THE CAREER PATH CHOICES OF VETERINARY RADIOLOGISTS MURRAY D. JELINSKI , TAWNI I. SILVER
Concerns of a shortage of board certified specialists willing to work in academia have shadowed the medical and veterinary communities for decades. As a result, a number of studies have been conducted to determine how to foster, attract, and retain specialists in academia. More recently, there has been a growing perception that it is difficult for academic institutions to hire board certified veterinary radiologists. The objective of this study was to describe the career paths (academia vs. private sector) of veterinary radiologists and to determine what factors influenced their career path decisions. A mixed mode cross-sectional survey was used to survey ACVR radiologists and residents-in-training, 48% (255/529) of which responded. There was a near unidirectional movement of radiologists from academia to the private sector: 45.7% (59/129) of the respondents who began their careers in academia had switched to the private sector while only 8% (7/88) had left the private sector for academia. If a shortage of academic radiologists exists, then perhaps the issue should be framed as a problem with retention vs. recruitment. The most influential factors in the decision to leave academia were remuneration (wages and benefits), lack of interest/enjoyment in research, geographical location, and family considerations. C 2014 It is salient that average salaries increased by twofold after leaving academia for the private sector. American College of Veterinary Radiology. Key words: academia, career, factors, radiology, survey.
Introduction
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large and steady number of residents in training, there are concerns, particularly amongst academics, about a shortage of radiologists. There is, however, a lack of data showing whether the shortage of veterinary radiologists is real or merely a perception. A review of ACVR’s website found 36 job postings, which were split equally between academic and private practice positions.5 Although these postings represent a snapshot in time, they provide some insight into the overall demand for veterinary radiologists by academic institutions and the private sector. The other means of determining whether there might be a shortage is to examine salaries, as high wages are often indicative of a shortage of employees. The AVMA’s Report on Veterinary Compensation (2013 Edition) reported that veterinary radiologists received the highest median income of all specialties ($184,000), followed by laboratory animal medicine specialists ($172,000), with surgeons, ophthalmologists and pathologists earning $148,000.6 These data suggest that veterinary radiologists are in demand and more are probably needed. The ultimate question for academic institutions relates to how to attract and retain radiologists. Historically, academia has been the primary employer of radiologists; however, this is no longer the case. In 1968, all but one radiologist was employed in academia and by 1998 57% of ACVR diplomates were employed in academia4 , decreasing
AMERICAN VETERINARY MEDICAL ASSOCIATION (AVMA) is composed of approximately 85,000 members, of which 4000 are employed by academic institutions.1 The AVMA also recognizes 11,000 veterinarians with diplomate status, 40 specialties, and 22 veterinary specialty organizations.2 The American College of Veterinary Radiology (ACVR) is one of these specialty organizations and as of February, 2014 it had 518 active diplomates and 113 resident members-in-training (residents),3 which includes diplomates and residents in radiation oncology. The ACVR has grown considerably since 1968 when it had 20 diplomates, one of which was employed in private practice.4 Concerns of an imbalance between the supply and demand for radiologists surfaced as early as 1971, with the ACVR, consisting of 35 diplomates, being concerned about an oversupply of radiologists. These concerns were largely unfounded and, from 1968 to 1998, the ACVR grew by 4 to 10 diplomates per year. Although there is a relatively HE
From the Department of Large Animal Clinical Sciences (Jelinski) and Small Animal Clinical Sciences (Silver), Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK, S7N 5B4, Canada. This project received institutional funding. This research has not been previously presented or published. Address correspondence and reprint request to Murray Jelinski, at the above address. E-mail: [email protected] Received December 15, 2013; accepted for publication March 14, 2014. doi: 10.1111/vru.12182
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to 31% by 2006.7 This, however, is not unique to radiology, the American College of Veterinary Surgeons experienced a similar decline in the proportion of diplomates employed in academia over a similar time period.8 Not only is the private sector a major employer of veterinary specialists, but it is also academia’s main competitor when it comes to hiring and retaining diplomates. The purpose of this study was twofold: (1) to determine what proportion of veterinary radiologists began their careers in academia vs. the private sector, and (2) to assess what factors were the most influential in the decision to pursue a career in academia or the private sector.
