Future of nuclear medicine?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

DukeNuc

New Member
10+ Year Member
Joined
Aug 27, 2009
Messages
9
Reaction score
0
I'm just cuirous if someone could weigh in and give an opinion on the future of nuclear medicine in regard to job stability and potential growth.

With PET/CT studies expected to double by 2016 and a relatively constant supply of radiologists being trained, where does that leave the physician only boarded in nuclear?

Also with the supply of isotopes in question, and the possibility of physicians being directed to order other studies, does anyone feel that will impact the nuclear industry, even if ample isotopes are produced?

Any input is appreciated. Thanks.

Members don't see this ad.
 
I welcome any nuclear physicians to give their opinions on the future of the field?
 
Does anybody that is interviewing, current residents, or nuclear physiciand that are interested in nuclear medicine have any comments on the future of the field, and how it will be affected by healthcare reform?

It seems like the indications for nuclear studies wont change, but if radiologists reimbursements get cut, they might take away more of the nuclear medicine pie.

Currently there are somewhere around 2700 nuclear physicians in the US. If the average person works to age 70, thats around 70 people retiring per year on average. With about 75 residency spots it seems like the job market should be ok. Any thoughts?

Im just trying to make an educated decision, but there is very little information about NUCs out there.
 
Members don't see this ad :)
DukeNuc, are you interested in Nuclear Medicine or currently in a program?
 
Im interested in nuclear medicine. I like almost every aspect of the field except for the prospect of struggling to find work.
 
First off the shortage of moly and tec will be significantly lessened, in the short to medium term by multiple reactors being up later this spring. But besides that, Nuke med is definitely on the move. I work in a high volume nuclear pharmacy lab, and we are seeing PET scans increasing at a drastic rate (gotta be at least 15% per year). Granted, tec/moly is going to fade out within the next 10-20 years, but in the process will be replaced by better drugs. Our facility is bringing online a new cyclotron to expand our delivery of PET molecules, including possibly some IND's. We are anticipating going from having less than 10% of our business be PET to eventually doing maybe 100+ a day in the near future.
 
Last edited:
What do you guys think about the cost effectiveness of nuclear studies vs MRI or conventional CT studies ? I have a feeling something like MRI will be more under the axe so to speak in the new economy/healthcare situation than nuclear will be. Do you physicians see any chance of a realignment of radiology procedures in the future due to the money and incentives shifting around? Personally I want to see these INDs make nuke med the king of imaging studies. Haha, but I bet the MRI people are working on doing the same thing. Too bad their cameras cost so much more though. :p
 
I am so happy to find there is someone who is still optimistic with nm. It seems like nobody care about the future of NM. Where are those attendings and residents?
 
I am wondering as well...sadly this forum looks slightly dead :(
 
I am wondering as well...sadly this forum looks slightly dead :(

Hello to everyone here, as a resident of the one of the top program in the country, I should tell you that the future of nuc med is great as it is now with PET/CT and PET/MRI are advancing fast . There are lots of new radiotracers in the pipelines of the pharmaceuticals which will expand the field in future. In addition, antibody labeled radiotraces are another very promising future. However, I think although it is a separate specialty, it is really better when you combine it with radiology. This is my presonal idea and I think I'll continue nuc med with radiology residency.
 
Hello to everyone here, as a resident of the one of the top program in the country, I should tell you that the future of nuc med is great as it is now with PET/CT and PET/MRI are advancing fast . There are lots of new radiotracers in the pipelines of the pharmaceuticals which will expand the field in future. In addition, antibody labeled radiotraces are another very promising future. However, I think although it is a separate specialty, it is really better when you combine it with radiology. This is my presonal idea and I think I'll continue nuc med with radiology residency.
which program are you in? come back frequently to give us some fresh air.
 
Hello to everyone here, as a resident of the one of the top program in the country, I should tell you that the future of nuc med is great as it is now with PET/CT and PET/MRI are advancing fast . There are lots of new radiotracers in the pipelines of the pharmaceuticals which will expand the field in future. In addition, antibody labeled radiotraces are another very promising future. However, I think although it is a separate specialty, it is really better when you combine it with radiology. This is my presonal idea and I think I'll continue nuc med with radiology residency.


