Radiology resident positions: Back to the future

 Dr. McGahan is the Vice Chairman of Radiology, Director of Abdominal Imaging, Department of Radiology, University of California, Davis Health System, Davis, CA. Dr. McGahan is a member of the Applied Radiology Editorial Advisory Board.

I have observed the pendulum swing in the job market within radiology throughout my career. Fortune tellers, no matter how sophisticated or how large their database, always seem to have the predictions wrong. It was predicted that by the year 2000, there would be a vast oversupply of radiologists when, in fact, the opposite occurred.¹ Jobs were plentiful, both residents and fellows graduating from our program had multiple opportunities for employment. However, over the past decade, how things have changed. Now it seems most residents in radiology choose a year of fellowship training. Rarely do I see residents completing their training and go directly into the job market, as occurred 10 years ago. Currently, we have the opposite phenomenon where we have fellows completing one fellowship, looking to the next year to complete a second fellowship, ultimately hoping to land a full-time position.

What has happened and should anything be done? I believe a number of things have had a direct impact on the job market in radiology. The first is the fact that some radiologists are postponing retirement. It is hard to know the exact numbers, but recent extrapolated data collected by Bluth² would estimate that 27% of the radiology workforce (9,450 radiologists) is >56 years of age and 7% (2,450 radiologists) are older than 65.² Do radiologists postpone retirement because they enjoy work? I don’t believe that is always the case. I believe much of this has to do with the stagnant nature of the stock market, which drives much of the retirement funds for radiologists. Certainly, if there would be a sudden rise in retirement funds for radiologists, there would be little doubt that many radiologists who want to retire would. This would create an automatic opportunity for younger radiologists to enter the job market.

The second issue has to do with federal cutbacks in professional/technical reimbursement in radiology services. At our institution, we have seen a decrease in work RVUs and reimbursement in some areas. For instance, in body CT with bundling of CT abdomen and pelvis, there is a reimbursement reduction of approximately 25%. However, starting in 2013, the professional component (PC) for multiple procedures payment reduction (MPPR), which currently applies to one radiologist interpreting multiple studies, would apply to 2 different radiologists interpreting multiple anatomical regions (say a chest CT, and abdomen/pelvic CT) on the same patient. This will further reduce radiology reimbursement. As I talk to those in private practice groups throughout the country, the current MPPR has had direct impact on the overall salaries of radiologists. With an increased workload, there would be an incentive for recruitment, but with decreased reimbursement would this be a disincentive to hire radiologists? On the upside of the equation, with future healthcare reform, would the possibility of inclusion of more of the uninsured increase access to medical care and imaging procedures? How large would this increase be and how many more radiologists would be needed to meet this potential demand?

Dr. Douglas Maynard has surveyed academic radiology chairs over the past 10 years and presented his data at last year’s RSNA meeting.³ The number of reported job vacancies has decreased in academic departments from 570 in 2001 to 187 in 2011. The average number of openings in academic radiology departments has decreased from 5.38 to 1.72.² In reviewing Dr. Jonathan H. Sunshine’s data from 2008,he shows the pendulum shift in the radiology job market.⁴ In 1995, the job listings to job seekers was at a ratio of <0.5. This swung to a ratio of 3.5 jobs per seeker in 2001 and has dropped to 0.6 in 2008. However, Bluth’s data collected from a survey of group leaders in radiology practice show a close to even job openings with the number of residents graduating. Thus, the mismatch may be in certain specialties and more desirable geography locations.²

Is this all doom and gloom or will the job market improve? There is certainly controversy about the answer. Talking to many of my colleagues in academic radiology, there is a split opinion. Some would feel that this is only a temporary dip in the market (the pendulum phenomenon). They feel the current state of the job market is reminiscent of the mid 1990s when residents and fellows panicked about the lack of quality jobs. By the end of the century, there was a shortage of radiologists. They feel with healthcare reform and the aging population, there will be a need for more radiologists. They point out that by the year 2030, it is estimated that 40% of the population will have some sort of cardiovascular disease; in which radiologists will play a major role in diagnosis and management.⁵ Others feel the job shortage is a long-term trend.

Should the status quo in the number of radiology residency positions be maintained or should there be a cutback? What is the right answer? I think that from a radiology leadership standpoint, they have a tough balancing act, “to build a workforce to an equilibrium level that will result in neither an excess supply nor a shortage” of radiologists in the future.⁵ If changes are made, an effect in the supply of radiologists will not be felt for 5 years or more. Who knows what circumstances will have changed by then? As the famous quantum physicist Neils&nbsp;Bohr said, “Prediction is very difficult, especially about the future.”

REFERENCES

1. Rosenquist CJ. How many radiologists will be needed in the years 2000 and 2010? Projections based on estimates of future supply and demand. AJR Am J Roentgenol. 1995;164:805-809.
2. Bluth EI, Short BW, Willis-Walton S. 2012 American College of Radiology Commission on Human Resources Workforce Survey. J Am Coll Radiol. (In press) 2012.
3. Maynard CD. Personal communication. 2012.
4. Sunshine JH, Maynard CD. Update on the diagnostic radiology employment market: Findings through 2007-2008. J Am Coll Roentgenol. 2008;5:827-833.
5. Forman HP, Larson DB, Kaye AD, et al. Masters of radiology panel discussion: the future of the radiology job market. AJR Am J Roentgenol. 2012;199:127-32.