Academic medicine doesn’t pay well?

[deleted1139416]

Does the whole “academic medicine doesn’t pay well” still hold true now that residency programs in community hospitals are rapidly expanding?

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[DrStephenStrange]

Does the whole “academic medicine doesn’t pay well” still hold true now that residency programs in community hospitals are rapidly expanding?

Why would it change?

 

[operaman]

Varies widely, but true in general. I know some academic ents making 7 figures, and I know others with similar titles and practices at other institutions making 300-500k for the same work.

Having recently been on the job market, academic starting comp was usually in the 250-350 range, but one place started assistant profs at 700k. Many do an rvu productivity bonus system and some academic shops were offering 35-45 per wrvu while others were 50-70. The 7 figure guys are at a place with an uncapped rvu bonus and higher end per-rvu comp.

Some of those numbers beat PP, but good PP docs have the potential for other established income streams that academic docs make lack. One PP I talked to started new associates at 175 for two years and then if you made partner you got collections minus overhead plus a share of ancillaries. Partners total comp ranged from 700-1.5. The 1.5m pp guy is probably working less than the 1.5m academic guy because the academic guy is making that off productivity while the PP is making a lot of that off ancillaries. Obviously that can vary quite a bit.

 

[Mad Jack]

I would imagine this varies widely by field. In psych you'll usually take a hit of about 50-120k to do academics, depending on the area. I've heard of some work for the name places that pay around 180k, while you can pull around 350k for the same job elsewhere in the city. Some large university-affiliated community programs pay a decent amount, usually a bit north of what you'd get at a VA but a little shy of what you'd get in PP or working outside of academics.

 

[mvenus929]

I mean, it depends on the pay structure. If you have 'protected time' for teaching, then you're going to take a pay cut because the teaching doesn't bring in money; seeing patients does. But my residency was pseudo-academic in that all the attendings were paid more on a private practice model, and the majority of the time they didn't have any trainees with them, so were still productive. In general, people in academics also work 'less' in terms of clinical activity, though total hours working may not be less given the other admin stuff they do.

 

[PikminOC]

My brother works academic. He doesn't make as much as he would make in pp, but he also has residents and fellows doing most everything

 

[aspiringcardiologa]

It's true that academic medicine pays lower compared to private practice medicine in general, but I wouldn't say that it "doesn't pay well". Moreover you have to look at it in context.
One, in academics you are also doing research on top of clinical work but for the most part you have residents/fellows doing most of the work for you. If passionate about teaching, may be more rewarding to be in academics. Also lifestyle may be better in academics because you are working your butt off in private practice.
Two, depends on the specialty. In cardiology you still earn a pretty good salary in academics. At my fellowship institution, starting salary for a new graduate is $328,000 and you can apply for tenure track in 5-7 years. The more established associate professors and full professors here earn high 300k to low/mid 400k, respectively.
Three, depends on the institution. My fellowship is hybrid academic/community. I've heard that at top tier institutions like Harvard salary is much lower. Strange because you would think that it would be higher at these places.

 

[deleted1065184]

Strange because you would think that it would be higher at these places.

They know that even with terrible pay, people will still go there for the prestige and research. My school is also a major biomedical research center and they pay pretty poorly too.

 

[Dr G Oogle]

I wouldn’t say it pays poorly but it doesn’t pay as well as PP on “average”. I’m biased but I prefer academics because PP seems kind of a grind unless you’re in a big group that can cover all the admin stuff, insurance etc. Also the potential for high income is greater in academics if you’re really academic. The more academic success you have the more “peripheral income” you get from being a consultant for various companies, having grants also lowers your threshold for getting bonuses so easier to make a lot more than your base. Obviously you have to do research for this to happen and most people in academics aren’t grinding out papers and clinical trials so it’s probably more the exception than the rule. But from my own experience it’s very doable if you set your mind to it and I don’t think it’s any harder to do that than to grinding through patients in PP to make 7 figures.

