Rethinking Residency

Should limited job opportunities for radiologists lead us to reduce residency training program sizes?

Radiology Jobs - Rethinking Residency

The ACR Commission on Human Resources has reported the results of its 2014 Workforce Survey, indicating that the number of job opportunities available in 2014 will be approximately 1,100,1 similar to the figures in 2013.2 (Read more about the 2014 results at

This prediction has led to discussion within the radiology community regarding a possible change in the number of radiology residency positions offered. Neither the ACR nor the commission have a primary role in deciding this issue, but as the group representing the interests of radiologists, we feel that offering a commentary on this matter is appropriate.

Many of the variables discussed here were analyzed in the 2013 survey commentary, which recommended that residency spots remain stable.3 However, the new 2014 survey warrants additional examination because the issue is of such great interest and importance. Consequently, this year, a new group consisting of senior radiologists working in both private and academic practices, many of whom are leaders in the ACR, discussed this issue in detail and achieved consensus. We should point out that the information in this paper is the opinion of the authors and has not been discussed by the ACR Board of Chancellors. It has not been voted on by the ACR Council and does not represent an official policy or position of the College.

The group appreciated that this is a complex and difficult issue to analyze and make recommendations about. Any change in the number of residency slots will not affect the job market until residents entering programs this year complete training programs in five years. Any change instituted now would not change the number of individuals searching for jobs in the immediate future.

If a five-year time frame is used, we must consider the future landscape. The next five years may see a significant increase in the number of examinations being performed because of the newly insured individuals receiving care as a result of the Affordable Care Act. The increasing number of elderly baby boomers may also result in a greater need for imaging studies. In 2013, Dall et al4 reported a projected increase of 18 percent in the demand for radiology services between 2013 and 2025. Considering all specialties, this need is only less than the increased demand for vascular surgery and cardiology services and is higher than the 14 percent increase in demand expected for adult primary care services. The number of radiologists needed to handle these increased volumes should lead to a greater number of job opportunities.

The validity of the workforce prediction data is also limited by not knowing what technology innovations will be introduced in the next five years. New imaging techniques or methodologies, such as molecular imaging and personalized imaging, may have an impact on the need for radiology services. Another uncertainty, which might affect workforce needs, is the DR/IR residency changes that have recently been introduced. Last, the impact of Imaging 3.0™ on the need for radiologists is still to be determined. As we increasingly get out of the reading room and interact with patients and referring physicians, we may see an increase in practices’ hiring needs. The integration of new tasks and services that radiologists should perform relative to patients, referring physicians, hospitals, and insurers is also to be determined. These services will require time and will likely impact workforce needs.

For all these reasons, we have concluded that it would be unwise to recommend any change in the number of radiology residency positions being offered. We are sensitive to the difficult situation graduating residents presently face when entering the job market. But we also believe that the workforce needs are cyclical and will improve in the future. 

By Edward I. Bluth, MD, FACR, James A. Brink, MD, FACR, Cheri L. Canon, MD, FACR, Jocelyn D. Chertoff, MD, FACR, Paul H. Ellenbogen, MD, FACR, Howard B. Fleishon, MD, MMM, FACR, Alan D. Kaye, MD, FACR, Paul A. Larson, MD, FACR, Carolyn C. Meltzer, MD, FACR

1. Bluth EI, Truong H, Bansal S. The 2014 ACR Commission on Human Resources Workforce Survey. JACR 2014;11(10):948–952.
2. Bluth EI, Truong H, Nsiah E, Hughes D, Short BW. The 2013 ACR Commission on Human Resources Workforce Survey. JACR 2013;10(10):750–756.
3. Meltzer CC, Mullins ME, Chertoff JD, Bluth EI, Canon CL. Are we training the right number of radiologists? JACR 2013;10(10):757–759.
4. Dall TM, Gallo PD, Chakrabarti R, West T, Semilla AP, Storm MV. An aging population and growing disease burden will require a large and specialized health care workforce by 2025. Health Aff (Millwood) 2013;32(11):2013–2020.

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