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The Status of Diagnostic Radiology Training Programs and Their Graduates in 1999

¹ Department of Public and International Affairs, George Mason University, 4400 University Dr., Fairfax, VA 22030-4444.
² Research Department, American College of Radiology, 1891 Preston White Dr., Reston, VA 20191.
³ Department of Diagnostic Imaging, Brown University Medical School, Box G, Providence, RI 02912.
⁴ Department of Diagnostic Imaging, Rhode Island Hospital, 593 Eddy St., Providence, RI 02902.

Received February 18, 2000; accepted after revision March 16, 2000.

 
Address correspondence to J. H. Sunshine.

Abstract

Top Abstract Introduction Materials and Methods Results Discussion References

 
OBJECTIVE. To address job market concerns, the American College of Radiology studied the employment of 1999 graduates from diagnostic radiology training programs and the programs' status and plans.

MATERIALS AND METHODS. In late April to the beginning of June 1999, the American College of Radiology surveyed a 50% random sample of diagnostic radiology residency directors about the employment status of their 1999 residency and fellowship graduates as well as about plans for their training programs. Seventy-seven percent responded. We compared findings from the 1999 survey with similar findings from earlier surveys using a p value of less than or equal to 0.05 to define statistical significance.

RESULTS. As of the survey, 95% of residency graduates and 96% of fellowship graduates were reported to have commitments for positions. Ninety-two percent of graduating residents and 95% of graduating fellows reportedly had commitments for positions that reasonably matched their training and personal goals. Completed plus planned changes in residency program size since 1993 would, if implemented, lead to an 8% reduction. Similar to previous years, 96% of the beginning-year residency slots were filled. Program directors reported that the job market had improved compared with that of recent years. The percentage of graduating fellows with commitments for positions was similar in almost all fields.

CONCLUSION. Fellows found jobs earlier than in past years, when unemployment among graduates decreased to 1-2% by 6 months after graduation. Results in 1999 should be at least as good. Employment prospects across all subspecialties are about the same. Planned program reductions are much smaller than those reported in 1998 and may continue to evaporate.

Introduction

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The employment market for physicians is a matter of serious concern throughout the medical community. For example, a widely publicized study predicted a 60% surplus of non-primary-care physicians by the year 2000 [1]. The outlook for diagnostic radiology may be for a surplus of physicians if extensive new technology does not continue to appear [2]. Unfortunately, the only systematic data continuously available (although unpublished) regarding the physician employment situation has been the all-physician unemployment rate from the United States Department of Labor, Bureau of Labor Statistics. This statistic shows trends over a number of years. However, it provides no information on individual specialities and no information on new graduates of training programs, a group whose employment situation may be most difficult because all must find jobs. Studies by the American Medical Association of residency graduates [3, 4] provide useful data on many specialities but are of limited value for diagnostic radiology, a field in which residents overwhelmingly go on to fellowships rather than directly entering the market for posttraining positions.

To help remedy the information deficit, the American College of Radiology has been conducting systematic studies of the employment market for diagnostic radiology [2, 5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20]. To maximize sensitivity to incipient problems and to complement existing data, the current study, the American College of Radiology's sixth annual survey of training program directors, focused on the job market for new graduates and the characteristics of training programs. Comparisons to previous years are included to provide a historical background for current findings.

Materials and Methods

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The American College of Radiology conducted a survey of training program directors and measured trends by comparing results with those of similar surveys conducted in previous years [7,8,9,10]. The survey was conducted from late April to the beginning of June 1999. It was mailed to a 50% random sample of diagnostic radiology residency training program directors in the United States, including heads of military and osteopathic programs. Follow-ups to nonrespondents were conducted by telephone, fax, and mail. Questions sought information about the number of 1999 graduates who had commitments for positions, the nature of these positions, directors' perceptions of the employment market, plans for changes in program size, and fill rates for training positions. There was a separate series of questions for residency and for fellowship graduates.

Tests of statistical significance (p 0.05, two-tailed test), variable definitions, and subgroup analyses remain largely the same as those used for the 1995, 1996, 1997, and 1998 surveys [7,8,9,10]. Estimates for the total number of graduates and the total number of positions offered were adjusted by a factor of 2.6 to represent what answers would have been if all programs had been surveyed and responded.

Results

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The response rate for the survey was 77% (86/111) compared with approximately 90% in 1997 and 1998. In our random sample of 111 of the approximately 220 diagnostic radiology residency program directors in the United States, 48% (41/86) of the respondents reported working at an institution offering a fellowship program. The greatest number of respondents were located in the Northeast (37%), reflecting the concentration of training programs in the region; the fewest were in the West (17%). The responses to the 1999 survey indicate that diagnostic radiology programs graduated 1040 (weighted) residents and 627 (weighted) fellows. This estimate of the number of graduating fellows is probably low, as described in the "Discussion."

Academic-based programs constituted 53% (46/86) of all residency and 75% (30/40) of all responding fellowship training programs. In 1999, these programs graduated an estimated 684 (weighted) residents, 66% (684/1040) of all resident graduates, and an estimated 515 (weighted) fellows, 82% (515/627) of all graduating fellows. There were five (weighted) osteopathic programs that reported eight (weighted) graduating residents and five (weighted) military programs (all allopathic) that reported graduating a total of 18 (weighted) residents in 1999.

