Dr. Dowling is president of Dowling Medical Director Services, a private health care consulting firm specializing in quality improvement, clinical informatics, and health care policy affecting specialty care. He is the former medical director of a large,
Academic urology can provide an array of opportunities.
According to James Montie, MD, professor of urology at the University of Michigan, there are as many business models in academic urology as there are in community practices; the main difference is the presence of a higher layer in the institution. While this sometimes brings with it a "dean's tax" (shared revenue), distribution of state funds, and other politics, the department runs like many businesses and seeks to be self-sustaining. According to Dr. Montie, their department is part of a common model called "Faculty Group Practice"; in this case a 2,000-person medical group that oversees all ambulatory care in the University of Michigan Health System. Revenue to each department in the group is determined by a combination of relative value unit production and a weighted conversion factor that is intended to compensate for the enabled revenue (and expenses) of the particular department. For example, because urology may contribute more to referral of patients to ancillary centers, its conversion factor is higher than that of pediatrics. Individuals with dedicated research time are expected to generate external funding to support that time. All members of the clinical faculty are allocated 1 day per week to pursue "scholarly" activity with an expectation of academic productivity.
Compensation based on salary, bonuses
What attracts urologists to the academic practice model? While a university department position may not offer the same salary as a large single-specialty group that realizes income from its ancillary businesses, urologists are drawn to academic models for the diversity of daily experience. The opportunity to be involved in clinical research activity, participate in the scientific discovery process, teach and work closely with residents and medical students, and specialize narrowly within a clinical or research interest are among the reasons that urologists enter and remain in academics, according to Dr. Montie. While balancing the diverse responsibilities can be a challenge, it must be a rewarding one, as the attrition rate from the University Michigan's department of urology is extremely low.
Bottom line: Academics may not be for everyone, but it remains an attractive and economically viable alternative for a significant portion of our professional community.
Dr. Dowling is an independent consultant and the former medical director of a large metropolitan urology practice. He resides in Fort Worth, TX.