Nuclear medicine residents see 'dismal' job market

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Nuclear medicine residents see 'dismal' job market

By Wayne Forrest, AuntMinnie.com staff writer
March 27, 2014

The job market is not what one would call robust for would-be nuclear medicine residents, and their limitations in reading hybrid images is just one reason why, according to a new survey published in the March issue of the Journal of the American College of Radiology.
In the survey, nuclear medicine residents expressed concerns about their preparedness for employment and acknowledged their limitations in reading CT images. Fewer than half of the respondents thought they were ready to independently interpret CT for all pathology.

That lack of expertise is one reason why radiologists have an advantage in the job market, but efforts are underway -- albeit slowly -- to expand training to broaden nuclear medicine residents' expertise.

Employment outlook

"Nuclear medicine physicians who are also radiologists have an easier time getting jobs than those who aren't," said lead author Dr. Jay Harolds from the division of radiology and biomedical imaging at Michigan State University's College of Human Medicine. "We have also found out that international graduates have a harder time finding jobs than those who are American graduates."

2014_03_25_11_11_25_592_Harolds_Jay_175.jpg

Dr. Jay Harolds from Michigan State University.

Harolds and colleagues emailed their survey to all 54 nuclear medicine program directors and asked them to distribute the questionnaire to their residents. In June and July of 2011, 61 (39%) of 155 nuclear medicine residents responded to the survey. Among the respondents, three (5%) had completed radiology residencies and 24 (41%) were in their final year of training. The majority of replies were from residents in three-year programs.

As Harolds mentioned, the majority of nuclear medicine residents polled believe the job market is much better for diagnostic radiologists than nonradiologists, whether they were trained in the U.S. or abroad. Approximately 50% said the marketability of U.S. and international radiologists is "outstanding" or "very good," while more than 60% believe the marketability of nonradiologists is "poor" (JACR, March 2014, Vol. 11:3, pp. 221-224).

If a job candidate can only read a nuclear medicine study, many radiology groups will be reluctant to hire that person, Harolds said. These practices are looking for individuals who can interpret a wide breadth of images to handle overnight and weekend call duties.

"Typically, they can't [take call on off-hours] unless they are also radiologists," Harolds told AuntMinnie.com. "Weekend call and night call are big things, with 24/7 expectations now. People expect quick reports, and report turnaround time has hurt the job market as well."

Hybrid image interpretation

Therefore, competency in reading hybrid images from PET/CT, SPECT/CT, and PET/MRI becomes more of a necessity for nuclear medicine physicians. "Clearly, [nuclear medicine physicians] need to know about these other modalities and become expert in them," Harolds added. "Those are big handicaps that these individuals have."

The majority of nuclear medicine trainees felt competent to independently interpret CT for anatomic localization and for common local pathology, but fewer than half thought they were ready to independently interpret CT for all pathology, the survey found.

"According to our survey, senior residents in three-year programs claim to be only slightly better prepared in CT interpretation for all pathology than seniors in two-year programs," the authors wrote.

Prospective nuclear medicine residents are also finding employment difficult because so much of nuclear medicine is nuclear cardiology, and those exams are typically whisked away and read by cardiologists.

The authors cited two studies that estimated that nuclear medicine physicians in the U.S. interpret fewer than 25% of all nuclear medicine examinations, while cardiologists and radiologists read the rest. Given that nuclear cardiology represents more than 50% of the nuclear medicine examinations in the U.S., according to previous research, nuclear medicine physicians compete directly with cardiologists in that regard.

"That takes a lot of potential studies that [nuclear medicine physicians] could be reading away from them," said Harolds, who also serves as the radiology residency director for Grand Rapids Medical Education Partners, which oversees the residency program.

Training options

Currently, there are three types of nuclear medicine residency available for applicants: three years after one year of graduate medical education, two years after two years of graduate medical education, and one year after completing an accredited diagnostic radiology program.

Previous studies have found that the majority of nuclear medicine residents are nonradiologists enrolled in two-year or three-year training programs, while the one-year training program includes individuals already trained in diagnostic radiology.

