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My pathologist colleague believes Canada is harder to match into.In fact, his residency program in the United States included Canadian medical graduates who failed to match in Canada.All the best!2017 NRMP Main Residency Match the Largest Match on RecordMore than 43,000 applicants registered and more than 31,000 positionsoffered.National Resident Matching ProgramWASHINGTON, March 17, 2017 /PRNewswire-USNewswire/ -- Today the National Resident Matching Program® (NRMP®) announced the results of the 2017 Main Residency Match®, the largest in its history. A record-high 35,969 U.S. and international medical school students and graduates vied for 31,757 positions, the most ever offered in the Match. The number of available first-year (PGY-1) positions rose to 28,849, 989 more than last year.2017 Main Residency Match InfographicMatch Day, celebrated around the world, is when applicants learn the location and specialty of the U.S. residency programs where they will train for the next three to seven years. Seniors at U.S. allopathic medical schools participate in Match Day ceremonies and open their Match letters in the company of family, friends, and advisors."We are honored to be part of this life-changing event for young physicians, and we wish them success in their residency training," says NRMP President and CEO Mona M. Signer. "There no doubt will be wonderful cause for celebration at the nation's medical schools today and for all Match participants as they commemorate this defining moment in their careers." Joint NRMP, American Medical Association (AMA), Association of American Medical Colleges (AAMC) celebrations take place on social media, this year with the #Match2017 hashtag.Program HighlightsResults of the Main Residency Match are closely watched because they can be predictors of future changes in physician workforce supply.Primary CareIn 2012, the NRMP implemented a policy requiring Match-participating programs to place all positions in the Match, spurring significant increases in the number of primary care positions offered. In the six years since implementation of the policy, Internal Medicine, Family Medicine, and Pediatrics have added a combined 2,900 positions, a 25.8 percent increase. Highlights from the 2017 Match include:Internal Medicine programs offered 7,233 positions, 209 more than in 2016; 7,101 (98.2%) positions filled, and 3,245 (44.9%) filled with U.S. allopathic seniors.Family Medicine programs offered 3,356 positions, 118 more than in 2016; 3,215 (95.8%) positions filled, and 1,513 (45.1%) filled with U.S. allopathic seniors. Since 2012, the number of U.S. allopathic seniors matching to Family Medicine has increased every year.Pediatrics programs offered 2,738 positions, 49 more than in 2016; 2,693 (98.4%) filled, and 1,849 (67.5%) filled with U.S. allopathic seniors.Other HighlightsEmergency Medicine offered 2,047 first-year positions, 152 more than in 2016, and filled all but six. The overall fill rate was 99.7 percent, and 78.2 percent were filled by U.S. seniors. Since 2012, the number of Emergency Medicine positions has increased by 379, or 23 percent.Psychiatry offered 1,495 first-year positions, 111 more than in 2016, and filled all but four. The overall fill rate was 99.7 percent, and 61.7 percent were filled by U.S. seniors. Since 2012, the number of Psychiatry positions has increased 378, or 34 percent, and the number of positions filled by U.S. allopathic seniors has increased by 307.Specialties with more than thirty positions that achieved the highest percentages of positions filled by U.S. allopathic seniors, which is one measure of competitiveness, were Integrated Plastic Surgery (93.1% U.S. seniors), Orthopedic Surgery (91.9% U.S. seniors), and Otolaryngology (91.5% U.S. seniors).Applicant HighlightsAlthough the 43,157 Match registrants was the most ever, the increase was due primarily to growth in U.S. allopathic medical school seniors and students/graduates of U.S. osteopathic medical schools.The number of U.S. allopathic medical school senior registrants was 19,030, 362 more than last year; of those, a record-high 18,539 submitted program choices, and 17,480 (94.3 %) matched to first-year positions. The 94 percent PGY-1 match rate for U.S. seniors has been consistent for many years.The number of U.S. osteopathic medical school applicants was a record high 5,000, and 3,590 submitted program choices, an increase of 608 over 2016; 2,933 (81.7%) matched to PGY-1 positions, also a record high.The number of U.S. citizen international medical school students and graduates (IMGs) who submitted program choices declined by 254 to 5,069; however, 54.8 percent (2,777) matched to PGY-1 positions, the highest match rate since 2004.The number of non-U.S. citizen IMGs who submitted program choices also declined, from 7,460 in 2016 to 7,284 this year, but 3,814 (52.4%) matched to first-year positions, 45 more than in 2016 and the highest match rate since 2005.Unmatched ApplicantsApplicants who did not match to a residency position participated in the NRMP Match Week Supplemental Offer and Acceptance Program® (SOAP®) to attempt to obtain an unfilled position. This year, 1,177 of the 1,279 unfilled positions were offered during SOAP. SOAP results will be available in the full Match report published in May.View the Advance Data Tables, Match by the Numbers, and infographicThe Match ProcessThe Main Residency Match process begins in the fall for applicants, usually during the final year of medical school, when they send applications to the residency programs of their choice. Throughout the fall and early winter, applicants interview with programs. From mid-January to late February, applicants and program directors rank each other in order of preference and submit the