A few years ago, nearly every radiologist completed a fellowship. It wasn’t so long ago that the job market was so tight there was a real concern that doing two back-to-back fellowships was going to become the norm.
Oh, how times have changed.
Recently I’ve been asked by several readers if I thought that fellowships were still necessary given the current radiologist shortage and white-hot market. Are practices desperate enough to hire general radiologists fresh out of practice?
Well, the short answer is no, fellowships are not strictly necessary. Absolutely some practices are hiring straight out of residency. We had one of our residents go straight into practice a couple of years back even. There’s a real opportunity cost to training for another year, and we shouldn’t pretend there isn’t.
But here was my longer answer:
There are absolutely places/groups in the country that are willing to take non-fellowship-trained general radiologists, but I believe going without a fellowship will still significantly limit your options fresh from training. I don’t foresee a world where this changes regardless of the current shortage.
Want something more than just my opinion? Well, I did do a completely unscientific informal Twitter poll of practicing radiologists. I asked:
Radiologists, in the current job market, are your institutions/groups *currently* *generally* willing to hire candidates straight from residency without fellowship?
Yes (no fellowship): 44.9%
No (fellowship required): 55.1%
So can you go to work without a fellowship? Absolutely.
Are you closing doors if you skip one? Absolutely.
Anecdotally, fellowship is probably least needed for the job most in demand: ER work, especially swing shifts and deep nights.
* * *
I think the only hope for a more efficient future is if more subspecialties begin tracks within residency like nuclear medicine, allowing for a “complete fellowship” experience/equivalence during the normal residency term. Though as a practical matter it seems absurd to place so much value on a one-year process after longer training, ultimately there is a difference (pro and con) between doing something for the majority of a year and not bouncing from month to month like we do as residents.
Out in practice and in the context of a long career, ultimately, there is a substantial difference in performance between those who practice subspecialized radiology working a lot within their subspecialty and most generalists. There are a ton of general radiologists practicing general radiology–and the world absolutely does need a lot more general radiologists–but there is also a big demand for subspecialty reads. The ordering providers want it, and various “quality” entities and certifying bodies (e.g. Covera Health) are also looking for it. So a significant number of our workforce does need to have those robust skills, and most residents really don’t have the reps to do subspecialty level MR interpretation without some additional focus.
Yes, in the long term, how you practice will matter so much more than that 1-year fellowship, but in the short term, it’s still considered a meaningful proxy for your strongest area and the hole you can fill for a practice. (Also, yes: when that hole is general or ER radiology, one should even acknowledge that a fellowship without significant moonlighting could actually detract from your overall skillset. Nonetheless, it’s a stretch to suggest that therefore you shouldn’t do a fellowship).
The level of neuroradiology I practice–such that it is–is 100% from doing a ton of neuroradiology as an attending and not from what I learned in fellowship. But the outside world doesn’t really know that. The outside world likes labels.
In the world to come where AI, non-radiologist physicians, and midlevel providers may play an increasing role in imaging interpretation in the future, radiologists will also likely need to perform at that higher level to maintain their edge/prove their value. We could make residency training more efficient by allowing residents to specialize earlier and focus their training, but the potpourri approach we currently use–especially where many residents are spending a significant fraction of their final year doing mandatory breast imaging and some nuclear medicine– isn’t going to get us there.
* * *
But back to the current reality:
To give you an idea, a group like mine would love to hire more people (seriously, it really is a very tough job market). But we are a large subspecialized group and have not/would not compromise on fellowship training for a recent graduate.
So, yes, in the short term, sure, there is absolutely work out there. Especially for ED coverage and general radiology. It may even always be there. But–reasonable or not–not everywhere.