The future is bright for aspiring breast imagers—but where best to practice?

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The medical job market is ripe for radiologists specialized in breast imaging, and new rads considering this career path would do well to read “What You Need to Know—A Primer for Radiologists Entering Breast Imaging,” published online Dec. 22 in the Journal of the American College of Radiology.

Along with training avenues to explore and noninterpretive skills to develop, authors Nathanial Margolis, MD, of the Ray W. Moody Breast Center in Middletown, N.Y., and Yiming Gao, MD, of New York University flesh out the two practice settings new breast imagers will have to pick from.

“The decision to pursue private or academic practice depends on the individual’s values and career goals,” they write.

Here are some of their key insights to guide this decision.

Private doesn’t mean secluded

Margolis and Gao note the wide variety of operational models in private-practice breast imaging. Some practices have all breast imaging read by breast specialists, while others share this workload between breast specialists and general radiologists and/or rads mainly focused on other subspecialties.   

“This could be a significant departure from the breast imager’s academic training,” the authors point out. “The new breast imager may encounter wide differences in the diagnostic approach and reporting language for each physician in the practice.”

In private practice, fellowship-trained breast imagers may be looked to for leadership.

Compared with large academic departments, private practices “allow a nimble physician to make changes without red tape,” the authors write. “A motivated breast imaging physician may partner with the practice administration and local hospital in marketing the breast imaging practice, as patients who present for screening mammography often return for downstream testing and procedures.”

Among the challenges they list, Margolis and Gao cite include high clinical volume, greater variation and less standardization in practice patterns, and fewer opportunities for multidisciplinary interaction.

Among the opportunities: the chance to collaborate with colleagues to standardize image protocols and quality.

“Hands-on scanning with the sonographer can help with optimizing ultrasound settings; familiarity with ultrasound physics and ‘knobology’ is important to obtain during training,” they write. “Consultations with fellow radiologists, double reading, can help with diagnostic dilemmas.”

Communicating with surgeons is critical to providing patient care, the authors emphasize, adding that the patient stands to benefit from a team approach that averts the forming of specialty-specific silos.

Biopsy result follow-up and discussion of radiologic–pathologic concordance with pathologists is critical for feedback, Margolis and Gao write.

“Even after training,” they add, “the breast imager can further learn about the imaging manifestations of breast disease and adjust his or her callback threshold.”

Academic doesn’t mean abstracted

Given the emphasis on subspecialty care within academic radiology departments, the vast majority of academic breast radiologists are fellowship-trained and fully dedicated to breast imaging, Margolis and Gao explain.

“This allows for a more coherent practice pattern in the group, given similar background of training, and increased opportunity for second-reads and consensus among colleagues,” they write. “That said, smaller academic departments may employ breast radiologists who also interpret other radiology studies, who are typically fellowship-trained in multiple radiology subspecialties.”

Academic practice is bound to present the new breast imager with a more familiar environment than private practice. However, transitioning from “green” trainee to attending subspecialist entails dedication and hard work regardless of practice setting.

“This is especially true in breast imaging, where clinical tasks are often colored with emotional and litigious difficulties,” Margolis and Gao write. “Even so, resources abound for the new breast imager in an academic setting, where teaching, learning and advancement of knowledge are of high priority.”

Among the attributes inherent to the academic setting are its ability to keep up-to-date with evidence and equipment, and its generally slower-than-private pace.  

“However, a day in academic breast practice may not be any less busy, given often higher-complexity levels of cases referred to larger centers and teaching responsibilities,” the authors write.

Breast care is best delivered by a multidisciplinary approach, and academic settings lend themselves to constant and consistent communication between subspecialty teams, Margolis and Gao write.

“A breast imager often does not have far to go to discuss a complicated case with a surgeon colleague in person in an academic practice,” they write. “Regular multidisciplinary, tumor board and radiology-pathology conferences not only help optimize patient care but are excellent learning opportunities for the new breast imager.”

Of course, academic practice has its unique challenges. Academic medical centers and large cancer centers may change only slowly, for example, not least because new initiatives often require getting broad buy-in from multiple directors and stakeholders. Breast imagers can help mitigate this effect by participating in committees and getting involved in policy making, the authors write.

“In the current practice climate, larger academic centers are increasingly taking on regional outposts, making standardization of practice and maintenance of quality a challenge,” they write. In this process, these centers are “creating opportunities for an enthusiastic new breast imager to make positive changes and improve patient care.”

“Whether in the private practice or academic setting, breast imagers have the opportunity to add value beyond image interpretation, a central tenet of the Imaging 3.0 change process,” Margolis and Gao conclude. “Training in breast imaging not only will prepare radiologists to save lives through early detection of breast cancer, but will enhance the institutions in which they practice and the community at large.”