 

[voxveritatisetlucis]

no

though there are some medical professors at UCLA and Columbia (and I’m sure other places too) making 2,000,000+

 

[Tenk]

Regardless of salary, it is pretty much always a massive, huge, gaping pay cut when you include the amount of unpaid time for teaching and working on things for students or research outside of “work.” Cause guess what, that’s still work! It’s just done unpaid and on your off time.

 

[Dr G Oogle]

Regardless of salary, it is pretty much always a massive, huge, gaping pay cut when you include the amount of unpaid time for teaching and working on things for students or research outside of “work.” Cause guess what, that’s still work! It’s just done unpaid and on your off time.

Most teaching is done at bedside so not overly cumbersome. I in general refuse to do anything extra uncompensated, even if that compensation comes in the form of protected time, and it is becoming more acceptable to say no to uncompensated things even if you’re very junior.

 

[Tenk]

Most teaching is done at bedside so not overly cumbersome. I in general refuse to do anything extra uncompensated, even if that compensation comes in the form of protected time, and it is becoming more acceptable to say no to uncompensated things even if you’re very junior.

So you never give lectures, do journal club, help a student with a research project, write a letter of recommendation, mentor anyone, answer emails to students, or literally do anything except clinic/hospital?

If you answered no to all of that you’re not actually in academics, you just work with residents and/or med students.

 

[deleted1064759]

no

though there are some medical professors at UCLA and Columbia (and I’m sure other places too) making 2,000,000+

That is the 1% -- academia will generally make much less than pp.

 

[IlDestriero]

I’ve been in academic practice for a while now. It’s very variable and depends on the specialty, university, facility and the department practice model. I would agree that in general, the anverage academic practice pays less than the average private practice and also doesn’t allow you access to any of the owner perks that a well run PP will offer. (Profit sharing, max tax deferred retirement, etc.). Having said that I work at a place that pays quite well and if you compare how much I work to a lot of non academic jobs, we are very competitive. If I work 30% less but still earn 80%, I’m happy with that. There are academic jobs that pay even more, but there’s no free lunch, so you’re working for it. PP income is also extremely variable. Just look for a 90th percentile academic job and you’ll be fine.

 

[Dr G Oogle]

So you never give lectures, do journal club, help a student with a research project, write a letter of recommendation, mentor anyone, answer emails to students, or literally do anything except clinic/hospital?

If you answered no to all of that you’re not actually in academics, you just work with residents and/or med students.

Of course I do but I asked for 15% protected time and have another 15% protected from grants , meaning that I am at .70 FTE clinically so that RVU thresholds are of 70% of someone who does not have protected time, but i work clinically 4 days a week which is enough to put me over the 90%ile for productivity because of the lower threshold (for instance if someone needed 10k rvu to get to 90%ile without any protected time, I only need 7K rvu to get to same level), so actually end up making more money than if I was only clinical. To be sure not every person can and wants to get grants, and they do end up doing that stuff for free, but the ones who are only interested in clinical can do just that.

There was and is a lot of free labor from people in academics, but I don’t think it needs to be free. People can ask to be pain in some fashion for this stuff. Even doing teaching “for free” will get you promoted in rank, and in most places a promotion to associate and full professesor does get a better raise and more vacation time.

Earlier this year the med school asked me to do more research with the med students and I said sure, as long as they gave me more protected time. They said they don’t have room in the budget and I said I won’t do it. The same thing happened when one of the hospitals asked me to take more call.

There is no reason why we as doctors need to continue to do stuff for free, sure there are basic expectations (1 week of call every 1-2 months, being 50% or higher mgma, giving occasional lecture, maybe showing up to a few journal clubs if you’re “teaching faculty”) but that’s really it. Anything else we should feel comfortable asking to be compensated for.

