Radiologist Robert Pyatt and his partners will lose a colleague to retirement in 2011.

They intend to start recruiting a replacement next spring -- a full two years early -- and they may have to help pay off some medical school tuition bills to entice a good candidate.

A series of factors, including low insurance reimbursement rates, high risk of getting sued, an aging roster of practitioners and a high demand for services, have converged to make radiologists a highly sought commodity in Pennsylvania.

"There are probably 40 jobs for every applicant," said Dr. Pyatt, who practices in the Chambersburg, Franklin County, area. This for a career that can pay $500,000 a year, doesn't require being on call and may exclude working nights or weekends.

What gives?

In this case, the cash is greener on the other side of the state line. "My residents tend to go where they will make more money," said Dr. Paul Kiproff, chairman of the radiology department at Allegheny General Hospital.

In his current class of 70, he said, no one has indicated an intention to stay in Pennsylvania once training is complete. Two already have announced they will leave, one for Alaska and another to Minnesota, "to make as much money as I do as an attending [physician]."

University of Pittsburgh Medical Center spokesman Frank Raczkiewicz issued a statement saying UPMC's hospitals have no shortage of radiologists but he refused a request to speak to any of them.

Recruiting and retaining radiologists appears to be a statewide problem, rather than an issue for any one center or practice. While Pennsylvania does attract radiologists from other states, resident physicians who train here seldom stay here.

Bob Powell, executive director of the Pennsylvania Radiological Society, estimates the state's 16 residency programs have graduated about 500 radiologists the past five years.

"We haven't kept 20 of them," he said. "In 2004, we didn't keep any."

Part of the reason is that Pennsylvania is among the top three states for residency programs, he said. Many out-of-state physicians come here to train, then return home when they're done.

Still, Dr. Pyatt said, only a decade ago Pennsylvania retained half the radiologists who trained here.

One issue is that reimbursements, particularly from Medicare, may barely cover the expense of necessary staff and equipment.

Another is that mammography is the single largest radiology subspecialty for getting sued. Given the thousands of mammograms performed and reviewed annually, the chance of a missed diagnosis is real.

"Pennsylvania is thought by some to be litigious," said Mr. Powell. "We don't have any tort reform and I'm sure that has an effect." That also raises medical malpractice premiums.

And while mammography is a procedure that touches every woman's life, it is not seen as a prestigious subspecialty.

Younger radiologists don't want to do mammography, said Dr. Pyatt. "They prefer to do MRIs, or CAT scans, specialty procedures and three-dimensional imaging."

Half of Pennsylvania's 2,000 or so radiologists are 55 years old or older, he said. "In the next 10 years, there are roughly 1,000 radiologists who will turn 65 and retire, and that's the main group that's doing mammography."

Mr. Powell maintains that, while there is a shortage of radiologists, it has not noticeably impacted patient care. "I don't think they wait long to get results, but I think in some areas they have to wait a bit longer."

Local breast cancer support groups say women typically can get an appointment for a mammogram within four to six weeks, and sooner if there's a suspected problem. Improved technology, such as the ability to ship images via computer, may make a shortage less worrisome.

But some are not waiting. The local Susan G. Komen For the Cure chapter has been funding two fellowships for breast imaging radiologists in recent years, said Executive Director Kathy Purcell.

"People donate money to us, so Susan G. Komen is very concerned about how we spend our money," she said. "The fact that we spend our money for those grants speaks to how important we think this is."