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Epi Wit & Wisdom Resources
The Private Practice of
Epidemiology
Robert W.
Morgan, MD
This is the second in a series
of commentaries by members of the Epi Monitor Advisory Board. We are
interested in publishing the opinions of epidemiologists on a variety
of issues of current interest to the profession. All readers are
invited to submit comments which they believe may be of interest to
the general epidemiology community.
I am frequently asked two
questions concerning the private practice of epidemiology. The first
is “Uh, how do you get your...uh, customers?” followed by, “Is there
more work around?” Since our company specializes in occupational and
environmental epidemiology contract research, usually for industry,
the questions are appropriate. So far, I have resisted the urge to run
advertisements in the Epi Monitor or AJE, exhorting all to “Make Money
at Home, Send $$$ for Valuable Kit to Establish Contacts and Attract
Projects.” And I have opted not to turn the repetitive questions into
a syndicated “Do-It-Yourself Entrepeneurial Column for Ambitious
Epidemiologists.”
Market For
Epidemiologists
We have proven, though, that
there is a commercial market for epidemiologists’ services. That
market we share with numerous universities and a few other companies,
some of which rely on part-time academics. We suspect that the market
may have peaked and is now in a mild decline, with relatively few new
and large projects in the planning stage. We also see that competitors
are increasing in number, especially as Federal grants and contracts
become scarcer. It may be unfortunate that if the best investigators
get funded by Government, the less competent will look to private
industry--our main client source--for money and support. I say
unfortunate because occupational and environmental epidemiology poses
some incredibly difficult problems that deserve the skill and
ingenuity of the level possessed by the most successful researchers,
academic or otherwise.
Advantages
As private practitioners, we
enjoy certain commercial advantages over academic competitors. For one
thing, we are available full-time and not tied down by teaching and
committee schedules. We suspect that we offer lower prices overall
because of an efficient organization, although some of our individual
hourly rates may appear higher. We track projects by the quarter-hour
so our invoices reflect exact labor; we do not estimate professional
effort in 5% multiples. Finally, our time sheets can be audited so
that clients get the persons they pay for and never junior staff or
students.
Is my practice fun? Certainly.
How else in the course of a year could I deal with sperm counts in
Hawaii, occupational asthma in New Jersey, abortions in Louisiana and
leukemia in Texas? With congenial colleagues (we have four partners)
for daily consultation, a capable staff (about 25 persons) and
interesting scientific problems, it is a great job.
Disadvantages
What is the “bad news?” First,
since we have neither endowment nor tenure, our financial security is
not assured. Second, most of our research arises out of controversy
(other people’s fires) rather than from the generation of sound
biologic hypotheses. Finally, our clients expect quick response, which
might include flying the same day. They also expect a project to
finish on time and on budget. As a minor annoyance, we must keep close
track of our time with detailed time sheets.
On rare occasions, a colleague
will question our credibility because we “take money from industry.”
Is there somehow the illusion that a university Contracts Office makes
cleaner the dirty money of industry? My somewhat sour question
illustrates a certain paranoia, since, of course, both academic and
free-enterprise epidemiologists must maintain objectivity and never
compromise scientific integrity for mere money. If anything, the
epidemiologic entrepreneur must bend over backward to ensure quality
and objectivity that will withstand scrutiny, since the accusation of
“industry’s whore” can be made so offhandedly.
Publishing? Although this is not
our primary goal, we usually find no problem in publishing. Many
clients ask us to publish, even before they know the results. Others
wait to see results, but they rarely attempt to prohibit or delay
making public an important finding. We encourage publication, because
it ensures our clients of some peer review. It is also our best
advertising medium.
Want to start? Your survival kit
should include the following instructions:
1) How to assemble a
multi-disciplinary team that will attract business
2) How to become known to
Fortune 500 companies
3) How to examine a problem;
design a study; and write a proposal in 10 days or less
4) How to deliver bad news
5) How to explain lack of power
in a negative study
6) How to advise against doing a
study that will make you money
7) How to maintain your staff,
sanity and composure when a client delays paying an invoice for 18
months with repeated variations on the theme that, “The check is in
the mail.”
After the kit, all you need is
capital, equanimity, courage, perseverance and optimism. In keeping
with the history of all pure and applied sciences, however, one of the
most important ingredients for success has been LUCK!
Dr. Morgan, a member of the Epi
Monitor Advisory Board, is with Environmental Health Associates Inc,
2150 Shattuck Ave, Berkeley, CA 94704.
Published June 1982
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