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?