Academic physician

[premed101]

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What is the advantage/disadvantage of getting a md/phd vs. a md if you want you become an academic physician?
Also, do academic physicians have their residents/fellows do the call?(in say a big hospital)
I thank all in advance for your responses.

 

[Saluki]

An MD/PhD can be really helpful if you're planning on running a large laboratory; it can help ease the way into the basic science world, give you an edge in residency placement, faculty recruitment. In the end, though, you can do the research either way. A lot of med students interested in academic careers choose to take a year off from school to do research, and there are also opportunities to do research fellowships after residency (some argue this is ideal because you're completing the bulk of your research at a time when you're making the transition to a faculty position...)
Personally, I think an MD/PhD is a long road to follow unless you absolutely love research, want to have your own lab, etc. And even then it's still a long road considering that you can probably get there other ways. I think the people who do the best are the ones who really enjoy the process of earning the PhD. And that sure as heck wouldn't be me😛

 

[oldbearprofessor]

Also, do academic physicians have their residents/fellows do the call?(in say a big hospital)

Residents and fellows do not "do the call" for any attending physicians. Rather, they are often the first to handle questions, problems and new patients. These must then be discussed with the attending physician. Who stays all night at the hospital and who works from home is extremely variable based on the field and the hospital. I'll give you some examples that will help explain.

In general, a pediatric endocrinologist (this would be similar for many of the pedi specialties) will not have many middle-of-the night emergencies. There is no need for a pediatric endocrine specialist, either a fellow or attending to be in the hospital 24/7. In a large children's hospital, patients with endocrine problems will be watched at night by the residents who stay in the hospital. At a program with fellows, the fellow (who in this case will be at home) might be called at night/weekends by the resident for major problems or new consults. Regardless, there will always be an attending who is also on call from home. If a new admission comes in at night, or a new consult, the patient will likely be seen by the resident and/or fellow and the attending called. In unusual circumstances (a very sick diabetic for example), the attending might come in at night. On weekends, generally the attending will do morning rounds and then go home. So, in this example, the resident and fellow are taking call and seeing patients, but they are not taking call "for" the attending. The attending is still responsible even if they are not the one having to be there at night for problems. The attending will maintain some legal liability for what happens to their patients when they are on call as well in this setting.

In acute care fields, such as pediatric critical care, neonatal intensive care and pediatric cardiology, it is much more likely at large hospitals that the fellow will be in the hospital 24/7. At some programs, even the academic attendings will be in the hospital 24/7. Like me. 😎 In this case, the resident and fellows may still be the first to be called about problems, but the attending is close at hand to help them deal with the sickest patients and to see all new admissions.

There are lots more variations on this theme, but these examples can give you and others some idea. Being an academic attending does not mean that you don't take call or that someone else sees your patients for you. It means that you are the "last stop" on the line for calls in many cases, but that doesn't guarantee you a quiet night. The last two nights I was on-call I got a total of about 3 hours of sleep.😱

 

[BigNavyPedsGuy]

There are lots more variations on this theme, but these examples can give you and others some idea. Being an academic attending does not mean that you don't take call or that someone else sees your patients for you. It means that you are the "last stop" on the line for calls in many cases, but that doesn't guarantee you a quiet night. The last two nights I was on-call I got a total of about 3 hours of sleep.😱

True, but an endocrinologist at an academic training facility has residents and fellows to write notes, admit, examine and field nurse calls FOR them. If a pediatric subspecialist works at a community hospital or private without residents and fellows they are doing all of the work themselves.

The majority of work done on call is the admin stuff that goes into admitting, discharging, transferring patients, and that is all done FOR the attending in an academic center. So, I think it's fair to say a lot of what being on call entails is done FOR the attending in an academic center. I would even venture to say that most of the work that is actually done in most NICUs overnight is actually done by trainees and the staff signs it off. That's much different than a private NICU would be.

 

[DarthNeurology]

Residents and fellows do not "do the call" for any attending physicians. Rather, they are often the first to handle questions, problems and new patients. These must then be discussed with the attending physician.

When a resident says that they are "on call" it means that they have patient responsibilities over night, same as if an attending is "on call" it means he/she has patient care responsibilities over night.

Residents sometimes say that they are "on call" for the trauma service, for example in a surgical residency, or "on call" for the newborn nursery in a pediatric residency. The phrase "On call for . . . " denotes what service the resident will be available for.

In terms of taking care of patients "for" an attending this denotes a transfer of ownership of the patient to the attending, such as saying we are only doing work for the attending who is the physician who has ownership of the patient. I think this is a bad state of mind, but it happens. Often residents will admit a patient for a private physician, and say that they are "staffing with Dr. So and so", . . . sort of like the residents are just middle men/women playing an almost trivial role, especially in the case of a private who doesn't do much/any teaching and uses the residents just as physician extenders in a way.

 

[oldbearprofessor]

True, but an endocrinologist at an academic training facility has residents and fellows to write notes, admit, examine and field nurse calls FOR them. If a pediatric subspecialist works at a community hospital or private without residents and fellows they are doing all of the work themselves.

The majority of work done on call is the admin stuff that goes into admitting, discharging, transferring patients, and that is all done FOR the attending in an academic center. So, I think it's fair to say a lot of what being on call entails is done FOR the attending in an academic center. I would even venture to say that most of the work that is actually done in most NICUs overnight is actually done by trainees and the staff signs it off. That's much different than a private NICU would be.

I think we have a different idea of what "training" entails. I don't concur that the resident and fellow are doing these things "for" the attending. The relationship between academic attending and trainee is more nuanced than that. However, you're entitled to your opinion on this. The situation in private hospital settings is often complex due to residents from other services and nurse practioners/PA's in place there among other things. It certainly is true that in that setting most will do more documentation themselves although even this isn't an absolute.

However, the reason I'm responding is that I want all the fellows deciding private vs academic to take your reasoning to heart. Go academic!

 

[BigNavyPedsGuy]

There's a very good chance that once I'm not in training my views will look more like yours. From where I sit now, I only see half of the story.

I do, however, want to go into academic medicine for a variety of reasons. Mostly it's that I like teaching.

 

[oldbearprofessor]

I do, however, want to go into academic medicine for a variety of reasons. Mostly it's that I like teaching.

This is the absolute best reason to do academic medicine. Of the big three - patient care, research and teaching, it's the teaching that's the most fun.

The second best reason is that academics (at least in pedi specialties) is, IMHO, the best way to stay up on the latest in your field.

 

[umass rower]

This is the absolute best reason to do academic medicine. Of the big three - patient care, research and teaching, it's the teaching that's the most fun.

Without a doubt, teaching is the main reason why I want to do academic medicine.

To the OP: you do not need an MD/PhD to do academic medicine, although I suspect that it would help to make your case more convincing if you did want to take a position that involved both clinical work and research. It's several extra years of work, though, and as someone who abhors bench research, I would have been miserable doing that myself. You can certainly go into academic medicine without it, and if you do a fellowship, MOST programs have some kind of research component anyway.

Call... it seems that in almost all settings, there is always a physician on call at the end of the line, but the extent to which that physician actually DOES call-like things varies immensely. If you're in endocrine, "on-call" will mean you might have to do a weekend consult. If you're in GI, you may have to come in overnight to fish something out of a kid's stomach. If you're in the NICU, there's a good chance that the on-call physician is in-house, though you would probably only call them if the feces hit the fan.