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the end of pure nucs in the U.S.
- Thread starter Cathance
- Start date
I think it shouldn't be an independent residency. PET/CT and general nuc should be part of radiology and a fellowship. Treatment should be part of internal medicine(endocrinology), like nuclear cardiology. Actually it is happening(search literature). Brain PET should be part of Neurology/psch.
This is not a rigt residency, which is proved by its poor marketability.
This is not a rigt residency, which is proved by its poor marketability.
I wish this thread was here before I decided to jump in. I did some online research. But I didn't find any useful information regarding Nuc residency. And I assumed it is like all residencies. I was totally wrong. Also, my friend who was in nuc residency gave me very inaccurate information regarding the job market. Keep this thread alive and ask the moderator to stick it on the top. Hopefully, nobody is going to make the mistake I made.
If I am going to do something, I prefer sending letters to ACGME. Ask it to abolish the accreditation of the so called Nuclear medicine residency.
You don't accredit a residency which doesn't produce marketable graduates. Also, you don't accredit a residency which is covered by another residency(nuc is part of radiology training, and the radiologists are doing the job largely).
I firmly believe nuc would end up much better if it is part of radiology, either a track like interventional radiology or a fellowship. Pure nuc should die and is dying. Jumping into a dying boat is stupid. I was stupid. No matter how hard those old folks in this field fight for it, it is going to die.
This is a dying field and gaining its rebirth in radiology, like pet/ct or PET/MRI in the future. This is the same world wide including Europe, Canada, China and Japan. Actually, an international meeting regarding hybrid imaging training early this year(check the journals you received) proposed both NM and radiology training by many significant speakers. The chairman of UMich radiology proposed a 5 year training program for hybrid imaging which includes both radiology, general nuc, and PET traing.( I guess nobody cares treatment at all). Also, many countries require both NM and radiology trained physicians to jointly read PET/CT. Apparently, dual board certified have the advantage. No matter where you are, the trend is radiology training is essential to nuclear medicine physicians, if they still exist in the future. In other parts of the world, get radiology training may not be very difficult. In this country, I think it is complicated by the competiveness of the radiology residency.
Also, don't forget one fact. ACNM/SNM are too much weak. Unimaginablely weak.
If I couldn't find a job, what I am going to do?
I do not know at this point.... .... Golden bridge is beautiful, I heard.
This is not a rigt residency, which is proved by its poor marketability.
This is not a rigt residency, which is proved by its poor marketability.
I wish this thread was here before I decided to jump in. I did some online research. But I didn't find any useful information regarding Nuc residency. And I assumed it is like all residencies. I was totally wrong. Also, my friend who was in nuc residency gave me very inaccurate information regarding the job market. Keep this thread alive and ask the moderator to stick it on the top. Hopefully, nobody is going to make the mistake I made.
If I am going to do something, I prefer sending letters to ACGME. Ask it to abolish the accreditation of the so called Nuclear medicine residency.
You don't accredit a residency which doesn't produce marketable graduates. Also, you don't accredit a residency which is covered by another residency(nuc is part of radiology training, and the radiologists are doing the job largely).
I firmly believe nuc would end up much better if it is part of radiology, either a track like interventional radiology or a fellowship. Pure nuc should die and is dying. Jumping into a dying boat is stupid. I was stupid. No matter how hard those old folks in this field fight for it, it is going to die.
This is a dying field and gaining its rebirth in radiology, like pet/ct or PET/MRI in the future. This is the same world wide including Europe, Canada, China and Japan. Actually, an international meeting regarding hybrid imaging training early this year(check the journals you received) proposed both NM and radiology training by many significant speakers. The chairman of UMich radiology proposed a 5 year training program for hybrid imaging which includes both radiology, general nuc, and PET traing.( I guess nobody cares treatment at all). Also, many countries require both NM and radiology trained physicians to jointly read PET/CT. Apparently, dual board certified have the advantage. No matter where you are, the trend is radiology training is essential to nuclear medicine physicians, if they still exist in the future. In other parts of the world, get radiology training may not be very difficult. In this country, I think it is complicated by the competiveness of the radiology residency.
Also, don't forget one fact. ACNM/SNM are too much weak. Unimaginablely weak.
If I couldn't find a job, what I am going to do?
I do not know at this point.... .... Golden bridge is beautiful, I heard.
Last edited:
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How to survive this tumultuous period:
#1: Recognize that there is a lot you can do as a doctor, no matter what your board scores are or your residency training. It may take some time to figure it out, but eventually we will all find jobs that pay the bills.
#2: Keep working at it. You may find yourself on a path into radiology, or into another field in clinical medicine, or into industry/pharma, or perhaps something entirely different. Some (few) lucky ones will get to stay in Nucs without doing radiology. Keep your options open and try to keep expanding.
#3: Don't forget to keep breathing. Enjoy life and everything it has to offer.
So with that, I'm off to play with my kids...
#1: Recognize that there is a lot you can do as a doctor, no matter what your board scores are or your residency training. It may take some time to figure it out, but eventually we will all find jobs that pay the bills.
#2: Keep working at it. You may find yourself on a path into radiology, or into another field in clinical medicine, or into industry/pharma, or perhaps something entirely different. Some (few) lucky ones will get to stay in Nucs without doing radiology. Keep your options open and try to keep expanding.
#3: Don't forget to keep breathing. Enjoy life and everything it has to offer.
So with that, I'm off to play with my kids...
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Erin,
Thank you for your sincere, thoughtful, but rather oblivious reply. I, for one, do not need the NMRO's "mentorship program" or "quarterly newsletter," or its help with "basic interview skills" or "job hunting skills." We can't use any help in running "a successful out-patient NM center" if we can't get jobs out of residency because we aren't board certified radiologists. We can't do any "telemedicine" if the firms that organized tele never respond to our letters and CVs because we aren't radiologists. My "work ethic" is second to none, and yet success in this field (i.e., landing a nucs job) escapes me...
What we need is your support to an end to the "residency in nuclear medicine" that promised jobs and greater "prestige" after a 3-year residency but clearly can't deliver. End the process that got us all into this mess. End the 3-year track, so that the problem is not compounded. (It's okay for internists and neurologists to do the 2 year track, since they have something to fall back on and they bring a lot of value to the field. Radiologists should also have to do 2 years (one of which can be their last year of radiology, 12 full months of nucs.)
THEN, -- and here's the good part
-- we need you to help us NM residents get the ABR certification we need to be able to be nuclear medicine physicians in the U.S. (or at least those of us that want it).Maybe Medicare should know that they are throwing money away by paying for us to train, only so we can either leave this country or go into some other residency, or even leave clinical practice entirely. I'm starting to like FDGme's idea. Can we get some attention on this in Washington, D.C.?
Is it possible to get CMS/Medicare or the American Board of Medical Specialties to put some extra dollars or effort toward a transition of NMs to radiology training and board certification?
Is it feasible to get CMS to give a "bonus" to radiology residencies for training ABNM diplomats for two years or more? Meaning... Can we NM-program graduates get a little boost in getting radiology training?
Is it realistic to get ABR to offer a framework for NM residents and ABNM diplomats to achieve ABR certification through a "fellowship" route in radiology? Already, foreign-trained radiologists can come to the U.S., spend 4 years in training status at an academic radiology program, and sit for the ABR boards. They don't even have to be in an approved "residency spot." Why can't we do something like that? Why don't we plead with the ABR to get them to offer a 2-year or 3-year fellowship so we can learn all the U/S, MRI, plain film, IR, MSK, and mammo that we need to know to pass the ABR exam, achieve full "board-certified radiologist" status, allowing us to confidently cover call and be full-fledged radiologists in addition to experts in nucs?
Is it conceivable to get the NRC to require full ABNM certification to become an AU (authorized user)? This is the only way to keep radiologists from dancing around the country injecting patients with radioactive diagnostic agents and therapeutic doses of anti-thyroid and anti-cancer radiopharmaceuticals with minimal training and experience in handling dangerous unsealed radioactive medications.
That's what we need, Erin. Can you help?
Last edited:
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I am writing my experience during the recent SNM meeting in the other post. I had the opportunity to be present at the residents meeting with representatives of the SNM and ACNM.
Here is the link
http://forums.studentdoctor.net/showthread.php?t=736479
Here is the link
http://forums.studentdoctor.net/showthread.php?t=736479
I attended the board review course. But I missed the resident meeting.
The review course is OK. The PET/CT anatomy chest is terrific. Abd/pelvis is good. Head/neck is ok. The CT cases for nuc physicians are good too. I went to the job placement too, just because of my curiosity. I didn't expect anything. Like my expectation, it is worthless for us, just like Partusa said. In our hospital, almost all specialties have a board for job opportunities, except nuc. Even pathology has a couple of job ads.
About the PET/CT lectures, maybe some nuclear lectures, my feeling is: if the lecture is given by a radiologist, at least it is good. The radiologists taught you how to read. If it is given by a nuclear physician, I have to say, it is almost worthless. It is like a scientific presentation full with numbers and statistics plus some basic/easy stuff. Not the techniques about how to read scans. I can find those numbers and statistics myself. Actually, me and my coresident have a conclusion, nuc residency is a joke. Unfortunately, I am part of the joke.
I am thinking to file a complaint to ACGME, which should take its part of the responsibility because it accredits this residency. If I was from a rich family or from some background, I would sue ACGME.
I think ACGME plays the most important role. The congress appropriation for GME is based on ACGME. If I'm wrong, correct me. This is still a capitalism country. The practice of ACGME is it controls the quota and existence of residency programs based on this country's medicial demand. It failed to change nuclear medicine training based on market demand, not program director's demand. It failed to adjust the available quota of nuclear medicine based on the market demand, too.
So, conclusion: ACGME should take the responsibility.
The review course is OK. The PET/CT anatomy chest is terrific. Abd/pelvis is good. Head/neck is ok. The CT cases for nuc physicians are good too. I went to the job placement too, just because of my curiosity. I didn't expect anything. Like my expectation, it is worthless for us, just like Partusa said. In our hospital, almost all specialties have a board for job opportunities, except nuc. Even pathology has a couple of job ads.
About the PET/CT lectures, maybe some nuclear lectures, my feeling is: if the lecture is given by a radiologist, at least it is good. The radiologists taught you how to read. If it is given by a nuclear physician, I have to say, it is almost worthless. It is like a scientific presentation full with numbers and statistics plus some basic/easy stuff. Not the techniques about how to read scans. I can find those numbers and statistics myself. Actually, me and my coresident have a conclusion, nuc residency is a joke. Unfortunately, I am part of the joke.
I am thinking to file a complaint to ACGME, which should take its part of the responsibility because it accredits this residency. If I was from a rich family or from some background, I would sue ACGME.
I think ACGME plays the most important role. The congress appropriation for GME is based on ACGME. If I'm wrong, correct me. This is still a capitalism country. The practice of ACGME is it controls the quota and existence of residency programs based on this country's medicial demand. It failed to change nuclear medicine training based on market demand, not program director's demand. It failed to adjust the available quota of nuclear medicine based on the market demand, too.
So, conclusion: ACGME should take the responsibility.