 

[Future_Bone_Docta]

It's true that academic medicine pays lower compared to private practice medicine in general, but I wouldn't say that it "doesn't pay well". Moreover you have to look at it in context.
One, in academics you are also doing research on top of clinical work but for the most part you have residents/fellows doing most of the work for you. If passionate about teaching, may be more rewarding to be in academics. Also lifestyle may be better in academics because you are working your butt off in private practice.
Two, depends on the specialty. In cardiology you still earn a pretty good salary in academics. At my fellowship institution, starting salary for a new graduate is $328,000 and you can apply for tenure track in 5-7 years. The more established associate professors and full professors here earn high 300k to low/mid 400k, respectively.
Three, depends on the institution. My fellowship is hybrid academic/community. I've heard that at top tier institutions like Harvard salary is much lower. Strange because you would think that it would be higher at these places.

I thought new cardiology attending salaries usually start 450k+?

PS- I am totally ignorant to it, that has been through word of mouth.

 

[deleted1064759]

I thought new cardiology attending salaries usually start 450k+?

PS- I am totally ignorant to it, that has been through word of mouth.

Not even close bud.

 

[voxveritatisetlucis]

That is the 1% -- academia will generally make much less than pp.

I meant to say yes. I meant that academics don’t pay well though there are outliers in some some instances

 

[Future_Bone_Docta]

Not even close bud.

Medscape: Medscape Access

I was more so referring to the medscape physician comp report. They had average at 490k. Do you think response bias is that prevalent in the reports they publish?

Edit: Went through your post history, your acting awfully confident about salaries for an M2 now aren't you bud? lmao

 

[deleted1065184]

Medscape: Medscape Access

I was more so referring to the medscape physician comp report. They had average at 490k. Do you think response bias is that prevalent in the reports they publish?

Edit: Went through your post history, your acting awfully confident about salaries for an M2 now aren't you bud? lmao

There probably is some response bias but nobody can know if that shifts the average up or down. First you said it was word of mouth, then you said it was based on Medscape. Which is it? And I think there are other problems with using it how you did.

(1) You asked about starting salaries, and I don't think Medscape collects that data (correct me if I'm wrong). I don't believe they segregate based on time in practice. So if we're to assume Medscape is accurate, the average overall salary of $490k is likely much higher than the average starting salary (think about how some senior cardiologists making $1M+ could severely skew the average...median would've been more useful but still couldn't be used to estimate expected *starting* salary).

(2) The person you were responding to was saying that their expected starting salary in *academic medicine* was ~ $328k. Medscape doesn't separate individual specialties based on academic vs private practice, so their reported average would be higher than the average for academic medicine.

 

[Future_Bone_Docta]

There probably is some response bias but nobody can know if that shifts the average up or down. First you said it was word of mouth, then you said it was based on Medscape. Which is it? And I think there are other problems with using it how you did.

(1) You asked about starting salaries, and I don't think Medscape collects that data (correct me if I'm wrong). I don't believe they segregate based on time in practice. So if we're to assume Medscape is accurate, the average overall salary of $490k is likely much higher than the average starting salary (think about how some senior cardiologists making $1M+ could severely skew the average...median would've been more useful but still couldn't be used to estimate expected *starting* salary).

(2) The person you were responding to was saying that their expected starting salary in *academic medicine* was ~ $328k. Medscape doesn't separate individual specialties based on academic vs private practice, so their reported average would be higher than the average for academic medicine.

I have talked to maybe a half a dozen cardiology attending, caveat being they are all 40-50 y/o and in the same region (where I am from in the Northeast-- not a MAJOR metro area). They all make well over 400k. That is the word of mouth.

Then I have also looked at the medscape data as well. Yeah medscape does not I collect starting to my knowledge. That makes sense, I guess I didn't realize salary yearly increase was THAT MUCH over time like some union jobs do, I thought the largest discrepancies in pay would be more so geographic in nature.

Also good point, I did not take that into consideration.

