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Currently, the Center for Medicare and Medicaid spend an average of $80,000 per resident per year to train Nuclear Medicine Physicians in residency programs around the country. The trouble is... nobody wants them.
Nuclear medicine residents (currently trained with three years of nuclear medicine instruction and experience to become Nuclear Medicine Physicians, or NMPs) have dismal job prospects. On AuntMinnie.com, a popular radiology community website that gets its name from the types of patterns in imaging that radiologists should recognize as easily as they would their "Aunt Minnie," there are zero (yes, that's a goose-egg ZERO) jobs posted for nuclear medicine physicians. Some might say it's because NMPs don't use AuntMinnie.com. However, if you view job postings at the Society of Nuclear Medicine website (snm.org), you will see the true demand for NMPs: again, ZERO. On the date of the submission of this letter, there is not one job posted looking for an NMP. There are several postings, however, for wide-open training positions (resident or fellow in nuclear medicine or PET/CT). Granted, there are significantly fewer graduates of NMP training programs (total NMP residents numbering 193 according to http://www.acgme.org/adspublic, divided by [the former duration of] 2 years of training, producing about 97 new NMPs per year). But ZERO jobs is a very small number for these 97 newly trained NMPs hoping for a career. That means AuntMinnie.com job postings cover ZERO percent of the supply of new NMPs. All NMPs must find their jobs by word of mouth recruiting or other posting sources unknown to me. One might speculate, accurately in my estimation, that most recruiters are looking for nuclear radiologists (radiologists with a fellowship in NM) to read their nuclear medicine, but then settle for an NMP due to supply issues (often negotiated at a significantly lower salary and even exclusion from the partnership career track).
On the other hand, there is enormous demand for radiologists in the United States. On just AuntMinnie.com alone, there are 704 jobs posted looking for radiologists, covering 35% of yearly supply of new radiologists. The American College of Radiology website (ACR.org) posts 74 jobs. There are many other sites advertising more positions. I get spam from recruiting and staffing agencies that advertise hundreds of jobs for radiologists. As is the case in most career fields, the majority of jobs available are actually never posted but are filled by word-of-mouth recruiting (i.e., internally or with people already familiar to the group). Around 1,100 radiologists complete their training every year to cover this demand (4,670 total residents according to http://www.acgme.org/adspublic, divided by 4 years of training). For radiologists, the field is wide open, the demand intense, which is why radiologists are well paid (low supply, high demand). During their training, radiologists receive instruction and experience in all fields of imaging, including nuclear medicine (only 4 months, but that is considered by most credentialling institutions to be enough to read and bill for any nuclear medicine imaging and therapies). Board-eligible radiologists interested in more training in nuclear medicine can do a one year "fellowship" (actually, they jump in at year #3 of nuclear medicine residency) and qualify for board certification by the American Board of Nuclear Medicine, the same certification that we get after 3 years of training (under new rules as of 2006). The biggest difference is that... they get the jobs. We don't.
In another comparison, radiation oncology residencies (four-year training in the delivery of external and sealed internal radiation to treat cancer) have a total of 600 residents (according to http://www.acgme.org/adspublic), meaning that about 150 new physicians are produced every year. AuntMinnie.com posts 54 jobs for radiation oncologists (matching to 36% of the supply). By comparison, nuclear medicine should have between 35 and 38 jobs posted on AuntMinnie.com to be considered of equal demand compared with radiologists and radiation oncologists. Even 10-15 posted jobs would be somewhat respectable and make an enormous difference. But ZERO?
It should be clear to any layperson at this point that U.S. tax dollars should not be going toward training more NMPs. They are not "needed" in a true market sense. They are not trained to perform the needed broad-based cross-coverage and multimodality imaging interpretation (MRI, ultrasound, mammography, muskuloskeletal) and interventional procedures that radiologists can provide. Radiologists in comparison are in sharp demand. The government (more specifically, the Centers for Medicare and Medicaid, which funds residency training) should be putting tax money toward more radiology training positions; if that happens, this nation will have all the nuclear medicine services it needs. Radiologists will be able to cover the need, partly also because nuclear medicine will become a more respected field rather than being the "red-headed stepchild" in the room. As it is right now, many in the radiologist-dominated U.S. medical imaging profession view non-radiologist (and even radiology-trained) nuclear medicine physicians as a lesser breed.
