Academic Peeps

[pd4emergence]

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Hey everyone,
It's been a while since I've been on the forum. It's great to see some of the same regular posters sharing knowledge and sage advice. I had a few questions for the academic folks on the board.

1. How does your department dole out nonclinical time? Are you able to generally pursue academic endeavors with the time provided?

2. How many rooms do you supervise when you don't have residents?

3. How many hours per week do you average?

4. Quality of life: Are you generally happy?

5. Promotions: If you have been promoted, How long did it take? What criteria does your department look at when considering someone? Do you feel that your department promotes in a fair manner?


At this point, I'm trying to get a feel for where my department stands. Thanks in advance for any info.

 

[cchoukal]

1. This is becoming more and more of a challenge. At the main house, I think they start at around a half day per week and have guidelines in terms of what amount of additional time is generated by certain activities. At our VA, where I spend most of my time, we generally have a day per week. You'd a,ways want more. I mean, a day just get you caught up on paper work, evaluations, etc. We're currently struggling with how to demonstrate our workload to hospital leadership, and depending on how that turns out, it may be that our available time is reduced.


2. Two.

3. Depends on whether I'm in the ICU, but a typical or week is 50-60.

4. We're paid pretty low for the region, and the work demands have definitely accelerated in the last few years. I like my work, but I sometimes think I should be earning more while it's still available.

5. We have a pretty routinized promotion track. Every two years is a "step" and three steps equals a "ranks," like from assistant to associate. They are generally pretty tightly focused on moving us along and promotion, at least in the more clinical tracks, is fairly straightforward.

 

[BuzzPhreed]

4. We're paid pretty low for the region, and the work demands have definitely accelerated in the last few years. I like my work, but I sometimes think I should be earning more while it's still available.

I am currently making $130K/yr more than I was making as a junior faculty member for my one-year post-residency job. That is not a typo. And overall this current job is far less demanding.

 

[pd4emergence]

Thanks for the replies. I've done both PP and academics. For me I made a fair amount more in PP comparing W2's from both places. I worked in a very busy practice with a not great payer mix but we made up for it in volume. If I look at the total package from my current job and compare, the numbers get closer. In PP, I funded my retirement myself. In academics, about 1/2 is funded by my employer. My health insurance is 1/3 of what I was paying in PP. I don't have to pay for private school…..Other things add up so that honestly I haven't really seen a big difference in money. I do like my job. We do big cases on sick people. I like to teach. We have good residents. Unfortunately, over the past year my current job is approaching my old PP job in relation to hours, caseload, and expectations. We are staying later (avg prob 60 hrs/wk). When not with residents, I run 4 rooms about 90% of the time. I rarely work with residents. We have no nonclinical time built in and basically have to beg for it from the department. We are constantly understaffed and really have no plans to hire in the regular OR section and morale is very low. There's also all the political drama that goes along with an academic department in regards to promotions, policies, etc.

So at this point, I'm trying to decide whether to stick with it, go to a different academic department, or go back to PP.

Thanks again for the replies….

 

[Planktonmd]

Thanks for the replies. I've done both PP and academics. For me I made a fair amount more in PP comparing W2's from both places. I worked in a very busy practice with a not great payer mix but we made up for it in volume. If I look at the total package from my current job and compare, the numbers get closer. In PP, I funded my retirement myself. In academics, about 1/2 is funded by my employer. My health insurance is 1/3 of what I was paying in PP. I don't have to pay for private school…..Other things add up so that honestly I haven't really seen a big difference in money. I do like my job. We do big cases on sick people. I like to teach. We have good residents. Unfortunately, over the past year my current job is approaching my old PP job in relation to hours, caseload, and expectations. We are staying later (avg prob 60 hrs/wk). When not with residents, I run 4 rooms about 90% of the time. I rarely work with residents. We have no nonclinical time built in and basically have to beg for it from the department. We are constantly understaffed and really have no plans to hire in the regular OR section and morale is very low. There's also all the political drama that goes along with an academic department in regards to promotions, policies, etc.