Methods The sampling frame consisted of 449 ACVR Diplomates and 80 resident members-in-training. Radiation oncology members were included if they were double-boarded in veterinary radiology. Survey pretesting was performed with 20 diplomates who attended the 2012 International Veterinary Radiology Association Congress and European Diagnostic Veterinary Imaging Conference in Bursa, Turkey. The survey was approved by the University of Saskatchewan’s Behavioural Research Ethics Board (BEH 12–281). The survey questionnaire comprised 14 questions, beginning with the respondents providing their current employment status: academia (tenure or clinical), private practice, teleradiology practice, and “other.” There was also a similar question relating to where they began their radiology career. From these two questions it was possible to determine the percent of radiologists that initially chose a career in either academia or the private sector (private practice, teleradiology practice or “other”), and whether they had switched career paths. The survey defined academia as a position in a recognized teaching institution (e.g., University). If the person had left academia for a career in the private sector, then they were directed to rank 12 factors, on a scale of 1 to 5, as to how influential each factor had been in their decision to leave academia. The respondents were also given the opportunity to identify any other factor(s) not listed. The same type of question, but with a few modifications to the list of factors, was asked of those who had left private practice for an academic position. The factors chosen for inclusion in these questions were formulated, in part, from previous studies of career paths of veterinarians and medical physicians.8–10 Respondents who changed career paths were also asked to specify by what percent their annualized salary had increased or decreased. The second part of the survey involved a series of background questions relating to the percent of time spent on cases of a particular species (i.e., small animals, equine, etc.) and time spent using specific radiological modalities (i.e., teleradiology, in-house radiology, CT/MRI, nuclear scintigraphy, etc.). The survey concluded with questions
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relating to board certification, age, gender, and an openended question asking respondents to provide any further thoughts regarding career path changes. The background data were collected and analyzed but for the most part are not included in this report. The survey was mailed in November, 2012 to 529 ACVR members (diplomates and residents); those specializing only in radiation oncology were omitted from the sampling frame. Each respondent received a covering letter, copy of the survey questionnaire, and a self-addressed, postage-paid, return envelope. Due to logistics, the nonNorth American respondents (n = 21) were required to affix their own international postage to a self-addressed return envelope. The mailing was followed 3 weeks later with an e-mail reminder prompting the recipients to participate in the survey. A second survey package was mailed to all North American members in March, 2013, followed by an email reminder. Due to the low initial response rate from the international ACVR members, only the North American members were contacted in the second mailing. In addition, residents were excluded from the second mailing because it was evident from the early returns that many of the residents had not decided on where they would be working following completion of their residency program. Only 420 potential respondents were contacted in the second mailing and all returns were accepted until July 15, 2013. The data were entered onto a relational database (Access 2010, Microsoft, Redmond, WA, USA), transferred onto a spreadsheet (Excel 2010, Microsoft, Redmond, WA, USA), and analyzed using a statistical software package (SPSS ver 20, IBM, Armonk, NY, USA). Normally distributed data were analyzed using Student’s t-test and analysis of variance. Mann-Whitney and Kruskal-Wallis test statistics were used for non-normally distributed data. The Pearson chi-square test statistic was used to analyze categorical data. The level of significance for all tests was P < 0.05.
Results Herein, radiologists involved in private practice, teleradiology practice, or any other nonacademic position (“other”) were collectively labeled as having a career in the private sector. The overall survey response rate was 48% (255/529) and the breakdown of the respondents by current career status was as follows: private sector 54.9% (n = 140), academia 30.2% (n = 77), residents 9.4% (n = 24), and retirees 5.5% (n = 14). The majority (86.3%; n = 220) of the respondents were board certified in medical imaging; 16 (6.3%) were double-boarded, 8 in radiation oncology. The breakdown of the respondents by gender was as follows: academia, 51.9% females; private sector, 55.7% females; residents, 58.3% females; and retired, 7.1% females (P = 0.001). Omitting the retirees, the mean
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TABLE 1. Cross-tabulation of the Respondents by Initial Career Path Following Completion of Radiology Resident Program vs. Current Employment (n = 217 responses)
TABLE 2. Cumulative Rankings of the Relative Influence of the Factors Associated with Leaving Academia (n = 54 responses)
Current career path Initial career path Academia (n = 129; 59.4%) Non-academia (n = 88; 40.6%)
Academia (n = 77; 35.5%)
Nonacademia (n = 140; 64.5%)
70 (55.6) 7 (8.0)
59 (45.7) 81 (92.0)
(median; range) age of the respondents was 46.7 years (43.0; 27–76), with females being younger (46.0 years) than males (50.4 years) (P = 0.02). Table 1 is a cross-tabulation of the answers to the first question, “What is your current primary employment setting?” Retirees and residents were omitted from this table, leaving 217 responses. Of the 217 respondents, 59.4% (n = 129) began their careers in academia compared to 40.6% (n = 88) in the private sector. Nearly half (45.7%; 59/129) of those who began their career in academia were now employed in private sector. Conversely, 92.0% (n = 81) of those who began their radiology career in private sector had remained there, only 8.0% (n = 7) had left for academia. Forty-nine of 59 individuals who left academia for the private sector had their salaries increase by an average of 132% (median = 100%; SD ± 118%; range 20–500%). While three people reported a reduction in salary after moving from academia to the private sector, decreasing by 20%, 50%, and 50%, respectively. At the time of the survey, 35.5% (n = 77) of the 217 respondents were employed in academia compared to 64.5% (n = 140) in the private sector. Three respondents had switched from academia to the private sector and then back to academia; they were coded as having stayed in an academic career path. Another respondent did the opposite, started in the private sector, went into academia, and then returned to the private sector; this person was coded as having remained in a private sector career path. Table 2 is the cumulative rankings of the factors associated with the decision to leave academia. Fifty-four of the 59 individuals identified in Table 1 who had switched careers provided data for Table 2. The factors with the highest cumulative rankings for being either “important” or “very important” in the decision to leave academia were remuneration (wages and benefits), lack of interest/enjoyment in research, geographical location, and family considerations. Seventeen people provided “other” reasons for leaving acedemia, of which “politics” was the most commonly cited (n = 6), followed by issues relating to tenure (n = 4) and a lack of support/mentorship (n = 3). Seven residents nearing completion of their program, who had already decided on a career in the private sec-
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Lack of organizational efficiency Geographical location Remuneration (wages and benefits) Workload (hours, nights, weekends) Lack of support and/or mentorship Type of caseload Lack interest/enjoyment in research Lack interest/enjoyment in teaching Job availability Family considerations Just need a change of pace Job flexibility Other:
Not important 1
2
3
4
Very important 5
13
4
16
6
13
18 3
2 3
12 20
7 11
15 17
8
12
15
9
10
13
11
11
9
10
29 13
9 4
12 12
2 12
2 12
26
13
10
3
2
33 17 25 18 0
7 7 7 4 0
11 8 6 12 0
2 6 7 9 2
0 16 9 1 15
tor, answered the question relating to the factors that influenced their decision to leave academia. Five of the residents ranked remuneration and organizational efficiency as being either “important” or “very important,” while four ranked geographical location and family considerations as “important” or “very important.” Twenty-one respondents answered the question relating to the factors associated with leaving private practice for academia. The wording, however, of this question was ambiguous and based on the respondents’ comments it was determined that 12 of the respondents interpreted this question to mean leaving general practice for training in radiology; therefore, there were nine qualified responses. Five of nine respondents ranked “looking for an intellectual challenge” as either “important” or “very important,” followed by “looking for job security” (n = 4), and “interest/enjoyment in teaching” (n = 4).
