the end of pure nucs in the U.S.

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Sorry for the miscalculation,

Should be :
X-ray: 1 month
Ultrasound: 1.5 month
MRI: 1 month

Research: 3month
vacation: 3month
Elective (recommend Rad Onc, Interventional, Cardiology): 2.5 month


Your numbers are great, but I don't get your point.
Do you think the ACR will let you take the radiology boards or certify you in order to read their most preciated studies?

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I came across this article at the JNM, this was published in
THE JOURNAL OF NUCLEAR MEDICINE • Vol. 45 • No. 5 • May 2004.

http://jnm.snmjournals.org/cgi/reprint/45/5/17N.pdf

Increasing the residency duration to 3 years. The proposal has the greatest impact on the nuclear medicine residents who have not completed residency training in other specialties. Four of the main reasons cited for increasing the length of training are the perceived needs to:
(a) train residents in new and changing modalities such as PET/CT.
(b) raise the standards of nuclear medicine residents.
(c) make nuclear medicine training more academically oriented.
(d) increase the respect for nuclear medicine physicians.
Although these are honorable reasons, many issues must be addressed before these decisions are finalized.


Point d) is very funny!!
 
Your numbers are great, but I don't get your point.
Do you think the ACR will let you take the radiology boards or certify you in order to read their most preciated studies?

I am not expecting ACR will let us take the radiology board or certify us to read all the studies.

I am expecting with this training criteria we can show other people that we are adequately trained, and we can earn the respect from them, as you quote the 2004 paper, the point D

I am hoping with this criteria, we can show the employer we can read PET and Dedicated CT. Because, in the future, CT component in PET CT will be dedicated/diagnostic CT, with or without contrast.

Do you want to draft a letter to ACGME to express our concern for NM? We can post it on facebook and here, and we can get some serious response. I will try to get more people to sign on such a letter.

http://acgme.org/acWebsite/resInfo/ri_formalcomplaint.asp
 
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Dear Fellow Residents,

While there is no question that finding a job is a top or the top concern of residents in Nuclear Medicine, there are so many variables that make addressing this situation extremely difficult.


The NMRO is doing its best with what it can do about this complex situation. Several things have been done in the last year by the NMRO (Nuclear Medicine Resident Organization) and YP (Young Professionals) to help with job hunting skills and methods. Forums have been given at the ACNM /SNM Conjoint Midwinter Meeting on how to find a job. The PowerPoint files or pdf of these files will be made available to residents on the acnmonline.org page when they are submitted to the NMRO for posting. The YP will be hosting a CV workshop at the upcoming SNM meeting in Salt Lake City, Utah. While this is a good start, it has not been enough.


The SNM is now starting a “Jobs Taskforce” to carefully look into the issues contributing to the current problems, many of which this thread seems to have some grasp of. This situation is extremely complex, and more complex than is described in this thread and may even take years to normalize. Cooperative work between radiology societies and nuclear medicine societies is happening now. This work is tenuous and it may take time for the culture of this situation to change.

If you are interested in the NMRO, it does a LOT for residents. The mission of NMRO is to promote the interests of Nuclear Medicine residents by supporting the highest standards of education in diagnostic and therapeutic Nuclear Medicine and related fields; promoting resident research in Nuclear Medicine; coordinating projects within Nuclear Medicine residency programs; and advocating the role of Nuclear Medicine specialists in clinical practice.



Below are just some of the things it offers:
  • Facebook forum (search “Nuclear Medicine Resident Organization” on facebook)
  • Quarterly newsletter addressing issues for residents (on the acnmonline.org under Residents/“Scintilator Newsletter”) – the next issue will be coming out soon and discusses more about jobs
  • Planning leadership classes for nuclear medicine trainees
  • Mentorship program
  • Job hunting skills
  • How to write your curriculum vitae (academic versus non-academic)
  • Basic interview skills
  • How to negotiate a contract
  • How to transition from class to career
  • Learning to network your job connection
  • Learning about the consultant role of nuclear medicine physicians
  • Creating a work ethic for career success
  • How to lease a NM department from a hospital
  • How to run a successful out-patient NM center: cardiology, mobile PET, etc.
  • Understanding the telemedicine application in nuclear medicine
More information can be found on the acnmonline.org page under the residents tab.

If I could give advice to all of us as residents, I would say that we need to learn as much as we can, work as hard as we can, and do the best we can to overcome these situations. When it comes time for you to go job hunting, having as many resources as possible in the form of networking, skills regarding job hunting and interviewing, mentoring, etc. will be invaluable. Make no mistake, those things will help, but are no replacement for very hard work on our part in the hunting process.

There is no doubt that giving years of your life to train for something you’re passionate about should result in a job, and one you enjoy. I wish us all much luck in the future.

Warmly,
Erin Grady, MD
NMRO President
 
Dear Fellow Residents,

While there is no question that finding a job is a top or the top concern of residents in Nuclear Medicine, there are so many variables that make addressing this situation extremely difficult.


The NMRO is doing its best with what it can do about this complex situation. Several things have been done in the last year by the NMRO (Nuclear Medicine Resident Organization) and YP (Young Professionals) to help with job hunting skills and methods. Forums have been given at the ACNM /SNM Conjoint Midwinter Meeting on how to find a job. The PowerPoint files or pdf of these files will be made available to residents on the acnmonline.org page when they are submitted to the NMRO for posting. The YP will be hosting a CV workshop at the upcoming SNM meeting in Salt Lake City, Utah. While this is a good start, it has not been enough.


The SNM is now starting a “Jobs Taskforce” to carefully look into the issues contributing to the current problems, many of which this thread seems to have some grasp of. This situation is extremely complex, and more complex than is described in this thread and may even take years to normalize. Cooperative work between radiology societies and nuclear medicine societies is happening now. This work is tenuous and it may take time for the culture of this situation to change.

If you are interested in the NMRO, it does a LOT for residents. The mission of NMRO is to promote the interests of Nuclear Medicine residents by supporting the highest standards of education in diagnostic and therapeutic Nuclear Medicine and related fields; promoting resident research in Nuclear Medicine; coordinating projects within Nuclear Medicine residency programs; and advocating the role of Nuclear Medicine specialists in clinical practice.




