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Fellows, Funding, and Fewer Radiologists
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Released: August 20, 2025

John Marshall
John Marshall, MD
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MedBuzz: Fellows, Funding, and Fewer Radiologists

 

[00:05]

 

John Marshall: John Marshall for Oncology Unscripted, with a little bit of buzz, a little bit of gossip, a little bit of stuff that's trending.

 

You know, this is the end of July when we're filming this, and the squeaky-clean new fellows are here. Don't you love July? New residents and new fellows—you get to teach 'em how 5-FU works and where the bathroom is, and all of those things. But it is—I love this time of year with the new fellows because they're very eager and very interested in learning everything they can. They're not too tired. Everything is good and positive as they learn and go forward. And so, it's just been a great month for us here at Georgetown, and I hope if you work with new trainees—residents, fellows—that you too are having a positive time with them.

 

I've also—the month of July—been struck by a certain late-night TV host who was fired, let go, because his message was to counter the sort of government message that is going on right now. So, I've been really anxious about having any sort of counter message that's out there, because you know what? You might get canceled if you are caught too often with this sort of counter message.

 

How that's affecting us here at an NCI-designated cancer center—or wherever you are—is that I'm not sure what the NCI is gonna look like too long from now. We know there are gonna be cuts. We know the payline—there have been predictions that it'll drop as low as 4% for grants. So, if cancer research was being—most, or a lot of it—was being funded by NCI, and that is being cut dramatically and refocused, how does anybody doing the kind of research that we're doing continue? And so, we spend a lot of time at our center—and I'm sure it's true at your center as well—trying to understand how we evolve from here. Is it gonna be philanthropy? Is it gonna be public-private partnerships? Are we gonna work in a different way to keep the progress going that we are seeing?

 

Now, the other component that's affecting all of us—or gonna affect all of us—is changes in public health. So, if Medicaid cuts are dramatic, then a lot of patients won't have access to cancer care in general. It'll be too expensive or unreachable for a lot of patients. There are certain regions of the country where there is a lot of Medicaid—not just necessarily cities, could be rural places as well. So, those of us who have oncology practices are also trying to understand what the future is gonna look like if we have fewer patients able to get cancer care. So, changes in academia, changes in practice that are coming ahead because of all the changes that are top-down happening in our nation today.

 

One that is affecting me—and I don't know if it's affecting you as well—is that there has actually become a fairly dramatic nationwide shortage of radiologists. Now, radiologists right now often work in their basements at home. They have shift work. There is support from AI, but it's also a threat from AI. Could it take their jobs eventually? Is the support that it's providing making their job easier or less easy? But regardless, we don't have the same number of radiologists. And so, instead of having a scan being read in a day or two—which is fairly standard for the industry—we see it now taking three, four, five days. And our patients are nervous because they don't know why their scan hasn't been reviewed and the like. So, I'd love for you all to share with me if you're having the same issue too. I meet with my radiologist. We love them. We consider them very tight partners with us, and we are supportive of trying to make their increasingly stressful job less stressful. But that's one of those things that we're gonna have to figure out before too long. Otherwise, we are gonna be stuck without radiologists to read our scans—or we're gonna let Elon Musk read all of our scans. One way or the other, we'll figure it out, I guess. But a lot of changes have occurred just in the last month of July. A lot of those are affecting our day-to-day practice and our ability to deliver the best cancer care and the best research opportunities for our patients in our communities.

 

I'm not sure what August holds, but I think I'll go to the beach and take a break from it all. John Marshall, Oncology Unscripted.

 

[04:40]

 

This transcript has been lightly edited for clarity.