Academic Rads

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MouseChair

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Hello everyone.

current R1 here. Doing some self reflection and I think I really fit in well with Academic profile. I like participating in research, I love the prospect of teaching residents at the workstation, and enjoy working in a large tertiary care center and interacting with similar minded clinicians.

I have read a lot about private practice vs academia over the years. However, a lot of these discussions tend to be vague. I feel like especially over the last five years things have changed in terms of the private practice land scape (growth of private equity firms, lack of true partnership, cutting reimbursements) and academics (increased volume requirements).

specifically at my institution, some attendings have mentioned they are reading at PP pace while still balancing educational requirements. Where I went to medical school, some attendings said they made like half of the community Rad down the street.

Can anyone with some expertise break this down more for us:
1. Compensation : is it true that Academic rads make less? If so, how much less? Is it half the amount, or closer to 80-90%?

2. If the above is true and that people are taking significant pay cuts for academia, why would anyone do that? Aside from the noble aspects of teaching residents and moving the field forward, isn’t it a tough pill to swallow to take such a cut? Or is it because the breakneck pace of PP is not worth it?

3. what does the average week look like? How many days in the reading room? Any academic days

4. how hard is it to get a job at an academic institution? What are the differences between clincal instructor roles and assistant prof/associate prof role?

5. what is considered in terms of career advancement and promotion?

6. many community hospitals are being gobbled up by nearby universities. Do “academic” appointments at these clinical hospitals truly count within academia

I really want to get into the nitty gritty of this. I appreciate any and all insight - I hope open discussion will help people like me in finding our career path

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Some other points to add -

I assume there are still RVU targets to meet. How do these compare to PP? Is there any modification in your role in terms of non tangible aspects of the job, like teaching or research

what does tenure mean for the academic radiologist? How difficult is it to obtain a tenure track role? Is tenure ever offered to someone who is mostly clinical, or is significant research output a requirement?

How important is it for where you train to factor in to your selection for an academic position?

sorry if some of these are trivial Qs
 
1. Compensation : is it true that Academic rads make less? If so, how much less? Is it half the amount, or closer to 80-90%?
Yes, like 30% less.
2. If the above is true and that people are taking significant pay cuts for academia, why would anyone do that? Aside from the noble aspects of teaching residents and moving the field forward, isn’t it a tough pill to swallow to take such a cut? Or is it because the breakneck pace of PP is not worth it?
Nobility, prestige, intellectual stimulation, and pace.
3. what does the average week look like? How many days in the reading room? Any academic days
4 reading, 1 academic.
4. how hard is it to get a job at an academic institution? What are the differences between clincal instructor roles and assistant prof/associate prof role?
Easy. Social status.
5. what is considered in terms of career advancement and promotion?
The length of your CV, impact on the field, and reputation (locoregional - assistant, national - associate, and international - professor).
6. many community hospitals are being gobbled up by nearby universities. Do “academic” appointments at these clinical hospitals truly count within academia
Count for what?
 
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I assume there are still RVU targets to meet. How do these compare to PP? Is there any modification in your role in terms of non tangible aspects of the job, like teaching or research
They're less. Academics need time to do teaching and research.
what does tenure mean for the academic radiologist? How difficult is it to obtain a tenure track role? Is tenure ever offered to someone who is mostly clinical, or is significant research output a requirement?
Tenure means permanent prestige points, university-funded salary, and sabbatical. It is an uncommon choice. Significant research output is a requirement.
 
Hello everyone.

current R1 here. Doing some self reflection and I think I really fit in well with Academic profile. I like participating in research, I love the prospect of teaching residents at the workstation, and enjoy working in a large tertiary care center and interacting with similar minded clinicians.

I have read a lot about private practice vs academia over the years. However, a lot of these discussions tend to be vague. I feel like especially over the last five years things have changed in terms of the private practice land scape (growth of private equity firms, lack of true partnership, cutting reimbursements) and academics (increased volume requirements).

specifically at my institution, some attendings have mentioned they are reading at PP pace while still balancing educational requirements. Where I went to medical school, some attendings said they made like half of the community Rad down the street.

Can anyone with some expertise break this down more for us:
1. Compensation : is it true that Academic rads make less? If so, how much less? Is it half the amount, or closer to 80-90%?

