Since the creation of radiology as a specialty, the duration of radiology residency has slowly increased. When the first “radiologists” began training, a radiology apprenticeship/residency took as a little as one year. After the American Board of Radiology (ABR) was formally created, the board decided to increase the number of years in residency to three years in 1940. (1) And finally, in 1982, the ABR had set the number of required years for board certification to 4 years. (2)
So, what is magical about the “most recent” decision in 1982 to set residency as a 4-year process? And, would it make sense to create a different length of time for completion of radiology residency? Using a thought experiment, we are going to imagine what would happen if the ABR suddenly changed the length of radiology residency from four years to either three years or five years. More specifically, we will address the most important benefits and disadvantages of changing the time spent in residency if the ABR changed the requirements for both a three or five-year residency.
What Would Happen If Radiology Residency Was Three Years?
Based on my own experiences, a certain threshold of reads and/or procedures need to be met in order to establish competency in a given area. In the setting of a three-year residency, I believe not all the thresholds will be met in all subjects. Could the job market withstand new trainees with experience? Possibly, if we no longer created general radiologists and only wanted to make subspecialist radiologists. However, the current demand for radiologist currently seems to be for subspecialists that can practice general radiology. So, the new output of radiologists would theoretically not meet the demands of the workforce.
Furthermore, training that we all know as part of radiology residency today would need to be canceled. For instance, would residents have the time to structure a one-month rotation at the AIRP if the residency length is only three years? (I found it to be a valuable experience!) Or, how can you substantiate the need for mini-fellowships when you have significantly less time for training. Together, the ABR and residencies would have a lot of these issues to work out.
And finally, you would create one year when you would have double the number of radiology trainees entering the workforce. You may think that is not a big deal. However, due to the laws of supply and demand, those radiologists that graduated in that year of change would likely have significantly more problems obtaining a job!
With the significant rise in student debt, eliminating a year of residency would have a significant impact on the lives of new residents. Imagine being able to pay your debts off a year sooner? Furthermore, trainees have already delayed gratification for so many years already. Wouldn’t it be nice to start your actual career a year earlier?
From a program director perspective, one less year of residency would reduce some bureaucratic burdens upon the residency programs. Naturally, you would need one less year of paperwork to be processed. So, that would reduce some costs on the individual programs. But, this is more of an indirect benefit to residency programs in general.
What Would Happen If Radiology Residency Was Five Years?
If we started with five-year residency programs, I think the first thing we would notice would be increased radiology resident fatigue and burnout. More specifically, this would mostly affect the first class of “outgoing” seniors the most since their expectations would need to be radically altered. Believe me. An extra year of residency is no small issue!
On the financial side, residents would increase their debt burdens by an extra year of relatively lower pay. For those of you without debt, this probably would not impact you as much. But for the majority of residents, an extra year can add to a significantly increased financial burden.
Less specific to individual residents, the extra year would cause a one-year dearth of outgoing trained residents into the workforce. Understaffed private practices would become more severely burdened because many practices would have to freeze hiring for one year until the typical graduating schedule returned to normal. This is no small matter.
First and foremost, radiology residents would have increased experience when they enter the workforce after a five-year residency. An extra year means significantly more mammograms, CT scans, MRIs, and procedures prior to beginning a career pathway. Moreover, the fifth year seniors would easily be able to run academic radiology departments throughout the country. The large academic centers would love this. More “free” labor with more academic time for faculty members!
In that same vein, you would also satisfy the current needs of practices to hire subspecialists that can also practice general radiology, the biggest current need in the private practice workforce. And similarly, you would also be creating less super subspecialized radiologists that could only read their own subspecialties.
Additionally, you could make an argument to return the board exam to the last year of year residency prior to graduation. For the individual resident, this would mean more time to study during residency instead of having to study for the certification examination after you had entered the workforce.
Change is never easy. But, change that can lead to significant improvements for the current residents and workforce makes a lot of sense. In this case, I do not see that the advantages outweigh the problems of changing the number of years of radiology residency. Perhaps, at some point in the future, the balance may be altered. But, based on current practices, changes in duration would present undue burdens upon residents, faculty, and private practices without enough rewards to make the change worthwhile. Let’s continue to monitor the situation but keep things just the way they are for now!