Baylor College of Medicine recently chose not to renew its nuclear medicine residency, due in part to employment prospects and recruiting issues.

2014_03_25_11_11_25_149_Guiberteau_Milton_175.jpg

Dr. Milton Guiberteau from Baylor College.

"One of our motivations for not continuing the program was that it was perhaps not the best situation in which to train people that we feel could not get jobs without training in something else," said study co-author Dr. Milton Guiberteau, professor of radiology and nuclear medicine at Baylor. "It isn't in anyone's interest to recruit people to commit to programs knowing that they can do this training, but the job market for them remains quite dismal."

To improve employment prospects and better train residents for a variety of image interpretations, there have been calls for more joint radiology and nuclear medicine training programs, but so far they have been slow to materialize.

Guiberteau is president-elect of the American Board of Radiology (ABR), which has had talks in the past with the American Board of Nuclear Medicine (ABNM) and other stakeholders to develop training pathways that lead to board certification in both disciplines.

"From our point of view, we think that is the way to start, because if we say we will accept people for our examination who satisfy these requirements, that would give motivation to the [residency review committees (RRCs)] to develop training pathways," he added. "We are working on it, but we right now have no uniform solution."

Some progress was made in 2010, when ABR and ABNM each developed four-year diagnostic radiology programs in which residents could be board-certified by both organizations. The four-year program includes 16 months of training in nuclear radiology or nuclear medicine.

The program is in place, and this year ABR will examine its first resident to have completed the requirements. "But [the program] is still quite small and not nearly enough to produce sufficient well-trained nuclear radiologists or nuclear medicine folks to populate the vacancies that will ultimately happen when existing practitioners retire," Guiberteau said.

With the survey results in hand, Harolds and colleagues plan to analyze the barriers to employment and the perceptions of would-be residents and physicians.

"We really don't intend to let it drop until we can see something done for people who want to train in nuclear medicine and be marketable in terms of obtaining employment and who will fit into a practice pattern for the best care of patients," Guiberteau said.

"We are more hopeful than we were a few years ago, but still it would be disingenuous for me to say that the problem is on the verge of being solved," he said.

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The job market for Nuc Med residents is "dismal" these years. I think one of the main reasons is due to the unfair treatment to pure Nuc Med residents.

Actually, the job markets are also fluctuate for other specialties. However, residents in other specialties are offered more further training opportunities if the market needs more. For instance, a radiology resident will be offered Nuc Med fellowship/IR fellowships//...; A pathologist will be offered hemo/molecular// fellowships... But there are almost no further training opportunities for pure Nuc Med residents. The only way to survive the dismal job market is to jump out of the field and start over another residency. This really hurt people who really love Nuc Med. If the job market needs a "combo" nuc medicne physician rather than a pure high quality Nuc med physician only , why ABNM or ABR does not offer further training opportunities on "CT" or MRI to them? ABNM open arms to radiology residents, why ABR does not open arms to Nuc Med residents?

Years ago, I was inspired by a very encourging lecture "Nuc Med will lead the medicine in the future...". I still believe so even the job market is not good right now because of a lot of reasons... I still choose Nuc Med !
 
The job market for Nuc Med residents is "dismal" these years. I think one of the main reasons is due to the unfair treatment to pure Nuc Med residents.

Actually, the job markets are also fluctuate for other specialties. However, residents in other specialties are offered more further training opportunities if the market needs more. For instance, a radiology resident will be offered Nuc Med fellowship/IR fellowships//...; A pathologist will be offered hemo/molecular// fellowships... But there are almost no further training opportunities for pure Nuc Med residents. The only way to survive the dismal job market is to jump out of the field and start over another residency. This really hurt people who really love Nuc Med. If the job market needs a "combo" nuc medicne physician rather than a pure high quality Nuc med physician only , why ABNM or ABR does not offer further training opportunities on "CT" or MRI to them? ABNM open arms to radiology residents, why ABR does not open arms to Nuc Med residents?

Years ago, I was inspired by a very encourging lecture "Nuc Med will lead the medicine in the future...". I still believe so even the job market is not good right now because of a lot of reasons... I still choose Nuc Med !