Discussion The first objective of this study was to determine what proportion of veterinary radiologists chose a career in academia vs. the private sector upon completion of their radiology training. The sampling frame initially included residents because it was anticipated that they would be able to provide insight into the factors that influenced a radiologist’s initial choice of a career path. However, it soon became evident from the initial survey returns that most residents were undecided as to which career path to follow. Data were, however, generated from seven residents who had decided on a career in the private sector. While this is a very limited data set, in general, the residents’ responses
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were similar to the main cohort of respondents who had left academia for the private sector. Perhaps the most significant finding from the residents’ data was that remuneration was a very influential factor in the decision to pursue a career in the private sector. This decision to maximize income may be related in part to the high student debt load incurred by many veterinary students. More than half (59.4%) of all radiologists began their careers in academia; however, only 54.3% of this cohort had remained in academia at the time of the survey. Conversely, 92% of those who began a career in the private sector had remained on this career path. Essentially there was a unidirectional movement of radiologists from academia to the private sector. If there is a shortage of academic radiologists, then perhaps the issue should be framed as a problem with retention vs. recruitment, because it would appear that teaching institutions are capable of attracting radiologists, but struggle with retaining them. If the survey’s sample is representative of the general population of radiologists, then approximately 35% of all radiologists are employed in academia. This finding is essentially unchanged from a survey completed in 2006 in which 31% of radiology diplomates were employed in academia.7 Although a retention rate of 30–35% may seem low, it is actually higher than many of the other veterinary specialties and subspecialties.7 It is also important to appreciate that the ACVR is experiencing very rapid growth, with over 100 residents-in-training. Therefore, it should come as no surprise that the proportion of academic radiologists will probably decrease as the overall number of radiologists continues to increase. This reasoning is based on the fact that despite more veterinary colleges being planned and others expanding, growth in the private sector will probably exceed that of academia. Therefore, rather than examining the percent of radiologists in academia, reporting the actual number employed in each sector would be much more informative. The ACVR should be encouraged to collect and report these types of data. The most influential factors associated with switching careers from academia to the private sector were level of remuneration, lack of interest/enjoyment in research, geographical location, and family considerations. These factors are not unique to veterinary radiologists. The medical profession has been concerned for decades with a shortage of academic radiologists,11–13 and as a result multiple studies have been conducted to determine what factors influence radiologists’ career path decisions.10,14–16 . Factors identified in the these studies included poor monetary compensation, a lack of interest in research, low efficiency in academic institutions, lack of academic time, and too much clinical work. There have also been a number of more broadly based studies dedicated to examining what factors influence a person’s decision to enter or leave academia. A survey of
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newly hired veterinary clinical faculty found that these individuals often selected places of employment based upon the potential for a good working environment as well as the perceived collegiality of fellow faculty.9 Other factors included the level of compensation, institutional support, institutional quality/reputation, quality of the surrounding community, geographical location, administrative support and the employers search, and hiring process. Not only is there a myriad of challenges associated with attracting and recruiting new faculty, but these individuals must then be retained. A study of veterinary surgeons found that poor compensation was the main reason for why surgeons left academia for private practice, followed by an undesirable location of the university hospital, a personal lack of interest in research, and concerns that the university’s administration was not supportive of their specialty.8 What emerges from all these studies is that, regardless of the discipline or specialty, there are a number of common factors that influence a person’s decision to leave academia, of which compensation is a recurring theme. In the current study, remuneration received the most number of rankings for being an “important” or “very important” determinant in deciding on whether to leave academia for the private sector. This finding is similar to the survey of veterinary surgeons wherein 71% of respondents indicated that compensation was one of the main motivating factors for leaving academia.8 It is noteworthy that in the current study 26 of 54 respondents (48.1%) ranked compensation a “3” or lower. Hence changing careers is not always about remuneration, which should come as no surprise. Employees in general seek to maximize their utility (happiness), not their income, by obtaining jobs that maximize pecuniary (monetary compensation) and nonpecuniary rewards.17 It has also been posited that the disparity in compensation between private practice and academia is perhaps less than many perceive if academic benefits such as a fixed salary, health care and retirement plans, vacation time, travel funds for conferences, structured sabbatical leaves, and other benefits are taken into consideration.18 Furthermore, the 2013 AVMA compensation report shows that private practice income decreased by 6.65% between 2009 and 2011, while compensation for academics increased by 4.17%.6 Although academia offers many nonmonetary awards, of which job security is a significant factor once tenure is achieved, it is difficult to dismiss the finding that most veterinary radiologists’ salaries doubled after leaving academia for the private sector. Choosing a career path is a complex socio-economic decision that cannot be distilled into a single deciding factor such as remuneration. However, academic institutions that fail to offer the prevailing wage rate may confuse a true shortage with a false labor shortage, the latter arises when the wage rate is not competitive.19 This is salient because academic institutions must be prepared to offer the
