Radiology Private Practice Versus Other Career Pathways- Is It Worth “The Extra Money”?
The herculean question up for debate: is a private practice career path worth the extra money? In order to really answer this question, you really have to know your standard career options. If you are talking about standard career options for the radiologist (not the alternative career paths discussed in a prior post), you can really divide it into three main choices: private practice, academic/government, and the hybrid model. Lucky for you, if you are reading this article and you are in the process of making this decision, you have come to right place. I have worked in the world of academics as a fellow, worked in the world of private practice at my first job out of training at Princeton Radiology, and presently work at Saint Barnabas Medical Center where we operate with a hybrid model (I was also formerly a resident at a program with a hybrid model-Brown University). So, I am uniquely qualified to talk about how to decide between each option and I am going to do just that!!! (Don’t let other posers fool you!)
What is the difference in income for an academic practice radiologist versus a private practice radiologist? If you look at the Medscape Radiologist Compensation Report from 2016, the academic radiologist made on average 262,000 dollars (in this category also is included the military and government physician). On the other hand, some of the other private practice type radiologists made significantly higher amounts: the office based solo practitioner- 434,000 dollars; the office based single specialty group practitioner – 386,000 dollars; and the typical hospital compensated radiologist- 381,000 dollars. So, if you take these debatably inaccurate academic and private practice numbers into account, then there is a pretty substantial difference between the income of a private practice and academic radiologist (almost 100-150 thousand dollars per year). But not so fast! In terms of numbers alone, the true compensation may not really account for other benefits like pension and health care. Employees that work for the government or large institution academic hospitals can sometimes get substantial fringe benefits such as a pension of 70-80 percent of the final salary, incredible health care insurance that you cannot get elsewhere, or other interesting perks such as free tuition for children in college. These are perks generally not available for the typical radiology private practitioner. If you take the pension alone, that could amount to a guaranteed (0.8)(262000 dollars per year) or about 210000 for the rest of your life based on 2016 salary numbers. In fact you would need to have 5.24 million dollars in the bank to have that kind of money guaranteed on an annual basis assuming a 4 percent fairly risk free return. So, the difference may not be as substantial as initially assumed upon first glance.
So, now that I have debunked some of the income based differences (there are always exceptions to every rule!), let’s talk about the different models and help you to decide which option is the right one for you. Let’s start!
The Academic/Government Model
In the pure academic or government model, the primary goal is not reading films and making money. Instead, it is to publish, teach, or subsist (if you are talking about a place like the VA hospital!). Prestige and promotion is a result of these activities. For comparison, the typical private practitioner couldn’t give a lick about these job requirements. The philosophy is often: publish or perish!
The typical academic sort writes a lot, is always obtaining grants, and is heavily responsible for the teaching and welfare of his/her residents. He/she typically reads fewer studies and sees fewer patients than a typical private practice radiologist. But, that may vary depending upon the institution for which you work. He/she gives many conferences, travels all over the country/world to give lectures, mingles with other academic sorts on all different types of committees, and plays a big role in directing the future of radiology. Many of these radiologists have outside ventures and partnerships with different companies and academics centers since they are not entirely occupied with the standard day-to-day role of reading films. Some of the partnerships may be based on their research or area of expertise.
The higher-up academic radiologists manage their staff as chairmen and may be responsible for budgeting and hiring and firing depending upon the institution. Again, your mileage may vary depending upon the role that you have in the institution. This is all to say that your day-to-day work is somewhat less controlled by the almighty dollar. (Although many would say it still plays a nice sized role!)
The Pure Private Practice Model
What is private practice about? In general it is about maximizing income and the numbers of patients that go through your system. Of course, there is also an element of quality. But the quality is there, to increase profitability. The almighty dollar tends to rule the day and all roads lead back to the almighty dollar. Employees and owners grind out films on a daily basis, day in day out. The philosophy: if you are not working, you are not making money.
Now of course, it is essential that the private practitioner accomplish other activities in the process of trying to make money. These folks may be responsible for some or all of the following practice needs: advertising, buying and selling equipment, strategic partnerships and mergers, maintaining relationships with a hospital hospitals, hiring and firing an army of numerous employees (possibly radiologists, technologists, janitors, nurses, physicists, and so on), maintaining and purchasing real estate, payroll, billing, legal issues, parking, and utilities. Academic hospitals/facilities typically take care of some or all of these issues in a typical academic/governmental practice. Therefore, you really need to enjoy playing many different hats and roles as well as being a self-motivated entrepreneur.
The Hybrid Private Practice/Academic Model
This is my current role. I like to think that I get the best of both the private practice and academic world. (Although some would like to say that is the worst!) The philosophy of the hybrid practitioner: A dabbler who likes to do some of the elements of both private practice and academia, but not in such depth.
So, how does the hybrid model work? First of all, there are a few variations on a theme. In my situation, I am involved in a hospital based private practice with a residency program and multiple covered hospitals and imaging centers. Others may be employed by a hospital but may be more tied to the private practice world via output bonuses and so on. But, essentially you are expected to teach, do a little bit of research, and also maximize your work output and thereby income by grinding through studies. Most of these practices are not involved in the purely academic activities such as obtaining grants. And, you will probably not be involved in typical pure private practice issues such as maintaining the building utilities.
The hybrid practitioner/dabbler likes to do a little bit of everything without having to delve in some of the serious academic and pure private practice issues. I was never interested in writing and obtain grants, but I certainly wanted to teach. I was not interested in dealing with some of the very basic issues of private practice, such as hiring/firing technologists, but yet I was interested in the mechanics of business and private practice. For the sort of person that likes to be a bit more generalist, the hybrid model is a great career path.
How To Make The Final Choice?
I think the final choice becomes a personality based thought process, not one that should be based on the different income constructions of each career model. If you hate business in all forms, work for the government or academia. If you hate writing and teaching, private practice may be for you. And, if you love doing a little bit of everything, think about the hybrid model. Bottom line: You need to be true to your self. Do what you like, not what others will think you will enjoy. If you follow these precepts, you will make a great choice and have a fantastic career!
Comments are welcome!!!