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Should radiology residency be reduced to 3 years?
Our leaders are still working on changing radiology residency structure.
To my knowledge, radiology residency was changed from three to four years in early 80s with the intention of having a focused sub-specialized fourth year. In early 80s it was decided that the field was growing rapidly and there was a need for more sub-speciallization. However, that model never happened.
For 20 years for unknown reasons, our leaders and academic centers were happy with the structure of training. In mid 2000s, it was decided that the structure of training should be changed. A mixture of good intentions and self-serving intentions in academics got together and changed the structure of training. I was lucky to be one of the last classes in the old board format. The new board format added more problems to the new trainees. To my knowledge, spending fourth year as a full fellowship has never been emphasized in the new model and people have been talking about mini-fellowhsips.
Going back to my first discussion. It is depressing that the training structure that was supposed to be implemented in early 80s ( i.e. 3 years of residency and one year of sub-specialization) has not been implemented yet in year 2015 and our leaders are still talking about it. Similar to what happens in IR. In the last 15 years the structure of IR training has changed multiple times and still nobody knows what will happen to the direct IR residency.
In a bigger picture, the structure of training is one of less important problems in today’s radiology at least for people who want to join private practice. Still more of community radiology is general radiology and not high end specialized imaging. While we need the latter, the former is the majority of work that we do.
It is annoying that rather than talking about decreasing the number of trainees, ways to improve job market, ways to attract top medical students to the field and discussing other major issues in the field, academic radiology is still in doubt about the best training structure. From a medical student perspective, a field that changes its structure of training and structure of board format every now and then is not a stable enough field to pursue. Right or wrong, a medical student seeks a field with a stable training structure and a stable job market.
Sorry for the long post. Couldn’t stop my anger. Rather than these BS posts, I expect to open radiology news one day and see an academic department talking strongly about decreasing the number of trainees.
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31 Replies
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Totally agree. However, I think the real point of the article though is that the mini-fellowship year that was supposed to occur in fourth year by virtue of moving the core exam to the end of third year simply doesn’t really work because places still need fourth years to cover services while the third years now study. The myth of protected time to do a “mini-fellowship” proved illusory to all but the larger academic centers. The way to fix this problem really isn’t to create more formal fellowships in fourth year to give those fourth years “protected time”, so much as just make the core exam something third years don’t need months of studying to pass. something the third years should easilly pass just being on service, as was originally advertised. As such this is a hugely contrived fix that could be obviates if the ABR just did as they promised and made a simple test. If they made this something 90% should pass with zero studying, fourth years could do their minifellowhips and this article would never be needed.
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by the end of one’s third year, the resident is pretty competent. the 4th year is so the resident can become more skillful and a free radiology attending; while the paid $$$$ attending chills…………..
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be a free radiology attending
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“oh yeah, 4th year residents are competent to work as attendings. ”
Perhaps you have some hokey attendings at your residency program or you have some savant 4th years.
In the course of my PGY-2 through PGY-7 at top places, I’ve worked with some pretty sharp 4th year residents, but I wouldn’t want any of them to interpret a family member’s imaging without a real attending looking over everything.
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I don’t agree with Anonymous 22’s point, and do think this article is more based on the failings of mini fellowships stemming from the ABRs mishandling of the Core, than about an actual need to restructure residency. As to your (Flounce) latter point though, to be fair though, a lot of 4th year residents on June 30 will be non-ACGME fellows on July 1 “interpreting family members imaging without a real attending looking over everything”, and signing off on those reports. So yeah, I’d say they are deemed competent to work as attendings — not much changes in that one day.
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As for non-board certified, non-ACGME fellows vs. 4th year residents… just because they are interpreting someone’s imaging independently doesn’t mean that I’d want them to do it for my family. My preference is to lump all these trainees who should not be acting as attendings in residency training programs into one big group, rather than splitting them into different groups of people in whom I lack confidence to varying degrees. I guess I’m a lumper and not a splitter.
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Quote from Anonymous 22
by the end of one’s third year, the resident is pretty competent.
[:D][:D][:D]
Pretty cocky statement!! That’s how I was thinking when I was a third year.
