Nuclear Medicine--Beware!

[Buck Thesystem]

I'm a board certified nuclear medicine physician with 10+ years of experience, (including PET-CT). I chose to leave the field and work in another branch of medicine, mainly due to the large number of shady operators and downright crooks in the field. Some examples:

My first job out of residency training was with an elderly Nuclear doc who was a throwback to the Jim Crow South. When I arrived for my interview, I exchanged pleasantries with one of his technologists, who happened to be of East Indian ethnicity. The doc's first words to me, "You'll never get very far here being nice to a [N word]!" This guy used extortion, character assasination, and just about anything else you could think of to run roughshod over his competition. However, he was just about the only person in the country who was offering jobs to nukes without radiology training, so I signed on with him until I could find something else.

The next person who offered me a job was a "venture capitalist" who sold PET scanners to Oncology groups, and hired docs trained to read the scans. His MO was to hire a Nuke, have the Nuke PRETEND TO BE A CANCER PATIENT, and make an appointment with the oncologist! When the Nuke got through the exam room door, he was supposed to start his sales pitch! Needless to say, I wasn't interested in perpetrating fraud, so I declined.

My most recent job offer was from a doc in the Houston area, who offered me a contract that both my attorney and CPA told me was patently illegal. This guy was trying to set up a relationship where I would be an independent contractor in theory, but his employee in practice. The IRS frowns on such duplicity.

My point: There are jobs available for non-radiologist nukes, but there isn't a CRITICAL MASS of jobs available. You may land a job as a nuke, but if you end up working for or with a crook or a slimebag, there will be very few, if any, opportunities to find something better. You have to ask yourself, is working in your chosen field important enough to sacrifice your self respect?

I'm now practicing general medicine, and a large number of my patients are incarcerated felons or drug addicts. I treat mass murderers, serial rapists, and mothers who would sell their children for a hit of crystal meth. All things considered, I'm associating with a much better class of people than I ever met as a nuclear medicine doc!

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[Faebinder]

I'm a board certified nuclear medicine physician with 10+ years of experience, (including PET-CT). I chose to leave the field and work in another branch of medicine, mainly due to the large number of shady operators and downright crooks in the field. Some examples:

My first job out of residency training was with an elderly Nuclear doc who was a throwback to the Jim Crow South. When I arrived for my interview, I exchanged pleasantries with one of his technologists, who happened to be of East Indian ethnicity. The doc's first words to me, "You'll never get very far here being nice to a [N word]!" This guy used extortion, character assasination, and just about anything else you could think of to run roughshod over his competition. However, he was just about the only person in the country who was offering jobs to nukes without radiology training, so I signed on with him until I could find something else.

The next person who offered me a job was a "venture capitalist" who sold PET scanners to Oncology groups, and hired docs trained to read the scans. His MO was to hire a Nuke, have the Nuke PRETEND TO BE A CANCER PATIENT, and make an appointment with the oncologist! When the Nuke got through the exam room door, he was supposed to start his sales pitch! Needless to say, I wasn't interested in perpetrating fraud, so I declined.

My most recent job offer was from a doc in the Houston area, who offered me a contract that both my attorney and CPA told me was patently illegal. This guy was trying to set up a relationship where I would be an independent contractor in theory, but his employee in practice. The IRS frowns on such duplicity.

My point: There are jobs available for non-radiologist nukes, but there isn't a CRITICAL MASS of jobs available. You may land a job as a nuke, but if you end up working for or with a crook or a slimebag, there will be very few, if any, opportunities to find something better. You have to ask yourself, is working in your chosen field important enough to sacrifice your self respect?

I'm now practicing general medicine, and a large number of my patients are incarcerated felons or drug addicts. I treat mass murderers, serial rapists, and mothers who would sell their children for a hit of crystal meth. All things considered, I'm associating with a much better class of people than I ever met as a nuclear medicine doc!

The problem with nuclear medicine is that the tests are freaking expensive. A quote from my program director commenting on one of our affiliated VA hospitals "It would take an act of congress to order a PET scan in the VA". I hope you find a good academic job. Consider picking up an IM residency, that way you can get double certified and not have to depend 100% on NM.

