diagnostic radiology getting less competitive?

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mcatsucksss

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mcatsucksss said:
so i was browsing wash u's residency guide site and saw that diagnostic rads was trending down in competitiveness and is now considered LOW competitiveness... i always thought rads was ridiculously hard to get into. so whats going on?

http://residency.wustl.edu/medadmin/resweb.nsf/L/B1A2B4EE4AF135B386256F8F0072972A?OpenDocument

i was thinking about going into rads for the longest time but now im kinda scared that im missing something:scared:
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Like medicine, rads is a top heavy specialty with the top academic programs and those in desirable locations being hard to match into and ones in undesirable locations being hard to match into. That being said, the average step 1 for the ~1000 allo seniors applying rads was 241; 25% of applicants had > 251. I think that counts as competitive.
 
It isn't among the most competitive (derm, ran onc...), and probably getting less competitive, but still more competitive than average.
There is concern about decreasing reimbursement for imaging from the currently unsustainable and unjustifiable levels, and also concern about outsourcing to places like Australia and India.
 
I didnt mean to say radiology was among the hardest to get in, what i meant was why is there a downward trend in competitiveness in recent years.
and isn't decreased pay a fact of life for almost every specialty in the next few years? or is it certain ones (like rads) that are gonna get hit the hardest?
 
mcatsucksss said:
I didnt mean to say radiology was among the hardest to get in, what i meant was why is there a downward trend in competitiveness in recent years.
and isn't decreased pay a fact of life for almost every specialty in the next few years? or is it certain ones (like rads) that are gonna get hit the hardest?
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There isn't. Average step scores have increased from 235 in 2009 to 241 in 2011.
 
officedepot said:
this concern is not among radiologists... It's a myth med students have. As others have stated in other posts around these forums most "outsourcing" is done overnight to other groups within the states. These studies are then finalized the next day.

Also there is decreasing reimbursement in everything...

Radiology is getting less competitive probably for a wide variety of reasons that can't really be quantified. My school only has a few interested. The reason I think for my particular case relates to how medical students were selected in the first place (lots of volunteer, people loving, etc), what is emphasized in lectures and on rotations, the strength of the home program, the type of curriculum a school adopts, any class's particular interests (a class 2 years ahead of mine saw almost 20% go into peds when the following year only around 10% did), etc.

The trend for rads is down but that isn't necessarily a bad thing. The decreasing competitiveness of radiology only means that other fields are becoming more competitive. Apparently there were only 50 open slots on SOAP this year for IM when in previous years there were hundreds.
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The reality is worse, there are far too many active radiologists and residency spots. It is currently quite difficult to land a decent job post residency.
 
officedepot said:
this concern is not among radiologists... It's a myth med students have. As others have stated in other posts around these forums most "outsourcing" is done overnight to other groups within the states. These studies are then finalized the next day.
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I'm deciding between rads and another field right now but this still worries me. While overnight reads are being done right now by other US rads and finalized by the primary rads in the a.m. there is no guarantee it will remain this way in the future 10, 20, 30+ years from now. I know there is a law that says all final reads have to be done by a licensed rad in the state the image was taken, but there is also no guarantee that wouldn't change. The fact remains the technically it is easy to outsource rads overseas even though it isn't happening right now. Just a few legislative changes and the situation looks a lot gloomier.

I love what radiologists do but the future is just so uncertain. Part of why I'm still struggling to decide what I will apply into.
 
dude1344 said:
I'm deciding between rads and another field right now but this still worries me. While overnight reads are being done right now by other US rads and finalized by the primary rads in the a.m. there is no guarantee it will remain this way in the future 10, 20, 30+ years from now. I know there is a law that says all final reads have to be done by a licensed rad in the state the image was taken, but there is also no guarantee that wouldn't change. The fact remains the technically it is easy to outsource rads overseas even though it isn't happening right now. Just a few legislative changes and the situation looks a lot gloomier.