I agree with Flounce.-
It’s understandable. By the end of third year residency, you feel comfortable calling acute appendicitis, colitis, ureteral stones, DVT, acute subarachnoid, and have substantially decreased your overcalling of PEs.
Since you can survive a bad night of solo call at a Level 1 trauma center, you have some confidence and feel that this radiologist thing isn’t so complicated after all.
Thing is, you ask that same resident to prepare and present the cases the ENTs want to discuss at the Head and Neck Multidisciplinary conference; or the liver lesion conference with GI; or the tough MSK cases that the orthopods wants to discuss; and that confidence will drain away in a pool of yellow and brown liquid that stains your scrubs.
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“Thing is, you ask that same resident to prepare and present the cases the ENTs want to discuss at the Head and Neck Multidisciplinary conference; or the liver lesion conference with GI; or the tough MSK cases that the orthopods wants to discuss; and that confidence will drain away in a pool of yellow and brown liquid that stains your scrubs.”
Pretty sure if you asked any attending breast imager or pediatric radiologist to do those things, they wouldn’t be so confident either. So it’s not about attending versus resident. It’s about being asked to do something you have a ton of experience in, versus not.
I think after about 3 years a hardworking resident would be able to handle 99% of things in general community practice. And for the 1% that is beyond their capability, to know when to consult a subspecialist or refer out to the tertiary care center.
Residency isn’t the end of education; neither is fellowship, or two fellowships. It takes about 10 years to become great at anything. That doesn’t mean training should be 10 years long.-
Quote from golden gate
Residency isn’t the end of education; neither is fellowship, or two fellowships. It takes about 10 years to become great at anything. That doesn’t mean training should be 10 years long.
+1-
I am curious where we think lowering the amount of training to be a radiologist combined with the fact that fewer and fewer quality applicants choose radiology will land us.
Rads filled 59% of slots with USA graduates this last match, plummeting further from prior years. There are many fine foreign graduates, but everyone understands this to mean that the quality of the applicants is dropping.
Setting aside the number of graduates debate, do we really think that a combination of less competitive condidates and a 25% reduction in radiology training time is going to translate into equivalent or better care in the future?
Maybe I am looking at this from the wrong perspective, but this seems to fail the common sense sniff test.
If you are going to eliminate a year, eliminate the intern year requirement. It was added in 1996 on a lark to convince our colleagues that we are clinicians too. That is really not necessary at all, they know our worth and order imaging because of it.
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The article didn’t actually suggest a reduction of training, but rather making fourth year a true fellowship. The title was misleading/sensationalist.
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Totally agree on cutting intern year, especially if DR and IR become separate residencies.
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I don’t agree with cutting intern year. Does it stink? Yes, but you learn some medicine (or surgery) and get a better idea for what our medical or surgical colleagues are looking for from a rad. Cutting internship would make us even more vurnerable (i.e. lazy) in the eyes of other collegues. And that does nothing to help solve supply and demand problems.
And I think residency should still be 4 years – lots to learn. But there should just be more flexibility in the 4th year – either you continue training where you are with standard electives or you can focus like a fellowship or perhaps even “transfer” for a 4th year fellowship.
But the worst change in all of this is the altered Board exam timing. All the crap about 4th years not working hard enough was just not true. I did lots of call a but also learned a great deal studying for the oral boards, with lots of attending and fellow/resident help discussing cases. And moving the certification back to end of 4th year would get rid of this limbo a bunch of recent grads fin themselves in… -
Yep. None of this would even be discussed if the ABR didn’t screw up so bad playing with the timing of the test OR making a test you still have to spend months preparing for. I think they could have gotten away with either or seamlessly, or an easy test in third year that allows third years to stay on service and not study so fourth years could do minifellowships, or a hard test in fourth year, like the orals but on computer. But they tried to dock around with too much and as a result created the worst of all worlds– they moved board frenzy to third year which made minifellowships impossible because 4th years now have to cover for studying third years AND people don’t finish fellowship BC to boot. I don’t know who this helps but they certainly dicked over lots of new entrants to the profession without much tangible benefit. With moves like this I really wouldn’t be surprised if next years match makes this one look good.
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Ah thanks I should have rtfa
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Agree the new certification process is a huge boner in every way, from timing, to pertinence, to usefulness. The prior system was so much more applicable to certifying trustworthy graduates. The written was still far too esoteric, but the overall scheme was far more appropriate, particularly the timing.
