Academic

[WilburSK]

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Hello y'all!

I have recently begun considering pursuing academic medicine after completing residency.

I am looking to enter into an international fellowship within the next couple years. My goal is to return to the midwest to be a part or a pioneer in an international response team/international (or domestic) disaster relief.

I am concerned that I will have difficulty finding a job in the midwest after completing the fellowship as I'm not aware of many opportunities of this sort.

My impression is that participation in academic medicine requires a niche. Well, if I complete an MPH and fellowship, I should have a niche. But would it be sufficient for a job?

Or I could work as an attending at a community hospital (I am bound to the midwest) until an appropriate academic position opened up.

Do you think this sounds reasonable...the reason I want to be an academic is for flexibility in pursuing my interest in international work, an ability to teach, and the opportunity to be at the forefront of evidence based disaster response.

 

[xaelia]

There are ample academic opportunities advertising in the back of SAEM journal every month - with a significant portion of them in the midwest.

You could, if you so desired, likely get a job without doing an MPH or a fellowship. In fact, some places might hire you and help connect you with funding to do an MPH part-time.

 

[docB]

The hardest part of doing disaster med is finding a job that will let you take off on a moment's notice and find a way to cover your shifts.

 

[WilburSK]

That is interesting...I was hoping that by my niche being international response, I would have more mobility in terms of response.

Is that an unfounded perspective?

 

[docB]

One thing about disaster med, search and rescue, tac med, etc. is they usually don't pay very much. You have to have a regular clinical EM job and do those on the side. That then puts you in the difficult situation of having scheduled shifts that you're responsible for. When you get activated you will have to have a way to cover those shifts.

Most groups have mechanisms to cover emergencies which should be rare on a per physician basis and we are able to cover the military guys because we have time to reschedule.

If you are getting activated and leaving for a few weeks several times a year that will not be viable long term in the majority of groups, even academic groups.

There are a few ways to make it work. Most of them revolve around you making less money.

You can get a job with an agency like CDC, FEMA, various state agencies where part of your job is responding to situations. The downsides of those spots is that they pay way less than a clinical job and you can lose your skills sitting in an office most of the time.

You can find a job where you are part time and you have an understanding with the group that you will get activated. You will need to find a group that's ok with that which will be tricky.

You do a hybrid where you commit to work for X months a year and not respond during that time and reserve the rest of the year to be available. That's less money but probably not as little as in the first option but limited response.

You can also take a regular job and only respond when you are not scheduled. That is likely to leave you unsatisfied because you'll only get to go to a small percentage of disasters (that sounds weird but in context it makes sense).

I sympathize. I've never been able to do the DRT bit because of schedule issues. It's also limited my role in search and rescue and aero med. Once you throw a family in on top of working to pay the bills time gets tight.

 

[WilburSK]

Thank you for the insightful reply! I think you are correct in noting the difficulty that is experienced when one wants to do overseas work.

I am a bit confused about one aspect of your comment. Where you discussing community or academic med? While I know I won't be able to hop on a plane to every disaster that occurs, my hope is for my research and practical niche to be response.

So would it be reasonable to get a position at a university with that niche and not be allowed to travel abroad? Do you know of any good resources to read up on this?

 

[snoopy85k]

I am also highly interested in disaster management. One of the things I have been told is that it is actually easier to participate in disaster management in a large academic center. That is because your time is already split between shifts and teaching/research/whatever. So long as the extra "slash" does not have a dedicated time slot, you have a higher likelihood of being available when disaster strikes.

Because of this split duty life of academics, it also means that there are more EPs available to cover shifts than in the private world. More or less, I have been told that you need to be about 3 deep in order to do disaster management. And even in that setting, if you can't get your shifts covered, you can't go.

One way to get more involved (and thus have a better chance of getting others to cover your shifts) is to actually be involved with an organization at the state, federal, or international level. On the state level, this is usually a DMAT and on the federal level FEMA. Internationally, I am not as well versed, but I know that there is a pyramid in which different levels of people are called into action in an international response.

 

[docB]

Thank you for the insightful reply! I think you are correct in noting the difficulty that is experienced when one wants to do overseas work.

