Cathance

Junior Member
10+ Year Member
5+ Year Member
Nov 13, 2005
41
1
0
Status
Resident [Any Field]
Currently, the Center for Medicare and Medicaid spend an average of $80,000 per resident per year to train Nuclear Medicine Physicians in residency programs around the country. The trouble is... nobody wants them.

Nuclear medicine residents (currently trained with three years of nuclear medicine instruction and experience to become Nuclear Medicine Physicians, or NMPs) have dismal job prospects. On AuntMinnie.com, a popular radiology community website that gets its name from the types of patterns in imaging that radiologists should recognize as easily as they would their "Aunt Minnie," there are zero (yes, that's a goose-egg ZERO) jobs posted for nuclear medicine physicians. Some might say it's because NMPs don't use AuntMinnie.com. However, if you view job postings at the Society of Nuclear Medicine website (snm.org), you will see the true demand for NMPs: again, ZERO. On the date of the submission of this letter, there is not one job posted looking for an NMP. There are several postings, however, for wide-open training positions (resident or fellow in nuclear medicine or PET/CT). Granted, there are significantly fewer graduates of NMP training programs (total NMP residents numbering 193 according to http://www.acgme.org/adspublic, divided by [the former duration of] 2 years of training, producing about 97 new NMPs per year). But ZERO jobs is a very small number for these 97 newly trained NMPs hoping for a career. That means AuntMinnie.com job postings cover ZERO percent of the supply of new NMPs. All NMPs must find their jobs by word of mouth recruiting or other posting sources unknown to me. One might speculate, accurately in my estimation, that most recruiters are looking for nuclear radiologists (radiologists with a fellowship in NM) to read their nuclear medicine, but then settle for an NMP due to supply issues (often negotiated at a significantly lower salary and even exclusion from the partnership career track).


On the other hand, there is enormous demand for radiologists in the United States. On just AuntMinnie.com alone, there are 704 jobs posted looking for radiologists, covering 35% of yearly supply of new radiologists. The American College of Radiology website (ACR.org) posts 74 jobs. There are many other sites advertising more positions. I get spam from recruiting and staffing agencies that advertise hundreds of jobs for radiologists. As is the case in most career fields, the majority of jobs available are actually never posted but are filled by word-of-mouth recruiting (i.e., internally or with people already familiar to the group). Around 1,100 radiologists complete their training every year to cover this demand (4,670 total residents according to http://www.acgme.org/adspublic, divided by 4 years of training). For radiologists, the field is wide open, the demand intense, which is why radiologists are well paid (low supply, high demand). During their training, radiologists receive instruction and experience in all fields of imaging, including nuclear medicine (only 4 months, but that is considered by most credentialling institutions to be enough to read and bill for any nuclear medicine imaging and therapies). Board-eligible radiologists interested in more training in nuclear medicine can do a one year "fellowship" (actually, they jump in at year #3 of nuclear medicine residency) and qualify for board certification by the American Board of Nuclear Medicine, the same certification that we get after 3 years of training (under new rules as of 2006). The biggest difference is that... they get the jobs. We don't.

In another comparison, radiation oncology residencies (four-year training in the delivery of external and sealed internal radiation to treat cancer) have a total of 600 residents (according to http://www.acgme.org/adspublic), meaning that about 150 new physicians are produced every year. AuntMinnie.com posts 54 jobs for radiation oncologists (matching to 36% of the supply). By comparison, nuclear medicine should have between 35 and 38 jobs posted on AuntMinnie.com to be considered of equal demand compared with radiologists and radiation oncologists. Even 10-15 posted jobs would be somewhat respectable and make an enormous difference. But ZERO?

It should be clear to any layperson at this point that U.S. tax dollars should not be going toward training more NMPs. They are not "needed" in a true market sense. They are not trained to perform the needed broad-based cross-coverage and multimodality imaging interpretation (MRI, ultrasound, mammography, muskuloskeletal) and interventional procedures that radiologists can provide. Radiologists in comparison are in sharp demand. The government (more specifically, the Centers for Medicare and Medicaid, which funds residency training) should be putting tax money toward more radiology training positions; if that happens, this nation will have all the nuclear medicine services it needs. Radiologists will be able to cover the need, partly also because nuclear medicine will become a more respected field rather than being the "red-headed stepchild" in the room. As it is right now, many in the radiologist-dominated U.S. medical imaging profession view non-radiologist (and even radiology-trained) nuclear medicine physicians as a lesser breed.

I should know. I am a resident in my third year (PGY-4 if you include internship) of nuclear medicine training at one of the top hospitals in the country (according to U.S. News & World Report). The published job prospects for me are slim (none, really). I am still confident I'll find something decent through networking and word of mouth, plus my own hard work, but each day that passes brings me closer to finishing...jobless.

One might ask why training programs want to keep pumping out NMPs. In reality, they don't. What academic nuclear medicine division faculty members want is a continuing and growing supply of residents, because these trainees perform a considerable amount of clinical and research work, freeing the faculty to concentrate on research and expansion. A few years ago, it was decided that the programs should last 3 years, not just two. My class is the first 3-year class at my institution. The people that started a year ahead of me finished in only two years. Why I took the position is a long and complicated story, and unique to me. However, the bleak job prospects and absurdly low demand that I am now seeing is common to all nuclear medicine residents in training. Even with ZERO NMP program graduates last year due to the move from 2 years to 3, nobody complained about insufficient supply of NMPs. We have been sold on a training route that pumps us out into a market in which nobody is looking for us (because they are ALL looking for radiologists).

Taxpayer dollars in the form of Medicare funding and reimbursements at teaching hospitals should be excluded from funding any more new residents pursuing 3-year nuclear medicine training pathways. Residents currently in NMP training should be funded through the completion of their training. Funding for 2-year fellowship-level training in nuclear medicine imaging and therapies should continue for the small number of internal medicine-trained physicians that want to incorporate nuclear therapies into their internal medicine practices, and 1-year fellowship training should be made available for radiologists who want specialty training in nuclear medicine and PET/CT. Any further available funding for primary residency training in imaging should be routed toward radiology training. This will dry up much of the supply of residents to do the clinical work for academic/research NMPs, but that demand will be filled by an increased number of radiologists choosing to do fellowships in nuclear medicine and PET/CT as the demand (and respect) for imagers in nuclear medicine and PET picks up. More importantly, no longer will there be a divide between radiologists and NMPs; they will be coming from the same fold -- they will all be radiologists. The only pure NMPs out there would be internists who practice therapeutic as well as possibly some traditional diagnostic nuclear medicine (likely in addition to other primary care or specialty clinic duties).
 

PistolPete

10+ Year Member
Jul 16, 2006
1,934
404
281
Status
Attending Physician
Wow... and I thought pathologists had it bad. Thanks for that detailed post and good luck in your job hunt, I'm sure you'll find something suitable!
 

