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[Yale Medicine]

It has more politics than you can shake a stick at. Politics, politics, politics.

 

[TexasPhysician]

Academic psych has less money, more bureaucracy, more requirements (projects, lectures, research), and may be entitled to full ownership of things you create/invent in the field.

 

[Celexa]

I have very consciously chosen to stay in academics. It's the right choice for me. It's a terrible choice from a lot of other angles, though.

Some of the many reasons not to do academics:

-Less money. A lot less.
-The depts think they own your life and you should be working on the academic mission all the time, and will also pile on responsibilities without taking things away unless you aggressively and continuously boundary your time
-politics
-beurocracy

Some possible reasons to do academics:
-You love teaching or research (you don't have to love or do both, but if you don't want to do either, there's absolutely no reason to stay), and being directly part of those communities (my friends who went into non-academic jobs, they are happy, but sometimes they miss the built in communities in academia where you can throw a pen into the hallway and hit three people who would be happy to talk through a case with you).
- PSLF really makes sense for you and an academic center is the best option for your geographically, maybe?

Personally, I think academic depts should embrace part time faculty more than many historically have (see my second bullet point). Lots of people enjoy teaching and the camaraderie of being in academia but don't want to give up entirely on the money or play the full rat race.

Prestige is bull**** and means nothing unless you love research, in which case it is meaningful currency, but not a reason in and of itself.

 

[tr]

What exactly does a career in academic psychiatry look like (salary comparison, quality of life, daily routine) besides the obvious component of being able to teach and/or do research? Or, to put it another way - what are the reasons not to do academic psychiatry?

Salary: Lower

Quality of life: Completely dependent on your own preferences and the environment within your institution/department

Daily routine: Highly variable, depends on your actual job

Reasons *not* to do academics? Mainly reimbursement related I would think, if you otherwise like the position you've been offered.

 

[tr]

Personally, I think academic depts should embrace part time faculty more than many historically have (see my second bullet point). Lots of people enjoy teaching and the camaraderie of being in academia but don't want to give up entirely on the money or play the full rat race.

Sure there are lots of people who would love to do a little teaching while still making a competitive clinician's income. They're called 'voluntary' or 'adjunct' faculty and they do the teaching for free, in exchange for an academic affiliation they can put on their business card.

From the point of view of the department, there's no benefit in having lots of part time faculty. It's an administrative headache and more importantly, it prevents the dept from commandeering the revenue generating capacity of their clinical faculty. They want you to do your teaching as part of a full time faculty job so they can dean's tax the h3ll out of your clinical revenue, not have you keep it all for yourself.

 

[tr]

Academic psych has less money, more bureaucracy, more requirements (projects, lectures, research), and may be entitled to full ownership of things you create/invent in the field.

To speak to the QOL issue: If the 'requirements' of projects/research are something you would actually enjoy and prefer to do with your time vs all clinical work, then academics may be for you. If you view these activities as a burdensome extra, then academics may not be for you.

Personally I would be quite unhappy doing clinical work 5 days per week. I love seeing patients... 2 days per week. 40 hours a week of patient care, I couldn't do.

 

[tr]

-The depts think they own your life and you should be working on the academic mission all the time, and will also pile on responsibilities without taking things away unless you aggressively and continuously boundary your time

This I have to say I have not experienced. The only kind of pressure I've ever gotten from the dept is to make my clinical revenue targets. Other than that, they don't care what I do. I do research and teaching because I like it. Service I don't do, and nobody has ever cared.

 

[TexasPhysician]

To speak to the QOL issue: If the 'requirements' of projects/research are something you would actually enjoy and prefer to do with your time vs all clinical work, then academics may be for you. If you view these activities as a burdensome extra, then academics may not be for you.

Personally I would be quite unhappy doing clinical work 5 days per week. I love seeing patients... 2 days per week. 40 hours a week of patient care, I couldn't do.

I guess truly academic projects like research and posters aren’t bad if you enjoy them.

Are there psychiatrists that really enjoy quality improvement types of projects though?

