Current radiology job market

[Zoltar69]

Hello

 

I am thinking of applying to radiology. What is the current job situation like? Are there good jobs out there?

 

Thanks

 

Zolt

[rmorelan]

Hello

 

I am thinking of applying to radiology. What is the current job situation like? Are there good jobs out there?

 

Thanks

 

Zolt

 

Not yet saturated as of last report, some increasing challenges getting employment but still ok

 

Obviously not sure what it will be in 10 years

[tooty]

I heard it's not looking good. Majority will have to do a fellowship or two. Most openings are in the boonies.

[Zoltar69]

I heard it's not looking good. Majority will have to do a fellowship or two. Most openings are in the boonies.

 

Thats not good. Is a fellowship mandatory at this point?

[km88]

Are there any reliable resources that we can use to delineate job prospects?

[noncestvrai]

I was lucky to get a great job without a fellowship, in suburbia. In the city, for a non-fellowship trained radiologist, it's almost impossible, except for a few non-university hospitals, almost saturated anyways.

 

There are opportunities in more remote areas.

 

Don't pass on too quickly on these, often these offer great QOL.

[tooty]

Are there any reliable resources that we can use to delineate job prospects?

 

No. Many jobs are spread by word of mouth and nothing is centralized. I learned a lot from new staff, hearing about the crap they put up with to get their job.

[Med0123]

As a side note it is the same for every surgical specialties and heavy on procedures IM specialty. Dont rely on future job market to choose your specialty (except for cardiac surgery or ortho maybe)

[Ian Wong]

The radiology job market is tough right now. Having said that, if you graduate from a Canadian program, you will find a radiology job, it just might not be where you want or exactly what you want.

 

The job market is tight in the large cities. I'm only really familiar with Vancouver, as that's where I'm working, but I've heard that the other large metropolitan cities in Canada are similar.

 

Unfortunately, the number of radiologists needed is not really correlated with the demand as much as infrastructure availability. With only a certain number of CT and MR scanners in one hospital, there's a finite limit to the number of radiologists needed to staff that hospital.

 

Still, it would be extremely rare to find a Canadian graduate that is incapable of finding a job somewhere, unless they are really geographically limited, or they were a really poor resident and have bad references. Most UBC graduates tend to do a fellowship, and then find a job immediately after. To be sure, many of those jobs are locum positions, but usually just getting your foot into the job market and developing good word of mouth will eventually open up a stable full-time job. If you have interest in working in a smaller centre/city, I think you'd have better luck.

 

Although the job market isn't great right now, there's a large fraction of currently practising radiologists in their 50's, many of whom will be retiring in the next decade. If you go by the bar graph on page 8 of the CMA specialty profile, it looks like around 40% of radiologists are over the age of 55 years, which is a massive proportion of the whole workforce.

 

http://www.cma.ca/multimedia/CMA/Content_Images/Policy_Advocacy/Policy_Research/Specialty_Profiles/Diagnostic-Radiology_en.pdf

 

When you combine those impending retiring radiologists with the continued growth in medical imaging, I suspect there will be more jobs opening up in the future. As the Canadian population ages, they consume more and more health care resources, which includes an ever increasing number of imaging exams.

 

The crazy thing is that the earliest baby boomers who were born in 1946 are just 68 years old. That's a relatively "young" age compared to the 70 and 80 year old people who I see on a daily basis getting cross-sectional imaging to assess malignancy, strokes, disc protrusions, etc. The amount of imaging will inevitably increase in the future as all of the boomers hit their 70's and 80's.

 

I think the bottom line is that you should do radiology because you enjoy it. The job will take care of itself. Worst case scenario, you do locums for a year or two to build up your speed and word of mouth, and a job will likely open itself up for you, particularly if you are flexible about location.

 

Ian

[frankg]

Thank you so much for the post, Ian! It is comforting to hear your opinion that the job market will likely get better.

 

Do you have any comments on the often-heard assertion that the field will get over-saturated and the pay will decrease as a result of potential out-sourcing? Is our situation in Canada different from the USA in terms of out-sourcing and teleradiology?

 

Thanks!

 

The radiology job market is tough right now. Having said that, if you graduate from a Canadian program, you will find a radiology job, it just might not be where you want or exactly what you want.

 

The job market is tight in the large cities. I'm only really familiar with Vancouver, as that's where I'm working, but I've heard that the other large metropolitan cities in Canada are similar.

 

Unfortunately, the number of radiologists needed is not really correlated with the demand as much as infrastructure availability. With only a certain number of CT and MR scanners in one hospital, there's a finite limit to the number of radiologists needed to staff that hospital.

 

Still, it would be extremely rare to find a Canadian graduate that is incapable of finding a job somewhere, unless they are really geographically limited, or they were a really poor resident and have bad references. Most UBC graduates tend to do a fellowship, and then find a job immediately after. To be sure, many of those jobs are locum positions, but usually just getting your foot into the job market and developing good word of mouth will eventually open up a stable full-time job. If you have interest in working in a smaller centre/city, I think you'd have better luck.

