 Welcome back to my channel everybody. For those of you who are new around here, my name is Michael A.K.A. Dr. Cialini and I am a radiologist doing my final year of training in interventional radiology in New York City. Now, I'm almost done with fellowship. I have just under five months left, which means I am currently in the process of looking for a job and with that process comes the decision of what I wanna do with my life. And what I mean by that is what kind of job am I looking for? Is it academic? Is it private practice? And that's the question I keep asking myself and that's the question that so many people keep asking me. I figured I'd do a video and show you all the difference between private practice and academic jobs and everything in between. So let's go. Now, one thing people never told me upon finishing fellowship was that there is another hurdle that you must jump across and that is finding a job. And that's come to be one of the hardest parts of this entire medical training thus far because now that you're finally done, you have to commit to a job and settle down for the most part in one location and you have to find the perfect job and not every job is perfect and it's just difficult. When I was in training, I thought when this day came, I was going to finish training and all of a sudden the job would just appear in front of my face and that's not exactly what happens. Now, of course people want you and of course people need interventional radiologists and diagnostic radiologists and surgeons and all that stuff and every other type of doctor. But you actually have to go searching and do your homework and see which job is right for you. So the bare bones question you have to ask yourself right off the bat is do you want to go into academics or do you want to go into private practice because those are the two different job markets out there and you kind of have to pick one way before going on all of these interviews. It was after much thought that I decided private practice was the right career path for me. The next question I always get asked when I tell people I'm looking for private practice career options, how does a radiologist see patients in their office? Do they come to their office to get scans? Not many people realize how it all works being in radiology. So I'm going to use this video to kind of a shed some light on the differences between academia and private practice and then talk about what private practice, radiology and interventional radiology is all about. So before we do any further, let's talk about the differences between private practice and academic radiology. Now this is mostly regarding radiology but it can be applied to a lot of different other specialties as well. For all intents and purposes, this is purely about radiology. So I'm going to touch on a topic and I'm going to compare the difference between private practice and academic on that topic. Topic number one, teaching. Now there's an obvious difference between private practice and academic radiology and the fact that in academic you are obviously teaching residents throughout your entire career. Most programs are entirely resident run and as an attendant you have requirements to continue teaching these residents throughout their journey. Now the other hand, private practice doesn't always have residents in their hospitals. It's ultimately just the physician, me, who's doing all the procedures, dictating all the studies and there are no residents to overlook or teach throughout your time there. Honestly, this was the hardest part in my decision because I love teaching as you know from my channel but ultimately I decided I teach all the time on YouTube. I can still do the same thing anytime I want without the requirements of academic medicine. However, in private practice you're not necessarily working with residents but you will be working with a lot of physician assistants and nurse practitioners which you can also teach as well and like I've said many times before a good physician assistant or nurse practitioner are worth their weight in gold and you should treat them and train them as your colleague and you will be rewarded for such. Topic number two is patient complexity. Now, academic hospitals are notorious for having the sickest of the sickest patients. Obviously the academic institutions are going to have complex patient care. They have a ton of different subspecialists in their hospitals taking care of the sickest of the sickest patients and that's not always the case in private practice. Yes, there are sick patients at the hospitals but overall you're not going to be treating very complex patients. If the patients have complex disease or complex chronic diseases you're going to ultimately probably send them out to a tertiary care center like the ones I trained at and it's good, right? Because for one you don't wanna be handling these complex patients with limited supplies compared to these tertiary care centers and you want these patients to go somewhere where there are specialists to take care of them. So my thoughts on this are I love taking care of complex patients but I don't wanna do it day in and day out. Maybe if there are a few complex procedures here and there but doing complex procedures for multiple hours every single day is very exhausting and it takes a toll on you. So I'm glad there are physicians that do that but I'd rather have more of the bread and butter type stuff. Next topic or topic number three is pace. The pace of an academic institution is not very fast because it's not necessarily money driven and the reason being is because like I said prior a lot of these patients are very sick and complex and it takes a lot of thought and a lot of time to organize