Academic vs private career

[Alpetragius]

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Good evening everyone

can anyone who worked in both private and academic settings tell us his/her experience.
- patient load
- midl level support (is it that available in private practice?)
- compensation: does it really worth it , having in mind the difference in patient load
- type of patients: do you see the same kind of cool stuff in private practice that you would see in academics.
- satisfaction with work
- any other valuable points in terms of difference between private and academics

thank you everyone and happy holidays

 

[Thama]

I haven't, but I recently had a conversation with someone who had and touched on many of these points.

1) He sees more people in private practice than he did in academics, but feels less busy because he has far less other stuff to do.
2) He doesn't have mid-level support. I do know people at practices that employ midlevels, however.
3) He makes substantially more in private practice, though he stressed this wasnt the driving factor in moving.
4) He is overall happier in private practice as he wasn't that interested in the end in the things academic departments provide.
5) We didn't discuss patient complexity. However, my experience rotating in private practice makes me think that the types of patients seen by general neurology at an academic center vs private practice are likely pretty similar, while more subspecialized centers in academic departments get a higher density of atypical cases.

 

[deathmerchant]

Good evening everyone

can anyone who worked in both private and academic settings tell us his/her experience.
- patient load
- midl level support (is it that available in private practice?)
- compensation: does it really worth it , having in mind the difference in patient load
- type of patients: do you see the same kind of cool stuff in private practice that you would see in academics.
- satisfaction with work
- any other valuable points in terms of difference between private and academics

thank you everyone and happy holidays

There are many more settings than those two, like - Big University academic program with residents and fellows, Small university with 2-3 residents/yr, Community programs with small residency prog, Large busy private hospitals with all specialities, small private hospitals, multi- specialty private groups, multiple providers' private group and solo private practice.

- solo pp patient load is usually flexible and you can seen as few (enough to sustain practice) or as many as you need to make crazy money. Your schedule can also be very flexible. But obviously much more admin work and responsibility. In rest of the settings there will always be the push to see more patients and take call, esp in private settings, and somewhat in academic settings

- It depends on how busy you are, you can usually get that in any setting, if you can justify based on workload.

- There is a significant compensation difference in academic and private practice. I would say at least 60k-100K for similar workload.

- Obviously academic centers will have more complex cases and second and third opinion cases. But in neuro there is no shortage of cool stuff. Also in tertiary centers you end up collecting a lot of "never happy" patients and/or 'functional patients' because you can't refer them further. But you also get to diagnose rare stuff. In pp you get to see a lot of new diagnoses.

- That depends on how much you like teaching/research/didactics, which I personally think is very important/fulfilling in neuro.




-

 

[neglect]

5) We didn't discuss patient complexity. However, my experience rotating in private practice makes me think that the types of patients seen by general neurology at an academic center vs private practice are likely pretty similar, while more subspecialized centers in academic departments get a higher density of atypical cases.

You'll see a few more "atypical" cases like CJD, FTD, venous thrombosis, and odd seizure cases in academics. General neurologists will send their 'hard' cases to you. But if you're sub-specialized, then they're easy and common for you. For example, a general neurologist is seeing MS, carpal tunnel, then migraine. So if a case of NMO comes along, and they are not expert enough to feel comfortable with this rarish disease state, they will send to an academic center for a second opinion and perhaps to initiate treatment. If you're an MS doc in an academic center, then you'll probably have dozens of NMO cases, so it isn't that atypical for you.

But you'll certainly attract MUCH different cases on two important populations. Academic centers serve people we called poor, hostile, and difficult before we became woke and now call "socioeconomically disadvantaged." Not a big deal. The other population are the ones that see themselves as VIPs, too good for the local docs, and who insist on the best. Nevermind that they just have run of the mill MS, want you to affirm their stupid MS-keto diet and herbs. So yes, atypical cases, but perhaps not the way it is framed by @Thama.

 

[Epic786]

- patient load: private practice would have more patient than academics.
- midl level support (is it that available in private practice?) more midlevel support in private practice. in big academic center they will have one nurse for whole division.
- compensation: does it really worth it , having in mind the difference in patient load :300K plus in private to 130K in big academic center (Ivy League)
- type of patients: do you see the same kind of cool stuff in private practice that you would see in academics. depends
- satisfaction with work: yes it depends if you are looking for name sake or money at the end of the day
- any other valuable points in terms of difference between private and academic
I would suggest going for a hospital employed setting in which you are both associated with a medical school and making money close to a private practice.

 

[Thama]

You'll see a few more "atypical" cases like CJD, FTD, venous thrombosis, and odd seizure cases in academics. General neurologists will send their 'hard' cases to you. But if you're sub-specialized, then they're easy and common for you. For example, a general neurologist is seeing MS, carpal tunnel, then migraine. So if a case of NMO comes along, and they are not expert enough to feel comfortable with this rarish disease state, they will send to an academic center for a second opinion and perhaps to initiate treatment. If you're an MS doc in an academic center, then you'll probably have dozens of NMO cases, so it isn't that atypical for you.

But you'll certainly attract MUCH different cases on two important populations. Academic centers serve people we called poor, hostile, and difficult before we became woke and now call "socioeconomically disadvantaged." Not a big deal. The other population are the ones that see themselves as VIPs, too good for the local docs, and who insist on the best. Nevermind that they just have run of the mill MS, want you to affirm their stupid MS-keto diet and herbs. So yes, atypical cases, but perhaps not the way it is framed by @Thama.