 

[Buck Thesystem]

The problem with nuclear medicine is that the tests are freaking expensive. A quote from my program director commenting on one of our affiliated VA hospitals "It would take an act of congress to order a PET scan in the VA". I hope you find a good academic job. Consider picking up an IM residency, that way you can get double certified and not have to depend 100% on NM.

I'd really like to do that. Do you know of any IM residencies that would consider an applicant in his mid-50's?

 

[Buck Thesystem]

I'd really like to do that. Do you know of any IM residencies that would consider an applicant in his mid-50's?

Academic job openings in NM have about 50-100 applicants for every open position (that "critical mass" problem again!)

 

[Faebinder]

I'd really like to do that. Do you know of any IM residencies that would consider an applicant in his mid-50's?

Don't see why not. Redo the USMLEs cause yours are probably ancient. Make sure you pass first try on the first two steps (I dont see the need to pass step 3, you already did long ago). Meanwhile, apply to programs that have open IM 2 or FM second year spots. They will use your nuclear medicine rotations to fill in electives. It's really negotiable, you are in better shape than many applicants.

If you did 1 year of internship in IM or TY for your nuc med, then you can probably easily apply to neurology, PMR, radio-onc, anesthesia. Plenty of programs out there. Get an LoR from docs in each of those specialties and you are all set.

 

[Buck Thesystem]

Don't see why not. Redo the USMLEs cause yours are probably ancient. Make sure you pass first try on the first two steps (I dont see the need to pass step 3, you already did long ago). Meanwhile, apply to programs that have open IM 2 or FM second year spots. They will use your nuclear medicine rotations to fill in electives. It's really negotiable, you are in better shape than many applicants.

If you did 1 year of internship in IM or TY for your nuc med, then you can probably easily apply to neurology, PMR, radio-onc, anesthesia. Plenty of programs out there. Get an LoR from docs in each of those specialties and you are all set.

I've already sent in applications to about 175 different programs over a 3 year period--no offers of interviews from any of them. When I contact the program directors by phone, they all say the same thing: "you're too old!"

If you know of any SPECIFIC programs I might contact, let me know!

 

[f_w]

Mh, quite a different perspective from the fairy tales in other threads on this forum.

 

[apich214]

I already in nuclear medicine for 6 month and no way out to back in radiology. But I think it will better in next future.

 

[horizon411927]

Oh that has shown a different face of this field...i was thinking to advice my cousin about this course but after reading this i wont do that.
thanks to share this...

 

[rick sambora]

Oh that has shown a different face of this field...i was thinking to advice my cousin about this course but after reading this i wont do that.
thanks to share this...

Do not judge the specialty or the people who practice it based on one experience.

 

[Cathance]

deleted....

 

[Astrocyte]

I stumbled onto nucs during the last year of my neurology residency, as I learned about amyloid imaging. Now I am happily in my nucs residency, learning anatomical radiology at the same time.
I have been amused by people's reaction when I tell them my background. Most of them assumed I have abandoned neurology. Some of them probably think (without saying it) I am trying to get into a radiology residency.
But I think subspecialization within radiology, incorporation of more anatomical imaging into nucs training, and consensus in certification between rad and nucs will soon make rad residency unnecessary for nonrad nucs docs. This is already evident in the academic setting. By the time I finish my nucs residency, I hope to be eligible for certification by the American Society of Neuroimaging (neurologist organization), with vouch of competence from fellowship-trained neuroradiologists. So, I can potentially read nucs and neuro, within a nucs/rad group, if my research career stalls. The fact is, there is a shortage of 'good' readers in both nucs and neuro. If you can prove your competence, you service will be in great demand...without a rad residency.


BTW, I think if you do rad residency, you only have to do 3 years, because of nucs training.

