Fellowships and ACGME

[fedor]

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Are there any plans for ACGME (Accredited Council for Graduate Education) to recognize any additional radiology sub-specialties?

At the moment I believe they only recognize 5:
1) interventional rads
2) nuclear medicine
3) pediatric radiology
4) MSK
5) neuroradiology

However, plenty of programs are offering non-ACGME approved rads fellowships including:
1) mammo
2) body mri
3) neurointerventional
4) womens imaging
5) abdominal

Are there even any advantages for having ACGME recognition?

 

[Docxter]

Are there any plans for ACGME (Accredited Council for Graduate Education) to recognize any additional radiology sub-specialties?

At the moment I believe they only recognize 5:
1) interventional rads
2) nuclear medicine
3) pediatric radiology
4) MSK
5) neuroradiology

However, plenty of programs are offering non-ACGME approved rads fellowships including:
1) mammo
2) body mri
3) neurointerventional
4) womens imaging
5) abdominal

Are there even any advantages for having ACGME recognition?

MSK is the newly ACGME accredited one and the vast majority of the MSK fellowships are not ACGME approved. You also have to add the Endovascular Surgical Neuroradiology fellowship to the list of ACGME approved ones. The only possible advantage is that in the more established ACGME-approved ones (neuro, IR, peds, nucs) have a CAQ (certificate of added qualification) boards examination to demonstrate subspecialty status, if one choses to get it. Otherwise, no advantage.

 

[hans19]

MSK is the newly ACGME accredited one and the vast majority of the MSK fellowships are not ACGME approved. You also have to add the Endovascular Surgical Neuroradiology fellowship to the list of ACGME approved ones. The only possible advantage is that in the more established ACGME-approved ones (neuro, IR, peds, nucs) have a CAQ (certificate of added qualification) boards examination to demonstrate subspecialty status, if one choses to get it. Otherwise, no advantage.

Concerning CAQ specialties.

The downside to a CAQ specialty is shelling out the $3,000 to take the test and then having to recertify every 10 years.

The CAQ in interventional radiology may have been intended to help 'protect turf', but now has become a hassle. Case in point, Vascular surgeons and Interventional Cardiologists can get credentialed to perform renal and carotid artery stenting at hospitals. In many cases they learned the procedure from a weekend-long device manufacturerer-sponsored course. However for an interventional radiologist, without an IR CAQ, many hospitals won't credential them to perform the these procedures-- despite the fact that the IR is usually the most technically proficient.

Furthermore, if you don't have a CAQ its additional fodder for a plaintiff's attorney in the case of a suboptimal outcome.

Concerning ACGME vs Non-ACGME specialties:

The 'hot' general MRI fellowships are, in general, not ACGME accredited. The advantage of this is that one is not technically a 'fellow'. Rather, one is hired on at the 'instructor' level and you can negotiate a better salary than the going PGY6 rate.

However, as a Non-ACGME fellow, you are not protected by the 80 hour work rule which means they can overwork you. At the same time there are no restrictions to moonlighting. Furthermore, you may have to pay for benefits out of pocket, and since you are technically no longer in training, you will have to begin repayment of your loans.

 

[f_w]

ACGME accredited:
+++ limited liability. Someone else who is better insured signs off on all or your reports
+ work hour limits (rarely an issue in fellowship)
+++ less paperwork (often no need for a full medical license. can be a big headache reliever in some notorious states)
+- many of are CAQ. (If you like framed certificates it is a +, considering the additional $3000 to the predatory ABR is a big ---)

Non accredited:
+++ often pays far better because the department is not limited by the PGY-x level stipends the medical school offers
-- often pressed into service as junior attending to cover low-reimbursement high liability work (pedi, ED board, staffing out residents on weekends)
--- needs a full license, hospital credentialing sometimes a medicare number. Can be a major paperwork headache at a time when you least need it (just before the orals).

 

[nev]

Just a question.....is it easy for a radiologist who has a fellowship in any of the above fields to get a job? I was told that such highly trained specialists are employed only in less numbers. Is it true?
Thanks
Nev

 

[fedor]

Just a question.....is it easy for a radiologist who has a fellowship in any of the above fields to get a job? I was told that such highly trained specialists are employed only in less numbers. Is it true?
Thanks
Nev

At the moment it's easy for radiologists, whether fellowship trained or not, to get private practice jobs.

A lot depends on the group you're aiming for. One group I know in particular, has been looking for a neurorad for about 2 years now and has had to make do with locums. They also have been looking for a rad which has had a mammogram fellowship because none of the partners enjoy reading mamms. When I asked this partner if he would have done mamm or neurorad fellowship because of the demand, he replied with: "Hell no, MSK all the way."

This paper is a bit dated but it may help answer your question a little:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9419674&dopt=Abstract

"RATIONALE AND OBJECTIVES: We surveyed diagnostic radiology group preferences and considerations in hiring radiologists and compared these findings with those of a survey performed in 1990. We sought to identify changes in hiring practices that might have occurred because of socioeconomic changes. We also sought to identify features of job candidates that make them more attractive to hiring groups. METHODS: One hundred surveys were mailed to a stratified random sample of diagnostic radiology groups identified by the American College of Radiology. We solicited information on the importance of various attributes and the level of experience of a candidate, the fellowship training considered most desirable, and the effect of changes in the health care socioeconomic environment. The responses were weighted by group size and geographic location to estimate what results might have been obtained if we had surveyed all groups in the United States.

RESULTS: Seventy-five groups returned the survey. The two most important factors in choosing a candidate were motivation and radiologic knowledge. The fellowships that groups that were hiring considered to be the most desirable were body imaging, neuroradiology, and angiography/interventional radiology. Groups overwhelmingly preferred recent training over long experience.

CONCLUSION: Fellowship training increases a candidate's marketability, but the two factors that hiring groups consider the most important are motivation and radiologic knowledge."