A few further thoughts about NVIDIA CEO Jensen Huang’s farcical description of the impact AI has “already” had in completely revamping the field of radiology.

Huang presents radiology as the “evidence” of what the near-future impact of AI on the workforce will be. I’ll include the quote again in this post for completeness:

One thing that I will say, give you some evidence, is that, and I was just telling Elon about this earlier, radiology, for example, has largely been converted to AI-driven radiology. And there’s some really great companies doing that. And the surprising thing is the prediction that all radiologists would be the first jobs to go was exactly the opposite. The trend shows that there are more radiologists being hired now as a result of AI.

And the reason for that, if you take a step back, it’s because the goal of a radiologist is not to study the images. The goal of a radiologist is to diagnose a disease. Now the studying of the images became so productive they could study more images, study more modalities, spend more time with the patients, and as a result, they were actually accepting more patients. We’re doing more radiology all around the world, we’re doing a better job with diagnosing disease.

Again, none of that is even merely an exaggeration. It’s just wholly untrue as to the current use of AI in radiology, let alone the impact far enough in the past to have percolated through and already changed how the whole field practices.

This is a man personally worth almost $200 billion in charge of a company with a market cap over $4 trillion. One imagines he has access to reality if desired.

I’ve seen the clip shared countless places by credulous people who don’t know any better. This is not to say these things won’t happen, but the use of the past tense is a real problem. I think it’s worth putting the fantasy in context.

Radiology Isn’t Illustrating Jevons’ Paradox

Jevons Paradox is the observation that technological advancements that increase resource efficiency can counterintuitively lead to an overall increase in resource consumption. Jevons’ original formulation concerned improving coal technology leading to paradoxically increased demand/consumption of coal. As in, when it’s cheaper, you can buy more and do more.

Huang is parroting a recently commonly invoked human radiology analogy: AI makes radiologists more efficient in interpreting scans, more scans somehow get done, and voila demand magically increases.

The problem is this doesn’t reflect reality, at least not currently. Imaging volumes have been increasing steadily for decades. Scan acquisition time has nothing to do with scan interpretation time (the former actually ironically is benefiting from machine acceleration in some situations). Interpreting efficiency has barely moved, if at all, and turnaround times are actually lengthening amidst unmanageable volumes. Increased demand for radiologists is just the secular shortage of qualified radiologists struggling to keep up with organically increasing volumes. AI has nothing to do with it.

To further compound how much we are not in Jevons’ land yet: reimbursement for radiologist professional services is stable to falling from payors (again, not related to efficiency), but radiologists have actually cost the system more recently as they demand stipends from hospital systems to provide continued access to services. More simple supply/demand at work. Those scans, even the “more efficient” ones, do not cost less for patients or payors yet. More efficient MRIs and radiologists are both paid the same on a per-study basis.

There are some AI tools for radiologists with reasonable market penetration: variations on list triage (enabling potentially positive scans to jump the queue for interpretation) and generative draft impressions derived from the findings section of the report. Meaningful computer vision is frankly not in particularly widespread use despite what is parroted by tech companies using the news as free marketing, and so far limited to narrow pathologies like brain bleeds, blood clots, fracture detection. Any purported efficiency benefits have been unconvincing. A mediocre tool allows careless people to move faster but gives careful radiologists just another thing to review. So far, the state of the art has been mostly a wash.

Again, this isn’t one of those “AI could never do what my amazing organic brain can do!”; it’s an “AI really certainly hasn’t yet in real practice, and nothing on the market so far has really moved the needle.”

Greater efficiency could trickle down to depress prices in the future and/or eventually lead to increased demand for imaging, but it hasn’t happened yet, and it’s unclear if it did that it would lead to increased demand for the human component. Healthcare is not really a free market. No one in healthcare is the equivalent of coal.

Is it possible that one day AI will lead to automated scan acquisition and instantaneous scan interpretation a la Star Trek, and we will suddenly not just want but need all scans all the time, and everyone will be building more and more machines to scan more and more people because interpretive costs are down, and physical throughput is the real bottleneck? Sure. We can just put a conveyor belt at the entrance to the ER!

