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Reflections on the differences between academic medicine and private practice
Reflections on the differences between academic medicine and private practice Michael R. Soules, M.D. Seattle Reproductive Medicine, Seattle, Washington
There is agreement that assimilating assisted reproductive technology into academic reproductive endocrinology and infertility has been problematic. Having made the transition from academics to private practice, the author reflects on the attributes and deficiencies of both settings. Both groups of physicians should feel compelled to further define and solve the problem. (Fertil Steril威 2005;84:583. ©2005 by American Society for Reproductive Medicine.)
When you submit a potentially controversial editorial (1), there is inherent apprehension that your opinion will seem foolish or be ridiculed. In that context, I read the articles by Drs. Paulson, Sauer, Barbieri, and Reindollar (2–5) with great interest. They each agreed that there was a problem, and each had a different and interesting perspective. I do not disagree with anything that was expressed in these four articles. Personally, I think the solution of public/private partnerships, as proposed by Dr. Reindollar (5), will prove to be the best approach. I was in academic medicine for 24 years and have been in private practice for the past 6 months. Although it would be presumptuous for me to claim complete insight into the latter, I thought it might be interesting to reflect on my transition: ● I am providing better continuity of care for my patients
because clinical practice is my only job now. ● I really miss the fellowship/residency training environment. ● Practicing outside of a large institution is even more
efficient and pleasant than I had imagined. ● I feel more vulnerable to medical market forces, and I do
not feel as protected and sheltered from medical malpractice claims. ● I find myself declining the opportunity to review submitted articles because I want to spend my professional reading time on published articles (better quality). ● There is an inherent alignment of the medical and business aspects within private practice, which is reasReceived February 11, 2005; revised and accepted February 11, 2005. Reprint requests: Michael R. Soules, M.D., Seattle Reproductive Medicine, 1505 Westlake Avenue North, Suite 400, Seattle, Washington 98109 (FAX: 206-285-4555; E-mail: [email protected]).
0015-0282/05/$30.00 doi:10.1016/j.fertnstert.2005.04.024
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suring because it always seemed to be disconnected at the university. I have witnessed a tendency for endocrinology (noninfertility) patients to not be referred as frequently as at the university. I miss the availability of all medical specialties within the same building (especially my colleagues in other obstetrics and gynecology subspecialties) and institutional resources, such as the Reproductive Technology Ethics Committee. I now read the business section of the newspaper. I think there is a danger in private practice of falling behind the medical knowledge curve if physician education is not made an integral part of the practice. I believe physicians in academics and private practice both work incredibly hard and put in long hours (while believing the other group has it easier).
I think there is a serious problem in our specialty, and both academic and private practice physicians will need to solve the problem together. REFERENCES 1. Soules MR. Assisted reproductive technology has been detrimental to academic reproductive endocrinology and infertility. Fertil Steril 2005; 84:570 –2. 2. Paulson RJ. Academic practice plans have been detrimental to the practice of assisted reproductive technology. Fertil Steril 2005;84:578 –9. 3. Sauer MV. Surviving the shifting focus from basic research to clinical activities in reproductive endocrinology and infertility. Fertil Steril 2005; 84:573–5. 4. Barbieri RL. A renaissance in reproductive endocrinology and infertility. Fertil Steril 2005;84:576 –7. 5. Reindollar RH. Assisted reproductive technology has been detrimental to academic reproductive endocrinology and infertility: depth of the problem and possible solutions. Fertil Steril 2005;84:580 –2.
Fertility and Sterility姞 Vol. 84, No. 3, September 2005 Copyright ©2005 American Society for Reproductive Medicine, Published by Elsevier Inc.
583
There is agreement that assimilating assisted reproductive technology into academic reproductive endocrinology and infertility has been problematic. Having made the transition from academics to private practice, the author reflects on the attributes and deficiencies of both settings. Both groups of physicians should feel compelled to further define and solve the problem. (Fertil Steril威 2005;84:583. ©2005 by American Society for Reproductive Medicine.)
When you submit a potentially controversial editorial (1), there is inherent apprehension that your opinion will seem foolish or be ridiculed. In that context, I read the articles by Drs. Paulson, Sauer, Barbieri, and Reindollar (2–5) with great interest. They each agreed that there was a problem, and each had a different and interesting perspective. I do not disagree with anything that was expressed in these four articles. Personally, I think the solution of public/private partnerships, as proposed by Dr. Reindollar (5), will prove to be the best approach. I was in academic medicine for 24 years and have been in private practice for the past 6 months. Although it would be presumptuous for me to claim complete insight into the latter, I thought it might be interesting to reflect on my transition: ● I am providing better continuity of care for my patients
because clinical practice is my only job now. ● I really miss the fellowship/residency training environment. ● Practicing outside of a large institution is even more
efficient and pleasant than I had imagined. ● I feel more vulnerable to medical market forces, and I do
not feel as protected and sheltered from medical malpractice claims. ● I find myself declining the opportunity to review submitted articles because I want to spend my professional reading time on published articles (better quality). ● There is an inherent alignment of the medical and business aspects within private practice, which is reasReceived February 11, 2005; revised and accepted February 11, 2005. Reprint requests: Michael R. Soules, M.D., Seattle Reproductive Medicine, 1505 Westlake Avenue North, Suite 400, Seattle, Washington 98109 (FAX: 206-285-4555; E-mail: [email protected]).
0015-0282/05/$30.00 doi:10.1016/j.fertnstert.2005.04.024
●
●
● ●
●
suring because it always seemed to be disconnected at the university. I have witnessed a tendency for endocrinology (noninfertility) patients to not be referred as frequently as at the university. I miss the availability of all medical specialties within the same building (especially my colleagues in other obstetrics and gynecology subspecialties) and institutional resources, such as the Reproductive Technology Ethics Committee. I now read the business section of the newspaper. I think there is a danger in private practice of falling behind the medical knowledge curve if physician education is not made an integral part of the practice. I believe physicians in academics and private practice both work incredibly hard and put in long hours (while believing the other group has it easier).
I think there is a serious problem in our specialty, and both academic and private practice physicians will need to solve the problem together. REFERENCES 1. Soules MR. Assisted reproductive technology has been detrimental to academic reproductive endocrinology and infertility. Fertil Steril 2005; 84:570 –2. 2. Paulson RJ. Academic practice plans have been detrimental to the practice of assisted reproductive technology. Fertil Steril 2005;84:578 –9. 3. Sauer MV. Surviving the shifting focus from basic research to clinical activities in reproductive endocrinology and infertility. Fertil Steril 2005; 84:573–5. 4. Barbieri RL. A renaissance in reproductive endocrinology and infertility. Fertil Steril 2005;84:576 –7. 5. Reindollar RH. Assisted reproductive technology has been detrimental to academic reproductive endocrinology and infertility: depth of the problem and possible solutions. Fertil Steril 2005;84:580 –2.
Fertility and Sterility姞 Vol. 84, No. 3, September 2005 Copyright ©2005 American Society for Reproductive Medicine, Published by Elsevier Inc.
583