Is There a More Efficient Approach to Constructing a Radiologist?
Amid a variety of alternative approaches to addressing the radiologist shortage, one should be mindful of the educational track it takes to become a radiologist.
You might have heard that there is a shortage of radiologists. I have talked about it in previous editions of this blog, but much deeper dives have been done elsewhere, including all sorts of trends and statistics. One I stumbled across recently was that the number of imaging studies is expected to increase by up to 5 percent each year, while the number of residency training spots rises 2 percent. That is not a self-correcting formula.
With any shortage, it is worth examining ways to increase supply (hence noting the insufficient 2 percent residency growth). Make the shortage big enough or sufficiently prolonged, and it becomes “background noise” for folks living with it. The issue is never far from their minds. Potential remedies can intermittently spring to mind, even without active brainstorming.
Ninety-nine percent may be dead ends but can still serve a purpose. A podcaster I like occasionally refers to such things as “bad idea” exercises. In other words, he will float a notion that he knows is probably non-viable (even if he can’t specify why it is no good). Then, as either he or his audience considers why it is a bad idea, they improve upon it or are inspired to come up with a better alternative that might not have come to light without the bad idea to get the ball rolling.
What was my “bad idea” this past week? With a supply shortage of radiologists, maybe it is worth looking at what it takes to build a rad. Perhaps we can construct rads faster or more efficiently.
The system I know is the one in the United States of America where I live. Right now, it takes an undergraduate degree (four years), med school (another four years), and residency (four years, plus another one for internship). That is a 13-year pipeline, and you can add to it if you want your rads to be fellowship-trained. A little trimming can occur with maneuvers like getting the undergrad degree done in three years, but not everyone is capable of that.
I am far from the first to regard this and wonder: Is everything in those 13-plus years really necessary? That is, if we have a worsening shortage (a crisis in the future if it is not already), shouldn’t we at least consider that some academic pruning may be in order?
A non-scholarly review does not show me any point in modern history that there was a substantially shorter path. That is, one couldn’t skip directly from high school to med school, nor could one short-circuit med school to do radiology training with an undergrad degree.
There are valid reasons for this. Learning/understanding/mastering certain things requires that other more fundamental things be learned first. A certain degree of gatekeeping is fitting too. If 10 people say they want to be a rad, but only one of them has the wherewithal to pass classes in biology, anatomy, etc, we might not want to waste time and resources on the other nine.
When this system got developed, society as a whole was a lot less specialized. Folks used to have a broader base of general skills. If we could magically grab 100 young people from the 1920s and another 100 from today, and give them each similar sets of supplies to live in the wilderness, is there any wonder which would turn out better? Society has, for better or worse, decided that it is okay for folks to have less “Jack of all trades” capability.
That hasn’t happened (yet) with the established system of doctor creation. Rads have the same nuts-n-bolts medical and pre-medical training as any other doc, just as someone from the 1920s might have been able to maintain a garden, fix basic mechanical stuff, or go hunting. Do we really still need that? How many rads are likely to go into work and find out that they are going to have to retool themselves as, say, surgeons?
Before going further, I will step back and repeat something I have previously mentioned in this blog. As a med student contemplating specialties, I opted for radiology because it made use of the most of what I had learned. In other words, doing peds would leave my geriatrics knowledge on the shelf, doing ob/gyn would discard what I had learned about males, etc. It wasn’t that I ever expected to switch to any of those other specialties. I just prized what I had learned and wanted to “keep” it.
Not everyone has the same attitude, and I don’t blame them. Thirteen-plus years is a long time to be plugging away before one can even begin a desired career. If people wanted to, say, lock themselves into being rads without having the option of doing other types of medicine, and could do it in a shorter interval while helping to alleviate the rad shortage, would it be a disservice to society?
So, as my “bad idea” formed, I thought through the various bits of med school education. Can you construct a rad without every last bit of it? Undergrad seems easy to tweak. I could condense all of my pre-med requirements into two years, and I don’t think any of my work as a doctor would suffer for my not having studied things like philosophy, economics, and French.
Mentally walking through my med school curriculum, I decided it would be easier to consider what couldn’t be done without than what could. Building a radiologist, for instance, would require anatomy (gross as well as neuro) in the same way building a house would need supporting walls. Embryology was a separate course for me but seemed nearly as vital. A rad who never learned how things developed would be moderately hamstrung.
Some things seemed particularly easy to leave on the cutting room floor. I will single out behavioral science, partially because I suspect few would disagree with me but also because my original aim was psychiatry. I found the subject that compelling but am still of the mind that it has been pretty irrelevant to my radiological career. I was pretty confident that histology could be skipped as well.
I couldn’t see any good reasons to cut away at the core clinical clerkships. For most rads, those clinical clerkships and internship are the only chances we get to see the perspective of referrers who send their patients for imaging. Elective rotations (dermatology, for instance) might be skipped more easily.
To get buy-in from rads, other docs, etc., these cuts would have to be very conservative. Everybody has got their own ideas about what is “essential” for competence in our field. Pretty much anything removed would alienate a percentage. Do that enough and you would no longer have enough of a “critical mass” to proceed.
Meanwhile, in absence of our finding a way we can approve to increase rad supply, the system has come up with one on its own: Giving radiological privileges to folks who haven’t gone through med school or residency at all. How much buy-in has that gotten from rads who have done the 13-plus year approach?
Physicians of other specialties might not have quite as strong feelings on the matter, but I can’t say I have seen anything resembling standing ovations and we haven’t seen encouraging things in terms of their clinical or cost-saving impact.
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