Last edited:
Hi, all:
I sent a concern to ACGME:
======================
[email protected]
======================
The email body basically is the letter in another post.
I encourage all nuc residents and attendings to do the same at this point. I know they take complaints seriously. I believe it is appropriate first step for us to do. As of what they can do, it depends on the politics and the complication/difficulty of the problem. Remember we have small resident body and weak ACNM and SNM compared to ACR and RNSA. But I believe in this country's values: fairness, honestness, equalness, respect.(I hope I am right)
Letter from the thread: to the end, and to a new beginning - a letter to congress
......................................................................
Dear [INSERT NAME OF SENATOR OR REPRESENTATIVE],
Did you know there is an easy solution to end the waste of up to $1,352,000 taxpayer dollars per year? It's a bit complicated, which is why it has continued so long, but the solution is simple. Please read carefully:
Acronyms/Organizations involved:
ABNM: American Board of Nuclear Medicine
ABR: American Board of Radiology
ACGME: Accreditation Council for Graduate Medical Education
ACR: American College of Radiology
CMS: Centers for Medicare and Medicaid Services
HHS: U.S. Department of Health and Human Services
RRC: Residency Review Committee (of ACGME)
RSNA: Radiological Society of North America
SNM: Society of Nuclear Medicine
FACTS: According to http://www.acgme.org/adspublic/, there are 169 residents currently filling positions at the 56 ACGME-accredited nuclear medicine programs, supported by CMS (part of the U.S. Department of Health and Human Services) at an average of over $80,000 per year per resident, for a total of $1,352,000 per year. Residents completing a 3-year training track in one of these residencies (total cost averaging $240,000) earns eligibility for board certification by the American Board of Nuclear Medicine (ABNM), but not for certification by the American Board of Radiology (ABR), which has a completely separate residency requirement. On 4/25/2010, according to www.snm.org, the Society of Nuclear Medicine's website, there was only one posted job opening in the whole country. The American College of Radiology's website, http://jobs.acr.org/search/browse/ , features no jobs for nuclear medicine physicians that are not also ABR-certified radiologists. The Radiological Society of North America (RSNA) Career Connect website, http://careers.rsna.org/, also features no jobs unless the candidate is ABR-certified. A job search for nuclear medicine physician on the popular "Aunt Minnie" website (www.auntminnie.com) resulted in zero returns. Most of the recruiting companies don't even have a category for "nuclear medicine physician," and none of them have any jobs posted. Queried firms include PracticeLink.com, Medhunter.com, Alliance Recruiting, Merritt Hawkins & Associates, MDSearch.com, and Action Medical Search. Non-advertized job availability is difficult to measure, but is estimated to be extremely low to non-existent for 3-year nuclear medicine residency graduates.
PROBLEM: Even after 3 years of specialized training in nuclear medicine at huge cost to taxpayers, these board-eligible graduates have near-zero opportunities for jobs. This is due to in part to a marked preference in the nuclear medicine physician market for nuclear radiologists certified by both the ABNM and the ABR, as well as the ABNM's policy to allow radiologists to qualify for certification after just one year of nuclear medicine.
WASTE and ABUSE: The directors of these nuclear medicine residency programs and the Chiefs of the academic nuclear medicine divisions that host these programs continue to petition the nuclear medicine ACGME Residency Review Committee (RCC) for more resident training spots. They continue to apply for more CMS funding for such residents, and they continue to invite people to come to their programs and fill those spots. Why? These academic directors are benefiting by having residents do a large part of the work required to bill for very expensive procedures. But it is hurting the field of nuclear medicine. The word is getting out that people cannot get jobs coming out of these residency programs, so the number of applicants is sharply dropping. Yet, the residency directors continue to try to fill their programs…at taxpayer expense. Caught in this vicious cycle, residents invited to train at these problems are having a harder and harder time getting jobs, and many are electing to pursue further training in another field. The taxdollar investment is thereby not put to good use actually caring for patients (including Medicare patients).
How do I know? I am one of these residents, and my colleagues and I can't seem to get a job in what we were trained to do.
WHAT WE WANT:
1. Stop the injustice and immediately END Medicare support for new residents applying for a 3-year training track at any ACGME-accredited Nuclear Medicine residency programs. END new nuclear medicine training for any medical school graduate that has not already completed requirements for board certification in another field (such as radiology, internal medicine, neurology, etc). This should not affect residents already in training in 3-year primary nuclear medicine residency tracks at such programs, allowing those in such programs to complete their programs if so desired. It must also not affect those in a 1-year post-radiology track, or any 2-year post-clinical training track in nuclear medicine, as these residents have many opportunities to find work based on their primary board certification and will be able to augment their practices with their nuclear medicine capabilities, thereby returning the taxdollar investment.
2. Immediately set up a training fund for current nuclear medicine residents to complete 2 or 3 years of training in an ACGME-accredited radiology residency, using the CMS funds freed up by immediately ending support for 3-year nuclear medicine residents. The result will be no change in cost to CMS, but a major increase in return on taxpayer investment in residency training (in the form of more high-demand radiologists dual-boarded by ABR and ABNM), by allowing nuclear medicine residency graduates to gain the training they need to enter a market thirsting for radiologists.
Thank you for your attention on this critical matter in the field of nuclear medicine and national healthcare delivery.
Sincerely,
[YOUR NAME, ADDRESS, AND PHONE NUMBER HERE, FOR BEST RESULT]
--------------------------------------------
Below is from ACGME website:
------------------------------------------------
Reporting a Concern or Making a Formal Complaint about a Residency Training Program
Do you have a concern or formal complaint about residency education and/or the learning environment in an ACGME accredited program/institution?
How Resident Services Responds to Concerns and Complaints
Resident Services encourages you to bring your concerns and complaints to the attention of the program director and/or the institution's designated institutional official (DIO). If this does not lead to resolution, bring your concern or complaint to us for review. Resident Services will work with the DIO to resolve issues surrounding concerns. Valid complaints will be processed by Resident Services, which will require a response from the program director and attestation to the response by the DIO, and review by the relevant review committee.
You may submit your:
concern by mail, fax or email
signed complaint by mail or courier service
Be sure to include the following:
a brief summary of the issues, including steps taken - if relevant
the name, street address, city, and state of the residency program
your contact information
Providing your name and contact information enables Resident Services to inform you about the actions taken in response to your concern or formal complaint, and also to contact you should additional information be needed.
It is our policy to treat your name as confidential information and not to disclose it without your permission. However, depending on the circumstance, it may be necessary to share your name with the DIO in the course of the concern (not complaint) investigation.
E-mail:
[email protected]
Fax:
(312) 755-7498
ACGME Staff:
Marsha Miller, MA
Mail:
Resident Services
ACGME
515 North State St. Ste 2400
Chicago, IL 60654
Scope of Concern Evaluations
Information provided is used to investigate, in a confidential manner, specific concerns by physicians in graduate medical education (residents, fellows, and faculty members) when the existing channels of communication or dispute resolution have proven unsatisfactory. If, in the judgment of Resident Services, any given case suggests a need for change to specific institutional, common program requirements, procedures, or policies, Resident Services will direct its recommendation to the ACGME Chief Executive Officer. Submitting a concern does not affect the program and/or institution's accreditation status. There may be instances when Resident Services will recommend that you submit a formal complaint, which could affect the program and/or institution's accreditation status.
Scope of Complaint Evaluations
Information provided is used to investigate, in a confidential manner, specific alleged areas of non-compliance with the ACGME's Institutional and Program Requirements. Anyone having evidence of non-compliance with these standards by a program or institution may submit a formal complaint to the ACGME. Please review the "Procedures for Addressing Complaints against Residency Programs and Sponsoring Institutions" at www.acgme.org. You will find the document under "Resident Services." Submitting a formal complaint may affect the program and/or institution's accreditation status.
Scope of Egregious or Catastrophic Events
The occurrence of an alleged egregious accreditation violation or catastrophic institutional event, which, because of its urgency, must be addressed outside of the established processes of the ACGME is reported promptly to the Chief Executive Officer of the ACGME who will initiate an investigation to determine credibility and degree of urgency. Examples of egregious or catastrophic events are: loss of the program's entire faculty; hospital bankruptcy that affects residency training; or program closure without assistance provided to the residents and fellows in locating other positions. Please review "Egregious Violations" at www.acgme.org. You will find the document under "Resident Services."
I sent a concern to ACGME:
======================
[email protected]
======================
The email body basically is the letter in another post.
I encourage all nuc residents and attendings to do the same at this point. I know they take complaints seriously. I believe it is appropriate first step for us to do. As of what they can do, it depends on the politics and the complication/difficulty of the problem. Remember we have small resident body and weak ACNM and SNM compared to ACR and RNSA. But I believe in this country's values: fairness, honestness, equalness, respect.(I hope I am right
)Letter from the thread: to the end, and to a new beginning - a letter to congress
......................................................................
Dear [INSERT NAME OF SENATOR OR REPRESENTATIVE],
Did you know there is an easy solution to end the waste of up to $1,352,000 taxpayer dollars per year? It's a bit complicated, which is why it has continued so long, but the solution is simple. Please read carefully:
Acronyms/Organizations involved:
ABNM: American Board of Nuclear Medicine
ABR: American Board of Radiology
ACGME: Accreditation Council for Graduate Medical Education
ACR: American College of Radiology
CMS: Centers for Medicare and Medicaid Services
HHS: U.S. Department of Health and Human Services
RRC: Residency Review Committee (of ACGME)
RSNA: Radiological Society of North America
SNM: Society of Nuclear Medicine
FACTS: According to http://www.acgme.org/adspublic/, there are 169 residents currently filling positions at the 56 ACGME-accredited nuclear medicine programs, supported by CMS (part of the U.S. Department of Health and Human Services) at an average of over $80,000 per year per resident, for a total of $1,352,000 per year. Residents completing a 3-year training track in one of these residencies (total cost averaging $240,000) earns eligibility for board certification by the American Board of Nuclear Medicine (ABNM), but not for certification by the American Board of Radiology (ABR), which has a completely separate residency requirement. On 4/25/2010, according to www.snm.org, the Society of Nuclear Medicine's website, there was only one posted job opening in the whole country. The American College of Radiology's website, http://jobs.acr.org/search/browse/ , features no jobs for nuclear medicine physicians that are not also ABR-certified radiologists. The Radiological Society of North America (RSNA) Career Connect website, http://careers.rsna.org/, also features no jobs unless the candidate is ABR-certified. A job search for nuclear medicine physician on the popular "Aunt Minnie" website (www.auntminnie.com) resulted in zero returns. Most of the recruiting companies don't even have a category for "nuclear medicine physician," and none of them have any jobs posted. Queried firms include PracticeLink.com, Medhunter.com, Alliance Recruiting, Merritt Hawkins & Associates, MDSearch.com, and Action Medical Search. Non-advertized job availability is difficult to measure, but is estimated to be extremely low to non-existent for 3-year nuclear medicine residency graduates.
PROBLEM: Even after 3 years of specialized training in nuclear medicine at huge cost to taxpayers, these board-eligible graduates have near-zero opportunities for jobs. This is due to in part to a marked preference in the nuclear medicine physician market for nuclear radiologists certified by both the ABNM and the ABR, as well as the ABNM's policy to allow radiologists to qualify for certification after just one year of nuclear medicine.
