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 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 now making this decision, you have come to the 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). Since I’ve been through it all, I am uniquely qualified to talk about how to decide between each option. So, I am going to do just that!!! (Don’t let other posers fool you!)
Are There Really Income Differences?
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 a pretty substantial difference exists between the income of a private practice and academic radiologist (almost 100-150 thousand dollars per year).
It’s Not Just About The Income Though!
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 receive substantial fringe benefits such as a pension of 70-80 percent of the final salary, incredible health care insurance that you cannot earn elsewhere, or other interesting perks such as free tuition for children in college.
Moreover, the typical smaller radiology private practice will not give these perks. If you take the pension alone, that could amount to a guaranteed (0.8)(262000 dollars per year) or about 210,000 dollars 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 at 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, you will need to publish, teach, or subsist (if you are talking about a place like the VA hospital!). Prestige and promotion results from 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 do not only occupy themselves 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. These individuals may be responsible for budgeting, hiring, and firing depending upon the institution. Again, your mileage may vary depending upon the role that you have in the institution. Basically, the almighty dollar has less control over your day-to-day work. (Although many would say it still plays a nice sized role!)
The Pure Private Practice Model
What is private practice about? In general, private practice wants to maximize income and the numbers of patients that go through your system. Of course, good practices have an element of quality. But quality exists 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 do not work, you do not make money.
Now, of course, the private practitioner also accomplishes other activities in the process of trying to make money. These folks may perform 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. On the other hand, 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, you have 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. In another type of system, the hospital may employ you but the hospital may tie you to the private practice world via output bonuses and so on. But, essentially the practice expects you to teach, do a little bit of research, and also maximize your work output. Thereby, you create 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 involve yourself in typical pure private practice issues. For instance, you will probably not need to maintain the building utilities.
The hybrid practitioner/dabbler likes to do a little bit of everything without having to delve into 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. 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 can be 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, a 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!!!