As the field evolves abroad, are radiology residencies becoming ‘skippable’?

The path from medical school to residencies and fellowships might be cut and dry in U.S. colleges and hospitals—but international post-grads are facing different issues, including the fact that residencies seem to be becoming obsolete, a radiologist wrote in the Indian Journal of Radiology and Imaging.

In many countries, medical school graduates are required—or at least expected—to complete a three-year residency prior to joining a practice, but that’s not the case in India and other developing countries, author Chander Mohan, MD, wrote in an editorial. While senior residencies do offer post-grads the opportunity to hone their radiologic skill while proving their eligibility for a staff post, the draw of more money and better hours is pulling some candidates in a different direction.

When the medical education system was set up, Mohan said, three-year residencies were nearly mandatory. Now, they’re “skippable.”

“The biggest pride in the academic career of a medical student was, and is still for some, being the professor and head of the department in prestigious medical colleges and institutes,” Mohan wrote. “Times have evolved.”

This “relaxation of norms,” he said, stems from the widespread privatization of healthcare, which has resulted in both public hospital and private practice growth. Demand for radiologists quickly shifted from too low to too high—with too few specialists available to fill all open positions—leading to the recruitment of radiologists who haven’t completed residencies or who have little specialized training.

Mohan said radiologists are at the forefront of this shift despite their quiet reputation in the medical sphere.

“There is hardly any personal identity of the radiologist in most practices in the eyes of the general public,” he wrote. “This undesirable situation has become a blessing in disguise for diagnostic centers, many of whom have ceased to have any norms for recruiting radiologists barring a postgraduate degree or even a diploma in radiology.”

While countries like the U.S. have been more dedicated to developing senior residency programs, India’s government has been lackadaisical in its approach, Mohan said. The senior residency, though it still exists, has become more of a “rote would-be-consultant eligibility program,” with little attention being paid to residents’ intellectual stimulation or specialization.

“The most ironic part is, even if the senior resident gets good subspecialty exposure in three years, he leaves the senior residency as a general radiologist only,” the author wrote.

According to Mohan’s paper, if a post-grad wishes to skip residency, they have other options—and some are more appealing than long shifts and nights on-call. The biggest differences between paths are more tuned to compensation than experience, though, which Mohan said stays relatively uniform no matter where a soon-to-be-radiologist ends up.

If the candidate decides to go into private practice, they’ll be paid almost double a resident’s salary. If that person opens a practice in a tier two or three city, they’ll enjoy less competition while gaining the same specialized exposure in three years that a residency would allow. Some candidates also opt to pay fees, or work for very little, in return for working with a famous name in the field. Working under a well-known, private consultant “is far more lucrative than working three years in a glorified residency,” Mohan said.

In all, there is a lack of qualified radiology candidates in the field, the editorial stated. Private colleges are beginning to offer greater stipend to radiology post-graduates just to fill the vacancies in their practices.

“Is there a way forward?” Mohan wrote. “The answer is ‘no,’ unless and until the radiology community starts to rethink this rote pattern of senior residency that is being followed blindly. They have to give the candidate a choice in their senior residency to practice in their fields of interest, as well as start transforming the program into a subspecialty program where the candidate actually gets the choice of where they want to head in their careers.”