 

[eddieberetta]

I stumbled onto nucs during the last year of my neurology residency, as I learned about amyloid imaging. Now I am happily in my nucs residency, learning anatomical radiology at the same time.
I have been amused by people's reaction when I tell them my background. Most of them assumed I have abandoned neurology. Some of them probably think (without saying it) I am trying to get into a radiology residency.
But I think subspecialization within radiology, incorporation of more anatomical imaging into nucs training, and consensus in certification between rad and nucs will soon make rad residency unnecessary for nonrad nucs docs. This is already evident in the academic setting. By the time I finish my nucs residency, I hope to be eligible for certification by the American Society of Neuroimaging (neurologist organization), with vouch of competence from fellowship-trained neuroradiologists. So, I can potentially read nucs and neuro, within a nucs/rad group, if my research career stalls. The fact is, there is a shortage of 'good' readers in both nucs and neuro. If you can prove your competence, you service will be in great demand...without a rad residency.


BTW, I think if you do rad residency, you only have to do 3 years, because of nucs training.

Except, correct me if I am wrong, you will have zero training in neuroradiology... sorry I guess you will know how to read a brain perfusion SPECT
No radiology group will accept someone with the "certificate" you are talking about...on the plus side you can probably send away for it now C.O.D.
Don't get me wrong, I think your neurology background would make you a very strong neuroradiologist but I would suggest you do a combo rads residency. You could skip the neurorad fellowship. But I do not think your current training would may you a qualified subspecialty neuroradiologist.

 

[Astrocyte]

Except, correct me if I am wrong, you will have zero training in neuroradiology... sorry I guess you will know how to read a brain perfusion SPECT
No radiology group will accept someone with the "certificate" you are talking about...on the plus side you can probably send away for it now C.O.D.
Don't get me wrong, I think your neurology background would make you a very strong neuroradiologist but I would suggest you do a combo rads residency. You could skip the neurorad fellowship. But I do not think your current training would may you a qualified subspecialty neuroradiologist.

Apparently I have trouble explaining my position...again. Sometimes, comments like this makes me wonder if my decision to do nucs is rational. But still...I think it is. And I am glad some people (including some neuroradiology faculty) at my institution understands and supports what I am trying to do.

I am very glad I didn't go into rad residency. And certainly I will not do even a 3 year residency now. I picked nucs because I think functional imaging is way cool, and full of potential. I fully understand the advantage of having a gen rad background for nucs. But I will not feel this way any more when I graduate from my nucs program, because I will make sure I have enough training in CT, plain films, and MR to read correlative anatomical studies.

As for neurorad, you are preaching to the choirs about the neurorad job market. I have no desire to read neuro in the community. But it's a nice to be able to do so as a last resort if my research career stalls. As the radiology landscape changes, I am confident that I will be able to read neuro-only in any setting, once I have established myself as a neuroimaging expert in CT/MR, having read over 650 cases with fellowship trained neuroradiologists, as required by ASN certification...and 5000+ as a neurology resident.

I think it's useful to remember that many practicing radiologists today never had residency type of CT or MR training. They self-educate to become competent. So can I, with help of my radiologist colleagues.

 

[eddieberetta]

Apparently I have trouble explaining my position...again. Sometimes, comments like this makes me wonder if my decision to do nucs is rational. But still...I think it is. And I am glad some people (including some neuroradiology faculty) at my institution understands and supports what I am trying to do.

I am very glad I didn't go into rad residency. And certainly I will not do even a 3 year residency now. I picked nucs because I think functional imaging is way cool, and full of potential. I fully understand the advantage of having a gen rad background for nucs. But I will not feel this way any more when I graduate from my nucs program, because I will make sure I have enough training in CT, plain films, and MR to read correlative anatomical studies.

As for neurorad, you are preaching to the choirs about the neurorad job market. I have no desire to read neuro in the community. But it's a nice to be able to do so as a last resort if my research career stalls. As the radiology landscape changes, I am confident that I will be able to read neuro-only in any setting, once I have established myself as a neuroimaging expert in CT/MR, having read over 650 cases with fellowship trained neuroradiologists, as required by ASN certification...and 5000+ as a neurology resident.