I partially agree with this, but not entirely. The experience that many of us have of academics meaning extremely high numbers of low SES patients with all the medical issues that go along with that disadvantage is IMO mostly based on our residency experiences (especially those of us that trained in massive urban dystopian hospitals). Once you're in the attending practice, that mostly goes away.

On the other side, I do believe that academics gets more VIPs referred to it, but my experience with this was not that they were coddled in academia, but more often they were rapidly offended at being treated like everyone else and rapidly fled to the comfort of their concierge doctor/acupuncturist/chiropractor/life coach. My fellowship mentor would tell people who didn't want to see the resident or fellow that they were welcome to reschedule with a different practice and wouldn't see them until the trainee had seen them first. The real privileged pieces of work that I know personally (mostly extended family) all go to Mayo or CCF, which makes me really really really glad I didn't end up training there.

 

[Thama]

- midl level support (is it that available in private practice?) more midlevel support in private practice. in big academic center they will have one nurse for whole division.

Not always true - my division of ~10 MDs currently has 4 nurses, hiring 2 more actively, and an NP.

- compensation: does it really worth it , having in mind the difference in patient load :300K plus in private to 130K in big academic center (Ivy League)

MGMA 50th percentile for academics at the junior (asst prof) level is ~195k, and I personally know of several recent offers right around that amount at centers most would consider top ~20ish. Only a few places can get away with paying ~130k (looking at you everyone that just wants to tell their grandma they went to Harvard).

 

[Epic786]

I am talking about Hopkins and MGH. If you are getting 200K you should take out at least half of it in taxes. If you are in a RVU system you have to generate the RVU other wise they will cut your salary. In academic either you get research grant or work more. Living in a big city with 200K....

 

[Thama]

You would have to be pretty lazy or incredibly slow to not generate your RVUs in that kind of system if you are an academic clinician. Usually the department is using its productive clinicians to keep it in the black. If you have protected time then the salary support comes from elsewhere so your RVU goals will be proportionately less.

And yes, MGH and Hopkins are known to do that kind of thing with salaries. They are also known to offer minimal support to junior faculty, and be nearly impossible systems to advance in. Prestigious places in the urban Northeast basically require you to sell your soul or your organs, and I would stay away from them in favor of equivalently good places in less self-congratulatory parts of the country.

 

[neglect]

I partially agree with this, but not entirely. The experience that many of us have of academics meaning extremely high numbers of low SES patients with all the medical issues that go along with that disadvantage is IMO mostly based on our residency experiences (especially those of us that trained in massive urban dystopian hospitals). Once you're in the attending practice, that mostly goes away.

On the other side, I do believe that academics gets more VIPs referred to it, but my experience with this was not that they were coddled in academia, but more often they were rapidly offended at being treated like everyone else and rapidly fled to the comfort of their concierge doctor/acupuncturist/chiropractor/life coach. My fellowship mentor would tell people who didn't want to see the resident or fellow that they were welcome to reschedule with a different practice and wouldn't see them until the trainee had seen them first. The real privileged pieces of work that I know personally (mostly extended family) all go to Mayo or CCF, which makes me really really really glad I didn't end up training there.

I had a certain toxic narcissistic personality in mind, who considers themselves VIPs. I guess we all have to deal with the personality disorders, and have to find coping mechanisms.

 

[kchan99]

I am talking about Hopkins and MGH. If you are getting 200K you should take out at least half of it in taxes. If you are in a RVU system you have to generate the RVU other wise they will cut your salary. In academic either you get research grant or work more. Living in a big city with 200K....

There is even variation in pay among academic centers. Basically, for academic, must teach residents and publish something once in a while. Even with grant funding, sufficient time for research is not a guarantee. Many places still have tenure track and non-tenure track but even if opting for tenure track and getting it, there is usually no real salary guarantee.

 

[Epic786]

You would have to be pretty lazy or incredibly slow to not generate your RVUs in that kind of system if you are an academic clinician. Usually the department is using its productive clinicians to keep it in the black. If you have protected time then the salary support comes from elsewhere so your RVU goals will be proportionately less.

And yes, MGH and Hopkins are known to do that kind of thing with salaries. They are also known to offer minimal support to junior faculty, and be nearly impossible systems to advance in. Prestigious places in the urban Northeast basically require you to sell your soul or your organs, and I would stay away from them in favor of equivalently good places in less self-congratulatory parts of the country.

trust me about 3-4 clinicians were flagged as producing less than 60% percentile of their RVU, the billing is also very important in that case. One of my friends is in the movement disorder but was not billing correctly and hence was flagged as making less RVU.

 

[Acherona]

The prestigious academic medical centers definitely attract more difficult patients. I used to be at a big research university and my clinic was filled with functional patients who would come in with a huge stack of papers from the previous 5 doctors they had seen and the entitled patients who would page at 2am because they couldn't sleep. The surrounding community neurologists would just dump on us any patient they didn't feel like treating anymore. There were more rare "interesting" cases but these were also much more labor intensive, and you don't get more RVUs for them. I am now at a less prestigious academic center and I derive all the benefit of academics (and actually more research and teaching time, and a higher salary) without a lot of the other headaches. I have mostly socioeconomically disadvantaged patients and they are generally pleasant and grateful. So there are huge differences even between academic institutions.