I have blogged before about the shrinking residency and job opportunities in radiology (see: Job Prospects Dimming for Residents in Radiology; Defining the Underlying Problems; Radiology Jobs Trend Downward; Blame Technology and Reimbursement). Also see this: Job Prospects Are Dimming for Radiology Trainees. This seems to be the result of a number of factors including: (1) incumbent radiologists are able to work more efficiently due to RIS/PACS support; (2) some radiologists have reportedly postponed their retirement due to the financial downturn in 2008; (3) teleradiology enabled some radiologists to find part-time or full-time positions working from home; (4) teleradiology has also enabled some hospitals to outsource their radiology departments to "nighthawk" firms (see: Dayhawk Radiology and the Decline of the General Radiologist). Below is an excerpt from a recent article on this topic (see: Radiologists Having a Hard Time Finding Residency As Teleradiology Takes Over “Day” Jobs):
Radiologists and orthopedic surgeons are still at the top of the doctor occupation chain but those jobs too are facing reimbursement cuts. In [one hospital], which is losing money, ...[radiology residents]... were given their pink slips. The hospital is ending the residency program and is going with Teleradiology that reads images remotely. So these students need to look elsewhere to finish their post graduate training. The next obstacle is getting a job as if this hospital is relying more on remote image reading....Medicare too has made cuts with radiology reimbursements in order to shift more over to primary care, which is not a bad thing, except when you have the remote services coming in and replacing them instead of less income....Anesthesiologists, facing competition from nurse anesthetists and California just passed a law to allow more use with nurses with anesthesia. Dermatology and Ophthalmology are the only two entities that are seeing an increase or staying level....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.....Radiologists still make twice as much as family doctors, but are high on the list of specialists whose incomes are in steepest decline....On Internet forums, younger radiology residents agonize about whether it is too late to switch tracks....Though outsourcing to India grabbed headlines, the big growth in teleradiology was domestic. Now the nighthawk companies, staffed by recent radiology graduates, are competing for the daytime work, too. 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 is some irony in the fact that the field of radiology, as a ROAD medical specialty (see above), is attractive to medical students for reasons of lifestyle. However, the better hours and more sedentary demands of the specialty also enabled some older radiologists to remain in their positions past the usual retirement age. One radiologist told me that he was working twice as hard to maintain the same income and that his RIS/PACS systems have enabled him to do this.
When writing this note, my mind was drawn to the field of interventional radiology that has been booming for years. I think that this continues to be the case. There is one cloud on this horizon, however, for radiologists. As intravascular approaches to certain lesions such as abdominal aneurysms becomes more common (see: Endovascular Grafts for Abdominal Aortic Aneurysms), some surgeons will be also be learning these techniques. For example, the Integrated Pathway of the American Association of Thoracic Surgery includes a rotation in interventional radiology.