Private practice versus academics: Making an informed decision

Every resident in radiology ultimately faces a pivotal decision about whether to pursue a career in private practice or in academic medicine. This decision has profound implications for the trainee’s future in radiology. The choice of private practice versus academics relates in part to the age-old quandary of whether it is better to be a “generalist” or a “specialist.” Some residents choose private practice because they feel strongly about plying their craft as general radiologists, but others choose academics because of an equally strong desire to be experts in one area of radiology. Other considerations affecting this decision include the greater financial rewards of a career in private practice versus the more diverse intellectual rewards of a career in academics.¹ However, another important but underappreciated factor that drives many trainees away from academic radiology is the antipathy they feel for “research” in any form.

I personally believe this negative perception about scientific research has become an increasingly powerful influence on a large number of residents, as they develop a mindset early in their training that research interferes with their primary mission of learning clinical radiology. Because of this mentality, scientific research becomes anathema for many residents, who would rather spend their time on the clinical radiology service than on research activities or grant applications. Such trainees believe they have neither the interest nor the skills for scientific research, so, by default, private practice becomes the only viable alternative.

A major problem with this scenario is that trainees are making an uninformed choice based on preconceived notions about academic radiology. In most cases, the trainees have no experience in scientific research and no sense of what this type of work entails (including clinical research, health services research, and bench research). As a result, their decision is based more on an emotional response to the abstract concept of “research” than on any real understanding or knowledge of its meaning.

For all of these reasons, I believe it is important for radiology residents to be exposed to one or more forms of scientific research during their training. Such research should be performed in collaboration with department faculty who can serve as ideal mentors, leading and guiding the trainees through all phases of the research process, which includes: reviewing the scientific literature; collecting, tabulating, and analyzing the data; and, finally, preparing an original manuscript, with the trainee as lead investigator and first author of the work.² The ultimate goal is publication of their research findings in a peer-reviewed scientific journal and, it would be hoped, presentation of these findings at a major scientific meeting. Not all trainees will find this experience worthwhile. In fact, disenchantment with the research process ultimately may be the deciding factor for those who choose private practice over academics. However, others may find the research process so rewarding, fulfilling, and even exhilarating that they become intensely motivated to pursue a career in academic radiology for the express purpose of continuing this research experience.

Trainees also should be expected to provide formal teaching to their peers, giving lectures or showing cases in morning conference and serving as the speakers for one or more department Grand Rounds. Once again, not all trainees will find this experience worthwhile, but some may realize they have a passion for public speaking and for being on center stage.

Trainees ultimately will make their own choices about whether to pursue a career in private practice or in academic medicine. However, I believe it is absolutely essential for the faculty in academic radiology departments to expose all residents both to research and teaching during their training by including these important activities in an integrated residency program. I personally have trained a number of radiology residents, now themselves successful academic radiologists, who would never have pursued academic careers if not for the research and teaching experiences they had during their own training programs.

In the end, trainees will make highly personal decisions about their future, but these should be informed decisions. The faculty in academic radiology departments, therefore, has a fundamental obligation to provide all radiology residents with training in research and teaching and to serve as enthusiastic and dynamic mentors for this research experience.