I doubt many of you have not heard by now that the job market for Radiologists-both newly minted ones and those already in practice-is very tight. Tales of woe abound, told by those finishing their fellowship and now in the hunt. They relate their angst to more junior trainees who in turn pass theirs along to senior and junior medical students. And some of them who have expressed an interest in our specialty are being put off by a fear of being unemployable after 6 years of post-graduate preparation. It is likely they may decide to pursue another specialty for this reason. This past year the number of allopathic American medical school graduates accepted to Radiology residencies declined by 27 % from the previous year. This decline does not take into account those dissuaded from seeking a residency in the first place. Much of the discrepancy between offered positions and filled positions was taken up by foreign medical graduates, which an immediately substantial supply accommodates. But, if present trends continue, it will change the complexion of residencies in terms of homegrown talent. This will deflect us from our present resemblance to Dermatology, which many accomplished students choose, and we will become more akin to Pathology, in which in many programs American-trained residents are a distinct minority. Of course, brains do not stop at the border, but even those bright, productive foreign-born residents may experience the same dearth of jobs when they finish that our allopathic fellows perceive they will contend with when they finish training.

So what of the job market? Is it a temporary imbalance between openings and applicants, soon to right itself, as has happened several times before in the 40 year history of Radiology’s stupendous and continual growth from 1970 to 2010? Over those two score of years it was actually a cyclical event, reflecting the ebb and flow natural to any economic situation across time. Or is it a structural metamorphosis, a signal of Radiology’s inevitable and soon to be protracted contraction as forces conspire to limit our growth and even reduce the volume of studies we will be allowed to perform and interpret?

First let us consider how this latent imbalance occurred. This is important because it can give us clues about the consequences to be anticipated in the near and medium term.