- Email: [email protected]
The Job Market of the Future: How Will the Recent Change in Boards Influence the Job Market for New Graduates?
RESIDENTS’ AND FELLOWS’ COLUMN C. MATTHEW HAWKINS, MD
The Job Market of the Future: How Will the Recent Change in Boards Influence the Job Market for New Graduates? Lance A. Warren, MD, Tirath Y. Patel, MD, Matthew S. Layman, MD, Manish Y. Patel, MD The constant threat of declining reimbursement, the uncertainty of accountable care organizations, and the unpredictable economy are negatively influencing the radiology job market. Within this climate, a new concern has arisen for the crop of recently graduated residents: how will the change in board format affect hiring practices? The ABR has recently changed the initial certification process. Those radiology residents graduating in June 2014 and later are required to pass two computerized examinations to become board certified, with the second examination occurring 15 months after residency completion. As with the first Core Examination, those taking the initial Certifying Examination in October 2015 likely will not receive their results for some time, possibly as long as the 2 to 3 months needed to grade the first Core Examination. This leaves the new group of freshly trained job applicants only “board eligible” through up to 6 months after they would finish a typical 1-year fellowship. Subsequently, if graduating residents choose not to do fellowships, their future employers would have to accept their being “board eligible” for up to 18 months after starting their jobs. Although the designation “board eligible” will be the new norm for residents graduating in 2014 and beyond, it is uncertain how practices will adapt to the changes. If you were to quickly browse the ACR’s job listings, you
206
would see that many of the advertised positions require board-certified radiologists. With these changes and the already difficult job market, a handful of questions for those beginning the job hunt have arisen: n
n n n n n
Will practices know about the board change and recognize that most applicants will only be board eligible? Will there be a significant bias toward those who are already certified? Will any graduating residents choose not to do fellowships? Will groups offer lower salaries to those who are only board eligible? Will board eligibility interfere with hospital credentialing? Will some groups delay hiring for at least 6 months, until a candidate passes the examination? And how will those freshly trained radiologists manage being jobless for that time?
Both the 2012 and 2013 ACR Commission on Human Resources workforce surveys predicted relative stability for the job market in the upcoming years, with an approximate 1:1 ratio of new jobs to graduating fellows and residents entering the market [1,2]. The commission summarized the data in 2013 by noting, “Each of the 1200 residents.should have a position available, but the job may not necessarily be in the subspecialty, geographic area, or type of practice that the individual desires” [2]. However, if only a small percentage (let us say 10%) of
openings are delayed by 6 months, how will those 120 jobless radiologists manage? And will starting salaries decline as demand for jobs exceeds the supply and graduating fellows accept lower offers, faced with the real possibility of being unemployed with a significant debt burden? Additionally, if a larger number of board-certified radiologists decide to switch jobs around this time because they have a competitive advantage for the “best” openings, those who are designated as board eligible may be forced to take less desirable positions. Furthermore, 2 to 3 years later, there may be greater job turnover as those radiologists who initially settled for positions look elsewhere, which cannot be best for the specialty. Most current residents already understand that they are unlikely to find their perfect jobs; however, worsening dissatisfaction with job prospects will filter down to medical students, further decreasing the popularity of radiology and thus the quality of radiology applicants. Recent research suggests that the competitiveness of radiology has declined each year since 2009 and is the lowest it has been since 1998 [3]. The concerns over board eligibility and the job market have been raised at both the 2014 annual meeting of the Association of University Radiologists, with considerable discussion within the American Alliance of Academic Chief Residents in Radiology, as well as at the ACR’s 2014 AMCLC and
1546-1440/14/$36.00
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ª 2015 American College of Radiology http://dx.doi.org/10.1016/j.jacr.2014.07.034
among those on AuntMinnie’s public discussion forums. To the ABR’s credit, it was receptive to residents’ concerns at the Association of University Radiologists meeting and in an effort to disseminate the information about the board changes, recently notified the ACR of the changes, which have subsequently been published on the ACR’s website [4]. Moreover, the ABR had considered the ramifications of the change in its frequently asked questions section, responding to the question “Can residents find employment without being certified?” with “Most boards delay the Certifying Examination until the individual has practiced. The ABR is simply joining the mainstream. Physicians in all other specialties manage to find gainful employment despite the delay in the Certifying Examination until after training” [5]. Although it is true that some surgical subspecialties delay certification for greater than 12 months to allow time to accrue case logs, most nonsurgical fields, such as dermatology (<1 month), internal medicine (1 month), and family medicine (during residency), allow their residents to take the certifying exam much earlier after residency [6-8]. With nearly all of radiology residents going on
to fellowship, it would be much more palatable for a certifying examination offered in months 6 to 9 of fellowship to ensure no significant competitive disadvantage in the job market. Like the ABR, the American Board of Anesthesiology is implementing a new examination structure. Within its new system, an anesthesiologist can register for the certifying examination in the October immediately after residency completion. Moreover, they are planning on offering their certifying examination up to 8 times each year [9,10]. Five years from now, the delay of 15 months for radiology initial board certification may not make any difference as hospitals and practices accept board eligibility as the norm upon hiring. However, in the first few years, particularly the first year, we do anticipate growing pains, the extent of which is currently unknown. We plan on further evaluating the impact, at least within private practices, through a survey sent to groups. We plan on publishing the results in the coming months. As John F. Kennedy once said, “Change is the law of life.”