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
Unfortunately I think that you are right in some aspects, but you forgot to mention that part of the problem is that the SNM is not supporting the residents or coming up with a solution, meaning that they are not backing up the specialty.
I am a second year NM resident and this is a daily discussion within my program, residents, fellows, attendings, etc... we all agree. There are two solutions; as you mentioned, one is to stop training residents and let radiology to take over. I don't know why NM has to become a radiology fellowship, currently the are not required to have a NM fellowship in order to read nuclear medicine, no?, they have a few months of NM rotation during the residency and everyone thinks that they are ready to read, probably this is one of the reasons of the ZERO jobs for NM. We all know that the problem is not because of academics job positions; the real problem is private practice, they don't look for NM physicians because we can only read NM, so they prefer to get a radiologist who can read NM and Radiology, this will save them money, etc.
Is a radiologist without NM fellowship capable of reading NM? Yes; is the quality of their reading as good ours? I don't think so. Are we capable of reading CT? Yes; is the quality of your reading as good as theirs? No. But the difference is that they can take care of our business with only a rotation during the residency.
The second solution and most remotely, is that the regulatory entities, such as SNM, ABNM, RSNA, etc... come with new rules, restrictions and regulations to stop radiologist without NM fellowship to read nuclear medicine. But we know that this is unreal.
Bottom line, we need a stronger and more supportive SNM who can come up with a quick and wise solution; unfortunately this is also unreal!
 

Cathance

Junior Member
10+ Year Member
5+ Year Member
Nov 13, 2005
41
1
0
Status
Resident [Any Field]
SNM and ABNM does not have control over credentialing at each hospital and insurance group, and credentialing is where the problem is. If hospitals and insurance groups refused to reimburse for NM reads by people not certified by ABNM, things would change. But ABR is going to continue certifying radiologists to read NM with only a minimum of NM training, and the hospitals and insurance companies will continue to recognize such minimal training as adequate.

The only solution is to stop the wasted tax dollars on training doctors who can't get jobs. CMS should stop supporting new 3-year tracks. Make ABNM certification strictly a fellowship-level subspecialization.

Call HHS and let them know that CMS is wasting their money.
http://oig.hhs.gov/fraud/hotline/
 

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
SNM and ABNM does not have control over credentialing at each hospital and insurance group, and credentialing is where the problem is. If hospitals and insurance groups refused to reimburse for NM reads by people not certified by ABNM, things would change. But ABR is going to continue certifying radiologists to read NM with only a minimum of NM training, and the hospitals and insurance companies will continue to recognize such minimal training as adequate.

The only solution is to stop the wasted tax dollars on training doctors who can't get jobs. CMS should stop supporting new 3-year tracks. Make ABNM certification strictly a fellowship-level subspecialization.

Call HHS and let them know that CMS is wasting their money.
http://oig.hhs.gov/fraud/hotline/
I agree, but who is our representation as a society? Who has to try to change the current situation? Can you speak to the ABR? Can you speak with the insurances?. The SNM and ABNM should act like our lawyers and try defend their ''clients''. I don't think that closing the residencies is feasible and I don't think it can happen in the near future. Do you have another solution? Unfortunately for me, the only solution is to finish NM residency and start a second specialty, anything except radiology!!
 

Cathance

Junior Member
10+ Year Member
5+ Year Member
Nov 13, 2005
41
1
0
Status
Resident [Any Field]
The ABNM is effectively infiltrated by ABR-certified radiologists. There is no incentive to compete with ABR. The ABNM is not going to try to keep an exclusive hold on nuclear medicine training certification, and is not in a position to start offering its own certification in CT, MRI, ultrasound, mammogram, or IR.

I do not advocate shutting down NM training programs. Rather, I advocate the combination of all nuclear medicine training with radiology training (except in cases of the 2-year post-clinical-specialty track, which I think is fine to leave as it is). The challenge is to produce a combined nuc-med/radiology track that provides the needed number of residents in both programs but also respecting ACGME accreditation resident quotas (maximum approved residency positions) in both the Radiology program and the Nuclear Medicine program. At my institution, there are plenty of nucs residents, often spilling over into elective and research rotations, whereas the radiology residents are clamoring for help on call rotations.

There is a possible transitional solution, where Nuc Med programs would negotiate with their sister radiology programs to essentially give them control over admissions and give them help in the call arena. In return, Radiology would offer a combined track (through ERAS) that starts with one year of nuclear medicine (counting toward the Nucs ACGME quota), then transitioning to 1st year of radiology residency (counting toward the Radiology ACGME quota), continuing one more year as a radiology resident (Radiology ACGME quota for a total of 2 years, equating to the first and second years of radiology training, the second year of which would include call), then complete one year counting toward Nuc Med ACGME quota, billed as a nuc med "cross sectional" year but structured in such a manner as it would count also toward the 3rd year of radiology residency, including call, and then the last year entirely in nuclear medicine and PET/CT (counting towards the nuc med ACGME quota). This would give the radiology program an extra guy for call and rotations in the third year without counting toward the resident quota. Here is a summary:

PGY-1 Internship (same as everyone)
PGY-2 Nuc Med R1
PGY-3 Radiology R1
PGY-4 Radiology R2 (including call)
PGY-5 "Nuc Med resident" for ACGME quota purposes, but organized around a radiology 3rd year structure and counting also toward Radiology R3 (including call).
PGY-6 Nuclear Medicine and PET/CT (counted toward the Nuc Med ACGME resident quota).

Total years counted against radiology resident quota: 2
Total years counted against nuclear medicine resident quota: 3

Total years of general radiology training: 3
Total years of exclusive training in nuclear medicine: 2

This fits perfectly into the new radiology 3+1 training paradigm (3 years general and 1 year of specialty "mini-fellowship" training), which is set up to motivate for an additional year of fellowship for all residents (basically, more like a 3+1mini+1fellow). Only, in this case, the "fellowship" year would be tacked onto the front side.

Here's the plus side for radiology programs:
1. The "first year radiology resident" coming from his/her nucs year would already be savvy at dictating and reporting, and have a nice grasp of nuclear medicine and the general medical imaging profession, and would be an asset to the educational environment for other radiology 1st years.
2. All nuclear medicine residents in this type of track would be far more competitive (higher testing, better IQs, better work ethic/professionalism/bedside manner, "best and brightest"), because they would have to pass muster for the radiology residency program.
3. With only 2 years counted against its quota, the radiology program gets to produce a radiologist that would otherwise require 4 years of training against its quota. It's like a free resident to them.
4. More predictability in setting up the training programs for all their residents. The radiology program wouldn't have to guess how many people will do their "mini fellowship" 4th year of radiology in nuclear medicine. It should be a welcome "given" in an otherwise tumultuous transitional period as they move toward the new 3+1 paradigm. (The "4-years of general radiology" paradigm is being phased out nationwide.)

The benefit to the nuclear medicine program should be obvious: better residents, better reputation.

This won't help you or me get a job this year. However, it will end the injustice of program directors promising a job with nice income (even if a big step down from radiology) and a nice lifestyle (in many respects BETTER than radiologists'), when those jobs are really being preferentially marketed to dual-boarded nuclear radiologists (ABR/ABNM), which are apparently plentiful enough to marginalize me out of a job so far.
 
Last edited:
Mar 2, 2010
19
0
0
Status
Resident [Any Field]
Keep going. I heard our current and next SNM leaders are both great advocator. I hope they can achieve sth during their terms.
 

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
Right now, you can do radiology, then nuclear medicine fellowship and if you are not happy with the exposure to NUCS, you can spend a year after your fellowship in a PET/CT fellowship. I think that is the same as your proposal to combine residencies.
I am sorry, but what pisses me off, is that they extended NM residency to 3 years, because 2 years were not enough, but they didn't change the 4 month rotation for radiology residents. What if we rotate through radiology for 4 months, are we able to read radiologic studies? NOOOOOOOOOO!!! because it's a different imaging modality. (sarcastic LOL)!!
This is the only specialty screwed by other specialties, and it's because we don't have good representation, because as you said, our Society is inflitrated by radiologist.
Things are not going to change, if we don't make something. Who is in charge of medical credentialing? Who regulates who can read NM studies? What do you think of creating a document or letter, get the signatures from all the residents, fellows, etc and sending that to the AMA or someone who can do something? There is nothing to lose.
 
