Increasing nuclear medicine residency training requirements: for better or worse?

Residency Training Requirements: For Better or Worse? A proposal has recently been put forward to increase the duration of the nuclear medicine residency and implement a 3-tier residency training requirement beginning in 2005 or 2006. The proposal includes increasing the length of the nuclear medicine residency from 3 to 4 years (1 basic clinical year [PGY-1] plus 3 years of nuclear medicine) for medical graduates fresh out of medical school. Internal medicine physicians will be required to complete 2 years of additional training in nuclear medicine, and radiologists will be required to complete a fellowship year of nuclear medicine to be eligible to take the American Board of Nuclear Medicine (ABNM) examination. The proposal has the greatest impact on the nuclear medicine residents who have not completed residency training in other specialties. Four of the main reasons cited for increasing the length of training are the perceived needs to: (a) train residents in new and changing modalities such as PET/CT, (b) raise the standards of nuclear medicine residents, (c) make nuclear medicine training more academically oriented, and (d) increase the respect for nuclear medicine physicians. Although these are honorable reasons, many issues must be addressed before these decisions are finalized. First, simply increasing the length of residency training does not guarantee that residents will receive training in new techniques, in technologies such as PET and CT, or in innovative research. The requirements are not properly structured to mandate such training. Moreover, residency programs with only 1 or 2 residents might actually need to increase the number of residency slots, because the thirdyear resident may not be available to perform the same duties as a firstor second-year resident. The final-year resident might be in a research or CT rotation, leaving the clinic without coverage. This will eventually create tensions and problems within the department. In addition, the new recommendation does not address the case of a resident deciding to switch to nuclear medicine after 2 years of residency training in another specialty. What would be the requirements in such a situation––2 or 3 years of nuclear medicine residency? Some have suggested that 2 years of training in nuclear medicine after internship are inadequate for nuclear medicine physicians. This does not seem rational––the majority of nuclear medicine scans in the United States are currently being read by general radiologists with only 4–6 months of training in nuclear medicine. Many nuclear medicine procedures that were commonly used in the past are no longer in use. The time spent learning these now outdated procedures can be diverted to other training, such as PET or PET/CT experience. Moreover, many nuclear medicine physicians who were never trained in PET during their own residencies are currently doing excellent work reading PET scans. This proves that once a reasonable level of training and experience is achieved, further knowledge can be built on previous training and experience. Second, increasing the length of training with no added benefit may not increase the quality of the residents, because it does not make nuclear medicine residency graduates more marketable for jobs or more advanced training. After the proposed training requirement increase, a nuclear medicine residency would require 4 years and a radiology residency would require 5 years. Most medical students would prefer to do the radiology residency, because radiology offers more job opportunities for only slightly longer training. Those who opt for radiology would be able to read nuclear medicine scans, along with many other modalities, without additional training. If the purpose of the extended training requirement is to attract more and higher quality residents, the result of this change would not only be poor but would ultimately be detrimental to nuclear medicine. Third, although the notion that extending residencies would provide extra time for research and better prepare physicians for academic positions is admirable, fellowships might provide a more practical and beneficial alternative. Higher professional social status and pay come after a fellowship year rather than after an additional year of residence. Young physicians today are confronted by many issues that were not as evident 5 years ago, such as stringent Medicare reimbursement rules for residency and the everincreasing cost of medical school tuition. A year of fellowship training after residency, allotted exclusively for nuclear medicine residency graduates, would be a better option. Fourth, improving the perception of nuclear medicine among other specialties might be accomplished more effectively if we try to increase the marketability of nuclear medicine physicians rather than simply increasing the length of their training. The reason for the low marketability of both nuclear medicine residencies and their graduates is not a lack of training or respect from the physician community but the limited availability of postresidency employment. The few jobs available are mostly in academic centers, where ABNM-certified physicians or radiologists with certification in nuclear radiology are preferred. The typical nuclear medicine resident graduating in June will not be able to sit for the C o m m e n t a r y