Is it also possible that—instead of a Jevons process—professional fees could crash as radiologists become box-checking liability-operators, but that as the field contracts, the smaller number of remaining radiologists will enjoy persistent high wages in the form of obscolence rents? Also, sure.

Is any seismic AI change, if it occurs, going to be limited to radiology? I doubt it.

Ultimately, humans are not quite a natural resource. The tortured metaphor may or may not hold in the future, but we should all be able to agree that it sure hasn’t happened in the past.

The Obsession with the Jevons

So why is the world—and everyone contributing to the AI bubble—so obsessed with Jevons’ Paradox?

Because it’s comforting.

Instead of worrying that the economic value of most humans is going to trend toward zero and that our entire society will have to contend with massive disruption, it’s far easier to believe that AI efficiency will unlock the magic of productivity. That somehow, this machine intelligence revolution will set us free to do our best, most magical, most human work.

A narrative where increased efficiency leads to increased demand soothes the uncertain soul. In that version of the story, the highest-skilled humans won’t be made obsolete—they’ll be unleashed.

I don’t know if that logic will hold in real life over the coming years or not. What I do know is that invoking it right now is a marketing fantasy.

To reiterate: I don’t know what will happen to radiology or to any other field. The future is uncertain, and I certainly don’t have a crystal ball. We have plenty of bullshit jobs already, even without the help of AI.

What I do know is that all attempts to pretend radiology has already seen the fruits of AI and absorbed them—that AI is responsible for the current surge in demand for radiologist services—are lies.

But we can appreciate why this specific variation of the lie is being told:

In 2016, AI Godfather Geoffrey Hinton famously said:

People should stop training radiologists now—it’s just completely obvious within 5 years deep learning is going to do better than radiologists. It might be 10 years, but we’ve got plenty of radiologists already.

So the fact that we’re still here and in more demand than ever is supposed to be comforting to other humans.

Don’t fear AI! Even the radiologists are thriving!

I’m sure that in advance of an earnings call, a narrative where AI unlocks human potential is so much more compelling than one with a zero-sum game where the short-term economic value goes to tech companies but the long-term impact is to potentially destroy human enterprises and sink the economic value of previously high-training, high-skill, once-human tasks.

If we think further ahead, no one is going to pay for computer work the same as we did for comparable human work for a sustained period. The RVU system in healthcare already attempts to account for effort, liability, etc. We don’t get to hold even that one system’s current balance fixed while the world changes. Causes yield effects, and consequences themselves have consequences.

Anyone who imagines a perpetual money-printing machine generating revenues to match the humans they once replaced is naive, so maximum AI utopianism (and the value tied up in these companies) doesn’t envision that world. The devastating disruption fears may or may not be valid, but Huang and others in the tech world clearly feel compelled to address them.

It seems to me that Huang is trying to wave away generalized replacement fears by pretending that radiology is the canary in the coal mine and we’re still here, therefore rainbows and unicorns.

Maybe that “doomer” path to darkness is wrong, but that doesn’t mean radiology is the example to light the way.

I believe in the importance of thriving independent private practices for the field of radiology. True private practice—where doctors control the organization, are responsible to their peers and patients, and earn the full fruits of their labor—is the benchmark that sets the market and provides the anchor against exploitation from unscrupulous employers.

My group, like most groups in this market, is hiring. Here are several more 100%-independent radiologist-owned private practices across the US that are recruiting. If you’re in the market for a new position, consider reaching out with your CV. (Click the triangles for more information.)

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Iowa Radiology

(Des Moines, Iowa)

34-radiologist subspecialized collegial private practice with long-term stability providing coverage to 30 locations across Central and North Central Iowa. Ownership of several outpatient imaging locations yields distributions from technical fees, and Des Moines is one of the fastest-growing areas in the country with a low cost of living, excellent schools, and low taxes.