REFERENCES 1. Bluth EI, Short BW, Willis-Walton S. 2012 ACR Commission on Human Resources
2.
3.
4.
5.
6.
7.
8.
9.
10.
workforce survey. J Am Coll Radiol 2012;9: 625-9. Bluth EI, Truong H, Nsiah E, Hughes D, Short BW. The 2013 ACR Commission on Human Resources workforce survey. J Am Coll Radiol 2013;10:750-6. Chen JY, Heller MT. How competitive is the match for radiology residency? Present view and historical perspective. J Am Coll Radiol 2014;11:501-6. American College of Radiology. Information notice regarding American Board of Radiology certification of diagnostic radiologists. Available at: http://www.acr.org/ News-Publications/News/News-Articles/2014/ ACR/20140502-ABR-Certification-Notice. Accessed July 5, 2014. American Board of Radiology. The exam of the future: FAQs. Available at: http:// theabr.org/the_abr/sites/all/themes/abrmedia/pdf/faq_ic_v2.pdf. Accessed July 5, 2014. American Board of Dermatology. Certifying examination. Available at: http:// www.abderm.org/certification/exam.html. Accessed July 5, 2014. American Board of Internal Medicine. Initial certification: taking the internal medicine exam. Available at: http://www.abim.org/ exam/certification/internal-medicine.aspx. Accessed July 5, 2014. American Board of Family Medicine. Dates: certification and recertification. Available at: https://www.theabfm.org/moc/datescerti.aspx. Accessed July 5, 2014. American Board of Anesthesiology. Staged examinations. Available at: http://www.theaba. org/Home/TrainingPrograms. Accessed July 5, 2014. American Board of Anesthesiology. Staged exams. Available at: http://www.theaba.org/ pdf/Staged-Timeline.pdf. Accessed July 5, 2014.
Lance A. Warren, MD, is from the Department of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri. Tirath Y. Patel, MD, is from the Department of Radiology, University of Toledo Medical Center, Toledo, Ohio. Matthew S. Layman, MD, is from the Department of Radiology, University of Tennessee Medical Center, Knoxville, Tennessee. Manish Y. Patel, MD, is from the Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama. Lance A. Warren, MD: Washington University School of Medicine, Mallinckrodt Institute of Radiology, Department of Neuroradiology, 510 South Kings Highway, Campus Box 8131, St Louis, MO 63110-1076; e-mail: [email protected].
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The Job Market of the Future: How Will the Recent Change in Boards Influence the Job Market for New Graduates? Lance A. Warren, MD, Tirath Y. Patel, MD, Matthew S. Layman, MD, Manish Y. Patel, MD The constant threat of declining reimbursement, the uncertainty of accountable care organizations, and the unpredictable economy are negatively influencing the radiology job market. Within this climate, a new concern has arisen for the crop of recently graduated residents: how will the change in board format affect hiring practices? The ABR has recently changed the initial certification process. Those radiology residents graduating in June 2014 and later are required to pass two computerized examinations to become board certified, with the second examination occurring 15 months after residency completion. As with the first Core Examination, those taking the initial Certifying Examination in October 2015 likely will not receive their results for some time, possibly as long as the 2 to 3 months needed to grade the first Core Examination. This leaves the new group of freshly trained job applicants only “board eligible” through up to 6 months after they would finish a typical 1-year fellowship. Subsequently, if graduating residents choose not to do fellowships, their future employers would have to accept their being “board eligible” for up to 18 months after starting their jobs. Although the designation “board eligible” will be the new norm for residents graduating in 2014 and beyond, it is uncertain how practices will adapt to the changes. If you were to quickly browse the ACR’s job listings, you
206
would see that many of the advertised positions require board-certified radiologists. With these changes and the already difficult job market, a handful of questions for those beginning the job hunt have arisen: n
n n n n n
Will practices know about the board change and recognize that most applicants will only be board eligible? Will there be a significant bias toward those who are already certified? Will any graduating residents choose not to do fellowships? Will groups offer lower salaries to those who are only board eligible? Will board eligibility interfere with hospital credentialing? Will some groups delay hiring for at least 6 months, until a candidate passes the examination? And how will those freshly trained radiologists manage being jobless for that time?