I think it's useful to remember that many practicing radiologists today never had residency type of CT or MR training. They self-educate to become competent. So can I, with help of my radiologist colleagues.

Cases you looked at as a resident, report in hand, do not count, even the flaky "neuroimaging" societies probably will not acccept that (unless you pay the higher "no experience" certification fee .

If you have time to interpret and report hundreds of brain MRs, your nukes fellowship is not busy enough. If you are not actually reading and reporting the cases yourself, then my comment from the last paragraph apply.

If you do read a high number of neuro MR and CT cases, get a dodgy "certificate" and finish nukes you will be able to:
- work as a neurologist, anywhere
- work as a general nulclear imaging physician, anywhere (but few jobs)
- possibly and I mean possibly, read neuro at your own home institution only. Remember, the neuro guys may like you but they are partners in a radiology group and their partners will not. Even assuming the neurorads do not cover general, no one will appreciate that you do not know how to do basic procedures such as myelograms, spine biopsies, diagnostic angio etc. You will of course leave all the scut work such as plain films (yes, we still do a ton of them), protocolling, etc to your partners, or will rely on them to an annoying extent. You will of course have no interest or training in ENT imaging (what we call Head and Neck Imaging), and will leave these often challenging cases for your parners. Why would they go for that???

However, on the other hand, if you can integrate into your local radiology program, the combined program usually you only have to do one addtional year (and a heelluva lot of studying) to get the combined ABR/ABNM certification. And the neuroradiology rotations would be like a fellowship for you if you are already as knowledgemable as you say. That would be my suggestion. It would also give you excellent backgrd and credibility to be a neuroimaging researcher.

 

[Astrocyte]

Cases you looked at as a resident, report in hand, do not count, even the flaky "neuroimaging" societies probably will not acccept that (unless you pay the higher "no experience" certification fee .

If you have time to interpret and report hundreds of brain MRs, your nukes fellowship is not busy enough. If you are not actually reading and reporting the cases yourself, then my comment from the last paragraph apply.

If you do read a high number of neuro MR and CT cases, get a dodgy "certificate" and finish nukes you will be able to:
- work as a neurologist, anywhere
- work as a general nulclear imaging physician, anywhere (but few jobs)
- possibly and I mean possibly, read neuro at your own home institution only. Remember, the neuro guys may like you but they are partners in a radiology group and their partners will not. Even assuming the neurorads do not cover general, no one will appreciate that you do not know how to do basic procedures such as myelograms, spine biopsies, diagnostic angio etc. You will of course leave all the scut work such as plain films (yes, we still do a ton of them), protocolling, etc to your partners, or will rely on them to an annoying extent. You will of course have no interest or training in ENT imaging (what we call Head and Neck Imaging), and will leave these often challenging cases for your parners. Why would they go for that???

However, on the other hand, if you can integrate into your local radiology program, the combined program usually you only have to do one addtional year (and a heelluva lot of studying) to get the combined ABR/ABNM certification. And the neuroradiology rotations would be like a fellowship for you if you are already as knowledgemable as you say. That would be my suggestion. It would also give you excellent backgrd and credibility to be a neuroimaging researcher.

Thank you for the lengthy reply. Your breakdown is true of the current landscape, and I think I understand all that. However, there are two ways to look at this: competence and politics/practice. Regarding competence, again I say, once someone learns the fundamental approach to imaging and interpretation, he can self-educate. It's incorrect to think older radiologists can learn CT/MR on their own, with help of their colleagues, or attend CME lectures, even to the extent they can read neuro competently in the community, but a nucs/neuro person, with MR/CT training during residency, cannot in the same setting. As for politics/practice, I know turf issue is an obstacle, and older rad and new nonrad nucs might be looked at differently because of calls in a traditional practice setup. But I believe this will change with increased subspecialization and telerad, and (hopefully) consensus between ABNM and ABR (ABNP and ABR?) on qualification for a nucs (neuro) person to be a part of rad groups, in the near future.

