How to switch from community to academics

[RadOnc2013]

What advice would you give to someone who wants to switch from community practice to academics?
How would your advice change if that someone is at an academic satellite but wants to get back to the main campus?
How about if someone wants to switch from that acaedemic satellite to a DIFFERENT academic's hospital main campus?

Should this person do research? Or is it just office political maneuvering that needs to be done?

This discussion is probably just "academic" as I am very happy in my current position, but I still want to think about what I might need to do were I want to make a switch sometime in the future.

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[Gfunk6]

Big Caveat: I'm in community and have no experience switching to academics but I know others who have done so

Nowadays, all Rad Onc academic motherships have two broad categories of physicians:

1. Tenure-track, in-residence, or "research" faculty - you need some kind of research background, experience and achievements; they don't give anyone this job. Unless you were involved at research in the community at a high level you would not likely have the chops for this kind of work.

2. RVU-generators or "clinical" faculty - your primary non-clinical job would likely be teaching residents/fellows. Barring academic satellites, most clinical faculty do specialize in one or two subsites so you would have to prove that you were capable of doing it. For instance if you were in community practice for years and you farmed out all of you GYN brachy elsewhere, you would probably be a poor candidate for such a job in academics.

 

[medgator]

 

[elementaryschooleconomics]

Yeah, @Gfunk6 nailed it for the most part, though the lines are just so blurry now.

I technically went from community to academics.

In that I have a faculty appointment with a college of medicine.

But my day-to-day job is similar.

Caveat being I'm not super far out of training, and the rumor is that it's hard to go back after >5 years out in the community. Personally, I think that's confirmation bias, simply because most folks have locked in "their path" and it's less that you "can't" do it, more that you don't have a lot of people trying.

But because the distinction is mothership vs satellite, R01s vs RVUs, it was very easy for me. The geography I wanted wasn't mothership. I crush RVUs at a superhuman pace. They wanted an RVU crusher.

Now, if I wanted to go to the mothership, it's the same old game you play everywhere. It's who you know, and who knows you. Also the timing needs to be right, it's way easier if someone is leaving.

You could brute force your way in with a bunch of grants and papers and whatnot, but it's a lot less work just to be generally known and generally liked.

 

[elementaryschooleconomics]

Now, if I wanted to go to the mothership, it's the same old game you play everywhere. It's who you know, and who knows you. Also the timing needs to be right, it's way easier if someone is leaving.

You could brute force your way in with a bunch of grants and papers and whatnot, but it's a lot less work just to be generally known and generally liked.

Forgot to add, but very relevant: me switching jobs started when I sent a text to a buddy because...networking.

Networking in the 2020s: who's programed in your phone to text, and who will text you back?

 

[medgator]

Forgot to add, but very relevant: me switching jobs started when I sent a text to a buddy because...networking.

Networking in the 2020s: who's programed in your phone to text, and who will text you back?

Goes both ways. Not sure I'd trust anyone at the mothership for 5-10+ years treating only 1-2 sites to go back into a full spectrum community practice either

 

[NotMattSpraker]

Yeah, @Gfunk6 nailed it for the most part, though the lines are just so blurry now.

So blurry that I would suggest dropping the labels entirely and approaching each job on its individual merits.

I would also just add that most people seem to underestimate what kind of support it takes to be a successful researcher in a primarily clinical job.

 

[BobbyHeenan]

Every situation/department is different.

The one "tip" i'd suggest is if you are part of a satellite and the main house has tumor boards in which you can attend in person, I'd suggest you try to do that. Or at least try to attend virtually if that's an option. Unless you're a jerk at tumor board, face time never hurts.

 

[sirspamalot]

Yeah, its when the tumor boards are venomous pits egged on by a sadomasochistic Chair that it gets old real quickly.

Or, you could just find a nice quiet # job and be the boss, live like a king, answer to almost no one and quietly amass wealth in a low cost of living location.

 

[evilbooyaa]

Have not done it myself, but the main thing is to feel comfortable filling a hole that an academic program has. Imagine it is easier said than done.

Let's say you've been doing community and now really want to do say academic H&N in a major institution. I agree that super sub-specialized things that frequently get farmed out (brachy, peds), if you haven't been doing it since residency, is going to be VERY difficult.

Would probably be a multi-step process - I imagine either:
1) transitioning to a big center at satellite, joining TB weekly and playing politics, attempting to corral all the satellite's H&N patients all to your service (and giving up the easier breast/prostate to your other colleagues), churning that for a few years while waiting for a H&N attending to leave the mothership, then swooping in and telling your chair you'd be really interested in transitioning to main campus.
2) Transitioning to a program that struggles to maintain adequate attending numbers (and/or are a hellpit residency beefing up attending numbers in prep for the potential 1.5:1 ratio of faculty to residents) and trying to fill a hole they have at H&N. Do that for at least say 2 years, then start putting out feelers to bigger places where you'd actually want to live so that your 'most recent' experience is being the 'H&N specialist' at U of whatever Rad Onc

Of course, in scenario 2, not infrequently, the job one signs up for in terms of disease site, and the job they ACTUALLY end up treating can frequently be two very different things. So lots of uncertainty.