Employment Situation of Graduates
Program directors reported that 95% (983/1040) of graduating residents and 96% (603/627) of fellows had secured a commitment for a posttraining job or fellowship (Table 1). In 1998, the figures were 96% for residents and 89% for fellows. The increase for fellows is statistically significant. In the 1999 survey, 92% of residency graduates and 95% of fellowship graduates were reported to have, as of the survey's date, commitments for "positions of interest"—that is, positions that reasonably matched the individual's training and personal employment goals. In 1998, 94% of graduating residents and 88% of fellows were reported to have "positions of interest." The 1998 to 1999 changes were a 2% decrease for residents and a 7% increase for fellows; only the latter is statistically significant. In 1999, the percentage of graduating fellows with posttraining commitments differed significantly from the overall figure of 96% for only a single subspecialty: abdominal imaging, for which the percentage was 79%.

This year, graduating residents received, on average, three job offers, whereas fellows received an average of 3.8. This difference is not statistically significant. In 1998, graduating residents averaged 2.2 job offers; fellows, 2.7. A comparison between the 2 years indicates that, for residents, the number of offers increased by a statistically significant amount. Eighty-eight percent (918/1040) of residents who graduated in 1999 had passed the American Board of Radiology written examination, whereas 62% (21/34) of those without a firm commitment had passed the examination.

Among residency graduates with commitments for positions, 83% were reported to be going on to a fellowship. Among diagnostic fellows with commitments for positions, 3% were reported to be taking another fellowship.

Subgroup Analyses
Our subgroup analyses showed no statistically significant differences between academic-based and community hospital-based programs for the percentage of residents who had commitments for positions—94% for university-based versus 96% for community hospital-based. For positions of interest, the 1999 figures indicate that 93% of the university-based resident graduates had secured positions of interest compared with 89% for the residents graduating from community hospital-based programs. The 4 percentage point difference is not statistically significant.

For fellowship graduates, the 1999 survey indicates that academic-based and community hospital-based programs were about the same in terms of the percentages of graduates, 97% and 93%, respectively, who had secured commitments for positions as of April-June 1999. Ninety-five percent of fellows who graduated from academic-based and 90% of those from community hospital-based programs had secured commitments that matched their training and personal goals. No statistically significant differences between graduates of academic-based programs and community hospital-based programs were found among these results.

Among diagnostic residency graduates who had commitments for positions, no statistically significant difference in graduates going on to a fellowship existed between the 85% from academic-based and the 79% from community hospital-based programs. However, a comparison between the 83% of all 1999 residency graduates with commitments going to fellowships and the 15% of those from military programs doing so reveals a significant difference.

Programs' Results and Plans
The National Match (which excludes osteopathic programs) reported 92% of the available diagnostic radiology residency positions filled in 1999 compared with 86% in 1998, 70% in 1997, 60% in 1996, and 80% in 1995 [21,22,23,24]. Filling of positions after the Match has always been extensive. Our 1999 survey found that 96% of available beginning-year residency positions filled by late April to early June. It is likely that additional positions were filled during the 2 months remaining before training actually began.

The number of beginning diagnostic radiology residency positions offered in 1999 reported in the 1999 survey was 1100, a figure approximately the same as those reported in the 1999 survey for 1998 (1113), 1997 (1092), and 1996 (1100).

Approximately 15% of the beginning residents in 1999 were graduates of medical schools outside the United States and Canada. Retrospective estimates for earlier years as reported by program directors in the 1999 survey were 24% (1998), 24% (1997), and 11% (1996). For all specialty and primary care fields in the United States, the overall proportion of beginning residency positions filled by graduates of foreign medical schools is approximately one fifth.

Directors of programs encompassing 39% of graduating residents reported that since 1993 their training programs had made changes or planned changes that would result in an alteration in the number of residents graduating from the program each year (Table 2). Reductions predominated, and the estimated change in average size among programs planning changes—from 5.7 in 1993 to 4.6 in 1999—is statistically significant. If all planned and completed changes take place, the net effect will be a reduction of approximately 81 positions, or 8% of the number of residents who graduated in 1999. Funding and job market concerns are reported as the primary reasons for the reductions. The 1998 survey reported planned or actual reductions totaling 215 openings, or 21% of the total number of graduates. Comparing these figures indicates that some previously planned reductions are no longer intended.

Directors of fellowship programs also reported changes that will affect the number of graduates. In 1999, directors of programs including 35% of graduating fellows reported planning or making changes in the size of their programs since 1993. In contrast to the reported declines in the number of beginning residency positions offered, the number of fellowships positions offered is reported to be increasing. The average size of programs reporting changes was seven graduates per year before the change compared with a planned 8.2 after the change; this difference is not statistically significant. If all planned changes occur, the net effect will be an estimated increase of 41 fellows graduating annually, or approximately 7% of all 1999 fellowship graduates.