WASTE and ABUSE: The directors of these nuclear medicine residency programs and the Chiefs of the academic nuclear medicine divisions that host these programs continue to petition the nuclear medicine ACGME Residency Review Committee (RCC) for more resident training spots. They continue to apply for more CMS funding for such residents, and they continue to invite people to come to their programs and fill those spots. Why? These academic directors are benefiting by having residents do a large part of the work required to bill for very expensive procedures. But it is hurting the field of nuclear medicine. The word is getting out that people cannot get jobs coming out of these residency programs, so the number of applicants is sharply dropping. Yet, the residency directors continue to try to fill their programs…at taxpayer expense. Caught in this vicious cycle, residents invited to train at these problems are having a harder and harder time getting jobs, and many are electing to pursue further training in another field. The taxdollar investment is thereby not put to good use actually caring for patients (including Medicare patients).
How do I know? I am one of these residents, and my colleagues and I can't seem to get a job in what we were trained to do.
WHAT WE WANT:
1. Stop the injustice and immediately END Medicare support for new residents applying for a 3-year training track at any ACGME-accredited Nuclear Medicine residency programs. END new nuclear medicine training for any medical school graduate that has not already completed requirements for board certification in another field (such as radiology, internal medicine, neurology, etc). This should not affect residents already in training in 3-year primary nuclear medicine residency tracks at such programs, allowing those in such programs to complete their programs if so desired. It must also not affect those in a 1-year post-radiology track, or any 2-year post-clinical training track in nuclear medicine, as these residents have many opportunities to find work based on their primary board certification and will be able to augment their practices with their nuclear medicine capabilities, thereby returning the taxdollar investment.
2. Immediately set up a training fund for current nuclear medicine residents to complete 2 or 3 years of training in an ACGME-accredited radiology residency, using the CMS funds freed up by immediately ending support for 3-year nuclear medicine residents. The result will be no change in cost to CMS, but a major increase in return on taxpayer investment in residency training (in the form of more high-demand radiologists dual-boarded by ABR and ABNM), by allowing nuclear medicine residency graduates to gain the training they need to enter a market thirsting for radiologists.
Thank you for your attention on this critical matter in the field of nuclear medicine and national healthcare delivery.
Sincerely,
[YOUR NAME, ADDRESS, AND PHONE NUMBER HERE, FOR BEST RESULT]
--------------------------------------------
Below is from ACGME website:
------------------------------------------------
Reporting a Concern or Making a Formal Complaint about a Residency Training Program
Do you have a concern or formal complaint about residency education and/or the learning environment in an ACGME accredited program/institution?
How Resident Services Responds to Concerns and Complaints
Resident Services encourages you to bring your concerns and complaints to the attention of the program director and/or the institution's designated institutional official (DIO). If this does not lead to resolution, bring your concern or complaint to us for review. Resident Services will work with the DIO to resolve issues surrounding concerns. Valid complaints will be processed by Resident Services, which will require a response from the program director and attestation to the response by the DIO, and review by the relevant review committee.
You may submit your:
concern by mail, fax or email
signed complaint by mail or courier service
Be sure to include the following:
a brief summary of the issues, including steps taken - if relevant
the name, street address, city, and state of the residency program
your contact information
Providing your name and contact information enables Resident Services to inform you about the actions taken in response to your concern or formal complaint, and also to contact you should additional information be needed.
It is our policy to treat your name as confidential information and not to disclose it without your permission. However, depending on the circumstance, it may be necessary to share your name with the DIO in the course of the concern (not complaint) investigation.
E-mail:
[email protected]
Fax:
(312) 755-7498
ACGME Staff:
Marsha Miller, MA
Mail:
Resident Services
ACGME
515 North State St. Ste 2400
Chicago, IL 60654
Scope of Concern Evaluations
Information provided is used to investigate, in a confidential manner, specific concerns by physicians in graduate medical education (residents, fellows, and faculty members) when the existing channels of communication or dispute resolution have proven unsatisfactory. If, in the judgment of Resident Services, any given case suggests a need for change to specific institutional, common program requirements, procedures, or policies, Resident Services will direct its recommendation to the ACGME Chief Executive Officer. Submitting a concern does not affect the program and/or institution's accreditation status. There may be instances when Resident Services will recommend that you submit a formal complaint, which could affect the program and/or institution's accreditation status.
Scope of Complaint Evaluations
Information provided is used to investigate, in a confidential manner, specific alleged areas of non-compliance with the ACGME's Institutional and Program Requirements. Anyone having evidence of non-compliance with these standards by a program or institution may submit a formal complaint to the ACGME. Please review the "Procedures for Addressing Complaints against Residency Programs and Sponsoring Institutions" at www.acgme.org. You will find the document under "Resident Services." Submitting a formal complaint may affect the program and/or institution's accreditation status.
Scope of Egregious or Catastrophic Events
The occurrence of an alleged egregious accreditation violation or catastrophic institutional event, which, because of its urgency, must be addressed outside of the established processes of the ACGME is reported promptly to the Chief Executive Officer of the ACGME who will initiate an investigation to determine credibility and degree of urgency. Examples of egregious or catastrophic events are: loss of the program's entire faculty; hospital bankruptcy that affects residency training; or program closure without assistance provided to the residents and fellows in locating other positions. Please review "Egregious Violations" at www.acgme.org. You will find the document under "Resident Services."
Last edited:
.Actually, me and my coresident have a conclusion, nuc residency is a joke. Unfortunately, I am part of the joke.
I am thinking to file a complaint to ACGME, which should take its part of the responsibility because it accredits this residency.
I think ACGME plays the most important role. The congress appropriation for GME is based on ACGME. If I'm wrong, correct me. This is still a capitalism country.
The practice of ACGME is it controls the quota and existence of residency programs based on this country's medicial demand. It failed to change nuclear medicine training based on market demand, not program director's demand.
So, conclusion: ACGME should take the responsibility.
Here is the link about to file complaints to ACGME
http://acgme.org/acWebsite/resInfo/ri_complaint.asp#6
And I quote:
If the efforts above do not resolve the issue, or the complainant cannot discuss the complaint with the institutional officials, contact the ACGME Office of Resident Services ([email protected]) to discuss submitting a formal complaint. This initial contact can occur by telephone or email, but must be followed by submission of a formal written and signed complaint.
I was hoping NMRO can be a strong voice for us. However, I may be wrong.
No doubt ACGME should shut down all the NM residency if the training can not help MDs find a job at the end of training--They are wasting taxpayer's money and our time!!
There should be just NM fellowship, no Residency (Unless they combine the NM and Rad into total 6yr training )
I am doing this complaint process now. And I hope you can do it on your end too. Let ACGME know that this is universal problem in NM residency.
Folks, let's take action now, by ourselves individually but all together!
Liver Free or Die!
below are most nuclear medicine program coordinator's email addresses. I don't know if anybody can come up with an idea to unite them to join us. That will be easier for us.
United we stand.
--------------------------------------------------------
[email protected],[email protected],
[email protected], [email protected],
[email protected], [email protected],
[email protected], [email protected],
[email protected],[email protected],
[email protected], [email protected],
[email protected], [email protected], kathy-
[email protected], [email protected],
[email protected], [email protected],
[email protected], [email protected],
[email protected], [email protected],
[email protected], [email protected],
[email protected], [email protected], [email protected],
[email protected], [email protected], gina-
[email protected], [email protected], gina-
[email protected],[email protected], [email protected],
[email protected], [email protected],
[email protected], [email protected],
[email protected], [email protected],
[email protected], [email protected],
[email protected]
United we stand.
--------------------------------------------------------
[email protected],[email protected],
[email protected], [email protected],
[email protected], [email protected],
[email protected], [email protected],
[email protected],[email protected],
[email protected], [email protected],
[email protected], [email protected], kathy-
[email protected], [email protected],
[email protected], [email protected],
[email protected], [email protected],
[email protected], [email protected],
[email protected], [email protected],
[email protected], [email protected], [email protected],
[email protected], [email protected], gina-
[email protected], [email protected], gina-
[email protected],[email protected], [email protected],
[email protected], [email protected],
[email protected], [email protected],
[email protected], [email protected],
[email protected], [email protected],
[email protected]
Below is from the thread: Nuclear Medicine--Beware! author: eddieberetta
Quoted:
As far as the ABR and radiologists are concerned, Nukes is already a subspecialty of radiology. We do rotations in Nukes and Nukes is an equal part in training and the licensing exam (i.e. given equal weight to Neuro, IR, chest etc.). In addition, from a practical standpoint having expertise in anatomic imaging and multimodality imaging can only make you a better nuclear radiologist. In most non academic groups, one person will be fellowship trained (will be the go-to person for admin, QC, difficult cases, regulatory issues etc) but all radiologists will rotate on Nukes (and it is considered a light low stress day!!). Many places will make you cover Nukes all day but do sth else like mammo or films in the downtime.
I think most of us are pretty good readers of nukes studies, and we know the basic QC issues and artifacts. But of course in terms of the nuances, the rare studies, and the regulatory/QC issues fellowship or residency trained person will know more.
NB ABR certification is sufficient to be an AU if you apply for it at the time of taking the boards -- you can also apply for it after. If you do a 1 yr fellowship, you can get a certificate of added qualification (CAQ) from the ABR which as I understand it is essentially equivalent to ABNM (from hospital/regulatory perspective), but as an added bonus if you do a 6 yr combined program you can get all the certificates as I noted above.
Since ABR already has a mature and accepted certification pathway for fellowship trained radiologists), I doubt there will ever be any grandfathering for ABNM holders. That is why doing the extra work to make yourself ABR eligible as a resident would be so beneficial for you.
==================
This explains all.
Quoted:
As far as the ABR and radiologists are concerned, Nukes is already a subspecialty of radiology. We do rotations in Nukes and Nukes is an equal part in training and the licensing exam (i.e. given equal weight to Neuro, IR, chest etc.). In addition, from a practical standpoint having expertise in anatomic imaging and multimodality imaging can only make you a better nuclear radiologist. In most non academic groups, one person will be fellowship trained (will be the go-to person for admin, QC, difficult cases, regulatory issues etc) but all radiologists will rotate on Nukes (and it is considered a light low stress day!!). Many places will make you cover Nukes all day but do sth else like mammo or films in the downtime.
I think most of us are pretty good readers of nukes studies, and we know the basic QC issues and artifacts. But of course in terms of the nuances, the rare studies, and the regulatory/QC issues fellowship or residency trained person will know more.
NB ABR certification is sufficient to be an AU if you apply for it at the time of taking the boards -- you can also apply for it after. If you do a 1 yr fellowship, you can get a certificate of added qualification (CAQ) from the ABR which as I understand it is essentially equivalent to ABNM (from hospital/regulatory perspective), but as an added bonus if you do a 6 yr combined program you can get all the certificates as I noted above.
Since ABR already has a mature and accepted certification pathway for fellowship trained radiologists), I doubt there will ever be any grandfathering for ABNM holders. That is why doing the extra work to make yourself ABR eligible as a resident would be so beneficial for you.
