This past week at the RSNA meeting, there was a symposium on the current shortage of radiologists. Among the panelists were representatives from the ACR, ABR and ABMS. Each in turn expressed frustration with the situation and described what have been tried and what they thought should be done. The following is a brief summary: ACR representative: There is/will be a continuing shortage of radiologists by 5%. A recent review showed 44 openings in neuroradiology with only 4 candidates. Radiology leads the shortage among all specialties, followed by Orthopedics. A reason for the shortage is the yearly growth in number of radiologists by 1.5%, with a yearly increase in the number of procedures performed by 4.5%. Total number of procedures performed per year will rise to 450 millions. The procedures are also increasingly more complex and radiologists must now be available 24/7. RRC (Radiology Review Committee) and ABR representatives: Academia is particularly hard hit. Attendings are overworked and underpaid. There are 600 vacancies, with an average of 5 per residency program. Fellowships are going unfilled. And there is no light at the end of the tunnel because programs are not producing more radiologists. In 1995, the number of residents in training was 4,181 (all levels). The most recent tally is 3,769. Last year, there were only 872 candidates for the oral board. The number of candidates for the CAQs has also decreased. The RRC has approved an increase of 172 slots spread over the next three years. However, two programs are losing accreditation, with a loss of 16 positions. One third of applicants last year failed to match into Radiology. ACR and ABMS (American Board of Medical Specialties) representatives: Labor estimates can be wrong. In 1990, a shortage of 5,000 radiologists was predicted. 1n 1996, it was thought that there would be a glut. Now in 2002, too few radiologists. By 2020, there will be a shortage of 200,000 physicians, particularly specialists and a need for 40 new medical schools. WHAT OPTIONS HAVE BEEN CONSIDERED AND TRIED? 1. The RRC has relaxed and watered down rules goverrning residency programs. a) In the past, programs must have 1:1 ratio of attending FACULTY to trainee. The wordings have been changed to FACULTY EQUIVALENT. This is sham because PhDs and physicists can now be counted. b) In the past, fellows must have been trained in ACGME-approved or Canadian residency programs. Now, training considered adequate by program directors is sufficient. This is an attempt to bring in foreign graduates with disparate training and who will never have to/ or can become board certified. These fellows can then stay on to teach and work. 2. Increase the number of trainees in the pipeline - this was not seriously considered and only about 50 additional positions per year were approved. Residency programs do have room to grow. Under RRC rules, programs must do at least 7,000 procedures per year per trainee. On average, they are doing 12,000 now. One stumbling block is funding. Attempts will be made to solicit federal support. Alternative sources are also being considered, such as having private practice groups pay the salaries of residents they intend to hire. This practice does not violate any rule. In fact, the military has sponsored residents in civilian programs for years. 3. Shorten the training period to three years - this was immediately thrown out because four years is barely adequate. 4. Fast tract other specialists - this may soon become a reality, despite vociferous opposition. A most likely scenario is allowing pediatricians to practice pediatric radiology following a short training period. The opposition cites that radiologists in practice can't just do Peds and maybe called upon to read other studies. But Pediatric radiology is in a critical crunch. 5. Develop Radiologist Extenders who, like PAs and CRNAs, can practice under supervision. 6. Consider limitting the scope of the specialty - like letting the orthopods read their things (cardiologists have already taken echo and nuclear cardiology, OBGyns have siphoned off Sono). This is considered a bad idea. WHAT OTHER FACTORS MAY AFFECT/ALLEVIATE THE SHORTAGE? 1. Managed care. 2. PACS and technical advancements making radiologists more efficient. But these may well lead to more procedures being performed. 3. Self referral pattern? WHY IS THE SHORTAGE CRITICAL FOR RADIOLOGY? 1. Training programs suffer for lack of faculty. Fellowships may have to be scrapped. Last year there were only 22 CAQs awarded in Peds, 122 in Neuro, 135 in IR and 8 in NM. 2. Will lose TURF battles with other specialties.