Below are just some of the things it offers:
  • Facebook forum (search “Nuclear Medicine Resident Organization” on facebook)
  • Quarterly newsletter addressing issues for residents (on the acnmonline.org under Residents/“Scintilator Newsletter”) – the next issue will be coming out soon and discusses more about jobs
  • Planning leadership classes for nuclear medicine trainees
  • Mentorship program
  • Job hunting skills
  • How to write your curriculum vitae (academic versus non-academic)
  • Basic interview skills
  • How to negotiate a contract
  • How to transition from class to career
  • Learning to network your job connection
  • Learning about the consultant role of nuclear medicine physicians
  • Creating a work ethic for career success
  • How to lease a NM department from a hospital
  • How to run a successful out-patient NM center: cardiology, mobile PET, etc.
  • Understanding the telemedicine application in nuclear medicine
More information can be found on the acnmonline.org page under the residents tab.

If I could give advice to all of us as residents, I would say that we need to learn as much as we can, work as hard as we can, and do the best we can to overcome these situations. When it comes time for you to go job hunting, having as many resources as possible in the form of networking, skills regarding job hunting and interviewing, mentoring, etc. will be invaluable. Make no mistake, those things will help, but are no replacement for very hard work on our part in the hunting process.

There is no doubt that giving years of your life to train for something you’re passionate about should result in a job, and one you enjoy. I wish us all much luck in the future.

Warmly,
Erin Grady, MD
NMRO President

I can see your enthusiasm for NMRO, and I do respect that.

However, if NMRO is realizing the job problem, do you think it's a good idea to write a formal letter to ACGME, ABNM, ABR, SNM/ACNM?

And, shall this letter be written and signed by NM residents, addressing the concerns from NM residents?

Is NMRO willing to take this responsiblilty?

Is NMRO by, of and for the NM residents?
 
Dear Fellow Residents,

While there is no question that finding a job is a top or the top concern of residents in Nuclear Medicine, there are so many variables that make addressing this situation extremely difficult.


The NMRO is doing its best with what it can do about this complex situation. Several things have been done in the last year by the NMRO (Nuclear Medicine Resident Organization) and YP (Young Professionals) to help with job hunting skills and methods. Forums have been given at the ACNM /SNM Conjoint Midwinter Meeting on how to find a job. The PowerPoint files or pdf of these files will be made available to residents on the acnmonline.org page when they are submitted to the NMRO for posting. The YP will be hosting a CV workshop at the upcoming SNM meeting in Salt Lake City, Utah. While this is a good start, it has not been enough.


The SNM is now starting a "Jobs Taskforce" to carefully look into the issues contributing to the current problems, many of which this thread seems to have some grasp of. This situation is extremely complex, and more complex than is described in this thread and may even take years to normalize. Cooperative work between radiology societies and nuclear medicine societies is happening now. This work is tenuous and it may take time for the culture of this situation to change.

If you are interested in the NMRO, it does a LOT for residents. The mission of NMRO is to promote the interests of Nuclear Medicine residents by supporting the highest standards of education in diagnostic and therapeutic Nuclear Medicine and related fields; promoting resident research in Nuclear Medicine; coordinating projects within Nuclear Medicine residency programs; and advocating the role of Nuclear Medicine specialists in clinical practice.






Below are just some of the things it offers:
  • Facebook forum (search "Nuclear Medicine Resident Organization" on facebook)
  • Quarterly newsletter addressing issues for residents (on the acnmonline.org under Residents/"Scintilator Newsletter") – the next issue will be coming out soon and discusses more about jobs
  • Planning leadership classes for nuclear medicine trainees
  • Mentorship program
  • Job hunting skills
  • How to write your curriculum vitae (academic versus non-academic)
  • Basic interview skills
  • How to negotiate a contract
  • How to transition from class to career
  • Learning to network your job connection
  • Learning about the consultant role of nuclear medicine physicians
  • Creating a work ethic for career success
  • How to lease a NM department from a hospital
  • How to run a successful out-patient NM center: cardiology, mobile PET, etc.
  • Understanding the telemedicine application in nuclear medicine
More information can be found on the acnmonline.org page under the residents tab.

If I could give advice to all of us as residents, I would say that we need to learn as much as we can, work as hard as we can, and do the best we can to overcome these situations. When it comes time for you to go job hunting, having as many resources as possible in the form of networking, skills regarding job hunting and interviewing, mentoring, etc. will be invaluable. Make no mistake, those things will help, but are no replacement for very hard work on our part in the hunting process.

There is no doubt that giving years of your life to train for something you're passionate about should result in a job, and one you enjoy. I wish us all much luck in the future.

Warmly,
Erin Grady, MD
NMRO President


Hi Erin,

With all my respect to you. Your post is very unrealistic, to be honest I don't know where to start. First of all, I don't think this issue is so complex, the main problem is that we spend 3 years in residency, and after graduating we don't have any jobs because all the nuclear medicine jobs are taken by radiologist, as we discussed in this forum. I will not go over this again. We all feel that the SNM and ABNM are not protecting the specialty, the resident, fellows and recent graduates.
My impression is that in your post you are trying to say that there is no problem with the job market, the problem is that we don't look competitive enough, right? I can attend to workshops and pay $$$$$ to assist to courses in order to get a nice CV and I can even be more polite that the President of the United Nations, however, if the job postings are looking for a radiologist with Nuclear Medicine training(meaning 4 months of experience), no one will ever call me for an interview. You can even check the SNM website, there more job postings looking for a nuclear radiologist. BTW, If you are saying that there is a crisis, start banning all the jobs posting directed to radiologists with nuclear medicine training, in my opinion this is a reflection of how serious is the SNM dealing with this problem.
If you want to solve a problem, you have to identify the problem first and then look for the solution. If the problem is a problem just for some people, that's different.
Please, don't take this in the wrong way, but we are not playing here, we are spending 3,4 or 5 years in a specialty with no future. This is a serious problem that needs to be solved by the SNM, ABNM or ACGME, inmediately.
I will attend to the SNM, and as you said, if the SNM is working on this topic, we should be able to see a lot of presentations addressing this topic, right?.
Thank you,
 
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Hi Erin,

With all my respect to you. Your post is very unrealistic, to be honest I don't know where to start. First of all, I don't think this is so complex, the main problem is that we spend 3 years in residency, and after that we don't have jobs because all the nuclear medicine jobs are taken by radiologist, as we discussed in this forum. I will not go over this again. We all feel that the SNM and ABNM is not protecting the specialty and the resident, fellows and recent graduates.
My impression is that in you post your trying to say that there is no problems with the job market, the problem is that we don't look competitive enough, no? I can attend to workshops and pay $$$$$ to assist to courses in order to get a nice CV and I can even be more polite that the President of the United Nations, however, if the job postings are looking for a radiologist with Nuclear Medicine training(meaning 4 months of experience), no one will ever call me for an interview. It's even worse, seeing the job postings in the SNM website looking for a nuclear radiologist. If you are saying that there is a crisis, start banning all the jobs posting directed to radiologist with nuclear medicine training.
If you want to solve a problem, you have to identify the problem first and then look for the solution.
Please, don't take this in the wrong way, but we are not playing here, we are spending 3,4 or 5 years in a specialty with no future. This is a serious problem that needs to be solved by the SNM, ABNM or ACGME.
I will attend to the SNM, and as you said, if the SNM is working on this topic, we should be able to see a lot of presentations discussing this topic, right?.
Thank you,


Hi, I appreciate Erin's response. At least we catch eyeballs from NMRO.