==================
This explains all.
- Joined
- May 11, 2008
- Messages
- 104
- Reaction score
- 6
the ACGME complaint site is basically for non-compliance of program towards ACGME regulations. the basis of complaint of NM residents is not that.
what you guys are suggesting is something entirely different - changing the policies of ACGME, which i think requires to be addressed by very high authorities.
i doubt if the ACGME will take the representation from residents only, seriously. in long run, it seems necessary that the whole pure nucs community including PDs and other attendings (opinions of PDs are very important for ACGME) present the matter to ACGME and ABNM, ABR as well. The role of common board members of ABR and ABNM should be really important.
the role of ABMS is also not discussed so far, which regulates 24 member boards. i think the changes in the regulatory requirements of boards, development of new board and conflicts between overlapping specialties are handled under leadership of ABMS and it makes final recommendations to ACGME. the ABMS has representatives from all boards, like Dr. Segall, VP of SNM is on ABMS and it is a common platform for various specialty boards to discuss certification issues.
so, the roles of ABNM, ABR and ABMS can not be underestimated and they must be involved before ACGME can take some steps.
please correct me if i am wrong anywhere.
what you guys are suggesting is something entirely different - changing the policies of ACGME, which i think requires to be addressed by very high authorities.
i doubt if the ACGME will take the representation from residents only, seriously. in long run, it seems necessary that the whole pure nucs community including PDs and other attendings (opinions of PDs are very important for ACGME) present the matter to ACGME and ABNM, ABR as well. The role of common board members of ABR and ABNM should be really important.
the role of ABMS is also not discussed so far, which regulates 24 member boards. i think the changes in the regulatory requirements of boards, development of new board and conflicts between overlapping specialties are handled under leadership of ABMS and it makes final recommendations to ACGME. the ABMS has representatives from all boards, like Dr. Segall, VP of SNM is on ABMS and it is a common platform for various specialty boards to discuss certification issues.
so, the roles of ABNM, ABR and ABMS can not be underestimated and they must be involved before ACGME can take some steps.
please correct me if i am wrong anywhere.
Last edited:
the ACGME complaint site is basically for non-compliance of program towards ACGME regulations. the basis of complaint of NM residents is not that.
what you guys are suggesting is something entirely different - changing the policies of ACGME, which i think requires to be addressed by very high authorities.
i doubt if the ACGME will take the representation from residents only, seriously.
the role of ABMS is also not discussed so far, which regulates 24 member boards. i think the changes in the regulatory requirements of boards, development of new board and conflicts between overlapping specialties are handled under leadership of ABMS and it makes final recommendations to ACGME. the ABMS has representatives from all boards, like Dr. Segall, VP of SNM is on ABMS and it is a common platform for various specialty boards to discuss certification issues.
so, the roles of ABNM, ABR and ABMS can not be underestimated and they must be involved before ACGME can take some steps.
please correct me if i am wrong anywhere.
Dude, we need action, not talking. And don't discourage us.
Did you sign your NM residency contract yet? From your earlier post, seems like you are going to be a PGY2 NM resident, right?
If so, run! before the NM building collapse!
At this moment, ACGME is a reasonable way to approach, and they are in charge of residency.
WE ARE FILING A SERIOUS COMPLAIN, NOT FOR INDIVIDUAL PROGRAM, BUT FOR ALL THE NM PROGRAMS!
For individual ones, we can complain if any NM service hire some radiologist WITHOUT NM fellowship over NM resident, given that NM residents do all the work for PET/CT and other NM scans-----This is DISCRIMINATION, and also illustrate the necessity of shutting down NM residency.
And, dude, don't sit there talking all day long who should get involved, let's do it, do it from ACGME!
Join us or leave us!
I agree.
Gathi, you need to wake up. Only ACGME is interested in protecting residents as I understand. It is the right channel to complain. Rely on people in those bureaucratic offices to help you is not just stupid. You don't have the same interest.
Quote:
when the existing channels of communication or dispute resolution have proven unsatisfactory. If, in the judgment of Resident Services, any given case suggests a need for change to specific institutional, common program requirements, procedures, or policies, Resident Services will direct its recommendation to the ACGME Chief Executive Officer.
Gathi, did you read before you wrote? Do you think the communication channel is existing? What is your suggestion? Talk to the members of ABMS? Talk to ACR or SNM/ABNM? Tell me how. One thing I know: PDs are not interested. ABNM/SNM is not interested.Sending concern to ACGME is based on the responsibility ACGME should take. At the same time, I understand this is a complicate issue. But I would like to do something before I leave this field. I don't think it is right time to comment only without any virtual action.
THE JOURNAL OF NUCLEAR MEDICINE • Vol. 45 • No. 5 • May 2004
http://jnm.snmjournals.org/cgi/reprint/45/5/17N.pdf
Increasing Nuclear Medicine
Residency Training Requirements:
For Better or Worse?
Aproposal has recently been put forward to increase
the duration of the nuclear medicine residency and
implement a 3-tier residency training requirement
beginning in 2005 or 2006. The proposal includes increasing
the length of the nuclear medicine residency from 3 to 4
years (1 basic clinical year [PGY-1] plus 3 years of nuclear
medicine) for medical graduates fresh out of medical school.
Internal medicine physicians will be required to complete 2
years of additional training in nuclear medicine, and radiologists
will be required to complete a fellowship year of
nuclear medicine to be eligible to take the American Board
of Nuclear Medicine (ABNM) examination.
The proposal has the greatest impact on the nuclear
medicine residents who have not completed residency training
in other specialties. Four of the main reasons cited for
increasing the length of training are the perceived needs to:
(a) train residents in new and changing modalities such as
PET/CT, (b) raise the standards of nuclear medicine residents,
(c) make nuclear medicine training more academically
oriented, and (d) increase the respect for nuclear medicine
physicians. Although these are honorable reasons,
many issues must be addressed before these decisions are
finalized.
First, simply increasing the length of residency training
does not guarantee that residents will receive training in new
techniques, in technologies such as PET and CT, or in
innovative research. The requirements are not properly
structured to mandate such training. Moreover, residency
programs with only 1 or 2 residents might actually need to
increase the number of residency slots, because the thirdyear
resident may not be available to perform the same
duties as a first- or second-year resident. The final-year
resident might be in a research or CT rotation, leaving the
clinic without coverage. This will eventually create tensions
and problems within the department. In addition, the new
recommendation does not address the case of a resident
deciding to switch to nuclear medicine after 2 years of
residency training in another specialty. What would be the
requirements in such a situation––2 or 3 years of nuclear
medicine residency?
Some have suggested that 2 years of training in nuclear
medicine after internship are inadequate for nuclear medicine
physicians. This does not seem rational––the majority
of nuclear medicine scans in the United States are currently
being read by general radiologists with only 4–6 months of
training in nuclear medicine. Many nuclear medicine procedures
that were commonly used in the past are no longer in
use. The time spent learning these now outdated procedures
can be diverted to other training, such as PET or PET/CT
experience. Moreover, many nuclear medicine physicians
who were never trained in PET during their own residencies
are currently doing excellent work reading PET scans. This
proves that once a reasonable level of training and experience
is achieved, further knowledge can be built on previous
training and experience.
Second, increasing the length of training with no added
benefit may not increase the quality of the residents, because
it does not make nuclear medicine residency graduates more
marketable for jobs or more advanced training. After the
proposed training requirement increase, a nuclear medicine
residency would require 4 years and a radiology residency
would require 5 years. Most medical students would prefer
to do the radiology residency, because radiology offers more
job opportunities for only slightly longer training. Those
who opt for radiology would be able to read nuclear medicine
scans, along with many other modalities, without additional
training. If the purpose of the extended training requirement
is to attract more and higher quality residents, the
result of this change would not only be poor but would
ultimately be detrimental to nuclear medicine.
Third, although the notion that extending residencies
would provide extra time for research and better prepare
physicians for academic positions is admirable, fellowships
might provide a more practical and beneficial alternative.
Higher professional social status and pay come after a fellowship
year rather than after an additional year of residence.
Young physicians today are confronted by many
issues that were not as evident 5 years ago, such as stringent
Medicare reimbursement rules for residency and the everincreasing
cost of medical school tuition. A year of fellowship
training after residency, allotted exclusively for nuclear
medicine residency graduates, would be a better option.
Fourth, improving the perception of nuclear medicine
among other specialties might be accomplished more effectively
if we try to increase the marketability of nuclear
medicine physicians rather than simply increasing the length
of their training. The reason for the low marketability of both
nuclear medicine residencies and their graduates is not a lack
of training or respect from the physician community but the
limited availability of postresidency employment. The few
jobs available are mostly in academic centers, where
ABNM-certified physicians or radiologists with certification
in nuclear radiology are preferred. The typical nuclear medicine
resident graduating in June will not be able to sit for the
ABNM certification exam until later in the fall, with results
unavailable until December. This keeps the nuclear medicine
residency graduate out of work and training for a
minimum of 6 months. The pass rate of the ABNM certification
examination is lower than those in many other American
Board of Medical Specialties certification examinations,
including that of the American Board of Radiology.
The ABNM also should be aware that general radiologists
with nuclear medicine training of 4–6 months are eligible to
read any nuclear medicine scan with no additional certification
or training. Prospective employers prefer radiologists
over nuclear medicine physicians, because the radiologists
can read many other modalities in addition to nuclear medicine
scans. The ABNM should take these factors into consideration
and make the passing criteria of its certification
examination less stringent.
The major limiting factor for the marketability of the
nuclear medicine residency is the job market that confronts
residency graduates. The big question is whether the increase
in training requirements will be the solution it is
expected to be or the beginning of the end of the existence
of nuclear medicine as an independent specialty. If the job
situation and the demand for nuclear medicine physicians
remain the same, it will be very hard to recruit quality
residents to 4-year nuclear medicine residency programs.
Many residents recruited are likely to be medical graduates
from other countries, some of whom are willing to accept
any residency to satisfy visa requirements. Even this source
of recruitment could dry up when these students realize that
there is no future for nuclear medicine physicians in the
United States. Many residency programs would eventually
be forced to close. This will have a tremendous effect on the
field of nuclear medicine and the development of molecular
imaging. Nuclear medicine technologists, physicists, and
scientists depend on nuclear medicine physicians for guidance
in clinical matters. Subsequent development could be
hindered in other sectors of nuclear medicine, including the
basic sciences, leading the United States to fall behind other
developed countries in the field––a situation that may already
have occurred, as evidenced by increasing percentages
of nuclear medicine–related articles in U.S. journals authored
by individuals working outside the country.
Physicians trained in internal medicine have many other
subspecialties from which to choose for additional fellowship
training. Because most of these fellowships are for 2
years, many internists will prefer to be trained in another
internal medicine subspecialty rather than in nuclear medicine.
In the present situation, they will be more marketable
after a fellowship in an internal medicine subspecialty. The
number of internists deciding to do further training in nuclear
medicine will be far fewer than the number of residency
spots available.