preference lists to NRMP, which processes them using a computerized mathematical algorithm to match applicants with programs. Research on the NRMP algorithm was a basis for awarding The Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel in 2012.About NRMPThe National Resident Matching Program® (NRMP®) is a private, non-profit organization established in 1952 at the request of medical students to provide an orderly and fair mechanism for matching the preferences of applicants for U.S. residency positions with the preferences of residency program directors. In addition to the annual Main Residency Match® for more than 43,000 registrants, the NRMP conducts Fellowship Matches for more than 60 subspecialties through its Specialties Matching Service® (SMS®).Contact:Diane [email protected] Performance in the 2017 Match - ECFMG NewsCharting Outcomes in the Match for International Medical Graduates 2016 (www.nrmp.org)[DISHEARTENING DISCUSSION FROM STUDENT DOCTOR NETWORK PATHOLOGY FORUM]2017 Pathology NRMP statisticsDiscussion in 'Pathology' started by Doormat, Mar 17, 2017.Doormat Status: Attending Physician It's official. Pathology is the worst of the worst. The bottom of the barrel. Statistics for the 2017 match are available on the NRMP website. This year, a paltry 231 US medical graduates applied for pathology residency positions. 35.9% of all pathology residency slots were filled by US applicants this year. That’s nearly 10 percentage points less than the next lowest major specialty -- family medicine, with 45.1% of positions filling with US grads. 21% of all pathology training programs in the US went unfilled. In recent years Pathology has been commoditized like no other specialty and US grads are taking notice. They are avoiding our specialty in droves.#1Doormat, Mar 17, 2017jupiterianvibe Status: Post Doc That's why I'm leaving. better late than never.I can assure you that every single one of those unfilled positions is going to be filled with an IMG. This field is a joke. Should be a PhD program.#2jupiterianvibe, Mar 17mikesheree Physician Gold Donor Classifieds Approved Status: Attending Physician Very sad but no surprise at all. #3mikesheree, Mar 17, 2017coroner Peace Sells...but who's buying? Physician Status: Attending Physician I wonder why it was so low this year. I remember when I matched, it was actually majority AMG's i.e. about 55%. This shouldn't be anything to get too depressed about...competitiveness and interest of specialties tend to wax and wane over the years with the exception of the few steady ones at the top e.g. derm, plastics, etc.jupiterianvibe said: That's why I'm leaving. better late than never. Care to tell us your backup plan? For all we know it could be anything from real estate to freelance hacking for the Russians...#4coroner, Mar 18, 2017postbacpremed87 Status:Medical Studentgbwillner said: ↑Definitely a down year and recent downward trend. CAP and other groups should be alarmed by this. When I joined this specialty, it wasn't competitive, but certainly more so than pediatrics and IM. Now it certainly seems like US students are staying away. Think they will consider cutting spots now? 1/5 of all spots didn't fill. I think US students would be open to Pathology if they started limiting Path spots. #6postbacpremed87, Mar 18, 2017Thrombus Member Status: postbacpremed87 said: ↑Think they will consider cutting spots now? 1/5 of all spots didn't fill. I think US students would be open to Pathology if they started limiting Path spots. Big Academia thrives on the labor and the 6 figure pay checks that come with it. No way they cut. We don’t need pathologists for 10 years at least. Pathology is run by fools!!!#7Thrombus, Mar 18, 2017jupiterianvibe Status: Post Doc Thrombus said:Pathology is run by fools!!! I disagree.The pathology rank-and-file are fools, but its overlords are geniuses. #8jupiterianvibe, Mar 18, 2017jupiterianvibe Status: Post Doc gbwillner said: ↑Definitely a down year and recent downward trend. CAP and other groups should be alarmed by this. When I joined this specialty, it wasn't competitive, but certainly more so than pediatrics and IM. Now it certainly seems like US students are staying away.They're gonna do the same thing they do every year. "it's just a bad year, let's get more data".Meanwhile every unfilled spot is going to go to whatever IMG walks through the door. We've no standards in this field. None.I wonder if the ivy leagues like that the rest of the field is populated by dumbasses so that they can have more consults sent to them (kidding, kind of) #9jupiterianvibe, Mar 18, 2017Pathman1000 Status: Resident [Any Field]docprincess said: ↑Please stop spreading rumors about this speciality.if you are not happy, please leave this field and apply for another speciality. But realize that everyone doesn't want to go for Internal medicine or family medicine. People are frustrated in those fields too. Every field has its prons and cons. You can't tract any speciality down based on no reasons. This is a field of interest and skill. US grads don't apply much to pathology because they do not have Pathology in their medical school curriculum. Many of them don't know what this field is about. Foreign grads have extensive exposure and so they do have interest. You show a slide to one us grad and one foreign grad, you will see the difference. Still those US grads who are applying to this field do rotations in path and they really like it. I personally know many who switched from SURGERY or other speciality to Pathology. So please please stop this negativity on this forum. This is still great field for those who have skills to make diagnoses. It's not easy. You look under microscope and you realize it's not easy. People who are new to this field , do not go by any negative posts.We all know it's