Unfortunately, the NMRO doesn't look like an independent or semi-independent organization. So, even Erin agrees with us, she dares not to say this officially/publicly, right?

I think we can start to ask NMRO, if they want to represent NM residents from the U.S. and which they claimed they do, to write a letter on behalf of all NM residents, address our concerns and provide our proposals for solving the problems, post it here, or auntiminnie.com, or any place we can catch eyeballs from NM residents, modify it based on the reflection, and get as many signatures as we can , send it out to ACGME, ABNM, ABR, SNM/ACNM and even the congress.

If we can count on nobody, we have to act by ourselves, we have to save ourselves.

Can NMRO do, or be willing to do this for us? I am curious.

Become a member of NMRO, attend all the meetings/courses, no problem. We are willing to pay the membership fee, or whatever is necessary, but, we have to have the right representative, can NMRO be the one???
 
Dear Erin,

Can you please explain the complexity of this problem? Probably we are missing something important here.
Can you please summarize the possible solutions that the SNM, NMRO and ACR are working on?

I will appreciate your reply.

Thank you.
 
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I can see how involved is the NMRO! I am Still waiting for a reply!
 
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I can see how involved is the NMRO! I am Still waiting for a reply!

Dude, they just want us to join the NMRO and pay the membership fee!

What's the benefit joining NMRO while they do not want to speak for your or even answer your question?

BTW, did you receive letters from SNM president candidates, asking us to vote for him? Ridiculous, doesn't want to address/solve the problem, just want the title!

This is one of the reasons why we hate politicians....

We need an organizatin of, by and for our NM residents. Maybe we can register one, as you started on the facebook.

What do you guys think?
 
Dude, they just want us to join the NMRO and pay the membership fee!

What's the benefit joining NMRO while they do not want to speak for your or even answer your question?

BTW, did you receive letters from SNM president candidates, asking us to vote for him? Ridiculous, doesn't want to address/solve the problem, just want the title!

This is one of the reasons why we hate politicians....

We need an organizatin of, by and for our NM residents. Maybe we can register one, as you started on the facebook.

What do you guys think?

LOL, Nice post!! You are right!! I am not investing more money in NM organizations/meetings/workshops/etc... as we all know the end of nucs is around the corner and I am going to be jobless after the residency so I will need that money to survive.
In terms of the organization, I created the facebook page and there is only one person who sign in in 2 weeks, so take your own conclusion. Probably everyone is talking about this crisis, however looks like that they are all waiting for the NM entities to solve the problem, in my opinion, that's completely UNREALISTIC.
I also believe that many residents are waiting for the residencies to close, probably they think that RAD PDs will take us all, that's even more UNREALISTIC!!.
 
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Note: my bias/experience is that of the private practice radiologist at a busy public teaching hospital. The OP touched on one of, if not the biggest problem with dedicated Nucs as a specialty.

Basically, out in the non-academic world, there isn't usually enough NM work to justify a full-time nucs person. First off, many places have cardiologists doing the cardiac nucs, so both you and I have lost business. At my hospital, we typically do 5-7 hearts and 4 whole body bone studies per day. We only do PET's 1 day/wk - usually 4-6 studies, and 1-3 renal and thyroids per week. Everything else is even more rare. Our weekly volume is less than a day's work. We're one of the busiest hospitals in California and we don't have the volume to support 1 full-time nucs person.

In this setting the question of whether the radiologists in my group - none of whom are fellowship trained in nucs - are good enough is irrelevant because we couldn't justify the expense of hiring a nucs person regardless. And even if you, as a NM body changed the residency to include more anatomic imaging, I doubt a nucs person would be hired over a traditional rads-trained person with a radiology fellowship. This is even more true given the current state of the job market. Contrary to what the job boards would lead you to believe, the imaging market isn't great right now - especially in places where lots of people want to live (West Coast, NYC, DC...) An exception would be at a dedicated NM outpatient facility; of course if such places exist, then they'd probably hire nucs grads without residency changes.

Additionally, clinical ignorance plays a huge role in imaging volume - despite our best attempts at guidance. We get 50 ultrasound requests each day to r/o cholecystitis or assess renal function. And despite our phone calls, the requests for inappropriate requests keep coming.

So yeah, it seems that several external forces are colluding to paint you all into a corner. If a med student asked me if he should apply to NM, I would definitely say no. I realize this sucks for many of you deeply invested in your career. I am not sure what the best solution is.
 
Dear Fellow Residents,

I want to let you know that the ACNM along with the SNM and ABNM are aware of the challenges facing residents and are working together to present solutions to these issues. The NMRO wants to help residents and give them a voice. During this time, please be patient as much is happening behind the scenes.

We would also like to hear your personal experiences in job-hunting as well as any other concerns. As this is a delicate problem, we would appreciate constructive feedback so that we can do our best to help out. But, first and foremost, let us concentrate on education as that is what will help all of us in the long-run.

Warmly,

Erin Grady, MD
NMRO President

 
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Note: my bias/experience is that of the private practice radiologist at a busy public teaching hospital. The OP touched on one of, if not the biggest problem with dedicated Nucs as a specialty.

Basically, out in the non-academic world, there isn't usually enough NM work to justify a full-time nucs person. First off, many places have cardiologists doing the cardiac nucs, so both you and I have lost business. At my hospital, we typically do 5-7 hearts and 4 whole body bone studies per day. We only do PET's 1 day/wk - usually 4-6 studies, and 1-3 renal and thyroids per week. Everything else is even more rare. Our weekly volume is less than a day's work. We're one of the busiest hospitals in California and we don't have the volume to support 1 full-time nucs person.