I love what radiologists do but the future is just so uncertain. Part of why I'm still struggling to decide what I will apply into.
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Outsourcing sounds like an incredible cost-saving maneuver. Especially since imaging is such a large part of the cost of medicine. And if studies prove it to be without negative consequences? Well, I think the fear is justified.
 
dude1344 said:
I'm deciding between rads and another field right now but this still worries me. While overnight reads are being done right now by other US rads and finalized by the primary rads in the a.m. there is no guarantee it will remain this way in the future 10, 20, 30+ years from now. I know there is a law that says all final reads have to be done by a licensed rad in the state the image was taken, but there is also no guarantee that wouldn't change. The fact remains the technically it is easy to outsource rads overseas even though it isn't happening right now. Just a few legislative changes and the situation looks a lot gloomier.

I love what radiologists do but the future is just so uncertain. Part of why I'm still struggling to decide what I will apply into.
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This would require a radical shift in ALL of medicine. I doubt one specialty will be singled out to suddenly allow non US trained, non licensed, non BC/BE physicians to provide services billed MOSTLY to our own government. If this occurs across all disciplines, it won't only be Radiology, but all disciplines in medicine that will be in trouble from a financial and job security standpoint.
 
upright said:
Outsourcing sounds like an incredible cost-saving maneuver. Especially since imaging is such a large part of the cost of medicine. And if studies prove it to be without negative consequences? Well, I think the fear is justified.
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You are confusing the costs of the technical component (technology/scanner/PACS) with the cost of the professional component (radiologist fee).

The radiologist gets a relatively small piece of the imaging money pie. There wouldn't be as much cost savings as you'd expect.
 
DrBowtie said:
This would require a radical shift in ALL of medicine. I doubt one specialty will be singled out to suddenly allow non US trained, non licensed, non BC/BE physicians to provide services billed MOSTLY to our own government. If this occurs across all disciplines, it won't only be Radiology, but all disciplines in medicine that will be in trouble from a financial and job security standpoint.
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You can't outsource surgery. Money talks brah.
 
DrBowtie said:
You are confusing the costs of the technical component (technology/scanner/PACS) with the cost of the professional component (radiologist fee).

The radiologist gets a relatively small piece of the imaging money pie.
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I was unaware. Either way, I don't trust what the government is going to do with medicine. An entire restructuring is most certainly in order, because the status quo is simply unsustainable. Remember, politicians don't give 2 $hits about the profession of medicine. They have a looming and large problem on the horizon. And the general public doesn't have a clue what a radiologist does, so the public outcry will be a whisper.
 
Declining reimbursements, long training with now required fellowship, and lack of many job opportunities in desirable locations have taken their toll on radiology's cachet. Private practice is definitely more of a grind now with the increased throughput made possible by easy retrieval of digitized images.

As drizzt mentioned, radiology is very bimodal in that the top university and California programs remain extremely competitive, but the community programs and university programs in the middle of the country are a much easier ballgame.

I think radiology will continue to attract smart applicants because the specialty is very efficient for smart people. In radiology you are not limited by how many patients come in on a Sunday afternoon, or the availability of the OR. Your productivity is dictated by your reading speed and your value addition is dictated by your knowledge, both of which correlate with high intelligence. It's a field that continues to reward intelligent people, more so than others, and hence will continue to attract intelligent people.
 
It's extremely impractical to sue someone in India. This is one of the reasons why radiology will not be outsourced.
 
I think the bigger problem isn't outsourcing but oversaturation of the market. As someone said previously, there is just too many active radiologists and residency spots. From the residents that I've talked to, doing fellowship is almost a necessity now to make yourself more competitive and to get paid while you're waiting for job opening. So you're looking at about 6-7 years of training post med school.
 
XRanger said:
I think the bigger problem isn't outsourcing but oversaturation of the market. As someone said previously, there is just too many active radiologists and residency spots. From the residents that I've talked to, doing fellowship is almost a necessity now to make yourself more competitive and to get paid while you're waiting for job opening. So you're looking at about 6-7 years of training post med school.
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Makes sense, why would you retire from Rads. It seems pretty lifestyle friendly and no procedures, so you can get better in older age.
 
XRanger said:
I think the bigger problem isn't outsourcing but oversaturation of the market. As someone said previously, there is just too many active radiologists and residency spots. From the residents that I've talked to, doing fellowship is almost a necessity now to make yourself more competitive and to get paid while you're waiting for job opening. So you're looking at about 6-7 years of training post med school.
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Isn't that pretty standard as far as sub-specialization goes? The fellowships within internal medicine that many people are shooting for have a similar timeline, and it's often longer within surgery.
 
