Q&A: Students Need More Exposure to Radiology

In 2009, interest in diagnostic radiology residency positions hit a peak. However, according to a study in the Journal of the American College of Radiology, the number of medical students applying for these spots has since dwindled annually. This year, the Match, the program run by the National Resident Matching Program, reported 64 diagnostic radiology residency programs were left unfilled for both first- and second- year residency programs.

Diagnostic Imaging spoke with Carol Geer, MD, diagnostic radiology residency director for Wake Forest Baptist Health associated with Wake Forest University School of Medicine, to learn more about radiology’s performance in the Match, what drives students to radiology, and what radiology programs can do to increase their attractiveness.

DI: As a radiology residency director, how do you feel radiology is doing overall in attracting medical students?

Geer: I think over the last few years, if you look nationally, there has been a dip in interest in radiology. I think it’s about to go back up, though. Some of that had to do with the job market not being as good a few years ago. Medical students are wise enough to look at what the job market is – or, perhaps, not wise enough. You really need to choose your medical profession not based on the job market, but on what you might enjoy as a career. If you choose your specialty based on the job market, you could be very unhappy in your chosen specialty. Despite that, though, they do look at the job market, and it was tight a few years ago for graduating radiology residents and fellows. They were finding jobs, but not the jobs they wanted because, when the economy took a dip, some older radiologists didn’t retire. Radiology is a profession that you can do for a long period of time. You can do it when you’re older because it isn’t as physically taxing on your bones, if you will. It’s mentally taxing, but it’s a specialty where you can work a bit longer. That influenced – and has been influencing – medical students.

We know, nationally, that there were something like 153 unfilled positions last year after the Match. It was a large number, but I think that number will go down as the job market has opened up in the last few years. That has a lot to do with some of the lack of interest. It’s a little difficult when third-year medical student curriculum nationwide differs in where it puts radiology. A lot of third-year medical students need to see radiology, but they’re trying to cover a lot of ground – ob/gyn, internal medicine, neurology, surgery. It’s difficult to determine where to plug in radiology and many other sub-specialties, including dermatology, pathology, and anesthesiology. The students can’t do everything. Some of it is how do we get medical students exposed to radiology so they can make the decision to go into it?

DI: What are the reasons behind why some students opt against radiology?

Geer: I think there is a perception that there is less patient contact on a daily basis. I think that does keep some people from looking at the specialty. There are some portions of radiology where you certainly have less daily patient contact than a primary care physician, pediatrician, or surgeon. But, then there are other sub-specialties in radiology where you have enormous patient contact all the time, such as interventional radiology or mammography. Some of the people who choose radiology find in their third year that the part they like is the diagnostic dilemma – what’s wrong with the patient and how radiology and imaging plays an important role in helping physicians figure out what is wrong and what to do. For example, an older patient might have abdominal pain, and imaging can help determine the source of the illness. I think that, for some medical students, is something they can be very interested in. It draws them to radiology. Imaging is ubiquitous. Now, most patients who are ill have some sort of imaging to help augment the physical exam and history. Physicians and medical students are attracted to the field because they enjoy the diagnostic part of medicine. And, a lot of medical students enjoy that radiologists are consultants to physicians, and they spend a lot of their day as those physician consultants. If you enjoy the consultant role, I think that’s another thing that draws some people to the field. They really enjoy having those intellectual and problem-solving discussions multiple times a day, trying to figure out what’s wrong with patients. If that’s a draw, the medical students will find that radiology is a nice fit for them.[[{"type":"media","view_mode":"media_crop","fid":"39653","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_3008984125831","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3988","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right; height: 208px; width: 160px;","title":"Carol Geer, MD","typeof":"foaf:Image"}}]]

DI: What is happening to the perceptions that have kept medical students away from radiology?

Geer: Now that the economy is starting to recover, people are able to retire. That’s one of the main reasons that the job market has opened up. If you’re a strong medical student and you’ve had strong medical school and residency training, you’re going to find a good job. I think that’s something medical students over-worry about. If you’re good, you’re going to find a very good job. This happened in the early 1990s when people were talking about imaging going away or being outsourced. It’s hard to predict these things, but imaging is certainly not going away right now. It’s an integral part of taking care of patients. I think sub-specialty radiology is becoming more and more prevalent, not just in academic centers, but in the private practice arena. I think good diagnostic imagers will be valued and will be hire-able.

DI: When you talk with medical students who do choose radiology, what considerations do they say went into their decision?

Geer: I think one of the obstacles for medical students considering radiology is that they don’t have enough exposure to what we do. A number of medical students who have done the radiology rotation at the beginning of their fourth year come to my office and say they’d never thought about radiology before. But, they see that it’s not what they thought it was, and they think they might want to do it. Some of this is based solely on exposure, and that’s not critical of medical schools. They’re trying hard to give exposure to all specialties, but it’s nearly impossible to do that in one year. I think the medical schools are trying very hard to hit balanced exposure. It’s difficult. One of the main problems, though, is the medical students just don’t have exposure to what we do. They see the imaging and interpretations, and some of them don’t see the patient contact that does go on in radiology.