Partnership track:

• 2-year partnership track with 12 weeks vacation
• On-site daytime coverage; hybrid night and weekend call coverage
• Greatest needs: Breast, Neuro, General. All subspecialties considered for the right candidate.

Employee track:

• Fully remote, hybrid, or on-site options
• Excellent salary and benefits package, including up to 10 weeks of vacation depending on role/shift
• Immediate Need: 3^rd Shift Radiologist
  • Nine-hour shift, 7 on/14 off, 100% teleradiology
  • 90-120 cases/shift; ~40 of those CT
  • Base compensation $450,000 w/ additional compensation opportunities
    • Additional comp consideration based on subspecialty (for example, can final read neuro cases)
    • Moonlighting available
    • RVU productivity incentives
  • Full benefits package including 401k, health/dental/vision, pension, life insurance, etc. ($83k benefit value annually)
  • Malpractice and tail paid
• Other Available positions: General, Breast, Flex Shift, Overnight
  • Overnight shift is 10p-8a CST, 7 on/14 off, 100% teleradiology with average 90-120 total cases per shift
  • Evening shift is 4p-12a CST, alternating weeks M-F only (26 weeks and no holidays/weekends)

Learn more at http://www.iowaradiology.com
Contact: recruit@iowarad.com

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RAPA

(Central Arkansas [Little Rock, Conway, Searcy, and Pine Bluff] & Northwest Arkansas)

40+ radiologists covering 20+ sites (hospitals + clinics) with a multi-subspecialty mix of inpatient, outpatient, and ED imaging.

• Robust reading room assistants and IT presence to promote peak efficiency
• Unified Clario reading list, Inteleviewer PACS, Powerscribe dictation (no switching stations or PACS to read other sites)
• RadAI automated impressions to improve efficiency.

Partnership track – Central Arkansas (Little Rock, Conway, Searcy, and Pine Bluff) and Northwest Arkansas:

• 1 year to partnership
• 10 weeks vacation + 1/2 day off per week on average for partners
• Highly competitive compensation combined with low cost of living
• Internal moonlighting options to boost income
• Robust CME allowance, signing and moving bonuses, full benefits
• Many work-from-home shift options
• Minimal after-hours requirements – overnight shifts are fully staffed with telerads

100% Remote Nighthawk, partnership track:

• 7 on/14 off, 10 pm-7:45 am CST
• 1 year to partnership
• Competitive compensation, robust CME allowance, signing bonus, full benefits

100% Remote Neuro/General:

• Daytime tele neuro/general radiology approximately 50/50 split.
• Option for employed or partner track. Partner track includes call weekend shifts, approximately 1 in 5 weekends.

Employee track:

• General radiology, mammography, and other options available
• Fully remote, hybrid, or on-site options available
• Flexible scheduling
• Competitive salaries
• Robust CME allowance, signing and moving bonuses, full benefits

Greatest needs are IR, mammography, body imaging, MSK, and nuclear medicine, but all subspecialties and general radiologists are welcome.

Learn more at http://rapaxray.com/
Contact: recruitment@rapaxray.com and Dr. Brandon Kelly at bkelly@rapaxray.com

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Eastern Radiologists

(Greenville & Coastal North Carolina)

Eastern Radiologists is a private practice in Eastern North Carolina that is physician-owned and operated and seeking to hire multiple radiologists due to growth and retirement. The well-established private practice serves a large geographic region through 14 area hospitals and several state-of-the-art imaging centers. Support is provided by nearly 70 subspecialty radiologists.

Currently seeking candidates with the following training:

• Pediatric Imaging
• Breast Imaging
• Neuroradiology
• Body Imaging
• Nighthawk/Overnight
• General Diagnostic Radiology
• Vascular/Interventional

Details:

• Positions are available in Greenville and other coastal communities in Eastern North Carolina.
• Most are partnership track positions which include evening and weekend call responsibilities, but other employment options can be considered. Employment positions can be customized to fit desired schedule/income. Internal moonlighting is available for extra income.
• Great benefits, competitive salary including profit sharing and bonus, generous vacation and paid family leave, and business/educational discretionary account.
• Sign-on bonus

Learn more at https://www.easternrad.com.
Contact: Erica Askew at easkew@easternrad.com

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Midwest Radiology

(Minneapolis – St. Paul, Minnesota)

Large 175+ subspecialized practice with 17 weeks of vacation. Two-year shareholder track for new graduates and a one-year track with experience.

