One last word on "towns vs. gowns"
Be that as it may, however, one comment in Kevin's response by a primary care physician named Dr. Hebert reinforced my point that some PCPs in the community having misconceptions about academic medicine:
I agree with you, Kevin. I just finished residency in 2001 and, though academics certainly work hard, I also have the strong impression that they are out of touch with the "real world." Even when an academic has an active clinical practice, the organization he is with is so large and bureaucratic that he does not face the same situations and decisions a doc in private practice does.
Academics don't have to discipline employees, worry about salary structure, choose hospitals to apply for prividges for, decide on managed care contracts, deal with partnership issues, or deal with patient access issues (like having to treat RA yourself because there isn't a rheumatologist within 100 miles).
These differences in experience do make pronouncements of academics seem out of touch.
That sounds pretty "real world" to me.
His complaint about dealing with lack of access to care seems more due to a rural location than any difference between working in academia versus private practice. Private practitioners I know who work in nice suburbs and see mostly insured patients have little problem getting access to care for their patients. And, as another commenter pointed out, there can be access problems in academia that are just as bad as some private docs experience, if not more so. In our case, we see a lot of uninsured patients, and, to take one example, getting ininsured women with breast cancer access to a plastic surgeon to do a reconstruction after a mastectomy is a frequent and vexing problem, mainly because very few plastic surgeons around here accept Medicaid or our state's Charity Care.
Perhaps the best comment came from Aggravated DocSurg:
As a surgeon in private practice, I have seen the "town and gown" game played, unfortunately, both sides. Neither private practitioners nor academicians has a lock on appropriate behavior and understanding of the other side.
We are really at a critical time in medical education and research. The financial pressures faced by everyone in medicine is squeezing the life blood out of academic institutions. In the long run, I think there will need to be greater involvement of private practitioners in the education of residents -- but that will take a hefty dose of humility from both sides of the aisle. We in the private world need to understand that academicians have to have time for research and teaching; those in the academic world need to understand that private practitioners do see a large chunk of "interesting" cases and provide good care, and that their residents would benefit from private practice experience.
One thing that's become apparent to me is that the relentless downward pressure on physician reimbursement, coupled with the present malpractice environment, is putting private practitioners and academic physicians in the same boat. Academic medical centers and physicians have had to change their practices to a financial model that more and more resembles that of very large private practices, leaving less time for the research and teaching missions that have traditionally been within their purview. It's becoming increasingly apparent that the present system is, if not broken, rapidly breaking down. It will be up to us, both private practitioners and academicians, to come up with a new model to replace it.