I recall meetings as a chief that included creating quality improvement projects. No one ever seemed that interested, and it appeared like the department couldn’t bring anyone in with IT/stats knowledge to carry out a real project.

I brainstormed something like IT evaluating the stats on how soon patients obtain ordered labs in the past 6 months and then creating a plan for how to get patients to do them sooner. I was looked at as crazy to think we could calculate such numbers.

I pretty much zoned out after, but I think the winning project was front desk staff handing out a survey on what can be improved. I think we then had a meeting on what to improve based on surveys.

Other projects were things like how to get residents to volunteer to be on emergency staffing teams like who would stay in the hospital in the event of a tornado strike.

Many of these “projects” are not truly psychiatry related even though they try to spin them as such.

I’m not trying to bash academia as I find that aspects of teaching are quite enjoyable. The pay isn’t bad for reduced clinical work. The OP was just wanting to know more negatives.

 

[comp1]

Just remember, there are lots of ways to do teaching outside of a formal university FTE appointment. There are also lots of ways to do research in industry. And of course student loan forgiveness is offered by many if not most employers, some far surpassing PSLF. Academia, I have to assume, is stayed in for cultural reasons.

 

[clozareal]

The salary tends to be on average lower by about 20-30% from what I've seen. However, I've also seen many people in academics do really well financially: they have private practices on the side, do consulting for pharmaceutical/medical device companies, write a book, and supplement their income in other ways. Some of the highest paid psychiatrists I know were/are in academic medicine.

The productivity varies. I've seen places where the requirement is 10 hours of patients per week whereas others 30. It depends on the mix of clinical, research, teaching, and administrative duties. I've also heard of places not doing anything if you don't meet the RVU threshold other than send you a finger wagging email. Not sure if that is just because of the flexibilities during the pandemic though.

I think the more important in job satisfaction depends on whether you are working in inpatient, outpatient, ER, consult, PHP, IOP, residential, etc. and whether that is a good fit for your personality, clinical interests, and how you find meaning out of your work. I would be burnt out doing ER work but I know some people would burn out doing what I do: private practice and seeing mostly therapy and children/families all day long.

Another important aspect is the ability to have creativity in how you want to deliver care and if you have departmental backing or not. Do you want to start a unique program treating OCD where there is none in your area? Do you want to start up a collaborative clinic between neurology and psychiatry? Do you want to create a clinic specifically treating X diagnosis? Are you wanting to start a TMS/ECT/ketamine/DBS program? Lots of creative options that you can do in other settings, but without the financial backing, referral sources, interdisciplinary teamwork and support, and institutional reputation, it might be much tougher.

 

[whopper]

Academic psychiatry usually makes less. Some places let you have side gigs. (Others do not). Academia could provide an outlet for you to make much more money but this is not the norm. E.g. you could publish a book that makes a lot of money. Academia opens doors to help you author books.

The bureaucracy problem varies by institution. Some institutions are far worse than others in this regard.

Prestige is bull**** and means nothing unless you love research, in which case it is meaningful currency, but not a reason in and of itself.

The prestige isn't young attractive people wanting your autograph. It's from a bunch of old geezers like me.

 

[Yale Medicine]

If you publish a book that makes a lot, doesn't the institution have full rights and you get a paltry % royalty good enough for, perhaps, buying a fast food dinner on occasion or a pair of shoes?

 

[comp1]

What exactly the institution has rights to is highly variable by both the university and your specific contract, but it's going to generally be much more than pretty much anywhere else you might work.

 

[tr]

I guess truly academic projects like research and posters aren’t bad if you enjoy them.

Are there psychiatrists that really enjoy quality improvement types of projects though?

Oh yeah, I wouldn't know about that. QI I don't do but I agree it looks awful. I would consider that more like service, not research.

 

[tr]

Just remember, there are lots of ways to do teaching outside of a formal university FTE appointment. There are also lots of ways to do research in industry. And of course student loan forgiveness is offered by many if not most employers, some far surpassing PSLF. Academia, I have to assume, is stayed in for cultural reasons.

Research in industry is driven by the financial interests of the company. You do what they tell you.