Positions (On-site):

Positions (Remote):

Learn more at www.midwestradiology.com.
Contact: Barry.Lindo@MidwestRadiology.com

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Mecklenburg Radiology Associates

(Charlotte, North Carolina)

Established in 1917 and fiercely independent, MRA is a well-respected subspecialized practice of 60 radiologists and growing. They especially take pride in their group culture (seriously, there are some really nice people in that group including one of my old senior residents).

Partnership track:

• 3-year partnership track with 8 weeks of vacation per year
  $400K starting salary and an additional $75K sign-on bonus ($125K with 2+ years of experience)
• On-site daytime hospital and imaging center coverage. Hybrid evening and weekend call coverage, including the option to read from home.
• Available positions: Breast, Body, Cardiovascular, Neuro, Light IR, MSK, Nuclear Medicine, and General

Employee track:

• Fully remote, hybrid, or on-site options
• Competitive salary
• Available positions: MSK, General, Overnight ER, Swing Shift ER, Neuro, Body, and Cardiovascular

Learn more at www.meckrad.com/recruitment.
Contact: Charlene Eichinger at ceichinger@meckrad.com

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Radiology of Huntsville

(Huntsville, Alabama)

ROH is 60+ physician, high volume, private practice with a 2-year partnership track and nominal buy-in. Hiring for a remote partnership-eligible overnight position as well as onsite/remote openings in most subspecialites. Huntsville is a tremendously livable, high-tech, and growing mid-sized city (a #1 Best Place to Live in the U.S. by U.S. News and World Report).

Learn more at www.radiologyofhuntsville.com.
Contact: Brandy McCown at bmccown@radhunt.com or call 256.713.0621.

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Radiology and Imaging Specialists

(Central Florida: Lakeland/Winter Haven, SW Orlando, Bradenton)

Independent and long-standing group covering a diverse mix of financially sound hospital partners, outpatient imaging centers, an ASC/OBL, clinics, and a multi-specialty group. 50+ radiologists and 10+ midlevel providers. In-house and experienced IT, Credentialing, HR, and Admin team including dedicated Radiology Liaison support 24/7/365.

Recruiting for Body, Breast, Cardiac, Neuro, IR, and General.

Partnership Track:

• 1-year track for diagnostic radiologists, 2-year track for interventional radiologists
• 10 weeks of vacation
• Sign-on bonus for diagnostic radiologists
• Call compensation for interventional radiologists
• Internal moonlighting available but not required
• Full benefits including CME allocation

Employee or Contractor:

• Flexible scheduling: Hospital (ED/IP) or outpatient coverage options available
• Fully remote, hybrid, or on-site depending on location(s) and coverage schedule desired
• Competitive compensation models (including benefits if employed/full-time)

Learn more at http://risimaging.com.
Contact: Alice Varnadore, Executive Assistant at avarnadore@risimaging.com

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South Texas Radiology Group

(San Antonio, Texas)

STRG is a well-established, expanding, independent subspecialty practice of 70+ radiologists serving 15 hospitals, multiple freestanding ED facilities, and a large outpatient imaging practice (STRIC). Both onsite and remote positions are available.

STRG is a forward-thinking practice with a strong and cohesive culture. Multiple AI projects are in place and in progress to improve efficiency and quality. Internal moonlighting opportunities are available.

