Academic Physician vs. Community

[baconshrimps]

Does an attending at an academic medical center have to engage in the research activities of that institution? Is it rare for an attending at an academic medical center to only be involved in patient care and teaching?

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[vc7777]

Does an attending at an academic medical center have to engage in the research activities of that institution? Is it rare for an attending at an academic medical center to only be involved in patient care and teaching?

Academic institutions tend to be very large. There are plenty of physicians who do zero research at such places. However, I think you'll find many are engaged in teaching capacities.

 

[baconshrimps]

Academic institutions tend to be very large. There are plenty of physicians who do zero research at such places. However, I think you'll find many are engaged in teaching capacities.

Do these non-research physicians have a difficult time securing attending positions at academic institutions though? Would I need to have a strong medical research background through medical school, residency, and my fellowship in order to be considered for such a position, and then elect to drop the ball so-to-speak on research once I become an attending? Or could I practice my skills (lets suppose I'm in a procedural specialty, like surgery or interventional radiology) as a physician in a more community based residency/fellowship and then move into an attending position at an academic hospital?

 

[IlDestriero]

Do these non-research physicians have a difficult time securing attending positions at academic institutions though? Would I need to have a strong medical research background through medical school, residency, and my fellowship in order to be considered for such a position, and then elect to drop the ball so-to-speak on research once I become an attending? Or could I practice my skills (lets suppose I'm in a procedural specialty, like surgery or interventional radiology) as a physician in a more community based residency/fellowship and then move into an attending position at an academic hospital?

Does an attending at an academic medical center have to engage in the research activities of that institution? Is it rare for an attending at an academic medical center to only be involved in patient care and teaching?

It varies from university to university and hospital to hospital and department to department.
I'm at a major medical center and premiere specialty hospital, and have a clinical faculty appointment at the medical school with no research requirements at all. I had a similar arrangement at another well known research powerhouse as well. Other departments here require all faculty to engage in significant research. That's determined by the Chair of the department.
As for how hard it is to get a job, that depends on what your Chair wants at that time. If they want to boost the research productivity, they may hire research track people (w/ 20-50% protected research time) if they want to increase the clinical output, they could hire non research track people (with 5- 10% protected admin time). If you get hired to do research and "drop the ball" you may be able to switch tracks, but you'd probably get fired at my shop unless it was in the first couple years. In one of the departments where everyone is expected to publish or perish, you'd be out. Having significant protected research time with little or nothing to show for it shows a lack of commitment to your chosen field and that you wasted the investment that they made in you.
All of my teaching is clinical teaching or lectures to the residents/fellows.

 

[vc7777]

I take it you have an aversion to research? An additional, albeit minor, point is that even if you have no research interest or career goals, you should be very comfortable "consuming" research to thrive at a large academic center (aka "tertiary care" or even "quaternary care" providing super specialized medicine or surgery)

Your colleagues will be very conversant and may even ask for you to enroll your patients into their studies. Your grand rounds will be very technical, and you will be seeing higher-acuity patients and be potentially practicing closer to the "envelope of medical knowledge" requiring you to stay abreast of the latest research outcomes in order to apply it to your patients.

 

[baconshrimps]

I take it you have an aversion to research? An additional, albeit minor, point is that even if you have no research interest or career goals, you should be very comfortable "consuming" research to thrive at a large academic center (aka "tertiary care" or even "quaternary care" providing super specialized medicine or surgery)

Your colleagues will be very conversant and may even ask for you to enroll your patients into their studies. Your grand rounds will be very technical, and you will be seeing higher-acuity patients and be potentially practicing closer to the "envelope of medical knowledge" requiring you to stay abreast of the latest research outcomes in order to apply it to your patients.

I worked for 3 years at one of the most well regarded neuroscience institutions in the world, and am currently in graduate school....I made a very conscious decision to make a switch from graduate school into the medical profession, and the stark difference here, is research. I don't anticipate that I would have a difficult time following the grand rounds, or engaging with my colleagues, I just don't see myself leading studies. I want to be a clinician first, a teacher second, and one of the advantages of being at a major academic medical center is in fact access to trials that may benefit my patients...but I don't want to be the head honcho. When I'm not with patients or teaching, I want to enjoy life with my family (didn't have much of a Dad growing up, and I want to make damn sure I'm there for my children...birthdays...recitals..etc.) I don't want to be a 7-day-a-week on-site physician...and as I understand it, once I'm an attending, I won't need to be.