One alternative to the proposed changes in residency
training requirements is to have an integrated 3-year program
for medical students straight out of medical school,
similar to the residency programs offered in obstetrics and
gynecology. The first year could be a PGY-1 year, with 9
months of basic clinical training integrated into a 2-year
nuclear medicine residency. If all integrated nuclear medicine
programs participated in the National Resident Matching
Program or similar matching programs and if medical
students were made aware of such an opportunity, recruitment
would be easier. The feasibility of making nuclear
medicine residency a training program with an integrated
PGY-1 should be actively considered. It also carries the
advantage of getting higher quality applicants, especially
because radiology residencies have recently become extremely
competitive in the match. Physicians trained in other
specialties but wanting to pursue a career in nuclear medicine
need not be required to do the integrated clinical year.
They could do 1 or 2 years of additional nuclear medicine
training, depending on their previous graduate medical education.
The other alternative is to create fellowship positions
designated exclusively for nuclear medicine residency
graduates, with emphases on research, oncology, PET, and
CT training.
The existence of nuclear medicine as an independent
specialty is now at a crossroads. It is time to either revive its
independence or become a subspecialty. The major challenge
is to attract quality residents and produce excellent
nuclear medicine physicians for the future. The SNM Young
Professional Committee, representing residents and recent
graduates, believes that simply increasing the length of training
without a thorough consideration of the issues raised
here will be detrimental to the future of nuclear medicine.
The SNM and other professional organizations should
work closely with professional bodies such as the American
Medical Association to increase awareness of nuclear medicine
as a separate specialty among the medical fraternity
and, most important, among referring physicians and the
public. In most other specialties, the present trend is to hire
and grant clinical privileges to board-certified or boardeligible
physicians. It is surprising that this is not the case in
nuclear medicine. Instead, it does not seem to matter who is
better trained but who is most influential in getting these
privileges. The ABNM, as the certifying body, should emphasize
that physicians who are board eligible or board
certified in nuclear medicine are the most competent professionals
for reading nuclear medicine scans, including cardiac,
PET, and PET/CT images. It will take a concerted
effort and cooperation from many individuals, other specialties,
many professional organizations, and involved committees
to achieve this goal.
Aju Thomas, MD, Board Member
Kelly H. Pham, DO, Co-Chair
Gina Caravaglia, DO, Co-Chair
SNM Young Professionals Committee
http://jnm.snmjournals.org/cgi/reprint/45/5/17N.pdf
Increasing Nuclear Medicine
Residency Training Requirements:
For Better or Worse?
Aproposal has recently been put forward to increase
the duration of the nuclear medicine residency and
implement a 3-tier residency training requirement
beginning in 2005 or 2006. The proposal includes increasing
the length of the nuclear medicine residency from 3 to 4
years (1 basic clinical year [PGY-1] plus 3 years of nuclear
medicine) for medical graduates fresh out of medical school.
Internal medicine physicians will be required to complete 2
years of additional training in nuclear medicine, and radiologists
will be required to complete a fellowship year of
nuclear medicine to be eligible to take the American Board
of Nuclear Medicine (ABNM) examination.
The proposal has the greatest impact on the nuclear
medicine residents who have not completed residency training
in other specialties. Four of the main reasons cited for
increasing the length of training are the perceived needs to:
(a) train residents in new and changing modalities such as
PET/CT, (b) raise the standards of nuclear medicine residents,
(c) make nuclear medicine training more academically
oriented, and (d) increase the respect for nuclear medicine
physicians. Although these are honorable reasons,
many issues must be addressed before these decisions are
finalized.
First, simply increasing the length of residency training
does not guarantee that residents will receive training in new
techniques, in technologies such as PET and CT, or in
innovative research. The requirements are not properly
structured to mandate such training. Moreover, residency
programs with only 1 or 2 residents might actually need to
increase the number of residency slots, because the thirdyear
resident may not be available to perform the same
duties as a first- or second-year resident. The final-year
resident might be in a research or CT rotation, leaving the
clinic without coverage. This will eventually create tensions
and problems within the department. In addition, the new
recommendation does not address the case of a resident
deciding to switch to nuclear medicine after 2 years of
residency training in another specialty. What would be the
requirements in such a situation––2 or 3 years of nuclear
medicine residency?
Some have suggested that 2 years of training in nuclear
medicine after internship are inadequate for nuclear medicine
physicians. This does not seem rational––the majority
of nuclear medicine scans in the United States are currently
being read by general radiologists with only 4–6 months of
training in nuclear medicine. Many nuclear medicine procedures
that were commonly used in the past are no longer in
use. The time spent learning these now outdated procedures
can be diverted to other training, such as PET or PET/CT
experience. Moreover, many nuclear medicine physicians
who were never trained in PET during their own residencies
are currently doing excellent work reading PET scans. This
proves that once a reasonable level of training and experience
is achieved, further knowledge can be built on previous
training and experience.
Second, increasing the length of training with no added
benefit may not increase the quality of the residents, because
it does not make nuclear medicine residency graduates more
marketable for jobs or more advanced training. After the
proposed training requirement increase, a nuclear medicine
residency would require 4 years and a radiology residency
would require 5 years. Most medical students would prefer
to do the radiology residency, because radiology offers more
job opportunities for only slightly longer training. Those
who opt for radiology would be able to read nuclear medicine
scans, along with many other modalities, without additional
training. If the purpose of the extended training requirement
is to attract more and higher quality residents, the
result of this change would not only be poor but would
ultimately be detrimental to nuclear medicine.
Third, although the notion that extending residencies
would provide extra time for research and better prepare
physicians for academic positions is admirable, fellowships
might provide a more practical and beneficial alternative.
Higher professional social status and pay come after a fellowship
year rather than after an additional year of residence.
Young physicians today are confronted by many
issues that were not as evident 5 years ago, such as stringent
Medicare reimbursement rules for residency and the everincreasing
cost of medical school tuition. A year of fellowship
training after residency, allotted exclusively for nuclear
medicine residency graduates, would be a better option.
Fourth, improving the perception of nuclear medicine
among other specialties might be accomplished more effectively
if we try to increase the marketability of nuclear
medicine physicians rather than simply increasing the length
of their training. The reason for the low marketability of both
nuclear medicine residencies and their graduates is not a lack
of training or respect from the physician community but the
limited availability of postresidency employment. The few
jobs available are mostly in academic centers, where
ABNM-certified physicians or radiologists with certification
in nuclear radiology are preferred. The typical nuclear medicine
resident graduating in June will not be able to sit for the
ABNM certification exam until later in the fall, with results
unavailable until December. This keeps the nuclear medicine
residency graduate out of work and training for a
minimum of 6 months. The pass rate of the ABNM certification
examination is lower than those in many other American
Board of Medical Specialties certification examinations,
including that of the American Board of Radiology.
The ABNM also should be aware that general radiologists
with nuclear medicine training of 4–6 months are eligible to
read any nuclear medicine scan with no additional certification
or training. Prospective employers prefer radiologists
over nuclear medicine physicians, because the radiologists
can read many other modalities in addition to nuclear medicine
scans. The ABNM should take these factors into consideration
and make the passing criteria of its certification
examination less stringent.
The major limiting factor for the marketability of the
nuclear medicine residency is the job market that confronts
residency graduates. The big question is whether the increase
in training requirements will be the solution it is
expected to be or the beginning of the end of the existence
of nuclear medicine as an independent specialty. If the job
situation and the demand for nuclear medicine physicians
remain the same, it will be very hard to recruit quality
residents to 4-year nuclear medicine residency programs.
Many residents recruited are likely to be medical graduates
from other countries, some of whom are willing to accept
any residency to satisfy visa requirements. Even this source
of recruitment could dry up when these students realize that
there is no future for nuclear medicine physicians in the
United States. Many residency programs would eventually
be forced to close. This will have a tremendous effect on the
field of nuclear medicine and the development of molecular
imaging. Nuclear medicine technologists, physicists, and
scientists depend on nuclear medicine physicians for guidance
in clinical matters. Subsequent development could be
hindered in other sectors of nuclear medicine, including the
basic sciences, leading the United States to fall behind other
developed countries in the field––a situation that may already
have occurred, as evidenced by increasing percentages
of nuclear medicine–related articles in U.S. journals authored
by individuals working outside the country.
Physicians trained in internal medicine have many other
subspecialties from which to choose for additional fellowship
training. Because most of these fellowships are for 2
years, many internists will prefer to be trained in another
internal medicine subspecialty rather than in nuclear medicine.
In the present situation, they will be more marketable
after a fellowship in an internal medicine subspecialty. The
number of internists deciding to do further training in nuclear
medicine will be far fewer than the number of residency
spots available.
One alternative to the proposed changes in residency
training requirements is to have an integrated 3-year program
for medical students straight out of medical school,
similar to the residency programs offered in obstetrics and
gynecology. The first year could be a PGY-1 year, with 9
months of basic clinical training integrated into a 2-year
nuclear medicine residency. If all integrated nuclear medicine
programs participated in the National Resident Matching
Program or similar matching programs and if medical
students were made aware of such an opportunity, recruitment
would be easier. The feasibility of making nuclear
medicine residency a training program with an integrated
PGY-1 should be actively considered. It also carries the
advantage of getting higher quality applicants, especially
because radiology residencies have recently become extremely
competitive in the match. Physicians trained in other
specialties but wanting to pursue a career in nuclear medicine
need not be required to do the integrated clinical year.
They could do 1 or 2 years of additional nuclear medicine
training, depending on their previous graduate medical education.
The other alternative is to create fellowship positions
designated exclusively for nuclear medicine residency
graduates, with emphases on research, oncology, PET, and
CT training.
The existence of nuclear medicine as an independent
specialty is now at a crossroads. It is time to either revive its
independence or become a subspecialty. The major challenge
is to attract quality residents and produce excellent
nuclear medicine physicians for the future. The SNM Young
Professional Committee, representing residents and recent
graduates, believes that simply increasing the length of training
without a thorough consideration of the issues raised
here will be detrimental to the future of nuclear medicine.
The SNM and other professional organizations should
work closely with professional bodies such as the American
Medical Association to increase awareness of nuclear medicine
as a separate specialty among the medical fraternity
and, most important, among referring physicians and the
public. In most other specialties, the present trend is to hire
and grant clinical privileges to board-certified or boardeligible
physicians. It is surprising that this is not the case in
nuclear medicine. Instead, it does not seem to matter who is
better trained but who is most influential in getting these
privileges. The ABNM, as the certifying body, should emphasize
that physicians who are board eligible or board
certified in nuclear medicine are the most competent professionals
for reading nuclear medicine scans, including cardiac,
PET, and PET/CT images. It will take a concerted
effort and cooperation from many individuals, other specialties,
many professional organizations, and involved committees
to achieve this goal.
Aju Thomas, MD, Board Member
Kelly H. Pham, DO, Co-Chair
Gina Caravaglia, DO, Co-Chair
SNM Young Professionals Committee
- Joined
- Nov 13, 2005
- Messages
- 41
- Reaction score
- 2
Notice the year this article was published. This issue has been open for a long time, yet program directors have continued to say "Thank you very much, we're doing just fine..." and promised that the job market, though not as good as radiology, would be viable, and even increasingly so. That was what lead me down this path.