 

Although the job market isn't great right now, there's a large fraction of currently practising radiologists in their 50's, many of whom will be retiring in the next decade. If you go by the bar graph on page 8 of the CMA specialty profile, it looks like around 40% of radiologists are over the age of 55 years, which is a massive proportion of the whole workforce.

 

http://www.cma.ca/multimedia/CMA/Content_Images/Policy_Advocacy/Policy_Research/Specialty_Profiles/Diagnostic-Radiology_en.pdf

 

When you combine those impending retiring radiologists with the continued growth in medical imaging, I suspect there will be more jobs opening up in the future. As the Canadian population ages, they consume more and more health care resources, which includes an ever increasing number of imaging exams.

 

The crazy thing is that the earliest baby boomers who were born in 1946 are just 68 years old. That's a relatively "young" age compared to the 70 and 80 year old people who I see on a daily basis getting cross-sectional imaging to assess malignancy, strokes, disc protrusions, etc. The amount of imaging will inevitably increase in the future as all of the boomers hit their 70's and 80's.

 

I think the bottom line is that you should do radiology because you enjoy it. The job will take care of itself. Worst case scenario, you do locums for a year or two to build up your speed and word of mouth, and a job will likely open itself up for you, particularly if you are flexible about location.

 

Ian

[Ian Wong]

Hi there,

 

Unfortunately, it is impossible to predict what is going to happen with radiology. We are one of the most volatile fields in medicine, at least in my opinion.

 

For one, we are probably the most heavily reliant field on computers, and as you know, computer technology advances in leaps and bounds. Surgeons, pediatricians, neurologists, and obstetricians were all doing pretty much the same thing 30 years ago.

 

However, the radiologist of 30 years ago could never have envisioned the practice of radiology today. PACS systems, digital imaging, widespread CT/MRI usage, and image-guided interventions were not around then. Radiology was not as critical to patient flow as now. Most complex hospital and ER patients are now highly reliant on imaging to guide their medical course.

 

Even just the idea of the internet and acquiring and transmitting images digitally is a massive game-changer. Back when I was in medical school (and I only graduated 11 years ago), we were all carrying around Palm Pilots and PocketPC's, and downloading songs off Napster was cool. The iPhone hadn't even been invented yet.

 

I don't think outsourcing is going to have a massive effect on our field, for the simple reason that it has failed significantly in the US, and by extension in most other first world countries that I know of. There really hasn't been a legitimate push to have radiologists in other countries reading images for a cheaper fee, and that is because our interpretations really do change management dramatically. There is no appetite from clinicians to take the medicolegal risk by acting on an outside interpretation.

 

Canada has always maintained high standards of its medical community (which is why it is so hard for foreign doctors to come to Canada and practise medicine without undergoing significant retraining or extensive proof of adequate training). Allowing a foreign radiologist to practise imaging interpretation in a Canadian jurisdiction is really no different than allowing a foreign surgeon to do surgery in Canada, and getting those practice rights is very difficult.

 

I used to think that the bigger risk would be that various subspecialties would carve out radiology into smaller niches, so that pulmonologists would read chest CT's, GI docs would read CT colon, neurologists would read brain MRI, etc, but that for the most part doesn't seem to be happening.

 

Yes, radiology has lost areas of practice, such as vascular surgeons taking over arterial interventions, neurosurgeons taking over neuro-interventional radiology, or cardiologists taking over cardiac nucs/echo and partially cardiac CT/MR, but by and large, most of radiology has stayed with radiologists. Imaging crosses multiple areas, and chest CT covers a lot more than just lung parenchyma, etc. We are the only people who safely can interpret the whole study.

 

As well, most other specialties are busy enough with their own work that they don't have the free hours or time to spend churning out reports, and most don't want that medicolegal liability.

 

As far as income goes, who knows? All areas of medicine have seen income increases, but a lot of that I think is due to increased workloads. The radiologist of today is interpreting a lot more images, and is doing much more complex imaging than even 5-10 years ago. As previously mentioned, we haven't even begun to hit the baby boomer generation, where we will see both a massive influx of elderly patients, as well as have a massive retirement wave of all the boomer physicians.

 

I think there will be tons of work to go around, I'm just worried that as a country we won't have the tax base to pay for it all!

 

I believe there is a giant elephant in the room, which is: Will the boomers accept and embrace two-tier health care?

 

I think the public system will likely have longer and longer waitlists in the future (for everything, surgery, imaging, specialty consults, etc), and at some point the waitlists will be bad enough that two-tier health is going to be brought forward as a possible solution. Under that system, radiology has definite potential to be in both a public and private system (as we have already in the US), and that will have a direct impact on income, as now you would have both public and private income streams.