Varies but I'd say it's like 50-75%

2. If the above is true and that people are taking significant pay cuts for academia, why would anyone do that? Aside from the noble aspects of teaching residents and moving the field forward, isn’t it a tough pill to swallow to take such a cut? Or is it because the breakneck pace of PP is not worth it?

stability, easier workday, brainwashing

3. what does the average week look like? How many days in the reading room? Any academic days

its usually 4 clinical and 1 academic which may be divided into 2 half days. if you have grants or large admin roles you may get 2 days academic a week

4. how hard is it to get a job at an academic institution? What are the differences between clincal instructor roles and assistant prof/associate prof role?

not hard, they are desparately looking for warm bodies to take a pay cut and read the ever growing volume of cases.

5. what is considered in terms of career advancement and promotion?

assuming you are fine clinically, its service and publication and teaching

6. many community hospitals are being gobbled up by nearby universities. Do “academic” appointments at these clinical hospitals truly count within academia

not sure what this means

imo academics radiology sucks. the volume has gone crazy and the pay has stayed relatively stable. promotion is tied to publications and the promotions committee is made up of people that used to pubish articles in Radiology like

"MRI appearance of a renal cell carcinoma, first case reported"

and they wonder why you dont have many enough publications
 
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Hello everyone.

current R1 here. Doing some self reflection and I think I really fit in well with Academic profile. I like participating in research, I love the prospect of teaching residents at the workstation, and enjoy working in a large tertiary care center and interacting with similar minded clinicians.

I have read a lot about private practice vs academia over the years. However, a lot of these discussions tend to be vague. I feel like especially over the last five years things have changed in terms of the private practice land scape (growth of private equity firms, lack of true partnership, cutting reimbursements) and academics (increased volume requirements).

specifically at my institution, some attendings have mentioned they are reading at PP pace while still balancing educational requirements. Where I went to medical school, some attendings said they made like half of the community Rad down the street.

Can anyone with some expertise break this down more for us:
1. Compensation : is it true that Academic rads make less? If so, how much less? Is it half the amount, or closer to 80-90%?

2. If the above is true and that people are taking significant pay cuts for academia, why would anyone do that? Aside from the noble aspects of teaching residents and moving the field forward, isn’t it a tough pill to swallow to take such a cut? Or is it because the breakneck pace of PP is not worth it?
3. what does the average week look like? How many days in the reading room? Any academic days

4. how hard is it to get a job at an academic institution? What are the differences between clincal instructor roles and assistant prof/associate prof role?

5. what is considered in terms of career advancement and promotion?

6. many community hospitals are being gobbled up by nearby universities. Do “academic” appointments at these clinical hospitals truly count within academia

I really want to get into the nitty gritty of this. I appreciate any and all insight - I hope open discussion will help people like me in finding our career path

Some other points to add -

I assume there are still RVU targets to meet. How do these compare to PP? Is there any modification in your role in terms of non tangible aspects of the job, like teaching or research

what does tenure mean for the academic radiologist? How difficult is it to obtain a tenure track role? Is tenure ever offered to someone who is mostly clinical, or is significant research output a requirement?

How important is it for where you train to factor in to your selection for an academic position?

sorry if some of these are trivial Qs

Former academic, current private practice rad here. I'll just speak to my personally experience, considering YMMV.

1. Including benefits, I made about 2/3rds of what I make now in academics.

2. Some people really enjoy teaching and the relative mental stimulation of high-complexity cases. Also, the pace can be more relaxing, not just because the volumes tend to be lighter, but because you are more likely have residents and fellows to answer the phones, protocol exams, report critical findings, and chase down the techs when they muck up the sagittal MPRs.

3. We did our scheduling within the section. When we were fat, you might get two academic days a week. If someone got another job and/or someone were away, then you'd be clinical the whole week.

4. At my former institution, the title clinical instructor applied strictly to fellows in non-ACGME accredited fellowships. Anyone who was considered faculty was at least an assistant professor. They also had tenure and non-tenure tracts. You could get promoted to associate professor on either tract, but full professorship was reserved for those on the tenure tract. The non-tenure folks are sometimes referred to as "clinical faculty".

