The response to the recent article in The New York Times about dwindling job opportunities for radiology residents, if the comments in the discussion forum at AuntMinnie.com are anything to go by, is similar in kind to the panic in the financial world when Enron became bankrupt. Some radiology residents have even threatened to short sell radiology, i.e. to change to a residency in dermatology or family practice.
If you entered radiology for the money, then it is fair to say that in the current labor market and for the foreseeable, indeed indefinite future, you are likely to be disappointed. Like William Sutton, you need to find another bank, or just a bank.
If you entered the profession for the love of the gray scale, for flirting dangerously with fractions as you decide between a moderate and severe facet joint narrowing, an unconditional love regardless of the reimbursement (within reasonable interval), then it is worth seeing out the storm before changing careers to psychiatry, radiation oncology or financial analysis.
Imaging might reduce at the margins but large scale reductions are improbable. It is unlikely that emergency physicians will overnight or ever rediscover Mc Burney’s point or Rovsing’s sign. The clinical “horse” has well and truly bolted the stable. Society is unlikely to get less risk averse with time and rediscover its frontier spirit, the removal of the ban on carrying knives aboard the plane by the TSA notwithstanding.
So fret not trainees. D-dimers will still be ordered and CT to rule out sub-segmental pulmonary emboli will still be performed to mop up the false positives. The referring physicians will demand imaging. The patients will not object. People are living longer and 85 is the new 65 (no that is not a subtle dog whistle to increase the age for eligibility for Medicare).
The value of radiologists has only just begun. If you don’t believe me, orchestrate a PACS and RIS shutdown and watch the pandemonium in the emergency department. (Actually don’t do it; just take my word for it). Fed with a long term diet of rapid turnaround time it is unlikely medical decision making will suddenly germinate without the input of the radiologist.
Why then are there so few jobs?
Uncertainty. The forthcoming integrated payment model, or bundled payment, so that everyone fights for the same needle in the bundled haystack, has created uncertainty. Groups do not know how much harder they will have to work to make the same ends given the unknown reduction in reimbursement. This is status quo bias. However, there is a limit to how much harder a radiologist can work. And at some point the groups will have to hire, albeit at lower salaries.
And with any luck, many radiologists (peri-80) will start retiring. There are reasons to believe that this process will be non-linear, i.e. there will be an exodus. The increasing burden of paperwork (checklists, quality metrics, mindless documentation of utter clinical irrelevance for bean counters), coupled with dwindling reimbursements and out-of-hours coverage will create a perfect storm. All it would need is a high school reunion or residency reunion for the senior radiologists to decide en masse to retire en masse and enjoy their well-earned timeshares.
So what’s the bad news? The bad news is that we are likely to working a lot harder for a lot less with more paperwork to fill than the CIA. So my advice is: Hang in there, read Seneca (he was a stoic), develop a hobby for the weekends, and don’t ask orthopedic surgeons what kind of car they drive.
Saurabh Jha, MD, MRCS, MS is assistant professor of radiology and cardiovascular imaging at the Hospital of the University of Pennsylvania and a member of the Diagnostic Imaging editorial board.