Switching from Academics to private practice several years out

[alteregoEMMD]

Made a throwaway account because my real account is not anonymous. I am several years out of residency and getting really fed up with my academic gig. So many frustrations. Has anyone left academics for the community? How did you go about it? What problems did you run into? How do you even find a community gig when you've been in academics?

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[RustedFox]

Priiiivaate... Praaaactice?

 

[Angry Birds]

I assume it is exactly the same as everyone else getting an EM job in the community. I'm sure they would love to have you.

You don't have to answer this but what sorts of things frustrated you in academics ?

 

[alteregoEMMD]

I assume it is exactly the same as everyone else getting an EM job in the community. I'm sure they would love to have you.

You don't have to answer this but what sorts of things frustrated you in academics ?

I assume it is exactly the same as everyone else getting an EM job in the community. I'm sure they would love to have you.

You don't have to answer this but what sorts of things frustrated you in academics ?

I have heard that people who have been in academics for several years or more have had some atrophy of our skills, especially procedural.. I am concerned about that. I am concerned that the community folks hiring will be concerned about that.



Some of my frustrations:
-expectations to be involved in a million administrative duties without any compensation or shift reduction whatsoever. Constantly having to attend meetings, answer emails, volunteer for crap etc on days off
-frustrations that come with being at a quaternary care center: constantly fighting about admissions and consults, having to take every single dump from OSHes because they "need a higher level of care" when really it's just social BS or a rude/uninsured patient, patient expectations that we will solve their 20-year non emergent problem because we are "Quaternary hospital" and their PCP told them to go directly to the ER so we can figure out what's been causing their toe pain x20 years
-the time it takes to get something as simple as a lab or CT because no one cares about throughput
-the constant push to publish with always looming threats of non advancement
-the hierarchy


I completely understand there are frustrations in the community as well but I have only been doing the academic attending thing for 4 yrs and it is already wearing on me...

 

[GeneralVeers]

You left off the salary, which is often half of what the average community salary is.

In order to do academics, you seriously have to love it. If not then, it's not worth the sacrifices. There are plenty of places in almost every state where you can do "community" medicine, make a big salary, and have the opportunity to teach residents, all without the time-wasting academic BS that you dislike.

 

[The White Coat Investor]

No big deal. Much easier than going the other direction. I worried private groups would worry about my skill atrophy while in the military seeing tons of low acuity patients for four years. Nobody did. Truthfully, there wasn't all that much atrophy. Chest tubes and intubations are like riding a bike. Nobody does many thoracotomies or perimortem c-sections, and I&Ds and lacs aren't a big deal anyway. What procedural atrophy are you most worried about?

 

[alteregoEMMD]

No big deal. Much easier than going the other direction. I worried private groups would worry about my skill atrophy while in the military seeing tons of low acuity patients for four years. Nobody did. Truthfully, there wasn't all that much atrophy. Chest tubes and intubations are like riding a bike. Nobody does many thoracotomies or perimortem c-sections, and I&Ds and lacs aren't a big deal anyway. What procedural atrophy are you most worried about?

This is really good to hear. Mostly the big ones: lines, ETTs, Chest tubes. I feel like I USED to be great at them but have done so few since I got out of training. I'm glad to hear it's like riding a bike.

 

[The White Coat Investor]

If you're really worried, try to work shifts while residents are in conference or do a little moonlighting on the side.

 

[Angry Birds]

Do your EM residents rotate in anesthesia at all? You might be able to find some timings where the EM residents aren't there, and just get a bunch of tubes down there. You could even say, "I'm from the ED," and they would assume you are the EM resident on anesthesia. (This would work at my former residency program, but may not at yours.)

 

[gamerEMdoc]

I love my academic gig. We get paid on par with the non-academic hospitals in our state, including 4 paid "academic" days a month. Can't beat it. I'd put up my salary against any EM doc practicing in a community ED as a hospital employee any day. The trade off, its a small town. You can't have everything....