Apr 19, 2010
1
0
0
Status
Fellow [Any Field]
There is no rationale for NM residency to continue as it is. Most of the graduates pursue second residency. Actually I know only one graduate practicing nuc med, I know roughly 15 residents collectively from 3 intuitions, since 2004. Unless the the practice separated as in Europe, Canada or the rest of the world, nuc med residency is waste of resources.

Nuclear medicine regulatory bodies, SNM or ABNM, do not care about residents’ future. Should they care? I hope so. Have I seen any evidence of imminent change? Definitely no.

In the end, if you are looking for your residency options, you should eliminate NM. If you are currently a NM resident, start searching for new residency. Don’t be fooled by imaginary future development.
 
Mar 2, 2010
19
0
0
Status
Resident [Any Field]
I believe all of us are willing to join this battle. This is for the benefit of us and the community. Please start it. Would everybody who reads this post requests people who are sufferring to follow the steps. Please start and continue.
 

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
I believe all of us are willing to join this battle. This is for the benefit of us and the community. Please start it. Would everybody who reads this post requests people who are sufferring to follow the steps. Please start and continue.

We would like to do something, the problem is that we don't know where to start, but we know that we don't have to start taking to the SNM or ABNM, and we all know why!!. Who do we need to write to? Senate? AMA? Medicare? Who regulates medical specialties? Can we make a nuclear medicine residents and fellows association and fight for our rights?.
I know that there is a PD meeting in the SNM, but there most important topic, is not the job market, they look to make the residency harder, increasing requirements, etc... .
We wish to send an email to all the residents and fellows, in order to get signatures from all of them and include them in a document. But we need to know who is the indicated person to write to, so he/she can do something about our situation.
If you or someone who reads this post have an idea, please share it!!

Thanks for reading and supporting!
 

Goober

Senior Member
10+ Year Member
15+ Year Member
Nov 28, 2003
427
1
241
Visit site
Status
Attending Physician
This situation has been the case for quite awhile now. It certainly isn't a recent development. It has difficult to get jobs in private practice just doing nucs for at least the last 15 years. It pays to do your research before you apply for residency. Simple solution: apply for a radiology residency. Your nuc experience will count. We had several former nucs residents in our program.
 
Mar 2, 2010
19
0
0
Status
Resident [Any Field]
Can we set up a group and ask all the people involved to join? We need a organization. We are smart. Someone may come up with novel ideas. In my opinion, the current hurdle is that we can not take radiology call. If we can address that, even wo radiology board, there will be enough job opening for us.
 
Last edited:

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
This situation has been the case for quite awhile now. It certainly isn't a recent development. It has difficult to get jobs in private practice just doing nucs for at least the last 15 years. It pays to do your research before you apply for residency. Simple solution: apply for a radiology residency. Your nuc experience will count. We had several former nucs residents in our program.


Thanks for your reply! I know that this problem is not new and I think part of the problem is because people doesn't want to get involve in politics with radiology, and I am taking about current SNM, attending, PD's, etc..., they don't want to be ''tagged'' and placed in the "black list" and then struggle to switch between jobs, this is my point of view. Right now, for the residents, there is nothing to lose and if this problem has been in the NM field for a long time, doesn't mean it cannot be changed.
With all my respect to you, I cannot understand why everybody is trying to make NM residents to continue with radiology. They are completely different specialties and that's why probably RADS residents get into rads and not into NM residency and vice versa.
It doesn't make sense that a NM resident has to be 3 years in a residency in order to read NM studies and a radiologist with only 4 months of NM can take over our job. If you take a NM resident during his 4 month of residency, he will probably know more than a radiology resident at the end of the rotation, because he is interested in the specialty and besides that radiology residents take vacation, personal days, come late to work, get out early for conferences, etc... meaning that those 4 months equals to 3 months and there is only 1 reason, because they are not interested in the specialty, right?
“The American Board of Radiology had offered certification in diagnostic radiology with special competence in nuclear medicine between 1957 and 1966, at which point the board no longer offered the certification (ABR).” Why? “American Board of Radiology had little affinity for the NM specialty since it was not viewed as an imaging specialty.” In 1970 with the improvement of pharmaceuticals and technology, and promising future ($$$$), the ABR re-started the certification.
This is not so complicated, and I believe that the solution is simple but complicated at the same time.
This is my proposal:
- NM specialist, with full NM training or Radiologist with NM fellowship and ABNM certification must be the only specialists who can read pure NM studies.
- Make NM an elective rotation for radiology residents, who are really interested in the field and are planning to do a NM fellowship. By the way, this will make radiology residents VERY HAPPY X 3, no nuclear medicine rotation; they can use that time to rotate through their area of interest or to study for the boards and NO MORE NM in the radiology boards!
- Keep PET/CT and hybrid imaging, as the only obligatory NM rotation for radiology residents with goal of XXX minimum cases reported, in order to fulfill the requirements of the rotation. The same argument for NM residents, but with CT rotation (currently implemented, minimum of 500 CT in order to read PET/CT)
My point is that hybrid imaging can be read by radiologist and NM; however I have to say that PET/CT currently uses CT for anatomical correlation and not for diagnostic purposes, but I think that can be read by both specialties, if the training in CT for NM and PET for rads is adequate.
If this is applied, there will be a lot of job opportunities for NM physicians, with no “collateral damage” in radiology jobs opportunities or salaries. This will benefit both parts.
However without the SNM and ACR collaboration, this will be impossible to achieve.
 

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
Can we set up a group and ask all the people involved to join? We need a organization. We are smart. Someone may come up with novel ideas. In my opinion, the current hurdle is that we can not take radiology call. If we can address that, even wo radiology board, there will be enough job opening for us.

I don't think that we are prepared to take radiology call, like radiologist are not prepared to read NM studies.
Radiology residents spend 4 years in residency, do you really think that we can take call and make a decent job, with only a few months of radiology rotation?.
I believe we are still physicians, even if we don't spend much time with the patients, meaning that we are here to help them, and if we are not prepare in a specific field, we shouldn't get involved. I don't want to miss something in a radiologic study and cause harm to the patient, because I was not prepared to read the study. In my personal opinion, this is what disqualified radiologist are doing, reading NM studies.
Read my previous post and let me know what you think about my proposal!.
Keep writing and please tell the residents in your program to get involved. I am very confident that if we fight together, we will achieve something.
 
Sep 13, 2009
2
0
0
NY
www.squidoo.com
Status
Attending Physician
I hear it is a little better if you want to do academics...you can balance your time with research, etc if you like that sort of thing, which is a reason I ended up liking nucs. I will not be double boarded when I graduate in 2 more years, but I was a resident in another field for 3 years and decided to switch.

(PartUSA, its me)
 
Apr 14, 2010
1
0
0
Status
Resident [Any Field]
This thread is what residents in our program have been discussing the last few months. We need to organize together. I suggest we start a group via e-mail and try to get as many residents from the different programs together. We need to formally write letters to the SNM, ABNM and even the ACGME, signed by as many residents/programs possible. We should consider getting together during the SNM meeting, maybe during the Board Review? Should we designate one of us on this board to organize an e-mail list from people who PM their information? We need to come up with a solid plan together and explain what our goals/objectives are, and how we can best achieve them.
 