I think the internship is invaluable, in understanding clinical surgical medicine, developing patient and clinician empathy, and making one a more well rounded clinicopathoanatomic imaging expert.
And why the f#£ do we need a PG5 fellowship when there is a PG6 fellowship? The push for subspecialization is detrimental in every setting other than high academia, and pushing it this way takes that much more away from producing radiologists who are experts in all facets, which is what is necessary in the great wide world outside the gleaming towers of self stroking glory.
I would so much rather hire a nonfellowship trained grad with confidence, moxie, a good eye, and work ethic, than most of the fellowship trained hires I’ve seen. Someone who knows a ditzel from a thing, and knows how to say so.
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Okay, maybe a bit over the top, but you get my chiz.
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+1
I would so much rather hire a nonfellowship trained grad with confidence, moxie, a good eye, and work ethic, than most of the fellowship trained hires I’ve seen. Someone who knows a ditzel from a thing, and knows how to say so.
I have known some pretty lame sub specialists. -
Quote from RADD2010
+1
I would so much rather hire a nonfellowship trained grad with confidence, moxie, a good eye, and work ethic …
I also value those qualities.
But nonfellowship trained grads don’t hold a monopoly over those qualities.
In recent history when most people have been doing fellowship, there is no reason why the lack of fellowship would confer those qualities to a radiologist and the choice to do fellowship would take away those qualities in someone that had them.
The more likely scenario is that radiologists who graduated many years ago, when fellowships were not routinely done, have more experience and confidence and real world savvy by nature of having graduated earlier and having worked more. If you hire someone who’s been working as in PP for 15 years, of course they have more confidence.
Radiologists who recently graduated, when fellowships have been routinely done, have less experience and confidence… by nature of having graduated later and having worked less. The lack of confidence is not because they did residency at MGH or did MSK fellowship at Duke, it’s because they’ve only been working for 2 years in PP.
I – as someone who also values the qualities you mentioned above and also being someone who went to so-called Top 3 programs and did two fellowships – I’ve found that those who are older and did not do a fellowship or trained in community programs (and are now often the ones calling the shots in PP groups) sometimes are prejudiced against the recent grads who entered radiology at a time when it was more competitive, went on to top academic programs, and have strong fellowship training.
Radiologists come in all flavors, and you have lazy rads without fellowship and lazy rads with fellowship, this is apparent to those in large groups. -
Quote from Flounce
I also value those qualities.
But nonfellowship trained grads don’t hold a monopoly over those qualities.
In recent history when most people have been doing fellowship, there is no reason why the lack of fellowship would confer those qualities to a radiologist and the choice to do fellowship would take away those qualities in someone that had them.
The more likely scenario is that radiologists who graduated many years ago, when fellowships were not routinely done, have more experience and confidence and real world savvy by nature of having graduated earlier and having worked more. If you hire someone who’s been working as in PP for 15 years, of course they have more confidence.
Radiologists who recently graduated, when fellowships have been routinely done, have less experience and confidence… by nature of having graduated later and having worked less. The lack of confidence is not because they did residency at MGH or did MSK fellowship at Duke, it’s because they’ve only been working for 2 years in PP.
I – as someone who also values the qualities you mentioned above and also being someone who went to so-called Top 3 programs and did two fellowships – I’ve found that those who are older and did not do a fellowship or trained in community programs (and are now often the ones calling the shots in PP groups) sometimes are prejudiced against the recent grads who entered radiology at a time when it was more competitive, went on to top academic programs, and have strong fellowship training.
Radiologists come in all flavors, and you have lazy rads without fellowship and lazy rads with fellowship, this is apparent to those in large groups.
A recent grad from a top program with an MSK fellowship at Duke or UCSD is a know commodity. Looking at their application and talking to their references that you may know many of them in person, gives you a very good guess about their skills, their strength and their weakness and their shortcomings.
