Question About Nuclear Medicine As A Dying Field:
Hi Dr. Julius!
What is the future of nuclear radiology? I have seen some programs that offer dual certification pathways within their DR residencies. Is that worth it? I’ve also heard it’s a bit of a dying field, thoughts?
Also, is therapeutic nuclear radiology becoming a feasible pathway for radiology grads? On paper, it sounds fantastic to use radionucleotides to not only diagnose but also treat patients.
Once again, an excellent question from one of my readers!
Well, I have a lot of opinions on this topic since I am first and foremost a nuclear radiologist. And I am happy to share them with you!
Nuclear Medicine History/Background
You first have to start by understanding the history of the specialty. Nuclear medicine is one of the oldest subspecialties in radiology. It came about before ultrasound and was once the only other high tech modality for radiologists other than x-rays. So, back in the old days, probably around 50 years ago or so, a lot of really smart radiologist went into the field. And, at that time, the area was distinct from the rest of the radiology field. So, they formed a separate board society and training programs “unattached” to radiology residency in addition to a fellowship after residency. Fast forward to our time, and you have a bit of a mess. Most applicants to nuclear medicine would prefer to get into radiology because you can do so much more. You have much better job prospects because the radiology training is so much more diverse.
But, this current organization of two separate radiology and nuclear medicine creates a problem. Generally, the folks that are only nuclear medicine need more to do than just reading nuclear medicine studies during the daytime. Most practices do not have enough work to support a nuclear radiologist. So, enter the new dichotomy. There are those nuclear medicine physicians who train primarily in radiology that, in general, prefer to do the diagnostic radiology work along with diagnostic nuclear medicine. And then, some are only nuclear medicine trained that need to create a new livelihood for themselves. And one of those areas is the realm of nuclear medicine treatment. In general, right now, these procedures do not pay well and are very time-consuming. However, these nuclear medicine physicians provide an essential service by administering the radioactive pharmaceuticals and following up the patients over time.
I believe in the future; the specialty will split into these two entities- diagnostics and treatment- because of the current mechanics of reimbursement and what procedures that nuclear medicine docs and nuclear radiologists can perform.
Is Nuclear Medicine A Dying Field?
Finally, to complete the answer to your question, diagnostic and therapeutic nuclear medicine are very active in research and new radiopharmaceuticals coming in for clinical use. So, nuclear medicine is certainly not a dying field. But, who performs what is changing. Of course, there is some overlap. For instance, I perform radioactive iodine treatments and do pretty much all diagnostics. But, I don’t do any of the Lutithera or Xofigo treatments or others available to the public. And, there are all variations in between. Nevertheless, nuclear medicine is an excellent specialty for someone who wants an exciting radiology subspecialty and likes to practice general radiology (Which is what I do!)
That is my long-winded answer to your question (I could have even gone on for longer but had to stop somewhere!)
Dr. Barry Julius
By the way, for those of you interested in a book for nuclear medicine, I would highly recommend the Mettler book. I used it to study for my recertification examination! (I am an Amazon affiliate and receive a commission)