The Journal of the American College of Radiology recently presented readers with opinions from both sides of the debate over whether radiology residency spots need to be reduced.

The discussion originally took place at the ACR Annual Meeting and Chapter Leadership Conference in 2014.

Point

Neil Lall, MD, University of Colorado department of radiology, said he believes radiology residency spots should be drastically reduced. Volume and reimbursements are down in recent years, but the number of practicing radiologists is up significantly.

And, Lall added, radiologists are starting to delay their retirement, making an already extremely competitive job market even more crowded.

“This surplus of radiologists not only leads to difficulty in finding jobs and a decrease in wages but hinders our undertaking new responsibilities,” Lall said. “As experts in imaging, we are responsible for determining the appropriateness of studies, so that we can maximize the efficacy of our resources. However, because the number of new jobs is dependent on the volume of imaging, there is a disincentive to manage utilization, as that may decrease volume.”

Lall went on to say medical students appear to be losing interest in radiology, pointing out that there were six unfilled radiology residency positions in 2010, but 81 just four years later.

“As the desirability of radiology decreases, the quality of medical students will decline,” Lall said. “We no longer will be training the brightest and the best. This is problematic, because the knowledge required of a radiologist is increasing, and many clinicians believe that they do not need radiologists to read imaging studies.”

Lall concluded that a shortage of radiologists is an easier problem to solve than a surplus of radiologists. A shortage can be solved by increased productivity, Lall said, or temporary assistance from radiologists trained outside the U.S. But with a surplus, you risk harming the careers of all radiologists.

“A surplus makes it difficult for trainees to find employment,” Lall wrote. “However, radiologists will not waste their training. Rather, they will accept salaries lower than customary. This risks a race to the bottom.”

Counterpoint

Colin M. Segovis, MD, PhD, Wake Forest Baptist Medical Center department of radiology, believes radiology residency spots should not be reduced.

“Drastically reducing residency slots is reactionary and a potentially dangerous course with the potential to permanently change radiologists’ scope of practice as others fill the vacuum left by a future scarcity of radiologists,” Segovis said.

Segovis added that radiologists may have largely lost the ability to set their own prices, but the future of imaging is still largely uncertain, and it would not be wise to do anything drastic based on assumptions.

In addition, Segovis pointed to statistics that indicate radiology jobs will remain available, and said leadership within the ACR is optimistic.  

The job openings may not quite be ideal, Segovis added, but they’ll be there, and they’ll be available.

“It is unlikely that available jobs will satisfy all of an applicant’s desires, such as practice location, doing exactly what an applicant wants, and with exactly who the applicant wishes to have as colleagues,” Segovis said. “Still, it is likely that two out of three will be met.”

Segovis advised against reducing the numbers of resident spots, calling it a “misguided” solution.

“A drastic decrease in the number of residents is an alarmist’s prescription, which is not supported by data,” Segovis said. “Health care is changing, and we must adapt to the new system, but the utilization of imaging is unlikely to decrease as coverage expands and the population ages. Quality and value, not volume, are the new metrics. How quality and value are measured is still under debate, but decreasing the number of graduating radiologists will not increase quality.”