BRUCE J. HILLMAN, MD
EDITORIAL
Manpower Crisis First elderly woman: The food is terrible here. Second elderly woman: Yeah, and there’s so little of it. —Woody Allen My having been in and around radiology since the last ice age allows me a certain perspective on any number of topics. One that is particularly interesting and that bears some scrutiny is “manpower.” Totally aside from the fact that the word is seriously gender biased, studies of manpower tend to raise strong emotions. That’s because manpower studies usually purport to show the relationship between how much work there is to do and how many people are available to do the work. Most such assessments in our field have focused on the count of radiologists adequately trained in clinical practice and projections of clinical work. However, there is other work to be done if our specialty is to remain successful: research, teaching, and the organizational and administrative work of leadership. How many radiologists do we need to perform these important but often overlooked tasks? It is common to hear an expert or organizational leader decry a perceived shortage of one kind of worker or another. Invoking the need for more radiology researchers, for example, sounds good in concept but has rarely been subjected to validation. The information needed to determine whether we truly need
more researchers (or whatever) is embodied in the answers to two questions: (1) “How many have we got?” and (2) “How many do we need?” Unfortunately, these are notoriously difficult questions to answer. What criteria pin down who is counted as a researcher? What inputs must be entered into the calculus to determine the gap between what we have and what we need? Even when we have some insight, changes in the health care environment can alter the situation in a hurry. Uncertainty over these types of questions can lead to a throwing up of hands and deciding that even in the absence of data, a need is evident. It wouldn’t matter so much except that a perceived shortage may encourage organizations to initiate programs intended to correct a miscalculated need. Radiologists may choose to alter their career paths to address a perceived underfilled professional niche that does not actually exist. Regarding most underfilled niches in radiology, I admit that I have a bias. I believe that in most such cases, there already are sufficient numbers of individuals pursuing careers to address the need, enough interested, newly minted radiologists emerging from our training programs to fulfill the need into the future. We actually don’t need more. But we do need better. The origin of the quality problem is insufficient education and training. The shibboleth persists that going to medical school and successfully
completing a residency and fellowship qualify radiologists to succeed in nonclinical roles. Nothing could be further from the truth. Careers in research, teaching, and leadership are competitive. They require radiologists to be as substantively educated and trained as nonradiologists who have focused their educations on these types of careers. In the end, as with most things, the demand for radiologist researchers, teachers, and leaders will be limited by the money available to support them. In a time when federal grant moneys have been in decline (in real dollars after adjustment for inflation), industry is nervous about its investments in innovation, and academic departments are less able to invest in the careers of their faculty members, there are fewer resources available for career development. Better to focus those resources on the radiologists who are the most thoroughly educated and most creative than to initiate new programs to increase the number of marginally trained individuals for whom the odds against success grow longer every day. I realize this argument may seem unseemly from one who has enjoyed an atypical career, filled with multiple jobs for which some might say I have been only marginally qualified. What can I tell you other than that times have changed? Darwin didn’t make the rules. He just described them.
Bruce J. Hillman, MD, UVA-Radiology Research, Box 801339, Charlottesville, VA 22908; e-mail: [email protected].
ª 2014 American College of Radiology 1546-1440/14/$36.00 http://dx.doi.org/10.1016/j.jacr.2014.01.006
337
EDITORIAL
Manpower Crisis First elderly woman: The food is terrible here. Second elderly woman: Yeah, and there’s so little of it. —Woody Allen My having been in and around radiology since the last ice age allows me a certain perspective on any number of topics. One that is particularly interesting and that bears some scrutiny is “manpower.” Totally aside from the fact that the word is seriously gender biased, studies of manpower tend to raise strong emotions. That’s because manpower studies usually purport to show the relationship between how much work there is to do and how many people are available to do the work. Most such assessments in our field have focused on the count of radiologists adequately trained in clinical practice and projections of clinical work. However, there is other work to be done if our specialty is to remain successful: research, teaching, and the organizational and administrative work of leadership. How many radiologists do we need to perform these important but often overlooked tasks? It is common to hear an expert or organizational leader decry a perceived shortage of one kind of worker or another. Invoking the need for more radiology researchers, for example, sounds good in concept but has rarely been subjected to validation. The information needed to determine whether we truly need
more researchers (or whatever) is embodied in the answers to two questions: (1) “How many have we got?” and (2) “How many do we need?” Unfortunately, these are notoriously difficult questions to answer. What criteria pin down who is counted as a researcher? What inputs must be entered into the calculus to determine the gap between what we have and what we need? Even when we have some insight, changes in the health care environment can alter the situation in a hurry. Uncertainty over these types of questions can lead to a throwing up of hands and deciding that even in the absence of data, a need is evident. It wouldn’t matter so much except that a perceived shortage may encourage organizations to initiate programs intended to correct a miscalculated need. Radiologists may choose to alter their career paths to address a perceived underfilled professional niche that does not actually exist. Regarding most underfilled niches in radiology, I admit that I have a bias. I believe that in most such cases, there already are sufficient numbers of individuals pursuing careers to address the need, enough interested, newly minted radiologists emerging from our training programs to fulfill the need into the future. We actually don’t need more. But we do need better. The origin of the quality problem is insufficient education and training. The shibboleth persists that going to medical school and successfully
completing a residency and fellowship qualify radiologists to succeed in nonclinical roles. Nothing could be further from the truth. Careers in research, teaching, and leadership are competitive. They require radiologists to be as substantively educated and trained as nonradiologists who have focused their educations on these types of careers. In the end, as with most things, the demand for radiologist researchers, teachers, and leaders will be limited by the money available to support them. In a time when federal grant moneys have been in decline (in real dollars after adjustment for inflation), industry is nervous about its investments in innovation, and academic departments are less able to invest in the careers of their faculty members, there are fewer resources available for career development. Better to focus those resources on the radiologists who are the most thoroughly educated and most creative than to initiate new programs to increase the number of marginally trained individuals for whom the odds against success grow longer every day. I realize this argument may seem unseemly from one who has enjoyed an atypical career, filled with multiple jobs for which some might say I have been only marginally qualified. What can I tell you other than that times have changed? Darwin didn’t make the rules. He just described them.
Bruce J. Hillman, MD, UVA-Radiology Research, Box 801339, Charlottesville, VA 22908; e-mail: [email protected].
ª 2014 American College of Radiology 1546-1440/14/$36.00 http://dx.doi.org/10.1016/j.jacr.2014.01.006
337