So at this point, I'm trying to decide whether to stick with it, go to a different academic department, or go back to PP.

Thanks again for the replies….

At this point going to private practice would be the worst option for you.

 

[IlDestriero]

Why? It sounds like he is doing PP level work for slave wages and probably a couple weeks less vaca per year as well.

 

[urge]

Why? It sounds like he is doing PP level work for slave wages and probably a couple weeks less vaca per year as well.

That's where academia is going in my experience.

 

[deleted171991]

That's where academia is going in my experience.

Absolutely. That's why I am talking about "academic AMCs." Because that's what at least my academic department feels like. And they have "partners", too. The old-timers who run the place and who make sure that they and their favorites make more than you while doing much less work, by being assigned academic days and easier schedules in the OR.

Not only that, but clinical excellence doesn't mean crap in academia so, if you're not a "let's invent some more BS and call it research" type of person, you're both screwed and going to stay screwed.

 

[Planktonmd]

Academia still provides you stability and job security that is becoming very rare in private practice.
Academia will not cut your salary or fire you if reimbursement declines as expected.

 

[urge]

Academia still provides you stability and job security that is becoming very rare in private practice.
Academia will not cut your salary or fire you if reimbursement declines as expected.

Not really. People get fired in academia also. Botched anesthetics, drugs, not playing well with others, etc.


They cut your salary too, if their collections are low. Many victims of that in the past few yrs.

FFP is right. Academic depts nowadays should be thought as AMC's.

 

[pd4emergence]

Academia still provides you stability and job security that is becoming very rare in private practice.
Academia will not cut your salary or fire you if reimbursement declines as expected.

I agree with you about the stability and job security thing. It's also nice to be relatively protected from a malpractice standpoint. Unfortunately salary wise, cuts do happen. In my department they are happening in the form each person having to attain vague metrics to get their full promised salary. At this point there is a significant portion of my salary that I might not get if the metrics aren't met. I kinda feel like this is a bait and switch. I probably would not have signed on if I knew that at any time they could decide that if I didn't do x or y then they wouldn't pay me what my contract says they will pay me. I feel this is their way of starting down the road of cutting salaries in the form of more and more stringent metrics as time goes by....

 

[criticalelement]

Academia still provides you stability and job security that is becoming very rare in private practice.
Academia will not cut your salary or fire you if reimbursement declines as expected.

WHAT?!!!??!?!?
Your contract in academics is on a yearly basis. Many people dont get "renewed". Very simple getting rid of someone in acdemics. The only way to be protected in academics is to be fully tenured and that is very difficult to obtain. There is no security as long as you work for somebody else. Just remember that.

The real way to be protected in anesthesia is to find a hospital that does not do the whole exclusive contract thing and get direct consults from surgeons. The only way they can fire you is if you violate terms of medical staff.

 

[kazuma]

One of the groups I looked at didn't have a contract with the main hospital but they were the only group that worked there. They said it afforded them a lot of freedom and they avoided many of the "demands" the hospital has tried to institute over the years. No subsidy, just keeping the surgeons happy and the OR's staffed and they haven't had any problems in the 20+ yes they've been there. The downside is that all their eggs are in that one basket.


I also agree with academics not being the safe haven it supposedly once was. However, I've only seen one attending be let go and it was for a ton of egregious mistakes and personality issues. But I believe that's about to change as there is a lot of uncertainty and speculation brewing in the dept and it looks like there may me some significant changes coming in the near future. Since I've been here I've seen our dept go from having near complete control of our own finances and hiring/firing to now having the college of medicine and hospital control the majority of it.

And don't forget about Texas tech el paso, an AMC swooped in a took over that academic department and displaced all of the residents and as far as I know, many or most of the attendings.