Program Directors' Views
In 1999, only 1% of residency program directors (responses weighted by program size) said finding positions was more difficult than in recent years. This percentage has fallen steadily over the years, from 76% in 1995, 59% in 1996, 38% in 1997, and 16% in 1998 to only 1% in 1999 (Table 2). Fellowship directors were equally optimistic, with only 1% reporting that graduates' job hunting was more difficult in 1999 than in recent years. In 1999, almost 60% of residency directors and 76% of fellowship directors reported that finding jobs was "somewhat" or "much" easier than in recent years, compared with 29% and 54%, respectively, in 1998.

The 1999 survey of program directors included two questions about the quality of residency program applicants. Both questions were phrased in terms of a comparison with earlier years' applicants. The first question compared 1999 applicants with those of the previous year (1998); the second, with those who applied 3 years earlier—that is, in 1996. Seventy-one percent of directors reported that the 1999 applicants were "somewhat" or "much" better than those of 1 year earlier. Sixty-seven percent of directors viewed the 1999 applicants as better than those of 3 years earlier. Also, these responses were more positive than those given by directors to a similar question on the 1998 survey (which compared 1998 applicants with those from 1997 and 1995).

Discussion

Top Abstract Introduction Materials and Methods Results Discussion References

 
General Findings
The percentage of graduating residents and fellows who had commitments for positions as of the April-June date of our 1999 survey was similar to or greater than that reported for 1998, 1997, and 1996. In 1996 and 1997, a December recontact of program directors showed less than 1% of graduates were unemployed 6 months after graduation. Data from graduates themselves ranged from 1% to 2%. On the basis of a comparison of placements as of April-June, we can again expect unemployment rates for 1999 diagnostic radiology graduates to be at or below the 1-2% level by 6-12 months after graduation.

The more optimistic outlook of program directors in 1999 coincides with evidence that the decline in hiring seen during the early 1990s has reversed, or at least ceased, since 1996 [18, 20]. Consistent with the increase in optimism about finding jobs is an improvement in suitability of jobs for fellows. The percentage of fellowship graduates reported to have positions that fit their goals and training increased from 72% in 1996 and 1995 to 85% in 1997, to 88% in 1998, and to 96% in 1999. The 1999 figure represents a statistically significant increase since 1998. On the other hand, the 92% of residency graduates reported to have a position fitting their goals and training is a not statistically significant decrease from 94% in 1998.

Although skeptics may point to individual incidents of unemployment as a sign of a weak job market, these incidents often result from applicants trying to find work in a narrowly defined locality. This factor may help to explain why individual instances of difficulty in securing employment coexist with low overall unemployment. In another study, we found that graduates who cannot, or will not, relocate have disproportionately more difficulty finding suitable employment in the months immediately after graduation [19].

We found, as we have before [8,9,10], that the employment market is about equal in almost all diagnostic radiology subspecialty fields. This conclusion is supported by studies of the other side of the employment market. In these studies [11, 14, 20], we examined the successes and failures that employers (specifically, physician groups) seeking diagnostic radiologists had in filling the positions for which they were recruiting.

Data Strengths and Limitations
Like all data sets, ours has strengths and weaknesses. The strengths include the following: our survey obtained data for a relatively large number of graduates; we obtained a 77% response rate, which exceeds the rate of 70% or less commonly obtained with mail surveys of physicians [25]; and data were obtained rapidly, so our data approximate a snapshot in time.

The limitations of our study include the following. Like all surveys generally, our study provides information about the present, whereas the future is what one wants to know. Previous years' surveys ended in mid May. Although we received few responses after that date in 1999, the beginning-of-June completion date for the 1999 survey makes some of the data not fully comparable with those of previous years. Some of the survey's data are subjective—most obviously, training program directors' ratings of the employment market and of their graduates' employment. Many observers suggest that program directors may not know the full details of positions offered to new graduates (e.g., nonpartnership track, appropriate type of work) and are unable to judge accurately whether a position is a "position of interest." Residency graduates may wish that posttraining positions were available without fellowship training to a greater extent than program directors realize [17, 19]. Additionally, program directors may tend to be optimistic about their programs. However, tendencies to optimism should be somewhat constant, so year-to-year comparisons should be relatively sound. Also, comparisons with surveys of graduates [17, 19] have shown that program directors and graduates agree reasonably on the critical variable of unemployment.

The number of fellowship graduates reported in our survey has been anomalously low in past years and continues that way. Given the number of residents taking fellowships, 700-8000 fellowship graduates would be expected each year—not the approximately 600 reported in 1999. Most likely, the problem is that our survey respondents are the residency program directors and they sometimes do not successfully obtain data from all the fellowship programs at their institutions.

Because of the limited size of our study samples, the statistical power of our analysis is restricted for some subgroup comparisons. This limitation is especially true for comparisons involving osteopathic or military programs. In addition, our study does not address the employment market for experienced radiologists. Results from another survey indicate that radiology groups generally prefer to hire recent graduates rather than radiologists with 10-20 years' experience [16].

Despite these limitations, our study has produced detailed, useful, and timely information about the situation of graduating trainees, the group presumably most sensitive to the ups and downs of the physician employment market. The results of the present study indicate that the job market continued to improve in 1999.

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