5. Consideration for promotion was equally divided into three broad categories - research, service (local or national committees or leadership positions, volunteer work), and clinical (RVU-production, resident/fellow teaching). For the tenure people, you had to excel at two and dabble in the third. Non-tenure faculty had to excel in one, usually clinical, and dabble in a second.

6. Doesn't mean much at all. They might send you a nice certificate that you can frame and add to your "I love me" wall.

7. We never had RVU targets, but your RVU production was factored in, along with a lot of other things, to the end-of-year bonus (assuming there was one). Unless you were bringing in grant money, we didn't have a ton of protected time to do research, but there was an expectation to publish nonetheless. I think this phenomenom is pretty widespread, which is why you see so many throwaway papers nowadays. "Utilization of CT cervical spine in trauma is on the rise" was the conclusion of a presentation at a conference I attended a few years ago. Well, duh. May I also add that smoking is bad for you.

There are certain things I miss about academia. I miss actually getting to take a lunch. I miss working with the good residents and fellows--the ones who really listen and learn. I miss the thrill of opening up a case and thinking, "I've got no idea what this is" and then really having to rub some neurons together.

I don't miss the "homework" that comes with academia, i.e. spending my entire Sunday afternoon putting together a lecture because I either didn't have an adademic day or because I was stuck in meetings. I don't miss dealing with residents/fellows who are just there to check the box. I don't miss the politics and the fiefdoms. I don't miss the skill atrophy--I once saw an attending body radiologist ask an MSK fellow to do a modified barium swallow because she "didn't feel comfortable with them anymore".

With respect to private practice, sure, I like the money, but more importantly, I like having more control over my schedule and my day. If it's 3 pm and slow, then I send my partner home. In academia, we'd both be stuck there until 5 pm. I like having beaucoup vacation. And I like the feeling that, as much as possible, no one is making money off of my work except me (mostly true, considering RVU production among the partners is roughly equal).

HTH.
 
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Can anyone with some expertise break this down more for us:
1. Compensation : is it true that Academic rads make less? If so, how much less? Is it half the amount, or closer to 80-90%?

Highly variable. Generally the average salary (and RVU productivity) of academics and PP have been creeping closer over time. Private equity buyouts have brought a lot of PP salaries into the 450-600k range. Conversely, community arms of tertiary care centers have pushed into low to mid 400's.

That being said, there are still some "true PP groups" that haven't sold out and clear 700-1mil plus after bonuses.

"True academic" center salaries often start in the low 300's, or in the case of the Harvards, low 200's sometimes. Anecdotally I heard Stanford offered one of their MSK fellows $160k salary to cover a community gig in the bay area.

I didn't see you mention vacation, but that's huge difference between academics and PP. Academics get 3-5wk vacation plus a few weeks for CME. I get 13 weeks of leave in PP and one of my co-residents took a full-time job with 20wk of leave.

2. If the above is true and that people are taking significant pay cuts for academia, why would anyone do that? Aside from the noble aspects of teaching residents and moving the field forward, isn’t it a tough pill to swallow to take such a cut? Or is it because the breakneck pace of PP is not worth it?
A lot of people in academics derive some "compensation" from the prestige of where they are working and the notoriety for the work they do. If they've stayed in the academic bubble their entire career, they honestly might just not know what they're missing out on money-wise.

4. how hard is it to get a job at an academic institution? What are the differences between clincal instructor roles and assistant prof/associate prof role?

In general, not super hard to get a job anywhere right now. The job market is HOT. Compared to 10 years ago when people were doing two fellowships just to get a crappy job. The elite programs are gonna have slightly higher standards, but its not by any means impossible to get a job at a top academic center right now.

"clinical instructor" in most places means a fellow that is credentialed to act as an attending (e.g. evenings, weekends and overnights). In most true academic places, medical instructor may be the bottom rung of the ladder. (Medical instructor -> Assistant prof. -> Associate prof -> full prof.)

I assume there are still RVU targets to meet. How do these compare to PP? Is there any modification in your role in terms of non tangible aspects of the job, like teaching or research

Yes there are still RVU targets to meet; even the VA has RVU targets to meet. It's highly variable what the demands of any random PP or academic institution are.

In academics, a lot of your productivity is determined by the level of trainee you're staffing and/or how much you have to read independently. If you're staffing two first years, you're not generating many RVU's for the day. If you're staffing two fellows, you might read far more cross-sectional than the average PP doc.