Research in academia is driven by the interests of the investigator. If you can get an agency to fund it, you can do it.

That is a very critical difference.

 

[comp1]

Research in academia is still driven by the interests of the funding organization. It might also be industry or it might be the government or it might even be a private donor. It's just something that you have to keep reapplying for. The academic institution gets to insert itself, however, for good or ill.

 

[whopper]

 

[Marasmus1]

The academics is pretty much exchanging somewhere around 10-20 h of clinical care with other duties such as research, teaching and/or administration. As a result, you get paid much less because research and teaching do not have as much monetary value in the medical system as much as service.

This kind of thing exists in some other fields as well. I know a IVY league lawyer who refused 500k in private sector in manhattan and currently working for 70k for a non profit environmental cause organization. So if you dont care about money and you enjoy the advancement of your field and raising next generations, academics might be a good place for you

 

[tr]

The academics is pretty much exchanging somewhere around 10-20 h of clinical care with other duties such as research, teaching and/or administration. As a result, you get paid much less because research and teaching do not have as much monetary value in the medical system as much as service.

Honestly this isn't even true. A 5y research project grant with 500K direct costs per year brings the institution $1.7M in indirects (assuming a 69% indirect cost rate).

As an individual clinician it would be difficult for me to bring in that much in clinical revenue to the university, over and above my salary. It would require a lot of cash pay patients at a pretty high rate.

 

[Celexa]

Honestly this isn't even true. A 5y research project grant with 500K direct costs per year brings the institution $1.7M in indirects (assuming a 69% indirect cost rate).

As an individual clinician it would be difficult for me to bring in that much in clinical revenue to the university, over and above my salary. It would require a lot of cash pay patients at a pretty high rate.

A very tiny minority of academic center physicians have grants of that type.

 

[SeniorWrangler]

This varies a lot by institution. Some of them are pretty hardcore about making you work for your pay and will discourage you from getting involved in education because they just want those RVUs. At point, you're basically working a regular psychiatry job but getting paid significantly less for the privilege of calling yourself a (Clinical) Professor. Also, if you don't get along with your chief, you might be toast! Be wary of signing a non-compete because then you're a captive of the system. It can be a good way to spend a few years among smart colleagues and getting to know the community as long as you have an escape route.

All this is different if you think you're a superstar educator or a grant magnet, but most doctors are not,

 

[PikminOC]

The academics is pretty much exchanging somewhere around 10-20 h of clinical care with other duties such as research, teaching and/or administration. As a result, you get paid much less because research and teaching do not have as much monetary value in the medical system as much as service.

This kind of thing exists in some other fields as well. I know a IVY league lawyer who refused 500k in private sector in manhattan and currently working for 70k for a non profit environmental cause organization. So if you dont care about money and you enjoy the advancement of your field and raising next generations, academics might be a good place for you

500 K private sector work would also be alllooooottt more work and hours than the 70 k job

 

[PikminOC]

This varies a lot by institution. Some of them are pretty hardcore about making you work for your pay and will discourage you from getting involved in education because they just want those RVUs. At point, you're basically working a regular psychiatry job but getting paid significantly less for the privilege of calling yourself a (Clinical) Professor. Also, if you don't get along with your chief, you might be toast! Be wary of signing a non-compete because then you're a captive of the system. It can be a good way to spend a few years among smart colleagues and getting to know the community as long as you have an escape route.

All this is different if you think you're a superstar educator or a grant magnet, but most doctors are not,

My brother works on academics. He loves it because residents do a lot of the work for him. He's a health nut so he has a lot of time to exercise. He also gets a lot of vacation.

 

[Mad Jack]

If you're willing to do a bit less glamorous of a job, university-affiliated community programs can let you teach residents while often having far more competitive salaries than typical university programs, at least from what I've seen. Personally I really like to teach, I feel like it keeps my skills far more sharp than they would be otherwise and I just enjoy working with medical students and residents. I'm signed up for a clinician-educator track, and given the small size of the department and my particular role within it, upward mobility is also much better than in bigger institutions.

Granted, the best paying of these positions often aren't in super desirable metros, so YMMV.

