Dr. Mirvis 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, ¹ residents tend to select academic careers because of the atmosphere, research, teaching, and specialization, while others choose private practice for autonomy, lifestyle, and financial reimbursement. 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 ² 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 teaching university.

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.