Is There a Win-Win Solution for Radiology and Nuclear Medicine?

It is with great interest that I read the contentious pair of articles in the recent issue of JACR by Dr. Graham (1) and Dr. Guiberteau (2), on the relationship between Radiology and Nuclear Medicine, with an analysis of the current situation, and projection into the future.

Representing the Nuclear Medicine community and ABNM, Dr. Graham argues that Nuclear Medicine physicians are better trained than Radiologists as they train for 3 years versus only 4 months, but since most physicians hired to read NM studies are ABR certified Radiologists, the job market has taken a hit, and number of programs have declined from 86 to 42. They attribute decline in NM procedures to subpar trained radiologists, and say that the “radiology community/ABR is not allowing NM to thrive in the US”.

Dr. Guiberteau, on the other hand, representing the Radiology community and the ABR, argues that board-certified radiologists have adequate training in nuclear medicine. He goes on to say that the decline in Nuclear Medicine is multifactorial. For example, about 50% of Nuclear Medicine is now performed by cardiologist certified by CBNC.

1. Both parties agree that Nuclear Medicine is in the state of decline.
2. They both also agree that future NM practitioners should be certified by both ABR and ABNM. Future for NM looks good due to advent of hybrid techniques and theranostics.
3. Both groups did try to resolve the differences recently and work something out, but the nonnegotiable dissolution of ABNM was not agreed-upon by the NM community.

As a physician trained in both NM and Radiology, I agree that in the interest of patient care, future NM practitioners should be certified by both ABR and ABNM. Radiology training has made me a better NM practitioner. I feel that both parties have presented valid points but they have both ignored the role of international medical graduates in this situation. For the last decade or longer, the NM training programs have recruited not so bright IMG MDs and the Radiology community has licensed IMG MDs under 5th pathway, with NO prior NM training in their home country. Here is what I propose as a win-win solution:

1. All MDs who graduate from a NM program are absorbed as Radiology residents and become ABR eligible after 3 yrs of Radiology training. With time only few large and strong programs will remain, which will train fewer trainees who will go on to train in radiology (some such programs do exist now and I thank them for their foresightedness) and become certified by both ABR and ABNM.

2. All IMGs who go through 5th pathway, train in NM for 1 or more years. They need to learn NM and its value as ABR certified Radiologists, and should be eligible for ABNM as well.

3. ABNM should co-exist with ABR and help to produce high quality future NM practitioners (certified by both ABR and ABNM), for academic radiology and private practice. ABNM is invested in supporting the already certified diplomates and should continue to do the same.

Here is the reality of the practice of Nuclear Medicine according to a recent article by Balthasar et al “up to two-thirds of NM studies are interpreted by physicians not certified by the American Board of Nuclear Medicine (ABNM). Additionally, those who solely practice NM interpret fewer than one-quarter of all NM ex- aminations, with cardiologists and radiologists interpreting most others” (3). In their study, they found that “the distribution of services rendered by the NM specialist workforce in the United States is highly variable, with most NM physicians devoting 90% or more work effort to NM, but most nuclear radiologists and nuclear cardiologists devoting 10% or less to NM.

I urge NM training programs to stop training people when there are no jobs. What good is ABNM certification if majority of NM studies are read by non ABNM certified physicians? Most advertised jobs are taken up by ABR certified Radiologists (who may or may not be certified by the ABNM), often fellowship trained in other subspecialties such as Body, Neuro, or MSK. Fellowship training in NM is a great option for Radiologists in the current job market. Many NM physicians go for Radiology residency after NM training. Many recent NM graduates have been forced to find jobs in other fields such as real estate, basic sciences, and insurance industry. I also urge ABR to stop certifying IMGs with no prior training in NM. These IMGs downplay NM in their reports leading to underutilization.

Peeyush Bhargava MD, MBA

1. Graham MM, Delbeke D, Jadvar H. Point: The Existential Threat to Nuclear Medicine.
J Am Coll Radiol. 2018 Mar;15(3 Pt A):384-386.

2. Guiberteau MJ, Oates ME. Counterpoint: Nuclear Medicine’s Decline: Radiology Is the Solution, Not the Problem. J Am Coll Radiol. 2018 Mar;15(3 Pt A):387-389.

3. Balthazar P, Schuster DM, Grady EE, Rosenkrantz AB, Duszak R Jr. Current Clinical Practice Patterns of Self-Identified Nuclear Medicine Specialists. AJR Am J Roentgenol. 2018 Aug 7:1-8.