Supply and Demand: Still a Dynamic Duo

March 20, 2015

Supply and demand play big roles in radiology.

With radiology being a somewhat small world, it’s no surprise that even somebody as non-academic as I gets word through the grapevine of what’s doing in the residency Match. Evidently, this year there were about twice as many unfilled radiology spots as last year, and this has some folks very excited. Heaven help me, I might become one of them.

When I was at the tail end of med school and going through the Match myself, radiology spots were supposed to be pretty easy to get. The rationale was that the job market was lousy, and newly-minted physicians with a competitive edge (high GPA, publication, not seeming overtly sociopathic during interviews, etc.) were heading for specialties that promised brighter futures.

I have no idea how long that state of affairs had been in effect, but it abruptly ended just as I was applying. The latest set of statistics suddenly revealed that-surprise!-the job market had become wonderful, and there was now an imminent radiologist shortage. A stampede of applicants came out of the woodwork, and I wound up being grateful to get a residency spot at all.

During the next few years, I heard from more than a couple of rads about how this was all cyclical, and one could either get accustomed or experience intervals of panic and euphoria for the rest of one’s career. This wisdom seemed reasonable enough, although no two rads seemed to agree on precisely what part of the cycle the field was in. At least their perspectives were more pleasant to hear than that of the doomsayers who insisted that the good days were done and gone…the only cycle they predicted was an inevitable death-spiral for the field, and woe betide anyone who had just entered it.

I don’t know whether we’re in a cycle or not. From my perspective, since I emerged from fellowship, it has gotten progressively less pleasant to be a working radiologist. Jobs have dried up, giving employers confidence to offer ever less to their wage slaves while demanding evermore from them. The field, and health care around it, have become much less inviting to those who might once have responded to a lack of good jobs by sticking their financial necks out to create their own. If this is indeed a cycle, it seems the trough is lasting a lot longer than the last peak did.[[{"type":"media","view_mode":"media_crop","fid":"33286","attributes":{"alt":"supply and demand","class":"media-image media-image-right","id":"media_crop_9685341069349","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3512","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 126px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©woaiss/Shutterstock.com","typeof":"foaf:Image"}}]]

Nevertheless, I’ve heard intermittent talk about how this cyclical downturn is just being prolonged by excessive radiologists in the workforce. In other words, too much supply of us rads versus not enough demand. I’m not sure how anybody could look at the typical imaging workload of a rad now versus a decade ago and say that there’s a dearth of demand for our services…but such points are rather academic since we have no control over utilization anyway.

Inevitably, the chatter amongst rads turns to solutions like 1) Older rads need to retire, or 2) Residency positions need to get cut, which is rather amusing, since most of us have just as little control over those matters. Residency hospitals aren’t looking to trim their workforces, and elder-statesman radiologists who have a motivation to go on working and the ability to do so with competency hardly deserve to be given the bum’s rush.

None of which is taken well by the “we’ve got to do something about this” crowd. After all, without corrective action, what’s to make things any better for those of us still looking to make a living in this biz for the next few decades?

If the rumored Match statistics are accurate, it seems we have our answer. Supply and demand don’t just pertain to rads already in the workforce versus anticipated volumes of imaging. It also impacts medical students looking at the different specialties and deciding what sort of career they’re about to have. And right about now, it seems the students have heard enough about what’s doing in radiology that their demand to enter the field is on the wane. This, in turn, will diminish the supply of rads in years to come just as effectively as the more artificial interventions mentioned above.

The question then will be how long the field takes to get back to a place where competitive med students want to apply. Or, the more cynical might retort, whether that is ever likely to happen again.