Time for change: new emphasis on training for radiology research.

The field of radiology has evolved dramatically with the introduction of new modalities, the refinement of established modalities, and the development of interventional techniques. The rapid deployment of ultrasound (US), computed tomography (CT), and magnetic resonance (MR) imaging necessitated a series of reviews of the imaging features seen with these modalities and their accuracy in detecting the suspected abnormality. Such descriptive research was essential to the development and use of these new imaging tools, but it lacked validity and generalizability. Moreover, it was not the hypothesis-driven research that is typically funded by the National Institutes of Health (NIH). These new imaging modalities proved to be enormously valuable for patient care. Their success has changed the practice of medicine. Exploratory laparotomy has essentially been replaced by CT examination of the abdomen. US has become the primary modality for examining patients suspected of having cholelithiasis and is an essential monitor during pregnancy. Patients with disease of the central nervous system cannot be cared for without MR imaging, which is replacing other methods for the evaluation of the heart, vessels (MR angiography), and female pelvis. The effect of interventional procedures has been no less dramatic. The ability to affect regional blood flow with percutaneous transluminal angiographic techniques has converted treatments from surgical to radiologic procedures for a number of clinical indications. Percutaneous drainage is now the primary treatment for abdominal abscesses, and percutaneous techniques are routinely used to alleviate obstructions in the urinary tract and biliary tree. The result of these improvements has been a marked increase in demand for radiology services. Approximately 10 years ago, managed care plans were developed in an effort to control the rapidly rising cost of medical care. Such plans often included efforts to reduce the use of expensive imaging technologies, and initial implementation suggested a reduction in the use of ancillary services by as much as 30%–50%. Because of concern that there may be too many radiologists (and other subspecialists), some residency training programs were reduced in size or closed. The Health Care Financing Administration (now the Centers for Medicare and Medicaid Services [CMS]) capped the number of residents at the December 1996 institutional level. For many hospitals, the residency training program was frozen at its lowest level in years. The predicted decreases in use of radiology services were not realized, and the volume of imaging began to grow by more than 10% a year. This exploding demand came at a time when radiology could not respond by increasing the size of residency training programs. Private practice groups, hungry to expand, hired new radiologists at the completion of their residencies rather than waiting for them to gain additional expertise in a fellowship program. Fewer radiology fellows, expanded resident supervision requirements, and a shortage of available faculty put further stress on academic radiology departments to provide timely clinical service. There was little time to perform research, and fewer radiologists were trained to do it. Acad Radiol 2002; 9:695–699