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  • Academics vs private practice

    Posted by annie.yeung_852 on May 13, 2023 at 4:09 pm

    Im currently a 2nd year associate at a PP group and am struggling with volume and not sure if I want to stay or go back to academics and looking for some feedback on how some of the more seasoned AM rads view work/life balance as their kids grew up.  
     
    My PP group is a democratic, physician-owned practice in a major midwestern city that is home to me, my partner, and two small kids and in-laws. Partner pay is ~$525K with 13 weeks vacation. Normal workday volume is 100-120 total studies, about half cross-sectional. We have 6p-12a evening call about 3-4x/month with ~120 studies (half cross sectional) in 6 hours and about 15 weekends with 200+ cases (about 100 CT/MR) in 8 hours. The group has a few minimally profitable outpatient centers, no stipend from the hospital system, and I just see volume going steadily up each year and pay probably staying about flat.  
     
    The academic center in town where I did my training wants to hire me back and has said I can pretty much work from home 80%+ of the time (which is my preference). Rads read about 30 cross sectional per day there total, pay ranges $350-450K as you slowly climb the ladder, you work 8a-5p with no evenings and about 8 fairly chill weekends/year, just 6 weeks vacation, but theres good retirement if you stay until 65.  
     
    I feel like with how fast Im reading that Im missing things and potentially hurting patients and that really weighs on me. There are a few rads in the group that can read this fast and do a good job but lots miss lots of things and I dont know if this volume is just normal in PP everywhere and if I should expect it to just keep going up? If so, what is barely doable now will be impossible for me. Maybe I’m just not fast enough for PP?
     
    While the kids are young and not sleeping, we arent taking advantage of the vacation time and the night shifts are killer with the early morning wake-ups. Weve got no debt, partner makes good money, and we are saving tons already on my associate salary. I am thinking the work from home and no nights would be invaluable…but I dont know if Im not thinking about this the right way or if as the kids grow up that vacation time becomes more valuable, you make fewer mistakes or it weighs on you less once you’re further into your career, or if the juice one day becomes worth the squeeze? 

    jeroen.maas_791 replied 1 year, 2 months ago 19 Members · 28 Replies
  • 28 Replies
  • ruszja

    Member
    May 13, 2023 at 4:24 pm

    Those volumes sound normal for PP.
     
    The volumes given by the academic place sound low.
     
    Kids are young only once. If you can make it work at that income (and it sounds like you can), it would appear to be a good move. If you want to make some extra, make sure you have nothing in your contract that restricts you from going outside for extra work.

    • 22002469

      Member
      May 13, 2023 at 5:51 pm

      Quote from fw

      Those volumes sound normal for PP.

       
      Definitely seen groups at this level though 50-60 cross sectional/weekday and 100 cross sectional/weekend shift is a grind after awhile.
       
      If you gave me the description of the workload and vacation without the partner salary and asked me to guess… I would have thought higher than 525k. I doubt the $/wRU is very good given those numbers and makes it honestly an easier decision to go academics if on the fence.
       
      If the partner salary was 600-700k that 200k+ drop is a tougher pill to swallow. 

  • amotter

    Member
    May 13, 2023 at 4:32 pm

    I have worked both. I made the transition from academics and private practice. There are strong pros and strong cons to both.
     
    In academics, you generally get less volume (for the most part), but have more responsibilities such as teaching residents +/- research. Although there are politics in both PP and academia, there is a lot more pettiness in academia in my opinion. The politics are quite an unpleasant experience at least where I was. If you are only wanting to do your fellowship related work, in academics you have a better chance to compartmentalize yourself in your subspecialty. PP that is difficult except in larger practices.
     
    Obviously, the salary will be less, but you already know that. You will get less vacation, but you do get dedicated CME time and sick leave. You also can bank a certain amount of vacation that adds up to almost PP amount the subsequent year. Probably the best part is that if you work in a county, state or federal institution you get sovereign immunity.
     