Also, I think you can learn sufficient nucs and still dictate 650+ neuro MRI/CT, in two years. How? Radiology residents do 4 months of nucs and 4 months of NR, (and 8? months of CT), and many can competently read both! The key is teaching. If an institution is willing to teach their nucs residents CT and even neuro MR, then why would you think a nonrad person, especially a neurologists, can't read neuro, including ENT, as well as nucs competently at graduation? An entering pgy2 rad resident is a 'nonrad' as well, less experienced at that.

And I think your low opinion of imaging learning in neuro residency is unfounded. The neuroimaging program within the residency has become more structured, and quality of resident's read will continue to improve. The neuroimaging fellowship mainly deals with the ENT part, and, provides a more formal training in methods of imaging interpretation/dictation. As far as I can tell, these fellowships provides sufficient training for NR reading, in the very least, at the level of a gen rad.

I can understand why neurorads might take such position against neuroimaging credentialing. They are smart and hardworking people, who strive to be the best interpreters around. But wanting to learn and be good at neuro MR/CT is a natural development for neurologists, since they rely on it so heavily (and they are equally legally responsible for misreads by a radiologist). So it stands to reason that qualified neurologists be able to bill for their expertise

 

[eddieberetta]

Thank you for the lengthy reply. Your breakdown is true of the current landscape, and I think I understand all that. However, there are two ways to look at this: competence and politics/practice. Regarding competence, again I say, once someone learns the fundamental approach to imaging and interpretation, he can self-educate. It's incorrect to think older radiologists can learn CT/MR on their own, with help of their colleagues, or attend CME lectures, even to the extent they can read neuro competently in the community, but a nucs/neuro person, with MR/CT training during residency, cannot in the same setting. As for politics/practice, I know turf issue is an obstacle, and older rad and new nonrad nucs might be looked at differently because of calls in a traditional practice setup. But I believe this will change with increased subspecialization and telerad, and (hopefully) consensus between ABNM and ABR (ABNP and ABR?) on qualification for a nucs (neuro) person to be a part of rad groups, in the near future.

Also, I think you can learn sufficient nucs and still dictate 650+ neuro MRI/CT, in two years. How? Radiology residents do 4 months of nucs and 4 months of NR, (and 8? months of CT), and many can competently read both! The key is teaching. If an institution is willing to teach their nucs residents CT and even neuro MR, then why would you think a nonrad person, especially a neurologists, can't read neuro, including ENT, as well as nucs competently at graduation? An entering pgy2 rad resident is a 'nonrad' as well, less experienced at that.

And I think your low opinion of imaging learning in neuro residency is unfounded. The neuroimaging program within the residency has become more structured, and quality of resident's read will continue to improve. The neuroimaging fellowship mainly deals with the ENT part, and, provides a more formal training in methods of imaging interpretation/dictation. As far as I can tell, these fellowships provides sufficient training for NR reading, in the very least, at the level of a gen rad.

I can understand why neurorads might take such position against neuroimaging credentialing. They are smart and hardworking people, who strive to be the best interpreters around. But wanting to learn and be good at neuro MR/CT is a natural development for neurologists, since they rely on it so heavily (and they are equally legally responsible for misreads by a radiologist). So it stands to reason that qualified neurologists be able to bill for their expertise

Well I do not know where you are in your nuke training, but most residents are busy memorizing the huge amount of minutae, physics and QC needed to become boarded in nukes. Most would not have time to also do a fellowship in neuro at the same time, as a hobby. If you can pull it off, I wish you well. But I still think the extra year to get double boarded in radiology would be a huge bang for your buck and will leave no ambiguity about your competency to interpret cross sectional imaging.

As for billing, there is nothing stopping any MD billing for any service (with a few exceptions, i.e. need for at least one nukes AU being one of them). It is not an issue of neurologists not being able to bill (even family MDs could bill for a brain MR) but rather one of getting privileges and being hired in a group that does imaging. I understand there are a few neurologists who read studies out there, and maybe you could find one of them, but most hospital/large centers do not and will not allow it.

