When I was applying, the smart money for trainees was on ophtho, rads, cardiology, anesthesia. Not ED. Not derm. I think a quarter of my class went into anesthesia. It wasn't from a lack of foresight. Things change. Different regions and systems put the hurt on you in ways you won't even be able to predict.
It's been said so many times, but again: the old ROAD radiology fantasy is gone. Actually three of the ROAD have issues to work out and there's nothing about the fourth that makes it immune forever. Radiology is still a good field if you go into it without some fantasy blinders on. In radiology you will be intellectually challenged, you will help people, and you will more than likely make a competitive salary for your region and work load level. You will not work 9-5, take hour long coffee breaks, and will not make half a million because you deserve it for your good step 1 score. Frankly, good riddance to those with that vision, because they were the worst.
AI is another bogeyman like outsourcing, or whatever. If there were no bogeyman we would have to invent one for sdn. AI will most likely have a mixed picture on work/life balance and employment.
Another point. PP radiology benefits as much from overtraining as academics. The idea of a PP not hiring the cheaper workers mentioned above is laughable. Academics is happy to expand and PP is just as happy to exploit with sometimes shameful offers and contracts. There are no heros here. They have both convinced themselves with their data that they are doing the right thing... and that sad thing is that there is some half-truth to their position. If the amount of work goes up and the reimbursement goes down, the right way to handle that is not a certainty. The trainee wisdom that you can just hole up in your castle, have fewer docs available to increase demand for your services is only partly corrrect... if you're too expensive in terms of whatever metric they're using, whenever the payer finds a cheaper workaround, they will take it, and bypass your castle. Politically, if necessary. If a PA for derm is found to be non inferior for 85% of cases, poof, the castle will start crumbling. If you are numerous and cheap then politically you're a tougher target. And a lot more of this goes back to politics than most trainees understand. An unfavorable political move hurts much more than trainee slots... and that's much harder to predict.
I support not expanding residencies, and especially poor quality community residencies. You can definitely hurt your specialty by expanding too quickly. But the work for radiology is there... like too much of it. There's just less per unit work. Imaging is not in secular decline, just paying for it is in decline compared with 15 years ago. For rads, trainee slots are a somewhat downstream problem, the problem is more macro for all of medicine and surgery. If you don't control the wallet you will get squeezed, it doesn't matter if you're a brand new FMG pathologist or a surgeon with decades of training.