    Just remember one thing, there is no partnership in academia. No matter the rank, awards, and accolades you get, you will always be a cog in the wheel.
     
    I loved working with and teaching residents, and I do miss it sometimes. But I wanted to feel like I have a stake/ownership to my craft. So now I am in a larger traditional PP group. So far, I am really enjoying my work and my colleagues.

    • JohnnyFever

      Member
      May 13, 2023 at 4:35 pm

      100 ct/mr and 100 plain films in 8 hours? Sounds horrible

    • y.rajshekar

      Member
      May 13, 2023 at 5:22 pm

      Quote from gg1184

      Probably the best part is that if you work in a county, state or federal institution you get sovereign immunity.

       
      I know about federal tort protections, but which county and state institutions provide those?

      • y.rajshekar

        Member
        May 13, 2023 at 5:36 pm

        To OP, I would choose academic in your situation. Reading for PP at such speeds is not great for so many reasons. How far would you have to travel from place of training to your home town?

        • JohnnyFever

          Member
          May 13, 2023 at 5:42 pm

          That volume is too high for that salary in midwest PP, unless you’re in Chicago or something

          • 22002469

            Member
            May 13, 2023 at 5:52 pm

            Quote from RoleCall

            That volume is too high for that salary in midwest PP, unless you’re in Chicago or something

             
            Yes. Something not adding up. 

            • consuldreugenio

              Member
              May 13, 2023 at 6:25 pm

              #s arent adding up. Sounds like rad partners, Riverside or whatever corp/PE group parading as a PP. Those volumes listed should earn 700k+ a year in the Midwest, unless there are some serious slacking old timers milking money out of the practice and doing minimal work.

              525k PP should be 1/2-2/3rds the volume posted.

              I can certainly crank out high volumes from time to time. However, I dont think that should be a the baseline day. Just from time to time, like weekends shifts or non frequent evening/ED shifts. Make templates as efficient as possible, train the mic, learn as much as you can on and off the job to make hard cases seem routine and the days might get a little less stressful.

              • 22002469

                Member
                May 13, 2023 at 6:51 pm

                Quote from Umichfan

                #s arent adding up. Sounds like rad partners, Riverside or whatever corp/PE group parading as a PP. Those volumes listed should earn 700k+ a year in the Midwest, unless there are some serious slacking old timers milking money out of the practice and doing minimal work.

                525k PP should be 1/2-2/3rds the volume posted.

                 
                Some internal or external skim going on for sure, if those volumes are accurate. 

              • Dr_Cocciolillo

                Member
                May 14, 2023 at 7:22 pm

                compleely agree.  OP, you can get a remote only job reading far less than that volume for day time work and making in the low to mid 5s range without nights or weekends.  something really does not add up here
                 

                Quote from Umichfan

                #s arent adding up. Sounds like rad partners, Riverside or whatever corp/PE group parading as a PP. Those volumes listed should earn 700k+ a year in the Midwest, unless there are some serious slacking old timers milking money out of the practice and doing minimal work.

                525k PP should be 1/2-2/3rds the volume posted.

                I can certainly crank out high volumes from time to time. However, I dont think that should be a the baseline day. Just from time to time, like weekends shifts or non frequent evening/ED shifts. Make templates as efficient as possible, train the mic, learn as much as you can on and off the job to make hard cases seem routine and the days might get a little less stressful.

                • ranweiss

                  Member
                  May 14, 2023 at 7:53 pm

                  Agree with all above. I’m in the midwest. Not even great payer mix. If you’re reading 100 mixed a day, should be easily clearing over 6, closer to 7.
                   
                  Also if you go back to academics, great. But don’t touch anything with a 3 in front of it in this market. Even academic rads are hitting 5’s with bonuses these days. 