 

[shoomer]

I really like the academic environment, being able to discuss complex cases with others, and want to continue teaching as an attending...however, the flexibility and control over my own schedule in private practice is really preferable to me.

Some people commented on how part time work isn't embraced in academia so I was wondering, is a hybrid private practice-academic work schedule feasible or hard to find?

 

[Fpg1245]

This was the old arrangement. Academics were paid less but given time to conduct research and teach. They had lower volumes but the eye residents did the work.

Post ACA? Not at all. You are expected to carry a large clinical load, expected to teach, and publish. Oh and you are expected to do the latter two mostly in your spare time.

It went from a decent deal to basically another crappy job with low prospects for most.

And now thanks to massive consolidation that will never end…you have no choice but to be an academic.

 

[Mad Jack]

This was the old arrangement. Academics were paid less but given time to conduct research and teach. They had lower volumes but the eye residents did the work.

Post ACA? Not at all. You are expected to carry a large clinical load, expected to teach, and publish. Oh and you are expected to do the latter two mostly in your spare time.

It went from a decent deal to basically another crappy job with low prospects for most.

And now thanks to massive consolidation that will never end…you have no choice but to be an academic.

It's hardly that grim. Most of the jobs out there are non-academic, I had to go out of my way for something that let me teach. And there's always private practice.

 

[sloh]

And now thanks to massive consolidation that will never end…you have no choice but to be an academic.

Maybe for Nephrology and Rad Onc. Not psychiatry.

 

[Fpg1245]

Maybe for Nephrology and Rad Onc. Not psychiatry.

Hospitals and PE haven’t figured out how to really profit from psychiatry the way they have from every other field but if they ever did forget it they’ll sweep through so fast you’ll never know what hit you.

 

[Celexa]

This was the old arrangement. Academics were paid less but given time to conduct research and teach. They had lower volumes but the eye residents did the work.

Post ACA? Not at all. You are expected to carry a large clinical load, expected to teach, and publish. Oh and you are expected to do the latter two mostly in your spare time.

It went from a decent deal to basically another crappy job with low prospects for most.

And now thanks to massive consolidation that will never end…you have no choice but to be an academic.

Working for a health care conglomerate that has an academic center and being an academic psychiatrist/having an actual academic position are not at all the same thing.

A good friend of mine works for an affiliate medical center of a big prestigious academic health system, but his job is a typical employed job. He makes market rate on an RVU system and works basically 9-5. It's working well for him. He is not academic, no matter what logo is on the door.

I took an actual academic job. I will have a faculty appointment at the medical school. My contract lays out FTEs of in terms of clinical and educational/admin time. I am expected to be 'productive', although since I am clinical track and not research track, the actual publication requirements are light and the various educational things I do count into the 'scholarly productivity' requirements. I have zero clinical productivity requirements.

My friend makes 30-50% more than I will depending on how much he decides to flog for RVUs. I get compensated in other intangibles. However, it the calculus shifts (if theres a leadership change, if they want me to take on responsibilities where the burden outweighs my personal benefit, etc) I'll jump ship to individual private pracrice.

 

[Celexa]

I really like the academic environment, being able to discuss complex cases with others, and want to continue teaching as an attending...however, the flexibility and control over my own schedule in private practice is really preferable to me.

Some people commented on how part time work isn't embraced in academia so I was wondering, is a hybrid private practice-academic work schedule feasible or hard to find?

It's not the easiest but it's not impossible. I left a dept that didn't allowed it and found one that would. They clearly would have preferred that I work for them full time but they would rather have me part time than not at all. I had to be firm but I got a contract that lets me have a private practice.

This is one area where training pedigree can matter. I will be fellowship trained. Academic depts need a certain number of board certified faculty in different areas to maintain various accredditations and and staff teaching services. Thats why I recommend people who want to stay in academics consider fellowship (if you aren't a top tier researcher).

It's not impossible to negotiate for these things as a general psychiatrist but your negotiating position won't be quite as strong, and will depend on how much they need certain things filled (which of course, means sacrificing at least some flexibility).

