The radiology job market in the Netherlands: which subspecialties and other skills are in demand?

Job opportunities for radiologists and nuclear medicine physicians continue to be a point of concern and discussion in Europe and the USA [1, 2]. The general perception is that the job market is overflooded and that vacancies are scarce [1, 2]. Factors that bring additional uncertainty for the job market in Europe and the USA are ongoing cuts in healthcare reimbursement, the continuing increase in workload for radiologists, and uncertainties regarding the effect of developments in artificial intelligence (AI) on daily practice [3‐7]. Furthermore, with the increased focus on inclusion and diversity, the number of female radiologists is expected to increase [8]. Female radiologists more often work part-time than male radiologists, which might lead to an even higher demand for radiologists in the future [8].

In the Netherlands, another factor to take into account regarding the job market is the relatively recent revision of the previously separate NM and radiology training curricula that have been combined into one integrated training in 2014 [9]. The Netherlands has been a frontrunner with this integrated training while in other European countries separate residencies for radiology and NM (with some attention to radiology) still exist. Residents who complete this integrated training can be deployed for radiology as well as NM, depending on the (sub) specialty they chose during the training [9]. In this new Dutch curriculum, a resident has to choose at least one (sub)specialty and a maximum of two subspecialties. There are seven radiology subspecialties, i.e., abdominal (ABDOM), breast, cardiothoracic (CTH), interventional (INT), musculoskeletal (MSK), neuro- head and neck (NHN), and pediatric radiology (PED), and one specialty dedicated to NM. A major change compared to previous curricula is that the residents who finish the NM pathway are called nuclear radiologists [9]. The first (nuclear) radiologists who were enrolled in this new curriculum graduated in 2019 [9]. Based on this change in the way residents are trained, some departments of radiology and NM in the Netherlands have decided to merge. This new curriculum could affect the employability and thus the job opportunities of new (nuclear) radiologists [10].

There are no recent data on vacancies for radiologists and nuclear medicine physicians in European countries such as the Netherlands, in terms of number of vacancies and the distribution of these vacancies between academic and non-academic hospitals, the most sought-after subspecialties, types of employment offered (locum or permanent employment), and requested tasks besides direct patient care (such as research, teaching, management, and ICT (information and communications technology)/AI assignments). This information is potentially useful to those who are considering or preparing to work as a medical specialist in radiology or NM in the future. Such data could also provide valuable feedback to all stakeholders who determine the contents and learning objectives of residency programs.

The purpose of this study was therefore to evaluate the current job market for medical specialists in radiology and NM in the Netherlands.

This study, which included 157 vacancies for medical specialists in radiology or NM that were published on the websites of the Dutch radiology and NM societies between December 2020 and February 2022, shows that in more than half of job postings either all-round radiologists, ABDOM radiologists, or INT radiologists were requested while the other four radiology subspecialties together with NM comprised the minority. This disbalance raises the question whether quota should be imposed to prevent unnecessary training in some subspecialties and to train sufficient residents in others. However, this speculation requires further longitudinal studies matching the qualifications of recently graduated radiologists with the demands in the job market that are probably dynamic in time. For example, further expansion of INT radiology services in the future is likely [13], and radiology departments that enlarge due to hospital mergers may aim to provide more subspecialty service. Nevertheless, the present data on subspecialty demands may already be helpful to current residents in choosing their subspecialisation.

Although the number of vacancies for nuclear medicine physicians in this study was relatively low, the majority of them specifically asked for a nuclear radiologist. This is most likely due to the versatility of a nuclear radiologist compared to a specialist trained in NM only, because the former can be deployed for both NM and radiology tasks (including on-call duties) [10]. The acceptation of and apparent preference for nuclear radiologists in the job market can be considered a potential success of the new integrated radiology and NM training and/or a reflection of the ongoing fusion of the radiology and NM departments in the Netherlands.

The far majority of vacancies in this study (approximately three-fourths) concerned jobs in non-academic hospitals. This distribution matches the number of non-academic hospitals (n = 74) and academic hospitals (n = 8) in the Netherlands [14]. Our results indicate that non-academic hospitals more frequently require all-round radiologists than academic hospitals, which seems logical because non-academic hospitals have a smaller pool of radiologists to fulfil all clinical tasks, and all-round skills increase flexibility and efficiency. Both permanent and locum vacancies in non-academic hospitals most frequently requested all-round radiologists, reflecting the high demand of all-round radiologists outside the academia. However, in the current Dutch curriculum, residents have to choose either NM or at least one radiology subspecialty, which somewhat conflicts with the time that can be evenly spent on all radiology subspecialties to become an all-rounder. This issue may be addressed in future revisions of the curriculum. On the other hand, only one out of 34 academic vacancies asked for an all-round radiologist. This indicates that, when choosing to become an all-round radiologist without subspecialisation, a career as an academic radiologist can almost be excluded in the Netherlands. Except for the all-round radiology profile, other subspecialty requests were not significantly different between non-academic and academic hospitals, indicating that radiologists with a subspecialty can find employment both non-academically and academically.