However, older radiologists or graduates of community programs are less known commodities. While I have found some of the best radiologists among this group, I have also found very crappy radiologists among them. In other words, the standard deviation is much broader in this group. Whether to choose from the first group or from the second group comes down to the priorities of a group and their referral base. We have a neurology group who wants only a fellowship trained neuoradiologist read their MRIs. You can not convince them that Mr. James who has been in practice for 15 years is better than a recent neurorad fellow from UCSF.
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I think the required intern year is a joke. I was fortunate to not have to do one but still went 4+1 with a Neuro fellowship I have worked with many young rads who have done a clinical year and many of them are not comfortable with clinical decision making. Many of them run faster from a code than I do but probably because they are younger. Radiology should go back to a 4 year residency at the least and if the Board is making it so specialized make it 3+1 year of fellowhip training.
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Intern year was a waste
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I wasn’t suggesting that non-fellowship trained rads hold an edge in liklihood of the qualities I listed, nor was I speaking of someone who is fellowship trained but may lack experience and therefore confidence, etc, compared to someone who has years of experience and the attendant confidence. I was suggesting that between a new grad, whether fellowship trained or not, I would prefer the one who could exhibit and enact those qualities, rather than just picking the fellowship trained rad. I know that confidence will grow with experience, but there is also a wide range of confidence in inexperienced newbies, (and among rads with years of experience for that matter), and my experience is that adding a fellowship doesnt do much to add that degree of confidence, I think it is more a function of the individual, not the training, and whatever and wherever the training is had, the degree to which it is assimilated into usable form is more dependant on the individual than the institution.
For the same reason, I respectfully disagree with CommunityRad, in that I don’t find that a fellow from MGH, or Hopkins, or Mayo is a “known commodity”. It is the individual that makes the rad, to a greater degree than the training. Just my anecdotal opinion.
“The curriculum of medical education has been well standardized for decades, the consumption of it, however, has not”. -JRG
Put another way, there is a greater difference between #1 and #100 in the same class at the same institution, than there is between #1 in a midling institution, and #1 at the “best” institution. Being #1 says something about that individual above and beyond being smart. Now, what it says may not be qualities that make the best physician, but that is another discussion. -
Quote from uncleduke
I think the internship is invaluable, in understanding clinical surgical medicine, developing patient and clinician empathy, and making one a more well rounded clinicopathoanatomic imaging expert.
Do you not have confidence in your pathologists because they don’t have an intern year? Do they not have the same empathy you have? Are they not well rounded? -
While we’re at it, lose a year of medical school. 4th year? Talk about a waste. You could easily do that in 3. Notice all the commonalities though when these things are lengthened? Extra labor.
The biggest scandal in my view, in all this, is that 3rd year cost the most (all we did was follow a system of residents already set up) of all the med school years – and no, a residency coordinator and other academic physicians also already have the job – and that as residents CMS pays probably closer to 150k now to the hospital, which only pays about 1/3 of that to the resident doctor. Who does overnights etc, up the wazoo. More grifting, as usual.
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Quote from Flounce
It’s understandable. By the end of third year residency, you feel comfortable calling acute appendicitis, colitis, ureteral stones, DVT, acute subarachnoid, and have substantially decreased your overcalling of PEs.
Since you can survive a bad night of solo call at a Level 1 trauma center, you have some confidence and feel that this radiologist thing isn’t so complicated after all.
Thing is, you ask that same resident to prepare and present the cases the ENTs want to discuss at the Head and Neck Multidisciplinary conference; or the liver lesion conference with GI; or the tough MSK cases that the orthopods wants to discuss; and that confidence will drain away in a pool of yellow and brown liquid that stains your scrubs.
4+.
I did a 50% Nucs- 50% mammo fellowship. In my residency among residents Nucs was considered memorization of radio-tracers + some colors added to CT. “Just see where the tracer lights up on PET-CT” mentality. It was the second week of my Nucs fellowship that my Nucs attending (radiologist + Nucs fellowship) asked me to prepare cases for tumor board which appeared to be easy to me in the first place. By the end of the tumor board, I found out that she intentionally asked me to do tumor board at the beginning of my fellowship to remind me that I had a long way to go (She had good intentions).
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No. Eliminate residency. Just do three year fellowship. Teleradiology has made the gereralist obsolete.
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No 3 years cheapens the specialty
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Keep radiology 4 years but get rid of intern year and let general radiologists work without fellowships.
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