The following letters were written in response to Dr. Ted Keats' Guest Editorial published in the October 2003 issue of Applied Radiology.
The following letters were written in response to Dr. Ted
Keats' Guest Editorial published in the October 2003 issue of
: Keats TE. How will we staff our academic departments?
. 2003;32(10):9. Editorial.
To the Editor:
I have great respect for Dr. Keats and his contributions to
radiology, but I cannot agree with his recent guest editorial in
this journal. I am now retired, but I spent 5 years in the private
practice of radiology and the remainder of my long career in
The solution to the problem of recruitment and retention of
academic radiologists does not result solely from a current
shortage of diagnostic radiologists, but also from a discrepancy of
salaries between the private sector and academia.
Academic radiologists are judged by their teaching talents,
research, and administrative contributions on local and national
levels, as well as their clinical talents and increasing
productivity in patient care. In the private sector, the objective
is much simpler: it is good patient care, and other endeavors are
not as important. Yet, in academia, it is expected that the
academic radiologist be as competent as or better than the private
practitioner. The financial rewards and security, however, are
less; consequently, most academic radiologists eventually leave for
the more financially secure private sector. They leave behind the
influence of chairmen, deans, and rules of tenure committees.
There was a period of time, not long ago, during which the
academic radiologist spent most of his/her efforts in teaching
medical students, supervising residents, and conducting research,
with only a lesser emphasis on clinical workload. That has
gradually changed with greater clinical productivity expected; yet,
the financial rewards remain significantly less than in private
The current changes in remuneration must be accelerated in order
to recruit dedicated American-trained radiologists, rather than
recruit from other countries for a short stay because of a manpower
shortage here in America. We should be able to keep the best and
the brightest in academic radiology by paying at least the same as
the private sector for the extra talent required in the academic
In summary, you get what you pay for. We cannot try to solve the
long-standing staffing problem in academic radiology of today with
yesterday's questionable methods. They were not the real answer
then and are short-sighted now.
John N. Diaconis, MD
To the Editor:
I respectfully disagree with the October guest editorial by Dr.
Keats. Instead of petitioning our deans and legislators for special
legislation to recruit foreign faculty, we should petition them to
restore and increase funding for academic medical centers.
U.S. computer professionals have been marginalized by special
visas that allow foreign computer professionals to enter the United
States. Do we want to marginalize our academic faculty? Recruiting
foreign faculty will not solve the long-term funding crisis facing
academic medical centers.
Donald D. Cameron, MD
I welcome the comments of Drs. Diaconis and Cameron regarding my
editorial on staffing our aca-demic departments.
There is no question that adequate salaries would solve the
problems of academic recruitment. Unfortunately, this has not
happened and a change is not imminent. Many departments of
radiology are obliged to support their faculties on earned income
with little university, hospital, or extramural support. In this
environment of declining revenues, it is not possible for most of
us to offer incomes that can compete with private practice. In
addition, the necessity to work very hard and long to earn our
incomes in academic practice has also had an adverse effect on the
nature of the academic environment. It has led to a decline in time
for and interest in teaching and research. What is there now in
academic radiology to attract new recruits, most of whom carry
large educational debts?
My suggestion of inviting help from abroad is certainly a
short-term solution. With the steady loss of academic faculty, it
may enable us to carry on until the financial picture is properly
addressed. To state that remuneration must be improved goes without
saying, but it does nothing to help an immediate problem.
T. E. Keats, MD
Alumni Professor of Radiology