interesting, but few are hiring. Talk to the fellows; the people on this forum are not lying. Jobs are not plentiful and 2-3 fellowships is common! US medical students aren't stupid. They see the writing on the wall! #12Pathman1000, Mar 19, 2017DrfluffyMD Status: Resident [Any Field]docprincess said: ↑US grads don't apply much to pathology because they do not have Pathology in their medical school Parked at Loopia derm curriculum during my us med school either#13DrfluffyMD, Mar 19, 2017Granular Status:Attending Physician@ docprincess: Are you kidding? In executive suites, pathology is seen as a commodity, regardless of your opinion of the field. Hospitals are contracting out their labs to "industry" or "expert" management teams as mechanisms to reduce costs. They go to the lowest bidders - like they do for food service or cleaning/environmental services. Do the hospitals' electricians need a medical director? Informed US med students do not want to go through all the expense and training for the reality of being viewed/treated like technicians or servants. For US grads, the high cost of med school raises the bar for what fields they should pursue to get the proper ROI; for FMGs, perhaps the financial barriers to entry are lower, so the ROI of becoming a pathologist is adequate.The medical-academic-industrial complex does not want this situation to change. UROs, Derms, GIs, are all profiting enormously from the current situation, at the expense of pathologists and pathology. Train more folks, and "per slide" bids will go lower. The field is doomed, and the problems are not analogous to the situations docprincess is invoking - frustration due to other factors (perhaps documentation, billing, etc). To correlate with path, imagine too many derms. Rather than refer patients to a dermatologist, family practitioners hire them in their practices as non-partners, bill for their work, and pay them 20% of their professional fees. Until they can find one to do it for less. Get real, docprincess!#14Granular, Mar 19, 2017jupiterianvibe Status:Post Doc DrfluffyMD said: ↑No derm curriculum during my us med school either. I know right? Academic pathology likes to attribute the lack of interest in our field to a lack of exposure in medical school (there are tons of articles saying this), all the while ignoring any evidence that refutes their stupid hypothesis, such as the fact that derm/ophthal/uro/anesthesia always do better yet are off the radar in most schools. They also ignore the fact that family medicine is right down there with us yet most schools have a heavy family medicine component in their curriculum. So exposure does not correlate with interest. Dead theory. Put it to rest.Students don't want to become pathologists because we are about as professional as a lab tech nowadays. monkeys.can't live in a decent place.can't get a job with professional respect.always having your income shaved by businessmen.working as a servant for your former classmates.all garbage.docprincess sounds like one of those 'grateful' IMGs. #15jupiterianvibe, Mar 19, 2017Thrombus Member docprincess said: ↑I am US grad for those who have concerns regarding IMG/AMG. But I did rotations in Pathology. I was just trying to say that those rotations helped me to decide my career and I like what I am doing. Everyone might have their own opinions regarding this field but it doesn't have to be bad for all. I am third year resident at prestigious institute and The advances in this field are beyond imagination unless you have worked in top ten institutions in this country.Are you aware of the number of private pathologists and their groups being forced out of their hospitals thanks to the large number of foreign nationals willing to work for pennies on the dollar, a direct result of overtraining thanks to reliance of Big Academia on the welfare rolls?#18Thrombus, Mar 19, 2017 Last edited by a moderator: Mar 19, 2017path24 Status:Attending PhysicianGo into pathology and you have no control/stability over your entire career. The truth is getting out some? A pathologist is just a glorified lab tech that can easily be replaced.#19path24, Mar 20, 2017jupiterianvibe Status:Post DocAZpath said: ↑Our leadership is stupid. Less spots for sure. Membership has got to be more vocal. If practicing docs don't press the issue the status quo will rule.Contact the CAP HOD members. We need to give CAP an enema. How can this be done when the CAPs major revenue source is big labs?i recently read the book 'the rape of emergency medicine'. what happened in that was the emergency medicine national society was corrupt in that corporate interests were superseding the professional interests, so a bunch of emergency docs got together to form their own thing, and it worked out for the field as a whole.Pathologists should follow suit.#21jupiterianvibe, Mar 21, 2017pathstudent Sound Kapital Status: Pre-Health (Field Undecided) I think it was even worse before. I think only a little over 100 applied in the late 90s. But there were 25% less spots back then #22pathstudent, Mar 21, 2017Thrombus Member KeratinPearls said: ↑Man there's a lot of negativity on here nowadays. Starting to think dudes like jupitervibes is Thrombus' second screenname. Nope, not me! Although I have been trying to sound the alarm for 10 plus years now. Now crazy Thrombus is proving to be sage as pathologists are forced to take drastic pay cuts, forced out of their jobs, lose their practices, consolidate, etc all due to the massive overtraining that has been taking place for decades thanks to government/resident subsidized Big Academia.