Sir,
This is with reference to the article “Subspecialization in radiology – Is it time
to hatch out of the cocoon?”[[1]] While we do concur with your views, in our opinion we feel there are very few structured
fellowship opportunities in India, and hence one usually has to look outside India
for subspecialty training.
Lack of segregation of radiology departments in the teaching hospitals into various
subspecialties is a contributory factor along with meager faculty who are subspecialty
trained.
Even though one is subspecialty trained, a dearth of subspecialty radiology jobs,
both in the government and the private sectors, discourages the young radiology graduates
from pursuing further training and move overseas for more lucrative opportunities.
The private sector prefers to recruit general radiologists to keep the workflow abreast,
which sometimes compromises the quality of reads.
There is an increasing trend of subspecialty hospitals opening up, such as children’s
and maternal, neurology/neurosurgery, and gastrointestinal, where hospitals are willing
to hire subspecialists of medical and surgical fields; there has to be a change regarding
the hiring of radiologists as well, for example, we would not expect a general surgeon
or an internal medicine trained doctor working in a children’s hospital, and the same
has to be applied to radiology.
There will always be a need for a general radiologist, but there has to be a job market
for a subspecialty radiologist too, with the latter not expected to work as a hybrid
imager, just like a cardiologist may not be expected to see patients pertaining to
general medicine.
It is well-known that radiology along with medical genetics are two of the most advancing
fields in medicine. With the advent of new disease discoveries and technologies, such
as artificial intelligence, a radiologist in the present times is expected to provide
in-depth reporting, no longer pertaining only to generic terminologies and anatomy-based
descriptive reporting. One needs constant upgrading of knowledge and practice, which
may be possible yet challenging for a general radiologist to do this in all the subspecialty
fields as mentioned in the article.[[1]]
A subspecialty radiologist is expected to know the clinical presentation, imaging,
and treatment protocols. Different subspecialties demand different machine learning
in terms of studies and sequences to be protocoled. Further training in these aspects
will only enhance the reporting standards translating to better patient care and management.
The detailed, clinically relevant information provided by a subspecialty trained radiologist
fosters a closer working relationship with the treating team of physicians. Active
participation in multidisciplinary case conferences and inputs by a subspecialized
radiologist will lead to wider acceptability and demand for such trained radiologists.
We understand that there are few public institutes offering limited seats in DM neuroradiology
and intervention radiology, and fellowships are also being offered at the same and
other private hospitals. There will always be a shortage of seats considering the
ratio of seats to applicants. We propose an introduction of secondary subspecialty
DNB/fellowships accredited to a common board in subspecialty hospitals, as seen in
other medical and surgical fields. In addition, subspecialties based on organ system
are a way forward than modality-based fellowship training for a complete one stop
shop for imaging needs.
We also feel that these programs should to be for 1-2 years as practiced by many Western
countries. This will provide more options to radiologists who may not be inclined
to commit to 3-year programs due to economical grounds and time frame, when he can
attain the same outside India in lesser time with better fellowship pay.
We hope prominent radiologists in association with recognized medical boards can pioneer
a change regarding subspecialty training and practice.