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prevailing or market rate for a given specialist. Relying upon a pay grid that fails to recognize the disparity between salaries of different academic specialties may lead to the conclusion that there is a major shortage of personnel where in fact the wage being offered is not competitive in the marketplace. If veterinary radiologists are the highest paid veterinarians within the profession, then this speaks to the high demand for these individuals and the need for academic institutions to provide a competitive compensation package or become more creative in providing other pecuniary and nonpecuniary benefits. While the vast majority of radiologists who switched careers left academia, there were nine individuals who began their radiology career in the private sector but left for academia. Based on this limited sample size, “intellectual stimulation” was ranked as the main reason for seeking a position in academia. This would seem to be one of those nonpecuniary benefits that academic institutions can use to attract radiologists. However, this factor may also become less important in time. Historically, universities were the only facilities that could justify purchasing a complement of advanced imaging modalities, allowing them the opportunity to attract and retain radiologists looking for a greater variety of cases and imaging modalities. But this is the old paradigm of private practice. The marketplace has evolved to include well-equipped referral practices and in some instances they are also offer radiology residency programs.20 Therefore, the private sector can now offer vet-
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erinary radiologists many of the features of working in a university, while providing better compensation, a greater diversity of locations in which to work, improved organizational efficiency, and more flexible working conditions. The shortcomings of this study relate to the fact that it was a survey and as such it was prone to a nonresponse error or bias, which arises when the answers provided by the respondents differ from those of the nonrespondents.21 Nearly half of the radiologists contacted did not respond to the survey and hence it is unknown whether they would have provided similar answers. A second common bias is measurement error, which arises if the respondents provide inaccurate answers, which may be related to the wording of the questions. In this case, the survey questionnaire should have been more explicit when asking about leaving the private sector for academia. Finally, it is important to appreciate that this study did not address the issue of whether there is a shortage of veterinary radiologists. This, however, is an important question and is deserving of research. Also, a large cohort of radiologists entered and subsequently left academia, of which remuneration was cited as being a primary motivating factor for leaving. This begs the question as to why compensation was less important when they initially chose their career in academia. It would be informative to conduct a multiyear study of newly trained radiologists in order to gain a better understanding of what factors influence initial career path choices.
REFERENCES 1. American Veterinary Medical Association Website. AVMA Membership. 2014. Available at: https://www.avma.org/KB/Resources/ Statistics/Pages/Market-research-statistics-AVMA-membership.aspx (accessed February 13, 2014) 2. American Veterinary Medical Association Website. Veterinary Specialties. 2014. Available at: https://www.avma.org/ professionaldevelopment/education/specialties/pages/default.aspx (accessed February 13, 2014) 3. American College of Veterinary Radiology Wesbsite. 2014. Current ACVR membership. Available at: http://www.acvr.org/page/members (accessed February , 2014) 4. O’Brien TR. Expanding the endangered species list to include the veterinary academic radiologist [Guest Editorial]. Vet Radiol and Ultrasound 1999;40:568–570. 5. American College of Veterinary Radiology Website. 2014. All job listings. Available at: http://www.acvr.org/jobs/all (accessed February 13, 2014) 6. AVMA’s Report on Veterinary Compensation (2013 Edition). 7. Hubbell JAE, Richardson RC, Heider LE. Workforce needs for clinical specialists at colleges and schools of veterinary medicine in North America. JAVMA 2006;229:1580–1583. 8. Adams SB, Schulz K, Hardy J, Bliss S, Lipowitz A, Baxter G, et al. Retention of surgery specialists in academia: a critical agenda. J Vet Med Educ 2005;32:404–415. 9. Grauer GF. Recruiting faculty with clinical responsibilities: Factors that influence a decision to accept an academic position. J Vet Med Educ 2005;32 :366–372. 10. Feng L, Ruzal-Shapiro C. Factors that influence radiologists’ career choices. Acad Radiol 2003;10:45–51.
11. Dawson P. Academic radiology in crisis in the United Kingdom. Acad Radiol 1995;2:924–925. 12. Dodd GD, Fletcher TB, Thorwarth WT. The crisis in academic radiology: will we help ourselves? J Am Coll Radiol 2006;3:243–247. 13. Vydareny KH. The manpower crisis in academic radiology: don’t kill the milk cow for the meat. J Am Coll Radiol 2004;1:100–103. 14. Hillman BJ, Fajardo LL, Witzke DB, Cardenas D, Irion M, Fulginiti JV. Factors influencing radiologists to choose research careers. Invest Radiol 1989;24:842–848. 15. Applegate KE. The future workforce in academic radiology: gender, generational, and cultural influences. J Am Coll Radiol 2005;2: 133–138. 16. Taljanovic MS, Hunter TB, Krupinski EA, Alcala JN, Fitzpatrick KA, Ovitt TW. Academic radiology: the reasons to stay or leave. Acad Radiol 2003;10:1461–1468. 17. Ehrenberg RG, Smith RS, Chaykowski RP. Modern Labour Economics: theory and Public Policy. 1st Canadian ed. Toronto: Pearson Education Canada, 2004;2–3. 18. Mai W, Sutherland-Smith J. Academic radiology careers: what is academia all about? Vet Radiol Ultrasound 2009;50:1–2. 19. Sargent J. Labor shortages: menace or mirage? Occupational Outlook Quarterly 1988;32:27–33. 20. American College of Veterinary Radiology Wesbsite. 2014. Approved radiology residency programs. Available at: http://www.acvr. org/page/approved-radiology-residency-programs (accessed February 13, 2014) 21. Dillman DA, Smyth JD, Christian LM. Internet, mail, and mixedmode surveys: The tailored design method. 3rd ed. New Jersey: John Wiley and Sons, 2009;16–18.