Patient contact will increase more and more. Radiology in the future will have us sitting with patients and going over results. It will be more like a consultation with us. That’s probably the future of radiology. As medical students see we have more patient contact than they realize, I think students who were thinking that radiology might not be a good fit for them will re-consider it as a valid job choice for themselves. Some of the specialties in radiology already have high patient contact, like breast imaging. You are actually the consulting physician for the patient. You sit with the patient and talk with them about imaging every day. That’s not a typical rotation that a student would go on nationwide. If medical students are going to do a radiology rotation, it most likely will be a rotation in the area of radiology that they’re going to use frequently, up on the surgical floor or in an internal medicine or pediatric sub-specialty during their fourth year. They’ll do chest X-ray, abdominal or neurological imaging, or interventional radiology. Medical students often don’t get a good view of that specialty. It isn’t practical for them to rotate through every radiology sub-specialty. But, it’s a misconception that radiologists aren’t seeing patients.

DI: Given that radiology hasn’t been performing well in the Match in recent years, what do you envision as the future of the industry?

Geer: I think imaging has become very complex. We have certainly seen that over the last 10-15 years. Imaging is better, and as it’s gotten better, it has grown in complexity and has become more utilized. I think it’s very hard to be outstanding in every area of radiology. It’s a little like internal medicine. It’s hard to be outstanding in every single aspect – that’s why we have cardiologists, hematologists, and oncologists in medicine. In radiology, the vast majority of students do a year fellowship to get a sub-specialty in something so they can provide the highest quality image interpretation to help referring physicians. This is where they can really offer something more than just simple interpretation. They can take and put the clinical history together with the imaging in consultation with referring physicians and really take the care of the patient to another level. It makes radiology more relevant – radiology sub-specialty is the future with everyone having some skill in the emergency radiology we do on call at night. During the day time, when you have clinics running with patients with complicated diseases coming in all day long, it’s nice to have the option of having a sub-specialty group there if you get a complex bone tumor from the ortho-surgeon. Having someone with that expertise will be able to render a far more relevant interpretation.

DI: What do you envision for the future of radiology?

Geer: Personally, I think it’s a happy picture. I think we’re an integral part of taking care of patients, and any physician would say that imaging is a very important part of the medical care that patients receive. I can’t say it’s the most important part, but it’s a very important part. If you ask primary care physicians and surgeons whether a well-trained, knowledgeable, available radiologist is helpful to your practice, they’ll all say, “yes, absolutely.” As long as we, in radiology, continue to be focused on how we can make ourselves more helpful to referring physicians and patients, I think our future is very bright. Technology has really driven improvements in imaging and will keep doing that – imaging in 15 years will fare better than today.

The future of the field is very bright. If you really enjoy the diagnostic side and the therapeutic side of taking care of patients, if you really relish being a high-level consultant to a referring physician trying hard to take care of a patient, then radiology is a career you should consider.

As for the job market opening up, I do wonder if we’re probably reading studies at a maximum pace. At times, it seems that we’re pushed to read so fast that a newer generation of radiologists might be willing to make a lower salary to read studies at a slower pace. And, that will open up more jobs in the field.

DI: From the perspective of one who trains students, what are things that can and should be done to improve radiology’s popularity?

Geer: It’s unrealistic to say we’re going to see everything in the third year. Something that radiology can do – and something we’re doing at wake – is getting exposure before that third year. First- and second-year medical students are taking courses in anatomy. It’s a very important part of diagnostic imaging. We’ve also set up a resident-medical student mentoring program that runs during the first two years just so they have exposure to radiology before their third year. Mentoring is important, and medical students are looking for, and need, faculty mentors. Residency program directors and radiology faculty are going to have to reach out to medical students to help them with career choices. They have to get more involved for medical students to see radiology as a career that might be for them. Radiology has to get involved in the medical school curriculum earlier, and we’re starting to do that. And, most medical schools are encouraging radiology departments to be creative in getting involved.

With our mentoring group, we’ve working through the radiology medical student interest group and have offered the group for two years. We offer it to first-, second-, and third-year medical students, and we pair them with a radiology resident who is preferably in his or her first or second year. That way, the resident will be here for a few years. As the first- or second-year students do rotations, they have a contact in radiology. We try to pair medical students and residents with similar interests, such as a neuroradiology resident with a medical student interest in neurology, and the medical student shadows or does work with them. By the time students get to their third year and they’re making career decisions, they’ve already have a resident contact to talk with. My door is always open, and I have a lot of medical students who come and talk with me, but it’s also good to have a house staff contact for students, as well. It’s a good way of showing medical students what we actually do. They can see for themselves if they find it interesting and fulfilling for a long career.