The fellowship year is now chosen by more than 90% of radiology residents. However, oversight of training programs is not uniform, with the number of occupied positions in non-ACGME programs now exceeding that of programs under periodic ACGME review. Lacking surveillance by a national regulatory body, non-ACGME programs are free to determine curricular content and the terms of employment, leaving trainees to function at program directors' behest, without guaranteed, codified appellate rights. Another area for concern is in ACGME-related fellowship programs, in which the record of citations, particularly in interventional radiology, is worse than for the core residencies. Moreover, the abandonment of the abortive fellowship match has recently led to the establishment of earlier deadlines for interviews and acceptance notification in many programs, in which such choices are now being made early in the third year of residency. These are troubling developments requiring increased attention by leaders in radiology education.