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
Partusa @ Shaolin Avatar, (what’s up J?) nice to see you joining the cause!! Tell the residents in your program to join us.

Partusa @ ResConfused, I agree with you, but in my personal opinion I don’t think the SNM or the ABNM are willing to help us, why is NM like this? but maybe I am wrong.
I would like to see people writing solutions, ideas, thoughts, etc… so we can come up with a definite solution. We don’t have anything to lose here!.
Unfortunately, we are doctors, not polititians, so problably all of the NM residents and fellows are taking about this topic, but no one is speaking up.

Do you think that creating a group in facebook can help?. It's easy and anyone can join it.

It's a good idea to get together after the board review in order to discussed about this topic.
 
Mar 2, 2010
19
0
0
Status
Resident [Any Field]
simply start a facebook group as the first step. Totally agree. Be organized! I will call my colleagues to join.
 

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
I hear it is a little better if you want to do academics...you can balance your time with research, etc if you like that sort of thing, which is a reason I ended up liking nucs. I will not be double boarded when I graduate in 2 more years, but I was a resident in another field for 3 years and decided to switch.

(PartUSA, its me)
Shaolin, you should change your name to KUNG-FU PANDA! Did you talk to your peers? What are they saying? Are you assisting to the SNM meeting?
 
Apr 25, 2010
6
0
0
Status
Resident [Any Field]
This situation is ridiculous. Cathance is right. Check out the job postings! See for yourself!

I'm taking this a step further and writing my senators and congresspeople. Heck if I'm going to put my name on it though. Nucs is a small world. You could get blackballed by the academic community.
 

Cathance

Junior Member
10+ Year Member
5+ Year Member
Nov 13, 2005
41
1
0
Status
Resident [Any Field]
Just make sure what you write will help nucs, not hurt it. There are a lot of residents still in training who are expecting to finish. We just need to stop the influx of residents who think they can actually get a job coming out of nucs. "Do nucs if you want, but realize you have to do something else, too," should be our message. And don't bite the hand that feeds you.
 

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
This situation is ridiculous. Cathance is right. Check out the job postings! See for yourself!

I'm taking this a step further and writing my senators and congresspeople. Heck if I'm going to put my name on it though. Nucs is a small world. You could get blackballed by the academic community.
Just make sure what you write will help nucs, not hurt it. There are a lot of residents still in training who are expecting to finish. We just need to stop the influx of residents who think they can actually get a job coming out of nucs. "Do nucs if you want, but realize you have to do something else, too," should be our message. And don't bite the hand that feeds you.

The solution is not to stop people to get into NUCS residency. That's not going to happen. Lot of IMG's are getting into nucs, because in my personal opinion, right now it's the easiest specialty to get into and lot of people interested in NUCS as a specialty. In other parts of the world, the specialty is very respected!!
I know that you will have to get into a second residency after nucs.
What I think it will hurt nucs, is to stop the influx of residents, to integrate nuclear medicine to radiology, etc... of course that's the easiest way to solve this problem.

What are you trying to say with don't bite the had that feeds you? Don't go against radiology? Don't go against the SNM?
As FDGme said in his post, we are afraid of getting blackballed by our colleagues in the academic world. It should be the opposite, no? We are trying to help the community of NM physicians, we are fighting for our rights, we want to keep this specialty alive.
FDGme, do you think writing to the congress or senate can help?
I proposed a solution in one of my previous posts, what do you think about it? I think that's the only reasonable solution. Probably dreaming; No?.

I would like to know what's the reason, besides the economic factor, for the RSNA to certify radiology residents in NM. Do they really believe that a 4 month NM rotation is critical in the training of a radiologist?
Do you believe the ACGME can help us?
Probably a lot of NM residents are waiting to be transfered to radiology if they decide to close the NM residencies, and that's not going to happen!!

PLEASE KEEP FORWARDING THIS FORUM TO ALL THE RESIDENTS AND FELLOWS!!!
 
Last edited:
Apr 27, 2010
28
0
0
Status
Resident [Any Field]
Folks, this is very good discussion. I am a PGY3 Nuc Med resident at a top Nuc Med residency program. I am also a member of NMRO (Nuclear Medicine Resident Organization)I really want to say something about the depressing reality.

I think the problems lies within Nuc Med itself, and we are destroying ourselves. In reality, Nuc Med residents are just working slaves for 3 years, "freeing attendings for their research and..." If you are willing to believe this is true, do we get what we deserved at the end of training?

At the end of trainig, you would often hear "Sorry, you may have to do something else to get job"----God DM it! It's THREE years!!!

The new 3-year residency is a BS, I think they should have just kept 2-yr NM residency and push ACGME credit PET CT fellowship, or try to combine NM and Rad as a 1+4+1 program at the first place.

Unfortunately, the ones get power and made the 3-yr residency stupid decision was none of us, not even a young(<45yr) NM physician. The following info was obtained from several differnce sources, and they are real:

Nuc Med is, maybe the only one, specialty having "Life members" certified by ABNM. These 3000 life members do not need to take board to be recertified even though they were trained in 1960-1970s. They are WORKING, and get 350k salary, not strongly speak for NM residents though some of them need in death to have residents predictate the scans. I hate to say they are out of date, but they do need take more current education and recertified, as other younger NM physicians do have to recertified from ABNM every 10 years. Plus, it's important for better patient care!!When my senior friend wrote to ABNM to inquire about this, ABNM's answer is these life members will need to take board exam STARTING form 2017!! Can you image that?? Why? ABNM said they need preparation! My God! we are able to answer all the board questions even during our PGY4 year, and they need 7 years to prepare, and at that time they will be in later 70s or early 80s!

I have to say, lots of these members are really good, however, they are not strong enough to speak for us, not agressive enough even though they are representing ABNM, SNM or ACNM.

Just imaging, if all the 3000 life members were forced to take ABNM board exam in order to actively practice in hospital, maybe half of them will chose to retire now, at their late 60s or early 70s, which is reasonable. Then there will be lots of job vacancy for new graduates.

No doubt we should downsizing NM residencies. We have to urge ACGME/ABNM made the solid criteria for NM residency, such as how much CT, PET/CT, MRI, Cardiac, General NM, General Rad and dedicated research training time, how many cases we should have, etc. If we have these solid numbers, we will be in better position neotiating with future employer, and we will be more confident reading CT and PET/CT.

If the program can't meet those criteria, they should close and stop wasting tax payer's money and, our resident's time.

The NMRO is affiliated to ACNM, we are targeted to recurite all the NM residents. We need such an oragnization to speak for our residents. With such an organization, we can write on behalf of all NM residents, to the Senator, to Medicare, to ACGME, to ABNM, even to the President.

Bottomline is, we need action to change the depressing situation.
 

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
Folks, this is very good discussion. I am a PGY3 Nuc Med resident at a top Nuc Med residency program. I am also a member of NMRO (Nuclear Medicine Resident Organization)I really want to say something about the depressing reality.

I think the problems lies within Nuc Med itself, and we are destroying ourselves. In reality, Nuc Med residents are just working slaves for 3 years, "freeing attendings for their research and..." If you are willing to believe this is true, do we get what we deserved at the end of training?

At the end of trainig, you would often hear "Sorry, you may have to do something else to get job"----God DM it! It's THREE years!!!

The new 3-year residency is a BS, I think they should have just kept 2-yr NM residency and push ACGME credit PET CT fellowship, or try to combine NM and Rad as a 1+4+1 program at the first place.