And of course you are right about ability to gain competence -- we were all medical students a few years ago, no? So we can all learn everything. But just as if I go and learn how to put in ventriculostomies the hospital and neurosurgery groups will not let me get OR provileges and join their group to do it, if you take this non standard approach you are liable to run into trouble. Since it is easily preventable, why do it?

 

[Astrocyte]

Well I do not know where you are in your nuke training, but most residents are busy memorizing the huge amount of minutae, physics and QC needed to become boarded in nukes. Most would not have time to also do a fellowship in neuro at the same time, as a hobby. If you can pull it off, I wish you well. But I still think the extra year to get double boarded in radiology would be a huge bang for your buck and will leave no ambiguity about your competency to interpret cross sectional imaging.

As for billing, there is nothing stopping any MD billing for any service (with a few exceptions, i.e. need for at least one nukes AU being one of them). It is not an issue of neurologists not being able to bill (even family MDs could bill for a brain MR) but rather one of getting privileges and being hired in a group that does imaging. I understand there are a few neurologists who read studies out there, and maybe you could find one of them, but most hospital/large centers do not and will not allow it.

And of course you are right about ability to gain competence -- we were all medical students a few years ago, no? So we can all learn everything. But just as if I go and learn how to put in ventriculostomies the hospital and neurosurgery groups will not let me get OR provileges and join their group to do it, if you take this non standard approach you are liable to run into trouble. Since it is easily preventable, why do it?

How can I get double-boarded in radiology with one additional year? I am not aware of such track. This would be great if it's true. But if I can do well in nucs and neuroimaging research in an academic setting, I won't ever need the additional formal training. How much can one person do?

I understand what you are saying about privileges. You are right, as of now, with my training, reading neuro in a rad group is not likely to happen--even if they think I am competent. Nucs, however, is likely (though fewer opportunities than a rad grad). But I think this will change. When privilege become available to qualified neurologists, my radiologist boss would be familiar with my work and, hopefully, will consider letting me do it. I just need to be ready for it...if I ever need it.

Research in this climate is not easy. So I am looking over all scenarios. Thank you for the input.

 

[eddieberetta]

No problem -- wish you well.

Regarding the one year thing, I forgot that in the states Nukes is only 2 years by itself (In Canada, it is a 4 year program ). Looking at it from the point of view of radiology it is only one additional year since most combined radiology - nukes programs are 6 years with 1 year of internship i.e. 5 years. By "double counting" a bit, these individuals are eligible for the ABR, ABR-CAQ Nukes and ABNM certificates, so they save a year.

For you I guess it would be an extra 3 years, maybe 2 if you could get some credit for your neurology training. Personally, I suggest you ask your program directors about it to make an informed decision.

 

[Cathance]

No problem -- wish you well.

Regarding the one year thing, I forgot that in the states Nukes is only 2 years by itself (In Canada, it is a 4 year program ). Looking at it from the point of view of radiology it is only one additional year since most combined radiology - nukes programs are 6 years with 1 year of internship i.e. 5 years. By "double counting" a bit, these individuals are eligible for the ABR, ABR-CAQ Nukes and ABNM certificates, so they save a year.

For you I guess it would be an extra 3 years, maybe 2 if you could get some credit for your neurology training. Personally, I suggest you ask your program directors about it to make an informed decision.

Correction: All U.S. nucs programs are now 3 years.

I'm in the first 3-year class at my institution, which means that there will be no graduates (anywhere!) after my second year. Either that means we will have higher demand when we graduate in 3 years (most likely), or radiologists will move even further into Nucs turf by that time and the job market will be even weaker for us.

Nucs is awesome. Best field out there. Problem ABNM does not own any scope of its practice. Most nucs/PET studies can be performed by and read by a radiologist (even without nucs fellowship), and in many situations they can even prescribe therapies up to 30 mCi (basically, hyperthyroidism I-131, usually less than 20 mCi). All unsealed radionuclide cancer therapies can be performed by a radiation oncologist. There's nothing left for the ABNM-boarded folks to say "That's ours, and ours alone."

