What will it take to reduce number of radiology spots?

[UCLA2014]

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81 spots went unfilled

People are SOAP'ing into radiology from other relatively uncompetitive specialties or IMG's are filling the spots

Job market isn't great right now

The solution is so obvious.

 

[TheTwits]

I agree with the above. I'm sure the logistics for lowering spots are quite complicated.

Which programs would reduce numbers or close, etc.? Realistically, it seems to need to happen. However, in practice it might be difficult to accomplish this task.

 

[UCLA2014]

Which programs would reduce numbers or close, etc.? Realistically, it seems to need to happen. However, in practice it might be difficult to accomplish this task.

Yeah I agree. I guess it would involve taking funding away from spots. I'd probably start with the ones that continue to go unfilled and work from there.

 

[JoshSt]

Yeah, it really irritates me to no end that this specialty is becoming a field to fill SOAP spots. As said in other posts, the top places are still as competitive as ever but what will become of this field when up to 10% of it is filled with people that didn't choose to do radiology?

We're not PD's or program funders, so we can't fully appreciate what reduced residency spots would do to a program. My thought is, what if every residency program with over 10 positions cut 1 position? I imagine that these programs - although the most deserving/prestigious - would take a smaller hit than those programs with only 3 to 6 positions.

 

[DrBowtie]

Yeah, it really irritates me to no end that this specialty is becoming a field to fill SOAP spots. As said in other posts, the top places are still as competitive as ever but what will become of this field when up to 10% of it is filled with people that didn't choose to do radiology?

We're not PD's or program funders, so we can't fully appreciate what reduced residency spots would do to a program. My thought is, what if every residency program with over 10 positions cut 1 position? I imagine that these programs - although the most deserving/prestigious - would take a smaller hit than those programs with only 3 to 6 positions.

Most places with 10 spots have volume and faculty to support them, not that they need 10 spots.

The programs that should close are those that are low on volume and those with poor didactics.

 

[shark2000]

They should decrease the number of spots. Small community programs and private groups running residency should be closed.

 

[auburnO5]

.

 

[maxxor]

So who is in charge of residency accreditation or the numbers of spots?

I see two problems:

1) # of spots in residencies
2) FMG 4 fellowship loophole is STILL open

Is this the ABR, the ACR, the RRC? Which committee directly controls the number of spots?

 

[JoshSt]

Most places with 10 spots have volume and faculty to support them, not that they need 10 spots.

The programs that should close are those that are low on volume and those with poor didactics.

I wholeheartedly agree with both this comment and shark's - that the small programs with poor didactics should close. However, since programs with 10 or more spots probably wouldn't lose anything in terms of residents' contributions, it may (and just may) be better received than taking away entire small residency programs or reducing spots in otherwise smaller residencies. Again, I absolutely agree those programs with poor didactics and that just get residents for cheap labor should be completely eliminated.

Of course, these are all just internet what if's, who knows how different strategies would/wouldn't work and how they would be received.

If those in leadership refuse to address this problem by proposing or enforcing reduced residency spots, a suboptimal strategy would be to aggressively promote radiology as a career to medical students. The ACP and family medicine organizations spend a good bit of money to do this for IM and FM. Again, suboptimal, but if there are continuously the high number of unfilled spots and they refuse to do anything about, may as well target lower-scoring, less stellar applicants in order to have a field of people who chose to do radiology, not forced to settle with it from scrambling from another field.

 

[maxxor]

Do people wonder about the CORE exam? Could the "minimum competency" actually be a way to force underperforming programs to close?

 

[JoshSt]

Do people wonder about the CORE exam? Could the "minimum competency" actually be a way to force underperforming programs to close?

A possibility. If so, that's a very passive aggressive way to address the issue.

 

[maxxor]

True, but it is an evidence based way to address it. "X% of your graduating residents failed the exam for Y years in a row. We are putting you on probation for 1 year to achieve a 100% pass rate, as we feel all accredited programs should produce radiologists capable of passing this minimum competency exam. If that is not achieved, then we will be forced to withdraw accreditation."

Slow way to go about it. Fastest would be eliminating FMG fellowship loophole.

I can't imagine this will happen unless through bureaucratic rules making, which takes forever. That way no particular person can be blamed.

What about requiring all residencies to affiliate with a medical school? Or requiring minimum verifiable volume per resident? There has to be a rule-change that could hit these programs disproportionately and get them to close down.

