The Portfolio Pathway for Breast Radiologists

Most of the doctors we speak to know that the portfolio pathway exists. Rather fewer know what it asks of them, and a good many are quietly deferring it on the grounds that it looks insurmountable. It is a substantial undertaking. It is not, however, a mystery, and the reasons applications come to grief are set out in public for anyone who cares to look.

A Quick Answer

Quick answerYou must be on the GMC’s Specialist Register to hold a substantive, fixed-term or honorary NHS consultant post — and for most breast radiologists the route there is the portfolio pathway, applied for in the CCT specialty of clinical radiology rather than the narrower breast route. The single commonest reason applications fail is the very thing that makes you valuable to a breast unit: thin general ultrasound and cross-sectional CT, MRI and musculoskeletal work. Evidence must come from your last five years, including a minimum of 60 personally generated reports. You have 24 months to submit once the application is opened, and the RCR then has 36 working days to evaluate it. The gaps are plannable — but only from inside a post that provides the missing work.

Why the portfolio pathway decides your consultant career

Two matters of fact first, since everything else follows from them.

You must be on the GMC’s Specialist Register to hold a substantive, fixed-term or honorary NHS consultant post. Not to work in the health service, and not to work in breast imaging, but to hold a consultant post. That single sentence is the reason this pathway matters at all.

To be eligible to apply you need either a specialist qualification in the specialty you are applying in, or at least six months of continuous specialist training in it.

Clinical radiology or breast radiology: which portfolio pathway route?

There are two routes, and the choice carries consequences.

Most applicants apply in the CCT specialty of clinical radiology, submitting evidence that their training, qualifications and experience taken together are equivalent to a United Kingdom CCT, judged against the specialty training curriculum.

There is also a non-CCT route in a narrower specialty, and breast radiology is among the examples the College gives. Eligibility requires either an overseas specialist qualification in breast radiology or at least six months of continuous specialist training outside the UK in it. A dedicated period of training, such as a fellowship, will count. Rotations within general radiology training are unlikely to.

Before anybody reaches for it as the gentler door, the College is quite explicit that specialist registration in a narrow area may limit one’s employment thereafter, and that you should satisfy yourself you are likely to find work in it. A non-CCT application in breast radiology must in any case reflect all twelve capabilities in practice from the curriculum — six generic, six specialty-specific. It is a different shape of application, not a lesser one.

For most breast radiologists working in NHS departments, clinical radiology remains the sensible route.

Why breast radiologists’ portfolio pathway applications fail

The College publishes this, and it repays reading before a single word is written.

The commonest causes of failure are not exotic. Limited general ultrasound workload, and limited cross-sectional non-neurological work such as body CT and MRI and musculoskeletal studies, are among the most frequent. However specialised your recent practice, the evaluators must be satisfied that within the last five years you can demonstrate competence across modalities, body systems and basic image guided procedures.

For a breast radiologist this is the whole difficulty in a sentence. The very depth that makes you valuable to a breast unit is what weakens a clinical radiology application. If your week consists entirely of mammography, breast ultrasound and biopsy, you have a gap that wants planning around rather than hoping nobody notices. They will notice. It is their occupation to notice.

What the GMC portfolio pathway evidence checklist asks for

The particulars live in the GMC’s specialty specific guidance, which is best treated as a checklist rather than as reading matter. In outline:

Most evidence should come from your last five years of clinical practice, whole time equivalent, and it need not be consecutive.

Applying to the portfolio pathway without the FRCR

You may still apply. The FRCR is the test of knowledge set out in the curriculum, so in its absence you must submit as much as you can about your training, the syllabus in force at the time, and the manner in which you were assessed. The specialty specific guidance indicates where the additional evidence is wanted.

One caution the College gives without ornament. If you have failed any part of a qualification, consider waiting until you have passed it. The RCR checks the record of its own examinations, outstanding failures included.

How long does the portfolio pathway take?

Once a GMC application is opened you have 24 months in which to submit your evidence. When the GMC passes a complete bundle to the RCR, the College has 36 working days to evaluate it, after which the GMC takes its own time to decide. Expect two to three months from that point, over and above however long verification requires.