The solution: Merge ABNM with ABR. They already control radiation oncology and radiology board certification (See their website). Eliminate the "nucs only" training track in the U.S. If you want to be a nucs imager, do rads with fellowship in nucs. Want nuc therapy? Do rad onc (at my institution, they do more Bexxar/Zevalin therapies than we do!). Simple. If you can't beat 'em, join 'em. There are ways to grandfather ABNM-boarded people into the ABR -- add restrictions that can be eliminated with proof of further training (CT, MR, plain film, mammo, IR, MSK, Neuro). Create pay-for-training modules in each to allow "catch up" training for those who want it. If an ABNM-boarded person does all of them, he/she gets full ABR cert. If a rads group will take someone with only a couple of the modules (CT, MR), FINE! GREAT! But some/most will continue to hold out for full ABR-certified radiologists who can cover call and read the flood of plain film.

More later...

 

[Astrocyte]

Correction: All U.S. nucs programs are now 3 years.

I'm in the first 3-year class at my institution, which means that there will be no graduates (anywhere!) after my second year. Either that means we will have higher demand when we graduate in 3 years (most likely), or radiologists will move even further into Nucs turf by that time and the job market will be even weaker for us.

Nucs is awesome. Best field out there. Problem ABNM does not own any scope of its practice. Most nucs/PET studies can be performed by and read by a radiologist (even without nucs fellowship), and in many situations they can even prescribe therapies up to 30 mCi (basically, hyperthyroidism I-131, usually less than 20 mCi). All unsealed radionuclide cancer therapies can be performed by a radiation oncologist. There's nothing left for the ABNM-boarded folks to say "That's ours, and ours alone."

The solution: Merge ABNM with ABR. They already control radiation oncology and radiology board certification (See their website). Eliminate the "nucs only" training track in the U.S. If you want to be a nucs imager, do rads with fellowship in nucs. Want nuc therapy? Do rad onc (at my institution, they do more Bexxar/Zevalin therapies than we do!). Simple. If you can't beat 'em, join 'em. There are ways to grandfather ABNM-boarded people into the ABR -- add restrictions that can be eliminated with proof of further training (CT, MR, plain film, mammo, IR, MSK, Neuro). Create pay-for-training modules in each to allow "catch up" training for those who want it. If an ABNM-boarded person does all of them, he/she gets full ABR cert. If a rads group will take someone with only a couple of the modules (CT, MR), FINE! GREAT! But some/most will continue to hold out for full ABR-certified radiologists who can cover call and read the flood of plain film.

More later...

Correction: nucs is still only 2 years if you are board eligible in another specialty; 3 if straight out of internship. So don't get your hopes up, there won't be a sharp increase in demand/supply when you graduate.

The way I see it, nucs is not going to merge with rad anytime soon. This might happen if rad residency curriculum undergoes drastic overhaul, with subspecialization built into it. In other words, most of the rad grad would already be a subspecialist when they graduate. More likely, at least for the short term, more formal cross-sectional imaging training will be incorporated into nucs residency, and nucs programs will continue to train anyone interested. Job market? Let's hope for the best...

 

[eddieberetta]

Correction: nucs is still only 2 years if you are board eligible in another specialty; 3 if straight out of internship. So don't get your hopes up, there won't be a sharp increase in demand/supply when you graduate.

The way I see it, nucs is not going to merge with rad anytime soon. This might happen if rad residency curriculum undergoes drastic overhaul, with subspecialization built into it. In other words, most of the rad grad would already be a subspecialist when they graduate. More likely, at least for the short term, more formal cross-sectional imaging training will be incorporated into nucs residency, and nucs programs will continue to train anyone interested. Job market? Let's hope for the best...

I think you are both a little off. As far as the ABR and radiologists are concerned, Nukes is already a subspecialty of radiology. We do rotations in Nukes and Nukes is an equal part in training and the licensing exam (i.e. given equal weight to Neuro, IR, chest etc.). In addition, from a practical standpoint having expertise in anatomic imaging and multimodality imaging can only make you a better nuclear radiologist. In most non academic groups, one person will be fellowship trained (will be the go-to person for admin, QC, difficult cases, regulatory issues etc) but all radiologists will rotate on Nukes (and it is considered a light low stress day!!). Many places will make you cover Nukes all day but do sth else like mammo or films in the downtime.

