Imaging in the ‘Ivory Tower’: Academic Radiology

Throughout the radiology community, there’s one thing every provider has in common. At one point in time, you all completed a residency as part of your training.

Some radiologists never left academia. Instead of opting for private practice or choosing a career in teleradiology, they’ve chosen to remain in the “Ivory Tower.” They’re providing care to your patients like every other provider, but being a radiologist in an academic setting carries its own habits, benefits, and challenges.

And, according to Vijay Rao, MD, chair of the Board of Directors for the Radiological Society of North American and radiology chair at Jefferson Medical School at Thomas Jefferson University, as well as Tejas Mehta, MD, MPH, chief of breast imaging at Harvard Medical School, it’s a job selection that they are frequently thankful for.

“I love what I do, and if I had to do it all over again, I wouldn’t change a thing,” Mehta said. “You need to be passionate about what you do, and academic radiology provides a great work-life balance at the same time.”

Still, there is much to consider if you’re contemplating an academic radiology career – or much to learn if you’ve never experienced radiology practice from this perspective.

Benefits of Academic Radiology
Alongside being able to, potentially, work side-by-side with some of radiology’s thought leaders, being an academic radiology has some upshots.

1. Subspecialty Reads: The same way your residency gives you the opportunity to concentrate on a subspecialty, opting for an academic career allows you to focus your efforts in one specific area, said Rao, who has spent her career as in head and neck imaging.

“Only academic radiology allows you the luxury of practicing only in your field rather than having to do reads of all types,” she said. “This is very meaningful in contributing to providing the highest levels of care.”

2. Staying Young: Yes, you’ll age in your career, but choosing to remain in an educational institution ensures you’ll be surrounded by the next generation of radiologists at all times. Not only are they likely to be forward-thinking as individuals, but it’s also a requirement that they keep up with the most up-to-date data and technology in providing radiological care. If you’re constantly training aspiring radiologists, your skill set won’t have time to get rusty or dated.[[{"type":"media","view_mode":"media_crop","fid":"51363","attributes":{"alt":"Academic radiology","class":"media-image media-image-right","id":"media_crop_9828609896680","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6331","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 133px; width: 200px; float: right;","title":"©hvostik/Shutterstock.com","typeof":"foaf:Image"}}]]

3. Making Your Mark: Throughout the industry, you all strive to provide the best clinical care you can to your patients. But, if you’re a private practice radiologist, you can only control the level of care you provide as an individual, Mehta said. As an academic radiologist, you can cast your net of influence much farther because you’re helping new providers hone their skills to offer quality services, as well.

“It’s rewarding to see my trainees, since 1998, out there,” she said. “They’ve become chiefs of breast imaging or they’re in other leadership positions. As an academic radiologist, it’s a way of paying it forward.”

Academic Challenges
Academic radiology isn’t without its drawbacks, however. In some ways, the career choice carries a burden that private practice or teleradiologists don’t face.

1. Tripartite Mission: As a radiologist in an educational institution, you’re expected to do more than just see patients. In addition to performance in clinical care, these positions also require productivity in teaching and research. A good chunk of your time is spent training residents and fellows on the finer points of sub-specialization, and you must also find the time to investigate and publish about some aspect of radiology, such as new technologies or new treatment methods.

2. Increased Clinical Demand: Although the tripartite mission is long-standing, recent years have seen an uptick in clinical care expectations for academic radiologists. As requirements for reimbursement have changed, academic radiologists are now expected to read a higher number of routine outpatient studies to help maintain the bottom line.

Differences in Reimbursement
Academic radiology follows the same Medicare fee schedule as private practice and teleradiology providers, but it can be harder for radiologists working in educational environments to recoup a healthy amount of reimbursement for services rendered, Rao said.

“The cases you see in a tertiary or quaternary hospital are often more challenging and complex, and they take longer because of the comparisons you often have to do,” she said. “Whether a case takes five minutes or an hour, you’re still going to receive the same amount of reimbursement for what you’ve done.”

Consequently, she said, academic radiology has had to pivot to take on more routine outpatient cases – bread-and-butter images, according to Rao – in order to bring in the dollars needed to maintain salaries and operations.

To help meet this goal, her department at Thomas Jefferson University launched a joint venture with community imaging centers. Through the partnership, the department supplies its expert, subspecialty skills to a community setting while garnering reimbursement from an increased number of simpler outpatient cases.

However, Mehta said, academic radiology departments do enjoy a stronger negotiating position with insurance companies. With the backing of a larger university behind them, the departments are able to secure better reimbursement levels for services rendered than can smaller, private practice groups.

Relationships with Referring Physicians
As conversations about changing reimbursement continue, a big part of the discussion is how providers will work together to provide the best possible patient care. This has created a significant paradigm shift in academics, said Michael Langenberg, executive director of the 28-member Association of University Radiologists associated with the University of Tennessee.

A decade ago, he said, academic radiologists were able to close their ranks and talk mainly with providers within their own silos. Today, however, expectations are higher. It’s now assumed these providers will foster and maintain open communication with referring physicians from other specialties, as well as those from the community.

This is one area where technological advancements have caused frustration in radiology, Rao said. The advent of the PACS revolutionized the ways providers stored, viewed, and shared imaging studies, but it also altered how radiologists and referring physicians work together.

Previously, referring physicians had to visit a radiologist in order to obtain requested images. Now, those same studies are a few mouse-clicks away, requiring zero personal interaction.

“It’s a trade-off because PACS is critical to how we practice now” she said. “Images must be available to everyone, but clinicians no longer have to come and talk with us in order to see the images.”

Critical, emergent findings are, however, still communicated with a personal phone call.

From an educational perspective, though, academic radiology offers much toward strengthening relationships with referring physicians, Mehta said. A growing number of medical school curricula now require most specialties to spend time getting to know in-house radiologists. Now, academic departments offer grand rounds for residents in others specialties, giving them the opportunity to learn about imaging and how best to use it appropriately. The face-to-face learning time also helps to solidify positive working relationships for the future.

Overall, Rao and Mehta said, academic radiology offers a wide breadth of opportunities in an environment that offers a greater degree of job satisfaction and security. Salaries, while somewhat lower than those of private practice providers, still offer financial stability and a desirable lifestyle.

It’s an attractive career option enjoyed by most providers who choose this path, Langenberg said. His only hope is academic radiologists will one day be able to better use their position to educate patients.

“Too often, patients don’t understand who the radiologist is and what his or her level of expertise is,” he said. “More people need to know the value of a radiologist in the health care process.”