 

[vc7777]

I worked for 3 years at one of the most well regarded neuroscience institutions in the world, and am currently in graduate school....I made a very conscious decision to make a switch from graduate school into the medical profession, and the stark difference here, is research. I don't anticipate that I would have a difficult time following the grand rounds, or engaging with my colleagues, I just don't see myself leading studies. I want to be a clinician first, a teacher second, and one of the advantages of being at a major academic medical center is in fact access to trials that may benefit my patients...but I don't want to be the head honcho. When I'm not with patients or teaching, I want to enjoy life with my family (didn't have much of a Dad growing up, and I want to make damn sure I'm there for my children...birthdays...recitals..etc.) I don't want to be a 7-day-a-week on-site physician...and as I understand it, once I'm an attending, I won't need to be.

Cool. I of course didn't know your circumstances. However, for other people's benefit I'll let the comment stand. Big intuitions= big tent. I was going to point out very large instiutions also have multiple centers and too might want to consider being at a "feeder" hospital to achieve your goals. You'd still have access to the main academics, trials, and professional relationships but could practice at a less-hectic pace.

 

[Leoz M Jiliums]

It varies from university to university and hospital to hospital and department to department.
I'm at a major medical center and premiere specialty hospital, and have a clinical faculty appointment at the medical school with no research requirements at all. I had a similar arrangement at another well known research powerhouse as well. Other departments here require all faculty to engage in significant research. That's determined by the Chair of the department.
As for how hard it is to get a job, that depends on what your Chair wants at that time. If they want to boost the research productivity, they may hire research track people (w/ 20-50% protected research time) if they want to increase the clinical output, they could hire non research track people (with 5- 10% protected admin time). If you get hired to do research and "drop the ball" you may be able to switch tracks, but you'd probably get fired at my shop unless it was in the first couple years. In one of the departments where everyone is expected to publish or perish, you'd be out. Having significant protected research time with little or nothing to show for it shows a lack of commitment to your chosen field and that you wasted the investment that they made in you.
All of my teaching is clinical teaching or lectures to the residents/fellows.

You pretty much have my dream job, IlDestriero. Would you mind sharing how you went about getting your first position? I've googled a lot about clinical educator tracks, but I've found little information about jobs without a research component to it.

 

[baconshrimps]

You pretty much have my dream job, IlDestriero. Would you mind sharing how you went about getting your first position? I've googled a lot about clinical educator tracks, but I've found little information about jobs without a research component to it.

Yes, I also would like your insight, if you wouldn't mind sharing @IlDestriero.

While I have your attention, is this you?

 

[Leoz M Jiliums]

Yes, I also would like your insight, if you wouldn't mind sharing @IlDestriero.

While I have your attention, is this you?

That's my nickname, my real name is much more normal

 

[lobo.solo]

You pretty much have my dream job, IlDestriero. Would you mind sharing how you went about getting your first position? I've googled a lot about clinical educator tracks, but I've found little information about jobs without a research component to it.

+1 @llDestriero. I'm also interested in this question. Also IIDestriero, could you do research even if is not a requirement for appointment? Thanks

 

[IlDestriero]

You pretty much have my dream job, IlDestriero. Would you mind sharing how you went about getting your first position? I've googled a lot about clinical educator tracks, but I've found little information about jobs without a research component to it.

I enjoy teaching, and looking at my evaluations from the trainees, I seem to do it pretty well. I also enjoy being on the tip of the spear and pushing the envelope, so academia was a good fit for me.
As to how I got here, I worked hard and did well all along the way. I was involved in research and education in medical school and residency, and even before, but I knew it was not for me as a career.
I worked hard in residency and rose to the top to be selected chief resident, secured a fellowship at a coveted location, working hard again to exceed expectations to secure strong LORs from people well known in my specialty. I actually joined the faculty there for a while before relocating to my current job. There are many clinical academic positions in anesthesia for people like me at large Children's Hospitals. Your mileage my vary. As I said, it's entirely dependent on how the Chair wants to run things and how much work there is to get done. If we get a new Chair, things could change and they could start hiring only research track people, but it is unlikely that the clinical faculty would be let go because we have significant experience, there's a ton of work to be done, and we free up the research people to do their thing by getting it done and doing many of the necessary administrative tasks as well.

 

[IlDestriero]

One other thing to keep in mind is that working at a big quaternary care center means you have to be comfortable doing a lot of high acuity cases on a regular basis. That's great for training, but when it is you making all the decisions and working the high wire without a net, you might feel differently. It's not for everyone.