I think most of us are pretty good readers of nukes studies, and we know the basic QC issues and artifacts. But of course in terms of the nuances, the rare studies, and the regulatory/QC issues fellowship or residency trained person will know more.

NB ABR certification is sufficient to be an AU if you apply for it at the time of taking the boards -- you can also apply for it after. If you do a 1 yr fellowship, you can get a certificate of added qualification (CAQ) from the ABR which as I understand it is essentially equivalent to ABNM (from hospital/regulatory perspective), but as an added bonus if you do a 6 yr combined program you can get all the certificates as I noted above.

Since ABR already has a mature and accepted certification pathway for fellowship trained radiologists), I doubt there will ever be any grandfathering for ABNM holders. That is why doing the extra work to make yourself ABR eligible as a resident would be so beneficial for you.

 

[Astrocyte]

I think you are both a little off. As far as the ABR and radiologists are concerned, Nukes is already a subspecialty of radiology. We do rotations in Nukes and Nukes is an equal part in training and the licensing exam (i.e. given equal weight to Neuro, IR, chest etc.). In addition, from a practical standpoint having expertise in anatomic imaging and multimodality imaging can only make you a better nuclear radiologist. In most non academic groups, one person will be fellowship trained (will be the go-to person for admin, QC, difficult cases, regulatory issues etc) but all radiologists will rotate on Nukes (and it is considered a light low stress day!!). Many places will make you cover Nukes all day but do sth else like mammo or films in the downtime.

I think most of us are pretty good readers of nukes studies, and we know the basic QC issues and artifacts. But of course in terms of the nuances, the rare studies, and the regulatory/QC issues fellowship or residency trained person will know more.

NB ABR certification is sufficient to be an AU if you apply for it at the time of taking the boards -- you can also apply for it after. If you do a 1 yr fellowship, you can get a certificate of added qualification (CAQ) from the ABR which as I understand it is essentially equivalent to ABNM (from hospital/regulatory perspective), but as an added bonus if you do a 6 yr combined program you can get all the certificates as I noted above.

Since ABR already has a mature and accepted certification pathway for fellowship trained radiologists), I doubt there will ever be any grandfathering for ABNM holders. That is why doing the extra work to make yourself ABR eligible as a resident would be so beneficial for you.

I think you misunderstood.

The point being: At this time, there is no way for nonrad abnm certified nucs to become abr certified, short of (at least) a 3-year radiology residency. We might not want/need to do that, since most of us have already done a full clinical residency in something else.

By merging, both cathance and I meant not having a nonrad track to nucs, and of course, no need for abnm to exist.

 

[eddieberetta]

I think you misunderstood.

The point being: At this time, there is no way for nonrad abnm certified nucs to become abr certified, short of (at least) a 3-year radiology residency. We might not want/need to do that, since most of us have already done a full clinical residency in something else.

By merging, both cathance and I meant not having a nonrad track to nucs, and of course, no need for abnm to exist.

Yes I think you and I are on the same page. Looks like that is the way it is going, effectively from a job point of view also.

Regarding the other poster -- I would not hold high hope for any type of grandfathering of ABNM people into ABR.

 

[Cathance]

Even without a nucs-only 3 year track, the ABNM will still be a viable entity for certifying subspecialty training in NM for radiologists and for clinical specialists. I no longer feel that ABNM needs to merge with ABR, but I do feel that the nucs-only residency track should go away, in conjunction with a corresponding increase in radiology residency spots to cover the need. Pure nucs NMPs like myself are simply having trouble getting the jobs. I'm not sure what I'm going to do in 2 months.

 

[Hedgeman]

Don't be fools, guys. Let me say this once and let it sink in:

ABNM stands for American Board of No Marketability