 

[collegestud2013]

Does the whole “academic medicine doesn’t pay well” still hold true now that residency programs in community hospitals are rapidly expanding?

Still true overall, but clinical productivity (eg as measured by RVUs) is generally lower in academics, since in most positions you're not practicing 100% of the time. And research and teaching usually don't pay nearly as well as clinical practices in most specialties, unless you are well established and can get a large amount of grant funding to supplement your salary. Salaries for more senior attendings can be quite a bit higher after many years of experience but usually still not PP level.

Still need to be careful though; unfortunately there are a fair amount of jobs at academic institutions that will try to take advantage of their reputation by expecting physicians to work full PP type workloads with nearly 100% clinical practice time, but still paying a lot less than in PP just because they're working for a supposedly reputable, brand name academic institution. After all, even a "non-profit" academic intuition still has a bottom line to maintain.

There are hybrid settings where you have some of the benefits of academic institution like doing some research and teaching residents, while still have a good RVU-based pay structure.

 

[collegestud2013]

I thought new cardiology attending salaries usually start 450k+?

PS- I am totally ignorant to it, that has been through word of mouth.

Probably not in most academic positions ,but can definitely make $450-500k in PP first year if you work a lot and pay is the base salary + RVU structure.

 

[tossaway000999888]

Anyone have thoughts about whether being in academics gives you more opportunity to collaborate with industry? I came from biotech before med school and almost every MD we worked with was at a big academic center. Now thats partially because of their interest and access to research, but talking with my bosses they would often just use their association with a medical school as a barometer for them being smart, i.e. "we've started working with Dr. X from the University of Washington so you know they know this patient population well" or something like that.

 

[Taddy Mason]

Anyone have thoughts about whether being in academics gives you more opportunity to collaborate with industry? I came from biotech before med school and almost every MD we worked with was at a big academic center. Now thats partially because of their interest and access to research, but talking with my bosses they would often just use their association with a medical school as a barometer for them being smart, i.e. "we've started working with Dr. X from the University of Washington so you know they know this patient population well" or something like that.

I worked in clinical research at a reasonably sized community medical center prior to med school - It’s more about networking which academic medicine inherently makes easier. However, it’s very doable outside of academic medicine or only being peripherally affiliated with an academic center as long as you have the interest and desire. That said, depending on how involved you want to be in industry academic medicine can be more conducive with greater flexibility for protected time and being able to negotiate parts of your contract/time being “bought out” by industry.

Academic medicine can make aspects of getting in industry somewhat easier, but outside of academics industry involvement is still pretty accessible.

 

[aldol16]

Academic medicine refers to the practice where you're seeing patients, operating if you're a surgeon, and have protected research and teaching time. The latter is what lowers your salary. Clinical work always pays better than research or teaching. Since there are a fixed number of hours in a week, doing more teaching/research means more time away from clinical work.

The difference is probably easiest to illustrate for proceduralists. For every hour you're doing research and teaching, that's an hour you're not generating RVUs in the OR. So when you compare an academic surgeon to a surgeon in private practice who's operating as much as they can, the latter is always going to be paid more for their work. But then again, there are non-tangible benefits to academic practice as well, which includes the benefits to the individual of the time for research and teaching. Maybe that's more fulfilling to you.

 

[deleted1139416]

Academic medicine refers to the practice where you're seeing patients, operating if you're a surgeon, and have protected research and teaching time. The latter is what lowers your salary. Clinical work always pays better than research or teaching. Since there are a fixed number of hours in a week, doing more teaching/research means more time away from clinical work.

The difference is probably easiest to illustrate for proceduralists. For every hour you're doing research and teaching, that's an hour you're not generating RVUs in the OR. So when you compare an academic surgeon to a surgeon in private practice who's operating as much as they can, the latter is always going to be paid more for their work. But then again, there are non-tangible benefits to academic practice as well, which includes the benefits to the individual of the time for research and teaching. Maybe that's more fulfilling to you.

