With the return of the radiology job market to a more healthy state, medical student applications to residency programs have steadily increased over the past several years. But, that got me thinking. Is the specialty of radiology better off with more hardcore medical students wanting to enter the profession? Or, does radiology benefit more from residents who truly want to be here when times are tough? So, let’s go through the advantages and disadvantages of having both a competitive and a non-competitive application process. And then, we will come up with a conclusion to the final question: Is the specialty radiology better off with increased competition?
What Happens With A Competitive Application Process
From a program director perspective, let’s first begin by saying that a program director’s job becomes much easier with increased competition. In order to find applicants, you do not have to interview as many candidates. And, the applications tend to have less “blemishes”. That being said, as much as it helps me, this factor impacts the specialty very little.
So, what other advantages does a competitive process offer? First, the candidates will often have more experience in research. But, does this really create better radiologists? Well, that is up for debate depending on whether the resident wants an academic career. However, I can say that it again makes the program director’s job a little bit easier because the faculty does not need to teach some of the basic mechanics of research to get them started. Additionally, this resident will also likely produce more research during residency.
With increased competition, residents also tend to be a little bit more attentive to keeping up with reading. Moreover, these residents tend to be more motivated by passing tests. In other words, they may be a bit more “obsessive-compulsive”. Now, this would theoretically work in the favor of passing the boards. However, according to the infinite wisdom of the test makers (the ABR), this doesn’t really change the pass the rates since they opt to create tests based on curves, not content.
Over the years, I have noticed that competition also motivates applicants who want radiology because of the competition; not necessarily for the love of radiology. In the long run, this can lead to increased burnout. Furthermore, it can change the culture of radiology residency and radiologists into a less forgiving and high pressured environment. Again, this is more of a tendency rather than a truism.
Increased competition also brings out less non-traditional applicants to radiology. These include folks who have completed other residencies and different careers. In the setting of increased competition, they have a much harder time receiving interviews because programs often screen them out of the system due to their increased time in or before residency. However, non-traditional applicants bring a different perspective to residencies. Moreover, they have been through more, are more mature, and often make better leaders.
What Happens With A Non-competitive Application Process
Residents who apply during a less competitive time are a different group of candidates. I like to call them the type B personalities. These folks create a less pressured environment and a calmer culture for the residency program. In itself, this can make the four-year residency process more tolerable for everyone.
Likewise, during tough times, limited selection of candidates force residency programs to accept nontraditional candidates to their fold. As stated above, these candidates lend a mature perspective to a residency program. In addition, these residents want to be involved in radiology for the love of the specialty rather than the competition and “great” job market.
And then, programs will often downgrade their expectations of these non-competitive residents. Decreased expectations lower the pressures on the residents during their program and can create a less harried culture with decreased burnout.
I don’t have the statistics to back this up. But, from my experience, I believe tough times lead to residents with an overall higher dropout rate. Sometimes, these residents cannot meet the rigorous academic challenges of residency. When this occurs, residencies can lose their precious spots to other specialties like primary care.
Also, these residents have overall less experience with research. So, most residencies with non-competitive applicants will create less output during these tough times. (This is a disadvantage for the more academic residency!)
And then finally, residencies have more work cut out for them. They need to put more time into teaching and spoon-feeding the residents to make sure they complete the program.
Weighing The Balance- Is Increased Competition Better For The Specialty?
So, where do I stand in this controversy? Well, residency directors and their programs need to put a bit more work into the residents during the “tough” years to get them “up to snuff”. But, you know, I’ve seen great residents during the lean times as well as during times of abundance. So, I think we put more emphasis on competition as a means to getting better residents than we should. In the end, good residencies mold their residents into great radiologists regardless of the zeitgeist of the times. And, that’s the way it should be!