Concerns of a shortage of board certified specialists willing to work in academia have shadowed the medical and veterinary communities for decades. As a result, a number of studies have been conducted to determine how to foster, attract, and retain specialists in academia. More recently, there has been a growing perception that it is difficult for academic institutions to hire board certified veterinary radiologists. The objective of this study was to describe the career paths (academia vs. private sector) of veterinary radiologists and to determine what factors influenced their career path decisions. A mixed mode cross-sectional survey was used to survey ACVR radiologists and residents-in-training, 48% (255/529) of which responded. There was a near unidirectional movement of radiologists from academia to the private sector: 45.7% (59/129) of the respondents who began their careers in academia had switched to the private sector while only 8% (7/88) had left the private sector for academia. If a shortage of academic radiologists exists, then perhaps the issue should be framed as a problem with retention vs. recruitment. The most influential factors in the decision to leave academia were remuneration (wages and benefits), lack of interest/enjoyment in research, geographical location, and family considerations. C 2014 It is salient that average salaries increased by twofold after leaving academia for the private sector. American College of Veterinary Radiology. Key words: academia, career, factors, radiology, survey.
Introduction
T
large and steady number of residents in training, there are concerns, particularly amongst academics, about a shortage of radiologists. There is, however, a lack of data showing whether the shortage of veterinary radiologists is real or merely a perception. A review of ACVR’s website found 36 job postings, which were split equally between academic and private practice positions.5 Although these postings represent a snapshot in time, they provide some insight into the overall demand for veterinary radiologists by academic institutions and the private sector. The other means of determining whether there might be a shortage is to examine salaries, as high wages are often indicative of a shortage of employees. The AVMA’s Report on Veterinary Compensation (2013 Edition) reported that veterinary radiologists received the highest median income of all specialties ($184,000), followed by laboratory animal medicine specialists ($172,000), with surgeons, ophthalmologists and pathologists earning $148,000.6 These data suggest that veterinary radiologists are in demand and more are probably needed. The ultimate question for academic institutions relates to how to attract and retain radiologists. Historically, academia has been the primary employer of radiologists; however, this is no longer the case. In 1968, all but one radiologist was employed in academia and by 1998 57% of ACVR diplomates were employed in academia4 , decreasing
AMERICAN VETERINARY MEDICAL ASSOCIATION (AVMA) is composed of approximately 85,000 members, of which 4000 are employed by academic institutions.1 The AVMA also recognizes 11,000 veterinarians with diplomate status, 40 specialties, and 22 veterinary specialty organizations.2 The American College of Veterinary Radiology (ACVR) is one of these specialty organizations and as of February, 2014 it had 518 active diplomates and 113 resident members-in-training (residents),3 which includes diplomates and residents in radiation oncology. The ACVR has grown considerably since 1968 when it had 20 diplomates, one of which was employed in private practice.4 Concerns of an imbalance between the supply and demand for radiologists surfaced as early as 1971, with the ACVR, consisting of 35 diplomates, being concerned about an oversupply of radiologists. These concerns were largely unfounded and, from 1968 to 1998, the ACVR grew by 4 to 10 diplomates per year. Although there is a relatively HE
From the Department of Large Animal Clinical Sciences (Jelinski) and Small Animal Clinical Sciences (Silver), Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK, S7N 5B4, Canada. This project received institutional funding. This research has not been previously presented or published. Address correspondence and reprint request to Murray Jelinski, at the above address. E-mail: [email protected] Received December 15, 2013; accepted for publication March 14, 2014. doi: 10.1111/vru.12182
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to 31% by 2006.7 This, however, is not unique to radiology, the American College of Veterinary Surgeons experienced a similar decline in the proportion of diplomates employed in academia over a similar time period.8 Not only is the private sector a major employer of veterinary specialists, but it is also academia’s main competitor when it comes to hiring and retaining diplomates. The purpose of this study was twofold: (1) to determine what proportion of veterinary radiologists began their careers in academia vs. the private sector, and (2) to assess what factors were the most influential in the decision to pursue a career in academia or the private sector.