                  • buckeyeguy

                    Member
                    May 15, 2023 at 7:45 am

                    That’s absolutely the case. I get great per hours because there are times when the ER isn’t ordering as much, and I don’t have to worry about stress all day, all the time …

      • ruszja

        Member
        May 13, 2023 at 7:34 pm

        Quote from DrBoogie

        Quote from gg1184

        Probably the best part is that if you work in a county, state or federal institution you get sovereign immunity.

        I know about federal tort protections, but which county and state institutions provide those?

         
        Sovereign immunity is what protects a cop who beats a guy to death in the course of his job or the corrupt district attorney who prosecutes someone for something that isn’t a crime. I dont see how that applies to the practice of medicine.
         
        FTCA protection applies to gigs like working for the Veterans Administration or a Federal Community Healthcare Center. It caps noneconomic damages at 250k and makes the cases uninteresting for the medmal racket.
         
        Now, if you work for a university or large health system, you tend to have a lot more insurance available to you than if you have to buy it yourself. A typical medmal coverage in PP would 1M/3M. If you work for a university or health system the coverage is in 100eds of millions. So even if there is a 10M verdict (vanishingly small chance to start with), you are never on the hook personally.
         
         

        • amotter

          Member
          May 13, 2023 at 7:42 pm

          Quote from fw

          Quote from DrBoogie

          Quote from gg1184

          Probably the best part is that if you work in a county, state or federal institution you get sovereign immunity.

          I know about federal tort protections, but which county and state institutions provide those?

          Sovereign immunity is what protects a cop who beats a guy to death in the course of his job or the corrupt district attorney who prosecutes someone for something that isn’t a crime. I dont see how that applies to the practice of medicine.

          FTCA protection applies to gigs like working for the Veterans Administration or a Federal Community Healthcare Center. It caps noneconomic damages at 250k and makes the cases uninteresting for the medmal racket.

          Now, if you work for a university or large health system, you tend to have a lot more insurance available to you than if you have to buy it yourself. A typical medmal coverage in PP would 1M/3M. If you work for a university or health system the coverage is in 100eds of millions. So even if there is a 10M verdict (vanishingly small chance to start with), you are never on the hook personally.

           
          I am not sure what you mean by that because Sovereign Immunity is a real thing in State university systems and is explicitly stated in the contract. If a patient sues you are protected from personal liability.
           
          [link=https://pubmed.ncbi.nlm.nih.gov/22415729/]Sovereign immunity: Principles and application in medical malpractice – PubMed (nih.gov)[/link]

          • y.rajshekar

            Member
            May 13, 2023 at 8:54 pm

            Looks like some states, like NY, given up sovereign immunity for it’s employees. Doctors working for FL university hospitals on the other hand are protected. 

            • william.wang_997

              Member
              May 13, 2023 at 10:33 pm

              To OP: Negotiate with your PP for a comfortable position and reading volume. If that doesn’t work, shift to Academics as this is where you and your life are at currently, for optimal work life balance.
               
              Your PP position currently sounds painful.

              • smfst7_929

                Member
                May 13, 2023 at 10:46 pm

                Zero chance that volume is real for that pay. Either OP is embellishing, multiple partners are severe outliers on the low end, or they have the worst billing company in the entire United States. If those numbers are real, youd be better off working for vrad remotely and vrad I hear is a crap job.

                • andy.lippman_422

                  Member
                  May 14, 2023 at 3:24 am

                  Be careful with the promised numbers. However, I would always take the job where you work half as hard and make 2/3 as much vs the busier higher paying job. Life is all about $/effort.

        • alex.nieto_484

          Member
          May 14, 2023 at 5:45 am

          Quote from fw

          Quote from DrBoogie

          Quote from gg1184

          Probably the best part is that if you work in a county, state or federal institution you get sovereign immunity.

          I know about federal tort protections, but which county and state institutions provide those?

          Sovereign immunity is what protects a cop who beats a guy to death in the course of his job or the corrupt district attorney who prosecutes someone for something that isn’t a crime. I dont see how that applies to the practice of medicine.