I am sorry, but I completely disagree with your post and as a resident of an average NM residency program, I believe that the future of nuclear medicine, as a specialty, is not as promising as you mentioned and it will probably disappear in the near future. This is a hot topic and you can find a lot of posts within this forum about it. Why are you wasting your time in NM if you are going to get into radiology after finishing you NM residency? 3 years of NM and luckily 3 years of RADS if they give you some credits for your NM residency? It's faster to do RADS with a 4 months NM rotation, no?
 
Members don't see this ad :)
Can any1 tell me the list of regionally accretied colleges, universities or hospital to get degree of nuclear medicine technology.......:confused:
 
I am also a resident of another top program in the country and also think that the future is bright. I do believe that you should be pragmatic and choose a robust field of medicine where you will be able to thrive in the future. During this tight economic moment, Nucs seems somewhat threatened by other specialties (not just radiology). However, Nucs is a complex diagnostic and treatment boutique specialty which is not easily replaceable. First, no other specialist is interested in doing all that we do; yes, radiologist may do a part of our PET/CTs and eventually will do our PET/MRs and cardiologists may want our cardiac stress and viability studies. However, we are trained to excel in those studies and many other nuclear studies as well as in oncologic treatment. Also, to add complexity to our already intricate specialty, there are many new PET radiotracers in the pipeline. In the near future, you are not going to be reading PET FDG studies most of the time as we do now, but studies that will be using other tracers with different targets and biodistributions. Hence, I don't see how physicians from other specialties will be able to read all of these with only a few months of training in Nucs (this is the usual time allocated for rotations).
I disagree with you partusa, I don't think you need to complement your training with a general radiology residency. Aside from the basics, you don't need to know how to read plain films, ultrasounds or barium enemas in Nuclear Medicine; and learning CT or MR is not rocket science, you can perfectly teach yourself the anatomy and technologies, you can even take courses at SNM, etc. Moreover, any good Nuclear Medicine program in the world will have mandatory rotations in these modalities. So at the end of your training you should be able to read the anatomic portion of PET/CTs as if you were a radiologist without continue to train for another 3 years (and if not, you chose the wrong training program).
Yes, today the market likes you better if you are both a radiologist and a nuclear medicine physician, but to me it seems a very large investment. Besides, most nuclear medicine physicians are interested in the academic jobs of this growing field at the forefront of medicine. The additional training in radiology will mostly help you for the non-academic jobs which have always belonged to radiologists.
 
Last edited:
I am also a resident of another top program in the country and also think that the future is bright. I do believe that you should be pragma........


LoveNucs, I'm tired of arguing anything here. But, sincerely, it looks like you are out of touch of the real world. And you live in the dream world probably drawn by your attendings.


The medicine as a whole is like what you described to Nuclear Medicine: advancing in a fast pace. Advancing of nuclear medicine is better considered under the umbrella of radiology, just like Nuclear medicine is a division of radiology in almost all institutions. This fact at least tells you something. No market demand, including academic position, tells the remainder of the story. I highly recommend you to search all open positions, including academic. Then tell me what you think.

To me, nuclear medicine is more like a technology branch, like MRI, rather than a specialty like IM, surgery, urology, etc.
 
radiologist may do a part of our PET/CTs and eventually will do our PET/MRs

Yeah, I think someone here is delusional. Radiologists do the entire PET/CT studies and do a better job reading them because cross-sectional interpretation is one of radiology's core strengths.
 
I dont' know if "nucrad" or "lovenucs" are real NM residents somewhere. If they are, then, they are too stupid and naive to think that, we, true NM residents, who graudated 2010, now ABNM certified, still job hunting, will believe them.
 
I dont' know if "nucrad" or "lovenucs" are real NM residents somewhere. If they are, then, they are too stupid and naive to think that, we, true NM residents, who graudated 2010, now ABNM certified, still job hunting, will believe them.

After getting my PhD in PET at UCLA in the MSTP program, I'm glad I chose rad onc instead.

Sanjiv Gambhir (Stanford, IOM member) seems to be doing pretty well with just a NM residency. He's clearly the exception!
 
