Academic and private practice doctors should not be adversaries

During my entire career I have seen unwarranted and unseemly squabbling between town and gown. I often hear the gown side insult the town side.

While I went straight into academic medicine, I did moonlight in community hospitals. For the past 6 years I have taught part time in a community hospital and part time in an academic VA hospital. I find recent negative comments about academic medicine unfortunate just like I find insulting practicing physicians unfortunate.

Both practicing physicians and academic physicians practice on a spectrum. We have great academic physicians who never worked in private practice. The great physicians do understand the world of practice and avoid insulting private MDs.

In community hospitals we have many wonderful physicians and some who are less good. I find the former more common than the latter.

So why are we so quick to criticize the other?

I believe these criticisms have the same origin as any prejudice. As humans we identify with our tribe and usually have an opposing tribe to criticize. These critiques make us feel better about ourselves and our decisions.

But these critiques have little foundation. The comments on the academic question showed bias and a lack of understanding of present academic medicine. Unfortunately, I believe, they showed anger at those who prepared the writers for practice.

Town and gown has likely always existed. I hope that I teach students to respect both. I hope I do respect both. I encourage everyone to understand that town and gown are not that different and both necessary.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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  • Juliet K. Mavromatis, MD

    Dr. Centor,
    I enjoyed your post. I recently left academic general internal medicine for career in private practice after 12 years in practice as a clinician teacher at Emory University. My career in academics was very fulfilling from the standpoint of variety: wonderful colleagues and patients, as well as the opportunity to teach, which certainly enhances one’s own learning. I would certainly recommend this as career choice for those who enjoy this variety and who aren’t quite ready to fend for themselves in the private sector.
    I terms of the rift, I find the academic docs worse than the private docs in their attitudes. There is common “ivory tower” attitude amongst many academic general internists, that they are more knowledgeable, more current, and more innovative than internists in the private sector, which I have found to be entirely untrue. I personally have enjoyed practicing in both realms, and believe that it has enhanced my professional development. We all need each other, and as clinician teachers we should also support our residents enthusiastically who decide to pursue careers in private practice. After all, how else will we succeed in solving the primary care crisis?

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