If you're interested in academic breast, congrats, you qualify, simply by virtue of treating more than 5 whole breasts and 5 RNI patients in a contemporary fashion over the past 5 years.

 

[sirspamalot]

Lol. As a famous former co-resident and now leading USA breast radiation oncologist said.. "all I do are breasts. Anything else, and I'd have to consider it malpractice.."

Academics. (snort)

 

[salubalu]

Lol. As a famous former co-resident and now leading USA breast radiation oncologist said.. "all I do are breasts. Anything else, and I'd have to consider it malpractice.."

Academics. (snort)

At least he has not subspecialized into only Left sided breasts...

 

[sirspamalot]

He? Lol.

 

[radoncftw]

He? Lol.

lol

 

[elementaryschooleconomics]

Lol. As a famous former co-resident and now leading USA breast radiation oncologist said.. "all I do are breasts. Anything else, and I'd have to consider it malpractice.."

Academics. (snort)

This is the strangest phenomenon to me.

We have one of (the?) longest Oncology-focused graduate medical training in American medicine.

It's always generalist in nature.

Our boards are generalist.

I'm definitely biased, because I went right from residency to heavy clinical load generalist and remain in that groove.

But like...our principles are the same, no matter what disease site you treat. Find the therapeutic window between too much and too little XRT. There are treasure troves of digital resources for contouring, treatment planning, treatment schemes, etc. Engage supportive care and services. Be a doctor.

You either understand how radiation affects the body or you don't. There's too much knowledge in the world now for anyone to afford to not "learn how to learn". Common things are common and I have the treatment algorithms tattooed on my soul, but I have a low threshold to engage my web of friends, colleagues, and resources when things I'm unfamiliar with come into the clinic.

This is more just a soapbox rant-post for me, like I get it, I've seen it time and time again (usually with the breast RadOncs), and I'm still confused.

 

[TheWallnerus]

This is the strangest phenomenon to me.

We have one of (the?) longest Oncology-focused graduate medical training in American medicine.

It's always generalist in nature.

Our boards are generalist.

I'm definitely biased, because I went right from residency to heavy clinical load generalist and remain in that groove.

But like...our principles are the same, no matter what disease site you treat. Find the therapeutic window between too much and too little XRT. There are treasure troves of digital resources for contouring, treatment planning, treatment schemes, etc. Engage supportive care and services. Be a doctor.

You either understand how radiation affects the body or you don't. There's too much knowledge in the world now for anyone to afford to not "learn how to learn". Common things are common and I have the treatment algorithms tattooed on my soul, but I have a low threshold to engage my web of friends, colleagues, and resources when things I'm unfamiliar with come into the clinic.

This is more just a soapbox rant-post for me, like I get it, I've seen it time and time again (usually with the breast RadOncs), and I'm still confused.

I guess the Palliative Radiotherapy Network makes more sense if there’s an academic rad onc to your left and right at the faculty meeting saying they don’t know how to treat a prostate bone met. And thinking that’s normal for a BC rad onc to say that.

 

[Pointless]

What advice would you give to someone who wants to switch from community practice to academics?

Don't.

 

[Gfunk6]

I guess the Palliative Radiotherapy Network

 

[Neuronix]

Regarding hospital system employed vs. academic hospital system, I'm not really sure what the difference is for most people.

Most "academic jobs" are mostly clinical anyway.

We hire people out of other employed positions to fill academic clinical positions, main campus or otherwise.

 

[sirspamalot]

A palliative care team can really juice the returns for the hospital, by relieving their expensive personnel to focus on higher revenue opportunities.

Goddamn world class cynicism right here bro.

 

[Mandelin Rain]

A palliative care team can really juice the returns for the hospital, by relieving their expensive personnel to focus on higher revenue opportunities.

Goddamn world class cynicism right here bro.

Also, by convincing un-placement-able inpatients with state insurance to be discharged to hospice.

 

[sirspamalot]

Also, by convincing un-placement-able inpatients with state insurance to be discharged to hospice.

That's exactly right. Free those rooms for revenue generators asap.

 

[Fpg1245]

Also, by convincing un-placement-able inpatients with state insurance to be discharged to hospice.

If you on the -caid, you ain’t gettin paid.

 

[Gfunk6]

If you on the -caid, you ain’t gettin paid.

Or as we say in Cali, if all you treat is -cal you generate RVUs but not your sal-