: 30-44