#24Thrombus, Mar 22, 2017WEBB PINKERTON Status: Non-Student It could be our dead outlook on life..Maybe you are right.I really don't care what people believe but I have lost count of the "card carrying" atheists I have ran into in this field. There are other pathology listservs/blogs online with these liberal dbags who love to show their intellectual superiority over the "believers". All they accomplished was chasing away the decent posters on the sites.#28WEBB PINKERTON, Mar 23, 2017gbwillnerPastafarianModerator Emeritus Status:Attending PhysicianWEBB PINKERTON said: ↑It could be our dead outlook on life..Maybe you are right.I really don't care what people believe but I have lost count of the "card carrying" atheists I have ran into in this field. There are other pathology listservs/blogs online with these liberal dbags who love to show their intellectual superiority over the "believers". All they accomplished was chasing away the decent posters on the sites.Don't worry- they won't be renewed at the time of carousel.#31gbwillner, Mar 23, 2017pathstudentSound Kapital Status:Pre-Health (Field Undecided)does anyone have the data? I always like seeing which top tier programs didn't fill.And to the woman above who said that we couldn't believe how advanced they are at a top ten academic facility, I couldn't disagree more. I came from a place like your and am now in a quaternary care private practice and the physicians in my community are way more advanced than the ones from where I trained.#34pathstudent, Mar 23, 2017yaahBoringAdministrator Physician Status:Attending Physician Sometimes institutions technically list that they have "residency spots" even though they don't plan on filling them, I think the reason being that it's a lot harder to get a spot back once you give it up than to just not fill it for a few years. At my residency program, they always had two dermpath spots but only filled one until starting a few years ago. So maybe this is a good thing - some programs are actually shrinking their residency. I am not in academics though, so I don't really know.#42yaah, Mar 26, 2017icpshootyz Status:Attending PhysicianWEBB PINKERTON said: ↑It could be our dead outlook on life..Maybe you are right.I really don't care what people believe but I have lost count of the "card carrying" atheists I have ran into in this field. There are other pathology listservs/blogs online with these liberal dbags who love to show their intellectual superiority over the "believers". All they accomplished was chasing away the decent posters on the sites.When do I get my card? I must have missed when they were handing them out...#43icpshootyz, Mar 27, 2017dr.weiner Status:Attending PhysicianI'd say this forum goes a long way in contributing to the decrease in US grads applying. It's one of the few online resources out there with practicing pathologists. Unfortunately the trolls are the loudest and discourage people from even doing a rotation. The happy people in path (the vast majority) have better things to do than troll this forum. Unfortunately people like yaah who constantly offer the reasonable contrarian opinion are few and far between. I don't blame them. It has to be exhausting.I guess I should relish my personal job security and marketability but I just feel bad for the lack of self respect that people have for their own livelihood and whatever circumstances lead them to this level of self loathing. I also think pathologists have the most free time at a computer than any other field and this contributes to the problem.Life isn't perfect, but path was the only field in medicine I could actually enjoy on a daily basis, I make more money per hour (40-45 hours a week) and have more vacation than most people in medicine. I have absolutely no regrets about my specialty choice. SDN was helpful for me but I had to sift through the doom and gloom 10 years ago to check the field out for myself to really figure it out what it entailed. I recommend that anyone the least bit interested should do the same.But what I do I know, I'm just a practicing pathologist and have been a member of this forum for over a decade.#45dr.weiner, Mar 28, 2017y2k_free_radical gbwillner said: ↑I think a point that is often overlooked is that, despite the market issues/pressures on our field, as noted above, we tend to do better monetarily than most other docs. We might make 70 cents on the dollar sometimes, but those dollars tend to be great in number. Peds and family docs in general don't make anywhere near what we make. Now, of course there are some who own their own practices and make a lot of money, but they are not the norm. We are also not on par with what our most closely interacting docs (oncologists, surgeons) make. But I think we have been very myopic on this forum, and things for the average pathologist are not as dim as would seem.I truly hope you two are correct about our sanguine future and we pessimists are wrong.#47y2k_free_radical, Mar 29, 2017neoevolution Status:Medical StudentI'm a US MD student and we cover normal histology in M1 and pathology in M2, but it's mostly to the extent that's relevant for Step 1. Radiology and derm get similar coverage. I think that's as much exposure as our curriculum can fit considering everything else we need to cover#48neoevolution, Mar 29, 2017razorJust an osteopathic turd awaiting excretion Status:Medical Studentdr. I'm a 4th year DO student matched into pathology. I have nowhere near any of the experience to comment on the status of pathology, but I can tell you I have met several pathologists in my medical school career that echo the above quoted opinion.I have made it a point to visit with the pathologists at the different hospitals I rotate at. Since I'm a DO, we do most of our rotations at private community hospitals so these aren't academic pathologists just trying to fill their program. These are just happy pathologists out working in the community. Off the top of my head I can count 11 pathologists I met from different hospitals in