GUEST
EDITORIAL
Do you do mammography?
John P. McGahan, MD, FACR
This future
A
s I listened to one of my abdominal
imaging fellows negotiate for his
shortage of future private practice radiology con-
tract, one of the first questions that his future
breast imaging employer asked was, “Do you do mammogra-
phy?” The willingness to do breast imaging
at our institution became a pivotal point of negotiations with
his future group. The group wanted his ser-
and at vices as an abdominal imager, including
doing breast imaging, but he did not want to
institutions do mammography in his future practice. He
finally negotiated that he would not perform
throughout the breast imaging in his new job. I listened to
another colleague in private practice who
United States does full-time breast imaging complain that
may exacerbate while his group is fully staffed in other sub-
specialties, there has always been a need for
a problem with breast imaging staff within his group, with
these positions remaining unfilled.
patient access Many subspecialties in radiology have
recently been producing an abundance of fel-
to imaging of lowship trainees. Recent trends indicate
there are fewer job openings than applicants
breast disease. in certain subspecialties in radiology. How-
ever, the opposite is true for mammography,
in which there are 2 to 2.5 job advertise-
ments per job seeker.1
Why is there such a national shortage of
breast imagers? In speaking with our residents
and future fellows, they are acutely interested
in new developing modalities such as MRI.
Within our institution (the University of
Dr. McGahan is Vice Chair, University of California, Davis Medical Center, Department of Radiology, Sacramento,
CA. He is also a member of the editorial board of this journal.
6 ■ APPLIED RADIOLOGY
©
www.appliedradiology.com
California, Davis Medical Center), none of
our residents in the past 10 years has chosen
a breast imaging fellowship, until this year.
Our graduates who choose private practice
have tended to choose subspecialties heavily
weighted in MRI and CT techniques rather
than breast imaging. Other problems with
breast imaging cited by some of our graduates
are the potential litiginous situations, the
repetitive nature of mammography, and the
perceived lack of cutting-edge technology in
this field. It seems that some of these prob-
lems may persist in the future.
Throughout the United States, the trends
are not particularly good. A recent publica-
tion by Basset et al2 showed that many breast
fellowship positions were unfilled in 2002.
There were 63 breast imaging fellowships
filled that year—surprisingly, 13 fewer than
in 1994. In phone interviews of senior resi-
dents, Bassett found that only 35% would
consider a fellowship in breast imaging if
one were offered to them. Their reasons were
“not high tech,” followed by “fear of law-
suits,” and “too stressful.”3
There are those who take a different route to
full-time breast imaging: migrating to breast
imaging once in practice. Even Dr. Bassett
switched from another subspecialty to
full-time breast imaging because of a depart-
ment need. At UC Davis, we are currently
adequately staffed in breast imaging, but
December 2008
GUEST EDITORIAL

with retirement just around the corner for a couple members
of our faculty, we are again in the position of looking for new
breast imaging faculty.
This future shortage of breast imaging at our institution and
at institutions throughout the United States may exacerbate a
problem with patient access to imaging of breast disease.
Anxiety is great among those patients who have a screening
mammogram and are called back for additional views and
who then have to wait 2 to 3 weeks to obtain their diagnostic
breast examination. This time delay is increased with a short-
age of breast imagers who often have a full and busy work
schedule.
How will this situation be remedied? Certainly, there must be
some incentive for radiologists to perform breast imaging.
Those general radiologists who have an interest in breast imag-
ing may increase the percentage of their time in breast imaging.
However, there are those who would argue that this is not the
solution, as these are not fellowship-trained breast imagers and
that “specialist” radiologists in breast imaging detect more can-
cers than general radiologists doing breast imaging.4 True or
not, until there are adequate numbers of full-time or fellowship-
trained breast imagers, many general radiologists will continue
to perform breast imaging. Will financial or other incentives
help? Well, certainly if a radiologist cannot get his or her
“ideal” job or location, he or she may seek fellowship training
in breast imaging.
Perhaps interest in breast imaging will increase as residents
are introduced to the newer aspects of breast imaging. Contin-
ued technical improvements in breast MRI will help. There is
current research at our institution into CT and PET of the
breast, which has increased the interest in breast imaging fel-
lowships by the residents at our institution. Breast tomosyn-
thesis is an up-and-coming modality that may make this field
“more exciting” to trainees and help alleviate the problem of
shortage of breast imagers. Until the perception of breast
imaging changes, there may continue to be a shortage of full-
time breast imagers for the near future. However, for the first
time in many years, the number of applicants to breast imaging
fellowships has increased. Maybe times are changing.
REFERENCES
1. Sunshine JH, Maynard CD. Update on the diagnostic radiology employment
market: Findings through 2007-2008. J Amer Coll Radiol. 2008;5(7):827-833.
2. Bassett LW. Breast imaging: Current utilization, trends, and implications. AJR
Am J Roentgenol. 2007;189:612-613.
3. Bassett LW, Monsees BS, Smith RA, et al. Survey of radiology residents: Breast
imaging training and attitudes. Radiology. 2003;227:862-869.
4. Sickles EA, Wolverton DE, Dee KE. Performance pramaeters for screening and
diagnostic mammography: Specialist and general radiologists. Radiology.
2002;224:861-869. Comment in: Radiology. 2003;227:609; author reply 609-611.

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