Taking the tide

ACMS 2019 October Bulletin

– Shakespeare, W. Julius Caesar, Act 4, Scene 3, 218-224

Shakespeare was a keen judge of human nature and as such knew that opportunity to accomplish a goal may only come once in a lifetime. For me, that opportunity for a career change came in 1982 as the result of a chance meeting. I have spent my entire medical career in academia. In 1982, I was on the faculty of Duke University Medical Center and was an associate professor. That spring, I was invited to be an examiner for the oral portion of the American Board of Radiology exam for the first time. As a rookie examiner (in musculoskeletal [MSK] imaging), I was awed by the veterans who represented a Who’s Who of radiology. One evening, after we had finished examining, I was invited to go to dinner with a diverse group of other examiners (disciplines other than MSK), some of whom I knew from society meetings and others from their publications. One of the members of our dinner party was Dr. Rolf Schapiro, who, I learned, chaired the Department of Radiology at Allegheny General Hospital (AGH) in Pittsburgh. Over the course of dinner, we discussed our philosophies of resident and student teaching and I was surprised at how similar our views were. I put his comments into my mental data bank.

When I came back to Duke, I was surprised by the sudden departure for private practice of one of my mentors, a full professor. Several years earlier, Duke, in anticipation of the coming change in healthcare, had begun a retrenchment program. All department chairs were told to reduce costs and streamline their operations. The chairman of radiology decided the best way to accomplish those goals was to “encourage” senior faculty to leave. While most academic departments have a pyramid hierarchy, his philosophy was to have an inverted “T,” with most of the faculty at the instructor and assistant professor levels. John, my mentor, was one of many faculty members to depart. I, too, was on the chairman’s “hit list” and was aware that my Duke days were numbered.

One day, during a lull in our caseload in our reading room, I was looking over the shoulder of my resident who was scanning the job listings published by the American College of Radiology. Radiologists are trained to look for details. As he turned a page, a familiar name suddenly appeared – Dr. Rolf Schapiro, in Pittsburgh. Rolf was looking for a radiologist with five to 10 years of academic experience to head a division of musculoskeletal, emergency and trauma radiology at a Level I trauma center. These were my three areas of interest, particularly spine injuries. I copied the ad and I remember, when showing it to my wife, that I said, “You know, I met Dr. Schapiro at Boards.” She replied, “It seems like he had you in mind when he wrote the ad.” Thirty-one years later, at my retirement dinner, I learned that, in fact, I was being subtly recruited with that ad.

The rest, as they say, was history. I called Dr. Schapiro, who invited me to come up as a visiting professor for an interview. It was then that he made me the proverbial “offer I couldn’t refuse.” Now, I had to convince my family that a significant change in my professional career would be best for all of us. We loved living in the college community of Durham and Chapel Hill. The weather provided four distinct seasons, although winter was mercifully short. A move would mean new schools for my sons and establishing new relationships for both my wife and me. And Pittsburgh was the largest city I had ever lived in.

As Shakespeare indicated, I took the current and accepted the offer. I was pleasantly surprised that the position offered the best combination of academics and private practice. Pittsburgh offers all the advantages of a big city without many of the disadvantages. Similarly, I had all the advantages of academe, without the negative aspects. Freed from the “publish or perish” atmosphere of the university, my academic productivity soared. In the eight years I was at Duke, I had produced two textbooks, two book chapters and 35 papers in peer-review literature. In the first eight years in Pittsburgh, I published seven textbooks, five book chapters and 55 papers. More importantly, I now was a mentor to my residents as well as to junior staff members at AGH. While we didn’t have as much of the exotica seen at university medical centers, there was ample clinical material for my interests. For example, while at Duke, we published data on the 400 cervical spine fractures seen over a 10-year period. At AGH, we saw, at the time I came, around 300 spine fractures in one year!

Yes, there is a tide in the affairs of us all. Opportunities come and go. Sometimes we decide to remain with the status quo, and sometimes we follow the tide. Was I lucky? Who knows. However, I stayed at the same job for just over 30 years. I think it worked out well.