Modality based training has become history. There is no such thing as CT fellowship. MRI fellowship has been phased out other than 3-4 institution and even that one is controversial.

But let's say there was such thing as CT fellowship. By doing it still you can not join a radiology group. You have to be trained in MRI. But even by doing a year of MRI fellowship you won't be able to join a radiology group because you have to be able to read X-rays. But even if you learn it by doing additional training, still you have to be able to do US. I can go on and on.

I have heard many times from Nuc Med residents about doing CT fellowship. Long story short, it won't make you more marketable. You have to be able to read a variety of scans include X-ray, CT, MRI, Ultrasound, Nucs, mammograms and do image guided procedures. You can skip one or two, but you have to able to do it for most private practice groups. In other words, the only additional training that can be useful for you is doing something equal to a complete radiology residency.

An abdominal imager reads CT, MRI, US and Xray and does image guided biopsies. The same for neurorad (which also does catheter angiogram), MSK, ... Nucs is probably the only part of imaging that is modality based and not organ based. As a result, nuclear medicine residents have a very wrong impression that a CT or MRI fellowship can help them getting a job. No it can't.

Going back to Nucs itself. I think the emergence of PET-CT has destroyed the field for only nuclear medicine people. CT that was initially intended for anatomical localization caused two major problems for non-radiology Nuclear medicine physicians: 1. Anatomical localization is not as easy as they thought. For example Neck anatomy is very complex and non radiology nuclear medicine physicians have hard time localizing things. 2. There is much more information in CT than just anatomical localization. As you know not everything cancer is hot on PET and vice versa.

I was trained in a place that had a combination of radiologists and non-rad Nuclear medicine physicians. When it comes to PET-CT, non radiologists were really scary. They did not know how to read CT and they had too many false positive and false negatives in their reads. Radiologists with Nucs fellowship were the best to interpret PET-CT and other parts of Nucs because they were really good at correlation between modalities.

One thing that you have to understand is the importance of cross modality correlation. You can not read a bone scan without looking at prior Xray or CT or MRI. The CT may be a CT abdomen. If I remember right after so many years, Mettler Nucs book talks about correlating with other imaging all the time. Who should do the correlation?

For reading PET-CT, quality-wise: Nucs rad > general rad >>> nonrad Nucs
For reading other Nucs quality wise: Nucs rad > nonrad Nucs >= general rad

Also you have to consider that at the level of community 80% of Nucs is PET-CT. The other 20% is Bone scan, HIDA and V/Q. Cardiac is read 80% by cardiologists and 20% by rads or Nucs. Other fancy Nucs studies that you have seen in academics do not exist in private practice. The volume of non PET-CT is very low and does not justify hiring a nonrad Nucs. Most groups want someone to do 70-80% other thing and also participate in call pool.

I personally think they have to close the Nucs medicine residencies. In fact, the had to do it about 10-15 years ago.
 
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Shark, If follow your opinion, I think Nuc Med will be ruined in the US. Actually, America already left behind European countries even Asian countries in Nuc Med , because not enough attention was paid. If you are really familiar with this field...

Nuc Med is not as easy as you said that one year training is better than 3 years training. Nobody is perfect, No one can do everything. That's why the subspecialties come from. Radiology have their advantage, but Nuc Med also have their advantage. They just have different focus.

I agree the job market is favored to radiologist in the U.S (attention: not in other countries). But if nuc Med residents are given some further training opportunities ( it is not necessary to cover the whole radiology residency), they could do the best job in a NUC Med main / radiologist job. In fact, ABR or ABNM should do this ASAP!!! If this had been done 10-15 years ago, the situation should have been totally different for Nuc Med residents.


Nuc Med has big potential in the future because of molecular Nuc Med, Gene Nuc Med, Immun Nuc Med and advanced medicine... I think giving opportunities to Nuc Med residents is giving opportunities to the US Nuc Med.
 
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Shark, If follow your opinion, I think Nuc Med will be ruined in the US. Actually, America already left behind European countries even Asian countries in Nuc Med , because not enough attention was paid. If you are really familiar with this field...

