is the Editor-in-Chief of this journal and a Professor of
Radiology, Diagnostic Imaging Department, University of Maryland
Medical Center, Baltimore, MD.
Within a year or two of starting my residency in our specialty,
it was pretty clear what the life of an academic radiologist was
like. The faculty arrived roughly 8 to 9 a.m., spent a lot of time
in their offices, no doubt thinking deep scientific thoughts, or
attending meetings outside the department in some really nice
places. Usually they had time to go to lunch outside the
department, often to the "world famous" Lexington market 2 blocks
away for good, inexpensive, international cuisine. By 4 p.m. one
could fire a cannon ball down the center of the department without
fear of hitting anyone. A resident covered the house evenings,
nights, andweekends (we ran a half-day schedule Saturday morning)
and checked out at 7 a.m. the next morning. The Vascular and
Neuroradiology faculty were on call, but most cases were handled by
the on-call resident and the faculty could cruise in, verify the
resident's diagnosis, and zip out. Some faculty never even took
their coats off. Reviewing cases with clinicians happened at the
convenience of the radiologist. Yes, one still had to write papers
and teach, but neither seemed so onerous. To a young resident, this
seemed a pretty idyllic life style. Of course, you made less income
than private practice, but as far as I could tell, the faculty
appeared to be doing just fine financially.
Of course, I needed to moonlight in the real world and do some
"locums" to try out the path most graduates chose. Clearly, you had
to work hard and fast. There was no time for long discussions about
esoteric topics. Lunch was a sandwich and soda at the alternator.
Clinicians ruled, and you did what they wanted happily and made
yourself available whenever for consultation. There did not seem to
be much interdepartment rivalry, and everyone was pulling in the
same direction-ie, figure out what's wrong, treat the patients, and
get them home or wherever. The income was very good, even for a
lowly moonlighter, and there seemed to be genuine camaraderie among
the radiology group members. The major problem for me was I could
not wait for the whistle to blow at 5 o'clock to zip down the
dinosaur's back like Fred Flintstone.
The line between the 2 worlds was very distinct. Now, it's 25
years later and the line has gotten fuzzy.
In my department, at least one section attending is expected to
be physically in their reading area at all times. We are totally
customer (patient and referring physician) oriented. The referring
physicians get consultations whenever needed, and we are usually
happy to do whatever studies they request, although we try to talk
them out of anything that is really contraindicated and offer
better choices. The house is covered 24/7 by attending
radiologists, and attendings covering after daytime hours act as
much as residents as our residents do in performing their duties.
No procedure is even started without an attending in the room. As
is increasingly common among academic radiology departments, our
department has taken over other radiology departments in area
hospitals that our medical system has acquired. Also, we have
acquired other departments, outside our hospital system, from which
private groups have left because of insufficient staffing or to
move to "greener pastures." We are always on the lookout for new
opportunities to increase revenue. We do this to be able to add new
staff, fund research, offer competitive salaries, and acquire a
"rainy day" fund, among other goals.
Today, few of us can spend a lot of time thinking deep thoughts
in our offices, and research time is provided as available (but is
certainly notplentiful). Publications, teaching, and administrative
duties are all still required. For many of us, the line between the
private and academic practice worlds has become fuzzy indeed. There
is now a lot of overlap. Some of the senior staff still wish to
return to the old days of the "classic" academic radiologist, the
one whom the clinicians made fun of for their easy life style
(driven by some jealousy, no doubt). Some really chafe at the new
work paradigm. Unfortunately, reality rears its ugly head and
pushes noses to the grindstone, like it or not.
P.S. I still sneak out to lunch, now and again, armed with a
pager and a cell phone. Even for an emergency radiologist, there
are few true emergencies, and it does a lot to boost my morale.
Please don't rat me out.