How exactly does teaching lower your income if you can get med students and residents to beef up your notes so you can bill more for them? Or am I just talking out of my a$$ and have no idea what I’m talking about….

 

[guytakingboards]

How exactly does teaching lower your income if you can get med students and residents to beef up your notes so you can bill more for them? Or am I just talking out of my a$$ and have no idea what I’m talking about….

Mostly talking out your ass unfortunately.

With few exceptions, attendings know how to do attending work better/faster/more efficiently than trainees. Using your example, attendings know what exactly needs to be included in a note to bill at X level. A med student putting in a 50 point review of systems and documenting that patient's cousin smokes pot doesn't help up-code the note. The attending should also know what encounters merit a level 3 vs level 5 visit and the corresponding level of detail in the note.

It's no knock on the trainees, it's a function of the system. The attending sees the results of bad/incomplete documentation in addendum requests, rejected pre-auths, lower than expected collections, etc..

Good upper level trainees (e.g. senior residents and fellows) can definitely be a force multiplier if they only need minimal supervision. That is not the case with lower level residents and certainly not with medical students.

 

[deleted1139416]

Mostly talking out your ass unfortunately.

With few exceptions, attendings know how to do attending work better/faster/more efficiently than trainees. Using your example, attendings know what exactly needs to be included in a note to bill at X level. A med student putting in a 50 point review of systems and documenting that patient's cousin smokes pot doesn't help up-code the note. The attending should also know what encounters merit a level 3 vs level 5 visit and the corresponding level of detail in the note.

It's no knock on the trainees, it's a function of the system. The attending sees the results of bad/incomplete documentation in addendum requests, rejected pre-auths, lower than expected collections, etc..

Good upper level trainees (e.g. senior residents and fellows) can definitely be a force multiplier if they only need minimal supervision. That is not the case with lower level residents and certainly not with medical students.

Ahhhh, ok that makes a lot more sense. Thank you!

 

[mrbreakfast]

How exactly does teaching lower your income if you can get med students and residents to beef up your notes so you can bill more for them? Or am I just talking out of my a$$ and have no idea what I’m talking about…

The time it takes an attending to see a patient themselves from scratch < the time it takes them to listen to an inaccurate med student history and physical, give them feedback, then go repeat everything themselves. When you present a new patient's H&P, you are oftentimes presenting to an attending who already went and saw the patient while you were reviewing the chart.

This doesn't apply to senior residents, but while you should keep doing your best and being detailed as a medical student, what you get from the patient likely won't change their medical course.

 

[deleted1139416]

Mostly talking out your ass unfortunately.

With few exceptions, attendings know how to do attending work better/faster/more efficiently than trainees. Using your example, attendings know what exactly needs to be included in a note to bill at X level. A med student putting in a 50 point review of systems and documenting that patient's cousin smokes pot doesn't help up-code the note. The attending should also know what encounters merit a level 3 vs level 5 visit and the corresponding level of detail in the note.

It's no knock on the trainees, it's a function of the system. The attending sees the results of bad/incomplete documentation in addendum requests, rejected pre-auths, lower than expected collections, etc..

Good upper level trainees (e.g. senior residents and fellows) can definitely be a force multiplier if they only need minimal supervision. That is not the case with lower level residents and certainly not with medical students.

The time it takes an attending to see a patient themselves from scratch < the time it takes them to listen to an inaccurate med student history and physical, give them feedback, then go repeat everything themselves. When you present a new patient's H&P, you are oftentimes presenting to an attending who already went and saw the patient while you were reviewing the chart.

This doesn't apply to senior residents, but while you should keep doing your best and being detailed as a medical student, what you get from the patient likely won't change their medical course.