Whether it is a miscalculation by oblivious educational leaders or it is a blatant abuse of the process of recognizing demand for specialized services, recruitment, training, and provision for filling that demand in the most effective and sustainable manner, is not clear to me. I suspect there are elements of both.
Kudos to all those who are standing up and making their voices known to the ACGME, ABNM, SNM, NMRO, ACR, Congress, CMS, and anyone else who should know and might have the power and will to change things for the better.
I still want to see what Erin Grady is doing to help US, the ones currently in this mess.
Whether it is a miscalculation by oblivious educational leaders or it is a blatant abuse of the process of recognizing demand for specialized services, recruitment, training, and provision for filling that demand in the most effective and sustainable manner, is not clear to me. I suspect there are elements of both.
Kudos to all those who are standing up and making their voices known to the ACGME, ABNM, SNM, NMRO, ACR, Congress, CMS, and anyone else who should know and might have the power and will to change things for the better.
I still want to see what Erin Grady is doing to help US, the ones currently in this mess.
Apparenlty, the 3 year residency is abusing the system and residents.
It is destroying our resident future, with knowing it ahead of time.
I suspect there is ugly politics in it!!!!
They can do a better job.
Like in Canada, the nuclear medicine incorporates significant amount of radiology training.
http://www.radiology.med.ualberta.ca/residency/nuclearmedicine.htm
Here in this country, section of nuclear medicine is in the department of radiology. But the 3 year track residency is a stepson of radiology.
There are reasons for the nuc to be part of department of radiology. THERE ARE REASONS for THE 3 YEAR TRACK RESIDENCY TO INCORPORATE SIGNIFICANT AND QUALITY RADIOLOGY TRAINING, PROBABLY UNDER THE UMBRELLA OF RADIOLOGY.
Nuclear medicine section is always small even in a big hospital. The directors and PDs try to run a separate residency without much help from radiology is completely stupid to me. They should and the residency program should integrate into radiology.
IF THEY CAN NOT RUN A QUALITY PROGRAM, THEN THE PROGRAM SHOULD BE SHUT DOWN.
For some reason, the ACGME agrees to compromise the common program training requirements. Like CT training, it should be training like what radiology residents get. But ACGME agree to change it to be institution dependent. 6 months requirement was changed to 4 months and 2 months can be done as PETCT training. You know our nuclear physician 's CT knowledge base. That is ridiculous. To me, even 6 months full radiology department CT training is not enough. It should be like the canadian program. A full year generalized radiology training. And the nuclear residency/fellowship should be run by both chair of radiology and director of nuclear medicine. It is impossible to avoid the radiology and then try to run a good nuclear medicine program.
============================
So, the problem is: the nuclear attendings are taking advantage of us. They are just simply using us.
They know what should be done. But they just simply don't want to change. Because the old system benefits them the most.
With knowing no market for us, they voted to change the residency to 3 years.
They are beyond selfish and dirty.
=============================
I believe the radiology has no problem to take over nuclear residency, if there is no resistence from nuclear medicine. Anyone interested can ask radiology chairman.
If I were radiology chairman, I am not going to hire pure nuc physician. I prefer fellowship trained. Just like all attendings in radiology. You can cover. You can do everything. You can adjust yourself to future change in radiology including nuclear medicine.
Like many posts said, pure nuclear medicine physician poses many problems. Vacation, call coverage. Flexibility. Future adjustment. Not enough patient volume, etc.
My feeling is if you don't have great research as pure nuclear physician, probably your job is not stable.They can kick you out at anytime and hire fellowship trained. I predict that is a trend. or they just wait for you to retire and then hire fellowship trained.
So, basically, there is no much future in the pure nuclear medicine field.
=============================================
Your choice is:
1. get into radiology residency
2. get into another residency, forget the nuclear residency completely and waste 1 to 3 years.
3. get a not accredited PET/CT fellowship, and feel confused one year later.
4. get a pure nuclear medicine job, do a great research and use us nuclear medicine residents as your slaves, or wait to be terminated.
5. get unemployed in medical field.
6. join us to fight in the way you are comfortable with. We may lose...but hoping for the right change.
==================================================================
Something was there doesn't mean it should stay there.
ACGME has the obligation and responsibility to change the situation.
Change is very popular, right? At least two years ago.
It is destroying our resident future, with knowing it ahead of time.
I suspect there is ugly politics in it!!!!
They can do a better job.
Like in Canada, the nuclear medicine incorporates significant amount of radiology training.
http://www.radiology.med.ualberta.ca/residency/nuclearmedicine.htm
Actually, to me, the system in CANADA is more like a special track of radiology. First year is general radiology training. Then you jump into nuclear medicine. But you still have a lot of radiology training. I would say it is a good design.
Here in this country, section of nuclear medicine is in the department of radiology. But the 3 year track residency is a stepson of radiology.
There are reasons for the nuc to be part of department of radiology. THERE ARE REASONS for THE 3 YEAR TRACK RESIDENCY TO INCORPORATE SIGNIFICANT AND QUALITY RADIOLOGY TRAINING, PROBABLY UNDER THE UMBRELLA OF RADIOLOGY.
Nuclear medicine section is always small even in a big hospital. The directors and PDs try to run a separate residency without much help from radiology is completely stupid to me. They should and the residency program should integrate into radiology.
IF THEY CAN NOT RUN A QUALITY PROGRAM, THEN THE PROGRAM SHOULD BE SHUT DOWN.
For some reason, the ACGME agrees to compromise the common program training requirements. Like CT training, it should be training like what radiology residents get. But ACGME agree to change it to be institution dependent. 6 months requirement was changed to 4 months and 2 months can be done as PETCT training. You know our nuclear physician 's CT knowledge base. That is ridiculous. To me, even 6 months full radiology department CT training is not enough. It should be like the canadian program. A full year generalized radiology training. And the nuclear residency/fellowship should be run by both chair of radiology and director of nuclear medicine. It is impossible to avoid the radiology and then try to run a good nuclear medicine program.
============================
So, the problem is: the nuclear attendings are taking advantage of us. They are just simply using us.
They know what should be done. But they just simply don't want to change. Because the old system benefits them the most.
With knowing no market for us, they voted to change the residency to 3 years.
They are beyond selfish and dirty.
=============================
I believe the radiology has no problem to take over nuclear residency, if there is no resistence from nuclear medicine. Anyone interested can ask radiology chairman.
If I were radiology chairman, I am not going to hire pure nuc physician. I prefer fellowship trained. Just like all attendings in radiology. You can cover. You can do everything. You can adjust yourself to future change in radiology including nuclear medicine.
Like many posts said, pure nuclear medicine physician poses many problems. Vacation, call coverage. Flexibility. Future adjustment. Not enough patient volume, etc.
My feeling is if you don't have great research as pure nuclear physician, probably your job is not stable.They can kick you out at anytime and hire fellowship trained. I predict that is a trend. or they just wait for you to retire and then hire fellowship trained.
So, basically, there is no much future in the pure nuclear medicine field.
=============================================
Your choice is:
1. get into radiology residency
2. get into another residency, forget the nuclear residency completely and waste 1 to 3 years.
3. get a not accredited PET/CT fellowship, and feel confused one year later.
4. get a pure nuclear medicine job, do a great research and use us nuclear medicine residents as your slaves, or wait to be terminated.
5. get unemployed in medical field.
6. join us to fight in the way you are comfortable with. We may lose...but hoping for the right change.
==================================================================
Something was there doesn't mean it should stay there.
ACGME has the obligation and responsibility to change the situation.
Change is very popular, right? At least two years ago.
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I have to say US nuclear medicine is not the greatest in many aspects in the world. The residency and the controversy in it is poorly managed.
If they don't change, this field would go down definitely. When they retire, they will take this field and pure nuc with them.
If they don't change, this field would go down definitely. When they retire, they will take this field and pure nuc with them.
Apparenlty, the 3 year residency is abusing the system and residents.
IF THEY CAN NOT RUN A QUALITY PROGRAM, THEN THE PROGRAM SHOULD BE SHUT DOWN.
============================
So, the problem is: the nuclear attendings are taking advantage of us. They are just simply using us.
They know what should be done. But they just simply don't want to change. Because the old system benefits them the most.
With knowing no market for us, they voted to change the residency to 3 years.
They are beyond selfish and dirty.
=============================
=============================================
Your choice is:
1. get into radiology residency
2. get into another residency, forget the nuclear residency completely and waste 1 to 3 years.
3. get a not accredited PET/CT fellowship, and feel confused one year later.
4. get a pure nuclear medicine job, do a great research and use us nuclear medicine residents as your slaves, or wait to be terminated.
5. get unemployed in medical field.
6. join us to fight in the way you are comfortable with. We may lose...but hoping for the right change.
==================================================================
Something was there doesn't mean it should stay there.
ACGME has the obligation and responsibility to change the situation.
Buddy, you said it all!
I am filing a complaint through ACGME, are you doing this?
Maybe you can draft a complain letter, different with the one you drafted to the congress, hopefully people will follow us....
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Guys,
I share your!! Unfortunately, as you can see, this thread has more than 5000 views and only a few people are really involved. We can discuss abput this topic for 200 years, but at the end, if we don't have the support from ALL or MOST of the residents and/or programs, all our efforts will be useless.
We have to fuse all our ideas, concerns, solutions in a template, email it to all the residencies, try to get as many signatures as possible and send it to the ACGME, SNM, ABNM, RSNA, ABR, FBI, CIA, IRS, CVA, CKD, CHF, etc....( )
I believe that we have to stop bothering the SNM and ABNM, they are not strong enough, they cannot go against the radiology society, so in a few words, we all know that our destiny depends on the RSNA, ABR and all the radiology society.
Does anybody have any template or letter ready to email it to the residencies? Please post it here, so we can add some ideas, make a final draft and submit that to all the NM programs. I will contact someone at the JNM, to see if they can publish it.
I share your
!! Unfortunately, as you can see, this thread has more than 5000 views and only a few people are really involved. We can discuss abput this topic for 200 years, but at the end, if we don't have the support from ALL or MOST of the residents and/or programs, all our efforts will be useless. We have to fuse all our ideas, concerns, solutions in a template, email it to all the residencies, try to get as many signatures as possible and send it to the ACGME, SNM, ABNM, RSNA, ABR, FBI, CIA, IRS, CVA, CKD, CHF, etc....(
)I believe that we have to stop bothering the SNM and ABNM, they are not strong enough, they cannot go against the radiology society, so in a few words, we all know that our destiny depends on the RSNA, ABR and all the radiology society.
Does anybody have any template or letter ready to email it to the residencies? Please post it here, so we can add some ideas, make a final draft and submit that to all the NM programs. I will contact someone at the JNM, to see if they can publish it.
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There is already a path. It is called a radiology residency. Anything less will put you in the same spot that you are already in...when you say "join them" you must do exactly that...with the same training to give yourself the same opportunities...otherwise, there will still be no job at the end of your journey.
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Unfortunately, I will have to agree with your statement. I believe that even if we get into a "special" radiology fellowship, we will be in disadvantage.
The only solution is to end all the NM residencies and get some help from the radiology society/residency programs/PDs and get a spot as a radiology resident, but.... that's impossible.
Does anybody have any news about the NM PDs meeting at the SNM?