I am a bit confused about one aspect of your comment. Where you discussing community or academic med? While I know I won't be able to hop on a plane to every disaster that occurs, my hope is for my research and practical niche to be response.

So would it be reasonable to get a position at a university with that niche and not be allowed to travel abroad? Do you know of any good resources to read up on this?

You are not likely to find a "niche" where you have no clinical responsibilities. You can find an academic post where you do research and administration as a part of your job (as snoopy correctly points out) but you will still have some scheduled shifts that you either have to stay and work or get covered.

 

[WilburSK]

Thanks folks, this has been very enlightening. It seems like folks, rightfully, are suggesting that it is very difficult to do overseas work, particularly response work in light of clinical responsibilities.

Perhaps I ought to be more specific. I think I would like to use the fellowship to set up a long term project in a particular country. Probably a second world country that is just getting thier EM program off the ground. I would like to spend a couple months a year in that country, working on that project.

Through the fellowship I would like to gain the public health perspective of disaster response so that I can respond to one or two events a year.

So it appears I have a couple options.

I could work at a community hospital and negotiate for a couple months off in the summer so that I could work on my project. I could join a DMAT team and respond to disasters when I was able. Though I would have a loss of pay and would I still be eligible for full benefits (including vacation). All the work would be on my own time working with an NGO. This may be good due autonomy and I wouldn't have to worry about grants like academics.

Or I could be an academic. I could work in the field a couple years, and once again, respond to disasters when able. But since I one of my roles would be to respond, hopefully I could work in some flexibility. I could build up programs with the help of residents and colleagues to encompass a more expansive project variety, while maintaining my own personal project. I would make less money...but maybe not much more than missing two months at a community job. And i would be able to do research to further the field.

My current thought is to pursue the fellowship. I know I am interested in this work, and it would be great to have dedicated time to establish myself and my interests. Then, once I go on the job market, I can just see what is available. If only a community job is open, I can take it an negotiate while keeping my eye open for an academic position.

What do you guys think is better? I know it is a difficult position. I am more interested in academics due to the fact that I can research on topic of interest throughout the year, i would have a lot of resources to work on a project (at least more than a community hospital), i would have residents, maybe a fellow to develop this program at a hospital. The community track is interesting so that i have full autonomy in my decisions. Obviously i have to work my shifts, but if i want to pursue a particular project, no problem (especially of concern since most of my work has been done with religious NGO's).

Thanks again!

 

[ptarmigan]

Focus on medical school first. The most important things for you now are good grades and a good step 1 score. Try to do an international elective when you are in your 3rd or fourth year. Who knows where you will be and how you will feel in 7-8 years when you are finishing residency. Give yourself some freedom to consider the broad variety of specialties before you decide what you will sub-specialize in.

 

[James105]

I am actually very interested in this too. It would be great to see what other people think!

 

[docB]

If you're looking to go and do research projects that you can schedule in advance that will be significantly easier to set up than the disaster response scenario. You can probably work more shifts throughout the rest of the year to make up for the time away. Some groups would still not want to deal with this but many would be ok with it.

 

[James105]

Doc B, do you think that academics or community practice would be useful for this type of scheduling.

From what I have understood, the academic route seems to have more "protected" time to pursue international interests

 

[Redrox]

I would like to spend a couple months a year in that country, working on that project.

Locums tenems positions could certainly allow you to take these long stretches of time off. Seems more workable than trying to negotiate such a stretch with a community group.

 

[deleted65604]

Locums tenems positions could certainly allow you to take these long stretches of time off. Seems more workable than trying to negotiate such a stretch with a community group.

I agree, locums tenems is really the only doable option. If I had to cover an extra 2-4 shifts a month randomly to pick up the slack while you jet-set around the world, I would be urging the director to can you and hire a permanent person who actually has decided they want to work in the ER full-time.

 

[WilburSK]

I understand your point. It does seem like locum positions would be advisable (though uncertain in terms of benefits) if one wants to pursue international med.

I guess it is a little confusing since I have read a lot of stories about academics completing research and projects overseas. Perhaps, this is not a possibility for me. But I would like to be a possibility.