Rads numbers are tricky to interpret. The high avg. step1 score suggest it is very competitive, but the very high match rate suggests that it is not. That suggests that it is not competitive in terms of number of applicants per spot, but is in terms of the quality of said applicants.

Based on that I'd guess that its not that hard to get a radiology residency, but the top end places are going to be extremely competitive.
 
upright said:
You can't outsource surgery. Money talks brah.
Click to expand...

Why can't you? What's to say that there won't be a highend tele-robotics with haptic feedback that comes out in a couple of years? One can come up with ridiculous sky is falling scenarios with nearly everything. Why bother with internal medicine? You could just enter stuff into Watson, pick the most likely diagnosis and follow the algorithm. Anesthesiology? OMFG, CRNA and AA. Primary care? PA, ARNP, FMGs. The list goes on and on. The people who talk about the outsourcing are the same people that have no true concept of what is involved with radiology, including the procedures and direct interaction involved.

Outsourcing is dependent on multiple things including the hospitals seeking it out, finding people over there, having doctors suddenly stop coming to the radiology department, having radiologists stop doing biopsies and other procedures, the countries with the outsourcing creating a large enough number of radiologists to meet the demands of an entire country in addition to their OWN needs, etc. If you think India wouldn't start restricting things on their end when local radiologists start ignoring patients over there, you'd be crazy. There is a growing population with an ever increasing demand for imaging studies.

All specialties go through ebs and flows. 50-80 open spots isn't much when you think about it as about 1 person out of every 2ish schools decided against going into a specialty that most of us get little exposure to during third year.
 
MossPoh said:
Why can't you? What's to say that there won't be a highend tele-robotics with haptic feedback that comes out in a couple of years? One can come up with ridiculous sky is falling scenarios with nearly everything. Why bother with internal medicine? You could just enter stuff into Watson, pick the most likely diagnosis and follow the algorithm. Anesthesiology? OMFG, CRNA and AA. Primary care? PA, ARNP, FMGs. The list goes on and on. The people who talk about the outsourcing are the same people that have no true concept of what is involved with radiology, including the procedures and direct interaction involved.

Outsourcing is dependent on multiple things including the hospitals seeking it out, finding people over there, having doctors suddenly stop coming to the radiology department, having radiologists stop doing biopsies and other procedures, the countries with the outsourcing creating a large enough number of radiologists to meet the demands of an entire country in addition to their OWN needs, etc. If you think India wouldn't start restricting things on their end when local radiologists start ignoring patients over there, you'd be crazy. There is a growing population with an ever increasing demand for imaging studies.

All specialties go through ebs and flows. 50-80 open spots isn't much when you think about it as about 1 person out of every 2ish schools decided against going into a specialty that most of us get little exposure to during third year.
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Anesthesiology and radiology would be nonexistent for decades before robots are independently performing surgery. Those two fields are much easier to automate. Looking at all the specialties, surgery would be one of the last to go.

[YOUTUBE]HbUeAdVXOVc[/YOUTUBE]
 
DoctwoB said:
Rads numbers are tricky to interpret. The high avg. step1 score suggest it is very competitive, but the very high match rate suggests that it is not. That suggests that it is not competitive in terms of number of applicants per spot, but is in terms of the quality of said applicants.

Based on that I'd guess that its not that hard to get a radiology residency, but the top end places are going to be extremely competitive.
Click to expand...

The top places are difficult to get interviews at, let alone match. High Step, AOA, and research doesn't guarantee much at all in terms of interviews. The most popular places like UCSF, MGH, BWH, UCLA etc are very difficult. Just imagine the quality at the top when the avg is 240 and over 1/4 have AOA.
 
Outsourcing in surgery is more traveling to foreign countries to have surgery.
 
I dunno if psychiatrists are worried but some off the rural programs I interviewed were all interested in setting up tele psych services
 
Lots of black pearls on this thread, IMHO:

-Radiology remains highly competitive, but not quite as competitive as a few years ago. I think this mostly has to do with the eventual realization among many medical students that private practice radiology is not - and has not been for awhile - a lifestyle specialty. It also has to do with the fact that - as compared to similarly competitive specialties like surgical residencies or radiation oncology - radiology is a much larger field. Also, I think some PDs tend to hang onto their 2006 expectations rather than adapt to the reality of the applicant pool.