There is also a residency called dermatology. Just kidding.
Right training leads to right job. That is what we are arguing. We are trapped in this residency by promise of a job, of course, not a guaranteed job, but now with dismal job future, actually no single job out there. Nuc should be part of radiology at first place. What I mean is there shouldn't be a 3 year track nuclear medicine residency. That is totally wrong.
When I decided to come into Nucs, I did very serious research. But as you know, not much information out there. So I made an reasonable assumption that this is a specialty just like all ACGME accredited specialties. You may ask why I chose nuc. Somthing very extraordinary happened to our Health system. I didn't have enough time to choose and think. I had to look at all open positions and I had to consider my family members.
The PD knows this field. They should tell me upfront the job future. That is the reason we are doing a residency.
The training requirements from ACGME are apparently not up to date, not following the trend of nuc development, which results in zero marketability. The trend and future of nuclear medicine is significant amount of radiology. That is why we are asking for radiology training, not necessarily radiology residency. As long as we have reasonable radiology training, job is not an issue. I believe even one year general radiology training, not observation, training including call, will do the trick. I don't suggest pure CT training, even one year. We need to learn systemically. We need broader knowledge for future self improvement.
(It doesn't mean we are desperate to be radiology resident. If the trend is you have to know dermatology, then put dermatology training into it, or shut it down. simple enough.)
We are victims from many aspects. It is reasonable for us to ask change:
Comment on 2: the fellowship in Radiology for nuclear physician could be as short as one year, which leads to a certificate of radiology competency for us. Don't forget we have radiology training in nuc and nuc is part of radiology.
They can do one year nuclear radiology fellowship to get a certificate, why we can't do the same. They invaded into our field. Not the other way around. Of course, to achieve that we need to fight. And it is not an easy job.
As of the possibility we had to get into radiology when we applied for nuclear medicine, that is really not an issue to discuss now and here.
20 +years ago, many people jumped into nuc from radiology, that include many nuc PDs.
As of the competitiveness and self respect of radiology residents, do they really love radiology? How many people couldn't get into dermatology residency and had to choose radiology? This reflects another stupidity: laugh at people without looking at yourself. Of course, this is not the issue we should discuss here. Who cares.
I am glad the thread is here. Every single person has the chance to know the truth about the nuclear medicine residency. I predict that in the future nuclear medicine residency would be a special need residency for those people who don't have any other choice or too stupid to find this thread.
Another issue is: ACR is strong doesn't means it should bully ACNM. In the medicine field, we always mention integrity. Radiologists are not immune to it. Of course, some residents would laugh at that.
As of the letter to send to ACGME, I think FDGme's letter to congress is thorough. I don't feel the need of another letter.
As of how many people are discussing in this thread, please consider we only have ~ 150 residents totally. 80 are first year with a dream to have a job when they are done or opportunists who want to slip into radiology(I have to say they harm this specialty a lot). 40 second year and 20 third year residents, 30 of them have had arrangement of their future, either radiology, or fellowship, or some kind of job. They wouldn't be interested in discussing here. They are kissing the PDs' *******. Not everybody likes to type. Some may just follow this thread and discuss behind the scene.
So, to me, 10 people discussing here is very reasonable and representing significant portion of the nuclear resident society. That is what we got here, I believe.
So, now , send letters to ACGME and ask for change. We may lose..... but hope for right change.
you also can send letters to the coordinators to solicit support from their residents. This is small filed. I don't have a better idea to get more residents involved.
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If there are so few pure nuc jobs for grads, I agree that they should simply discontinue the nuc med residencies and disburse the funding to other needy areas. Nuc med can be folded into radiology (which it basically has). Rads who want to further their training can do a nuc med fellowship.
But to argue that all existing nuc med residents should be allowed to enter into radiology residencies...well, that's a bit of a stretch. You essentially want to create a pathway for the least competitive specialty to enter one of the most competitive specialties. Plus, how will you make sure that the influx of all of these nuc med residents won't dilute the training so that all residents (rads + nuc meds) get the minimum level of training by graduation time? Um, I wouldn't be holding my breath for this bridge to happen.
But to argue that all existing nuc med residents should be allowed to enter into radiology residencies...well, that's a bit of a stretch. You essentially want to create a pathway for the least competitive specialty to enter one of the most competitive specialties. Plus, how will you make sure that the influx of all of these nuc med residents won't dilute the training so that all residents (rads + nuc meds) get the minimum level of training by graduation time? Um, I wouldn't be holding my breath for this bridge to happen.
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To wagy27 & Taurus,
I can tell you are both radiology residents, right?.
Why don't you give your opinion in the lack of respect and interest that you have for NM? Why don't you tell us how INADEQUATE is your training in NM? Do you really think that 4 months rotation is enough?
I hope that if NM will become officially part of the radiology residency, those 4 months will become 12 months at least, so you all can distinguish perfusion from ventilation images, that you all know how to calculate a dose for radioablation therapy, that you can etc, etc, etc, etc, etc, etc, etc, etc, etc, etc, etc, etc, etc, etc, etc, etc,.......................
BTW, PET/CT is a PET with a non diagnostic CT for anatomical correlation, not a CT with contrast (PET).
Kind regards,
I can tell you are both radiology residents, right?.
Why don't you give your opinion in the lack of respect and interest that you have for NM? Why don't you tell us how INADEQUATE is your training in NM? Do you really think that 4 months rotation is enough?
I hope that if NM will become officially part of the radiology residency, those 4 months will become 12 months at least, so you all can distinguish perfusion from ventilation images, that you all know how to calculate a dose for radioablation therapy, that you can etc, etc, etc, etc, etc, etc, etc, etc, etc, etc, etc, etc, etc, etc, etc, etc,.......................
BTW, PET/CT is a PET with a non diagnostic CT for anatomical correlation, not a CT with contrast (PET).
Kind regards,
Hi, all, if you are interested, please join in the discussion in the following thread:
http://www.auntminnie.com/forum/tm.aspx?m=260835
I hope the wave can be a hurricane like.
Also, don't forget to send email to ACGME regarding whatever you think, no matter where you are, either in nuclear medicine, radiation oncology, radiology or simply a medical student, or maybe a concerned citizen. You can cite this thread and the petition letter to congressman in the thread: a letter to congressman by FDGme.
[email protected]
If possible, send email or talk to your PD, chairman of radiology, and your senators. Please spread the words.
http://www.auntminnie.com/forum/tm.aspx?m=260835
I hope the wave can be a hurricane like.
Also, don't forget to send email to ACGME regarding whatever you think, no matter where you are, either in nuclear medicine, radiation oncology, radiology or simply a medical student, or maybe a concerned citizen. You can cite this thread and the petition letter to congressman in the thread: a letter to congressman by FDGme.
[email protected]
If possible, send email or talk to your PD, chairman of radiology, and your senators. Please spread the words.
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Somebody needs to take a chill pill.
I agree with you that we should end nuc med residencies if there are no job opportunities. However, it would be difficult to convince the radiology org's and PD's that there should be a bridge to radiology for existing nuc med residents. I would think that rad PD's probably would prefer to expand their existing classes via the match and not through some merger.I don't think that these scenarios are likely because there are too many old nuc med docs out there who wouldn't want to see the end of nuc med residencies and their cheap labor supply.
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My fellow Americans (and any other poor bastard reading this thread),
I agree that any "special program" in radiology that does not result in eligibility for full board certification by the ABR will not satisfy the needs of the nucs job market, which is for "board certified radiologists" with special training in nucs. However, an ABR-endorsed 2-3 year fellowship in radiology as proposed by Cathance, specifically for nuclear medicine physicians and resulting in full eligibility to sit for the ABR examinations and become "board certified radiologists," would indeed fulfill the needs of any qualified nucs resident to compete on the nucs job market. That is not to say that all nucs residents or physicians are qualified to enter such a fellowship. Such fellowships should be limited and competitive so as to maintain the quality of radiology in this country. One year will not be acceptable to the ABR; that is for sure (Sorry, NM2010).
The organization that would be most interested in supporting such a pathway would be the Centers for Medicare and Medicaid Services (CMS), since they are the ones who paid for NM residents to train for 3 years only to find themselves not in demand. CMS would be able to recoup its investment into nucs residents if they put forth a little bonus towards radiology residency (or per above, fellowship) programs taking nucs residents. No one else, other than we poor bastard NM residents ourselves, would have an interest in supporting this measure. Radiologists are comfortable seeing nucs docs forced out of the clinical nucs job market (as per previous posts), so do not expect them to support you. Radiation Oncology residents can be expected to feel the same way. Nuclear Medicine program directors and division directors (who also head up the ACGME/RRCs and the ABNM) just want to have their residents (as a labor supply), so they are not interested in changing things and have no will to come up with a solution that does not involve the continuation of (and even expansion) of their residency spots (the numbers of which can only be supported by maintaining the 3-year programs).
That is why Health and Human Services (HHS), CMS, and the whole of Congress and Senate so involved in recreating the healthcare industry/profession in this particular political era, MUST know about this problem. They will shut down the 3 year program, as a waste of taxpayer dollars and an easy contribution to reducing healthcare expenditures. They might support NMPs seeking residency or fellowship training resulting in ABR-certification, as a measure to maintain their investment in training nuclear medicine physicians to support America's need to maintain its lead in healthcare.
The American People (at least those they can understand it) will support the closure of 3-year NM residencies. Fellowship training in nuclear medicine must be maintained, however, and this field (NM) will eventually heal from the damage caused by the "open door policy" of nuclear medicine residencies that were, in the interest of keeping themselves freed of the mundane tasks involved in performing nuclear medicine studies, were willing to admit and train people who would clearly not be able to compete on the job market or even the radiology residency match (which is why most of them went into nucs) and therefore have clearly dragged down respect for the specialty.
For those of you who chose this field because you love nucs and followed the "mirage" of opportunity to train directly in your field of choice, the pathway is clear: get REALLY lucky on the job market with just nucs training(+/- PET fellowship, which may not help you actually secure a job), or do radiology residency. I only wish we could secure a faster track than the 4 years currently required by the ABR, which I would not even be able to start until 2 years from now according to the current ERAS application and match schedule. Hence, my support for the so-called fellowship track suggested by Cathance.
To all who have commented positively or critically on my "letter to Congress," thank you. To all those who have actually written to the powers that be: Consider yourself a hero. If you are an NMP looking for a job, may you and your career not become a martyr in this just cause.
I agree that any "special program" in radiology that does not result in eligibility for full board certification by the ABR will not satisfy the needs of the nucs job market, which is for "board certified radiologists" with special training in nucs. However, an ABR-endorsed 2-3 year fellowship in radiology as proposed by Cathance, specifically for nuclear medicine physicians and resulting in full eligibility to sit for the ABR examinations and become "board certified radiologists," would indeed fulfill the needs of any qualified nucs resident to compete on the nucs job market. That is not to say that all nucs residents or physicians are qualified to enter such a fellowship. Such fellowships should be limited and competitive so as to maintain the quality of radiology in this country. One year will not be acceptable to the ABR; that is for sure (Sorry, NM2010).
