Editor-in-Chief, Stuart E. Mirvis, MD, FACR talks about his experiences and criticism on academic professionals entering the world of private practices.
is the Editor-in-Chief of this journal and Professor of
Radiology, Diagnostic Imaging Department, University of Maryland
Medical Center, Baltimore, MD.
It is our department's practice to hold a resident/faculty
reunion at the RSNA meeting each year. Having been a department
member for 18 years (an old timer by today's standards), I know
most of the former residents and staff who attend the reunion. So,
it is a very pleasant occasion for me. This past year was not
atypical, but after the reunion something was bothering me that I
could not quite put my finger on. When all of the obligations of
the meeting were behind me, the memory and understanding of what
was bothering me began to emerge.
One of my long-time friends and a former resident had approached
me at the reunion. He is currently a successful member of one of
the two large and dynamic private radiology practices in the
Baltimore area. After the usual pleasantries, he chided me about
the fact that our university group had attempted some ventures in
the traditionally private practice world outside the academic
center. The comment roughly indicated that we should stay
behind our walls
and do what we do best (I guess that means research and teaching).
I really did not want to begin a long discussion, given the tone of
the evening, but I did point out the challenges of staffing created
by the shortage of radiologists and our need to offer people better
incentives to join us than those offered by other academic centers
or by private practices. He seemed to understand this concern at
least, but I could still detect an element of resentment about our
tiptoeing outside the walls.
I do not believe this former resident's opinion is unusual. As
the economic medical-care pie shrinks and as pressures to obtain
reasonable reimbursement for our services rise, there is every
reason to look at other approaches to boosting income sources.
While most academic departments would love nothing more than to be
able to exist on hospital-generated income and pursue their major
interests, this has become nearly impossible. To maintain a quality
academic practice, there must be adequate staffing for clinical
service, teaching, and research. Some support can be derived from
grants, but it is "hard to float the boat," as one of my colleagues
often notes, without additional outside revenue. Mainly, this
income is needed to compete in the current environment as well as
to encourage some individuals who may be "on the fence" about their
career path to try academics. As noted by Wood et al,
residents tend to select academic careers because of the
atmosphere, research, teaching, and specialization, while others
choose private practice for autonomy, lifestyle, and financial
These characteristics are not absolute
. Few academicians would refuse a salary increase, while many
private-practice radiologists really enjoy teaching and doing some
research within their practices.
In an interesting study, Ward et al
surveyed private-practice, university, and resident surgeons about
a number of issues. They all agreed that the university should
train physicians, receive complicated referral cases, and guarantee
quality of care in the state; but residents, and to a lesser extent
private surgeons, felt far less of a sense of obligation to the
We are fortunate to have a good relationship with our
private-practice colleagues. They spend some time teaching in the
university and have supported our needs in times of critical
staffing shortages. In turn, we continue to provide some of the
best-trained radiology resident graduates in the nation from whom
they can choose to offer practice opportunities.
University/academic practices need to and will reach over the walls
and offer services when and where there is a need and financial
opportunity. The expansion of traditionally insulated academic
practices to establish such "outside" venues is difficult, but it
can certainly be done with the expertise of the entire department
in support. The health and vigor of academic radiology should not
be taken lightly by the private-practice sector, for that minority
component of radiology creates the quality physicians that will
fill our specialty and drives the technologic developments that
keep us at the forefront of medicine.