I think I'm getting at exactly what you're saying about being the "rainmaker" - the idea that I, as the radiologist, should be the choke point of healthcare delivery. When I do a CT-guided biopsy in PP, the patient is typically consented, on the table, scanned, and marked before I even walk into the room. Contrast that to academics, where, as an attending, I've had to go as far as to retrieve the patient from their ward in order to do a procedure because transport and the nurses are "too busy".
I agree. I also agree that "respect" is not really the right word for this. Really good private groups get incredibly good at being efficient and maximizing the time the radiologist is doing radiology. Academic practices tend to be a lot sloppier, almost by definition since there are trainees involved--even so, some are actually quite efficient in their own way.
I'm interested to hear your thoughts on collegiality. My experience has been that teaching hospitals are more adversarial for several reasons. For one, they tend to be bigger, meaning that you are less likely to know or see the ordering providers. Heck, there were radiologists from my own department that I never met. And I think it's easier to dislike a stranger. Secondly, being so large and with so many trainees, communication becomes like a game of telephone. The orthopaedic surgeon wants a hip aspirated, so he tells his resident, who tells the hospitalist, who calls the radiology resident, who then talks to me, and I'm left wondering why I'm being asked to biopsy the prostate. It breeds confusion and frustration. Lastly, and there's no way to get around this, the profit motive is largely missing. It can turn into a race to the bottom in which too many people are trying to get away with doing as little as possible.
I'll admit that every institution has its own "culture". I've only really worked in 2 academic practices (first one gigantic, current one medium sized), did my internship in a hospital that was mostly private practice, and did some moonlighting when a resident/fellow at one private practice for about 2 yrs. My current practice is incredibly collegial--I sit with urologists, gynecologists, surgeons, internists, etc., etc. in the staff lunch room, my kids go to school with their kids, I sit on committees with these people. Do we see eye-to-eye on everything?--no way. Are there some people that I just don't get along with, or try to avoid? Yes. But it's collegial. When there's a complicated case, they send me emails or call me directly, or ask their residents to be sure to have me look at the case. At my former gigantic academic practice, I understand your point, especially about how convoluted communications can be and how big egos can get. I still had a pretty good relationship (albeit not personal in any way) with the attendings in those fields that intersected with mine (prefer not to specify since I'd rather stay anonymous) and didn't really know the specialists who weren't in my zone of expertise. Of course, I had to be agreeable first--some radiologists are so full of themselves that they are going to have a problem forming collegial relationships. Even more importantly, it helps a lot to move beyond the "junior faculty" stage. Especially at the big places, it takes a while to get "cred" in academics--for probably the first 5 years, other faculty in other disciplines treat you like a glorified resident/fellow. After you make some great calls or help them out in tough situations with some nifty interventional work, it improves. To be honest, I'm not sure that is much different in Private Practice. Frankly, it sort of depends on how subspecialized/recognized the attendings are in the private practice hospital--in today's world, there are some incredibly sophisticated and cutting-edge private groups that will dismiss you and your reports as a radiologist if you can't deliver care that meets their expectations. In my limited experience, the orthopods were much more dismissive of radiology/radiologists in PP than in academics. Where I did my internship, the PP attendings weren't that sophisticated, and it seemed easier for radiologists to meet their needs, making them "more collegial".
I have a related question... kind of a dumb one. I can understand how an academic hospitalist, for example, can easily leave for pp and “relearn” the scut (eg order entry) that residents had been doing for them. No problem. But for an academic radiologist who is a true subspecialist, isn’t it difficult to move between academics and pp? With the exception of the ED section that many academic centers now have, of course.
Yes, at some point in your career as an academic radiologist, you are going to "close the door" to doing general private practice. Depending on exactly how subspecialized you are, this happens by about 5 yrs. I actually considered going into PP instead of moving to my current position, which occurred at about the 5 yr mark for me. I was looking at joining my friend's practice (a person in my residency class), and my friend gave me some perspective which was brutally honest, probably a little flippant, and sobering. My friend said "Look, you and I were residents together and we were knocking the cases out left and right then, so you know you can do it. What will bother you for a while in PP is that you're going to be better at the stuff you are good at and possibly quite bad at the stuff you haven't done for a while--you won't be living up to your own standards of being a great radiologist with that stuff. You'll get better just by doing, and eventually you will learn to become comfortable with your level of incompetence in the stuff in which you aren't an expert." For more perspective on this, see below.
I had originally had a strong interest in going into academics, but based on the things I've heard and seen, I'm beginning to be convinced that maybe private practice would give me a job environment with much more career satisfaction...
Here's the thing--I know some incredibly good PP radiologists who are great at a lot of things, and they work much harder than I do trying to stay good in a lot of stuff. I'm always impressed by the effort they put in to continually learn--the unrecognized truth out there is that the subspecialized academic radiologist has a much easier time staying up to speed than the PP radiologist. In my opinion, if you don't mind the "non-radiology" efforts you have to make as an academic radiologist--putting together talks, giving conferences, analyzing some data, publishing some observations, correcting resident reports--academic radiology is a piece of cake compared to private practice. Why do you think academic radiologists usually work much longer than PP radiologists? It's not because they didn't make as much money over the years (although they didn't)--its because the work they do is less stressful and its easier to stay on top of your game for longer.
So if you are looking at "career satisfaction", I really wouldn't look at "politics" as the deciding factor. I'd just consider whether you gain any satisfaction from the "academic" stuff. If you don't, you'll be miserable in academics. On the other hand, if you like explaining the things you know, if you like being subspecialized, if you enjoy analyzing data, if you somehow get a kick by responding to questions posed by students on SDN, if you like "collecting interesting cases" and engaging in show and tell, then you might seriously consider academic radiology as the easier job--because quite frankly, it is. You are going to find politics in PP also.