 

[radiology2014]

Just out of curiosity, could someone explain the gist of this "loophole" (or post a link)? I've heard it mentioned a couple times in other discussions. Thanks!

 

[JoshSt]

True, but it is an evidence based way to address it. "X% of your graduating residents failed the exam for Y years in a row. We are putting you on probation for 1 year to achieve a 100% pass rate, as we feel all accredited programs should produce radiologists capable of passing this minimum competency exam. If that is not achieved, then we will be forced to withdraw accreditation."

Slow way to go about it. Fastest would be eliminating FMG fellowship loophole.

I can't imagine this will happen unless through bureaucratic rules making, which takes forever. That way no particular person can be blamed.

What about requiring all residencies to affiliate with a medical school? Or requiring minimum verifiable volume per resident? There has to be a rule-change that could hit these programs disproportionately and get them to close down.

Interesting insights, while that may/may not been their initial reasoning it could definitely be a bridge to enforcing performance.

Like your other ideas too. If only we could forward this thread to those in power, Hulk Hogan avatars and all.

 

[maxxor]

Just out of curiosity, could someone explain the gist of this "loophole" (or post a link)? I've heard it mentioned a couple times in other discussions. Thanks!

Foreign trained radiologists may come to an institution in the US and do 4 sequential fellowships at the same institution and become eligible for board certification after that time.

See: http://www.theabr.org/the_abr/sites/all/themes/abr-media/pdf/img_policy.pdf (particularly page 2).

 

[radiology2014]

Foreign trained radiologists may come to an institution in the US and do 4 sequential fellowships...

This is very interesting. I imagine it has been talked about in depth in other threads, but it seems the concern would be along the lines of:

Many IMG radiologists coming to the US through this easier route (?), increasing raw supply and thus hurting job market (?), the unregulated nature of these increases outside the more orderly ACGME quota/match system (?), increasing pressure on US grads to do more fellowships (?), influx of radiologists willing to tolerate international norms with possibly poorer working conditions/demands (?) and poorer compensation (?), decreasing political strength/prestige of specialty through perceived dilution of incoming talent pool (?).

Of course note the many question marks for all the wildly speculative statements for which I have no idea if they are even true to any degree, much less significant. Has this topic been studied?

 

[Puff-of-Snow Sign]

So who is in charge of residency accreditation or the numbers of spots?

I see two problems:

1) # of spots in residencies
2) FMG 4 fellowship loophole is STILL open

Is this the ABR, the ACR, the RRC? Which committee directly controls the number of spots?

Short answer: the RRC when it reviews a program q1-5yrs.

From the ACGME website FAQ on the Diagnostic Radiology RRC:

Q: What criteria are used to determine the number of trainees that a program is permitted?
A: A maximum number of residents in a program is set initially when an application is reviewed and an accreditation status of initial accreditation is approved. The resident complement number is re-evaluated at each subsequent survey/RRC review. Considerations typically include the volume and variety of cases performed in the department, the number of faculty, the board pass rate, and an assessment of the areas of non-compliance that have been identified.

*Emphasis added

Keep in mind that this is an FAQ, not an official policy statement, so there's room for interpretation here. But...it sounds like it would take a lot for them to justify reducing spots at any given program. It also sounds like it wouldn't be hard to achieve justification for increasing spots at a program. Therefore, it would take some pretty heavy lobbying on the part of the ACR and/or ABR to get the RRC to change it's criteria for residency program evaluation. Any resulting change in the number of residency slots would occur very gradually, as not all programs would be up for reaccreditation in a given year.

It seems that a quicker method (though probably just as difficult) would be to convince programs to voluntarily reduce their numbers. I doubt you could get the smaller programs to do this, but you might be able to convince some of the larger (>10 residents/yr) to do this.

Edits: sloppy typing and editing before initial post submission...

 

[DoctwoB]

The problem is that the RRC's job isn't to regulate the number of graduating residents relative to demand. Its job is to ensure that all programs meet appropriate standards. If all programs meet appropriate standards, then other measures will have to be undertaken to close programs (i.e. pressure from the ACR).

 

[DrBowtie]

The problem is that the RRC's job isn't to regulate the number of graduating residents relative to demand. Its job is to ensure that all programs meet appropriate standards. If all programs meet appropriate standards, then other measures will have to be undertaken to close programs (i.e. pressure from the ACR).