Shareholder Track:

• Flexible associate period as short as 18-months.
• Leads to full partnership with board of directors membership.
• Equity ownership within a large expanding outpatient imaging practice (STRIC)
• Competitive salary with up to $800K starting salary for experienced applicants. Up to $600K starting salary for inexperienced applicants.
• Excellent benefits package
• Onsite and work-from-home options for daily work and call
• Hiring across all specialties, with a current emphasis on Body Imaging and Cardiothoracic/Body

Emergency Radiology Track:

• 1 week on/1 week off (7/7) and 1 week on/2 weeks off (7/14) positions available
• Competitive salary with excellent benefits package available.
• Fully remote and onsite options available.

Employee Mammography Position (Onsite):

• Competitive base salary with excellent benefits package
• No call. No nights or weekends.
• Remote opportunities available for general radiology or body imaging work if interested.

Employee Position – All Subspecialties (Onsite, Hybrid, or Remote ):

• Competitive base salary with excellent benefits package
• 5.5 weekends (day shift) per year. No evening or overnight call.

Learn more at https://stric.com/.
Contact: Waynea Finley at wfinley@strg-pa.com

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Reno Radiological Associates

(Reno, Nevada)

Serving Northern Nevada since 1947, RRA is a strong, highly subspecialized, democratic, extremely collegial, high-earning group of 25 radiologists working in perhaps the best city in the country for raising a family and enjoying unparalleled access to natural beauty, endless outdoor activities (perhaps the best ski-city in the US), and incredible weather (jokingly referred to as “the cheapest city in California” for its proximity to Lake Tahoe (<30 min), Napa Valley, national parks, and more without the super high cost of living and no state income tax).

Shareholder Track (onsite):

• 1 year to 75% partner, 2 years to 100%
• Top 90+% comp nationally, maximally generous benefits
• 8/9/10+ weeks of vacation
• Remote shifts + opportunities for extra income, $100 buy-in

Employee Track (remote or onsite):

• High comp, Maximally generous benefits, opportunities for extra income
• Onsite preferred, fully remote night available (8p-3a PST)

Independent Contractor:

• Flexible shift options, high compensation

Learn more at http://www.renorad.com/
Contact: CEO Anthony Dispenziere at adispenziere@renorad.com

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Vantage Radiology & Diagnostic Services

(Near Seattle, Washington)

~35 subspecialized radiologists practicing near Seattle and enjoying a quality lifestyle focused on work-life balance, located minutes from urban amenities, and with easy access to abundant outdoor activities in the natural beauty of the Pacific Northwest. We’ve provided professional services for two hospitals since 1970 and are co-owners of their affiliated imaging centers.

• Competitive salary ($370-570k) with a signing bonus for a 4-day work week and 8 weeks of vacation.
• Benefits include a CME allowance, memberships to professional societies, profit-sharing, malpractice and disability insurance, 401K contributions, and a commitment to associate mentorship.
• All partners and partner-track associates share in general call responsibilities (many from a practice-provided remote home workstation). Overnight call is covered by our internal nighthawk team.

Openings:

Learn more at https://www.vrads.com/
Contact: recruiting@vrads.com

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Radiology Consultants of Little Rock

(Little Rock, Arkansas)

Founded in 1961, RCLR is a 25+ radiologist, subspecialized, independent private practice serving the largest healthcare system in Arkansas as well as the largest urology group in the state.

Learn more at https://www.radconlr.com
Contact: Terrie Threlkeld at terrie.threlkeld@radconlr.com

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Inland Imaging

(Washington, Oregon, Montana)

Inland Imaging is a 120+ radiologist-owned private practice proudly serving multiple outpatient, clinic, and hospital sites throughout the Inland Northwest region. We own and operate one of the first outpatient interventional labs in the West in addition to 7 outpatient imaging centers.