Do any academics have any experience in this area?

 

[Arcan57]

I understand your point. It does seem like locum positions would be advisable (though uncertain in terms of benefits) if one wants to pursue international med.

I guess it is a little confusing since I have read a lot of stories about academics completing research and projects overseas. Perhaps, this is not a possibility for me. But I would like to be a possibility.

Do any academics have any experience in this area?

Are these academics EM docs? Understand that outside of a few places (mostly on the coasts), there isn't a "international EM" niche in the same way there is an EMS, U/S, or tox niche. If you can secure grants then you may be able to carve a niche. But I wouldn't expect a lot of institutional funding to go abroad. My residency had an attending that did a lot of DMAT responses, but he had relatively minimal clinical responsibilities.

 

[docB]

Academics will provide more protected time for anything but it's not limitless and you still have a schedule. You keep mentioning that this would be "international." That's not the problem. The problem is the scheduling and availability. It doesn't matter where you're doing it. It's if you're at work or not.

 

[WilburSK]

I know that I would have to play by the scheduling rules like everyone else. No one is above the schedule, regardless of interests.

However, if I am engaged in active projects in places around the world, then I thought that I could work on said projects for the university. I thought it would be work, not a vacation, but it would build an additional program for the university.

So a month to two months spent abroad plus some disaster response. That is my ambition. Hopefully I could help build a universities capability in these areas.

 

[Arcan57]

I know that I would have to play by the scheduling rules like everyone else. No one is above the schedule, regardless of interests.

However, if I am engaged in active projects in places around the world, then I thought that I could work on said projects for the university. I thought it would be work, not a vacation, but it would build an additional program for the university.

So a month to two months spent abroad plus some disaster response. That is my ambition. Hopefully I could help build a universities capability in these areas.

Other than the whole getting into medical school and being successful in that arena, you need to start figuring out how you're going to get these projects funded. While it's not immediately apparent, academic departments won't pay you to do projects that aren't bringing in money to the institution. If your projects are in line with the departments goals, then you can usually get floated protected time to work on those projects until you can pay for the buy-down with grants. If your project isn't in line with an institution's goals, then you'll have an uphill fight to get grant money while working a full complement of shifts. Typically, if you don't have a buy-down, you'll work more in academics than in the community because your work is subsidizing those that do have buy-downs.

Nobody is saying your goal is impossible, but we are all suggesting it will be difficult (but not impossible) to find a place that lets you execute your plan and that you will likely have a significantly lower salary than the ED average.

 

[WilburSK]

I really do appreciate all the input; it is very good to hear from your experiences. It looks like I may have to get creative to make this happen (I'm not sure what a buy down is). Perhaps helping start a fellowship program.

What if I worked out a joint academic position, one with EM and the other with Public Health? Maybe that could help create some leverage for pursuing my interests.

 

[K31]

Academics isn't all that different from private practice in that you have to be of value monetarily to your institution/practice. Whether by seeing/billing patients, bringing in grant money, or however else you do it, you have to be paying for yourself (and likely more).

If you could convince a Public Health school to cover part of your salary in return for running a program overseas for part of the year, that gives you a bargaining chip to convince the clinical department to reduce your responsibilities proportional to the part of your salary that they don't have to pay. However, the Public Health department isn't going to do that for free either.

 

[anonymousEM]

A fellowship will help with learning how to develop meaningful contacts, find grants or develop other projects that would bring money into your institution. The buy-down the others discuss means "buying down" or decreasing the number of hours you are to work clinically by bringing in other revenue to the department's bottom line. The ultrasound guy in a department is justified by savings in throughput time or acutal billing for the ED. The research guru is bringing in grant money, etc., etc.

After a fellowship in IEM, I can tell you that a lot of other places are interested in someone coming to work on projects with them, but the difficult parts are often finding funding for the projects and the time away from the department to make it happen. Also, look closely at what different fellowships are doing to see if what you're looking for aligns with those places. Some don't do anything with disasters, some deal with refugees and complex disasters, not too many have anything to do with DMAT. A few specifically Hopkins had an International Disaster fellow a few years ago but I'm not sure what they're doing right now. IEM is possible in the midwest (there are several Chicago fellowships) but academics research and education or combining with a locums job are much more viable options than a private group. Good luck!