The problem in my opinion is that the requirements are too low in volume and do not reflect the variety of a general radiologist.
From: https://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramResources/420_DR_Case_Log_Minimums.pdf

Case Log Categories Required Minimum Number
Chest 1900
CTA/MRA 100
Mammography 300
CT Abdominal/Pelvic 600
US Abdominal/Pelvic 350
Image Guided Biopsy 25
Knee MRI 20
Brain MRI 110
PET 30
Body MRI 20
Spine MRI 60

As a first year resident, I have met nearly half of those categories and am well on my way for the remainder except mammo. Based upon data taken from the Rads ACGME site, the bottom 10th percentile of residents are barely making these benchmarks.

 

[Shifty B]

The problem in my opinion is that the requirements are too low in volume and do not reflect the variety of a general radiologist.
From: https://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramResources/420_DR_Case_Log_Minimums.pdf

Case Log Categories Required Minimum Number
Chest 1900
CTA/MRA 100
Mammography 300
CT Abdominal/Pelvic 600
US Abdominal/Pelvic 350
Image Guided Biopsy 25
Knee MRI 20
Brain MRI 110
PET 30
Body MRI 20
Spine MRI 60

As a first year resident, I have met nearly half of those categories and am well on my way for the remainder except mammo. Based upon data taken from the Rads ACGME site, the bottom 10th percentile of residents are barely making these benchmarks.

Not to diminish your first year achievements but these case log minimums are exactly that, bare minimum requirements, not overall volume requirements for the program. It is a more serious requirement that the program has to have 7,000 cases per resident, per year. (i.e. a program with 10 residents/year * 4 years would need a volume of 280,000 per year).

https://www.acgme.org/acgmeweb/Port...FAQ-PIF/420_diagnostic_radiology_07012013.pdf

This is a really difficult issue simply because there is a lag of at least 5 years before any change affects the market. You might say, "Well, it's better to have a shortage of radiologists than an oversupply." There are situations where that can backfire majorly. For instance, if a serious backlog for imaging develops, it will encourage other specialties to steal it. Imagine if wait time for lung cancer screening chest CTs became excessive, then there becomes an incentive for pulmonologists to start reading them. Hell, they might even create their own sub-sub-specialty just to do it (call it screening pulmonology). Don't think it can happen? Think again. Other specialties are envious of your job and your money, and will do what they can to try to get it.

At the current time, the supply of radiologists probably ranges from a few too many to just enough. There is probably no way to accurately make a fine adjustment because of the delay involved.

 

[DrBowtie]

Not to diminish your first year achievements but these case log minimums are exactly that, bare minimum requirements, not overall volume requirements for the program. It is a more serious requirement that the program has to have 7,000 cases per resident, per year. (i.e. a program with 10 residents/year * 4 years would need a volume of 280,000 per year).

https://www.acgme.org/acgmeweb/Port...FAQ-PIF/420_diagnostic_radiology_07012013.pdf

This is a really difficult issue simply because there is a lag of at least 5 years before any change affects the market. You might say, "Well, it's better to have a shortage of radiologists than an oversupply." There are situations where that can backfire majorly. For instance, if a serious backlog for imaging develops, it will encourage other specialties to steal it. Imagine if wait time for lung cancer screening chest CTs became excessive, then there becomes an incentive for pulmonologists to start reading them. Hell, they might even create their own sub-sub-specialty just to do it (call it screening pulmonology). Don't think it can happen? Think again. Other specialties are envious of your job and your money, and will do what they can to try to get it.

At the current time, the supply of radiologists probably ranges from a few too many to just enough. There is probably no way to accurately make a fine adjustment because of the delay involved.

My point was not to toot my own horn. It was a continuation of discussion about if there were to be closures, which programs should be targeted.

It was to demonstrate that the 10th percentile were reading or at least logging the bare minimums. There are really weak programs out there.

 

[Shifty B]

My point was not to toot my own horn. It was a continuation of discussion about if there were to be closures, which programs should be targeted.

It was to demonstrate that the 10th percentile were reading or at least logging the bare minimums. There are really weak programs out there.

It was a joke, but unfortunately doesn't come across too well in text format.

We agree that if you were going to remove them, you should take them from the weaker programs. There is no coordinated way to do that, unfortunately, and anything you do has no effect for 5 years or more.

The ACGME has been working to close that FMG loophole for a while now. Essentially, ACGME fellows have to have their prior training at an ACGME institution. Many institutions are no longer taking fellows for that 4 year plan.

 

[Substance]

There's not going to be any help from your governing bodies. How do you think it got this way?

I bet the "leaders" have monies tied up in telerad outfits or something and want to flood the market to drive down prices.