Since you both brought up the topic of the usefulness of senior residents, I had another question in mind. Is it obvious to discern between an intern who clearly blew off their 4th year taking bull$hit electives vs. interns who legitimately took 4th year rotations seriously and learned and improved on their clinical skills? And as an attending, do you trust their judgement more? Or is the difference so small that you don't notice it?

 

[guytakingboards]

Since you both brought up the topic of the usefulness of senior residents, I had another question in mind. Is it obvious to discern between an intern who clearly blew off their 4th year taking bull$hit electives vs. interns who legitimately took 4th year rotations seriously and learned and improved on their clinical skills? And as an attending, do you trust their judgement more? Or is the difference so small that you don't notice it?

Big picture: yes, it's fairly evident who is strong and who is weak. Early in intern year, it's moot because all of their work should be double-checked and verified anyway. Later on, yes, trainees who have proven themselves get more trust and more rope.

 

[Taddy Mason]

Since you both brought up the topic of the usefulness of senior residents, I had another question in mind. Is it obvious to discern between an intern who clearly blew off their 4th year taking bull$hit electives vs. interns who legitimately took 4th year rotations seriously and learned and improved on their clinical skills? And as an attending, do you trust their judgement more? Or is the difference so small that you don't notice it?

What you’re describing is individual inherent drive/motivation and skill set. It doesn’t matter what electives someone takes, if the motivation isn’t there the quality of skill set is unlikely to change. Interns all start at different levels and come with varying sets of strengths and weaknesses, which is multifactorial and not just a function of quality of 4th year electives. Unless considerable concern emerges, putting different weights on trust of interns’ clinical judgement doesn’t really start to become apparent until the later half of the year.

 

[aldol16]

How exactly does teaching lower your income if you can get med students and residents to beef up your notes so you can bill more for them? Or am I just talking out of my a$$ and have no idea what I’m talking about….

Most junior residents and definitely most med students have no idea what needs to be stated in a note for it to increase billing. It's not a matter of adding another review of systems category. Moreover, in some states med student notes cannot be used for billing. If you are a good medicine physician, you could maximize your billing through your notes alone because you know what the right words to say are.

Now that's medicine. In surgery it's different. Surgeons don't get paid by the quality of our notes. We are paid by the RVUs we generate. That's why surgery notes are short and to the point. (And why many attendings don't even bother to co-sign the resident surgery notes).

 

[mrbreakfast]

Since you both brought up the topic of the usefulness of senior residents, I had another question in mind. Is it obvious to discern between an intern who clearly blew off their 4th year taking bull$hit electives vs. interns who legitimately took 4th year rotations seriously and learned and improved on their clinical skills? And as an attending, do you trust their judgement more? Or is the difference so small that you don't notice it?

As others noted, it's more a question of motivation and work ethic. We have a variety of interns of different specialties rotate with us: IM, neurology, neurosurgery, PM&R, psychiatry. The best interns are always the neurosurgeons, even though they generally don't have the same knowledge base as the medicine interns, because as a group they have the best work ethic, drive, and interest in learning and getting feedback. That's how they matched into neurosurgery in the first place.

I can't tell what electives you took in medical school as an intern. I can probably tell how good of a medical school you went to. But I don't really care if you took an elective in endocrinology or whatever. I care that you work hard and are careful, thorough, and reliable.

 

[operaman]

Since you both brought up the topic of the usefulness of senior residents, I had another question in mind. Is it obvious to discern between an intern who clearly blew off their 4th year taking bull$hit electives vs. interns who legitimately took 4th year rotations seriously and learned and improved on their clinical skills? And as an attending, do you trust their judgement more? Or is the difference so small that you don't notice it?

Echoing my colleagues that you can absolutely tell who is strong and who is weak. I think back to July of my intern year and we had 4 interns on our service, and within a few days it was clear one of us was objectively terrible. They had a pristine pedigree, ivy league schools, prestigious research fellowships, etc, but they were just a terrible physician. They ended up not completing residency. As a PGY2 I had an off-service intern rotate with us who - in MARCH - did not know how to write a daily progress note. No I'm not kidding. They did not complete their initial residency either.

