Dr. O'Mara is Professor of Radiology and Chief of the Division of Nuclear Medicine at the University of Rochester Medical Center in Rochester, NY. He is also a member of the editorial advisory board of this journal.

I t is always difficult to balance manpower needs in medicine between over and under supply. Efforts by various groups, ranging from those in the private sector up to the Federal Government, have not been particularly successful at mandating medical staffing requirements. The balance between primary care and specialist needs remains as fragile as it was a decade ago, even excluding the special considerations of balancing coverage in localities with overserved and underserved populations in the United States.

In radiology, in general, we have done a fairly decent job of fulfilling such staffing needs over the years. This likely is the result of allowing the basic principles of free enterprise to determine the attraction of young men and women from medical school to our field. However, in my small area of expertise, nuclear medicine, we are facing an upcoming dire shortage. The field is "graying" rapidly. It is estimated that within 5 years, more than half of the current full-time practitioners of nuclear medicine will cease practicing due to retirement or attrition. The numbers of candidates sitting for either special certification in nuclear medicine or the American Board of Nuclear Medicine certification is not sufficient. I must admit to adding to this problem myself. Those of us established in the field of nuclear medicine are in no way keeping pace to resupply this field with interested and concerned individuals. What is needed is a concerted effort from the various societies that deal with the full-time practice of nuclear medicine or nuclear radiology to establish programs at the medical school teaching level to attract students interested in specialty medicine into this area. We certainly must make efforts to keep the field open to all practitioners of medicine, whether they come into it via radiology or through other branches. In addition, we must ensure that enough training slots are maintained or established so as to be able to accommodate these individuals, even in this age of reducing residency positions. This will require great effort and cooperation among the radiology and nuclear medicine groups responsible for such residency positions and training.

Can this problem be solved? I certainly hope so. I have been around long enough to live through 4 or 5 "deaths" of nuclear medicine, and it is as strong now as it has ever been. As we move into truly functional molecular imaging, nuclear medicine offers more diagnostic and curative potential than ever before. It would be a shame to let it backslide now, as its strengths and abilities are just coming to light, because we cannot supply or train enough interested full-time practitioners.