As most of you are now aware, these are parlous times for Radiology. The long run up in case volume has peaked. Although your practice may still be experiencing growth, for most of us we are now entering a period of retrenchment. The multi-decade expansion of our discipline has been accompanied by a 12 year interval of expansion of residency programs and now the former dearth in the number of newly minted specialists in our discipline has become a surplus [1].

Remember the managed care scare of the mid 1990s when it was predicted that volume would lessen with primary care doctors acting as gatekeepers. They would restrict utilization and then radiology practices should expect contraction. So some training programs decreased the size of their entering classes. But since then, even with the Medicare cap in place since 1997, nearly every program has become larger. So now we graduate approximately 1,100 residents annually up from 550, 15 years ago. And in the pipeline are even bigger classes. Thus with the specter of declining revenues and limitations of test-ordering just over the horizon (in essence a formula for decreased demand) coupled with increased supply, this uncertain future may be regarded with alarm by senior medical students. Since they are usually savvy consumers, we should see a declining interest by them in Radiology. Right? No wrong, or particularly wrong.

Judging by the record of the 2009 class and with no indication from preliminary results from the 2010 class of any change, radiology is still attracting in droves some of the best and highest achieving allopathic American medical students as well as a veritable flood of capable foreign medical graduates. But in the last 2 years, allopathic students are less inclined to seek radiology whereas foreign trained radiology seekers are still interested.

The following discussion will highlight details of the demographics of entrants to our unfavorable economic projections from seeking to join us.