I should know. I am a resident in my third year (PGY-4 if you include internship) of nuclear medicine training at one of the top hospitals in the country (according to U.S. News & World Report). The published job prospects for me are slim (none, really). I am still confident I'll find something decent through networking and word of mouth, plus my own hard work, but each day that passes brings me closer to finishing...jobless.
One might ask why training programs want to keep pumping out NMPs. In reality, they don't. What academic nuclear medicine division faculty members want is a continuing and growing supply of residents, because these trainees perform a considerable amount of clinical and research work, freeing the faculty to concentrate on research and expansion. A few years ago, it was decided that the programs should last 3 years, not just two. My class is the first 3-year class at my institution. The people that started a year ahead of me finished in only two years. Why I took the position is a long and complicated story, and unique to me. However, the bleak job prospects and absurdly low demand that I am now seeing is common to all nuclear medicine residents in training. Even with ZERO NMP program graduates last year due to the move from 2 years to 3, nobody complained about insufficient supply of NMPs. We have been sold on a training route that pumps us out into a market in which nobody is looking for us (because they are ALL looking for radiologists).
Taxpayer dollars in the form of Medicare funding and reimbursements at teaching hospitals should be excluded from funding any more new residents pursuing 3-year nuclear medicine training pathways. Residents currently in NMP training should be funded through the completion of their training. Funding for 2-year fellowship-level training in nuclear medicine imaging and therapies should continue for the small number of internal medicine-trained physicians that want to incorporate nuclear therapies into their internal medicine practices, and 1-year fellowship training should be made available for radiologists who want specialty training in nuclear medicine and PET/CT. Any further available funding for primary residency training in imaging should be routed toward radiology training. This will dry up much of the supply of residents to do the clinical work for academic/research NMPs, but that demand will be filled by an increased number of radiologists choosing to do fellowships in nuclear medicine and PET/CT as the demand (and respect) for imagers in nuclear medicine and PET picks up. More importantly, no longer will there be a divide between radiologists and NMPs; they will be coming from the same fold -- they will all be radiologists. The only pure NMPs out there would be internists who practice therapeutic as well as possibly some traditional diagnostic nuclear medicine (likely in addition to other primary care or specialty clinic duties).
Nuclear medicine residents (currently trained with three years of nuclear medicine instruction and experience to become Nuclear Medicine Physicians, or NMPs) have dismal job prospects. On AuntMinnie.com, a popular radiology community website that gets its name from the types of patterns in imaging that radiologists should recognize as easily as they would their "Aunt Minnie," there are zero (yes, that's a goose-egg ZERO) jobs posted for nuclear medicine physicians. Some might say it's because NMPs don't use AuntMinnie.com. However, if you view job postings at the Society of Nuclear Medicine website (snm.org), you will see the true demand for NMPs: again, ZERO. On the date of the submission of this letter, there is not one job posted looking for an NMP. There are several postings, however, for wide-open training positions (resident or fellow in nuclear medicine or PET/CT). Granted, there are significantly fewer graduates of NMP training programs (total NMP residents numbering 193 according to http://www.acgme.org/adspublic, divided by [the former duration of] 2 years of training, producing about 97 new NMPs per year). But ZERO jobs is a very small number for these 97 newly trained NMPs hoping for a career. That means AuntMinnie.com job postings cover ZERO percent of the supply of new NMPs. All NMPs must find their jobs by word of mouth recruiting or other posting sources unknown to me. One might speculate, accurately in my estimation, that most recruiters are looking for nuclear radiologists (radiologists with a fellowship in NM) to read their nuclear medicine, but then settle for an NMP due to supply issues (often negotiated at a significantly lower salary and even exclusion from the partnership career track).