 

[whopper]

If you publish a book that makes a lot, doesn't the institution have full rights and you get a paltry % royalty good enough for, perhaps, buying a fast food dinner on occasion or a pair of shoes?

Depends. Some institutions make more or less. Some won't even pay you at all!
But this is not so black and white in the bad sense. Say you publish a chapter on a textbook. Several academic institutions promote based on publications so this could help you with a promotion down the road that will pay more money. Also you could use that as a stepping stool for other things. E.g. if I published a chapter in a textbook (and I've been offered), I am a bigger prize in offering expert-witness testimony and could use that credential very well especially if the chapter was germane to the legal case.

Having seen different academic institutions some places will pay you decent amount for things such as the above. Others won't.

I will say that the last academic institution I was a part of IMHO wasn't paying the fair share from hard work so I left. While I was at U of Cincinnati I felt they were giving lots of opportunities that were going to yield nice dividends intellectually, financially, and collegially but I moved out of that area because my wife got a job that moved us out. The U of C job, however, would've had me working my tail off.

The last place, that I won't mention by name IMHO was robbing me, and the free headphones, pens, and other junk items I didn't even want wasn't going to compensate. They were paying me less than 1/3 of what I was bringing in, and I was bringing in way more than most doctors in the department. I remember doing a forensic case and they paid me NOTHING for it over my usual salary with no mentorship. While I was at U of C I would've gotten paid 70% of what the lawyer was paying which IMHO was more than fair given that because I was in the institution I was being given several legal cases, legal cases pay much more money than general psychiatry work, and I was part of a team where I was being given mentorship by the best people in the field.

Add to that the often-times great things being a part of a university weren't happening at the last place either. Food sucked, the hospital was very behind the times in terms of design, the IT department wouldn't fix broken computers period despite that there weren't enough computers on the unit....

 

[Mad Jack]

Hospitals and PE haven’t figured out how to really profit from psychiatry the way they have from every other field but if they ever did forget it they’ll sweep through so fast you’ll never know what hit you.

The difference between every other field and us is that we can literally work from anywhere and require zero equipment. I could set up with a card table, a notebook, and a pen in the woods if I wanted and take cash-only payments (though depending on your clientele you're either going to end up with very well-to-do earthy types or people that pay you in eggs and moonshine). The only way PE can screw you over is if you hand them your balls on a silver platter and choose to let them own you.

 

[clausewitz2]

The difference between every other field and us is that we can literally work from anywhere and require zero equipment. I could set up with a card table, a notebook, and a pen in the woods if I wanted and take cash-only payments (though depending on your clientele you're either going to end up with very well-to-do earthy types or people that pay you in eggs and moonshine). The only way PE can screw you over is if you hand them your balls on a silver platter and choose to let them own you.

Why not cater to both? One side of the chair for the patient is a spitting urn, the other is a display of herbal supplements.

 

[G Sheb]

Unless you have big grants and/or are one of the handful hand picked to climb the administrative rankings, you will be lowly and replaceable.
The culture of the environment will vary heavily though from program to program.
If you're not interested in higher up administration or research, I really don't see what's the positive of academia. High stress, low pay job. Thank you very much.

 

[Yale Medicine]

The difference between every other field and us is that we can literally work from anywhere and require zero equipment. I could set up with a card table, a notebook, and a pen in the woods if I wanted and take cash-only payments (though depending on your clientele you're either going to end up with very well-to-do earthy types or people that pay you in eggs and moonshine). The only way PE can screw you over is if you hand them your balls on a silver platter and choose to let them own you.

A friend of mine does just that. Telepsych from the road. He has a laptop and camera and can see patients as he travels as long as private space. He was in Hawaii, then Alaska, then Florida doing very well for himself making over $400K. I think Radiologists enjoy this freedom as well with their telerads services.

 

[clozareal]

My brother works on academics. He loves it because residents do a lot of the work for him. He's a health nut so he has a lot of time to exercise. He also gets a lot of vacation.

I always thought that attendings in academic centers don't do as much work or see as many patients. The residents/fellows see the patients, do the history gathering, returns messages/calls from patients, and tells the patient the plan. Seems chill.