Nuc Med is not as easy as you said that one year training is better than 3 years training. Nobody is perfect, No one can do everything. That's why the subspecialties come from. Radiology have their advantage, but Nuc Med also have their advantage. They just have different focus.

I agree the job market is favored to radiologist in the U.S (attention: not in other countries). But if nuc Med residents are given some further training opportunities ( it is not necessary to cover the whole radiology residency), they could do the best job in a NUC Med main / radiologist job. In fact, ABR or ABNM should do this ASAP!!! If this had been done 10-15 years ago, the situation should have been totally different for Nuc Med residents.


Nuc Med has big potential in the future because of molecular Nuc Med, Gene Nuc Med, Immun Nuc Med and advanced medicine... I think giving opportunities to Nuc Med residents is giving opportunities to the US Nuc Med.

I don't know what you mean by ruined. Especially with hybrid imaging, radiologists will pursue fellowship training in Nucs and move the field.

Nothing is easy, but a radiologist with one year of fellowship in Nucs is much better than nonrad Nucs physician to interpret Nucs imaging. Nucs is a modality and is not a new organ system. I am MSK trained and I am familiar with all sorts of bone tumors and bone pathologies. Learning Nucs for me does not need 3 years of training. But for a nonrad 3 years may required because you have to learn the bone tumors from scratch.


Still you don't get the pointYour mindset is totally wrong. No such thing as CT fellowship exists and even if existed, you could not learn it in one year. Imaging interpretation requires correlation between different modalities. Just learning CT is useless. You have to be able to compare different imaging modalities to be able to interpret a CT, MRI, X-ray and even Nucs well.

The big potential in Nucs is in hybrid imaging and radiologists are the best to pioneer this area.
 
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I don't know what you mean by ruined. Especially with hybrid imaging, radiologists will pursue fellowship training in Nucs and move the field.

Nothing is easy, but a radiologist with one year of fellowship in Nucs is much better than nonrad Nucs physician to interpret Nucs imaging. Nucs is a modality and is not a new organ system. I am MSK trained and I am familiar with all sorts of bone tumors and bone pathologies. Learning Nucs for me does not need 3 years of training. But for a nonrad 3 years may required because you have to learn the bone tumors from scratch.


Still you don't get the pointYour mindset is totally wrong. No such thing as CT fellowship exists and even if existed, you could not learn it in one year. Imaging interpretation requires correlation between different modalities. Just learning CT is useless. You have to be able to compare different imaging modalities to be able to interpret a CT, MRI, X-ray and even Nucs well.

The big potential in Nucs is in hybrid imaging and radiologists are the best to pioneer this area.
Disagree.
Most nonrad Nuc Medicine residents have background in the medical field,such as IM, Neuro, Surg, Nuc Med/Rad reserach... Their knowledage in radiology (CT, MRI, US...) is not Zero also. They could correlate patient history very well, and also CT/MRI/PET/US. They know more than a pure radioloist in their prior specialty and correlate this for better diagnosis. However, the job market needs a combo physician who are certified in both radiology and nuclear medicine. SO, ABNM or ABR should consider this situation.
 
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Disagree.
Most nonrad Nuc Medicine residents have background in the medical field,such as IM, Neuro, Surg, Nuc Med/Rad reserach... Their knowledage in radiology (CT, MRI, US...) is not Zero also. They could correlate patient history very well, and also CT/MRI/PET/US. They know more than a pure radioloist in their prior specialty and correlate this for better diagnosis. However, the job market needs a combo physician who are certified in both radiology and nuclear medicine. SO, ABNM or ABR should consider this situation.

I have not seen any surgeon or any neurologist who has done Nuc Med residency as a second residency. If you look for it, probably you will find an exception somewhere.

Your statement is wrong. I don't know what you mean by their prior specialty?

Also, the lion's share of Nuclear medicine in private practice and even academics is PET-CT for cancer staging. I don't know how a background in neurology or surgery or IM can help someone with that and I really don't know who much clinical correlation is needed for cancer staging.