On the other hand, there is enormous demand for radiologists in the United States. On just AuntMinnie.com alone, there are 704 jobs posted looking for radiologists, covering 35% of yearly supply of new radiologists. The American College of Radiology website (ACR.org) posts 74 jobs. There are many other sites advertising more positions. I get spam from recruiting and staffing agencies that advertise hundreds of jobs for radiologists. As is the case in most career fields, the majority of jobs available are actually never posted but are filled by word-of-mouth recruiting (i.e., internally or with people already familiar to the group). Around 1,100 radiologists complete their training every year to cover this demand (4,670 total residents according to http://www.acgme.org/adspublic, divided by 4 years of training). For radiologists, the field is wide open, the demand intense, which is why radiologists are well paid (low supply, high demand). During their training, radiologists receive instruction and experience in all fields of imaging, including nuclear medicine (only 4 months, but that is considered by most credentialling institutions to be enough to read and bill for any nuclear medicine imaging and therapies). Board-eligible radiologists interested in more training in nuclear medicine can do a one year "fellowship" (actually, they jump in at year #3 of nuclear medicine residency) and qualify for board certification by the American Board of Nuclear Medicine, the same certification that we get after 3 years of training (under new rules as of 2006). The biggest difference is that... they get the jobs. We don't.
In another comparison, radiation oncology residencies (four-year training in the delivery of external and sealed internal radiation to treat cancer) have a total of 600 residents (according to http://www.acgme.org/adspublic), meaning that about 150 new physicians are produced every year. AuntMinnie.com posts 54 jobs for radiation oncologists (matching to 36% of the supply). By comparison, nuclear medicine should have between 35 and 38 jobs posted on AuntMinnie.com to be considered of equal demand compared with radiologists and radiation oncologists. Even 10-15 posted jobs would be somewhat respectable and make an enormous difference. But ZERO?
It should be clear to any layperson at this point that U.S. tax dollars should not be going toward training more NMPs. They are not "needed" in a true market sense. They are not trained to perform the needed broad-based cross-coverage and multimodality imaging interpretation (MRI, ultrasound, mammography, muskuloskeletal) and interventional procedures that radiologists can provide. Radiologists in comparison are in sharp demand. The government (more specifically, the Centers for Medicare and Medicaid, which funds residency training) should be putting tax money toward more radiology training positions; if that happens, this nation will have all the nuclear medicine services it needs. Radiologists will be able to cover the need, partly also because nuclear medicine will become a more respected field rather than being the "red-headed stepchild" in the room. As it is right now, many in the radiologist-dominated U.S. medical imaging profession view non-radiologist (and even radiology-trained) nuclear medicine physicians as a lesser breed.
I should know. I am a resident in my third year (PGY-4 if you include internship) of nuclear medicine training at one of the top hospitals in the country (according to U.S. News & World Report). The published job prospects for me are slim (none, really). I am still confident I'll find something decent through networking and word of mouth, plus my own hard work, but each day that passes brings me closer to finishing...jobless.
One might ask why training programs want to keep pumping out NMPs. In reality, they don't. What academic nuclear medicine division faculty members want is a continuing and growing supply of residents, because these trainees perform a considerable amount of clinical and research work, freeing the faculty to concentrate on research and expansion. A few years ago, it was decided that the programs should last 3 years, not just two. My class is the first 3-year class at my institution. The people that started a year ahead of me finished in only two years. Why I took the position is a long and complicated story, and unique to me. However, the bleak job prospects and absurdly low demand that I am now seeing is common to all nuclear medicine residents in training. Even with ZERO NMP program graduates last year due to the move from 2 years to 3, nobody complained about insufficient supply of NMPs. We have been sold on a training route that pumps us out into a market in which nobody is looking for us (because they are ALL looking for radiologists).
Taxpayer dollars in the form of Medicare funding and reimbursements at teaching hospitals should be excluded from funding any more new residents pursuing 3-year nuclear medicine training pathways. Residents currently in NMP training should be funded through the completion of their training. Funding for 2-year fellowship-level training in nuclear medicine imaging and therapies should continue for the small number of internal medicine-trained physicians that want to incorporate nuclear therapies into their internal medicine practices, and 1-year fellowship training should be made available for radiologists who want specialty training in nuclear medicine and PET/CT. Any further available funding for primary residency training in imaging should be routed toward radiology training. This will dry up much of the supply of residents to do the clinical work for academic/research NMPs, but that demand will be filled by an increased number of radiologists choosing to do fellowships in nuclear medicine and PET/CT as the demand (and respect) for imagers in nuclear medicine and PET picks up. More importantly, no longer will there be a divide between radiologists and NMPs; they will be coming from the same fold -- they will all be radiologists. The only pure NMPs out there would be internists who practice therapeutic as well as possibly some traditional diagnostic nuclear medicine (likely in addition to other primary care or specialty clinic duties).