 

[tr]

I always thought that attendings in academic centers don't do as much work or see as many patients. The residents/fellows see the patients, do the history gathering, returns messages/calls from patients, and tells the patient the plan. Seems chill.

I like working with residents but they are not a net timesaver. They are orders of magnitude less efficient with their time than I am and they regularly leave critical information out of the H&P, which creates problems down the road and often requires me to go on fact-finding cleanup missions later in the course of treatment. All this is fine because they are learning. But from my perspective it's actually faster and more efficient for me to see patients solo.

 

[tr]

Unless you have big grants and/or are one of the handful hand picked to climb the administrative rankings, you will be lowly and replaceable.
The culture of the environment will vary heavily though from program to program.
If you're not interested in higher up administration or research, I really don't see what's the positive of academia. High stress, low pay job. Thank you very much.

I agree with this. Generally there are several different things called 'academia' that are actually pretty different from each other.

For clinicians hired to keep the patient care machine churning, there really isn't an advantage to being a big box hireling. It's the same work for less money and autonomy. For this reason, the big AMCs have a constant churn of hiring their own recent grads to fill clinical needs. People who don't have an abiding interest in research, teaching, or administration figure out it's a bad deal in a few years and move on. This is actually fine from the point of view of the department, from which clinicians are largely replaceable widgets who bring the same amount of revenue whether they've been working there for 6 months or 10 years.

For those who do have career interests in research or education, there isn't really an option to do these things seriously outside academia, so you take the bad with the good because leaving academics would completely transform the content of your job to something you would find significantly less interesting and rewarding.

 

[PikminOC]

Hospitals and PE haven’t figured out how to really profit from psychiatry the way they have from every other field but if they ever did forget it they’ll sweep through so fast you’ll never know what hit you.

Psychiatry departments are money losers for hospitals.

 

[Mad Jack]

Psychiatry departments are money losers for hospitals.

Yeah, I asked a higher up recently about why we don't expand psychiatric services with all of the demand, and the answer was basically, "we cost money, and that's always the issue. Why would the system give us office or inpatient space that they could give to a cardiologist or orthopedist instead?"

 

[G Sheb]

I agree with this. Generally there are several different things called 'academia' that are actually pretty different from each other.

For clinicians hired to keep the patient care machine churning, there really isn't an advantage to being a big box hireling. It's the same work for less money and autonomy. For this reason, the big AMCs have a constant churn of hiring their own recent grads to fill clinical needs. People who don't have an abiding interest in research, teaching, or administration figure out it's a bad deal in a few years and move on. This is actually fine from the point of view of the department, from which clinicians are largely replaceable widgets who bring the same amount of revenue whether they've been working there for 6 months or 10 years.

For those who do have career interests in research or education, there isn't really an option to do these things seriously outside academia, so you take the bad with the good because leaving academics would completely transform the content of your job to something you would find significantly less interesting and rewarding.

Agreed.
If you get the grants, you're the top dog.
I think a purely clinical career in academic psychiatry doesn't make a lot of sense, and a lot of these newer grads get locked in the system because they are hesitant to step outside their institution.
I've wrestled with this cause I have a big interest in research but decided being a perennial trainee in my mid to late 30s wasn't for me. Hopefully with the spread of big data and computer power, they system may change a bit and research can be more accessible for those not willing to get locked in the Ivory Tower.

 

[FlowRate]

Something I didn't see yet--and I think this is highly variable by department--a lot of academic jobs seem to have more call than a typical outpatient job (supervising residents overnight and possibly needing to be called in, for example.)

 

[coroner]

A friend of mine does just that. Telepsych from the road. He has a laptop and camera and can see patients as he travels as long as private space. He was in Hawaii, then Alaska, then Florida doing very well for himself making over $400K. I think Radiologists enjoy this freedom as well with their telerads services.

