Do radiology fellowships start too early in the year?

Fellowship training programs for radiologists start too early and interfere with the new fellows’ residency training, according to a new survey of radiology program directors (PDs). Most respondents said they think the specialty should consider making a change to avoid this issue going forward.

The full results of the survey were published in Academic Radiology.

“In the past, processing new fellows was simpler, with far fewer administrative requirements for both training programs and their host institutions,” wrote James Michael Milburn, MD, Ochsner Health System in New Orleans, and colleagues. “Today, however, the onboarding process is long and tedious. There are mandatory checklists of institutional and accreditation requirements to cover and required orientation sessions dedicated to learning the software that drives modern radiology: PACS, integrated voice recognition, and the electronic medical record.”

This change in the onboarding process, the authors explained, has caused some institutions to require fellows to arrive for orientation in June, when they are still typically scheduled to participate in residency training.

Milburn et al. surveyed 160 members of the Association of Program Directors in Radiology (APDR), asking each of them 11 questions about the timing of fellowships and residency training. Surveys were distributed on Nov. 4, 2018, and responses were accepted for a total of 30 days. All geographic regions in the United States were represented by responses.

Overall, 59% of respondents said that graduating residents had to leave their residencies early due to beginning a fellowship. Of those respondents, 44% said graduating residents had been required to arrive five or more days before July 1, when fellowships are typically expected to begin.

In addition, 35% of respondents said that up to 10% of their graduating residents are asked to leave for their fellowships early. Twenty-five percent of respondents said that more than half of their graduating residents are asked to leave early. Another key finding from the survey was that 78% of respondents said they were “in favor of radiology considering a delay to the start and end dates of fellowships.”

The survey also included an optional section for writing out comments, and 14 of the 56 respondents who left a comment said this scheduling issue was “a significant concern and appreciated that the authors performed the survey.” Another six respondents said fellowship start dates should be delayed, and 16 respondents said they were not concerned about the situation.

“Although trainees in U.S. residency programs are obligated to finish their residency requirements through June 30 of their final year, many of those continuing to fellowships at outside institutions ask to leave well before that date,” the authors wrote. “Some APDR members commented in our survey report that, in most cases, trainees leaving early reserve vacation days to use in the final weeks of residency so that they can relocate. However, many radiology educators, including some survey respondents, have perceived that over the past decade, trainees are leaving earlier than ever before, and the sum effect is causing disruption to the educational program and creating coverage gaps on the clinical services.”

Delaying the start of radiology fellowships comes with its own potential problems, Milburn and colleagues observed. The residency graduates would lose income and some benefits during the transition period, for instance, though residents “could choose to pay for coverage retrospectively if healthcare was needed during the gap period.”

“This would likely be a cost for a small minority of graduates, but it is still a concern,” the authors wrote.