-The job market has taken a tumble, without doubt, but it's not like radiologists are filing for unemployment benefits. I think the decline in the job market says more about the unsustainable highs the field experienced about 5 years ago than it does about the future. I continue to believe that it's mostly about readjusting expections, but I'll admit that is just my opinion.

-Can we please stop with the concerns about outsourcing? I mean, it's not impossible, but it's highly improbable. The concerns appear to be propogated by those with little-to-no knowledge about the field. Allowing a non-US trained/licensed radiologist to provide final reads would represent a sea change in American medicine that is highly unlikely to be enacted or allowed.

If someone is thinking of radiology, but is hesitant because of these concerns, please feel free to PM me. I can only offer my own perspective and opinion, but I would guess that it's more informed than most of what gets posted here.
 
XRanger said:
I think the bigger problem isn't outsourcing but oversaturation of the market. As someone said previously, there is just too many active radiologists and residency spots. From the residents that I've talked to, doing fellowship is almost a necessity now to make yourself more competitive and to get paid while you're waiting for job opening. So you're looking at about 6-7 years of training post med school.
Click to expand...

Right on! I think this is the major problem.

As long as you can keep your head up and see and mentate you can be a radiologist. WHich means there are plenty of 70-80 year old radiologist around which saturates the field if none of these greedy radiologists are retiring. Different for surgery. Its hard to be a 75 yo surgeon. Arthritis will get the best of you, standing for periods of time etc etc......

Same problem with Anesthesia. Anesthesiology has another subset of problems because all the all physician groups will be displaced by midlevels leaving a bunch looking for work supervising and there are only so many anesthesiologists that can supervise so there will be a glut i feel for some time. Coupled with the fact that in 10-15 years i see most states opting out of the medicare requiring an anesthesiologist present to get paid. Just fertile ground for major problems for the field. Add into the mix academic and society leaders who have their head in the sand not recognizing problems and having a fix for them. CRNAs are doing a major number on the medical specialty of Anesthesiology. The president of the AANA had choice words to say.

http://www.nurse-anesthesia.org/con...Medscape-Article-Comments-By-Anesthesiologist

and no response thus far.
 
I knew this would be like a bat signal for drizzt and with the only 5 minute response time I wasn't disappointed haha
 
DrBowtie said:
This would require a radical shift in ALL of medicine. I doubt one specialty will be singled out to suddenly allow non US trained, non licensed, non BC/BE physicians to provide services billed MOSTLY to our own government. If this occurs across all disciplines, it won't only be Radiology, but all disciplines in medicine that will be in trouble from a financial and job security standpoint.
Click to expand...

This is true. It would require a dramatic shift in all of medicine to allow non-US trained physicians to practice in the US. I realize images can be sent online but if you get sued, you get sued from the state the patient was physically in and have to defend yourself in that court. Legally speaking, outsourcing Radiology completely is just about impossible.
 
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CATrtb said:
It's extremely impractical to sue someone in India. This is one of the reasons why radiology will not be outsourced.
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This. I didn't see your post before I replied above but the fear that Radiology will be outsourced is not in line with reality. It isn't just denial either, it has everything to do with how the medical system works: In that, the patients sue the doctor that is responsible for the read, the doctor must then of course hold a license in that state it is illegal otherwise, and the doctor must be licensed at the hospital to which the patient was seen. The regulatory hurdles and licensing involved in just getting a job is totally insane I've seen people that have had to do it. Legally you can't outsource physician services, and if this were to change, ALL of medicine becomes a wide open field, as others have said, to any foreign trained graduate.

This would effect every specialty. Don't think fields like ER would be safe either because if you allow foreign trained physicians to practice medicine in one field without a state/US license, that applies to every field immediately. There would be nothing stopping then a mass wave of immigration into this country to fill just about every specialty no matter where you trained. Can you imagine if the government allowed doctors to practice medicine without a United States License? That is what would have to happen and is the type of change we are talking about for Radiology to be able to be truly outsourced.
 
DoctwoB said:
Rads numbers are tricky to interpret. The high avg. step1 score suggest it is very competitive, but the very high match rate suggests that it is not. That suggests that it is not competitive in terms of number of applicants per spot, but is in terms of the quality of said applicants.

