I believe we are deep into a period of uncertainty in Radiology. That uncertainty has manifold dimensions. Will the downturn in overall imaging use continue at its present rate of decline? For those of you who may not appreciate the reality of this national trend because you are still doing OK with respect to volume of high tech studies such as CT and MR countrywide the yearly decrease in MR utilization is now 6 years old and the decline in CT has begun more recently. The optimists or perhaps the fantasists out there may not worry because when the Affordable Care Act a.k.a Obamacare comes fully on stream in 2014, then all those uninsured will now get imaged and presumably the decline will reverse. Maybe so but the results from Massachusetts indicate no imaging volume flood from the institution of the more comprehensive inclusion of all its citizens in reimbursable health care coverage.

Hence, with no new imaging devices in the offering, we should expect to see nothing like the expansionary period from 1998 to 2006 which upon reflection might be fondly remembered as the Golden Age of Imaging. In response to that time of rapid growth and perhaps unfettered optimism buttressed by the rapid and steady increase in average income of radiologists, residency programs expanded all over the country. The justification for hiring more trainees had to be presented to the Residency Review Committee for Radiology, an arm of the Accreditation Committee for Graduate Education. Only two criteria are deemed relevant to grant such requests, considering of course, that the petitioning program was otherwise in good standing. Those criteria were and are (1) there are enough cases in all modalities to accommodate the additional residents and (2) there was adequate attending staff in all modalities to teach them.

I was a member of the Radiology Residency Committee for much of this expansionary period with my term recently. Although some of us pondered the ultimate demographic consequences of the aggregate effect of frequent justified approval of requests for program enlargement, such speculations were outside the boundaries of decision-making.