procedures and surgeries and care for these patients whereas private practice is more bread and butter so it tends to be faster paced and more efficient which is right at my alley. Fourth topic is vacation. This is very important to me. It is not so important to others but as you all know I like to travel and go somewhere anytime I have off. So having time off to travel and also having time off to make more YouTube videos and social media content is a top priority for me which is probably different from a lot of people. So the difference in vacation for academia is physicians or interventional radiologists will usually start around three to four weeks vacation per year and in private practice vacation time is actually quite higher, sometimes double and to start off you're probably looking at eight to 12 weeks of vacation a year and once you hit partnership track it could be up as high as 14, 16 weeks vacation. I've personally even seen jobs where you work night shifts only and work one week on and have two weeks off so you do the math. Top of number five and this is obviously a hot topic and that is salary. The salary of academic radiologists is lower than the average private practice radiologists and it starts low and it basically plateaus at that level with maybe some minor progression if you pick up more academic appointments or get involved in residency programs and all that stuff but in general private practice radiology pays quite a bit higher than academia. Furthermore, after you hit partnership track which is usually around two to three years after you start your job, your salary bumps up significantly and almost could double that of an academic radiologist. The next topic is research. Now research is obviously very heavy at academic institutions and a lot of academic appointments and academic jobs require their attendings to do research and oftentimes require them to do a certain amount of research or get a certain number of grants every single year while they are on staff there. Compare that with private practice. There is usually minimal to no research in private practice because like I said before, the case complexity isn't that high and it's more bread and butter type stuff and you don't really have time to spend doing research. It's more so that you're cranking out studies or doing procedures as fast as you can. Now I've obviously done my fair share of research in medical school and residency but I've learned over the few years that it's not really my favorite thing to do but I'm glad there are people that love it. The next topic is politics. Now academic institutions are notorious for having quite a bit of politics going on in their hospitals. The reason being is because there is a hierarchy amongst these hospitals. You start off as a social professor or assistant professor and then once you become a professor then you may become a chairman of the department and then once you become a chairman of the department you may become the hospital chief medical officer or the dean of the medical school or whatnot. There's a ton of different academic appointments and each of them has a hierarchy. Now I know politics is not supposed to get in the way of medicine but oftentimes it kind of does at these academic hospitals because if you're taking care of a patient and the chairman of medicine who's been there for 50 years and knows everybody in the hospital tells you he wants a procedure now, you kind of have no choice but to do it because you know they're more senior than you and if you don't do it, it looks bad on you and you want to look good to them and it's hard to explain but there's just a lot of politics. Now in the private practice world politics don't really come into play. If they do come into play it's more of like hospital administration type stuff but less so the hierarchy of medicine. A quick disclaimer is this is like a broad generalization just for radiology. It doesn't necessarily apply to every academic hospital. This doesn't necessarily apply to every private practice so take everything I say with a grain of salt. The next topic is marketing. Now for academic institutions obviously these are huge names that may be known internationally. If you start working for Harvard I don't think you have to do much marketing because you are a Harvard physician and patients will come see you no matter what. Alternatively if I go into private practice and work at some small community hospital the name doesn't really carry that much weight and nobody knows who I am and nobody's going to come see me over this Harvard guy unless I go around the hospital, meet people get a patient referral base and market myself. That's definitely a huge difference between going straight into one of these practices versus academia. The next topic is creativity. Now in academic hospitals your creativity is kind of limited by what the hospital wants or what the hospital needs. They don't really care that you want to do a certain type of procedure. They're going to do whatever is in the best interest of the hospital and they don't really care if you want to start doing some groundbreaking procedure or whatever is just whatever's in the best interest of the hospital and in order to start doing this you may have to get approval from the board at the hospital and all this stuff and it's just a lot more difficult to be creative under the hospital's name than it is to be creative under your name or your smaller private practice. If I wanted to start doing a specific procedure at my private practice I would likely just go talk to some of my partners and we would have a quick meeting and say yeah that sounds good but to do so at an academic institution would be quite a bit harder. The next topic is opportunity. Now