In PP, you crank high numbers by having a much lower acuity mix with lots of negatives.
 
I have read a lot about private practice vs academia over the years. However, a lot of these discussions tend to be vague.

This is an important discussion but by definition it has to be vague because there is enough variability in private and academic positions that makes it difficult to be specific.

What radiologists in the US make is such an artificial construct anyway, based on current payment paradigms. Do radiologists "work harder" than pediatricians?--as a group, perhaps not. Do some people decide to become pediatricians instead of radiologists, even if they have the option of being either? Yes, of course.

Asking "why" someone chooses to go into and then stay in academics when they "make" less than they could is like asking why someone chooses to be a pediatrician when they could make more being a radiologist. The answer depends on a million possible reasons, but ultimately it is because life is not always about what you make.

It very much varies based on your perspective. Also keep in mind that academic radiologists (on average) make less than private practice radiologists (on average) because they read or do fewer cases. At the end of the day, what you get paid has some basis on what you've done that gets paid. Academic radiologists do lots of stuff that doesn't get paid--so do private rads. It just so happens that academic radiologists do more of this non-paid work, generally--almost by definition, that means they do less of the "cranking it out" work. Those academic radiologists who complain about working "private practice volumes" haven't really seen "private practice volumes" at the real factories. And don't be under any illusion that PP doesn't have it's own share of "non-compensated" work--running a successful business is always work.

I laughed at colbgw02's characterization of academic "homework"--yes, it can suck. I have spent an entire weekend (literally, like 40 hours from Friday night to Monday morning) working on a project/paper and had blisters on my a** at the end of it, obsessing over it, and then bitching to myself on one level that I just ruined a weekend...but at the same time, proud as hell about the quality of the data and paper that was completed. I have spent countless hours getting and cropping images and videoclips to create presentations that I'm proud to deliver. My friend will do the same thing in his wood-working shop at home. To me, he should have just bought a table at Pottery Barn, but at some level he found creativity in his work.

You end up choosing and staying in and liking academics because of that chance for creativity and meaning in your work that resonates with who you are. I have friends in private practice who get some level of creativity and meaning in their business, but I sense that is harder to accomplish in private practice, especially these days as more private practice rads are working "for the man". Or, alternatively, those friends in PP see work ONLY as a means to enable their real interests/hobbies in something else. I don't judge this approach, it just doesn't work for me.

Of course there is BS in both paths. Some academic positions are horrible, as are some private jobs, but what makes them horrible for me (or you)--geography, pay, duties, work environment, organizational pride (or lack thereof), etc--may be tolerable for someone else because of what they value--or maybe they are just treading water on their way to something better.

In any case, to the OP, your first paragraph tells me that you could thrive in academics. I would not let the fact that you make 30% less than your PP friends because you read out 30% fewer cases, but still have to do non-compensated academic stuff instead of non-compensated PP stuff dissuade you from giving it a go.
 
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Pay differential is very real. I make almost 2-3 times what our local university rads start at (the salaries and other comp is public). Plus, they max out at 5 weeks vacay, which is awful (only Kaiser has less). They get .5 day per week for academic pursuits, but that can be recalled if they need the work for a sick out or something. I’m in a true PP that runs without any overhead so my type of position is becoming harder to find, but it’s amazing how much money PE backed rads, institutional rads and academics leave on the table. We also get 13 weeks off.

There are two types of academic rads in my opinion: those who love research/teaching and those who wouldn’t cut it in PP. Usually, academic rads want to focus on one modality/specialty. PP loves a generalist. No one in the community cares about the number of heads the semi membranosus has but they do want someone who can do a thyroid biopsy, then dictate some mammos.

The job market is super hot right now which means academics is suffering. This will swing the other way during the next economic downturn

Don’t even get me started on the academic “homework”. Where I did fellowship there was literally a conference every day. Tumor board, foot/ankle, total joint, rheumatology, sports medicine, interesting case and weekly cme conferences. That’s in addition to research and formal resident teaching. Kill me. Right now I have tumor board once a month and one committee meeting per month.
 
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Amazing discussions. Thank you so much. Keep them coming.
Private practice folk - what does partnership look like for you? How many years, is there a buy in, do you buy in to equipment/real estate?

what does “partnership” mean in a PE backed place?
 