Unfortunately, the ones get power and made the 3-yr residency stupid decision was none of us, not even a young(<45yr) NM physician. The following info was obtained from several differnce sources, and they are real:

Nuc Med is, maybe the only one, specialty having "Life members" certified by ABNM. These 3000 life members do not need to take board to be recertified even though they were trained in 1960-1970s. They are WORKING, and get 350k salary, not strongly speak for NM residents though some of them need in death to have residents predictate the scans. I hate to say they are out of date, but they do need take more current education and recertified, as other younger NM physicians do have to recertified from ABNM every 10 years. Plus, it's important for better patient care!!When my senior friend wrote to ABNM to inquire about this, ABNM's answer is these life members will need to take board exam STARTING form 2017!! Can you image that?? Why? ABNM said they need preparation! My God! we are able to answer all the board questions even during our PGY4 year, and they need 7 years to prepare, and at that time they will be in later 70s or early 80s!

I have to say, lots of these members are really good, however, they are not strong enough to speak for us, not agressive enough even though they are representing ABNM, SNM or ACNM.

Just imaging, if all the 3000 life members were forced to take ABNM board exam in order to actively practice in hospital, maybe half of them will chose to retire now, at their late 60s or early 70s, which is reasonable. Then there will be lots of job vacancy for new graduates.

No doubt we should downsizing NM residencies. We have to urge ACGME/ABNM made the solid criteria for NM residency, such as how much CT, PET/CT, MRI, Cardiac, General NM, General Rad and dedicated research training time, how many cases we should have, etc. If we have these solid numbers, we will be in better position neotiating with future employer, and we will be more confident reading CT and PET/CT.

If the program can't meet those criteria, they should close and stop wasting tax payer's money and, our resident's time.

The NMRO is affiliated to ACNM, we are targeted to recurite all the NM residents. We need such an oragnization to speak for our residents. With such an organization, we can write on behalf of all NM residents, to the Senator, to Medicare, to ACGME, to ABNM, even to the President.

Bottomline is, we need action to change the depressing situation.

:thumbup::thumbup::thumbup: for your post!! You are right, however don't forget that besides the old NM physicians, the real problem is that radiology is taking our jobs away with only 4 months of training, they are less prepare that those old NM physicians.
The job market is directed towards radiologist with NM training, they don't even consider you, me or a pure NM trained physician. Even with good training in CT and MRI, you cannot compete with radiologists.
Unfortunately the imaging field, NM & RADS, is not "physical demanding" meaning that we don't have to be rouding in the floors, or standing during surgery for 3 hours, so you can be 100 years old and still reading studies or signing studies read by your residents!! but we cannot change this, unless they force old physicians to retire at 65.
Please keep posting and forward this forum to the people you know!!
I am a member of NMRO, but I see no action from them!!
 

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
This are my questions for people in TOP NM residency programs :

Is this problem the same for you, even if you are graduating from a TOP program?

Are the the attendings in your program helping you in order to get you a job?

How many recent graduates from your program are working in NM?

Do you think that graduating from a TOP program makes a difference?

I just want to confirm that this is not a problem for some graduates! In my program. A recent PET/CT fellow who spent 2 years in fellowship just got a part time job as NM, the current fellow is getting into his second year of fellowship without any interviews.
We are not having any residency graduates till 2011, so I cannot comment on residents with no fellowship.
 
Apr 27, 2010
28
0
0
Status
Resident [Any Field]
I should say, from what I was told and have seen, lots of "life members" are really not qualified, I would say they are really not as good as Rad resident w 4 month NM training. I personally witnessed a life member (now retired b/o hospital bankrupcy) flip-flop reading a scan within 5min, right before the Chair of Rad, and his face turned red, saying :"listen clear, I changed,... or no, I changed again....", Another life member was not awared of the time between FDG injection and PET scanning can have effect on SUV, thus attention should be paied when doing direct comparison, let alone draw a conclusion out of it.

And they are our leaders, they are deciding the NM direction...

I was embarrassed, shame for NM! lots of old life mebers came into NM major b/o its easiness and good life style, and some research at that time. They, themselves are "unclear" about this "Unclear Medicine" at their time. Thus they are not confident enough to fight for NM, for new generation NM physicians.

So, we are not forcing them to retire, we are forcing them to be at least good as us, for God's sake, they are NM leaders!!! If people don't see excellence from them, what they are expecting NM residents??

So, my opinion is, life members, if you at least can pass the new ABNM exam, okay, you can keep working. Otherwise, pls, retire, enjoy your personal life and let us, the new generation NM physician to make change. And,don't let the NM specialty die at the time you have to retire.

More importantly, if they make wrong diagnosis, it will be bad for the patient, and bad for NM reputation...

Folks, let's push NMRO to speak for us, with the power of vote.---- We need a "union".
 

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
I should say, from what I was told and have seen, lots of "life members" are really not qualified, I would say they are really not as good as Rad resident w 4 month NM training. I personally witnessed a life member (now retired b/o hospital bankrupcy) flip-flop reading a scan within 5min, right before the Chair of Rad, and his face turned red, saying :"listen clear, I changed,... or no, I changed again....", Another life member was not awared of the time between FDG injection and PET scanning can have effect on SUV, thus attention should be paied when doing direct comparison, let alone draw a conclusion out of it.

And they are our leaders, they are deciding the NM direction...

I was embarrassed, shame for NM! lots of old life mebers came into NM major b/o its easiness and good life style, and some research at that time. They, themselves are "unclear" about this "Unclear Medicine" at their time. Thus they are not confident enough to fight for NM, for new generation NM physicians.

So, we are not forcing them to retire, we are forcing them to be at least good as us, for God's sake, they are NM leaders!!! If people don't see excellence from them, what they are expecting NM residents??

So, my opinion is, life members, if you at least can pass the new ABNM exam, okay, you can keep working. Otherwise, pls, retire, enjoy your personal life and let us, the new generation NM physician to make change. And,don't let the NM specialty die at the time you have to retire.

More importantly, if they make wrong diagnosis, it will be bad for the patient, and bad for NM reputation...

Folks, let's push NMRO to speak for us, with the power of vote.---- We need a "union".

I agree we need a union, an entity managed by NM residents, no attending, no nuclear radiologists, only people who care about the future of the field, who is eager to work and progress in the field!
I was thinking of starting a facebook page and send an email to the NM programs asking to forward that email to their residents, so they can sign in. What do you think?
 
Apr 27, 2010
28
0
0
Status
Resident [Any Field]
Absolutely agree. If NMRO can not do the job, let register a formal independant NMRO.

BTW, to answer your earlier questions. Our fellows do have lots of trouble to find a job at the time of graduation. Unfortunately, I don't see lots of, or some, help from attending. You are kind of on your own. Maybe you can get some recommendation letters from them, nothing else.

And, more depressingly, I see, not a few, attending relying on residents doing all the clinic job. Research? Some would like the resident do all the job, he or she get the corresponding author at the end. ----- I have to say some are very good, and I like their teaching and dedication. But, some get annoyed even when tech go to them for signing doses, because they think that's resident's job.

I see lots of radiology do their own dictations, however, not uncommonly, NM attendings want residents to do all the dictations, then they modify it.

This laziness is the killer of NM. In radiologists' eyes, NM residents are sort of joke, some "medicine refugees" has nowhere to go...

First, we should target at ACGME to change NM (this we can do through a letter with the signatures from all current NM residents), then ABNM (may needs politician to intervene, and now would be a good timing, b/o healthcare reform), we can use the same letter to Senator, President Obama, ABNM, ACGME, ACR, SNM, ACNM, and news media.