Although I don't know the details, I don't believe it is an exception. In this country, everywhere is the same. Of course, big name makes a little difference. But the fundamentals are not going to change.

Stanford is doing a lot of research. The head of the nuclear medicine is a researcher rather than a clinician. If you believe a good clinician must be good at research first, then he is very good clinician. But I believe clinician is a clinician. Researcher is researcher. I wouldn't mix them. Both are not easy. You can't do well at both at the same time. Of course, nuclear medicine could be different. Because the pure nuclear medicine is way too easy. You need something to consume your time, and to convince your employer you are worthy.


After getting my PhD in PET at UCLA in the MSTP program, I'm glad I chose rad onc instead.

Sanjiv Gambhir (Stanford, IOM member) seems to be doing pretty well with just a NM residency. He's clearly the exception!
 
I am sorry you are struggling to find a job "needsomehelp". I didn't mean to say it was easy to find a job in nucs, especially while the economy is still recovering, but there are a few jobs out there. What about the job postings in the SNM website. Obviously, you have to be willing to move anywhere in the country.

"NM2010": I disagree. As you said, PET/CT is another technology/tool. However, to produce a useful report to a referring oncologist, it is not enough to describe objective findings in a PET/CT as radiologists usually do. Nuclear medicine physicians should put those findings together and provide a comprehensive recommendation in the same way consultants do.
 
Last edited:
Don't be fools, guys. Let me say this once and let it sink in:

ABNM stands for American Board of No Marketability :laugh:
 
The problem is not only the ABNM/SNM :confused: (who did nothing to stop radiology from stepping in our toes) but the Nuclear Regulatory Commission (NRC) :mad:, who allowed radiologist with 4 months of nuclear medicine training to perform all nuclear medicine diagnostic studies and treatments since 2004 (as explained below). The ABNM and SNM board of directors from 2004 to the present ARE responsable for not fighting back!

http://theabr.org/ic/ic_dr/ic_dr_nuc_train.html

Nuclear Training

Please watch for an update of this statement.

:thumbdown:
Date: March 12, 2004
RE: Nuclear Medicine Training

Several years ago the Nuclear Regulatory Commission (NRC) proposed changes in the rules that govern training and experience required to use the types of radioactive materials commonly employed in clinical nuclear medicine. Controversies surrounding the proposed regulations delayed implementation, but the publication of a revised final version now seems near. In the past the NRC has accepted board certification by the ABR as evidence that a practitioner is properly trained to safely and effectively use radioactive materials in Nuclear Medicine. The ABR wishes to retain this status for diplomates when the new regulations are finalized and, accordingly, is preparing to match the length of training and the materials on which it examines to the final NRC regulations.

We know that radiology residents, nuclear medicine chiefs and radiology chairs are anxious for the ABR to clarify its new requirements and indicate when they will take effect. The latest NRC public comment period ended February 24, 2004, and a delay of several months is anticipated before the final regulations are published in the Federal Register. Accordingly, the dates and content listed below are SUBJECT TO CHANGE based on the final decisions of the NRC. The ABR also will attempt to remain consistent with the requirements of the Radiology RRC, which are being revised at this time.

