Lifestyle is a big difference. Academic surgeons get paid less, but are pampered more. For example, the residents buffer a lot of things that the private practice surgeon may have to deal with (like middle of the night phone calls for post op problems). They also do a lot less of the day to day hands on care of the patient. At my institution, they round once or twice a week, (if at all), and they're called to come to the OR after the case is well underway and they'll scrub in (if at all) only for the critical portion of the case. Academic surgeons see more tertiary care, challenging cases than a private practice surgeon. The flip side is again, they get paid less, and they are under the gun to publish. Plus, there are the politics involved with every academic center which can be a major hassle. Private practice surgeons probably have better hands-on skills (time is money) and make more money as well. They probably work longer hours than their academic collegues, although the transplant and trauma surgeons would disagree with this statement. Also, academic surgeons usually have a specific specialty in which they focus (ie endocrine, hepato-biliary, colorectal, etc) whereas a community general surgeon can often do it all. Both have distinct advantages and disadvantages. It's a tough choice, believe me.