People say pp has its issues which it may, and what the future holds, nobody knows. But in the meantime, all 5 of the groups I've talked to are very fair and are virtually void of all the drama and politics I see here in academics. All of my buddies who are in PP are loving life. They show up, work hard, make a decent living and are happy with their decision to do pp. I can't wait!

 

[IlDestriero]

I don't feel that my job is at risk in my academic practice. If you're clinical you need to be a strong clinician and have high teaching scores, if you're on the research track, you need to be publishing at a clip to be promotable at the designated time and have high teaching scores. If you do that, pick up your share of the administrative responsibilities, are easy to work with and are generally a good citizen, there's really no reason to ever get rid of you.
El Paso was an outlier. They folded and reopened not long before and clearly were not an academic practice. If the hospital and its board of directors were serious about wanting to maintain an academic practice they wouldn't have sold it out to an AMC. No AMC is going to want to train residents or CRNAs, teach medical students, or perform research. As long as that is the mission of my institution, I need not fear a takeover. And that mission isn't going to change. I suppose I f the department decided that every faculty needed to be on the research track, that would put an end to the clinical track, but it would take many years to hire enough faculty to replace us. There are many new fellows hitting the market each year, but few really have what it takes to succeed in the research track. It would be easier to just make the transition over time with the new hires. It would also decrease everyone's compensation, which isn't a great selling point.
Our contracts and appointments are for 3 years at a time btw.

 

[cchoukal]

The idea that academics is some safe haven from the forces of capitalism isn't realistic. The vast majority of a department's operating budget is from pro fees. Pro fees go down, and where will the money come from to continue to pay the same salaries? The University? The Medical Center? Public universities struggle every year to maintain funding levels from state governments. Privates sometimes have endowments, I suppose, although I can't imagine they'd be used to support a money-losing clinical enterprise. Medical centers sometimes subsidize departments, but the same forces driving pro fees down drive facility fees down as well. All at a time when the federal government is looking to get out of the business of paying for resident education. Imagine each medical center having to suddenly grapple with the loss of around $100K per resident (whether residents earn or lose money for a hospital is irrelevant; the CMS GME payment is money they're getting now that they may not get in the future) and a loss of that nebulous 3-4% upcharge in fees for being a teaching hospital.

We may not see pay CUTS per se, though. More likely, we'll see less hiring, and as clinical volume inevitably rises, that work will be done by existing people by eroding nonclinical time. Remember when the standard was 20% nonclinical time just to walk in the door? Anyone still have that? We'll probably also see slower increases in pay so as to have pay effectively cut as inflation progresses.

In most areas of the country these changes will be pretty well-tolerated. In expensive urban areas, though, it may become harder and harder to recruit people for these jobs. I already can't afford a home in my city, and although my pay has increased probably 20% during my 4.5 years here, home prices seem to be rising much faster. Other things, too, just seem to be so much more expensive. My college's tuition has tripled since I graduated. Tripled, in less than 15 years. Salaries certainly have not tripled in that same time, and so, again, while pay cuts probably won't happen, stagnation will be an effective cut as the world around us goes crazy.

 

[criticalelement]

If you're clinical you need to be a strong clinician and have high teaching scores, if you're on the research track, you need to be publishing at a clip to be promotable at the designated time and have high teaching scores. If you do that, pick up your share of the administrative responsibilities, are easy to work with and are generally a good citizen, there's really no reason to ever get rid of you.

Our contracts and appointments are for 3 years at a time btw.

In other words, If i kiss enough A** there is no reason for anyone to get rid of me.

If you really believe your employer cant get rid of you at a moments notice, you need to re read your contract.

Amc's will be happy to train residents as long as there is enough money in it for them. Across the country there are MULTIPLE MULTIPLE academic departments being managed and administered by anesthesia management groups. Look it up mon ami.

 

[kazuma]

In other words, If i kiss enough A** there is no reason for anyone to get rid of me.

