Wet Read: Practice choices

By C. Douglas Phillips, MD, FACR
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Dr. Phillips is a Professor in the Departments of Radiology, Neurosurgery, and Otolaryngology-Head and Neck Surgery, and the Director of the Division of Neuroradiology in the Department of Radiology, University of Virginia Health Systems, Charlottesville, VA.He is also a member of the editorial board of this journal.

This time of year we realize how transient many relationships truly are in academics. Folks come in, get trained, grow up, get smart, and then go into the real world. I hear a lot from our residents and fellows about their job hunts and their plans for big houses. This leads me to the following observations.

Early on I realized I could be pretty comfortable financially in private practice. I could pay for my kids' expenses through any school, have nice clothes and food, a nice house, a sweet car or two, and some scratch for all that vacation time. When I decided to stop working, I could run away to walk on the beach with a bad hat and a metal detector. That was all a given. But (and that is a big but), job satisfaction, comfort, and happiness were important to me, and I was comfortable, happy, and a bit satisfied here. There is an incalculable bonus in still smiling at the end of a day. There is an incalculable value in the friendships, laughs, traded quips, practical jokes, and off-hour relaxing after a job you enjoy. An academic career, my colleagues, my academic peers, and friends have all contributed to this. A few residents and fellows limit their job searches not so much on the colleagues they will gain, but on the financial value it promises. For my nickel, I think that is a mistake.

I have been mostly happy in my academic position most of the time. There are certainly times when I'm not happy and other times when I'm ready to run out of here like my hair is on fire. I am vexed by the sheer number of bureaucratic oddities and unbelievable tasks I am asked to perform. Such is the wonder of modern healthcare. However, most of my days still end with me a bit bedraggled, but smiling, nonetheless. There has been a certain amount of job satisfaction here. I enjoy watching residents and fellows come in knowing little and leave knowing a lot, and thinking that I may have helped a little. I know they will take good care of patients. It is a special bonus when some of these folks go into academic practices. I emphasize to people about the priorities they may consider on their job hunt and how to evaluate practices. Some pay attention, and others don't.

I hear from prior residents and fellows in good practices that they can't recruit new staff because they don't pay as much as another practice, or they offer a little less vacation or a smaller meeting allowance. Some can't even get people to interview because of the salary. I understand the pressures of medical school debt and loans, starting a new family, and moving to a new area, but a longer term view of one's career and mental health is in order. It is very difficult to put a price on the intangibles of a practice. Getting along with everyone in the group, loving the town, etc. They all add up.

Dr. Ted Keats (former editor of this journal and previous chair of my department) used to quip that living here was worth $75K a year. Well, that's a big opinion, and only that. Sorry, Ted. Wonderful places to live are everywhere. I could have used that $75K to put my kids through college. But, I agree that Charlottesville is a wonderful place to live and that I work with nice folks. All just another factor in staying here, working at this odd profession. Please consider some of these intangibles in your academic or private practice selection.

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Wet Read: Practice choices.  Appl Radiol. 

November 12, 2007
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