For the past decade residency positions in radiology in America continue to be highly sought. The competition is fierce but when the match is published and the applicant has gained a place for training after internship, it is a cause for celebration as the stresses of the months long application process are finally relieved. However, entering a residency is no guarantee that it can be completed, independent of the enthusiasm and capabilities brought to the program by the trainee himself.

Externalities can affect the 4 year residency interval. There is no guarantee that the quality of the program will continue indefinitely as decline is as likely as improvement, although maintenance of the status quo is probably more frequent. In the United States today at times prized faculty members may be recruited away from the program, leaving the residents with fewer teachers of quality. The administration of the hospital may no longer be interested in maintaining a residency program, and might seek to end it after only a short transition period. This is not merely a theoretical concern as program closure has happened several times in the past few years and with financial constraints more burdensome such a consequence may become increasingly frequent. Worse, the program or the hospital may become bankrupt and then may no longer value the benefits of continuing to maintain a graduate medical education program. Under such a drastic scenario, trainees will then be compelled to seek other positions elsewhere and only get them if they are lucky. In these circumstances, there is little protection for the residents when the program declines or disintegrates.