The practical consequence for anyone looking at posts is that “my portfolio pathway is nearly finished” is not a date, and trusts will treat it as such. We have seen good candidates lose posts on precisely this point, not through any fault of their own but because nobody had explained how the timing would be read.

Ask your department for help, and ask properly

The College asks departments to support colleagues through this, and sets out plainly what that support looks like: dedicated SPA time to prepare, the application written into appraisal as a formal objective, exposure or secondments arranged to cover gaps, and MDT attendance placed in the job plan.

That is your own College instructing your clinical director in what good practice amounts to. There is no reason on earth not to make use of it. And if your present department will not or cannot provide the general reporting and cross-sectional exposure you need, far better to discover that now than after a deferral.

How BDI Resourcing finds posts that close portfolio pathway gaps

We cannot write your application, and you should be wary of anyone who says they can. What we can do, and what a doctor cannot readily do alone, is find you a post that closes the gaps rather than widening them.

That is a harder task than it sounds. It means knowing which departments genuinely give SPA time for this and which merely say so at interview; which will arrange a secondment into general reporting; which clinical directors have taken colleagues through the process before and which have not. We hold that knowledge because we ask the question of every trust we deal with, every time, and we have been doing it for years.

Then we put it to them on your behalf, in advance and in writing, so that what you need for your application is part of the post rather than a favour to be requested awkwardly in your third month.

If you are partway through, tell us where the thin patches are. We will be candid about which trusts can fill them, and then we will go and arrange it.

We have also written a fuller guide to the portfolio pathway, covering the application itself in more detail than there is room for here. You will find it at Clinical Radiology Portfolio Pathway: a complete guide for senior doctors.

Speak to our radiology team →

Browse breast radiology jobs →

Next week: how to weigh a breast radiology post before accepting it.

Portfolio pathway for breast radiologists: FAQs

Do I need the Specialist Register to work as a breast radiologist in the NHS?

Not to work in the NHS, and not to work in breast imaging — but yes to hold a substantive, fixed-term or honorary consultant post. That distinction is what makes the portfolio pathway the deciding step in most breast radiology careers.

Should I apply in clinical radiology or in breast radiology?

For most breast radiologists in NHS departments, clinical radiology. The narrower non-CCT breast route exists, but the College warns that specialist registration in a narrow area may limit your employment afterwards, and the application must still reflect all twelve capabilities in practice. It is a different shape of application, not an easier one.

Why do breast radiologists’ applications get deferred?

Overwhelmingly for limited general ultrasound and limited cross-sectional non-neurological work — body CT, MRI and musculoskeletal studies. A week made up entirely of mammography, breast ultrasound and biopsy produces a portfolio that cannot show breadth across modalities and body systems in the last five years.

How many reports do I need for the portfolio pathway?

A minimum of 60, and it is not usually necessary to exceed 150. They must be personally generated, dated and anonymised, and organised by body system. Reports you signed off as a supervisor carry considerably less weight than your own independent reporting.

Can I apply without the FRCR?

Yes. In its absence you must evidence your training, the syllabus in force at the time and how you were assessed. But if you have failed any part of a qualification, the College advises waiting until you have passed — the RCR checks the record of its own examinations, outstanding failures included.

How long does the portfolio pathway take?

You have 24 months to submit evidence once the application is opened. The RCR then has 36 working days to evaluate a complete bundle, and the GMC takes two to three months to decide after that, plus verification. “Nearly finished” is not a date, and trusts will read it that way.

What should I ask my department for?

Dedicated SPA time to prepare, the application written into your appraisal as a formal objective, secondments or exposure arranged to cover gaps, and MDT attendance placed in the job plan. The College asks departments to provide exactly this, so you are not asking for a favour.

Sources

• RCR – Portfolio Pathway (formerly CESR), radiology
• RCR – Portfolio pathway: guidance for colleagues
• GMC – Clinical Radiology Specialty Specific Guidance
• GMC – Specialty specific guidance for portfolio pathway
• RCR – Clinical Radiology Specialty Training Curriculum
• RCR – GMC registration (radiology)
• BDI Consultants – Portfolio Pathway complete guide