different cities over the last 2 years of clinical rotations (not counting the faculty/residents at academic centers where I interviewed). Every single one of them loved their job, called pathology "the best kept secret" in medicine, and recommended it to me. When asked about the "job market" in pathology they all pretty much laughed and said that has been the word on the street for 20 years. They admitted getting a job isn't as much of a job-seekers market as primary care, but none of them spoke the doom and gloom on SDN. Also, the ages of these pathologist ranged from <5 years out of residency to near-retirement.I only bring this up because my face-to-face experience with 11 out of 11 private practice pathologists in the real world is 180 degrees different than this forum would lead the general medical community to think. So, my recommendation to any interested medical student is to walk into the pathology department at every hospital you go to and introduce yourself to the pathologists (my experience was even easier, most of my attendings would take me to the pathologists or email them to introduce me). Ask them for yourself. I'm not saying ignore the posters on this forum, just take it into consideration as useful information, because I respect the fact that people posting on here probably have very valid and real experiences to back up their dismal outlook. I'm not trying to start a "flee pathology now, path is dead" rant; I just wanted to share my perspective as a student for future young'uns in my shoes. Peace.#49razor, Mar 30, 2017yaahBoringAdministrator Physician Status:Attending Physiciany2k_free_radical said: ↑I truly hope you two are correct about our sanguine future and we pessimists are wrong.Pessimists can never be proven wrong. Their predictions are just delayed awhile, or they will latch on to some specific thing to prove their point. Optimists can have a similar problem although they are at least a lot more pleasant to be around and will typically work hard to keep improving things that they see need to be improved.I have always been an advocate for nuance and realism. Anecdotes can be informative but are not necessarily trend setting. Trends can be informative but are not necessarily easily understandable or predictive.The pessimist has the luxury of always dwelling in the negative. When the negative doesn't happen as much as they thought, they just shift that to further into the future. If they don't want to do that, they identify negative trends to focus on amidst the good.I tend to think it is far too exhausting and useless to be Chicken Little. It gets you nothing. If your fears are confirmed, you don't get a prize, you just get your worst fears confirmed and you can talk about how right you were. That and 25 cents can get you 10 minutes at a parking meter. Personally, I acknowledge the challenges and the difficulties, but work to make the future as good as I can. And I try to surround myself with people who feel the same way. Selfishness only goes so far, and the truly selfish usually end up the most miserable.If I listened to some people on this forum 13 years ago, I wouldn't be in the greatest career I could have imagined, working with a great group of people, and getting paid well to do something I enjoy and have a talent for. But that being said, you do have to listen to all voices. Understand what you are doing, understand who you are and what you want, and always be prepared and vigilant. So I appreciate the naysayers on this forum as well as the optimists, although I have greater respect for the realists.#50yaah, Mar 31, 2017https://www.carms.ca/wp-content/uploads/2017/04/2017-CaRMS-Forum-web-deck-EN.pdf

Q. How competitive is the job market for radiologists?A. The job market for radiologists has finally turned around.New survey finds radiologists are back in demandThe Radiology Job Market Must Change with the TimesTwo ways to make the most of the improving radiology job marketNew survey finds radiologists are back in demandBy Brian Casey, AuntMinnie.com staff writerJune 8, 2017 -- For the first time in a decade, radiologists have landed back in the top 10 of search assignments for U.S. physicians by recruiting firm Merritt Hawkins, as employment conditions in the specialty continue to improve.Merritt Hawkins noted that radiologists had been absent from its top 10 list since 2007. The specialty's return is due to an increase in diagnostic imaging procedures, a more limited pool of candidates, and the proliferation of teleradiology services.The firm said it received 80 requests for radiologist searches in 2016/2017, up 100% from 40 in 2015/2016. The growth was enough to land radiology in the tenth spot on the list, which was topped by family medicine physicians, psychiatrists, and internal medicine doctors.The firm also reported an average salary for radiologists of $436,000 in the 2016/2017 period. The company characterized radiology's resurgence as the continuance of a comeback. Demand for radiologists had diminished starting in 2003, when the specialty topped Merritt's list of most requested search assignments. Contributing to the decline was a "robust" supply of residents entering the job market, reimbursement cuts, and utilization suppression.But renewed demand for radiologists is "inevitable," according to the report, "because imaging remains central to diagnostic and procedural work in today's healthcare system, in which very little transpires without an image." Also, due to an improving economy and an aging population, "demand for radiologists was going to rise at some point." What's more, close to 50% of radiologists are older than 55, "and attrition is beginning to reduce the candidate pool. "Teleradiology has affected the field, but Merritt noted that demand is at the level where clients are seeking both traditional onsite radiologists as well as teleradiologists. The report can be accessed by clicking here.The Radiology Job Market Must Change with the TimesApr 14, 2017 | Nisha Mehta, MDAll signs indicate that the radiology job market is turning around. The number of available positions in 2016 well exceeded the number of finishing trainees, and this trend is expected to continue as more senior radiologists retire or cut back. A 2013 Health Affairs study projected that as the U.S. population ages, demand for radiology services will grow approximately 18 percent between 2013 and 2025 (Health Aff (Millwood). 