By Eric Barnes, staff writer

July 9, 2013 -- A survey of nuclear medicine residents found widespread dismay about the lack of job opportunities for newly minted nuclear medicine specialists, along with a strong conviction that combining residency programs with radiology is the only way to set things right, according to an article in the Journal of the American College of Radiology.

The survey of nuclear medicine residency program managers found that close to one-third of graduates were not yet working in the field during the first several months after completing their programs. The worst job prospects were seen among international medical graduates who were not also trained in radiology. There is a clear need for a combined residency pathway leading to dual certification from the American Board of Radiology (ABR) and the American Board of Nuclear Medicine (ABNM), the authors wrote (JACR, June 12, 2013).

Such a pathway, the subject of ongoing discussions at U.S. radiology and nuclear medicine meetings, would account for the needs of both specialties now and in the future, according to lead author Dr. Jay Harolds, from Michigan State University (MSU), and colleagues from Baylor College of Medicine, the University of Texas, and the University of Kentucky.

A dearth of opportunities

Nuclear medicine's leaders have long expressed concerns about the dearth of job opportunities for new graduates in nuclear medicine, both at conferences and in the medical literature, the group wrote. The JACR survey was conducted to gain insight into this challenge from a group of professionals most closely connected to the field: nuclear medicine residency program directors, Harolds said in an interview with

"The job market is not what we would like it to be; there are many excellent training programs, but even in some of these excellent programs the residents graduating can't find suitable jobs, so this is something we're very concerned about," he said. Harolds is a radiologist and nuclear medicine physician at Spectrum Health Butterworth Campus in Grand Rapids, MI, as well as a professor and radiology residency director at MSU's College of Human Medicine.

The questions were sent to all 54 U.S. residency program directors, 41 (76%) of whom responded by the March 24, 2011, deadline.

Dr. Jay Harolds from Michigan State University.

The first half of the 12-question survey was devoted to collecting nuts-and-bolts information about residency programs, including, for example, the number of residency slots, graduates in the prior two years, graduates who were foreign students, and residents who were radiologists. Among the graduates, the survey sought to determine how many were employed in nuclear medicine or another field.

The second half of the survey focused on job preparedness. In question No. 7, for example, the authors asked if program directors felt their nonradiologist graduates were qualified to "correlate, as part of SPECT/CT or PET/CT, anatomy and/or localized pathology as displayed on the CT component of the hybrid study." If the answer was yes, how many graduates are "credentialed to so interpret SPECT/CT and PET/CT?" the question continued.

Directors were then asked if they would be willing to participate in a joint nuclear medicine and radiology accreditation program. The last questions covered their view of the job market for U.S. nuclear medicine graduates, international nuclear medicine graduates, and nuclear medicine graduates who are also radiologists, as well as the morale of the residents.

The respondents reported a total of 148 residency positions in 41 nuclear medicine programs approved by the Accreditation Council for Graduate Medical Education (ACGME), a mean 3.6 positions per program. Twenty-eight of the residents were radiologists in training. In all, 83 of the residents were nuclear international graduates, and three-fourths of the programs had at least one international graduate. Fifty-eight residents graduated in 2010, while one-fifth of the programs had no graduates.

Eight months after the 2010 graduation, about half of the 58 graduates were employed part-time or full-time in nuclear medicine, 15% were employed less than half-time in nuclear medicine, one-fourth were employed but not in nuclear medicine, and almost 9% were unemployed.

One program director said his only graduate was employed 50% to 100% in nuclear medicine but noted that "it isn't a very good job," according to the authors.

Regarding graduates' qualifications to read SPECT/CT and PET/CT, many directors skipped the question because they had no residents graduating that year. However, 27 said "yes," their graduates were qualified, one was unsure, and two responded that their graduates were unqualified to read hybrid images. Three-fourths of respondents said they were willing to participate in a joint nuclear medicine and radiology program.

Overall, respondents were pessimistic about the job market for nuclear medicine specialists. Twenty respondents reported morale as "low," three responded with variations on "fair," and only one said the mood was "good."

Positive comments ranged from "Current residents are all radiologists, so morale is high" to "We have only one ACGME nuclear medicine residency position. None of our nonradiologist graduates has had a problem getting a job."

There were about twice as many negative comments, which included the following:

  • "During interview season, we emphasize the job market 'stall' in nuclear medicine."
  • "They are highly disappointed with the specialty and boards for not having put any valid cross-training certification in place."
  • "Lots of anxiety. Two of three will likely leave after this year. Both applied to radiology in the match."

Problem is multifactorial

Along with the challenges cited in the lack of training pathways, external factors played a significant role, especially socioeconomic and political concerns affecting radiologists, the authors wrote.

"Perhaps one of the more imminent trends is the tightening of the employment opportunities for new radiologists as well as new nuclear medicine physicians, which, although cyclic, seems intensified by changing and decreasing physician reimbursement, especially for physicians whose incomes are heavily dependent on imaging," they wrote.

Because of these factors, many imaging practices have put off taking on new associates, and the economic uncertainty has prompted many employed nuclear medicine physicians and radiologists to delay retirement, reducing job openings for new graduates.

The challenges are many for nuclear medicine graduates, Harolds said. Each year, hybrid imaging modalities become more prominent and incorporate more elements of nuclear medicine exams. Also, most nuclear cardiology is largely performed by cardiologists, reducing the demand for nuclear medicine physicians.

Graduates need broader range of skills

In response, nuclear medicine residents have set their sights on jobs in radiology departments, said Harolds.

"The problem for radiology groups is that they're now covering 24 hours a day, seven days a week, and practices want people who can take night call not just in nuclear medicine but in numerous modalities," he said. "And they also want, due to declining reimbursement rates and the need to be efficient, people who can read ... plain films of the chest, maybe that's CT examinations, maybe that's MR, maybe that's breast imaging. Most people who are nuclear medicine physicians can't do that. ... But the best job market for nuclear medicine physicians is for those who are radiologists as well."

This is not to say that many nuclear medicine physicians don't have fine jobs. But for many others in nuclear medicine, the job market is difficult. The hardest job market seems to be for international graduates who are not also radiologists, for reasons that aren't easily pinpointed, Harolds said.

It's important to remain optimistic, and for the past several years there have been major efforts to build bridges between nuclear medicine and radiology, principally in the radiology and nuclear medicine society leadership, he said. People coming from different perspectives on the issue agree there needs to be a coming together of the specialties, with more cooperation and collaboration on both sides, though it's unclear how that increased cooperation might play out.

For now, though, even though the survey is a couple of years old, little appears to have changed in 2012 and 2013 -- except that more people than ever seem to need help getting jobs.

"I see more complaints now than before, and the young physicians in nuclear medicine are very upset about the job market," Harolds said. "So I think I can confidently say in the last decade the job market is worse. My feeling is that it is likely worse as well more recently, but I don't have hard facts to back this up."

Research is continuing, however, and the job market trends will be reported as new information becomes available, he said.

The survey showed overwhelming support among nuclear medicine program directors for a combined residency program that accounts for both current and future nuclear medicine practice needs, the authors concluded.

Copyright © 2013

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