Our practice:

• Sub-specialty interpretations available across all locations.
• All studies are accessible on a common PACS system, one common voice recognition system, and one common worklist
• Internal Nighthawk System providing final interpretations on all ER, STAT, and Inpatient Exams. 24/7 Neuroradiology Coverage and IR Call Coverage.
• 2-year Partnership Track.
• Full-Time Radiologist Average Time Off = 15 weeks with the ability to decrease or increase total time off.
• Average after-hours obligations = 9 weekends per year and 22 evening/swing Shifts.
• Salary Range – $450,000 – $600,000
• Full Benefit Package including health, life, vision, dental, disability, and life.
• 401k match, profit-sharing contribution, and cash balance plan.
• Hybrid Work Options

Current Openings:

• Remote overnight ER
• Neuroradiology (choice of Spokane, Seattle, Walla Walla, Tri-Cities, or Missoula)
• Washington
  • Tri-Cities (with $75k signing bonus)
    • Breast
    • Neuro
    • MSK
  • Spokane – Pediatrics
  • Moses Lake – General/Breast (with $90k signing bonus, $20k relocation benefit, and annual retention bonus)
  • Colville – General/Breast
• Montana
  • Missoula – IR
• Oregon
  • Pendleton – General/Breast

More information about these positions can be found on our Independent Radiology listing.

Learn more at https://inlandimaging.com/careers
Contact: Sarah Russell, CEO at srussell@inlandimaging.com

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Charleston Radiologists

(Charleston, South Carolina)

Charleston Radiologists, PA (CRPA) is a private 18-physician radiology group providing care to Charleston and the surrounding area for over 50 years.

Partnership track:

• Open to any fellowship-trained radiologist willing to do a mix of general & subspecialty work
• $500K+ starting salary based on experience, followed by
• 90% of partner salary in year 2
• 2-year partnership track
• Sign-on bonus based on experience
• 8+ weeks vacation
• Nighthawk coverage beginning January 2026
• Benefits include health insurance, malpractice insurance, HSA, 401K match, $7,500 CME allowance, relocation stipend (over $78,000 in annual benefits)
• On-site daytime coverage. Hybrid evening and weekend call coverage, including the option to read from home.

Employee track:

• Fully remote, hybrid, or on-site options
• Competitive salary based on experience

Contact: Tonya McGue at tonyamcgue@gmail.com

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Grand Traverse Radiologists

(Traverse City, Michigan)

Established in 1938, GTR is a 100% physician-owned and operated private practice in a four-season resort town on the bays of Lake Michigan.

• High compensation and 12 weeks vacation
• Post-call weekend days off
• Internal moonlighting available
• Positions/partnerships are on-site, but multiple shifts can be done from home.
• Collegial and youthful group with an average age under 40. All partners are equal.
• Hiring for growth. Lists are caught up!

Needs: Body, Breast, ER/General, and IR

Learn more at https://www.grandtraverseradiologists.com
Contact: Dr. Anthony Livorine at alivorine@gtradiologists.com

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If you’re a group looking to advertise, get in touch. The monthly post here is limited to just a handful of groups at a time, but last year, I launched Independent Radiology as a resource for the broader community, a dedicated private practice radiology job board featuring 140+ groups. If you’re in the market, please also check it out for your job-hunting needs.

This week, Elon Musk and Nvidia’s Jensen Huang discussed AI and the future of technology at the U.S.-Saudi Investment Forum. Here is Jensen Huang discussing radiology:

One thing that I will say, give you some evidence, is that, and I was just telling Elon about this earlier, radiology, for example, has largely been converted to AI-driven radiology. And there’s some really great companies doing that. And the surprising thing is the prediction that all radiologists would be the first jobs to go was exactly the opposite. The trend shows that there are more radiologists being hired now as a result of AI.

This is sheer unadulterated fiction. Leave aside the fuzziness of what “AI-driven radiology” might mean; AI simply doesn’t drive a meaningful part of the radiology workflow. Some AI list triage and a few algorithms to detect intracranial blood or fractures has not changed the game in even the slightest of ways. The only thing that has been in meaningful if still limited use over the past few years that has arguably driven even small efficiency gains is generative AI for drafting impressions based on dictated findings.

There are, of course, more things in rare use and plenty of things announced that might matter, but that is beside the point here: Jensen is wrong.

