While the percentage of radiologists in the academic setting has remained relatively stable at around 20%-25%, academic radiology has not been immune to the changes impacting other radiology practice types, and indeed, medical practice, in general.
Practicing in academia isn’t as easy as it used to be due to a variety of complicating factors. If you’re thinking about pursuing a career in academic radiology, it’s helpful to have a realistic idea of what to expect in today’s academic workplace.
This post will provide an overview of the academic or medical school practice type and how it has changed.
|ACR definition: radiologists or ancillary personnel are employed by the academic university.|
What are the basic components of academic practice?
Academic radiology has traditionally been characterized by the combined missions of patient care, teaching, and research. More and more frequently, components of administration/leadership and community service are included and considered viable avenues for promotion and tenure.
Most academic departments have two or three promotion tracks, varying from highly research oriented to almost all clinical. There is usually also a track that is in-between where scholarly activity is required for promotion, but without requiring extramural funding.
Radiologists practicing in a university setting tend to be highly subspecialized and organized into sections based either on organ system (e.g., thoracic imaging) or modality/technology (e.g., MRI, nuclear medicine, or ultrasound).
The department is led by a chair, who is hired by the dean of the medical school. Depending on the size of the department, there may also be vice chairs, section chiefs, and directors (e.g., Director of Faculty Development). Although the chair is ultimately responsible for the operations and governance of the department, she may delegate many of those responsibilities.
Section chiefs may have full responsibility for running their section, including scheduling of clinical and academic time, research productivity, and section teaching responsibilities. Section chiefs may also have some degree of autonomy in hiring radiologists in their subspecialty, with oversight by the chair.
The nature of academic practice has undergone significant changes in the last couple decades. The clinical volume used to be much lower compared with private practice. That gap has narrowed. Decreased reimbursement has meant that clinical volumes have greatly increased even for academic radiologists.
It is becoming more common for academic salaries to be tied to performance measures, although the degree to which this occurs varies among institutions and the at-risk portion of salary can very from very little to a substantial amount. In some departments, a component of a radiologist’s salary may be calculated based on productivity standards.
A bone of contention
Work relative value units (RVUs), which attach a value to each imaging examination and procedure, are a measure used by the government to scale reimbursement under the Medicare program. These RVUs allow for benchmarking of productivity, but are an imperfect measure as they decrease when bundling occurs, they do not account for nonclinical work (e.g., teaching, research, administration, leadership, hospital and community service, professionalism, and quality and safety initiatives), and they do not assess the quality of the services they quantify or the professionalism of the physician providing them.
To address the shortcomings of work RVUs as a measure of productivity, newer complex models of physician productivity have been developed that account for diverse clinical and nonclinical activities [1-2]. Use of any productivity measures draws controversy among the stakeholders because inevitably, the methodology will not include every activity performed by a radiologist, radiologists will not always agree on the comparative value of individual activities, radiologists may feel they have little control over the degree to which they can participate in more lucrative activities (e.g., they may be assigned to work in areas that generate lower value RVUs, or they receive fewer resources that enable efficient scholarly production), and ultimately the amount of money available for salaries is fixed. That means that productivity-based compensation takes money from one radiologist and reassigns it to another who was more productive.
To make any compensation plan work, it is critical that all stakeholders have input into the development of the plan and that the plan is reassessed and revised as needed on a regular basis.
As has become the trend with all practice types, academic departments too have been asked by their associated hospitals to meet rigorous service standards. As government and other payers are requiring hospitals to provide outcome measures that justify the cost of health care, hospitals pass this expectation on to physicians, whether they are employees or independent physician groups.
An increasingly popular change in service expectations over the past 10 years has been non-radiology specialties, especially emergency medicine physicians, expecting radiologists to provide 24/7/365 in-house coverage and faster report turnaround times to allow for more efficient patient through-put. This represents a paradigm shift in the way academic radiology departments have functioned, traditionally with residents serving as the in-house radiologist during off-hours.
Check back soon for practical practice particulars. In the next post, I’ll discuss juicy details on compensation, scholarly activity, leadership opportunities, and practice location in academic practice.
- Lee CI, Herrington WT, Donner EM, Bluth EI. Citizenship in radiology: defining a concept and proposing its measure. J Am Coll Radiol 2013; 10:410-415
- Duszak R Jr, Muroff LR. Measuring and managing radiologist productivity, part 2: beyond the clinical numbers. J Am Coll Radiol 2010; 7:482-489