Call Expectations During the Breast Imaging Fellowship: A Survey of Fellowship Directors

After-hours call and moonlighting expectations in breast imaging fellowships vary by institution and may influence fellowship selection, educational experience, and trainee well-being. The purpose of this study was to characterize after-hours call requirements of U.S. breast imaging fellowship programs.

An institutional review board-exempt, 11-item anonymous survey was developed by the Society of Breast Imaging (SBI) Fellowship Director Committee and emailed to 94 SBI-registered fellowship program directors (September-December 2025). Items assessed the presence and type of call, call frequency and duties, procedural expectations, autonomy, and availability of internal moonlighting opportunities.

Thirty-four programs responded (36% response rate). Half of programs reported no call requirement (50%, 17/34; 95% CI: [32.4%, 67.6%]), 38% required call (13/34; 95% CI: [22.2%, 56.4%]), and 12% offered optional call (4/34; 95% CI: [3.3%, 27.5%]). Among programs requiring call, general radiology call was more common than breast-specific call (62% [8/13]; 95% CI: [31.6%, 86.1%] vs 38% [5/13]; 95% CI: [13.9%, 68.4%]) and consisted predominantly of weekend reading. Breast-specific call included pager coverage in all programs (100%, 5/5); 40% (2/5) also required additional image interpretation. After-hours breast procedures were uncommon (9%, 3/34; 95% CI: [1.9%, 23.7%]), most often involving abscess drainage. Moonlighting was widely available (74%, 25/34; 95% CI: [55.6%, 87.1%]), most commonly independent general radiology reading (80%, 20/25; 95% CI: [59.3%, 93.2%]) and contrast reaction coverage (32%, 8/25; 95% CI: [14.9%, 53.5%]).

After-hours expectations in breast imaging fellowships are highly heterogeneous. General call predominates over breast-specific call, after-hours procedures are rare, and moonlighting is prevalent. These descriptive findings can inform program policy, applicant counseling, and discussions regarding balancing service needs with trainee education.