Methods The sampling frame consisted of 449 ACVR Diplomates and 80 resident members-in-training. Radiation oncology members were included if they were double-boarded in veterinary radiology. Survey pretesting was performed with 20 diplomates who attended the 2012 International Veterinary Radiology Association Congress and European Diagnostic Veterinary Imaging Conference in Bursa, Turkey. The survey was approved by the University of Saskatchewan’s Behavioural Research Ethics Board (BEH 12–281). The survey questionnaire comprised 14 questions, beginning with the respondents providing their current employment status: academia (tenure or clinical), private practice, teleradiology practice, and “other.” There was also a similar question relating to where they began their radiology career. From these two questions it was possible to determine the percent of radiologists that initially chose a career in either academia or the private sector (private practice, teleradiology practice or “other”), and whether they had switched career paths. The survey defined academia as a position in a recognized teaching institution (e.g., University). If the person had left academia for a career in the private sector, then they were directed to rank 12 factors, on a scale of 1 to 5, as to how influential each factor had been in their decision to leave academia. The respondents were also given the opportunity to identify any other factor(s) not listed. The same type of question, but with a few modifications to the list of factors, was asked of those who had left private practice for an academic position. The factors chosen for inclusion in these questions were formulated, in part, from previous studies of career paths of veterinarians and medical physicians.8–10 Respondents who changed career paths were also asked to specify by what percent their annualized salary had increased or decreased. The second part of the survey involved a series of background questions relating to the percent of time spent on cases of a particular species (i.e., small animals, equine, etc.) and time spent using specific radiological modalities (i.e., teleradiology, in-house radiology, CT/MRI, nuclear scintigraphy, etc.). The survey concluded with questions
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relating to board certification, age, gender, and an openended question asking respondents to provide any further thoughts regarding career path changes. The background data were collected and analyzed but for the most part are not included in this report. The survey was mailed in November, 2012 to 529 ACVR members (diplomates and residents); those specializing only in radiation oncology were omitted from the sampling frame. Each respondent received a covering letter, copy of the survey questionnaire, and a self-addressed, postage-paid, return envelope. Due to logistics, the nonNorth American respondents (n = 21) were required to affix their own international postage to a self-addressed return envelope. The mailing was followed 3 weeks later with an e-mail reminder prompting the recipients to participate in the survey. A second survey package was mailed to all North American members in March, 2013, followed by an email reminder. Due to the low initial response rate from the international ACVR members, only the North American members were contacted in the second mailing. In addition, residents were excluded from the second mailing because it was evident from the early returns that many of the residents had not decided on where they would be working following completion of their residency program. Only 420 potential respondents were contacted in the second mailing and all returns were accepted until July 15, 2013. The data were entered onto a relational database (Access 2010, Microsoft, Redmond, WA, USA), transferred onto a spreadsheet (Excel 2010, Microsoft, Redmond, WA, USA), and analyzed using a statistical software package (SPSS ver 20, IBM, Armonk, NY, USA). Normally distributed data were analyzed using Student’s t-test and analysis of variance. Mann-Whitney and Kruskal-Wallis test statistics were used for non-normally distributed data. The Pearson chi-square test statistic was used to analyze categorical data. The level of significance for all tests was P < 0.05.
Results Herein, radiologists involved in private practice, teleradiology practice, or any other nonacademic position (“other”) were collectively labeled as having a career in the private sector. The overall survey response rate was 48% (255/529) and the breakdown of the respondents by current career status was as follows: private sector 54.9% (n = 140), academia 30.2% (n = 77), residents 9.4% (n = 24), and retirees 5.5% (n = 14). The majority (86.3%; n = 220) of the respondents were board certified in medical imaging; 16 (6.3%) were double-boarded, 8 in radiation oncology. The breakdown of the respondents by gender was as follows: academia, 51.9% females; private sector, 55.7% females; residents, 58.3% females; and retired, 7.1% females (P = 0.001). Omitting the retirees, the mean
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TABLE 1. Cross-tabulation of the Respondents by Initial Career Path Following Completion of Radiology Resident Program vs. Current Employment (n = 217 responses)
TABLE 2. Cumulative Rankings of the Relative Influence of the Factors Associated with Leaving Academia (n = 54 responses)
Current career path Initial career path Academia (n = 129; 59.4%) Non-academia (n = 88; 40.6%)
Academia (n = 77; 35.5%)
Nonacademia (n = 140; 64.5%)
70 (55.6) 7 (8.0)
59 (45.7) 81 (92.0)
(median; range) age of the respondents was 46.7 years (43.0; 27–76), with females being younger (46.0 years) than males (50.4 years) (P = 0.02). Table 1 is a cross-tabulation of the answers to the first question, “What is your current primary employment setting?” Retirees and residents were omitted from this table, leaving 217 responses. Of the 217 respondents, 59.4% (n = 129) began their careers in academia compared to 40.6% (n = 88) in the private sector. Nearly half (45.7%; 59/129) of those who began their career in academia were now employed in private sector. Conversely, 92.0% (n = 81) of those who began their radiology career in private sector had remained there, only 8.0% (n = 7) had left for academia. Forty-nine of 59 individuals who left academia for the private sector had their salaries increase by an average of 132% (median = 100%; SD ± 118%; range 20–500%). While three people reported a reduction in salary after moving from academia to the private sector, decreasing by 20%, 50%, and 50%, respectively. At the time of the survey, 35.5% (n = 77) of the 217 respondents were employed in academia compared to 64.5% (n = 140) in the private sector. Three respondents had switched from academia to the private sector and then back to academia; they were coded as having stayed in an academic career path. Another respondent did the opposite, started in the private sector, went into academia, and then returned to the private sector; this person was coded as having remained in a private sector career path. Table 2 is the cumulative rankings of the factors associated with the decision to leave academia. Fifty-four of the 59 individuals identified in Table 1 who had switched careers provided data for Table 2. The factors with the highest cumulative rankings for being either “important” or “very important” in the decision to leave academia were remuneration (wages and benefits), lack of interest/enjoyment in research, geographical location, and family considerations. Seventeen people provided “other” reasons for leaving acedemia, of which “politics” was the most commonly cited (n = 6), followed by issues relating to tenure (n = 4) and a lack of support/mentorship (n = 3). Seven residents nearing completion of their program, who had already decided on a career in the private sec-