In this setting the question of whether the radiologists in my group - none of whom are fellowship trained in nucs - are good enough is irrelevant because we couldn't justify the expense of hiring a nucs person regardless. And even if you, as a NM body changed the residency to include more anatomic imaging, I doubt a nucs person would be hired over a traditional rads-trained person with a radiology fellowship. This is even more true given the current state of the job market. Contrary to what the job boards would lead you to believe, the imaging market isn't great right now - especially in places where lots of people want to live (West Coast, NYC, DC...) An exception would be at a dedicated NM outpatient facility; of course if such places exist, then they'd probably hire nucs grads without residency changes.

Additionally, clinical ignorance plays a huge role in imaging volume - despite our best attempts at guidance. We get 50 ultrasound requests each day to r/o cholecystitis or assess renal function. And despite our phone calls, the requests for inappropriate requests keep coming.

So yeah, it seems that several external forces are colluding to paint you all into a corner. If a med student asked me if he should apply to NM, I would definitely say no. I realize this sucks for many of you deeply invested in your career. I am not sure what the best solution is.


Thanks for your reply. It's uncommon to see one of the busiest hospitals in California, just having 1 PET day/wk, but your general nucs number is not that bad, and probably you can afford to hire a NM physician.
We have an average of 7 PET/CTs (busy day 15/day) and 7 general NUCS/day (busy day 14/day), we also rotate through the VA, where we read an average of 25 general nucs (busy day over 40/day) and 2 PET/CT a day (busy day 6/day), and we are not located in a small city. Ok, we are a NM dedicated facility.

I think that the volume of studies in NM is not as high as in radiology, you will never find even an academic institution with 200 NM studies a day, like in radiology and that's the reason why NM salaries are lower than in radiology. As you know NM studies takes more time to acquire, more time to process and more time to read. I know that private practice is all about revenue, so the less people reading, the more $$$$ each partner makes.

About the clinical ignorance, I agree with you, but believe that if you are interested in teaching/educating the physicians in your institution to order more NM studies, you have to go to hunt them and teach them, give conferences, etc... But that applies only if you really want to perform more NM studies.

In my opinion, the solution is that there should be restrictions for physicians without adequate training in order to read NM. I believe that this is why medicine is divided in specialties and subspecialties, right?. I don't believe that someone is capable of MASTERING all the imaging modalities in radiology and also another specialty (NM).
How would you feel if surgeons take over IR? Where would take a relative for an endovascular procedure? IR or vascular surgeon? How long do you usually take to review, read and report each PET/CT?

Regards and thank you for your reply!
 
I think that the volume of studies in NM is not as high as in radiology, you will never find even an academic institution with 200 NM studies a day, like in radiology and that's the reason why NM salaries are lower than in radiology. As you know NM studies takes more time to acquire, more time to process and more time to read. I know that private practice is all about revenue, so the less people reading, the more $$$$ each partner makes.

Revenue is not the sole contributor. Actually, we (and probably most groups) try to balance income with lifestyle. More people means less money - but also more time off and a lighter work day. At a certain point, we're willing to take a pay cut for more vacation weeks and/or time off each week.

When it comes to potentially hiring a new person, we have to consider whether that person will do enough work to pay his or her salary. At our hospital, somebody reading 10-15 nucs studies per day would not justify a salary commensurate to his or her training. Even your busy VA day of 40 general studies (non-PET/CT) - a nucs person in private practice, fellowship/nucs residency or not, could do that in a morning. And of course I'm talking about going through a stack of completed exams. I realize that there are a buttload of other factors to be considered to make that a reality.

In my opinion, the solution is that there should be restrictions for physicians without adequate training in order to read NM. I believe that this is why medicine is divided in specialties and subspecialties, right?. I don't believe that someone is capable of MASTERING all the imaging modalities in radiology and also another specialty (NM).

This belief is shared by the ABR and the ACR, and is rationale behind the upcoming change in the radiology boards. The thought of only "masters" reading each modality or body system works at university medical centers where the volume supports dedicated rads and nucs attendings taking time to teach. This only works in the ivory tower or in huge groups covering multiple hospitals. Our main hospital has volume for 1 dedicated IR and 3 general radiologists. Just like nucs, we don't have the volume to support full-time neuro, msk, body, mri, mammo, ultrasound, etc. Do I read neuro as good as the fellowship trained neuroradiologist in the group? Nope. But I am good enough to provide decent service for the neurologists, and good enough to know when I don't know what the heck I'm looking at.

How would you feel if surgeons take over IR? Where would take a relative for an endovascular procedure? IR or vascular surgeon?

Surgeons already do IR in many places. Cardiology took over angio so long ago that some of them actually believe they invented it. And now they're making grabs at coronary CT and MRI. GI scoffed at virtual colonoscopy until their own studies showed its utility (ignoring what rads had already published). So turf battles are and will continue to be part of imaging for the foreseeable future - at least as long as the government allows self-referral. All we can do is continue to provide good service.

I would take my wife to whoever had done the most with the fewest complications.

How long do you usually take to review, read and report each PET/CT?

I could tell you that I spend 90 minutes on each PET/CT and generate a 5 page report. Of course that's rubbish. If it were true, I would be worthless to the other members of my group and 95% of that report would be unread by the clinicians, who just want to know if its cancer, and if not, what else can it be.

The only appropriate answer to that question is as long at it takes. A negative PET is quick. A non-negative PET - not so quick...

Regards and thank you for your reply!

I truly grasp the gravity of your situation. I remember working with the nucs residents during my own residency and wondering where they were going to get a job. Years later it seems you are still asking that question.
 
ringhal,

Thank you for your honest reply!! If you need a NMp in your private practice, let me know. I can email you my CV. LOL!!!

Regards,
 
ringhal,

I went over your answers again, and I think that NM can also provide decent service in CT, MRI, XRAY and US, we can also say I don't know and look for help, even the oncologist can recognize cancer in a PET/CT without NM or RAD training.
I am sorry to argue, but this is the main problem, radiologist without appropriate training can only provide a decent service. The point is to provide the patients/doctors with excellent service, which will lead to a better outcome. But that depends on the professional goals of each individual.
If I'll have to go to the doctor, I will go to the best, not to the decent.
 
ringhal,

I went over your answers again, and I think that NM can also provide decent service in CT, MRI, XRAY and US, we can also say I don't know and look for help, even the oncologist can recognize cancer in a PET/CT without NM or RAD training.
I am sorry to argue, but this is the main problem, radiologist without appropriate training can only provide a decent service. The point is to provide the patients/doctors with excellent service, which will lead to a better outcome. But that depends on the professional goals of each individual.