 

[Leoz M Jiliums]

I enjoy teaching, and looking at my evaluations from the trainees, I seem to do it pretty well. I also enjoy being on the tip of the spear and pushing the envelope, so academia was a good fit for me.
As to how I got here, I worked hard and did well all along the way. I was involved in research and education in medical school and residency, and even before, but I knew it was not for me as a career.
I worked hard in residency and rose to the top to be selected chief resident, secured a fellowship at a coveted location, working hard again to exceed expectations to secure strong LORs from people well known in my specialty. I actually joined the faculty there for a while before relocating to my current job. There are many clinical academic positions in anesthesia for people like me at large Children's Hospitals. Your mileage my vary. As I said, it's entirely dependent on how the Chair wants to run things and how much work there is to get done. If we get a new Chair, things could change and they could start hiring only research track people, but it is unlikely that the clinical faculty would be let go because we have significant experience, there's a ton of work to be done, and we free up the research people to do their thing by getting it done and doing many of the necessary administrative tasks as well.

One other thing to keep in mind is that working at a big quaternary care center means you have to be comfortable doing a lot of high acuity cases on a regular basis. That's great for training, but when it is you making all the decisions and working the high wire without a net, you might feel differently. It's not for everyone.

Thanks for your insight. From what I read, you truly love your job. You echo a lot of the reasons I think I'd like academics, and I'm excited to get the chance to learn more in a few months!

 

[Great White Buffalo]

Does an attending at an academic medical center have to engage in the research activities of that institution? Is it rare for an attending at an academic medical center to only be involved in patient care and teaching?

Yes, a lot are only on the clinical track. They sit on committees, etc, but are considered second class citizens in the academic hierarchy.

 

[baconshrimps]

Yes, a lot are only on the clinical track. They sit on committees, etc, but are considered second class citizens in the academic hierarchy.

That's okay 🙂 I'm a 3rd class citizen in life, so as far as I'm concerned thats an upgrade haha.

 

[Great White Buffalo]

That's okay 🙂 I'm a 3rd class citizen in life, so as far as I'm concerned thats an upgrade haha.

Yeah, but the clinical track people usually make more money than on the academic track (they generate revenue seeing patients, but research track only cover their salary and contribute indirects to the U, but not huge numbers). My Dad switched from academic to clinical after 15 years (hated wasting time writing grants that got reviewed, scored, but then ultimately not funded). He got a really healthy raise switching tracks. Go figure, ass backwards system.

 

[baconshrimps]

Yeah, but the clinical track people usually make more money than on the academic track (they generate revenue seeing patients, but research track only cover their salary and contribute indirects to the U, but not huge numbers). My Dad switched from academic to clinical after 15 years (hated wasting time writing grants that got reviewed, scored, but then ultimately not funded). He got a really healthy raise switching tracks. Go figure, ass backwards system.

I have approximately zero complaints about more cashflow, lol.

 

[oldbearprofessor]

There are a lot of great insights on this thread. I did want to note that some things are not universal and there is a tremendous amount of variability. Speaking from the pediatrician faculty side of a large academic children's hospital and as a professor (see username...) in a research oriented medical school, I see a few things in OUR parts a bit differently.

First, a primary NIH funded research training position used for new faculty (KO8 and others) usually mandates 75-80% protected research time. Of note is that it doesn't always PAY that percent and sometimes the department has to pitch in. This can be true for non-NIH positions too from different societies.

Second, not everyone pays NIH-funded researchers less than clinicians. Some will even pay them more based on the amount of $$ they bring in. A whole range of issues come to play here, not just clinical track vs research track in OUR setting.

Finally, I do not agree that clinical educators are universally seen as below researchers in academic settings. I would argue that although this was mostly true in the past, this is changing very rapidly in many places. The clinician educators direct clinical services in many cases (e.g manage the NICU), direct large residency programs, and many other tasks. I do not believe that currently, in OUR setting, there is a hierarchy favoring the researchers in meaningful ways. Academic institutions need to pay the bill and top notch clinicians are in demand in OUR setting.

As always, YMMV.

 

[IlDestriero]

Yes, a lot are only on the clinical track. They sit on committees, etc, but are considered second class citizens in the academic hierarchy.

I don't feel like I'm a second class citizen. I might not be able to ascend to Chair at a big research program, but that's fine. I think business skills and strong leadership will trump research at a lot of places moving forward.