 

Bottom line, I don't know what is going to happen, but I'm overall optimistic. The trend has been towards greater imaging for the last 2 decades, and I don't see that changing anytime soon. Canadian radiology grads shouldn't worry too much about finding jobs; jobs are out there, particularly if you aren't geographically constrained. If you like practising radiology, I still think it is a great career option. I really like going to work each day.

 

Ian

[entangledphoton]

Thanks for your post, Ian. Very interesting perspective. You mentioned that that outsourcing has failed elsewhere. Can you explain why it wasn't successful? Because, as you mentioned, costs are going to rise dramatically and outsourcing is a cost-cutting strategy that seems likely to take hold in medical imaging.

[Ian Wong]

Outsourcing has so far failed because we are not entirely a commodity. Clinicians take on medicolegal risk by acting, or not acting upon our reports. They have no incentive nor interest in receiving reports from non-Canadian trained and certified radiologists. A regular day of work for me includes many reports where the imaging makes a dramatic change in the diagnostic and treatment decisions for the patient.

 

We are characterizing liver lesions as being benign or malignant. We tell the clinicians whether there is a pulmonary embolus present. We tell them whether the patient has an obstructing ureteral stone or not. We tell them if the right lower quadrant pain is an acute appendicitis, or whether it is cecal diverticulitis. We tell them if the lesion we saw on the mammogram requires a biopsy or not. We tell them if the sclerotic lesion in the humerus seen incidentally is likely to be benign or malignant. We even hedge sometimes and tell them that there is another imaging test that is required to make a more definitive diagnosis. All of this takes a significant amount of skill and training.

 

You potentially save immediate costs by sending imaging out to a low-cost bidder. You will then potentially engender significant downstream additional costs if the interpretation was incorrect, and the patient was started down the wrong treatment path. Or, at worst, a critical finding is missed and the patient is harmed or dies.

 

In addition, there is a significant value added by having in-house radiologists. Today, in my community hospital, I did a mix of diagnostic and low-level interventional procedures. This included a mix of MR, CT, US, and plain films. I called a clinician discussing the results of a stat OB ultrasound for a patient who had been in an MVA earlier today, and now was having significant abdominal pain. I talked to the Emerg doc about an unusual knee x-ray showing an unusual sclerotic epiphyseal lesion in the proximal tibia, and the next stage of the workup. I looked at an extremity MRI on a local athlete. One of the clinicians called to ask if we could expedite an MRCP on an inpatient, and I was able to get it done and interpreted (with final report signed off) within 6 hours of the call.

 

Procedure-wise, I did 3 paracenteses, a lumbar spine facet steroid injection, a shoulder distention arthrogram, repositioned a Corpak feeding tube under fluoro, exchanged a leaking gastrostomy tube, and did a retrograde urethrogram, two upper GI series, and a single contrast enema.

 

The diagnostic component could be done remotely, but there is a strong relationship between the clinicians and the radiologists, and I do not believe there would be any clinician support for radiology outsourcing. We do our best to help the clinicians out, and they in turn trust that we are operating with the best intentions towards their patients.

 

As well, the procedural parts of radiology cannot be outsourced. We are doing ever more image-guided procedures, particularly in the form of ultrasound and CT-guided biopsies, as well as an ever increasing number of basic floor procedures like thoracentesis and paracentesis, as the clinicians are too busy or sometimes no longer confident in doing them on the floor without imaging.

 

Finally, I spent some time today working with our MRI technologists on their safety screening for cardiac stents, as with each iteration of new stents, the manufacturer comes out with new guidelines as to whether they are MRI compatible or not. The newest recommendations from many of these manufacturers no longer bluntly say that the stents are safe in a 1.5 T MRI magnet, but rather give out lots of technical qualifiers.

 

We radiologists are in charge of making sure the studies are done safely, and that post-procedure complications like contrast reactions or interstitial contrast injections are appropriately managed. We are also responsible for making sure that radiation doses are maintained as low as reasonably possible. This is much better done on-site. In fact, some things like assessing the neuro-vascular status of an arm after an interstitial contrast injection cannot be done remotely.

 

It is for all these reasons that we have not been outsourced. I personally think outsourcing is unlikely. It sounds like a great idea, until you realize that in-house radiologists provide a lot of day to day input in the flow of a hospital, and that is unlikely to be duplicated by an off-site team.

 

Sure, I might be wrong. In the future, radiology could be outsourced to the lowest bidder, and some form of super-tech or midlevel provider could be trained to do some of the low-level interventional work. However, clinical care is likely to suffer under that model, and it is also likely to result in increased medical costs and increased medicolegal liability.

 

You just have to look at the US, where the pressure to decrease medical costs is significantly higher than here, and yet the above outsourcing model has never taken off to any significant degree. I believe it is because the clinicians will not accept that.

 

Ian

[champ]

This is off topic from the original thread but I for one want to thank you for all of your invaluable posts over the years Ian. As a senior medical student going through the process of selecting a speciality you have done a great job relaying many important points to us up and coming students. I hope you find the time to keep sharing your wisdom in the future.