Both the 2012 and 2013 ACR Commission on Human Resources workforce surveys predicted relative stability for the job market in the upcoming years, with an approximate 1:1 ratio of new jobs to graduating fellows and residents entering the market [1,2]. The commission summarized the data in 2013 by noting, “Each of the 1200 residents.should have a position available, but the job may not necessarily be in the subspecialty, geographic area, or type of practice that the individual desires” [2]. However, if only a small percentage (let us say 10%) of
openings are delayed by 6 months, how will those 120 jobless radiologists manage? And will starting salaries decline as demand for jobs exceeds the supply and graduating fellows accept lower offers, faced with the real possibility of being unemployed with a significant debt burden? Additionally, if a larger number of board-certified radiologists decide to switch jobs around this time because they have a competitive advantage for the “best” openings, those who are designated as board eligible may be forced to take less desirable positions. Furthermore, 2 to 3 years later, there may be greater job turnover as those radiologists who initially settled for positions look elsewhere, which cannot be best for the specialty. Most current residents already understand that they are unlikely to find their perfect jobs; however, worsening dissatisfaction with job prospects will filter down to medical students, further decreasing the popularity of radiology and thus the quality of radiology applicants. Recent research suggests that the competitiveness of radiology has declined each year since 2009 and is the lowest it has been since 1998 [3]. The concerns over board eligibility and the job market have been raised at both the 2014 annual meeting of the Association of University Radiologists, with considerable discussion within the American Alliance of Academic Chief Residents in Radiology, as well as at the ACR’s 2014 AMCLC and
1546-1440/14/$36.00
n
ª 2015 American College of Radiology http://dx.doi.org/10.1016/j.jacr.2014.07.034
among those on AuntMinnie’s public discussion forums. To the ABR’s credit, it was receptive to residents’ concerns at the Association of University Radiologists meeting and in an effort to disseminate the information about the board changes, recently notified the ACR of the changes, which have subsequently been published on the ACR’s website [4]. Moreover, the ABR had considered the ramifications of the change in its frequently asked questions section, responding to the question “Can residents find employment without being certified?” with “Most boards delay the Certifying Examination until the individual has practiced. The ABR is simply joining the mainstream. Physicians in all other specialties manage to find gainful employment despite the delay in the Certifying Examination until after training” [5]. Although it is true that some surgical subspecialties delay certification for greater than 12 months to allow time to accrue case logs, most nonsurgical fields, such as dermatology (<1 month), internal medicine (1 month), and family medicine (during residency), allow their residents to take the certifying exam much earlier after residency [6-8]. With nearly all of radiology residents going on
to fellowship, it would be much more palatable for a certifying examination offered in months 6 to 9 of fellowship to ensure no significant competitive disadvantage in the job market. Like the ABR, the American Board of Anesthesiology is implementing a new examination structure. Within its new system, an anesthesiologist can register for the certifying examination in the October immediately after residency completion. Moreover, they are planning on offering their certifying examination up to 8 times each year [9,10]. Five years from now, the delay of 15 months for radiology initial board certification may not make any difference as hospitals and practices accept board eligibility as the norm upon hiring. However, in the first few years, particularly the first year, we do anticipate growing pains, the extent of which is currently unknown. We plan on further evaluating the impact, at least within private practices, through a survey sent to groups. We plan on publishing the results in the coming months. As John F. Kennedy once said, “Change is the law of life.”
REFERENCES 1. Bluth EI, Short BW, Willis-Walton S. 2012 ACR Commission on Human Resources
2.
3.
4.
5.
6.
7.
8.
9.
10.
workforce survey. J Am Coll Radiol 2012;9: 625-9. Bluth EI, Truong H, Nsiah E, Hughes D, Short BW. The 2013 ACR Commission on Human Resources workforce survey. J Am Coll Radiol 2013;10:750-6. Chen JY, Heller MT. How competitive is the match for radiology residency? Present view and historical perspective. J Am Coll Radiol 2014;11:501-6. American College of Radiology. Information notice regarding American Board of Radiology certification of diagnostic radiologists. Available at: http://www.acr.org/ News-Publications/News/News-Articles/2014/ ACR/20140502-ABR-Certification-Notice. Accessed July 5, 2014. American Board of Radiology. The exam of the future: FAQs. Available at: http:// theabr.org/the_abr/sites/all/themes/abrmedia/pdf/faq_ic_v2.pdf. Accessed July 5, 2014. American Board of Dermatology. Certifying examination. Available at: http:// www.abderm.org/certification/exam.html. Accessed July 5, 2014. American Board of Internal Medicine. Initial certification: taking the internal medicine exam. Available at: http://www.abim.org/ exam/certification/internal-medicine.aspx. Accessed July 5, 2014. American Board of Family Medicine. Dates: certification and recertification. Available at: https://www.theabfm.org/moc/datescerti.aspx. Accessed July 5, 2014. American Board of Anesthesiology. Staged examinations. Available at: http://www.theaba. org/Home/TrainingPrograms. Accessed July 5, 2014. American Board of Anesthesiology. Staged exams. Available at: http://www.theaba.org/ pdf/Staged-Timeline.pdf. Accessed July 5, 2014.
Lance A. Warren, MD, is from the Department of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri. Tirath Y. Patel, MD, is from the Department of Radiology, University of Toledo Medical Center, Toledo, Ohio. Matthew S. Layman, MD, is from the Department of Radiology, University of Tennessee Medical Center, Knoxville, Tennessee. Manish Y. Patel, MD, is from the Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama. Lance A. Warren, MD: Washington University School of Medicine, Mallinckrodt Institute of Radiology, Department of Neuroradiology, 510 South Kings Highway, Campus Box 8131, St Louis, MO 63110-1076; e-mail: [email protected].
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