This argument sounds a little semantic. Adequate vs decent vs excellent... Ultimately, as an imaging consultant, we are valued by concise, timely reports that clinicians can trust. Do that, and we are adequate or decent. The difference between decent and excellent is whether or not we're d-bags when we're interrupted by phone calls or visits to the reading room.

I'd say that someone without appropriate training cannot provide adequate service. To this end, I disagree with your assertion that nucs folks can provide adequate diagnostic imaging service for clinicians. Seriously, would you feel comfortable providing final reads for neuro MRI, OB ultrasound and trauma CT's?

Second, as someone with nuclear medicine training, I can't imagine you'd truly say that an oncologist can recognize cancer on a PET/CT because we both know that there are many things that show increased activity on PET besides malignancy. Do you think most oncologists can tell the difference between a PET, a whole body gallium scan and an I-123 MIBG?

If I'll have to go to the doctor, I will go to the best, not to the decent.

This is ridiculous. So if you get a forearm laceration, only the head of plastics at MGH can suture it? Hopkins is tops in urology, so it's off to Baltimore for your bph, then to UCLA endocrinology to adjust your metformin because your hemoglobin A1C's a touch high, then back to MGH cardiology to have your hypertension managed? It feels good and very self-important to say "only the best for me!" but in reality what you want is a convenient, competent physician smart enough to know when to say "I think you need a specialist."

Furthermore, your statement is insulting to yourself and your colleagues. Why should anyone go you for a nucs workup when the people who taught you are available? You're not the best nuclear medicine physician anymore than I am the best radiologist. Because we provide fast, accurate reports.

Look, I think the problem is that nuclear medicine is perhaps too subspecialized. Functional imaging, at the current time, does not have sufficient volume to stand on its own - at least not in most places. The fact that there aren't many nuclear medicine jobs should be prima facie evidence. Who knows, maybe when/if molecular imaging matures things will be different - assuming endocrinology or some other field doesn't try to steal it.

The claim that general diagnostic radiologists as a group are not trained enough for the job is hollow because there is nothing to support this. If non-fellowship trained radiologists were getting sued left and right for bad nucs reads, then one could make a claim for incompetence. An alternate argument, that nuclear medicine physicians are better than diagnostic radiologists at reading nucs studies, while true in many if not most cases, is only relevant if radiologists are 1. inadequate (see prior point) or 2. more expensive. Folks can make the same argument about radiologists. Why have us read msk? Why not let ER docs and orthpods read that stuff? 1. They miss stuff not in the bone. Every year I diagnose at least one lung cancer or multiple myeloma on a routine shoulder series and several renal cell carcinomas on L-spine MRI's. 2. Pretty much every study done on self-referral has shown that when clinicians own and bill for their own imaging, they order too many studies. Costs are higher without an improved quality of care.

Hiring an extra person will only be financially beneficial if his or her output pays the salary or there is a significant value-add (lifestyle improvement, prestige of having another "expert" in the group to address a real or perceived deficit.) I can say that for my group in my hospital, a dedicated nucs person would do neither of these. My guess is that our group represents the rule, not the exception.

I think that in many ways the fat cats in ABNM probably have failed the younger members. It's fairly well established that physicians in academia have a poor grasp of life outside the ivory tower. I have no problem admitting that most of the innovation in medicine comes from the university centers, but conversely, most of the work is done elsewhere. Lengthening the residency won't help because I'd say you probably get more than enough nuclear medicine training - and a whole year of diagnostic imaging probably wouldn't be enough for you to feel comfortable signing your name on a final read. What the ABNM should have done is decrease the residency size and focus on increasing the visibility of the field. More awareness = more studies ordered = more work. More work with fewer available bodies means great job opportunities for graduating residents. That's a lesson they could have learned from dermatology.
 
T Lengthening the residency won't help because I'd say you probably get more than enough nuclear medicine training - and a whole year of diagnostic imaging probably wouldn't be enough for you to feel comfortable signing your name on a final read. What the ABNM should have done is decrease the residency size and focus on increasing the visibility of the field. More awareness = more studies ordered = more work. More work with fewer available bodies means great job opportunities for graduating residents. That's a lesson they could have learned from dermatology.

:thumbup::thumbup:Can't agree more!!!

That's exactly I complained from very beginning. ABNM/ACGME should have just kept 2-yr NM Residency, decreased the number of programs by setting the strict training criteria. Alternatively, it's better to set up NM as a fellowship for radiology, just as DIRECT pathway for IR.

Personally, I think 1 year NM fellowship training for Radiology resident is necessary and should be adequate. 4-6 month rotation in 4yr Rad residency training will not be adequate for a radiology to read NM scans, given NM now is more than v/q, HIDA, renal scan and PET CT.

At least in my institution, NM scans are only be read by ABNM or ABR+ABNM double certified physicians.

A new attending (rad + NM fellowship) told me he has only read 19 MIBG scans in his whole residency + fellowship, while this week I read 18 MIBG! Maybe we should also decrease the number for NM fellowship programs!

Less programs with more strict criteria means more qualified physicians, and ultimately will generate more jobs for NM physicians.
 
ringhal,

Seriously, would you feel comfortable providing final reads for neuro MRI, OB ultrasound and trauma CT's?.
You question should be directed to radiologists: Do you feel comfortable providing final reads for NM studies, treating hyperthyroid patients with I-131, etc... after 4 months rotation? Do you think that a radiology resident after 4 months of NM can recognize a whole body gallium scan and an I-123 MIBG?
I can tell you that I evidenced a board review given to 4th year radiology residents in our institution and they didn't even recognized which was the ventilation and which was the perfusion in a V/Q, and they are joining private practice and of course they will be reading NM in a couple of months, just like you are.
We all know that 4 months in NM is not enough!
You don't need to travel worldwide to get the best doctors; you can find the best doctors in your town.
Any medical school graduate without residency can refer patients to a specialist if they need it.

Competence = Law suits? This is completely ridiculous and absurd. If you miss cancer in a study, 1 year later the patient presents with metastasis, and you don't get sued, you consider yourself competent?
Please!

