A reader question:
A lot of my attendings recommend my first job should be somewhere like academics or a hospital system where I have support if there’s a complicated case or someone to help me. Do you feel like you have that in private practice?
So I personally had/have that. Does everybody? No, it depends on the practice. I originally thought most people do, but the number of people I hear from on their second job search has informed me that this is certainly not universal.
But, overall, yes. I think the idea that academia has a monopoly on support is totally inaccurate. People can make you feel inept or give you a hard time for your inevitable mistakes in any environment (I often noticed more attending-on-attending cattiness when I was a trainee).
One key support-related question: Is there a way for you to ask people for help when you have a tough case?
There are plenty of practices now that have built-in instant messaging/case sharing features in their PACS. In this setting, even teleradiologists can share cases with their colleagues back and forth all the time so long as people are generally responsive and sufficiently pleasant.
(Call is always a bit of a different story when there are fewer people working, but this varies too. It’s often a lonelier one-person job. Texting or phoning a friend is always an option, but it’s certainly easier if people are on the outpatient list moonlighting etc and able to provide some support as needed when you’re stuck on a tough case. Being comfortable asking a colleague is, of course, a really helpful place to be psychologically.)
Yes, being in a big, vibrant, distracting reading room is probably going to feel more supportive and lively for most people. One question to answer for yourself when considering an academic job is whether that environment still actually exists. With demands for remote work and expansion of academic medical centers, even large institutions sometimes have their rads increasingly scattered to the winds. (Then, you have to ask yourself if you’ll actually feel more comfortable asking in person, potentially in front of additional attendings and trainees.)
Related and important: Do people share your mistakes with you in a way that’s not going to make you feel too bad, but still let you learn from it? Or do people roll their eyes when you have a miss but don’t tell you, potentially mocking you in front of others but robbing you of the chance to learn from it? Again, that can happen anywhere (including academics).
Ultimately, I think support has more to do with the specific job and less with the model. Every practice is “collegial” in its job postings, regardless of the reality, and plenty of radiologists in all environments take pride in their work and want new hires to learn and achieve high performance.
I think there’s a certain bubble doctors get into due to the nature of medical education, where we think academia is where the good work happens, and the outside hospital is where the bad work happens. My perception between my experience in academia, my current privademic model, and seeing the work of other practices working in our health system, is that there is no consistent relationship between overall model and quality. Subspecialization to extent, but there are good and bad radiologists and good and bad versions of every model, including in the academy.
I do think being 100 percent teleradiology is probably overall harder to feel supported. Certainly not impossible, but just those interactions won’t all feel the same if no one knows who you are and you don’t really know anybody. Asking a name on a chat list you’ve never met before doesn’t feel the same as asking a friend or a colleague in the same room or one you’ve had dinner with.
How “supported” you feel in that setting may have just as much to do with you and your needs as what the practice provides, but I’ve seen enough young radiologists on the market to know that many people discount how isolating even local radiology can be.