2013 Nov;32(11):2013-20). When accounting for other factors leading to an overall increased utilization of radiology services, the increase in volume will likely be larger. Compounding this numbers problem, a higher proportion of radiologists are interested in limiting the number of hours they spend at work. So along with the other challenges facing the field, radiology is now in the position of facing a shortage of physicians.In 2015, applications for radiology residency were the lowest in a decade, according to data from the National Resident Matching Program. Conversations with medical students yield concerns about declining reimbursement and uncertainty about the future of the field. However, this factor only accounts for a fraction of their concerns. Compensation cuts and rapidly evolving practice landscapes are realities across the board in medicine, and radiology remains one of the better reimbursed fields. So what is it about radiology that’s causing a decline in applicants?Digging deeper, a less discussed factor provides some answers. Medical students have been listening to the complaints of those they rotate with. As an increasing percentage of women and millennial physicians enter the job market, simply looking at compensation downplays the crucial role that work-life balance and job satisfaction play in selecting a specialty. Millennials have consistently shown that they are willing to take significant salary cuts to achieve better work-life balance. For women, who stereotypically place more emphasis on this, the numbers indicate that radiology is not faring well with recruitment. Although nearly 50 percent of medical students are female, only approximately 27 percent of radiology residents are female.1According to a recent study published in Mayo Clinic Proceedings, radiologists ranked fifth out of more than 23 surveyed specialties in their reported burnout rate (Mayo Clin Proc. 2015 Dec;90(12):1600-13). While 47.7 percent of radiologists reported experiencing burnout in 2011, that number jumped to 61.4 percent in 2014. Contributing factors include increasing volumes, the heavy emphasis on reducing turnaround times, decreasing reimbursement and the amount of required after-hours work. Also, as radiology groups look to compensate for lost income by taking back the night from teleradiology, companies and hospitals are increasingly requesting in-house (and in some cases, subspecialty) coverage and the frequency of in-house calls has become more burdensome. It’s been cited as a reason why many switch to teleradiology jobs, as well as a reason why competitive medical students choose to pursue other in-demand specialties, which for the most part allow calls to be taken from home and utilize physician extenders to cover basic needs in the hospital. While medical students are expressing a preference for lifestyle-oriented fields, the average radiology group is actually shifting in the other direction.Traditionally, radiology practices have operated on an egalitarian model, with work responsibilities, income, and vacation being evenly distributed amongst partners. There are obvious benefits to this framework, and its simple nature is appealing to groups that don’t want to get caught up in the many nuances that arise if they stray from it. Accommodating part-time physicians can significantly complicate work and vacation scheduling, for example. And employing part-time physicians can contribute to the mentality that shifts extra responsibility onto full-time partners, adding to an already perpetually increasing administrative burden. Structuring partnership agreements to reflect varying commitments to the practice while still remaining fair to everyone involved can become very subjective, and often contentious.Regardless, it is now time for a change. Although many groups would (understandably) make the argument that they are looking to recruit people who are willing to work more, rather than less, these radiologists are in limited supply. Recruitment and retention of full time radiologists with large call responsibilities will become increasingly difficult as the demographics of trainees change. The lack of part-time options or flexibility in scheduling is one of the most common cited factors in the decision of a growing number of radiologists to shift to locums or teleradiology positions. As this trend is often blamed for undermining the private practice radiology group’s ability to negotiate with hospitals, commoditizing radiologist skills and driving down reimbursement, groups should pay close attention to this new demographic.We as a field need to become more creative and address changing demographics and physician burnout. We need to make it possible for people to work varying amounts and recognize the needs of those who would trade a portion of their compensation for increased flexibility. As groups grow larger, the potential for these opportunities should increase. This would help groups with the recruitment of new physicians while also helping them keep senior partners who might be looking to scale back a bit.Time off is an obvious area that groups should revisit. Most radiology groups offer generous amounts of vacation, but