Radiology Residencies: Hard to Find, Hard to Land

At the recent Radiological Society of North America annual meeting, a Swiss researcher reported lagging interest from medical students in pursuing a radiology residency and career. She found that survey respondents recognized radiology’s importance but expressed a desire for more patient contact, among other reasons to bypass it.

So, while 99% of the 1184 respondents agreed that radiology is important in their future clinical practice, 64% ruled it out as a career.

However, three leading radiologists in the United States took issue with the survey, which included responses from 21 universities in Germany, Switzerland and Austria but not the United States. The scenario in the United States is very different, they told Medscape Medical News. Among US medical students, interest in radiology residences — both interventional and diagnostic — is on the rise. But, despite the increased interest, radiologist shortage is ongoing. The limited number of residency positions, an increased demand for imaging services and an aging population are major reasons.

“Interest in radiology by medical students is high, and matching into radiology is quite competitive,” said James M. Milburn, MD, vice-chair of the Ochsner Health Department of Radiology, New Orleans, and professor of radiology at the University of Queensland, Brisbane, Australia. The number of applicants to radiology residency positions exceeds the number who get in, with the number of unmatched hopefuls on the rise, he said.

“Many of the individuals not matching are very good applicants who could become fine radiologists,” Milburn said.

“It has become difficult to get a radiology residency slot even for a US grad,’’ agreed Robert Min, MD, chair of radiology at Weill Cornell Medicine and New York-Presbyterian and president and CEO of the Weill Cornell Physician Organization. “The number of applicants for residencies has gone up, but the slots have not.” 

When people apply for a specific specialty, it’s often tied to the job market, he said, and the demand for radiologists is expected to increase. 

“It’s still a very attractive field,” agreed Carolyn Meltzer, MD, a neuroradiologist and dean of the University of Southern California Keck School of Medicine, Los Angeles. But “we aren’t training enough [radiologists] to meet demand. If I were able to keep all the residents I train every year, it would take me several years to catch up to the need.”

A recent Medscape report found that radiologists earn an average of nearly $500,000 a year, the sixth-highest average salary for a physician.

Radiologists: Shortage & Projections

How severe is the shortage, and how much will demand for radiologists grow?

As of December 9, the American College of Radiology posted 1923 open radiology jobs. In a 2024 report, the American College of Radiology and the Radiology Business Management Association estimated a total shortage of 13,500 to 86,000 physicians by 2026; radiology falls in the “other specialties” category, which will face an estimated combined shortage of 19,500 physicians.

The Bureau of Labor Statistics estimates that employment for radiologists will grow by 4% between 2023-2033, with 1200 new jobs added. The trend mirrors overall physician employment, which is also expected to grow by 4% in the time period. In comparison, growth of 2% is projected for general pediatricians and pediatric surgeons, 3% for obstetrician-gynecologists and general internal medicine physicians, 7% for dermatologists and neurologists, and 8% for psychiatrists.

Barriers: Lack of Slots

Despite that rosy growth prediction, many applicants don’t get past applying. 

“In 2023, there were 1084 more applicants to diagnostic and interventional radiology than available positions, up from 570 excess applicants in 2020,” Milburn said. In the 2024 National Resident Matching Program, the applicants again outnumbered the matches.

“This makes people question why we do not simply increase the number of radiology positions available,” Milburn said. “The reason is that the 1997 Balanced Budget Act placed a cap on the number of positions at each hospital, based on the total number of residents training there in 1996. Caps are allotted to hospitals, not [specific] residency programs.”

Medicare is the largest funder of graduate medical education (GME) at public hospitals and Congress in the Balanced Budget Act sought to limit the cost of residency slots. 

Further, he said, “The vast majority of residency positions are funded by the government, and there has been little change in that number. Minor increases have come from additional caps at new teaching hospitals and a small increase that is being rolled out with the GME Enhancement and Consolidated Appropriations Act of 2021, but relatively few of the these are allocated to radiology.”

How to Increase Radiology Residencies

When residency positions are increased in university and hospital systems, most are self-funded, Milburn said. 

“My own radiology department at the Ochsner Clinic has decided to self-fund two additional positions in recent years, and I believe this is an increasing trend in many hospitals. Because so many of our faculty hires arise from our own residencies, departments should consider [funding] resident positions as a good way to improve the future recruitment pool.”

In 2023, the average annual compensation for residents was $67,400, according to a Medscape survey.

According to Milburn, “Self-funding one spot starts at just one resident salary plus benefits the first year.” 

Of course, since it is a 4-year residency, this would increase. 

“So, each position would have the additive cost of a PG2, PG3, PG4, and PG5 resident salary plus benefits. That would probably be around $400,000 per additional position.”

“While it’s nice to say we should increase the number of slots, if the federal government isn’t saying, ‘Oh we are going to give out more,’ then it’s up to each system,” Meltzer said. 

But there’s not always much incentive, she said, because systems can’t count on residents staying on as hires. Extra incentives, she said, such as offering a subspecialty opportunity in the last year of residency, or an offer to start a fellowship early might help, she said. However, “you can’t force someone to hold to employment just because they trained at your institution.”

In a bulletin posted on the American College of Radiology site, Alan H. Matsumoto, MD, chair of the ACR Board of Chancellors, proposed a number of strategies, including enactment of the Resident Physician Shortage Reduction Act (H.R. 2389/S.1302), referred to the US House Subcommittee on Health in April 2023. It would increase the number of federally funded residency positions by 2000 annually for 7 years, or a total of 14,000.

Milburn and others say the benefits of making residents feel valued and like they belong should not be underrated.

“Residencies should also create a positive environment in which their residents will want to practice in the future,” Milburn said.

Min agreed and said he meets regularly with his residents, as a group, for a minimum of 90 minutes each month, and individually as the need arises. “I interview every applicant. I believe [residents] are the foundation on which we build a great department. Making people feel valued, he said, pays off. Most of his residents stay on as faculty, Min said, even though Weill Cornell pays less than other institutions.

What Draws Med Students to Radiology?

Despite the competitive atmosphere, what continues to attract medical students to a radiology residency?

Taking a radiology elective was most likely to spark interest in a radiology residency, according to a University of Arizona, Tucson, Arizona, study that polled 57 medical school graduates who matched into a diagnostic or interventional radiology residency program. In recent years, mentors also matter. Of the 43 who responded, those who were to finish training in 2023 or later were more likely to say they were influenced by a mentor than those who finished before 2023.

Only a minority expressed concern about artificial intelligence having a negative impact on radiology. Remote reading had a positive impact, three of five said, citing it as a benefit towards a preferred lifestyle. Job satisfaction was rated high, 4.3 of 5.

Compensation likely plays a role. For average annual earnings, radiologists are in the top 20% of 29 specialties, coming in at number 6 with an annual average income of $498,000, according to the Medscape Physician Compensation Report 2024.

Meltzer and Min had no disclosures. Milburn had no relevant disclosures.

Doheny is a freelance journalist in Los Angeles.