If you really believe your employer cant get rid of you at a moments notice, you need to re read your contract.

Amc's will be happy to train residents as long as there is enough money in it for them. Across the country there are MULTIPLE MULTIPLE academic departments being managed and administered by anesthesia management groups. Look it up mon ami.

Actually AMC's would be happy to train srna's who pay significant amounts if tuition for their training. I was told that's what the plan was for el paso.

 

[Planktonmd]

WHAT?!!!??!?!?
Your contract in academics is on a yearly basis. Many people dont get "renewed". Very simple getting rid of someone in acdemics. The only way to be protected in academics is to be fully tenured and that is very difficult to obtain. There is no security as long as you work for somebody else. Just remember that.

The real way to be protected in anesthesia is to find a hospital that does not do the whole exclusive contract thing and get direct consults from surgeons. The only way they can fire you is if you violate terms of medical staff.

That fee for service model you just mentioned is very difficult to find and you will still be working for these surgeons and at their mercy, in addition to being at the mercy of insurance, medicare, and malpractice attorneys.
As for people getting their contracts not renewed in academia it only happens if you are really terrible and that is unfortunately a population of anesthesiologists that tends to gravitate towards academia.

 

[Planktonmd]

I agree with you about the stability and job security thing. It's also nice to be relatively protected from a malpractice standpoint. Unfortunately salary wise, cuts do happen. In my department they are happening in the form each person having to attain vague metrics to get their full promised salary. At this point there is a significant portion of my salary that I might not get if the metrics aren't met. I kinda feel like this is a bait and switch. I probably would not have signed on if I knew that at any time they could decide that if I didn't do x or y then they wouldn't pay me what my contract says they will pay me. I feel this is their way of starting down the road of cutting salaries in the form of more and more stringent metrics as time goes by....

All management companies and big private groups have a portion of your income tied to metrics and performance.

 

[cchoukal]

As for people getting their contracts not renewed in academia it only happens if you are really terrible and that is unfortunately a population of anesthesiologists that tends to gravitate towards academia.

Not to sound defensive, and I suppose this will hijack the thread, but where does all this "academics are ****ty doctors" stuff come from? There's so much of it on here, I suppose there has to be some truth, but for all you PP types, how many academic anesthesiologists' clinical work are you familiar with? Or is this based on something you saw as a resident that some attending "taught" you something that you later learned wasn't true? Is it that we are perceived to have limited clinical exposure? A vanishingly small number of truly lab-rat-once-weekly-clinical-types do exist, and I imagine their skillset would be limited, but the vast majority of use are almost exclusively clinical.

My own guess is it's more that academic attendings are conservative and take lots of precautions, residents are brash, and when they get out into PP, they realize they can be less conservative while still being safe, they think they're the first ones to realize this, and, therefore, "gee, what ******* those academics were." But that doesn't explain to me the fierceness with which people seem to hold the beliefs about academics' inferiority.

So let's hear it. I'm really curious.

 

[pd4emergence]

I don't see many or any people getting fired in my current gig. I think in my case the job is alot more predictable than my old PP job. I don't really see anybody coming in and taking over. I did in my old job. We went through some changes in my old job that revealed how precarious our position as a group really was. I think PP is changing a lot. Lots of AMC's, lots of mergers, lots of people looking for stability. I feel pretty secure in my job currently and thats important to me. I think any job has advantages and disadvantages. The trick is to figure out if those particular advantages and disadvantages fit with your preferences.

 

[pd4emergence]

All management companies and big private groups have a portion of your income tied to metrics and performance.

You are probably right. But I didn't really want to work for an AMC or big private group. I basically signed a contract for a set salary at an academic department and now I kinda feel like my department is going back on the deal. These metrics were not in place when I got here and were not mentioned at all as a possibility. I'm more worried about the precedent. They seem to be saying "hey jump through this hoop and we will pay you what we already agreed to pay you". Seems to me like if they really thought the metrics were important they would incentivize instead of going back on an already agreed upon salary.