also tend to offer vacation in one-week blocks to ease scheduling complexity. This process is problematic for those hoping to take more three day weekends or have an occasional day off to go to a school event. By offering at least a portion as individual days off, radiologists could choose to work less days a week, and part-time positions could be more easily accommodated.Job sharing doesn’t have to only involve two people; it could be a combination of three or four people who make up an even number of full time equivalents. Tailoring worklists such that certain assignments could be handled remotely would also allow for greater options in larger groups, including an expanding role for home workstations and the ability to customize work hours. The utilization of physician assistants can provide additional latitude. Many groups have found “weighing” shifts to be helpful, heavily incentivizing those who are willing to work nights, weekends and holidays. Those who don’t want to take as much call should be permitted to outsource their calls to other radiologists in the group or even locum radiologists.Groups in the Midwest and the South will have to adjust first, as this is where the largest percentage of open positions are right now. These groups have conventionally attracted fewer applicants, but have been able to successfully recruit by offering higher salaries and lower costs of living. Given that millennials are less lured by these factors, recruitment will become increasinglydifficult. This will be compounded by the fact that many of these groups are smaller and may need radiologists who are willing to be generalists. Today’s trainees, who are completing mini-fellowships in residency followed by formal fellowships after residency, may find themselves uncomfortable with these positions. Having more flexible options than those offered by in-demand urban groups would provide these groups with a competitive edge.Lastly, more groups may want to consider providing paid maternity leave. In the larger scheme of a radiologist’s career, paying for a few months of time off is likely a drop in the bucket. However, for young female radiologists coming out of training, who are often burdened with medical school debt, this unpaid time can be quite stressful. The prospect of paid maternity leave not only relieves that stress, but fosters goodwill in showing that a group is family friendly. This trait can be incredibly important to women physicians, and may be the reason why they pick one job over the other.Market forces will ultimately force radiology groups to adapt, despite the hassles that come along with shifting away from traditional models. Happy radiologists are good for business, and maintaining the competitiveness of radiology applicants is good for the field. The evolution of our group practice models is consequently not only necessary, but smart.Two ways to make the most of the improving radiology job marketBy John P. McGahan, MDFour years ago I recall writing in this space regarding a downturn in the radiology job market.How things have changed!A recent (2016) ACR-commissioned survey of radiology groups reveals that between 1,713 and 2,223 new jobs will become available this year. This represents over a 16% increase from the prior year. Breast imaging remains the most sought-after subspecialty, constituting 14% of job opportunities. This is closely followed by general interventional radiology (13%), and then by neuroradiology, general radiology, body imaging, and musculoskeletal imaging, which all share nearly equal opportunities for radiologist employment. Also worth noting is an upward trend in emergency radiologist hiring, at 10% of position openings. As a brief aside, the survey found that a relatively large portion—28%—of practicing radiologists are 55 or older.The survey results reflect my own impressions which, based on anecdotal evidence, indicate the job market is much more robust than it was even a year ago. At my own institution, I have seen a resurgence of our fellows obtaining multiple job offers in desirable locations. This was not the case just two years ago.At the same time, on our recruitment end, we are having a much more difficult time filling our openings in abdominal imaging. Two years ago my section had 55 applicants for one position. In the past year that decreased to 15 applicants. Surveys of program directors show them offering positions in academic radiology to their best fellows at the beginning of the year, knowing the pool of qualified applicants will be diminished by mid-year.I would argue that this all means we need to do two things: 1) spread the word to our residents, and especially to our medical students, that radiology job opportunities are back, and 2) broaden the scope of our radiologic training.An interesting study published in 2015 by Arleo et al showed that 50% of respondents going into radiology were concerned about outsourcing, and 45% of those not going into radiology thought the radiology job market was shrinking. This same study showed that intellectual challenge was listed as the top reason for students going into radiology, while degree of patient contact was listed as the most common reason medical students chose other specialties.Another telling survey statistic is that in 2009, 87% of radiology residency positions were filled by United States medical graduates, while in 2015, only 56% were filled by U.S. graduates. In addition, only 2.8% of women, compared to 11.8% of men, applied for radiology positions.The same survey found only a small fraction of residency applicants previously had radiology rotations at their medical schools. Having such a rotation was correlated with a higher likelihood of choosing radiology. Thus, to continue the supply of top-tier applicants into radiology, it