I closely track job prospects in radiology because of the similarity of the field to pathology. Two years ago, I posted a note about the declining job prospects in radiology (see: Radiology Jobs Trend Downward; Blame Technology and Reimbursement). A recent article provides more evidence about this decline (see: Job Prospects Are Dimming for Radiology Trainees). Below is an excerpt from it:
For years, medical students who chose a residency in radiology were said to be on the ROAD to happiness. The acronym highlighted the specialties — radiology, ophthalmology, anesthesiology and dermatology — said to promise the best lifestyle for doctors, including the most money for the least grueling work....Recent radiology graduates with huge medical school debts are having trouble finding work, let alone the $400,000-and-up dream jobs that beckoned as they signed on for five to seven years of relatively low-paid labor as trainees....At St. Barnabas Hospital in the Bronx, a dozen radiologists in training....are suddenly stranded on an expensive road to nowhere. All received termination notices recently because their hospital is ending their residency program next year as part of a plan to replace its radiologists with a teleradiology company that reads diagnostic images remotely....
Few specialties have been immune to the same factors depressing radiology: deep Medicare cuts, cut-rate competition driven by technology, doubts about the health value of many tests and procedures and new measures to tilt public money to primary care....Starting in the 1980s, the advent of technology like M.R.I.’s and CT scans, combined with a fee-for-service system, created ballooning demand for imaging and drove the compensation of radiologists to unsustainable heights, he said....By 2001, with the supply of radiologists limited by a 1997 Congressional cap on all Medicare-supported residencies, nighttime demand was unmanageable for smaller emergency rooms. So-called nighthawk radiology services began pooling the diagnostic imaging loads of several hospitals and transmitting them electronically to American radiologists stationed overseas or working from home.... Now the nighthawk companies, staffed by recent radiology graduates, are competing for the daytime work, too....
Medicare payments, which, besides their pay, is supposed to cover malpractice insurance and education in the program....But the hospital will not release the money to other programs where the radiology residents could complete their training, [a] hospital spokesman said, because it plans to use the money to expand primary-care residencies. That decision could be seen as a small victory for national policies intended to bolster primary care. But to many St. Barnabas residents, it mainly shows that the system of graduate medical education is broken....”St. Barnabas, a 461-bed community hospital that lost $10 million last year and pays its chief executive nearly $1 million annually, now contracts with a traditional group practice of 18 radiologists to be its radiology department....
In desperation to find a new traineeship... a fourth-year resident, offered to work without pay. He said hospitals told him that it would be unethical to accept free labor, or that training him would still be too costly without additional money for malpractice insurance and benefits. One hospital, McLaren Macomb, in suburban Detroit, instead offered several residents slots in its “unfunded program,” in which most radiology residents essentially pay for their own positions through donations, typically from a spouse or parents: $65,000 a year to cover a $42,000 salary and $2,000 for expenses.
There are so many juicy issues raised in this story and I hardly know where to begin. For this note, I will restrict myself to teasing out only the following major points that I hope to discuss in more detail in later posts.
- Radiology has historically been viewed as a highly desirable field for recent graduates because of good hours and attractive compensation.
- After the boom years fueled by the emergence of new imaging modalities, radiology is now contacting due to cost-cutting by insurance companies and the federal government.
- Radiologists are also becoming more efficient individually due to the deployment of RISs/PACSs.
- Many saw their net worth declining in recent years and are also postponing retirement, diminishing the availability of open hospital slots.
- As a cost-saving measure, hospital CEOs are dismissing their local radiology groups and outsourcing both night and day work to outside teleradiology ("nighthawk") groups.
- With no radiologists on-site to train radiology residents, a group of them have been dismissed by St. Barnabas Hospital in the Bronx.
- Medicare money, earmarked to resident training, is diverted by St. Barnabas executives to primary care specialities, leaving the radiology residents in the hospital adrift.
- Other hospitals are offering "unfunded" radiology training programs where the young physicians are being asked to pay for their post-graduate training. This is on top of their medical school debts and without rosy prospects for subsequent employment as fully trained radiologists.
- The situation in radiology training will self-correct (i.e, new medical school graduates will know to avoid the field) but there are large numbers of them still in the training pipeline.