I honestly could never give up academics. I like making a big salary, and if this job somehow went away, I'd be hard pressed to go somewhere and make less, but I would do it in the end. Working with residents keeps me enthused. It makes the job so much more fun. I spent the first 4 years after residency working on my own in a nonacademic setting and I started to hate it. There is only so many chest pain, abdominal pain, etc cases I could see without wanting to go crazy. But now when someone else sees them, and I have to find things to teach on, it changes the dynamics of the case. Makes it more interesting to me.

 

[Rendar5]

That's great and all gamer but don't think it addresses the OPs question at all. Just start cold calling hospitals in the areas you're interested in or the big corporate groups. Though you won't get away from the politics at all. They'll just be different. As for procedures as long as you're good on intubation you should be fine. Nothing special about any other procedure you would routinely do.

 

[gamerEMdoc]

That's great and all gamer but don't think it addresses the OPs question at all. Just start cold calling hospitals in the areas you're interested in or the big corporate groups. Though you won't get away from the politics at all. They'll just be different. As for procedures as long as you're good on intubation you should be fine. Nothing special about any other procedure you would routinely do.

Yeah, I was more so responding to the responses re: academicians being routinely paid way less. They absolutely do, on average, make less, but that isnt universally the case.

As for the OP, one piece of advice I'd consider would be to go work a shift or two a month elsewhere. Get a part time contract elsewhere, or do some locums work on the side. You'll quickly find out if you like life better as a community doc vs that of an academic doc. Also, consider that maybe its not academics, but your institution. If there are other residencies that are somewhat close and need staffing, consider a shift or two a month there to compare. Again, you may find that its not academics at all, but rather your hospital. Or you might find that it IS academics, and you love the community jobs. Or maybe you find a community EM academic hospital that gives you the right balance.

There are just SO MANY opportunities out there for us as EM physicians. And with a huge number of places being short staffed and using some locums coverage, you can basically just go out and try place after place out while getting paid until you find the right fit.

 

[gman33]

I think doing some locums work would be a great idea. I wish the academic docs would be required to spend some percentage of time seeing patients on their own. I believe this would make them better teachers and clinicians.

Spend a few months working 4 shifts on month at a community site.
This will probably help your decision.
If you make the switch and hate it, then you are kind of stuck.

 

[Janders]

Agree with above advice, try to find some local locums work. Just 2 shifts a month even. You'll see how you like being out of academics, you'll get your procedures, you'll get some extra money, and you'll make connections in the non-academic community. I certainly wouldn't hesitate to hire an academic doc, but I would be reassured to know they can move the meat on their own.

It can be hard to know which nearby group / hospital is actually good to work for. Nothing like trying before you buy....

I also agree with the other suggestion above that academic docs should spend some time still doing solo community work. Our academic affiliate sends its core docs out to one of 5 different community EDs and a couple UCs, for a couple shifts a month. It appears they like it, of course the extra income doesn't hurt, but its also a bit of fun to get to do your own intubations and reductions and such once in a while. Also helps to keep you grounded in "real world" medicine, AND you get to disperse fancy academic teachings to the colonies

 

[Angry Birds]

Yeah, I agree with the above. Just pick up a couple shifts a month to see how you like it, before going all in.

I'm trying to go the other way around: from the community to academics. Much harder. Yours is a cake-walk. In the community, most places just want to know you have a pulse, have a license, board certified/eligible, no red flags. I have a colleague who left the academic world after 20+ years and joined our practice. Our group was very grateful to have him with all that experience.

 

[Arcan57]

Agree with picking up a side gig to test the waters. It's been mentioned before how non selective most groups are in hiring (it's almost a straight binary "do we need a doc?" yes/no to hiring whichever doc gets to us first) so I wouldn't be concerned about that. Procedural stuff won't be a big issue (a surprising number of straight from residency folks end up needing procedural remediation) but I would be quite concerned about how you handle volume and your ability to move the meat. I'm not saying academicians can't flow pts smoothly but being in a quaternary care hospital with residents where no one gives a crap about LOS doesn't reward efficient MD workflow. It's also a culture shock to go from the team sport environment of academia where all sorts of special unique flowers flourish to the solo grind of the community where you are basically some amalgam of your PG score and your LOS.