would seem that elective rotation exposure to the specialty in medical school is vital.Preparing for the job marketWith these recent improvements in the job market, how should radiology residents prepare to be successful job applicants? For one thing, it helps to have broad training.Certainly, in the 1980s it was rare for radiologists to seek fellowship training: in 1984, only 8% had fellowship training compared to 95% of radiologists today. Furthermore, up to 18% of radiology residents pursue two fellowships.What are some important skills sought by prospective employers? Three-quarters of those in private practice are seeking applicants with subspecialty training and general radiology skills.Academic departments seek similarly prepared applicants in 38% of cases, while 44% seek candidates with specialty training only. This may have implications for fourth-year radiology students and their selection of fellowship. Residents and fellows should realize that finding an isolated niche in one subspecialty may not make them competitive for the current job market. Thus, some have suggested that the fourth year of residency should include multiple or all subspecialties of radiology.For example, at my institution we still provide an obstetrical ultrasound rotation, yet one of our seniors planning for a career in interventional radiology preferred to skip that rotation in favor of another on the interventional service to further prepare himself for his fellowship. However, given the data noted above, more competence in multiple areas of radiology may be preferable, especially to provide on-call coverage. The potential for fellows to handle many specialty areas beyond training points to the need to preserve a strong level of general radiology training rather than do a pseudo-fellowship in residency before an actual fellowship where true specialty training should occur.While I certainly hope that ongoing job growth in radiology will encourage U.S. medical students to choose our field as a specialty, there is more we can do to keep radiology a robust and popular specialty. One is to get the word out about radiology earlier. It seems wise to provide medical students more contact with radiology earlier in their clinical training, rather than confining it to a fourth-year elective, when it is too late to influence their specialty selection.Second, we need to broaden the scope of our training. If prospective employers are looking for broad-based skills to provide appropriate coverage, it seems the senior year of residency should provide diverse training that emphasizes general skills. Added experience outside the primary specialty definitely appears important, particularly in the private practice setting.Amid the uncertainty of how today’s political climate in Washington will impact health care, I believe that taking these steps can help prospective job seekers make the most of the improving job market in radiology.ReferencesBluth EI, Bansal S. The 2016 ACR Commission on human resources workforce survey. J Am Coll Radiol.2016;13 (10):1227-1232. doi:10.1016/j.jacr.2016.06.006Arleo EK, Bluth E, Francavilla M, et al. Surveying fourth-year edical students regarding the choice of diagnostic radiology as a specialty. J Am Coll Radiol. 2016;13 (2):188-195. doi:10.1016/Journal of the American College of Radiology 2015.08.005Sharafinski ME, Jr., Nussbaum D, Jha S. Supply/demand in radiology: A historical perspective and comparison to other labor markets. Acad Radiol. 2016; 23 (2):245-251. doi:10.1016/j.acra.2015.10.009Glover M, Patel TY. The radiology fellowship arms race cannot be won. J Am Coll Radiol. 2016:13 (4):461-464. doi:10.1016/j.jacr.2015.11.025Bluth EI, Larson PA, Liebscher LA . Radiologist hiring preferences based on practice needs. J Am Coll Radiol.2016; 13 (1):8-11. doi:10.1016/j.jacr.2015.06.011

Yes. If you have birth in the US,the USCIS will want to see evidence that your hospital and doctor bills were paid in full.While it is legal to come to the US to give birth, it is totally unacceptable to come to the US and fail to pay for care that can cost $30,000 for a normal delivery and a lot more, if a baby needs to be in intensive care, have surgery, etc. Basically, it is like stealing, since a person gets valuable services without paying for them. And it is the American people and the US government who are the victims of an increasing number of non-Americans who want their children to become citizens, by being born here, and who want top quality care, but who do not want to pay for the privilege. I am not saying that you behaved that way, but many people from overseas have been doing so lately.Americans generally have private insurance or government programs that pay for most of their care. Employed Americans generally get private insurance through their jobs. Most elderly Ameicans who have worked as adults are eligible for Medicare, sometimes supplemented by private insurance. Americans with low incomes usually get put on Medicaid, a government program that covers the costs. Low income people who have life-threatening emergencies will be treated, even if they cannot pay. When people from other countries don't pay their bills, the result is that insurance premiums go up and government benefits may get reduced. Some hospitals may close because they provide too much uncompensated care. Some doctors may stop working because they don't get paid enough to afford malpractice insurance, up to date medical equipment, and so on.The USCIS is not a debt collector. If you did not pay your non-emergency hospital and doctor fees — and choosing to go overseas to have a baby makes your care non-emergency — the USCIScannot chase after you and pressure you to pay. What it can do, however, is to refuse to let you come to the US again unless and until you pay your bills.