More radiologists are being hired because there is a shortage of radiologists due to steady, some would say incessant, imaging volume growth. The heavy utilization of CT and MRI in US healthcare has literally—and I do mean literally—nothing to do with AI.

The only thing AI could potentially have to do with hiring more radiologists is faster MRI scanning with some vendors/machines/protocols allowing for more patient throughput, impressive but still in its infancy and with limited market penetration.

And the reason for that, if you take a step back, it’s because the goal of a radiologist is not to study the images. The goal of a radiologist is to diagnose a disease. Now the studying of the images became so productive they could study more images, study more modalities, spend more time with the patients, and as a result, they were actually accepting more patients. We’re doing more radiology all around the world, we’re doing a better job with diagnosing disease.

Sure, the goal of a radiologist is to diagnose disease. But, let’s not pretend that radiology hasn’t, for the past century since its inception, essentially been the art and science of diagnosing disease through studying images and putting imaging findings in context. What Jensen is saying is just nonsense.

Even if we accept that the fraction of radiologists using clot- and fracture-detection tools is doing a better job diagnosing disease (very unclear), we are not, as a field “study[ing] more modalities” (what?!) or “spend[ing] more time with the patients” (less than ever thanks to heavy volumes, long turn-around-times, and the explosion of teleradiology). Current computer vision tools do not make radiologists significantly more efficient unless they inappropriately trust them enough to stop looking at the images.

And so that’s kind of the near term outcome of AI and productivity.

I don’t know if Jensen actually doesn’t know anything about radiology (everyone’s favorite white-collar AI-replacement use-case) or if this is a cynical don’t-fear-the-future puff angle. But either way, he’s wrong across the board.

I am reminded of Michael Crichton’s Gell-Mann Amnesia, where you realize how useless many perspectives and most news are only when confronted with obviously incorrect information in contexts for which you are a subject matter expert. Almost every single news article about AI and radiology is entirely wrong. They’re acting like what the world could look like in the coming years is what has already happened: that we are awash in game-changing, useful AI that has rapidly been deployed across the field and fundamentally altered the practice of radiology. And that’s not true. Ironically, clinicians using LLMs for documentation is probably far more ubiquitous and impactful so far.

Now being wrong about the present doesn’t necessarily mean being wrong about the future. Things are changing fast, and the future is always largely unknowable.

But the reality distortion is just so damn irritating.

This week, the ABR quietly dropped a big change in their long-term plans for the new oral board version of the Certifying Exam. After the very first administration in early 2028 during fellowship for the class of 2027, subsequent administrations will occur at the end of residency:

That’s the email I got as a program director.

As in, in 2028, diagnostic radiology, as a field, will again be graduating board-certified (not “board eligible”) radiologists.

The decision to change the (useless, duplicative) Certifying Exam was first announced back in February 2023. In April 2023, they then announced their intention to bring back the oral boards.

The original plan was to keep the timing the same despite the change in format, so that residents would take the exam during the calendar year after graduating from residency, typically a few months into their first post-fellowship attending job. Despite the reality that orals would be much harder to prepare for outside of the residency training environment than a written exam, the ABR referred to this timing as “the least bad choice.”

In that “Backwards to the Future” article, I wrote:

This exam needs to be at the end of residency like it used to be. If anything, it might help combat the post-Core senioritis that many fourth-years struggle with, particularly when rotating through services outside of their chosen specialty. I appreciate that many program directors don’t want this during residency because in the past seniors used to disappear from service (and especially the call pool) before Orals just like they do now before the Core Exam. It’s easier to run a residency with only one class preparing for one big test at a time. But convenience shouldn’t be our primary metric.

Time will tell. I think I had it right in 2023, and clearly enough stakeholders agreed that the ABR has changed its plan before even doing it a single time.

In order to prevent two classes disappearing concurrently in June for their respective boards, the Core Exam has been pushed back into early/fall R4 year so that the senior year will now contain both board exams. Even with that scheduling mitigation, residencies have a lot of work to do to make this happen.