1. Nuclear Medicine in Pakistan Durr-e-Sabih Director Multan Institute of Nuclear Medicine and Radiotherapy Past President Pakistan Society of Nuclear Medicine

2. Numbers o50 Nuclear medicine centres o19 owned by the PAEC o4 PET scanners o200 nuclear medicine physicians o2 training programmes 2 year MS (18 centres ) 4 year FCPS (11 centres)

3. There are no unemployed nuclear medicine physicians in the country!

4. Attrition in the local NM population oAbout 30 (~15%) NM physicians have changed their specialty to radiology, radiotherapy, medical oncology, medicine etc !

5. 29 Trainees in NM 803 trainees in Radiology

6. Will we run out of trained nuclear medicine physicians?

7. Satisfaction survey oThose who had completed their MSc degree in the last 10 years o32 were contacted o27 responded o12 dichotomous questions o2+1 open-ended questions

8. The Dichotomous Questions QuestionYesNo 1Are you happy professionally?1116 (59.3) 2Your usefulness in CPCs?224 3Would you choose NM again, if given a chance?1116 (59.3) 4Is professional infrastructure adequate?025 (100) 5Does future looks secure?1013 6Does future looks professionally satisfying?1016 (59.3) 7Does future looks financially rewarding?916(59.3) 8Have you tried to get into FCPS (NM)?620 9Does MSc provide enough training and knowledge?1511 (44.4) 10Should MSc program continue unchanged?225 (92.6) 11Have you considered going in private practice?917 12Is current training enough?125(92.6)

9. The Dichotomous Questions QuestionYesNo 1Are you happy professionally?1116 (59.3) 2Your usefulness in CPCs?224 3Would you choose NM again, if given a chance?1116 (59.3) 4Is professional infrastructure adequate?025 (92.6) 5Does future looks secure?1013 6Does future looks professionally satisfying?1016 (59.3) 7Does future looks financially rewarding?916(59.3) 8Have you tried to get into FCPS (NM)?620 9Does MSc provide enough training and knowledge?1511 (44.4) 10Should MSc program continue unchanged?225 (92.6) 11Have you considered going in private practice?917 12Is current training enough?125(92.6)

10. The Open-ended Questions oIs the professional infrastructure in the country adequate? oSuggestions for improving the MSc (NM) programme oDo you need any additional training?

11. Do you need any additional training? o52% wanted radiology training o30% wanted additional training in PET o11% wanted additional training in therapeutic nuclear medicine

12. Why did you leave? oFuture did not seem secure (77%) oNot enough opportunity or financial reward (66%) oDid not feel relevant to patient management (55%) oMonotonous and boring work (44%) oIntellectually not stimulating enough (33%) oNot enough patient contact (33%) oToo difficult (0%)

13. Are we alone? oShould nuclear medicine become part of radiology? 1 oSPECT use will decline over the next decade 2 oNuclear medicine will be taken over by radiologists 3 1. Wagner, H.N., Jr. and B.L. Holman, The future of nuclear medicine: autonomy or integration? J Nucl Med, 1993. 34(9): p. 27N-29N, 31N, 33N 2. Alavi, A. and S. Basu, Planar and SPECT imaging in the era of PET and PET-CT: can it survive the test of time? Eur J Nucl Med Mol Imaging, 2008. 35(8): p. 1554-9. 3. Holman, B.L., We are training our future. J Nucl Med, 1993. 34(1): p. 167-8.

15. Training

16. Worst case scenario

17. I am afraid to say that the future perspective of nuclear medicine is not so promising because we are standing against many competing modalities and procedures. I am sure that the next 10 years in new millennium must be very critical turning period for promoting of nuclear medicine and it will be a kind of survival game. Myung-Chul Lee, M.D. Chairman ARCCNM

18. Reasons oCompetition from Radiology at least as informative, referring physicians are familiar. oPET, the future is PET, which will be available to only a few, the rest will be left out oHybrid imaging is the future, and will need radiological skills to gain maximum benefit oFinancial opportunity, easier to make money as a radiologist oPure nuclear medicine physicians are irrelevant in today’s medical milieu

19. Solutions oBroad based training, add other imaging techniques. Have a major 4-5 year degree, dedicate two years to other imaging modalities oCreate radiologists with special expertise in nuclear medicine oEmphasize on therapy, dedicate one year to medical training and therapeutic nuclear medicine oImprove regulatory environment and allow easy setting up of a private nuclear medicine facility oImprove emoluments, stop discriminating

20. ASNM, ANMB oProvide material for learning… emphasize on correlative imaging For next year ANMB will have questions on cross sectional imaging Plan workshops on introduction to CT and MR for nuclear medicine physicians oEmphasis on evolving techniques on website with exciting developments in an easily accessible manner oMake therapy training stronger, accessible…move beyond thyroid oPush the envelope for providing information and training…Use the internet for e-lectures

21. Thank you