The length of the clinical nuclear medicine experience required for compliance with NRC regulations appears likely to decrease from the current 1100 hours (six months) to 700 hours (four months). ABR will amend its training and experience requirements accordingly. If the final rule is published on or before the NRC's own chosen "final" implementation date of October 24, 2004, the ABR will admit for the oral examination of June 2005 candidates with 700 or more hours of training and experience in nuclear medicine. The ABR will require that four months be spent on clinical nuclear medicine. Classroom education in nuclear medicine is to be in addition to the four months of clinical nuclear medicine experience.
LEAVE OF ABSENCE
Leaves of absence and vacation may be granted to residents at the discretion of the program director in accordance with local rules. Within the required period(s) of graduate medical education, the total such leave and vacation time may not exceed SIX CALENDAR WEEKS (30 working days) for residents in a program for one year, TWELVE CALENDAR WEEKS (60 working days) for residents in a program for two years, EIGHTEEN CALENDAR WEEKS (90 working days) for residents in a program for three years, or TWENTY FOUR CALENDAR WEEKS (120 working days) for residents in a program for four years. If a longer leave of absence is granted, the required period of graduate medical education must be extended accordingly.
This total training and experience must include all NRC-required items related to the safe handling, administration and quality control of the radionuclide doses used in clinical nuclear medicine. The Federal Register provides a comprehensive list of these items, which will not be repeated here. ABR testing will cover selections from subjects such as safe elution and quality control (QC) of radionuclide generator systems, calibration and QC of survey meters and dose calibrators, safe handling and administration of therapeutic doses of unsealed radionuclide sources (e.g., I-131), responses to radiation spills and accidents, radiation signage and related materials. Such items will be tested in both the written and oral exams.
In order to comply with the sections of the NRC regulations and expected new RRC guidelines related to I-131 therapy with unsealed sources, residents will have to participate with a preceptor in three therapies in each of two NRC categories for I-131 therapy--3 low dose ( < 33 mCi) and 3 high dose ( > 33 mCi). The specific dates on which these experiences occur should be kept in a log book by each resident in a format similar to the following:

Resident Name _______________ Program ________________

Date Disorder Dose
Administered Preceptor
Initials

1. 2-1-05 Plummer Disease ____ mCi 131I ______
2. _______ ______________ _____________ ______
3. _______ ______________ _____________ ______
4. _______ ______________ _____________ ______
5. _______ ______________ _____________ ______
Because of HIPAA concerns, no data that might identify a patient are to be included in the log book. This log is to be submitted by the program director along with the other materials that attest to the resident’s oral exam eligibility.

Our colleagues in Radiation Oncology are dealing with similar concerns about the therapy-related sections of the new NRC regulations. The ABR will be writing to Radiation Oncology training program directors in a separate memo to encourage new training content and to indicate ABR’s intention to include new NRC-related materials in future examinations.

To license an individual as an authorized user of radionuclides the NRC will require that another authorized user/preceptor – typically this would be the Nuclear Medicine Chief – attest to the successful completion of the training in Nuclear Medicine. The attestation of the Residency Program Director will not be accepted by the NRC unless the Program Director also is an authorized user. For admittance to the ABR exam, however, Residency Program Director attestation will suffice.

The ABR recommends that all residency programs re-evaluate their training in nuclear medicine and add the content elements outlined in this communication. In this way, all residents will be prepared and qualified to sit for the nuclear medicine portion of the ABR oral exam as early as June, 2005, and also will be better able to provide nuclear medicine services safely and effectively. Nuclear Medicine training should not be shortened, however, until the NRC has made its final ruling. To do so prematurely runs the risk of disenfranchising entire candidate classes of the ABR.
 
However, to produce a useful report to a referring oncologist, it is not enough to describe objective findings in a PET/CT as radiologists usually do. Nuclear medicine physicians should put those findings together and provide a comprehensive recommendation in the same way consultants do.

As an NM-trained, PET/CT-fellowship-trained physician now in private practice in California strictly doing NM and PET/CT, I wholeheartedly agree with that statement, and have seen the truth of it time and time again.

I am not naive to the problems of the NM job market and the attitude towards NM by US medicine and many radiologists. Fortunately there are radiologists (even young newly-trained ones) out there that are smart enough to realize that NM is more than just bone scans, and PET/CT is more than just a "glorified contrast", and they themselves would rather defer FDG, NaF, thyrogen-stimulated radioiodine, prostascint, mIBG and octreoscan SPECT studies to an NM physician.

While I agree that anyone considering NM (in the U.S.) should be very cautious and think hard about the reasons and expectations why they are considering NM, there are certain types of doctors that the future of the field needs, such as those with strong research, chemistry, engineering motivations. While the picture painted of NM (in the U.S.) on forums like this is dismal (and rightfully so) for those with the expectations of a typical U.S. doctor finishing medical school, there is a future for molecular imaging for the dedicated few scientific-minded who need a different type of stimulation than routine day-to-day patient care.
 
A nucs medicine doctor is not qualified enough to read PET-CT studies or even bone scans. If you think differently, you do not know anything about imaging.
 
