Becoming a faculty member right after graduation

[BlackBantie]

I'm a PGY4 and trying to figure out what to do career-wise. Right now I'm debating on working in a private hospital vs working on an inpatient unit as a faculty for a medical school. Obviously the pay is better in the private hospital and the one that I'm considering doesn't require the physicians to take call. But I'm worried that I'll become "stagnant" in the private hospital and wonder if working with residents and medical students will motivate me to stay current and up-to-date with treatments, etc. Another major concern I have is that I'll be a less appealing candidate in the future if I want to become a faculty member if I'm away from academia too long. However, for financial reasons, the private hospital is more appealing.

Does anyone have any thoughts?

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[NICUfello]

Just went through this. Turned down great Academic gig. Too much politics.

However, also turned down straight private gig.

Found a happy medium. A private gig, that has some teaching involved to residents. So I can teach a bit, and get paid more than academia.

Good luck.

 

[Yoyomama88]

Would it be possible to do a private practice job and find a way to run clinical trials at that hospital? This way, you can still stay academic in some sense and get paid well.

 

[MacDonaldTriad]

This is one of your biggest cross roads. Getting into medical school would be one, choosing psychiatry would be two, but this is the big life changing one that lasts 35 years. You seem to be seeing it right. It isn’t likely that you will come back to academics if you don’t start there. Now is when you haven’t become addicted to money and it will still feel good to go into academics and feel paid better. Imagine taking the pay cut to work harder down the road if you managed to get hired by academics after working outside of it.

The only reason to go into academics is because you are naturally curious and love to teach. Get used to your less skilled students out earning you the moment they graduate. The politics are big, the pay is lower, and the satisfaction is generally from your students and not the department in most cases. Still, academics surrounds you with impressive people who you will respect and be honored to be connected with. You will be challenged to stay current and part of the job description that you are being paid for will include learning. It is a lot like moving from being a med student to being a resident in that debt stops accumulating and the money is less than it probably should be. None the less, there is nothing else like academics. Being voluntary clinical faculty while doing PP can be an intermediate step, but sometimes I wonder who is more in need of the relationship, the supervisors or the supervisees. If you become a vol. clinical supervisor, the programs will want you to come to them and that takes time and money. Your employer will see this as your taking out play time and they will not value the university title as much as you will. Patients just don’t understand or care about our alpha male value system as much as you might think.

I once went to an anthropologist’s lecture on the study of the medical system’s sociology and it was very sobering. It matched primate behavior very well, right down to the length of white coat and the number of hired research associates connected to each clan. I guess the fight gets more intense the more you need to fight over crumbs, but the crumbs are not so small if you are a doctor so it is OK to go with what your heart wants to do.

 

[notdeadyet]

This is one of your biggest cross roads. Getting into medical school would be one, choosing psychiatry would be two, but this is the big life changing one that lasts 35 years. You seem to be seeing it right. It isn’t likely that you will come back to academics if you don’t start there. Now is when you haven’t become addicted to money and it will still feel good to go into academics and feel paid better. Imagine taking the pay cut to work harder down the road if you managed to get hired by academics after working outside of it.

The only reason to go into academics is because you are naturally curious and love to teach. Get used to your less skilled students out earning you the moment they graduate. The politics are big, the pay is lower, and the satisfaction is generally from your students and not the department in most cases. Still, academics surrounds you with impressive people who you will respect and be honored to be connected with. You will be challenged to stay current and part of the job description that you are being paid for will include learning. It is a lot like moving from being a med student to being a resident in that debt stops accumulating and the money is less than it probably should be. None the less, there is nothing else like academics. Being voluntary clinical faculty while doing PP can be an intermediate step, but sometimes I wonder who is more in need of the relationship, the supervisors or the supervisees. If you become a vol. clinical supervisor, the programs will want you to come to them and that takes time and money. Your employer will see this as your taking out play time and they will not value the university title as much as you will.

Awesome post. Totally agree...

 

[whopper]

I didn't stick to just one job when I first graduated. I did a bunch of different things, sampled what I liked, then made a decision that I felt I'd be comfortable with for a long time. First job you take after graduation will make you wonder if the grass is greener on the other side.

 

[BlackBantie]

Thanks all for the replies so far. It's reassuring to know that I'm not catastrophizing this issue too much.

Another factor that I forgot to mention is my spouse. He plans on returning to school once I'm done with residency. His career plans will involve him taking 3 years of school so we'll be essentially stuck in whatever city we decide to go to for my job during that period of time. That makes me feel more pressured to make sure that my choice is a good one. I agree with you, whopper, that there is some uncertainty with the first job. A lot of my resident friends who have gone and graduated only stayed with their first job for 1-1.5 years and then moved on to something else. I'm worried that there won't be anything appealing to move on to in the same city if that happens to me. FWIW, the two jobs that I'm looking at are in different cities so I can't pick one and switch to the other in the duration of 3 years.

 

[twright]

Well, you probably would want to stick around your first job for a few years anyway (even if your partner were not tied to the city). Just looks better when you are going for your second job.

Totally agree with MacDonaldTriad's post. At our program there weren't many salaried PP psychiatrists who were voluntary clinical faculty. Pretty much all of them were solo or group PP who had the luxury of being able to take time out of their day to supervise residents. (And it was pretty clear to all that they got a lot out of their academic titles in terms of marketing their practices .)

 

[whopper]

If your spouse is going to the same school where you could be faculty they might have a free-tuition for family policy. Happened to me while I was at U of Cincinnati, though they had a little rule where if the person was in graduate school or higher, the we had to pay taxes on the tuition money we saved. Still, a heck of a lot better than paying full tuition!

My current job at St. Louis U., the pay is significantly lower than my pay at U of C, but I'm actually one of the highest paid attendings in the department. What's going on is U of C is in a situation where there is an extreme shortage of psychiatrists and those doctors know it and actively tell the management they can leave for more money. The department figured their more productive attendings can get more pay for their productivity and if you do outpatient, you get a slice of the money you bring in. I did outpatient 2 days a week and got about $12K a year just from the outpatient and that was in addition to my usual attending salary. Had I expanded my outpatient hours to 5 days a week, (still within a 40-50 work week, lowering my ER hours) I could've likely make an extra $35K a year in addition to my usual salary.

Not all academic jobs will pay the same, and some places will be more flexible in paying you more. I figure once I'm here for awhile seeing how much I'm bringing in for the department, I'll be in a better position to figure out if I can ask for a raise or not.

One factor for me (and may not apply to you) is that my enjoyment with the job does go hand-in-hand with working with other doctors that I find intellectual equals or superiors. I wouldn't work where I did residency because where I'm at now is far ahead of almost all the attendings there in terms of experience, publications, clinical skill and knowledge. They would never pay me an amount of money to fill in the gap. I was happy at U of C in terms of the pay/satisfaction level, but would've still been mulling on leaving for other good opportunities had my wife not got her job offer that got us to St. Louis.

I'm willing to take less money if I get to work with some of the best. While my salary now is perfectly good, I am working with three of the top psychiatrists in their respective areas, one of which will directly help me with forensic psychiatry.