Our partnership track is 1 year based on start date. (Be aware that most tracks are tied to the calendar year, not start date. So if you start in July 2021 on a 2 year track you won’t be a partner until January 2024. It’s a way to squeeze another 6 months out of recent grads). I’ve seen 1-3 year tracks. Anything longer than 2 years is a red flag IMO. Partner compensation is generally much higher than associate salary.

A lot of groups are dropping global/tech fees and getting rid of equipment. If this is the case, then there should be essentially no buy in. If there are hard assets, then you’ll need to get a lawyer and accountant and figure out if you are paying a fair market price.

A rule of thumb is “the more confusing a partnership path is, the less advantageous it is to the person who is confused”. In other words, seek out something simple that you completely understand. If there are layers of partnership (junior/senior), a strange vesting scheme, etc. I’d keep looking.

PE “partners” are just people who have worked there for a certain amount of time. You might get a slight pay raise and the ability to buy some company stock or something. It’s not like they bring you to the board meetings and ask for your opinion.
 
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love this thread. trying to soak in all the wisdom :) -intern looking forward to starting rads
 
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One of the local PP groups has a 4 year partnership track and a buy in with no equipment. no idea how they get associates to sign on but they do
 
Large, stable PP groups in desirable locations can do 2-4 year partnership tracks and still get more applicants than they need.

"Partnership" in a PE group is little more than a deceptive marketing term, used to try to confuse new grads with true PP partnership. They may give you a bit of company stock that you can't sell or do anything else with. PE groups will extremely underpay you relative to your productivity compared to PP groups. For example, a friend of mine is in an RP group where they expect >15,000 RVU/year from everyone (for context, that's greater than 90th percentile productivity for radiologists in the country) and pay you around 50th percentile median salary. It's an incredibly s****y deal, but it's the only way they can make profits for their shareholders/investors.

They are already struggling to recruit in this current job market. If new grads were fully aware of median practice RVU expectations and salaries, no one would apply to PE groups.

It's kind of sad to see other fields like EM or anesthesiology or even dermatology talk about PE in their fields as if it's a given. Radiology is not quite there yet but on their way, and it's best to be fully aware and avoid PE groups before we end up like those other fields.
 
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Agreed.

You may find long partnership tracks in very desirable areas, but that doesn’t mean the job is good.

It’s good the job market is hot right now. It’s clearly squeezing PE backed groups for warm bodies. Currently 243 open positions for Radpartners on the ACR job board. Lots of “exciting opportunities”like la grange Texas and Minden Louisiana. They’d have a hard time filling these even during a bad job market.

Unfortunately if things swing the other way, they will find people willing to be a cog in the wheel (just maybe not in Minden). I urge new graduates to resist at all costs. Older rads will continue to sell out so PE will only fail if they can’t find enough employees.

Seek out PP that have a variety of ages. Younger rads are less likely to want to sell out
 
How much less (on avg) do non-partners make than partners in a PP group? And how much are "buy-ins" to avoid the non-partner / tryout period?
 
I assume you’re talking total comp and not just salary. It’s highly variable. But I would say that most first year associates will be offered 300-350k. Expect partner salary to be around 50% higher than that with total comp 2-2.5x higher (this depends on bonuses and other perks like retirement, CME, etc).

I don’t understand the second question. Typical “buy in” for a group without equipment is considered “nominal”. For example, my group priced shares for equal partner at $10 per share and equal partners hold 10 shares so $100 total. This type of buy in is almost never more than $1000. If there is equipment or real assets involved then you could pay anywhere from tens of thousands to over one million to fully buy in. I would not consider a group that includes good will or AR as part of the buy in.
 
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@2brads thanks for the response! I guess I was wondering if there was any way to "buy-in" up front and avoid the associate years?
 
@2brads thanks for the response! I guess I was wondering if there was any way to "buy-in" up front and avoid the associate years?
Um, no. Part of the reason is partners want to make sure you aren’t a psychopath, work hard, etc. The other reason is that you are actually paying your buy-in through “sweat equity”. I.e. the difference in what you bill and what your salary is can be thought of as a buy-in (typically several hundred thousand dollars.) you regain this buy-in when one of the other partners leave and you hire a new associate.
 