Nearly one-third of vacancies in this study asked for additional non-clinical tasks. Interestingly, non-academic hospitals also more frequently requested radiologists with research skills and tended to more frequently request teaching tasks and management skills in their vacancies than academic hospitals. Next to clinical excellence, research and teaching are important pillars in the mission statement of the non-academic top hospitals in the Netherlands [15], which is apparently reflected by the contents of the job vacancies for radiologists. It remains unclear why academic hospitals less frequently asked applicants to perform research tasks in their job postings. However, it can be postulated that performing research and teaching are considered matters of course in an academic institution. Overall, our findings highlight the necessity for all residents to acquire skills in both research and teaching, regardless of their future working place as a radiologist. The fact that management skills are more in demand by non-academic hospitals than their academic counterparts is probably related to their often more profit-driven nature and their smaller group of radiologists in which management positions frequently rotate. Importantly, although research and teaching are part of the Dutch curriculum, just like in other European and American radiology training programs, management is only trained in basics, if addressed at all [16, 17]. This issue is a potential point for improvement in these curricula. Of interest, management tasks were only requested in non-academic vacancies and not in any of the academic vacancies. This suggests that trainees who aspire a non-academic appointment should consider bolstering their management skills, while residents who pursue an academic career can perhaps better focus on research and teaching as additional non-clinical skills. In this study, only a few vacancies specifically mentioned a search for applicants who were skilled in AI or ICT tasks, while developments in this field suggest their role to rise in the near future [18]. Residents who want to best prepare for this could benefit from courses which focus on the role of AI in radiology, e.g., as provided by the ESR [19]. Finally, communication and empathy skills (so-called soft skills) were not explicitly asked for in any of the vacancies, although these aspects may also become more important in radiology practice [20]. The lack of requests for soft skills could also be due to the fact that in the Netherlands residents are trained according to CANMEDS criteria and these skills might also be tested during the application procedure [11].

Previous literature on which radiology subspecialties and skills are in demand is rather limited. Several previous studies in the USA focused on the supply and demand of radiologists on the job market. These studies reported that too many residents were trained compared to the number of available jobs in the years 2013 [21] and 2015 [1]. However, these data do not provide information on what qualifications are requested from radiologists looking for employment. In another study in which an anonymous survey was sent to Belgian radiologists (who graduated between 2013 and 2018) and to the heads of all Belgian radiology departments, it was reported that the most desired subspecialties were MSK imaging, INT radiology, and breast imaging [2]. However, these data may be less reliable because they are based on survey results and not on actual job postings. One recent study with a similar design as ours evaluated American College of Radiology (ACR) job postings in 2018, but limited their analysis to jobs labelled as MSK subspecialty [22]. In the 456 vacancies that were included in that study by Nellamattathil et al [22], approximately 19% were for a dedicated MSK radiologist, 25% sought a combination of MSK and a general skill set, and 56% were specifically for a general radiologist position. These data are somewhat in line with our findings, in that all-round radiology skills remain important. Otherwise, however, it is difficult to make a comparison with the present study, because Nellamattathil et al [22] limited their analysis to MSK job postings and did not perform any further analyses on required non-clinical skills and non-academic vs. academic vacancies.

The present study had some limitations. First, this study analyzed all vacancies posted on the radiology and NM society websites. Vacancies outside these media that were filled via non-official channels were not included. This probably means there were more vacancies available than included in this study. Second, whether or not the Dutch job market for radiologists is oversupplied or not cannot be determined in this study, because exact data regarding number of unemployed radiologists and their subspecialties vs. available vacancies were lacking. Third, the findings of this study are primarily applicable to the Netherlands. Nevertheless, some results are probably generalizable, such as the need for curricula to maintain the possibility for residents to be trained as all-round radiologists, the apparent interest of imaging departments in nuclear radiologists over nuclear medicine physicians from the previous curriculum who have no integrated radiology skills, and the need to train residents in important non-clinical skills (research and teaching, but also management), and to consider adding new elements to curricula such as ICT/AI and “soft skills” [20]. Our study also showed that a review of job vacancies over an extended period of time provides valuable information to residents and feedback to potentially improve radiology and NM residency programs. Fourth, data collection took place during the COVID pandemic which caused drastic changes in radiology practices. The periodic decline in imaging requests but also a decrease in available staff during lockdown periods might have been of influence on the job market in the Netherlands as well [23].

In conclusion, this study provided an overview of the current state of the job market for radiologists and nuclear medicine physicians in the Netherlands. All-round, ABDOM, and INT radiologists are most in demand on the job market. All-round radiologists are particularly sought after by non-academic hospitals, whereas nuclear radiologists who completed the Dutch integrated NM and radiology residency seem to be welcomed by hospitals searching for a nuclear medicine specialist. Finally, non-clinical skills (research, teaching, management, ICT/AI) are commonly requested. These data can be useful for residents and developers of training curricula.