Based on that I'd guess that its not that hard to get a radiology residency, but the top end places are going to be extremely competitive.
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Good post.

I predict that next year will see a large increase in competitiveness for Radiology.

Why?

There has always been a perception that it is so competitive many just don't apply. I kind of liked Derm but just wrote it off completely due to perceived competitiveness. A lot of people do this with Radiology.

I really believe more applicants have a chance now, and this window may only last a year or two we'll see, and I think some will see this. I predict it will increase the number of people applying next year.
 
officedepot said:
The trend for rads is down but that isn't necessarily a bad thing. The decreasing competitiveness of radiology only means that other fields are becoming more competitive. Apparently there were only 50 open slots on SOAP this year for IM when in previous years there were hundreds.
Click to expand...

I think it's just Ebb and flow.

Radiology is a good way to make a living (if you like the specialty) and everyone knows that. I don't think, even if there are decreasing reimbursements that it's going to become "easy" to just fill out an ERAS and match into.

Interestingly enough, it was more competitive year for IM - literally a blood bath for top candidates at the top programs. I saw lots more people matching at their number 2 or 3 than in years past.
 
officedepot said:
I'm pretty sure the field of anesthesia is far more complex than any of us give it credit for. I also do not think the general public wants their anesthesia/life to be in the hands of a nurse when they could have full fledged MDs. ...
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The generally public will take whatever they can get the cheapest.
 
michaelrack said:
The generally public will take whatever they can get the cheapest.
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This is so true, there is some doc who didn't even finish a residency in anything and does a whole bunch of cosmetic derm/medical spa stuff in my hometown and people flock there b/c he gives botox for cheaper than the dermatologists/plastic surgeons in town who were actually trained in that sort of stuff.
 
jdh71 said:
Interestingly enough, it was more competitive year for IM - literally a blood bath for top candidates at the top programs. I saw lots more people matching at their number 2 or 3 than in years past.
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Was it literally a blood bath? Was there blood flowing down the hallways, seeping out of patient rooms? :laugh: Just messing with you, but serious question - do you see this becoming a trend or is this more likely to be a one year spike? Just curious because I'll probably be applying to internal med in a few years to some academic programs and I'm wondering how rough it might be by then.
 
SteinUmStein said:
Was it literally a blood bath? Was there blood flowing down the hallways, seeping out of patient rooms? :laugh: Just messing with you, but serious question - do you see this becoming a trend or is this more likely to be a one year spike? Just curious because I'll probably be applying to internal med in a few years to some academic programs and I'm wondering how rough it might be by then.
Click to expand...

To soon to tell for sure, BUT last year things smelled a little more competitive, and some of the peeps at or near cutoff didn't get invites and or were eventually shut out of the big name programs. Now, this year, even the superstars have been rolling in with reports of match 3 or 4 on their lists (I mean if UCSF is 4th on your list, you're still doing fine but . . .) the same candidates in years past that were basically shot callers. The upper echelon group of candidates seems to be expanding for IM. Finding a spots outside of the top 20 programs though still seems relatively unaffected, if that changes for the next cycle, I think I'll feel pretty comfortable calling the rise of IM from back-water match with your eyes closed specialty to something people are going to have to start be a little more strategic with, more akin to gas or EM, than FP or PM&R.
 
jdh71 said:
To soon to tell for sure, BUT last year things smelled a little more competitive, and some of the peeps at or near cutoff didn't get invites and or were eventually shut out of the big name programs. Now, this year, even the superstars have been rolling in with reports of match 3 or 4 on their lists (I mean if UCSF is 4th on your list, you're still doing fine but . . .) the same candidates in years past that were basically shot callers. The upper echelon group of candidates seems to be expanding for IM. Finding a spots outside of the top 20 programs though still seems relatively unaffected, if that changes for the next cycle, I think I'll feel pretty comfortable calling the rise of IM from back-water match with your eyes closed specialty to something people are going to have to start be a little more strategic with, more akin to gas or EM, than FP or PM&R.
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I assume this is from top candidates who want competitive fellowships (cards, GI, etc) all trying to get into the same 15-20 programs? Or is the general IM/hospitalist track getting more desirable as well?
 