What do you think?
 

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
That's the way the residency is. Residents take care of the studies, research, presentations, journal clubs, etc and this is the only reason why NM residencies are still open.
The Hospital/Department gets around 90k for each resident, you get paid around 40-50, the rest of the money is used to cover ''administrative costs'', so bottom line, the department is getting money from the government only by having a few residents.
By the way the PI always is the last Author, and you need their name and backup to get an abstract accepted in a meeting or journal, it's a kind of parasitic relationship.
I think that a good way to show to the SNM that we are not kidding, and we want to do something about this crisis is to stop submitting abstract, papers and assisting to their annual SNM meeting, by the way, the crisis that NM is suffering is not reflected in those meetings at all!!
We are spending $1000 to go to the SNM meeting, what for? all your time and effort doing research is worthless, at the end not even your own colleagues care about your future.

The residents and fellows in my program are ready to sign any letter that can lead to a change in NM.
 
Apr 27, 2010
28
0
0
Status
Resident [Any Field]
I understand life is not fair, especially NM residency. However, the fairness we are asking for is the decent training, since now we are doing 3 years. Do you guys notice the difference between 3 yr and 2 yr residency?

Do we have solid criteria such as how many CT scans, PET-CT scans, cardiac stress test, EKG training, I-131 therapy/scan, Bexxa/Zevalin treatment, and research time?

I bet you not. No single residency has! Not even ACGME! Do you know why there is NONE criteria for such things? Because lots of program don't have enough volumn!

So, the 3 year residency benefit the unqualified program most, let them survive longer. If these unqualified program close, and existing program meet all the criteria, then even though there will be fewer NM residents, all NM graduates will be more competitive at the end of training, and these new generation NM physicians will change the aspect of NM.

Resident will have to do all the jobs, however, we also have our career goals, we need decent and deserved training, not just cover the service, right?

We need the solid criteria for our training, this is the bottom line.

Once we have these, we are at much better position to negotiate with PD/Dept./Hospital, and our future employers.
 

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
I understand life is not fair, especially NM residency. However, the fairness we are asking for is the decent training, since now we are doing 3 years. Do you guys notice the difference between 3 yr and 2 yr residency?

Do we have solid criteria such as how many CT scans, PET-CT scans, cardiac stress test, EKG training, I-131 therapy/scan, Bexxa/Zevalin treatment, and research time?

I bet you not. No single residency has! Not even ACGME! Do you know why there is NONE criteria for such things? Because lots of program don't have enough volumn!

So, the 3 year residency benefit the unqualified program most, let them survive longer. If these unqualified program close, and existing program meet all the criteria, then even though there will be fewer NM residents, all NM graduates will be more competitive at the end of training, and these new generation NM physicians will change the aspect of NM.

Resident will have to do all the jobs, however, we also have our career goals, we need decent and deserved training, not just cover the service, right?

We need the solid criteria for our training, this is the bottom line.

Once we have these, we are at much better position to negotiate with PD/Dept./Hospital, and our future employers.
I cannot comment on the difference between the 2 and a 3 year program, but if radiologist can get certified in NM after 4 month rotation, increasing the residency to 3 years was a joke.
I don't think that having less residents and fewer programs would change the actual crisis. As we mentioned before, I strongly believe that the problem is not our training at all. The problem is that radiology is taking over our specialty with no adequate training and probably causing harm to patients, but $$$$ is first and patient is second.
Have you ever heard of a patient suing a radiologist because they misread a NM study? I never heard of any, but if they start getting sued for NM studies, they will start refusing to read NM and people with REAL TRAINING will get the jobs.
A similar thing happened with breast imaging, why do you think that no one want to get involved in breast imaging?
"Philadelphia Jury Awarded $12 M for Delayed Diagnosis of Breast Cancer... 2 doctors at 2 different hospitals missed suspicious findings on mammograms that required follow-up evaluation" I can paste more cases like this.
If the insurance companied cut down on reimbursement arguing that radiologist are not qualified to read NM, they will stop reading.
Someone posted before that medicare is wasting money in our training as NMPs, but no one is saying that medicare is wasting their money paying reading fees to people without the adequate training.
Bottom line, there is a lot of things that are wrong. Can we change any?
 
Apr 27, 2010
28
0
0
Status
Resident [Any Field]
I still think we can start to make change from the traininig criteria.

As you said, "people without adequate training", so, how " adequate " do you think is "adequate"?

How many V/Q scans needs to be read to be certified V/Q reader? How many PET CT scans is "adequate", how many HIDA scans is "adequate", how many renal scans is "adequate", how many I-131 scans is "adequate", how many stress tests is adequate, how many CT training is adequate, how much research exposure is adequate?...

Such things are our NM training criteria, we definitely need this, and anyone who wants to be certified by ABNM need to meet this minimal (resident level) criteria.

Thus, NM would become a series specialty rather than a joke.

And, I strongly believe this is something we can do, and should do. With the signature from all NM residents, and maybe we can even get some attendings support, we can write to ACGME , medicare and ABNM, no one would dare to ignore this.

Only when we are qualified and confident in our own ability/specialty, we can push this specialty advance and revive it.

Less residents and less programs are good thing, we need quality, not quantity.
 

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
I agree that the minimun requirements in order be eligible to take the ABNM should be strict, and that's the main problem. As you know, the radiologist are not taking the ABNM after their residency, they just need to pass 10 oral NM cases during the ABR, no?
I think that after 3 years in a good NM residency you are more than qualified to read NM studies, confidence comes with experience, so I disagree with you in that point.

By the way, the main problem is that you cannot get any NM job after residency, because as we mentioned radiologist are getting those positions. So even if you want to increase the NM residency requirements, number of years in training, get the best medical school grads with highest scores and honors, etc... at the end you will end up having highly qualified jobless NM graduates, because of the previously described reason.

Looks like you are not very happy with your current training! Honestly I am happy with mine, I have a very good number of cases reported in general nucs, PET/CT, as well as in Body CT (we rotate through radiology for cross sectional anatomy) and research exposure.

I believe that this whole thread is a reflection of our specialty, people is not following up the posts, no new suggestions, etc...

I will try to write a draft during the weekend and I will post it here for your opinion.
How many signatures can you get from your program?. I can probably get 5 or 6.
 
Apr 27, 2010
28
0
0
Status
Resident [Any Field]
We can send out the draft to all NM residents. At least to NMRO president, a PGY 3 NM resident, Dr. Erin Grady [email protected] urge her to distribute to all NMRO members, ask for other's opinion. If NMRO doesn't want to do it, we may need post here or auntminni.com to get more response.

I suggest regist a specific email address to handle this. Once we have our well-accepted draft, we fax/email to all resident, and ask them to fax back with their signatures on it. For that purpose, we may need a fax number. I think efax.com can do this. Or, if you have personal fax number, we can do that.

I am willing to share the cost for this.

Talking about training, overall I am satisfied about my current program though it is not perfect, pitches here and there.

However, I am worried NM specialty as a whole, not only for my own future career. I believe I have enough publications and am confident reading all scans.

But, I want NM residents to get more, such as to get enough CT training that makes us eligible and confortable to read body CT; know MRI so we can read PET-MRI when it comes to use otherwise it will be taken over by radiologist.

To set up training criteria, is better for patient care, better for training, better for NM specialty. Having these, we can negotiate with ABR, ask them to follow the criteria in order to let radiologist eligible for ABNM.

