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Paradoxically, the source of most problems is previous solutions.
But, of course, not all problems are bad. As noted by the ancient Chinese philosophers, there is yin and yang in all aspects of life. There are good problems and there are bad problems. Take, for instance, the current heightened demand for diagnostic radiologists. That could be considered a good problem. There are innumerable unfilled job openings across the entire United States. No region or type of practice is free of need. In fact, there may not be enough radiologists to go around, enough to fill the current demand. That could be considered a bad problem.
What has transpired to create such a demand for diagnostic radiologists that many positions have gone begging? Simply put, diagnostic imaging is more important to the practice of medicine and surgery than ever before. The cumulative effect of recent improvements in imaging technologies has been an increase in both our capacity to detect disease and our specificity in identifying the nature of disease which, when coupled with the increasing sophistication of our interventions, has significantly increased the demand for radiologic services.
The reason for the increased demand for radiologic expertise is actually two-pronged. First, there is a growing requirement to extend our hours of operation and availability, not just to cover weekends and holidays, but also to implement full-time, 24-hours-a-day, 7-days-a-week coverage in hospitals, even in those institutions without trauma level 1 or 2 emergency departments. Such is the demand that CT scanners must run around the clock and, as a general rule, most MR facilities require more than a single shift, if not a full two shifts, to satisfy the demand for MR imaging. Extended hours of operation require either that the present complement of radiologists work longer hours and require more call or that more radiologists be hired to provide the necessary coverage. It does not take a long time operating under the former to realize that you need to do the latter.
Second, the level of diagnostic sophistication required by those who perform and interpret imaging examinations has been elevated by the greater sensitivity and specificity of advances in imaging technologies. Each improvement in technology has been accompanied by the need for added knowledge on the part of interpreting radiologists.
We have long recognized the need for sub-specialists in certain areas of diagnostic radiology. For instance, the specific skills required in the field of vascular and interventional radiology come immediately to mind. Neuroradiology is another obvious example. Although there are specific technical skills required in neuroradiology, it is more the extensive knowledge of anatomy and disease processes that years ago necessitated the development of neuroradiology.
More recently, the need for specialists in musculoskeletal imaging has skyrocketed, brought about by the introduction of MR imaging in the assessment of the full range of musculoskeletal diseases, including those of soft tissue as well as the bony skeleton. The application of MR imaging has resulted in an enormous escalation in the need for radiologists interpreting musculoskeletal imaging examinations to possess highly specific detailed knowledge of musculoskeletal anatomy and disease processes.
And the latest subspecialty in diagnostic radiology to reach this exalted status of high demand and low supply appears to be pediatric radiology. The need for specific knowledge of disease in children has long been recognized. The care of children has been concentrated in a few centers, particularly for the rare and less common diseases of childhood, thus limiting the demand for pediatric radiologists. However, sonography and helical CT have proven to be of great value in the assessment of the more common, everyday ailments of children. Add this to the use of sonography in the evaluation of neonates and you have an acute demand for pediatric radiologists that far exceeds the current supply. Too few radiologists are entering this now wide-open field. If you are a diagnostic radiology resident and thinking of specializing, give this subspecialty some thought. The job opportunities are limitless.
The yin of all of these recent advances in imaging technology is that diagnostic radiologists have more to offer than ever before; the yang is that there is more to do and yet we continue to train the same number of radiologists (or even fewer than before). The need to fill radiology's manpower requirements is not a bad problem; it's a good problem, but a serious problem nonetheless. Imaging is essential to the presentday practice of medicine and surgery. We need more radiologists. If there aren't enough radiologists to do the imaging, somebody else will.
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