This experience carried on in future years too - it's immediately obvious who is good and who isn't. You still don't trust anyone because they're interns and don't have much experience, but you do start to build that trust with the better ones over time. You learn to trust them in the things that they are qualified to do. I may not trust their assessment of an acute airway enough not to see it myself, but I may start to trust that they've carried out my plan without too much double checking behind the scenes.

I'm not sure if the 4th year rotations really determine this. I suspect it does to some extent simply in that we get good at what we do often. I definitely get rusty in clinic and the OR after a long vacation, and I can't imagine how bad I'd be if I did nothing clinical for 6 months straight.

 

[deleted1139416]

Echoing my colleagues that you can absolutely tell who is strong and who is weak. I think back to July of my intern year and we had 4 interns on our service, and within a few days it was clear one of us was objectively terrible. They had a pristine pedigree, ivy league schools, prestigious research fellowships, etc, but they were just a terrible physician. They ended up not completing residency. As a PGY2 I had an off-service intern rotate with us who - in MARCH - did not know how to write a daily progress note. No I'm not kidding. They did not complete their initial residency either.

This experience carried on in future years too - it's immediately obvious who is good and who isn't. You still don't trust anyone because they're interns and don't have much experience, but you do start to build that trust with the better ones over time. You learn to trust them in the things that they are qualified to do. I may not trust their assessment of an acute airway enough not to see it myself, but I may start to trust that they've carried out my plan without too much double checking behind the scenes.

I'm not sure if the 4th year rotations really determine this. I suspect it does to some extent simply in that we get good at what we do often. I definitely get rusty in clinic and the OR after a long vacation, and I can't imagine how bad I'd be if I did nothing clinical for 6 months straight.

Thank you for the response! The reason I brought up 4th year rotations is because I feel as though the more exposure I get the better my critical thinking skills and ability to “connect the dots” gets better. But more than that, it just teaches you more new things. For example - today I thought I saw a colostomy bag on a patient which ended up being a urostomy bag lol. It was empty so I didn’t see any urine in it. But now I know that a urostomy and colostomy look similar!

 

[qwerty89]

Varies widely, but true in general. I know some academic ents making 7 figures, and I know others with similar titles and practices at other institutions making 300-500k for the same work.

Having recently been on the job market, academic starting comp was usually in the 250-350 range, but one place started assistant profs at 700k. Many do an rvu productivity bonus system and some academic shops were offering 35-45 per wrvu while others were 50-70. The 7 figure guys are at a place with an uncapped rvu bonus and higher end per-rvu comp.

Some of those numbers beat PP, but good PP docs have the potential for other established income streams that academic docs make lack. One PP I talked to started new associates at 175 for two years and then if you made partner you got collections minus overhead plus a share of ancillaries. Partners total comp ranged from 700-1.5. The 1.5m pp guy is probably working less than the 1.5m academic guy because the academic guy is making that off productivity while the PP is making a lot of that off ancillaries. Obviously that can vary quite a bit.

UCLA?

 

[operaman]

UCLA?

Yeah. Also a couple east coast programs as well.

 

[mistafab]

You can absolutely not tell who took BS electives in 4th year vs coasted. However, you can easily tell when an intern sucks at their job.

Some people need to work hard 4th year to not suck. Some people work 4th year and still suck. You can usually figure out who you will be if you are paying attention on your Sub I. Are you as good as the intern? You should be. If you're not, then learn from them until you are at least half-way decent.

Since you both brought up the topic of the usefulness of senior residents, I had another question in mind. Is it obvious to discern between an intern who clearly blew off their 4th year taking bull$hit electives vs. interns who legitimately took 4th year rotations seriously and learned and improved on their clinical skills? And as an attending, do you trust their judgement more? Or is the difference so small that you don't notice it?