academic versus community psych / other ways to practice

[thomasina]

Could somebody tell me a little bit more about the difference between community, private practice vs academic setting psychiatry? The main thing I've heard is that the salaries are lower in academia. But... are the people in academia "better"? I care about doing a good job - I don't care about being the best, but I want to be surrounded by people who care about learning and improving their practices. I was hoping that at least in the few years after residency, I could practice in some sort of hospital (?academic?) setting so that I could learn from my more senior colleagues. But it is hard for me to start looking for a job when I am not clear on what possibilities are out there.

Other stuff - I do not see myself doing research longer term, but would probably not mind or even enjoy teaching.
Also - I really don't want to take any overnight call as an attending.
Thanks!

---

Members don't see this ad.

 

[oldiebutgoodie1211]

Yes the academic people are definitely better on average and at the extremes, they generally care more about their practice and are much more up to date on the evidence base. Community standard is quite low and you will see a wide variety of practice and very strange med regimens that pretty much don’t make sense..you see this much less often in academia and when you do the prescribing doc usually has a theory behind what he’s doing not randomly just mixing medications.

 

[NickNaylor]

I don't think there's anything to the idea that academics are "better" than community-based psychiatrists. Some of my colleagues are pretty terrible clinicians. That said, the fact that there are academic opportunities for continued learning and you generally work with a bunch of other people, which facilitates information sharing, may make people in academic settings more likely to at least be more up-to-date. But it's not as if everyone in academia - at least in my shop - is outstanding or the best-of-the-best. The expanding role of PAs and NPs also, in my opinion, means that the quality of care we are providing in our outpatient clinic is gradually declining.

Personally, I would never work in an outpatient clinic as an employee or in a big health system. At my institution, the outpatient psychiatrists are the lowest paid yet probably do the most amount of work on a typical work day, and they definitely have the most administrative hands in their work than any other setting. I have to do some clinic work (for interventional psychiatry assessments) and I thoroughly dislike it and would get rid of that aspect of my job if I could. I would much rather start my own practice and be my own boss than work in a huge system in the outpatient setting.

Benefits for academia for me include: 1) a reasonable workload in my setting (inpatient) which simply doesn't exist in private facilities, 2) being able to teach, and 3) being in a group of folks that I enjoy working with. I have no interest in research so that's not a big draw for me. You will definitely take a pay hit going into academia compared to what you could make in a private setting, but the benefits of working in the setting might outweigh that cost for you. Only you could make that decision.

I should also say that you can still maintain a community of folks even if you go into private practice: in our city, we have a local APA branch that is fairly active and is mostly filled with folks in private practice. Going to conferences and other formal educational activities can keep you up-to-date clinically. These things are not exclusive to being in academia - it's just a bit easier to do those things in academia, I think, by virtue of the environment.

 

[whopper]

Academia: You could be working with top people, on average the physicians are more on top of the data. You have more opportunity to teach and do research. If you have kids they could go to college likely tuition-free. The place could have a very good retirement package.

I was in academia and wasn't planning on leaving but my last job was so toxic I left. Private practice pays 2x as much and I work much less. My first academic job was good, but I moved to a new place cause my wife got a new job in another city. The second place was a disappointment to say the least.

The money and lesser hours I didn't care about in my younger years cause a 6 figure salary is fine for pretty much anyone,, but having kids and wanting to raise them for real, well that now matters.

Private Practice: Makes more money, you are your own boss (that can be good or bad. Good-if somethings wrong you can immediately fix it. Bad-if you don't like managing your place of business this can be frustrating worrying about non-medical/treatment issues). The overwhelming majority of the practice will likely limited to people with a GAF of about 50+ with very few people below that. Patients tend to have better SES due to them having the private insurance or funds to pay you.

Community psych: usually makes about as much as academia, maybe slightly higher. You deal with patients with a lesser GAF. More patients need more help due to worse mental illness or SES factors.