How much less (on avg) do non-partners make than partners in a PP group? And how much are "buy-ins" to avoid the non-partner / tryout period?

every group will have a different buy in depending on what they own and how much they think they can squeeze out of their associates becoming a partner. They can be substantial and overpriced
 
I just want I say that I’m in academics and I’m very happy with my job. It’s true that you have to like the “homework” at least a little bit — if you don’t you can’t survive. That’s probably the best litmus test to know if you’re an academic or not. If putting together ppts on your off time energizes you rather than irritates you - then you’re good. I mean this is true for all teachers of any discipline.

Two other points:

Bias is rampant here in this thread. You’ll never get a true picture of academics vs PP because there are very few happy successful academics who became happy successful PP rads. Or at least they’re not posting here. I know ONE person who did the reverse and he’s happy in academics - there are probably some who went the other way. These are the people you should hear from, really.

Also, it’s just as important WHO you’re working with as much as where and how. Some academic environments are a sick backstabbing collection of cliques and some PP rads are horrific to their junior colleagues. Give me 75-85% salary with a happy supportive team and a good boss any day. Any day. If you don’t get that, then you don’t get it.
 
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Obviously specifics matter. But most academics make well less than 75% of PP. To make near PP you have to become higher up in the admin pathway. But very few people want to deal with the politics that entails. Also, once you go the admin pathway it’s harder to maintain your diagnostic skills. When was the last time your chairman read out the residents? Better off just getting an MBA or JD.

I’m trying to paint an accurate picture for residents and fellows. They know what academics is all about since they’ve been in the education pipeline for years. What no one tells them is what a good PP looks like.
 
Obviously specifics matter. But most academics make well less than 75% of PP. To make near PP you have to become higher up in the admin pathway. But very few people want to deal with the politics that entails. Also, once you go the admin pathway it’s harder to maintain your diagnostic skills. When was the last time your chairman read out the residents? Better off just getting an MBA or JD.

I’m trying to paint an accurate picture for residents and fellows. They know what academics is all about since they’ve been in the education pipeline for years. What no one tells them is what a good PP looks like.

Average assistant prof salary (average young attending) is 350-390as of 2018. Average PP salary is 503 (non-IR).

maybe your numbers are better than mine, but total average has it around 75%




 
These are salaries, not total comp (including bonuses, which make up a large part of my comp). I just checked on the comp for a peer of mine at the nearest large university (number is total comp including bonus and overtime). I make over 2x what he does.

Also, these numbers include PE backed “PP” employees and institutional shareholder with places like Kaiser/Sutter/etc. Those guys do ok, but it’s well known that their billings are subsidizing less well compensated specialties within their health systems.
 
These are salaries, not total comp (including bonuses, which make up a large part of my comp). I just checked on the comp for a peer of mine at the nearest large university (number is total comp including bonus and overtime). I make over 2x what he does.

Also, these numbers include PE backed “PP” employees and institutional shareholder with places like Kaiser/Sutter/etc. Those guys do ok, but it’s well known that their billings are subsidizing less well compensated specialties within their health systems.
Both reports are generated using data that includes year end and productivity bonuses, not including other benefits like insurance, retirement, etc which are excluded from both.

maybe those numbers do include PE, but PE is becoming increasingly a reality for PP for now.
 
I stand corrected. But my greater point that these statistics include health system and PE backed groups remains. Strong, true PP groups make more than these numbers suggest.

I urge all radiologists to learn how much they are worth and to seek out opportunities that reward their efforts. Billing is a boring subject, but learning about it now might just pay off in the end.
 
I stand corrected. But my greater point that these statistics include health system and PE backed groups remains. Strong, true PP groups make more than these numbers suggest.

I urge all radiologists to learn how much they are worth and to seek out opportunities that reward their efforts. Billing is a boring subject, but learning about it now might just pay off in the end.
I might argue the best metric is $/RVU at the end of the year normalized for your specialization. Academics used to be pretty good at this, but lately volumes have been picking up without a matching uptick in compensation at academic groups. If they want to continue matching PP, they need to boost salaries to match higher volumes.
 
$/RVU or $/shift since academics typically get far less vacation time.

My local university I don’t think they’re working super high volumes. But yes, if you are considering an academic position that’s doing PP volumes, I hope you really love teaching and PowerPoints.
 
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