"Clinical correlation" is a myth in radiology and imaging. I never use it in my reports. It is used mostly by old generation of radiologists and is a way to hide incompetencies in imaging skills. In this age, by having access to EMR clinical correlation can be easily done by a radiologist. And I am telling this to you from my experience of interacting with many clinician's daily. Clinician's barely know patient's history.

But in any case, I don't know how much doing a surgery residency can help someone to interpret a HIDA scan. But a background in radiology is helpful to correlate with US and CT findings. Also if you are surgeon and you leave surgery for Nuclear medicine residency, after 5 years your knowledge of surgery won't be any different from a nuclear medicine physician who has not done a surgical residency before.

And just my 2cents. There is no need to downgrade radiology. You are not going to win this battle. Your best chance is to land a radiology residency. So rather than badmouthing radiology here, try to find a spot.
 
Hi, Do your home work about the Nuc Med field... Do not deny others before you did your investigation...

I did not downgrade or badmouth radiology or anyboday. On the contrary, you are the guy who looks over-confident about yourself.
 
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Nuclear medicine residents see 'dismal' job market

By Wayne Forrest, AuntMinnie.com staff writer
March 27, 2014

The job market is not what one would call robust for would-be nuclear medicine residents, and their limitations in reading hybrid images is just one reason why, according to a new survey published in the March issue of the Journal of the American College of Radiology.
In the survey, nuclear medicine residents expressed concerns about their preparedness for employment and acknowledged their limitations in reading CT images. Fewer than half of the respondents thought they were ready to independently interpret CT for all pathology.

That lack of expertise is one reason why radiologists have an advantage in the job market, but efforts are underway -- albeit slowly -- to expand training to broaden nuclear medicine residents' expertise.

Employment outlook

"Nuclear medicine physicians who are also radiologists have an easier time getting jobs than those who aren't," said lead author Dr. Jay Harolds from the division of radiology and biomedical imaging at Michigan State University's College of Human Medicine. "We have also found out that international graduates have a harder time finding jobs than those who are American graduates."

2014_03_25_11_11_25_592_Harolds_Jay_175.jpg

Dr. Jay Harolds from Michigan State University.

Harolds and colleagues emailed their survey to all 54 nuclear medicine program directors and asked them to distribute the questionnaire to their residents. In June and July of 2011, 61 (39%) of 155 nuclear medicine residents responded to the survey. Among the respondents, three (5%) had completed radiology residencies and 24 (41%) were in their final year of training. The majority of replies were from residents in three-year programs.

As Harolds mentioned, the majority of nuclear medicine residents polled believe the job market is much better for diagnostic radiologists than nonradiologists, whether they were trained in the U.S. or abroad. Approximately 50% said the marketability of U.S. and international radiologists is "outstanding" or "very good," while more than 60% believe the marketability of nonradiologists is "poor" (JACR, March 2014, Vol. 11:3, pp. 221-224).

If a job candidate can only read a nuclear medicine study, many radiology groups will be reluctant to hire that person, Harolds said. These practices are looking for individuals who can interpret a wide breadth of images to handle overnight and weekend call duties.

"Typically, they can't [take call on off-hours] unless they are also radiologists," Harolds told AuntMinnie.com. "Weekend call and night call are big things, with 24/7 expectations now. People expect quick reports, and report turnaround time has hurt the job market as well."

Hybrid image interpretation

Therefore, competency in reading hybrid images from PET/CT, SPECT/CT, and PET/MRI becomes more of a necessity for nuclear medicine physicians. "Clearly, [nuclear medicine physicians] need to know about these other modalities and become expert in them," Harolds added. "Those are big handicaps that these individuals have."

The majority of nuclear medicine trainees felt competent to independently interpret CT for anatomic localization and for common local pathology, but fewer than half thought they were ready to independently interpret CT for all pathology, the survey found.

"According to our survey, senior residents in three-year programs claim to be only slightly better prepared in CT interpretation for all pathology than seniors in two-year programs," the authors wrote.

Prospective nuclear medicine residents are also finding employment difficult because so much of nuclear medicine is nuclear cardiology, and those exams are typically whisked away and read by cardiologists.