I would think Psych still has the advantage as far as independence, right? As mentioned, there's relatively little overhead & equipment needed for Psych. Even though Rads can still do telework just as easily from their computer, its workflow is still a hospital-based specialty that requires X-ray, CT, U/S techs, etc. not to mention the costly equipment. More importantly, imaging tests which radiologists generate their income from has to be ordered by another provider. Rads has to rely on the middleman, whereas Psych doesn't and can have a one-one-one, payor-payee model.

 

[Mad Jack]

I would think Psych still has the advantage as far as independence, right? As mentioned, there's relatively little overhead & equipment needed for Psych. Even though Rads can still do telework just as easily from their computer, its workflow is still a hospital-based specialty that requires X-ray, CT, U/S techs, etc. not to mention the costly equipment. More importantly, imaging tests which radiologists generate their income from has to be ordered by another provider. Rads has to rely on the middleman, whereas Psych doesn't and can have a one-one-one, payor-payee model.

Yeah, we are literally the most independent field in medicine, both practically and when you look at the data. No field has the freedom we do, and more of us take cash than any other field for a reason

 

[Celexa]

I like working with residents but they are not a net timesaver. They are orders of magnitude less efficient with their time than I am and they regularly leave critical information out of the H&P, which creates problems down the road and often requires me to go on fact-finding cleanup missions later in the course of treatment. All this is fine because they are learning. But from my perspective it's actually faster and more efficient for me to see patients solo.

I agree with this. I think some academic jobs can be cush bc volumes are lower (from what I've seen and the non academic jobs that get asked about here, this seems to be particularly true of inpatient unit work?) but they are not cush due to working with residents. At least, not if you care about ensuring good patient care and actually teaching.

With strong residents there's a point in the year where they are experienced or returning to a service and trustworthy you can lean back a bit. But that's not the all of them, and you have to have worked with them enough to know their skill set. Those residents are balanced by the ones who need additional help or remediation.

 

[Celexa]

Yeah, I asked a higher up recently about why we don't expand psychiatric services with all of the demand, and the answer was basically, "we cost money, and that's always the issue. Why would the system give us office or inpatient space that they could give to a cardiologist or orthopedist instead?"

We're never going to be the biggest profit center of the hospital, that's for sure. However, the level of financial incompetence I've seen in some academic depts when it comes to the business and logistical side of clinical care (efficient scheduling, collections, effective billing) makes me seriously wonder if we HAVE to be a money loser or if that's a product of mismanagement. Call me a conspiracy theorist but breaking even at least doesn't seem completely unattainable.

 

[G Sheb]

I agree with this. I think some academic jobs can be cush bc volumes are lower (from what I've seen and the non academic jobs that get asked about here, this seems to be particularly true of inpatient unit work?) but they are not cush due to working with residents. At least, not if you care about ensuring good patient care and actually teaching.

With strong residents there's a point in the year where they are experienced or returning to a service and trustworthy you can lean back a bit. But that's not the all of them, and you have to have worked with them enough to know their skill set. Those residents are balanced by the ones who need additional help or remediation.

I agree that supervision is a job in and of itself and can be difficult and stressful.
But as someone who supervises residents in the ER, residents can take a bulk of otherwise very time consuming work if done on your own (writing full notes, getting collateral, answering RN calls, legals..etc).
With the rare exception, they also far more competent and efficient than 'midlevel' providers.

 

[calvnandhobbs68]

Yeah, I asked a higher up recently about why we don't expand psychiatric services with all of the demand, and the answer was basically, "we cost money, and that's always the issue. Why would the system give us office or inpatient space that they could give to a cardiologist or orthopedist instead?"

Meh I always call bull**** with this. It’s a “money loser” because academic centers are terribly inefficient. It’s a money loser because they do things like pay 3 middle managers in the finance department to calculate out if it’s a money loser or not and pay 3 secretaries to do the job of one secretary in private practice. The amount of incompetence in these big systems is hilarious and often times incompetent people just get shifted around, especially administrative staff. Big academic centers also negotiate big rates for themselves or keep their patients internal to their systems. If psychiatry was truly a money loser then I wouldn’t be able to go setup shop and make money year one anywhere.

Now inpatient psychiatry is a different story, that’s likely a money loser because a bunch of those patients are uninsured or Medicaid.