A nucs medicine doctor is not qualified enough to read PET-CT studies or even bone scans. If you think differently, you do not know anything about imaging.

It's good the world has such passionate & dedicated expert physicians like you.

I understand what you are trying to say, but I was surprised with the quite inflammatory over-generalized comment coming from a (presumed) physician. Then again, I am new to this forum and haven't spent enough time looking around to see what the tone of professionalism is on this site. I am just a full-time practicing Nuclear Medicine and PET-CT physician in California in a non-academic private practice setting with equal salary as my radiologist partners, and I had just thought I would participate in this forum to help balance the close-minded views I initially saw on this forum. Typically such absolute comments backfire for the author and tend to make them sound unqualified and inexperienced with the rest of the world outside of their little hospital...or bitter?.

So by your expertise I, as a "nucs medicine doctor", am apparently not be "qualified enough" and I "do not know anything about imaging". I'll be sure to let my colleague surgeons, oncologists, and radiation oncologists know of your wisdom during my educational lecture to them in tumor board this afternoon. In any case, it is disappointing if your tone is representative of the development of physicians these days.

But yes, I know there are unfortunate instances where what you are saying is true. I can only imagine you have experienced many incompetent nuclear medicine physicians or you were exposed to an incompetent training program during your nuclear medicine rotations, and you sound like those angry enough to be saying, "those damn FMGs in nucs". And it's unfortunate that these incompetent physicians have set the tone for the industry in the eyes of the medical community.

Time and time again, comments like yours typically come from those radiologists who view nuclear medicine as just another study in their stack of cases to read, where they just have to list all the black (or orange) spots, and then pull up the corresponding CT and MRI scans to use their MSK expertise better than any nuclear medicine physician can do. If this describes you, then by all means please get back to reading your stack and using your expertise to be a savior of lives.

But my positive tone about nuclear medicine in my prior post is not directed towards you. It is directed towards the physicians who are also scientists, researchers, chemists, physicists, and engineers. Likewise, it is directed towards the scientists, researchers, chemists, physicists, and engineers who dedicate themselves to medicine. It is up to us to continue our patient care & interaction, modifying protocols to properly evaluate physiologic processes, developing new tracers and completing their clinical investigation, and promoting new imaging technology. We need to continue to do all this so that our friend and colleague above can continue to be the expert who knows everything about imaging.
 
  • Like
Reactions: 1 user
As an MSK fellowship trained radiologist, who has done tons of body imaging (almost a body fellowship), I believe Nucs med docs are not qualified enough for clinical aspect of the field. They may be good at research or some esoteric parts of the field.

As you said before, the final conclusion is a combination of all findings together. We are not just describers of findings. We have to come into the conclusion or at least narrow the findings into 2-3 differential diagnosis. And then esp for a lot of groups, recommend the next step like further imaging or biopsy or ....

For example bone scan: A finding on a bone scan can be a totally benign entity to a frank mets. There are patterns that can help you differentiate benign from malignancy on bone scan, but non are definite. Like any other part of imaging, cross modality correlation is the key in combination with clinical aspect of the disease process. These days, most of cancer patients have tons of cross sectional imaging in addition to bone scan. Correlation of a finding to CT, MR or even X-ray is an indispensable part of final conclusion.
As an MSK radiologist, there has been many times that I have seen Nucs docs coming to me and ask about my opinion on a case that to me is a second year resident level. I have read more than several MRs on patients who had a suspicious bone scan per Nucs doctor and to me, MRI was not indicated at all because for example on CT abdomen that was done a month before the bone scan, on Lumbar spine you could see the benign lesion.

For PET-CT, no need to say that it needs a skillful imager to be good at CT. I have seen big name Nucs doctors called something suspicious in the neck or liver or .... that was obviously benign on the patients last year MRI. It was not reported because it was benign. But, Nucs docs only read the reports because they are not capable of interpreting MR. I have seen big time Nucs docs miss things on CT part of PET because it did not have high metabolic activity. Not every neoplasm is metabolically active and not anything that is metabolically active is a cancer. You need cross modality correlation.
 
Top