To your another point. Yes, 3 year residency make you feel confident to read NM scans. Actually, it is way too much for you to feel confident to read NM scans. And this is exactly my point, for a good program, 2 years training is enough for you to read current clinical NM scans. The 3rd year is unnecessary, or extra. How to use this extra year, is debatable. And that's why we need raise the bar, make us more capable doing other stuff, not just regular NM scans. We need to be able to read CT, do lab research just as Rad Onc resident who can do 9-12 month research in their residency, more general radiology training--- more training in the aspects people think is our NM weakness, to make NM became a "New Clear Medicine", rather than "Unclear Medicine"

What do you think?
 

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
I posted some questions for radiology residents. We all know the answers to those quetions, no?.

http://forums.studentdoctor.net/showthread.php?t=723212

I will try work on the draft during the weekend. I did some research in this topic, so I have a couple of articles that I am going to use as reference. Please communicate with other residents and tell them to get involved in the forum.
 

Cathance

Junior Member
10+ Year Member
5+ Year Member
Nov 13, 2005
41
1
0
Status
Resident [Any Field]
I think any effort to push radiologists out of the NM world will be an exercise in futility. ABR-certified radiologists already make up a large portion of the ABNM diplomats. More importantly, the RSNA and the ACR are both far more powerful than the ABNM. Most radiologists in the U.S. consider NM to be a subspecialty of radiology. I agree that outside of the U.S., things are different. In Australia, the NMPs read most of the MRI. In most or all of Europe, the NMPs read ultrasound and do biopsies, etc. Also, NMPs in other countries tend to garner much more respect. Indeed, NM is a competitive specialty outside of the U.S.

I do believe the ABNM should require more of the radiologists who want ABNM certification. I think 2 years of NM should be required for ABNM certification, but with the new 3+1+1 paradigm of radiology residency, a radiology resident can do 3 months of nucs during the first 3 years, then a full year of nucs during year 4, then a year of fellowship, and thereby become eligible for ABNM certification. This is reasonable. Absolutely under no circumstances should the ABNM allow a radiology resident to take just 4 months of NM during the 3 general years, then a year during year 4, and be eligible to sit for the ABNM (after just 4 years of combined radiology/NM training). Only 16 months is not enough time.

I also think that the NRC should require much more from radiologists wanting authorized user status. For one thing, radiologists should be expected to get ABNM certification. prior to applying for AU status. That radiology residents only need 3 (or even if raised to 6) radioiodine therapies to qualify for authorized user status is RIDICULOUS. They need to be as verse as any NM resident in all regulations, dosimetry, and safety measures.

I do think that the ABNM (both straight NMPs and dual-boarded radiologists) should start challenging the privileging of non-ABNM radiologists to perform and read NM studies at all major medical institutions (Kaiser, universities, insurance companies). This would be a good place to start. Demand that the issue be addressed from the perspective of safety and professionalism. But this will only be possible with the help of our dual-boarded radiologist friends.

I still think the road to nuclear medicine needs to be a fellowship pathway (radiologists 1 year (plus 1 during their 4th year), all other clinical specialites 2 full years). Then, all graduates from NM programs will have plenty of jobs (either radiology based or medicine/oncology/cardiology based). No longer will NM be only a refuge for people who couldn't get into another residency for whatever reason. NM needs to get out of the business of just taking the leftovers from the NRMP radiology match, and the only way to make that happen is to make nuclear medicine a fellowship level of training (after some other primary specialty).
 

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
Cathance,
What will happen to the current NM residents, recent graduates and PET/CT fellows without jobs? Do you think that's going to get us jobs?
I can tell that your main point is to shut down the NM residencies, and I still don't know why?.
I don't believe that the main problem is NM as a separate specialty. I don't believe that you were proposing to close the NM residency and make it a subspecialty, if the job market for NM was good.
We all know that the problem is the lack of regulations and adequate requirements for non-NM physicians to read NM, the problem is as simple as that.
You can rotate through radiology for 4 months, but you will never be eligible to take the radiology boards, no? probably because they don't want other people to take their jobs away from them.
At the end, nothing is going to happen and we know that, but its worth trying.
 
Apr 27, 2010
28
0
0
Status
Resident [Any Field]
I think any effort to push radiologists out of the NM world will be an exercise in futility. ABR-certified radiologists already make up a large portion of the ABNM diplomats. More importantly, the RSNA and the ACR are both far more powerful than the ABNM. Most radiologists in the U.S. consider NM to be a subspecialty of radiology. I agree that outside of the U.S., things are different. In Australia, the NMPs read most of the MRI. In most or all of Europe, the NMPs read ultrasound and do biopsies, etc. Also, NMPs in other countries tend to garner much more respect. Indeed, NM is a competitive specialty outside of the U.S.

I do believe the ABNM should require more of the radiologists who want ABNM certification. I think 2 years of NM should be required for ABNM certification, but with the new 3+1+1 paradigm of radiology residency, a radiology resident can do 3 months of nucs during the first 3 years, then a full year of nucs during year 4, then a year of fellowship, and thereby become eligible for ABNM certification. This is reasonable. Absolutely under no circumstances should the ABNM allow a radiology resident to take just 4 months of NM during the 3 general years, then a year during year 4, and be eligible to sit for the ABNM (after just 4 years of combined radiology/NM training). Only 16 months is not enough time.

I also think that the NRC should require much more from radiologists wanting authorized user status. For one thing, radiologists should be expected to get ABNM certification. prior to applying for AU status. That radiology residents only need 3 (or even if raised to 6) radioiodine therapies to qualify for authorized user status is RIDICULOUS. They need to be as verse as any NM resident in all regulations, dosimetry, and safety measures.

I do think that the ABNM (both straight NMPs and dual-boarded radiologists) should start challenging the privileging of non-ABNM radiologists to perform and read NM studies at all major medical institutions (Kaiser, universities, insurance companies). This would be a good place to start. Demand that the issue be addressed from the perspective of safety and professionalism. But this will only be possible with the help of our dual-boarded radiologist friends.

I still think the road to nuclear medicine needs to be a fellowship pathway (radiologists 1 year (plus 1 during their 4th year), all other clinical specialites 2 full years). Then, all graduates from NM programs will have plenty of jobs (either radiology based or medicine/oncology/cardiology based). No longer will NM be only a refuge for people who couldn't get into another residency for whatever reason. NM needs to get out of the business of just taking the leftovers from the NRMP radiology match, and the only way to make that happen is to make nuclear medicine a fellowship level of training (after some other primary specialty).

I think turning NM into a fellowship subspecialty is a good idea.

Nonetheless, as I emphasized on my prior posts, we really need a SOLID training criteria for NM resident/fellows, we need push this to ACGME/ABNM/ABR/ACR

No matter what's the background of residents coming into NM, they need meet the criteria to be ABNM BC/BE. We welcome more people come into NM, but we need qualified people only.

And, more important thing, we need push Medicare/Insurance/Hospital to allow only ABNM BC/BE physicians to read NM scans (You can be any other specialty such as ABR, Internal medicine, cardiology AND ABNM double BC/BE, but minimal requirement is ABNM BC/BE).

With all these be done, I believe NM will have a wonderful future.
 
Apr 27, 2010
28
0
0
Status
Resident [Any Field]
Another important thing is we need a DIFFERENT criteria for 3-yr residency. We CANNOT stay on the same old 2-yr residency criteria.

We should make ACGME set up a case log for NM residents/fellows, as surgery do. This way, we can follow up our training seriously.