We can spend days and days writing and arguing about this topic, so this will be my last reply to your posts.

Thank you for your time!
 
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ringhal,

Seriously, would you feel comfortable providing final reads for neuro MRI, OB ultrasound and trauma CT's?.
You question should be directed to radiologists: Do you feel comfortable providing final reads for NM studies, treating hyperthyroid patients with I-131, etc... after 4 months rotation? Do you think that a radiology resident after 4 months of NM can recognize a whole body gallium scan and an I-123 MIBG?
I can tell you that I evidenced a board review given to 4th year radiology residents in our institution and they didn't even recognized which was the ventilation and which was the perfusion in a V/Q, and they are going into private practice and of course they will be reading NM, just like you are.
We all know that 4 months in NM is not enough!
You don't need to travel worldwide to get the best doctors; you can find the best doctors in your town.
Any medical school graduate without residency can refer patients to a specialist if they need it.

Competence = Law suits? This is completely ridiculous and absurd. If you miss cancer in a study, 1 year later the patient presents with metastasis, and you don't get sued, you consider yourself competent?
Please!

We can spend days and days writing and arguing about this topic, so this will be my last reply to your posts.

Thank you for your time!

I think what ringhai described is very frank. Like it or not, this is reality. I appreciate that.

As I pointed out early, the problem of NM originates from NM specialty itself. We need ACGME criteria/case log for NM residency, we need ABNM/ABR and Medicare to work together, to assure NM scans only be read by ABNM or ABR+ABNM certified physicians, not from the NM job market standpoint, but from patient care point.

I hate to say this, it is good thing if any radiologist without NM fellowship training get sued by read NM scans, the more the "better", the more sensational the "better" . Only that, NM can catch more eyeballs and make people realize that it is a serious medical specialty, not an "unclear medicine" that can be read by "inadequately trained" radiologist.
 
:thumbdown:
I think what ringhai described is very frank. Like it or not, this is reality. I appreciate that.

As I pointed out early, the problem of NM originates from NM specialty itself. We need ACGME criteria/case log for NM residency, we need ABNM/ABR and Medicare to work together, to assure NM scans only be read by ABNM or ABR+ABNM certified physicians, not from the NM job market standpoint, but from patient care point.

I hate to say this, it is good thing if any radiologist without NM fellowship training get sued by read NM scans, the more the "better", the more sensational the "better" . Only that, NM can catch more eyeballs and make people realize that it is a serious medical specialty, not an "unclear medicine" that can be read by "inadequately trained" radiologist.

I agree with your comments. I know that ringhal was honest and I am not saying the opposite, however, I've never heard a radiologist saying, we are not prepared to read NM studies, 4 month rotation is not enough! As you can see, they think that NM is like reading plain films and we all know that reading NM is not so simple. This is also part of the problem.
As we mentioned, if they start getting sued because misreads, they will stop reading and they will need to hire qualified NM or NRAD. A good example; Mammography, right?
Changing the subject, only you, me and other 2 people are involved in the forum/discussion. I am very :thumbdown:thumbdown:thumbdown:thumbdown. Everyone is waiting for the SNM/ABNM/NMRO, etc... to do something, LOL!
 
:
Changing the subject, only you, me and other 2 people are involved in the forum/discussion. I am very :thumbdown:thumbdown:thumbdown:thumbdown. Everyone is waiting for the SNM/ABNM/NMRO, etc... to do something, LOL!

When the Nazis came for the communists,
I remained silent;
I was not a communist.

When they locked up the social democrats,
I remained silent;
I was not a social democrat.

When they came for the trade unionists,
I did not speak out;
I was not a trade unionist.

When they came for the Jews,
I remained silent;
I wasn't a Jew.

When they came for me,
there was no one left to speak out.


Buddy, I am starting to apply for PGY3 rad position now, though I like NM, both the clinic and research......

We are living in a real world....
 
When the Nazis came for the communists,
I remained silent;
I was not a communist.

When they locked up the social democrats,
I remained silent;
I was not a social democrat.

When they came for the trade unionists,
I did not speak out;
I was not a trade unionist.

When they came for the Jews,
I remained silent;
I wasn't a Jew.

When they came for me,
there was no one left to speak out.


I had a dream, and am still dreaming for Nuclear Medicine,

One day....
 
NMdreamer,

PGY3? Good luck with that! Now I know why you are calling yourself NMdreamer, DUDE STOP DREAMING!
Don't you need to finish your NM residency in order to get 1 year credit?
 
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you guys are creating waves, this discussion has had almost 3000 views!! but they are silent. I lie in the same boat, current resident and now deciding to part ways from nuke's. It is clear the future is bleak, even for established NM physicians. I am all for joining in the movement.

Although I would like to know what other residencies are NM residents pursuing and has it been easy. Also, are there issues with funding. If I finish 3 years is that going to be a problem. I would really like feedback on that.

please keep any developments posted on this website. any anonymous NM physicians or radiologists reading these, please help the NM residents who are left to find jobs. Post them here.

thats all. Good luck to all of us, who started NM residency in good faith! (It's the first time any of my non doctor friends have ever heard of a doctor not finding a job). Should I be embarrased or outraged.
 
you guys are creating waves, this discussion has had almost 3000 views!! but they are silent. I lie in the same boat, current resident and now deciding to part ways from nuke's. It is clear the future is bleak, even for established NM physicians. I am all for joining in the movement.

Although I would like to know what other residencies are NM residents pursuing and has it been easy. Also, are there issues with funding. If I finish 3 years is that going to be a problem. I would really like feedback on that.

please keep any developments posted on this website. any anonymous NM physicians or radiologists reading these, please help the NM residents who are left to find jobs. Post them here.

thats all. Good luck to all of us, who started NM residency in good faith! (It's the first time any of my non doctor friends have ever heard of a doctor not finding a job). Should I be embarrased or outraged.

I appreciate that another resident is writing and posting his point of view. Like you mentioned, 3000 views and only 5 or 6 users posting; In my opinion this is probably why our field is about to dissapear.
I think that the best person to reply to your questions is the NMRO president, (sarcastic LOL).
To be honest, I am very dissapointed and frustrated with this whole situtation. I know that I will be forced to get into another specialty after finishing NM.
I am playing lottery every week. In my opinion the chances of winning the lottery are better than getting a job as a NM.
I am waiting to travel to the SNM to get splashed with the UNREAL world of Nuclear Medicine. Personally, I don't care if the FDG activity is higher in the rat's brain, or if there is a new tracer to detect hair cancer, because I will not be able to apply these after graduating, why? LOL, we all know why!!
Keep posting!!
 
