Dr. Pope is Professor of Radiology at the Medical
University of South Carolina, Charleston, SC. Dr. Pope is also
a member of the Editorial Board of this journal.
When I finished my residency almost 20 years ago, there were
only a few available academic or private practice positions. If a
graduating resident had more than two job interviews, he or she was
considered blessed. The looming threat of "managed care" made
practices leery of hiring too many partners. But at the same time,
reimbursement was quite acceptable for academic programs and many
medical school programs could afford to be slightly overstaffed
without a significant effect on their bottom line. Then came the
American Medical Association manpower study in the late 1980s that
predicted a huge surplus of radiologists due to the continued
erosion of our specialty by managed care. This prediction was taken
seriously by both private and academic practices. Private practices
tried to do "more with less" and academic radiology chairs and
program directors "voluntarily" cut back on training slots. The
American Board of Radiology (ABR) then voted to require a clinical
year of training, thus compounding the overall decrease in supply.
During those times, the
American Journal of Roentgenology
(
AJR
) and
Radiology
featured 4 to 5 pages of job listings and 15 to 20 pages of
graduates looking for positions.
But "the times, they are a changin'!" During the 1990s, the
stock market did well and many radiologists took early retirement.
New developments in CT, ultrasound, and MR imaging and the
explosion of interventional techniques in all subspecialty areas,
especially vascular radiology and neuroradiology, heightened demand
for radiologists.
Fewer graduates, coupled with an explosion of academic and
private practice job opportunities, have created a shortage of
radiologists. Today every private practice and academic program I
know is looking for help. A recent survey by the ABR revealed 600
vacant faculty positions in 120 academic programs and, depending on
the day of the week, there are 35 to 40 vacant Radiology Chair
positions. This is evident in the employment listings; now
AJR
and
Radiology
have 30 to 35 pages of job listings and usually less than 1 page
(yes, 1 page) of individuals looking for employment.
When I assumed the Chair position in my department, I was
clueless about the actual challenges that the process of
recruitment would present to me. We have interviewed relentlessly,
we have increased the salaries of our faculty (though still not
enough, I fear), and we have used every tactic we know to fill our
6 vacant positions without success. As the national data supports,
we are not alone.
So what can be done? Caveat one is that simply there are just
not enough radiologists to go around. There are two bills in
Congress that may increase the number of radiology residency slots,
but this is a long-term solution. Perhaps some retired radiologists
will come back to work after the effect of September 11th on the
stock market. Perhaps we will have to limit certain services,
resulting in longer waits for some imaging exams. Compounding the
problem is that private practices are even resorting to much higher
starting (and in some cases percentage) salaries and reducing the
time to partnership. These tactics have resulted in an even greater
than normal efflux of academic talent to the private sector, thus
compounding the manpower challenges of the academic radiology.
In academics today, chairs merely "steal" from one another to
maintain staffing, but this tactic can succeed only for so long. We
must find a way to collaborate, cooperate, and merge forces if we
expect to succeed in the immediate future. Images can easily be
moved on the Internet today, and I hope Chairs of academic
departments (and also heads of private practice groups) will begin
to investigate helping each other out by
teleradiology or any means possible over the next few years. Almost
any program or practice has a little "fluff" that could allow for
extending a "helping hand" if the attitude (and the price) were
right. Let's hope we work together cooperatively in some way as I
firmly believe that the future of our subspecialty depends on
it.
Are we having fun yet?