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Lack of organizational efficiency Geographical location Remuneration (wages and benefits) Workload (hours, nights, weekends) Lack of support and/or mentorship Type of caseload Lack interest/enjoyment in research Lack interest/enjoyment in teaching Job availability Family considerations Just need a change of pace Job flexibility Other:
Not important 1
2
3
4
Very important 5
13
4
16
6
13
18 3
2 3
12 20
7 11
15 17
8
12
15
9
10
13
11
11
9
10
29 13
9 4
12 12
2 12
2 12
26
13
10
3
2
33 17 25 18 0
7 7 7 4 0
11 8 6 12 0
2 6 7 9 2
0 16 9 1 15
tor, answered the question relating to the factors that influenced their decision to leave academia. Five of the residents ranked remuneration and organizational efficiency as being either “important” or “very important,” while four ranked geographical location and family considerations as “important” or “very important.” Twenty-one respondents answered the question relating to the factors associated with leaving private practice for academia. The wording, however, of this question was ambiguous and based on the respondents’ comments it was determined that 12 of the respondents interpreted this question to mean leaving general practice for training in radiology; therefore, there were nine qualified responses. Five of nine respondents ranked “looking for an intellectual challenge” as either “important” or “very important,” followed by “looking for job security” (n = 4), and “interest/enjoyment in teaching” (n = 4).
Discussion The first objective of this study was to determine what proportion of veterinary radiologists chose a career in academia vs. the private sector upon completion of their radiology training. The sampling frame initially included residents because it was anticipated that they would be able to provide insight into the factors that influenced a radiologist’s initial choice of a career path. However, it soon became evident from the initial survey returns that most residents were undecided as to which career path to follow. Data were, however, generated from seven residents who had decided on a career in the private sector. While this is a very limited data set, in general, the residents’ responses
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were similar to the main cohort of respondents who had left academia for the private sector. Perhaps the most significant finding from the residents’ data was that remuneration was a very influential factor in the decision to pursue a career in the private sector. This decision to maximize income may be related in part to the high student debt load incurred by many veterinary students. More than half (59.4%) of all radiologists began their careers in academia; however, only 54.3% of this cohort had remained in academia at the time of the survey. Conversely, 92% of those who began a career in the private sector had remained on this career path. Essentially there was a unidirectional movement of radiologists from academia to the private sector. If there is a shortage of academic radiologists, then perhaps the issue should be framed as a problem with retention vs. recruitment, because it would appear that teaching institutions are capable of attracting radiologists, but struggle with retaining them. If the survey’s sample is representative of the general population of radiologists, then approximately 35% of all radiologists are employed in academia. This finding is essentially unchanged from a survey completed in 2006 in which 31% of radiology diplomates were employed in academia.7 Although a retention rate of 30–35% may seem low, it is actually higher than many of the other veterinary specialties and subspecialties.7 It is also important to appreciate that the ACVR is experiencing very rapid growth, with over 100 residents-in-training. Therefore, it should come as no surprise that the proportion of academic radiologists will probably decrease as the overall number of radiologists continues to increase. This reasoning is based on the fact that despite more veterinary colleges being planned and others expanding, growth in the private sector will probably exceed that of academia. Therefore, rather than examining the percent of radiologists in academia, reporting the actual number employed in each sector would be much more informative. The ACVR should be encouraged to collect and report these types of data. The most influential factors associated with switching careers from academia to the private sector were level of remuneration, lack of interest/enjoyment in research, geographical location, and family considerations. These factors are not unique to veterinary radiologists. The medical profession has been concerned for decades with a shortage of academic radiologists,11–13 and as a result multiple studies have been conducted to determine what factors influence radiologists’ career path decisions.10,14–16 . Factors identified in the these studies included poor monetary compensation, a lack of interest in research, low efficiency in academic institutions, lack of academic time, and too much clinical work. There have also been a number of more broadly based studies dedicated to examining what factors influence a person’s decision to enter or leave academia. A survey of