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Hi all,

First, some background...I completed a 4 year radiology residency and a one year nuclear fellowship. I am boarded by the ABR and also have a nuclear radiology certificate from the ABR and also certified by the ABNM. I am in a large private practice group in the southeast US and have been the main recruiter for that group over the last 8 years.

I really feel for your situation. However, I would say that what ringhal has said is for the most part spot on. I know that is difficult and not what most of you want to hear. My best advise, go do a diagnostic radiology residency while there is still opportunity. Then you will have the means to practice nuclear medicine. I know of at least 2 nucs residents who were able to make this transition without much difficulty. I dont see any way our group or any other rad group (that I know) would hire a pure nucs doc. I just doesnt make sense on many levels already discussed in this forum.
 
Question for those of you(non radiology) currently in a NM program:


Did you research the job market and job opportunities prior to going into your residency? This is not a new issue. Things have not changed much in the job market for the last 15-20 years! .
 
I dont see any way our group or any other rad group (that I know) would hire a pure nucs doc. I just doesnt make sense on many levels already discussed in this forum.

rvx421,

Thank you for your post, As a Nuclear Radiologist you should know better than anyone on this forum, that a 4 month rotation in NM cannot qualify, not even the best radiology resident, to get out of residency and start reading NM as we discussed 1000 times in this forum.
A short reply to your post quoted above, we all know that the only solution is to regulate who can read NM studies (already discussed).

If you want to become a private pilot you will need 60–70 hours of training, a minimum of 250 hours to become a commercial pilot and more than 2000 to be FAA certified and announce the weather in a Boeing 747.
Do you think the airline transport pilots are FAA certified to fly a Helicopter? Nope, they will need to go back to flight school.
Do you think that they know how to fly a helicopter? Nope, this is a rotorcraft, not an airplane.
Here are 2008 FAA statistics
· 80,989 student pilots
· 252 recreational pilots
· 2,623 sport pilots
· 222,597 private pilots
· 124,746 commercial pilots
· 146,838 airline transport pilots
· 21,055 glider-only pilots
· 14,647 helicopter-only pilots

As you can see, there are categories, meaning that private pilots cannot fly an airline plane and the airline pilot cannot fly a helicopter.
The 1930 Cessna Airmaster, the Boeing 747-400 and the Helicopter all fly, right?.

I don't think that the FAA will let Delta Airlines hire a private pilot with only 3% of the hours needed to fly their 747-400 with 403 passengers. Would you get into that plane from NY to LA?.
Bottom line, SNM and ABNM need to be more aggressive increasing the regulations, requirements and training for non NMp or Nuclear radiologist (rads+NM fellowship) in order to read NM studies and treat patients with radioactive materials.
 
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Question for those of you (non radiology) currently in a NM program:

Did you research the job market and job opportunities prior to going into your residency? This is not a new issue. Things have not changed much in the job market for the last 15-20 years! .

I think that anyone interested in NM is/was aware of the job market problem, but if this is the specialty that you like/enjoy, you will have to deal with the BS. Anyways, the problem is worse than 15 to 20 years ago and it doesn't mean that it has to continue for another 15 or 20 years.
We are asking for a definite solution. We all know that NM is going to dissapear and will be part of RAD residency, but not as a 4 month vacation, ups! sorry, I mean rotation.
 
Solution?

I think you can either fight the system or join the system. Fighting the system will be very difficult as the ABNM and SNM are weak in the whole scheme of things and really dont control who can read in any given hospital. That is up to the credential commitee. In the end, you will be spinning your wheels.

On the other hand, you and the other NM residents on this forum need to realize that your training does not need to be a waste of time. Someone who has 2-3 years of nuclear training in addition to a radiology residency is highly marketable and will prob also see an increase in demand as PET moves forward. In the end, the extra years in radiology will be worth it. Then if you want to find a larger rad group and do primarily nucs...you can. That is the only way....Good luck to all of you!
 
No more comments? :(

The Nuclear Medicine Resident Alliance facebook page has only 2 members in 1 month! Take you own conclusions!.
 
Wow, I didnt mean to put an end to this thread....just trying to open some eyes and give some useful advise...:confused:
 
what are the second residency options after NM? does it really help to be in a good NM program in order to get the second residency after finishing NM? how difficult it is to get the second residency after NM?
 
If you want a job where you can practice NM? Then only Radiology. The better nucs programs will give you a little edge but in my opinion the best thing would be to do your nucs where you would like to do rads. Do a great job in nucs then go talk to the radiology program director about half way through and let them know you have an interest in their radiology program. If you have done well....it would be hard to turn down someone they know and like...


If you want to do another residency and not practice NM....then it prob doesnt really matter...
 
thanks for your prompt reply. i am concerned because it seems almost impossible to survive with pure nuc med status. it seems imperative to have something additional for financial security. the idea of rads is really excellent but if it doesn't work, how about pursuing some easier residency like FM. do the average FM or IM programs accept candidates who wish to do it as a second residency? will the nuc med training at a top place help in this case? how easy or difficult it is to get into FM or IM after a nucs residency?
also,please let me know how would you rank these programs - UCLA, JPNM, Johns Hopkins, Yale and w. beaumont.
 
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You should be able to get FM or IM without any difficulty no matter what you do before. As things stand now...they are very noncompetitive. Nucs may or may not help. As far as nucs programs, there are several good ones. I am only really familiar with the ones in the south- Duke, Vanderbilt, Emory, UAB, Wake are prob at the top. Hopkins is also very good.
 
thanks for your prompt reply. i am concerned because it seems almost impossible to survive with pure nuc med status. it seems imperative to have something additional for financial security. the idea of rads is really excellent but if it doesn't work, how about pursuing some easier residency like FM. do the average FM or IM programs accept candidates who wish to do it as a second residency? will the nuc med training at a top place help in this case? how easy or difficult it is to get into FM or IM after a nucs residency?
also,please let me know how would you rank these programs - UCLA, JPNM, Johns Hopkins, Yale and w. beaumont.
harvard only accept candidates who already finished IM. Otherwise UCLA and johns hopkins are superior to your other options.
 
