Rationale and Objective
The modification of the initial radiology board exam series has as a concerted aim the promotion of subspecialization. Yet, in practice, fellowship-trained radiologists may be assigned to off-hours work in other diagnostic areas. The purpose of this study is to chart the prevalence of after-hour work among the various subspecialties in radiology and to relate those findings to the pertinence of a fourth-year training curriculum devoted to only one imaging discipline.
Materials and Methods
A questionnaire was sent to members of Society of Chairs of Academic Radiology Departments and to directors of the 50 largest American private radiology practices requesting that they list after-hours coverage obligations of their various subspecialists.
Results
Academic and private practice response rates were 40.8% (42 of 103) and 42% (21 of 50), respectively. In academic practice, 80% of neuroradiologists, 93% of interventional radiologists, and 84% of pediatric radiologists were not assigned after-hour coverage in other subspecialties. In private practice groups, only 24% of neuroradiologists, 48% of interventional radiologists, and 33% of pediatric radiologists were free of these duties. For other subspecialists, the likelihood of after-hours assignments to other disciplines was not so discrepant between academic and private practices.
Conclusion
Residents pursuing an academic career in neuroradiology, interventional radiology, or pediatric radiology could benefit from a full fourth-year experience in their area of subspecialty, whereas a more variegated curriculum would be more suitable for other specialists independent of practice type.
In 2007, the American Board of Radiology promulgated fundamental changes in the content, context and timing of the series of examinations that together comprise the initial evaluation process for certification in our specialty. The long-established physics and written examinations which could each be taken in the fall of the fourth year of training, or earlier if the resident wished to do so, would be replaced by a comprehensive “image-rich” computer-based test encompassing all divisions of diagnostic radiology and clinically relevant radiation physics. This new qualifying or core examination will first be given in the fall of 2013, but in subsequent years it will take place annually in the spring. Eligible candidates sitting for the exam for the first time in 2014 and in successive years must have completed 3 years as a diagnostic radiology resident in an Accreditation Council for Graduate Medical Education (ACGME)-accredited program. According to this newly instituted certification schedule, those who passed the core exam will be permitted to take a subsequent final or certifying exam approximately 15 months after completing their fourth year of residency . Most will have spent this fifth year pursuing subspecialty training in a fellowship, whereas others may have chosen this time to begin their career in a clinical practice position.
There is now the potential for the resident to choose from a variety of curricular options during the fourth year of residency training. Consequently, in some programs there may be the opportunity to concentrate time and effort in one imaging discipline in the fourth year, allowing for an uninterrupted and continuous focus on a single subspecialty for 2 successive years–the fourth and the fellowship year.
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Materials and methods
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Results
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Table 1
After-hours Coverage by Subspecialists in Radiology in both Academic and Private Practice Groups
Academic Practice: 42 Respondents
Private Practice: 21 Respondents Academic Private 1. Neuroradiologists Body imaging 2 11 General ER radiology 5 16 Interventional radiology 1 2 Pediatric radiology 2 6 None of the above 33 5 N/A 1 0 2. Interventionalists Body imaging 2 S General ER radiology 2 11 Interventional radiology 0 0 Pediatric radiology 1 6 Neuroradiology 1 8 None of the above 38 10 N/A 1 0 3. Interventional neuroradiologists Body imaging 0 4 General ER radiology 2 6 Interventional radiology 5 5 Pediatric radiology 0 3 Neuroradiology 11 8 None of the above 17 8 N/A 9 2 4. Body imagers Angiography 0 0 General ER radiology 20 19 Pediatric radiology 6 8 Neuroradiology 2 13 None of the above 20 1 N/A 0 1 5. Chest radiologists Body imaging 14 10 Angiography 1 0 General ER radiology 26 12 Neuroradiology 1 8 Pediatric radiology 5 7 None of the above 8 1 N/A 3 8 6. Musculoskeletal radiologists Angiography 0 0 General ER radiology 32 19 Neuroradiology 2 13 Pediatric radiology 6 8 None of the above 9 2 N/A 0 0 7. Pediatric radiologists Body imaging 2 8 General ER radiology 5 10 Neuroradiology 2 7 Angiography 0 0 None of the above 31 5 N/A 5 6 8. Breast imagers Angiography 0 0 Neuroradiology 0 12 General ER radiology 18 16 Body imaging 10 13 Pediatric radiology 6 7 None of the above 21 5 N/A 0 0
ER, emergency room; N/A, not applicable.
Tabulated survey results comparing after-hours, weekend, and holiday coverage obligations between subspecialists in the academic and large private practice settings. An answer of “none of the above” indicates that the radiologist had no formal off-hours assignment outside his or her own specialty, whereas “nonapplicable” was selected if the particular practice in question lacked a designated subspecialist in that particular discipline. In the survey, respondents often selected multiple areas of designated off-hour coverage for each of their subspecialists, resulting in a total number of answers per question that exceeded the number of completed surveys received.
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Neuroradiologist after-hours Coverage
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IR after-hours Coverage
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Interventional Neuroradiologists after-hours Coverage
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Body Imagers after-hours Coverage
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Chest Radiologists after-hours Coverage
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Musculoskeletal Radiologists’ after-hours Coverage
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Pediatric Radiologists after-hours Coverage
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Breast Radiologists’ after-hours Coverage
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Discussion
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Appendix
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References
1. American Board of Radiology. The exam of the future: 8 facts about the core exam. http://www.theabr.org/the_abr/sites/all/themes/abr-media/pdf/overview_changes_2.pdf . June 22, 2011.
2. Proval C.: The 50 largest radiology practices. Radiol Bus J 2010; pp. 27-35.
3. ACGME program requirements for graduate medical education in diagnostic radiology. http://www.acgme.org/acWebsite/downloads/RRC_progReq/420_diagnostic_radiology_07012008.pdf . Accessed June 22, 2011.
4. American Board of Radiology Nuclear Regulatory Commission (NRC) update. http://theabr.org/ic/ic_nuc/ic_nuc_nrc.html . Accessed June 22, 2011.
5. US Department of Health and Human Services. The Mammography Quality Standards Act final regulations: preparing for MQSA inspections; final guidance for industry and FDA. http://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm094441.pdf . Accessed June 22, 2011.
6. Bhargavan M., Sunshine J.H.: The growing size of radiology practices. J Am Coll Radiol 2009; 5: pp. 801-805.