          FTCA protection applies to gigs like working for the Veterans Administration or a Federal Community Healthcare Center. It caps noneconomic damages at 250k and makes the cases uninteresting for the medmal racket.

          Now, if you work for a university or large health system, you tend to have a lot more insurance available to you than if you have to buy it yourself. A typical medmal coverage in PP would 1M/3M. If you work for a university or health system the coverage is in 100eds of millions. So even if there is a 10M verdict (vanishingly small chance to start with), you are never on the hook personally.

           
          You are incorrect. I work for a large institution and we have sovereign immunity. We can’t get named personally on a lawsuit. The institution gets named and settles or goes to trial on our behalf that it ever comes to that. It doesn’t go on your record and you can still claim to have never been sued for all intents and purposes.

          • ljohnson_509

            Member
            May 14, 2023 at 6:06 am

            Rushing through cases for 8-10 hrs straight non stop is inhumane and a recipe for burnout and disease

            • Unknown Member

              Deleted User
              May 14, 2023 at 1:14 pm

              To the op, if your posted numbers are correct, that is very high volume work and the compensation quoted does not seem correct for any geographic area but especially the Midwest. Either your numbers are off or you are in an extremely bad $/RVU scenario.

              Even if the partner pay were 150% of what you quoted, or the volume of work is 2/3 of what you told us, youve stated that you are not comfortable with the volume of work and the call schedule is going to pull you away from your family a lot. Regardless of pay, it sounds like a bad fit for you.

              Id take the academic job, but also consider other geographic areas. Even if you are not likely to move, it will give you some perspective.

          • ruszja

            Member
            May 14, 2023 at 2:44 pm

            Quote from RadCog

            You are incorrect. I work for a large institution and we have sovereign immunity. We can’t get named personally on a lawsuit. The institution gets named and settles or goes to trial on our behalf that it ever comes to that. It doesn’t go on your record and you can still claim to have never been sued for all intents and purposes.

             
            I stand corrected. I have worked for two state hospitals in different states and did not enjoy any type of specific liability protection for that. I guess its state specific.
             
            Now I have worked for the state health department and had sovereign immunity for that.  But that was because I did something specific to a government agency, in this case administer a federal program.

          • jeroen.maas_791

            Member
            May 15, 2023 at 11:17 am

             
            Lucky you!
            Even in the VA, the hospital settles and sends the name of the practitioner to the national database.

  • BILAONTI

    Member
    May 13, 2023 at 4:46 pm

    I can relate to your situation. I am currently an associate in a PP group with volumes higher (and rising) than I handle without compromising the level of scruitiny given to each study. There are a few partners who can get through the work while still providing good reports with few misses, and I am in awe daily. However, I have also observed some bad misses from speedy readers who self identify as going too fast. I don’t criticize since technically the work is “getting done.” Staying late is routine for me to make sure I meet average expectations, but it’s not sustainable. Like you, I’m debt free and have saved enough for freedom to design the work flow that I can handle.  Now I’m looking into outpatient only work with intermittent hospital time and it already feels like relief is on the way even if my pay and vacation are lower than PP associate/partner compensation. Do you feel a sense of relief when considering the academic job?
     
    Don’t forget about the ongoing tech revolution and hopping on that train if it grabs your interst. 

    • satyanar

      Member
      May 13, 2023 at 5:12 pm

      OP. Is your currents group leadership smart enough to listen to your ask of creating a salaried position for you? Could be a win win if structured properly.

  • aldoctc

    Member
    May 14, 2023 at 5:32 am

    Reading threads like this, I always have the same thought.

    “Your money or your life.”

    • ljohnson_509

      Member
      May 14, 2023 at 5:39 am

      You have to be very money motivated to keep doing radiology in the current times. Once thats gone its reduced to a liability laden grind with a faster and faster moving assembly line and lack of human interaction.