I am back from the SNM meeting at Salt Lake City. I will write some comments about the meeting and updates in terms of the job market, young proffesionals meeting with the residents, etc...
To give you all an idea, a waste of time and money.
 
your detailed feedback from SNM meet will be really helpful for people like me who wish to enter NM.
i have a NM residency offer outside the match for 2011. i am an IMG with good profile (96/96 and good experience) but i am worried bcoz of reducing match ratio for IMGs and IM becoming more competitive. if i refuse the NM offer now and wait till match and do not get IM also, it will be a bad position. how about accepting NM for now so as to have something on hand, and pursue IM afterward.
i read about some funding issues for second residency. is it true that doing a 2nd residency after NM will be more difficult?
how about doing NM residency on J1 visa? should it be acceptable?
i need your help and suggestions guys... thanks.
 
I am back from the SNM meeting at Salt Lake City. I will write some comments about the meeting and updates in terms of the job market, young proffesionals meeting with the residents, etc...
To give you all an idea, a waste of time and money.

I disagree.

It worths our time and money.

As I said before, we need fight for ourselves, we can not keep silent.

I attend the SNM meeting, I heard lots of heart breaking stories from graduating NM residents... And, some attendings are laid off, or received termination of contract notice...

I strongly believe that:
1. we need speak up, through an organization, against any Radiology department have NM residency refuse to hire NM residents for NM vacancies, especially hire General radiology graduates without NM fellowship---If they have fellowship, I think they have priority over pure NM residents. Especially more and more hospitals are buying PET CT, but only hire radiologist for the vacancy, and let NM residents run the service.

If anyone know such an example, we should fire a "discrimination" lawsuit against the department, set up an example and stop the trend.

2. NM specialty is booming, but NM physician in US is dooming. The radiology is taking advantage of the opportunity. More and more radiology resident are getting into NM fellowship...

On the other hand, the NM in Asia (Japan, China) and Europe is fantastically good, they are expanding, hiring...

BTW, after interviewing with a community hospital for a PGY3 radiology spot, I decided to stay in my current NM program, even they intended to offer me the spot. Why? The hospital doesn't have PACS, still read X-ray films, not digital, only have 16 slice CT (going to buy a 64 slice CT), single detector SPECT, no SPECT/CT, old generation of PET CT, no electronic medical record system, everything is still on paper....

I am encouraged by the prosperous NM in Asia, and I will go back to my home country in Asia next year if I can not find a job in the US.

3. Radiology with NM fellowship will beat pure NM residents in the US. However, in the long run, these radiologists will lose interests in NM, they will still want to go back to radiology. NM fellowship is helping them to find a job at this moment---Because radiology residents also facing job issues now, though is much better than us. And, those guys are not willing to do NM research, usually.

So, years later, NM vacancies opens, however, Asia and Europe will far more superior to the US, both in clinical practice and research.
 
NMDreamer,

Can you please post the information of that RADIOLOGY residency program in order to help all the NM residents who are interested in getting into radiology?
That will be helpful for a lot of residents!!

Thank you in advance for your help!

We will be waiting for the information!
 
NMDreamer,

Can you please post the information of that RADIOLOGY residency program in order to help all the NM residents who are interested in getting into radiology?
That will be helpful for a lot of residents!!

Thank you in advance for your help!

We will be waiting for the information!

The positions were filled 2-3 wks ago. They are on probation, 2 PGY-3 spots, NYC area, filled. Sorry, man.
 
The positions were filled 2-3 wks ago. They are on probation, 2 PGY-3 spots, NYC area, filled. Sorry, man.

Thank you for your reply.

Which Hospital?
 
Thank you for your reply.

Which Hospital?

You are so desperate. As I said, the spots are filled.

If you can quit NM residency without a blinking, I suggest you quit now, don't waste your time. Do whatever you want to do...

Is radiology really what you want? Or you just want to find a secure job?

If radiology is what you are longing for, send out email with your CV to all the radiology PDs, ask them to see if there is opening for you.

Remember the last post you said I am dreaming, and you understood why I am "NMDreamer"? You want to stay in the US to turn your America Dream to reality, you need work for it.

Whatever you want, you need work hard by yourself.

At the SNM meeting, I know another current PGY3 NM resident, IMG, found a PGY3 radiology spot in a small community program in the South(This one is true). And a DC PGY2 NM resident, IMG, claimed she had 3 offers as PGY3 radiology resident from John Hopkins, Columbia, Emory (I think it is untrue).

For me, I still believe NM is promising, but not in America for the near future, at least clinically, especially for NM physicians.
 
You are so desperate. As I said, the spots are filled.

If you can quit NM residency without a blinking, I suggest you quit now, don't waste your time. Do whatever you want to do...

Is radiology really what you want? Or you just want to find a secure job?

If radiology is what you are longing for, send out email with your CV to all the radiology PDs, ask them to see if there is opening for you.

Remember the last post you said I am dreaming, and you understood why I am "NMDreamer"? You want to stay in the US to turn your America Dream to reality, you need work for it.

Whatever you want, you need work hard by yourself.

At the SNM meeting, I know another current PGY3 NM resident, IMG, found a PGY3 radiology spot in a small community program in the South(This one is true). And a DC PGY2 NM resident, IMG, claimed she had 3 offers as PGY3 radiology resident from John Hopkins, Columbia, Emory (I think it is untrue).

For me, I still believe NM is promising, but not in America for the near future, at least clinically, especially for NM physicians.


If you read all my previous posts, you can tell that I am not interested at all in radiology, but I know that most of the NM residents are willing to get a spot to become double boarded.
The american dream? Come on! This is not a movie from the 70's.
Why did you apply for that radiology spot?
 
If you read all my previous posts, you can tell that I am not interested at all in radiology, but I know that most of the NM residents are willing to get a spot to become double boarded.
The american dream? Come on! This is not a movie from the 70's.
Why did you apply for that radiology spot?

I applied, mainly due to the depression from job market, partly want to give a shot to see how competitive I am.

Though NM was not my first choice, neither radiology, but I like oncology in general, now I found lots of interesting things in NM that excites me---Which I think mainly from my research background.

As I said, I believe NM field is promising, however pure NM physician will not be able to see future in the US.

BTW, I was told at SNM that the NM PDs voted, and passed, to turn NM residency into one year intern+ 1 year NM + 4 yr radiology in the future---In America, I guess it will take at least 5 years to make it become true.

However, I didn't confirm this rumor with any PD, but you can check with your PD, if S/he attended the meeting.
 
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