The organization that would be most interested in supporting such a pathway would be the Centers for Medicare and Medicaid Services (CMS), since they are the ones who paid for NM residents to train for 3 years only to find themselves not in demand. CMS would be able to recoup its investment into nucs residents if they put forth a little bonus towards radiology residency (or per above, fellowship) programs taking nucs residents. No one else, other than we poor bastard NM residents ourselves, would have an interest in supporting this measure. Radiologists are comfortable seeing nucs docs forced out of the clinical nucs job market (as per previous posts), so do not expect them to support you. Radiation Oncology residents can be expected to feel the same way. Nuclear Medicine program directors and division directors (who also head up the ACGME/RRCs and the ABNM) just want to have their residents (as a labor supply), so they are not interested in changing things and have no will to come up with a solution that does not involve the continuation of (and even expansion) of their residency spots (the numbers of which can only be supported by maintaining the 3-year programs).
That is why Health and Human Services (HHS), CMS, and the whole of Congress and Senate so involved in recreating the healthcare industry/profession in this particular political era, MUST know about this problem. They will shut down the 3 year program, as a waste of taxpayer dollars and an easy contribution to reducing healthcare expenditures. They might support NMPs seeking residency or fellowship training resulting in ABR-certification, as a measure to maintain their investment in training nuclear medicine physicians to support America's need to maintain its lead in healthcare.
The American People (at least those they can understand it) will support the closure of 3-year NM residencies. Fellowship training in nuclear medicine must be maintained, however, and this field (NM) will eventually heal from the damage caused by the "open door policy" of nuclear medicine residencies that were, in the interest of keeping themselves freed of the mundane tasks involved in performing nuclear medicine studies, were willing to admit and train people who would clearly not be able to compete on the job market or even the radiology residency match (which is why most of them went into nucs) and therefore have clearly dragged down respect for the specialty.
For those of you who chose this field because you love nucs and followed the "mirage" of opportunity to train directly in your field of choice, the pathway is clear: get REALLY lucky on the job market with just nucs training(+/- PET fellowship, which may not help you actually secure a job), or do radiology residency. I only wish we could secure a faster track than the 4 years currently required by the ABR, which I would not even be able to start until 2 years from now according to the current ERAS application and match schedule. Hence, my support for the so-called fellowship track suggested by Cathance.
To all who have commented positively or critically on my "letter to Congress," thank you. To all those who have actually written to the powers that be: Consider yourself a hero. If you are an NMP looking for a job, may you and your career not become a martyr in this just cause.
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Probably we all agree that the fellowship a great idea and a feasible solution for us, but as you posted, do you think that the ACR/ABR/radiology society will approve a radiology fellowship for us?. Do you think that radiology residencies are going to open a fellowship for us? Do you really think that the same guys who are taking away our jobs are going to help us to get a radiology board certificate? If they are willing to help, there are easiest solutions for this problem, just stop certifying unqualified radiology residents/physicians to read NM.
In my opinion, the only solution for us is either to try to get a NM job (mission impossible), get a radiology residency spot or get into a second specialty.
I strongly agree, that we have to try to make NM residency dissapear, or at least make them non ACGME accredited.
Sorry, atomicdocotr, I copied the link to your thread here without your permission. Simply because it adds great value to this discussion.
http://www.auntminnie.com/forum/tm.aspx?m=261623
This is a must see.
http://www.auntminnie.com/forum/tm.aspx?m=261623
This is a must see.
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That thread is a reflection of our own reality! Nothing new!
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Radiation oncology? Come on!!! Anyone can tell the technologist to press enter in the computer and radiate people. So radiation oncology is not needed for that.
I would like to keep writing, but I prefer not to waste my time arguing with someone who's not involved in NM, not even in the imaging field!
Regards,
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It is clear to me that you really don't know how the radiologists are trained in NM. As a radiation oncologist you can treat patients with radioactive agents only because you are an authorized user, not because you are trained to do so, but you will make money from it. This is the main reason for a radiation oncologist and also for a nonqualified radiologist to get involved in NM.
Do you really think that a hospital is willing pay 2 salaries, because they want to have someone qualified to read NM?, if this is the case, we wouldn't be discussing here.
How can you say that a radiation oncologist/oncologist can aptly judge the value of a scan being read by a NM v. a radiologist? You are not even trained in NM so how do you know that they are not misreading? how do you know what should be included in a NM report? how do you know etc, etc, etc, etc, etc......?.
I would change your sentence to: radiation oncologist/oncologist can VAGUELY judge the value a scan being read by a NM v. a radiologist.
Regards,
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wagy27,
I would like to keep discussing this with you, but I have better things to do. For your information, the job crisis is not because radiologists are good or bad reading NM, there are good and bad physicians in any specialty, including NM and radiation oncology. This crisis is because of people like you that don't realize that in order to be a specialist, you need to have adequate training. But, some physicians only care about the money $$$.
Have a wonderful evening,
Regards
I would like to keep discussing this with you, but I have better things to do. For your information, the job crisis is not because radiologists are good or bad reading NM, there are good and bad physicians in any specialty, including NM and radiation oncology. This crisis is because of people like you that don't realize that in order to be a specialist, you need to have adequate training. But, some physicians only care about the money $$$.
Have a wonderful evening,
Regards
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The ACGME is asking for your help
The ACGME is working with the University of Wisconsin Survey Center (UWSC) to review the Resident / Fellow Survey to improve the survey's usability for residents and fellows, and its usefulness for assessing programs.
We are asking you to participate in this assessment conducted by UWSC. Participation would involve talking with a UWSC interviewer on the phone while you complete an online version of the questionnaire.
Your responses about the survey will be combined with those of others for the purposes of analysis, and will remain completely confidential. Your choice to participate will not affect your program or its accreditation in any way.
If you would like to participate, please contact the UWSC by clicking this link: https://research.uwsc.wisc.edu/recruit1
Sincerely,
ACGME Resident Survey Staff
Questions about the process? Contact us at [email protected]
The ACGME is working with the University of Wisconsin Survey Center (UWSC) to review the Resident / Fellow Survey to improve the survey's usability for residents and fellows, and its usefulness for assessing programs.
We are asking you to participate in this assessment conducted by UWSC. Participation would involve talking with a UWSC interviewer on the phone while you complete an online version of the questionnaire.
Your responses about the survey will be combined with those of others for the purposes of analysis, and will remain completely confidential. Your choice to participate will not affect your program or its accreditation in any way.
If you would like to participate, please contact the UWSC by clicking this link: https://research.uwsc.wisc.edu/recruit1
Sincerely,
ACGME Resident Survey Staff
Questions about the process? Contact us at [email protected]
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Notice another disturbing trend:
The SNM job board (the most likely place to find a nuclear physician job) is featuring more and more jobs for nuclear CHEMISTS and PHYSICISTS and IMAGING SCIENTISTS, so there is obviously a lot of interest in tracer development and instrumentation.
But the clinical nucs jobs are just about nil that do not also require ABR certification. The clinical nucs jobs are going to raidologists.
There are plenty of Nuclear Medicine residency positions and PET/CT fellowship positions out there, though. Notice where the supply and demand is.
If I could do over, I would have done research in radiology for a couple of years, then either matched to radiology, or matched to anesthesiology (much easier to get into) if radiology didn't work out. Internal medicine is another decent option, to specialize thereafter.
Stay away from Nucs.
Also, keep this in mind:
If you start a Nucs program, then CMS (Medicare) commits to 3 years of your training. Any years you actually complete will count against this limit; for instance, if you hope to do radiology residency after 2 years of nucs, then CMS will only pay for 1 more year of radiology residency. If you finish all 3 years, CMS will not fund any further residency training. Some rads/FP/IM/gas/etc residencies will take this into account when you apply, and not even consider people who have already done a nucs residency. Others may fund their residency training independent of CMS support. This might be important to find out when choosing programs to which to apply.
The SNM job board (the most likely place to find a nuclear physician job) is featuring more and more jobs for nuclear CHEMISTS and PHYSICISTS and IMAGING SCIENTISTS, so there is obviously a lot of interest in tracer development and instrumentation.
But the clinical nucs jobs are just about nil that do not also require ABR certification. The clinical nucs jobs are going to raidologists.
There are plenty of Nuclear Medicine residency positions and PET/CT fellowship positions out there, though. Notice where the supply and demand is.
If I could do over, I would have done research in radiology for a couple of years, then either matched to radiology, or matched to anesthesiology (much easier to get into) if radiology didn't work out. Internal medicine is another decent option, to specialize thereafter.
Stay away from Nucs.
Also, keep this in mind:
If you start a Nucs program, then CMS (Medicare) commits to 3 years of your training. Any years you actually complete will count against this limit; for instance, if you hope to do radiology residency after 2 years of nucs, then CMS will only pay for 1 more year of radiology residency. If you finish all 3 years, CMS will not fund any further residency training. Some rads/FP/IM/gas/etc residencies will take this into account when you apply, and not even consider people who have already done a nucs residency. Others may fund their residency training independent of CMS support. This might be important to find out when choosing programs to which to apply.
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Where are you getting this information from? I know people who did IM and RADS or 4 years of surgery and RADS, and they did not have any problems with their financial sponsorship and they were not sponsored by the Hospital or University. I also know someone who switched from surgery after 3rd year into nucs, with no problems.
In regards to the SNM job board, during the SNM residents meeting, Dr. Segal and other representatives present, agreed in making the job postings free, among other changes. If they take decades to work in a solution for the NM crisis, just imagine how long are they going to take to change a simple thing like this.
Another person you can contact:
Fleming, Missy
Executive Director, RRCs for Anesthesiology, Diagnostic
Radiology and Nuclear Medicine
755-5043 [email protected]
Fleming, Missy
Executive Director, RRCs for Anesthesiology, Diagnostic
Radiology and Nuclear Medicine
755-5043 [email protected]
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Cathance is correct regarding funding. Once you start a categorical program, your funding clock starts. If you want to switch out to another specialty, your new program may need to fund you from their own sources. This funding issue is a major reason why many programs won't even bother looking at you if your funding clock is almost out.
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Taurus,
Thank you for your reply, but where did you get this from?
I would like to know if there is any paper, website, etc... explaining how the funding works, because this is also important when looking for a solution for the NM crisis.
thanks
Thank you for your reply, but where did you get this from?
I would like to know if there is any paper, website, etc... explaining how the funding works, because this is also important when looking for a solution for the NM crisis.
thanks
Hi, please go through following links/documents for a good idea about funding-
http://www.aamc.org/advocacy/library/gme/dgmebroc.pdf
(funding details)
http://www.aamc.org/reform/summary/dgmeime.pdf
(changes affecting residency in reform)
http://www.aamc.org/advocacy/gme/
(more information)
http://www.aamc.org/advocacy/library/gme/dgmebroc.pdf
(funding details)
http://www.aamc.org/reform/summary/dgmeime.pdf
(changes affecting residency in reform)
http://www.aamc.org/advocacy/gme/
(more information)
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Excellent!
Also, some interesting historical and conceptual articles to read:
Medicare Financing of GME - J Gen Intern Med 2002
Graduate Medical Education - WJM 1998
Health Care Transformation as Adaptive-Renewal Cycles - Ann Fam Med 2009
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...gives me a headache...