I know that's a broad topic but what I'm trying to say is the hospital doesn't really care about what benefits you so much as a physician. They're more so worried about what benefits them as an institution versus private practice where you have the ability to think outside the box per se and maybe start some other business ventures or investment opportunities that may or may not pertain to medicine but they may benefit your practice and your partners as a whole. That doesn't necessarily fly in academia. For instance, if I wanted to open up a vein clinic and start treating baritose veins and doing sclerotherapy it would probably be a lot easier for me to do so at my private practice than it would at an academic institution and trying to convince them to spend a whole bunch of money on me to start this whole venture. Furthermore, if I wanted to invest some of our private practice funds into real estate or land or something it would be quite a bit easier to convince my partners to do so versus the board of a hospital. The last topic I wanted to talk about is student loans, which is a very hot topic as well. In academia, you may be working for a nonprofit hospital which means you will still qualify for the Public Service Loan Forgiveness Act which means you may get all of your loans forgiven after 10 years if you work at a 503C, I believe nonprofit organization for those 10 years. Now I've been working for a 503C nonprofit hospital for the past six years but if I go into private practice that is completely null and void and the government will not pay off my student loans after 10 years because the next three years will be in private practice and probably not at a nonprofit organization. In private practice, some places offer you lump sums as an incentive to join their practice. So they may offer a 50 or $100,000 loan repayment upfront if you join their practice and the other side of that is your salary will be quite a bit higher in private practice and you will have the ability to pay off your student loans quicker. It's kind of whatever you want. I see pluses and minuses to both sides of those and honestly, this was the hardest decision for me because I've already worked six years at a nonprofit hospital. It was hard for me to give up on that 10 year Public Service Loan Forgiveness and venture off into private practice. Now, obviously this isn't black and white when I'm talking about academic versus private practice because there's always an exception to the rule. There are a few kind of hybrid private practice academic institutions around the country which are also very favorable to work at. They're kind of rare, but they also offer the benefits of private practice with the benefits of academics kind of mixed into one but they're very difficult to find the job at sometimes because nobody ever wants to leave those places because for instance, you have the private practice salary but then you have residents do all your work for you. So yeah, I wouldn't want to leave that if I had that job either. Now, before I end the video, I just want to touch quickly on the private practice model itself as it pertains to interventional radiology because people don't really understand how radiology can be private practice. We don't have an office like family medicine, internal medicine or surgeons do. We ultimately get contracts through hospitals. So the way these private practices work is there's a group of interventional and diagnostic radiologists that come together as a partnership. They get contracts at hospitals around the area. So if there's a smaller community hospital that has no radiologists, they have to have somebody read all their images so they pay this radiology group to read all their studies. Furthermore, they will pay the interventional radiologists to work at their hospitals and do procedures on their patients. So essentially it is a partnership group that gets contracted out by the hospitals to read their studies. We don't really have an office per se seeing patients day in, day out but I will be seeing patients at the hospital and interventional radiology and read all the studies from around the area as well. In addition to that, these radiology groups often own their own imaging centers so they will benefit from that as well. So if you have any questions about that, let me know in the comments below because it can be a bit complex and no two private practices are the same. This model is actually very similar to the way anesthesiologists work as well. The newest venture lately for interventional radiologists is something called office-based labs or OBLs in which an interventional radiologist essentially buys their own radiology suite, has their own patients, does their own procedures on their own patients in their own radiology suite and they get to basically profit from the entire thing as a whole versus giving some of the profit to the hospital who host that radiology suite or whatnot. That model is up and coming and a few people have done that very well so far so I'm curious to see how it goes in the future. All right, so that officially concludes this video. Let me know in the comments below if you have any questions about academics versus private practice and I will try to answer it. Like I said, this is just a very general overview. This is not specific to any certain academic hospital or private practice. This is just some of the stuff I've seen across the interview trial thus far. And also let me know where I should work because that's still kind of up in the air at this moment. Also hit the thumbs up on this video, subscribe to my channel. I see a lot of you lurking around still. Call me on Instagram and TikTok if you don't already and I'll see you all on the next video.