The following letters were written in response to Dr. Ted Keats' Guest Editorial published in the October 2003 issue of Applied Radiology : Keats TE. How will we staff our academic departments? Appl Radiol . 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 academic radiology.

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 practice.

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 world.

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

Timonium, 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

Response:

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

Editor Emerius, Applied Radiology