A Snapshot of US ACGME-Approved Neuroradiology Fellowship Programs- How are We Training and Growing?

PURPOSE: U.S. ACGME-approved neuroradiology fellowship positions continue to increase in the setting of a national radiologist shortage, and the challenges faced by expanding fellowship programs could vary with program size. The aim of our project was to survey neuroradiology fellowship Program Directors (PDs) at US ACGME-approved diagnostic neuroradiology fellowship programs to better understand the challenges and practices in fellow recruitment, growth of fellowship class size, and other factors. MATERIALS AND METHODS: An online 21-question survey was distributed to PDs of US ACGME-approved diagnostic neuroradiology fellowships (n=91). All variables were appropriately summarized and correlations assessed. Programs were dichotomized as large (greater than median number of approved spots) or small (less than or equal to median). Differences between large and small programs were evaluated with appropriate statistical tests. Effects associated with P<0.05 were considered statistically significant. RESULTS: PDs from 60/91(66%) institutions had evaluable responses. For the 2024-2025 academic year, 37/60(62%) programs filled all their fellowship positions. The proportion of large programs (20/25,80%) filling all their positions was higher (P=0.017) than small programs (17/35,49%). Large programs (14/25,56%) increased the number of fellowship positions more than small programs (5/35,14.3%) since 2019-2020 (P=0.002). Small programs had more difficulty filling all fellowship positions (19/34,54%) than large programs (5/25,20%) through national residency match program (P<0.001). Both large and small programs were challenged by other large programs and geographical location. Unique challenges for large and small programs were the high number of fellowship positions and competition from nearby programs, respectively. Length of PD tenure was not statistically correlated with the ability to fill the fellowship program (P=0.75). Small programs had a larger median of ABR-alternative pathway candidates [29%(0-66.7%)] than large programs [9.5%(0-16.7%)], the distribution did not differ significantly (P=0.19). CONCLUSIONS: Large neuroradiology fellowship programs filled all ACGME-approved positions with less difficulty and often increased their available fellowship positions in the last 5 years, compared to small programs. Competition from large programs and geographical location challenge recruitment for neuroradiology fellowship programs irrespective of size. Strategies for expanding and filling U.S. neuroradiology fellowships should vary based on fellowship size with a goal to help alleviate the on-going radiologist shortage.