 

[PikminOC]

I don't think there's anything to the idea that academics are "better" than community-based psychiatrists. Some of my colleagues are pretty terrible clinicians. That said, the fact that there are academic opportunities for continued learning and you generally work with a bunch of other people, which facilitates information sharing, may make people in academic settings more likely to at least be more up-to-date. But it's not as if everyone in academia - at least in my shop - is outstanding or the best-of-the-best. The expanding role of PAs and NPs also, in my opinion, means that the quality of care we are providing in our outpatient clinic is gradually declining.

Personally, I would never work in an outpatient clinic as an employee or in a big health system. At my institution, the outpatient psychiatrists are the lowest paid yet probably do the most amount of work on a typical work day, and they definitely have the most administrative hands in their work than any other setting. I have to do some clinic work (for interventional psychiatry assessments) and I thoroughly dislike it and would get rid of that aspect of my job if I could. I would much rather start my own practice and be my own boss than work in a huge system in the outpatient setting.

Benefits for academia for me include: 1) a reasonable workload in my setting (inpatient) which simply doesn't exist in private facilities, 2) being able to teach, and 3) being in a group of folks that I enjoy working with. I have no interest in research so that's not a big draw for me. You will definitely take a pay hit going into academia compared to what you could make in a private setting, but the benefits of working in the setting might outweigh that cost for you. Only you could make that decision.

I should also say that you can still maintain a community of folks even if you go into private practice: in our city, we have a local APA branch that is fairly active and is mostly filled with folks in private practice. Going to conferences and other formal educational activities can keep you up-to-date clinically. These things are not exclusive to being in academia - it's just a bit easier to do those things in academia, I think, by virtue of the environment.

What is interventional psychiatry?

 

[NickNaylor]

What is interventional psychiatry?

TMS, ECT, and ketamine (specifically esketamine) for our purposes. Experimental treatments (e.g., DBS for depression) would be included too, but we don't offer those forms of intervention.

 

[WisNeuro]

What is interventional psychiatry?

In our system, it's what they group ECT, TMS, and things like ketamine infusions into.

 

[Sushirolls]

Neurostimulation is a better term over interventional psych.

 

[Stagg737]

Generally speaking I've found the non-academic docs to be less up-to-date with more recent literature and treatment guidelines. Whereas almost all of my academic attendings save 1 or 2 to be very pretty well-versed in the literature including recently published studies. There's also a more reliable level of care from the academic docs in our city where the the community/PP people range much more from excellent to "did you even go to med school?" levels of care.

I don't care about being the best, but I want to be surrounded by people who care about learning and improving their practices. I was hoping that at least in the few years after residency, I could practice in some sort of hospital (?academic?) setting so that I could learn from my more senior colleagues.

This can be found outside of academia, but idk how common it is or how easily you could find someone in your practice to essentially mentor you. You can also teach outside of academia. Most DO schools don't have home hospitals and private docs act as preceptors to 3rd and 4th year students. So if you're near a DO school you could contact them about becoming a preceptor to students or even with MD schools about being available as an elective rotation.

 

[Sushirolls]

Academics versus community practice can equally hold sway over quality. It's not the practice environment that will dictate "better" but the Psychiatrist them selves.

A bad academic doc also has the power to do far more harm than their private practice colleagues. Producing article after article that everything is Bipolar for example. Or integrating too deep into the pharma industry and producing their shell research.

I've also seen people get academic jobs simply because they were the warm body who showed up. Or their spouse was the real star the institution wanted, and their job was a consolation prize to get the real person of interest. I've also seen some docs kept around simply because they are publishing. Not because they were quality colleagues or clinicians, but they simply did just enough.

I've also seen the community doc who practically rubber stamps the same note on everyone and pursues clinical volume.

 

[comp1]

Consider a VA with an academic affiliation! You can teach and have your grand rounds without as much need for research and the pay is generally better for the amount of work than straight academics or community based clinics, although not as much as you might make at a HMO or in a fancy private insurance/cash practice.