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newly hired veterinary clinical faculty found that these individuals often selected places of employment based upon the potential for a good working environment as well as the perceived collegiality of fellow faculty.9 Other factors included the level of compensation, institutional support, institutional quality/reputation, quality of the surrounding community, geographical location, administrative support and the employers search, and hiring process. Not only is there a myriad of challenges associated with attracting and recruiting new faculty, but these individuals must then be retained. A study of veterinary surgeons found that poor compensation was the main reason for why surgeons left academia for private practice, followed by an undesirable location of the university hospital, a personal lack of interest in research, and concerns that the university’s administration was not supportive of their specialty.8 What emerges from all these studies is that, regardless of the discipline or specialty, there are a number of common factors that influence a person’s decision to leave academia, of which compensation is a recurring theme. In the current study, remuneration received the most number of rankings for being an “important” or “very important” determinant in deciding on whether to leave academia for the private sector. This finding is similar to the survey of veterinary surgeons wherein 71% of respondents indicated that compensation was one of the main motivating factors for leaving academia.8 It is noteworthy that in the current study 26 of 54 respondents (48.1%) ranked compensation a “3” or lower. Hence changing careers is not always about remuneration, which should come as no surprise. Employees in general seek to maximize their utility (happiness), not their income, by obtaining jobs that maximize pecuniary (monetary compensation) and nonpecuniary rewards.17 It has also been posited that the disparity in compensation between private practice and academia is perhaps less than many perceive if academic benefits such as a fixed salary, health care and retirement plans, vacation time, travel funds for conferences, structured sabbatical leaves, and other benefits are taken into consideration.18 Furthermore, the 2013 AVMA compensation report shows that private practice income decreased by 6.65% between 2009 and 2011, while compensation for academics increased by 4.17%.6 Although academia offers many nonmonetary awards, of which job security is a significant factor once tenure is achieved, it is difficult to dismiss the finding that most veterinary radiologists’ salaries doubled after leaving academia for the private sector. Choosing a career path is a complex socio-economic decision that cannot be distilled into a single deciding factor such as remuneration. However, academic institutions that fail to offer the prevailing wage rate may confuse a true shortage with a false labor shortage, the latter arises when the wage rate is not competitive.19 This is salient because academic institutions must be prepared to offer the
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prevailing or market rate for a given specialist. Relying upon a pay grid that fails to recognize the disparity between salaries of different academic specialties may lead to the conclusion that there is a major shortage of personnel where in fact the wage being offered is not competitive in the marketplace. If veterinary radiologists are the highest paid veterinarians within the profession, then this speaks to the high demand for these individuals and the need for academic institutions to provide a competitive compensation package or become more creative in providing other pecuniary and nonpecuniary benefits. While the vast majority of radiologists who switched careers left academia, there were nine individuals who began their radiology career in the private sector but left for academia. Based on this limited sample size, “intellectual stimulation” was ranked as the main reason for seeking a position in academia. This would seem to be one of those nonpecuniary benefits that academic institutions can use to attract radiologists. However, this factor may also become less important in time. Historically, universities were the only facilities that could justify purchasing a complement of advanced imaging modalities, allowing them the opportunity to attract and retain radiologists looking for a greater variety of cases and imaging modalities. But this is the old paradigm of private practice. The marketplace has evolved to include well-equipped referral practices and in some instances they are also offer radiology residency programs.20 Therefore, the private sector can now offer vet-
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erinary radiologists many of the features of working in a university, while providing better compensation, a greater diversity of locations in which to work, improved organizational efficiency, and more flexible working conditions. The shortcomings of this study relate to the fact that it was a survey and as such it was prone to a nonresponse error or bias, which arises when the answers provided by the respondents differ from those of the nonrespondents.21 Nearly half of the radiologists contacted did not respond to the survey and hence it is unknown whether they would have provided similar answers. A second common bias is measurement error, which arises if the respondents provide inaccurate answers, which may be related to the wording of the questions. In this case, the survey questionnaire should have been more explicit when asking about leaving the private sector for academia. Finally, it is important to appreciate that this study did not address the issue of whether there is a shortage of veterinary radiologists. This, however, is an important question and is deserving of research. Also, a large cohort of radiologists entered and subsequently left academia, of which remuneration was cited as being a primary motivating factor for leaving. This begs the question as to why compensation was less important when they initially chose their career in academia. It would be informative to conduct a multiyear study of newly trained radiologists in order to gain a better understanding of what factors influence initial career path choices.
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11. Dawson P. Academic radiology in crisis in the United Kingdom. Acad Radiol 1995;2:924–925. 12. Dodd GD, Fletcher TB, Thorwarth WT. The crisis in academic radiology: will we help ourselves? J Am Coll Radiol 2006;3:243–247. 13. Vydareny KH. The manpower crisis in academic radiology: don’t kill the milk cow for the meat. J Am Coll Radiol 2004;1:100–103. 14. Hillman BJ, Fajardo LL, Witzke DB, Cardenas D, Irion M, Fulginiti JV. Factors influencing radiologists to choose research careers. Invest Radiol 1989;24:842–848. 15. Applegate KE. The future workforce in academic radiology: gender, generational, and cultural influences. J Am Coll Radiol 2005;2: 133–138. 16. Taljanovic MS, Hunter TB, Krupinski EA, Alcala JN, Fitzpatrick KA, Ovitt TW. Academic radiology: the reasons to stay or leave. Acad Radiol 2003;10:1461–1468. 17. Ehrenberg RG, Smith RS, Chaykowski RP. Modern Labour Economics: theory and Public Policy. 1st Canadian ed. Toronto: Pearson Education Canada, 2004;2–3. 18. Mai W, Sutherland-Smith J. Academic radiology careers: what is academia all about? Vet Radiol Ultrasound 2009;50:1–2. 19. Sargent J. Labor shortages: menace or mirage? Occupational Outlook Quarterly 1988;32:27–33. 20. American College of Veterinary Radiology Wesbsite. 2014. Approved radiology residency programs. Available at: http://www.acvr. org/page/approved-radiology-residency-programs (accessed February 13, 2014) 21. Dillman DA, Smyth JD, Christian LM. Internet, mail, and mixedmode surveys: The tailored design method. 3rd ed. New Jersey: John Wiley and Sons, 2009;16–18.