I am thinking some numbers for radiology training in NM, such as 500 body CT scans, and 50 MRI , 100 Ultrasound, 50 CXR, 50 other plain XR such as bone/abd etc,

Also, I think 3-6 month lab research, with 3 month as minimal, is necessary. And it's better to put this dedicated research time at PGY3/4 year as a rotation block, don't just slice them into pieces among 3 yr training time.

What do you guys think?
 
Mar 2, 2010
19
0
0
Status
Resident [Any Field]
in my ipinion, these kind of problem is quite complicated. In addition, different person has different understanding. This is not one person's war. We'd better start the organization first( like facebook, etc). AFter we have most of the victims involved, we can send a survey to summarize all the possible problems and solutions and followed by a vote. Step by step in a systematic way. We have a big pool of intellegence to use. We should not waste it.
 

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
in my ipinion, these kind of problem is quite complicated. In addition, different person has different understanding. This is not one person's war. We'd better start the organization first( like facebook, etc). AFter we have most of the victims involved, we can send a survey to summarize all the possible problems and solutions and followed by a vote. Step by step in a systematic way. We have a big pool of intellegence to use. We should not waste it.
I completely agree with your post. I created a group in facebook called Nuclear Medicine Residents Alliance (NRMA)
An alliance is an agreement between two or more parties, made in order to advance common goals and to secure common interests.
Here is the email: [email protected]
Please forward the page to the people you know!
Thanks!!
 
Apr 27, 2010
28
0
0
Status
Resident [Any Field]
I completely agree with your post. I created a group in facebook called Nuclear Medicine Residents Alliance (NRMA)
An alliance is an agreement between two or more parties, made in order to advance common goals and to secure common interests.
Here is the email: [email protected]
Please forward the page to the people you know!
Thanks!!
I agree with you guys. We should do it.

Just want to point out, given current situation, turning NM to a pure radiology fellowship is a good idea,or we can push them generate a 1+1+4 or 1+2+3 NM-Radiology program, just like DIRECT pathway for Interventional Radiology.

And, just let you know, the Departmental Chair in my program (a radiologist, and has utmost dominancy over our faculty), already set up the rule, the future NM vacancy is for Radiologist with NM fellowship training, not for NM physician. And, sadly, our faculty is not brave or selfconfident(scientfically and clinically ) enough to fight against it. So, situation in my institution is NM resident as cheap labor for 3 years, covering all the service, dictate all the scans, then get on ourselves at the time of graduation.

So, what do you think they want the 3-yr residency for?
 

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
I agree with you guys. We should do it.

Just want to point out, given current situation, turning NM to a pure radiology fellowship is a good idea,or we can push them generate a 1+1+4 or 1+2+3 NM-Radiology program, just like DIRECT pathway for Interventional Radiology.

And, just let you know, the Departmental Chair in my program (a radiologist, and has utmost dominancy over our faculty), already set up the rule, the future NM vacancy is for Radiologist with NM fellowship training, not for NM physician. And, sadly, our faculty is not brave or selfconfident(scientfically and clinically ) enough to fight against it. So, situation in my institution is NM resident as cheap labor for 3 years, covering all the service, dictate all the scans, then get on ourselves at the time of graduation.

So, what do you think they want the 3-yr residency for?

In my personal opinion, the radiology residency structure is not our problem. I think that right now, the radiologist interested in NM have the option of 1 year fellowship. Why are we trying to change their residency, if the problem is not their residency.
By the way, do you think that changing the radiology residency structure and abolishing the NM residency, will open the job market for the current and future NM physicians?
 
Apr 27, 2010
28
0
0
Status
Resident [Any Field]
In my personal opinion, the radiology residency structure is not our problem. I think that right now, the radiologist interested in NM have the option of 1 year fellowship. Why are we trying to change their residency, if the problem is not their residency.
By the way, do you think that changing the radiology residency structure and abolishing the NM residency, will open the job market for the current and future NM physicians?
I strongly believe turning NM into a radiology fellowship will change the future of NM.

BTW, my proposal is NOT changing radiology residency, rather, is CHANGING Nuc Med residency.

If you google "DIRECT PATHWAY, INTERVENTIONAL RADIOLOGY", you may get some idea what I am proposing.

Unfortunately, under current situation, I would say maybe 5% NM graduates, or even less, can find a position. They all think we are lack of radiology training, and we can not prove them how we are different during this 3-yr residency.

Imaging you are the employer, can you convince yourself hiring a NM physicain rather than a radiologist + NM fellowship training?

So, if you can, you can list the things that we have advantage and emphasize it on the training requirement,

And if you can not, then we should address our weakness in the training requirement.
 

partusa

10+ Year Member
7+ Year Member
May 11, 2008
104
3
141
Status
Post Doc
I strongly believe turning NM into a radiology fellowship will change the future of NM.

BTW, my proposal is NOT changing radiology residency, rather, is CHANGING Nuc Med residency.

If you google "DIRECT PATHWAY, INTERVENTIONAL RADIOLOGY", you may get some idea what I am proposing.

Unfortunately, under current situation, I would say maybe 5% NM graduates, or even less, can find a position. They all think we are lack of radiology training, and we can not prove them how we are different during this 3-yr residency.

Imaging you are the employer, can you convince yourself hiring a NM physicain rather than a radiologist + NM fellowship training?

So, if you can, you can list the things that we have advantage and emphasize it on the training requirement,

And if you can not, then we should address our weakness in the training requirement.
If I have to hire someone to read NM I will hire either a NMp or like you said a radiologist with NM fellowship = Nuclear Radiologist (radiology residency + 1 year NM fellowship) but I will never hire a radiologist with only 4 months of training in NM. If you have a private practice and you need someone to read both, NM and radiology, I will hire a Nuclear Radiologist (meaning rads + 1 year fellowship).
The problem is that right now, any radiologist with only 4 months NM is able to read NM.
In the real world, it's cheaper for the employer to hire someone who can do a mediocre job in NM and is also able to read radiology, instead of paying 2 salaries, no?.
What I am trying to say is that ethically, morally, etc... any physician without proper, adequate, etc... training should not read NM. Only NMp, Nuclear cardiologist and Nuclear radiologist, should take care of NM studies, because they are trained to do so!
 
Apr 27, 2010
28
0
0
Status
Resident [Any Field]
Yeah, we are on the same page.

Then again, this is why we need solid training criteria, push it become official by ACGME, and ABNM

Let's start get vote on these numbers for our 3-yr NM residency:

Nuclear Cardiac stress test (200): about 3-month rotation

RAI for thyroid (50 dosimetry, 30 outpatient clinic visit, 100 diagnostic scan, 100 post therapy scan, 100 therapy including 10 for hyperthyroid dz): about 3-month rotation

General Nuclear test (50 renal scan, 50HIDA, 50 MIBG/Octreotide, 10 Gallium scan, 100 V/Q, 10 GI bleeding, 400 bone scan): about 6 month rotation

PET/CT (800 scans): about 6-month rotation

CT (800 scans): about 6-month rotation

MRI (50 scans): about 1 month roation
X-ray (50 CXR, 50 bone, 50 abdomen): about 2-month
Ultrasound (50 neck/thyroid, 20 DVT/vascular, 50 abd,): about 3 month

Rad-Onc elective (10 IGRT, 10 Brachytherapy, 10 IMRT, 10 simulation): about 2 month
vacation: 3 months
research: 3 month
Elective 1 month (recommend cardiology rotation for EKG reading and Echo reading)

What do you guys think?
 
Apr 27, 2010
28
0
0
Status
Resident [Any Field]
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