SteinUmStein said:
I assume this is from top candidates who want competitive fellowships (cards, GI, etc) all trying to get into the same 15-20 programs? Or is the general IM/hospitalist track getting more desirable as well?
Click to expand...

Probably more the first group.

But hospitalist isn't a bad way to make a living if you like the work, and I think more and more people are looking at that as an option
 
jdh71 said:
To soon to tell for sure, BUT last year things smelled a little more competitive, and some of the peeps at or near cutoff didn't get invites and or were eventually shut out of the big name programs. Now, this year, even the superstars have been rolling in with reports of match 3 or 4 on their lists (I mean if UCSF is 4th on your list, you're still doing fine but . . .) the same candidates in years past that were basically shot callers. The upper echelon group of candidates seems to be expanding for IM. Finding a spots outside of the top 20 programs though still seems relatively unaffected, if that changes for the next cycle, I think I'll feel pretty comfortable calling the rise of IM from back-water match with your eyes closed specialty to something people are going to have to start be a little more strategic with, more akin to gas or EM, than FP or PM&R.
Click to expand...

I feel like the top IM people at UW all got their #1 (JHU x 2, UCSF x 2, BWH, MGH, UCLA, Washington, Michigan). The only people that didn't were people who wanted to stay (I think we had like 10-12 people stay) and ended up at a top 10-15 place instead. People slid a little more in the surgical subspecialties. I think all of us in rads got 1 or 2 though.
 
officedepot said:
I'm pretty sure the field of anesthesia is far more complex than any of us give it credit for. I also do not think the general public wants their anesthesia/life to be in the hands of a nurse when they could have full fledged MDs. Beyond that while anesthesia from a med student perspective is seen as one where nurses/crnas could take over I would bet if you talk to anesthesiologists they would paint a different picture because lots of people still pursue that field. Also the same argument for midlevels could be made for many many fields. Why does it take 6 full years of training to do a screening colonoscopy. I bet you could train a person to do only that job in, well, a PA's education time.

I also find it telling of how pathetic CRNAs are as an organization when the president of their association has to write a letter defending themselves based off the comments on an internet article...
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Never would I allow anyone in my family or myself to have a medical decision made by any sort of nurse. Let alone something like being put to sleep...(and possible complications arising).
 
I am one of 2 (maybe 3) people in my class applying for rads. Every school is different, but my class largely has no clue what a radiologist even does. They all hear me say radiology and say, "Ew, I could never spend all day in a dark room by myself!" The only viewpoint of the specialty they get are the comments from other attendings in other fields. I've had clerkship directors and attendings tell me, "Radiologists aren't real doctors", "You are far too gifted with patients for that", "That is a waste of your talents",etc. Meanwhile, I was a "patient" for a demonstration of a telemedicine robot the other day where the user, from thousands of miles away, could examine me, auscultate, use an otoscope and view images/telemetry/labs (with a little assistance from a nurse). I guess those jobs will be outsourced at some point too.

Honestly, I don't care if it isn't viewed as "competitive". I would rather see people go into the fields they fit best than the ones they choose strictly because of perceived comfort/income. In 20 or 30 years, that dip may create another spike. All of these specialties seem to ebb and flow. Radiology wasn't tremendously popular in the 60s and early 70s and then you saw the peaking of incomes in the 80s and 90s. There are tons and tons of other factors in that, but I can't help but suspect it is a contributing one.
 
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Don't worry SDN, Rads being less competitive doesn't mean you're less of a person.🙂
 
JackShephard MD said:
Don't worry SDN, Rads being less competitive doesn't mean you're less of a person.🙂
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Hahaha, this.

Some people just place so much stock into what others think. They would go into something because it is perceived as competitive by others. Mucho sadness.
 
medking said:
Hahaha, this.

Some people just place so much stock into what others think. They would go into something because it is perceived as competitive by others. Mucho sadness.
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tumblr_ltuzjvbQ6L1qzgpx9.gif
 
It is still an intellectually challenging specialty that has a very high rate of job satisfaction. It still has very little paperwork compared to most other specialties. It still has great compensation and good hours. Hey, if you make your application decision based on a specialties perceived competitiveness that is your own prerogative. But 10 years down the road you'll be shoving cameras up some fat persons butt while I'm sipping coffee in my PJ's while reading some scans from home. You may then realize that there are more important factors to consider when choosing ones specialty.
 
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