 

[Planktonmd]

Not to sound defensive, and I suppose this will hijack the thread, but where does all this "academics are ****ty doctors" stuff come from? There's so much of it on here, I suppose there has to be some truth, but for all you PP types, how many academic anesthesiologists' clinical work are you familiar with? Or is this based on something you saw as a resident that some attending "taught" you something that you later learned wasn't true? Is it that we are perceived to have limited clinical exposure? A vanishingly small number of truly lab-rat-once-weekly-clinical-types do exist, and I imagine their skillset would be limited, but the vast majority of use are almost exclusively clinical.

My own guess is it's more that academic attendings are conservative and take lots of precautions, residents are brash, and when they get out into PP, they realize they can be less conservative while still being safe, they think they're the first ones to realize this, and, therefore, "gee, what ******* those academics were." But that doesn't explain to me the fierceness with which people seem to hold the beliefs about academics' inferiority.

So let's hear it. I'm really curious.

Usually people who come to private practice from long careers in academia are slow, inefficient, dogmatic, and most of them can not survive in a real busy private practice environment.
The longer you stay in academic anesthesia the less likely you will be successful in the trenches of private practice.
This does not always mean that academic anesthesiologists are inferior in their knowledge or skill level, but it's just difficult to unlearn bad habits.
Also there are some residents and fellows who just don't feel they can cut it in the lonely world of private practice, and those choose to remain in the warmth of their training places after graduation but they never admit why they made that choice. These guys belong in academia and should never leave it.

 

[cchoukal]

You are probably right. But I didn't really want to work for an AMC or big private group. I basically signed a contract for a set salary at an academic department and now I kinda feel like my department is going back on the deal. These metrics were not in place when I got here and were not mentioned at all as a possibility. I'm more worried about the precedent. They seem to be saying "hey jump through this hoop and we will pay you what we already agreed to pay you". Seems to me like if they really thought the metrics were important they would incentivize instead of going back on an already agreed upon salary.

This is definitely happening on a larger scale as an effort to deny payment/increase "Quality." One of the provisions of the ACA was to put a certain amount of the payment for a given episode of care (I think 1-2%) "at risk," meaning dependent upon satisfying some set of requirements. Some of these requirements make sense/are feasible, and some do not. I can understand feeling like you got the bait/switch, but I don't think you'll find too many places that won't already or soon have this kind of arrangement. He who holds the purse makes the rules.

 

[pd4emergence]

This is definitely happening on a larger scale as an effort to deny payment/increase "Quality." One of the provisions of the ACA was to put a certain amount of the payment for a given episode of care (I think 1-2%) "at risk," meaning dependent upon satisfying some set of requirements. Some of these requirements make sense/are feasible, and some do not. I can understand feeling like you got the bait/switch, but I don't think you'll find too many places that won't already or soon have this kind of arrangement. He who holds the purse makes the rules.

Unfortunately you are right. I just wish that our "at risk" portion of salary was 1-2% or even 5%. But 15-20%, is crap....

 

[IlDestriero]

In other words, If i kiss enough A** there is no reason for anyone to get rid of me.

If you really believe your employer cant get rid of you at a moments notice, you need to re read your contract.

Amc's will be happy to train residents as long as there is enough money in it for them. Across the country there are MULTIPLE MULTIPLE academic departments being managed and administered by anesthesia management groups. Look it up mon ami.

I didn't say they can't fire me, I said that there is no reason for them to fire me if I'm meeting expectations and providing high quality clinical care. I'm not sure that qualifies as kissing ass. That's more job security than many PP jobs can offer as my groups "contract" isn't really at risk of being lost in competition to a competing group of 100+ peds trained Physicians and a small army of CRNAs, and NPs.
I would love to know what really happened at El Paso to make them do what they did. I'm sure there's a lot to that story.