The authors cited two studies that estimated that nuclear medicine physicians in the U.S. interpret fewer than 25% of all nuclear medicine examinations, while cardiologists and radiologists read the rest. Given that nuclear cardiology represents more than 50% of the nuclear medicine examinations in the U.S., according to previous research, nuclear medicine physicians compete directly with cardiologists in that regard.

"That takes a lot of potential studies that [nuclear medicine physicians] could be reading away from them," said Harolds, who also serves as the radiology residency director for Grand Rapids Medical Education Partners, which oversees the residency program.

Training options

Currently, there are three types of nuclear medicine residency available for applicants: three years after one year of graduate medical education, two years after two years of graduate medical education, and one year after completing an accredited diagnostic radiology program.

Previous studies have found that the majority of nuclear medicine residents are nonradiologists enrolled in two-year or three-year training programs, while the one-year training program includes individuals already trained in diagnostic radiology.

Baylor College of Medicine recently chose not to renew its nuclear medicine residency, due in part to employment prospects and recruiting issues.

2014_03_25_11_11_25_149_Guiberteau_Milton_175.jpg

Dr. Milton Guiberteau from Baylor College.

"One of our motivations for not continuing the program was that it was perhaps not the best situation in which to train people that we feel could not get jobs without training in something else," said study co-author Dr. Milton Guiberteau, professor of radiology and nuclear medicine at Baylor. "It isn't in anyone's interest to recruit people to commit to programs knowing that they can do this training, but the job market for them remains quite dismal."

To improve employment prospects and better train residents for a variety of image interpretations, there have been calls for more joint radiology and nuclear medicine training programs, but so far they have been slow to materialize.

Guiberteau is president-elect of the American Board of Radiology (ABR), which has had talks in the past with the American Board of Nuclear Medicine (ABNM) and other stakeholders to develop training pathways that lead to board certification in both disciplines.

"From our point of view, we think that is the way to start, because if we say we will accept people for our examination who satisfy these requirements, that would give motivation to the [residency review committees (RRCs)] to develop training pathways," he added. "We are working on it, but we right now have no uniform solution."

Some progress was made in 2010, when ABR and ABNM each developed four-year diagnostic radiology programs in which residents could be board-certified by both organizations. The four-year program includes 16 months of training in nuclear radiology or nuclear medicine.

The program is in place, and this year ABR will examine its first resident to have completed the requirements. "But [the program] is still quite small and not nearly enough to produce sufficient well-trained nuclear radiologists or nuclear medicine folks to populate the vacancies that will ultimately happen when existing practitioners retire," Guiberteau said.

With the survey results in hand, Harolds and colleagues plan to analyze the barriers to employment and the perceptions of would-be residents and physicians.

"We really don't intend to let it drop until we can see something done for people who want to train in nuclear medicine and be marketable in terms of obtaining employment and who will fit into a practice pattern for the best care of patients," Guiberteau said.

"We are more hopeful than we were a few years ago, but still it would be disingenuous for me to say that the problem is on the verge of being solved," he said.

Great research!
I will have the interview in Nuclear Medicine residency program. And with this information about unemployment I don't know what to do with this ... Should I still consider NM or this is a dead end?
 
Disagree.
Most nonrad Nuc Medicine residents have background in the medical field,such as IM, Neuro, Surg, Nuc Med/Rad reserach... Their knowledage in radiology (CT, MRI, US...) is not Zero also. They could correlate patient history very well, and also CT/MRI/PET/US. They know more than a pure radioloist in their prior specialty and correlate this for better diagnosis. However, the job market needs a combo physician who are certified in both radiology and nuclear medicine. SO, ABNM or ABR should consider this situation.


You are misleading people. You know better. There are NO jobs for nucs docs.

Nobody is going to be able to hire you to bill for CT / MRI / US. Nucs docs are worthless in current radiology practice environments.
 
Great research!
I will have the interview in Nuclear Medicine residency program. And with this information about unemployment I don't know what to do with this ... Should I still consider NM or this is a dead end?

If you're even considering Nucs, do Radiology and a Nucs fellowship.
 
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