 

[WilburSK]

This has been an extremely beneficial conversation for me! Thank you for all who contributed your time and knowledge.

It seems like an academic job would be most ideal. For most of the year, I would carry the same burden of coverage as everyone else...but perhaps i can negotiate for a month or so abroad a year (obviously more bargaining power the longer i am at it) at a research project or projects for the university. i would be able to help with administrative work with residents and med students that are interested in international work. hopefully this would blossom into a highly developed program, but there are no guarantees. so for the most part, i won't have to "buy down" any shifts (at least as I understand the term).

it also seems that i would have to write grants in order to get this type of program up and running (could i work on this during a fellowship?). i wanted to try to avoid having to write grants (which i could if i just worked as a locum) but it is not a huge deal if i can help get something accomplished.

This raises a question for me though. What skills (academic) would be useful to complement international interests? it seems that if i don't get funding for any international programs, then i would really not have anything unique to offer a university (other than fantastic clinical skills, but that's not unique 😉.

how do grants work? would my job always be at the mercy of the grant committee or would it just be my pursuits in international med?

more help, please

 

[gutonc]

how do grants work? would my job always be at the mercy of the grant committee or would it just be my pursuits in international med?

In academics (which is the only arena I'm remotely competent to discuss and is the most relevant to your question), you need to justify your existence - which is to say, your salary - one way or another. Grants is one way to do it, teaching (non-clinical or teaching EMS/nursing/PA students) and administrative work is another, and clinical work is a third (there are other ways but these are the big ones).

So if you want to spend X amount of your time pursuing your own academic interests, you need to come up with a way to pay for that time. If that's going to be 20% of your time (1 day/wk or ~10 weeks/yr), you need to find a way to pay 20% of your salary (AND benefits) with other income streams, like grants. So you apply for a grant (let's say $200K) to do your "international work." If you intend to spend 20% of your time on that project and your salary is $200K (which is crazy high for academics but it makes the math easier), you need to use $40K of that grant (plus 35-40% for benefits, so let's say another $15K) to cover your salary/benes during that time. So you now have $145K of that grant to use on your "international work."

That's how grants work.

If you don't get the grant (which is the most likely scenario) and still want to do the "international work," you do one of 3 things, squeeze 20% of your shifts into the 80% of the year you're already working so you can take 10-ish weeks "off" to go do that, or you add on .2 FTE in administrative/teaching duties, or you find a place willing to let you go for 1/5 of the year and pay you 1/5 less.

 

[WilburSK]

thanks...that is a very useful explanation. with your help, i have a much better vision of the practicality of this type of opportunity.

i would like to do public health research, presumably this would be covered by grants?

also, what if i took on additional administrative duties for residents, med students, and even tried to start a fellowship? would i be able to "down-pay" some of my time abroad with these types of duties?

also, where does one find grants? could i work on grants for a future project in a fellowship?

 

[gutonc]

thanks...that is a very useful explanation. with your help, i have a much better vision of the practicality of this type of opportunity.

i would like to do public health research, presumably this would be covered by grants?

also, what if i took on additional administrative duties for residents, med students, and even tried to start a fellowship? would i be able to "down-pay" some of my time abroad with these types of duties?

also, where does one find grants? could i work on grants for a future project in a fellowship?

Dude...you seriously need to chill. You haven't even started med school yet. You are a minimum of 7 years (potentially longer) away from any of this being even remotely relevant. Focus on passing gross anatomy and let's talk in 5 or 6 years.

 

[James105]

I am interested in the answer too. just because he is zealous doesn't mean the answers to his questions won't help others.

 

[Arcan57]

I am interested in the answer too. just because he is zealous doesn't mean the answers to his questions won't help others.

That's not really the issue. The issue is nature of communication on a forum, and what types of questions are best answered by what type of communication. The original question had a specific scope and implied the poster was a resident ("Iooking to enter an international fellowship in the next couple of years"). He received multiple answers to his follow up queries, during which it became obvious he was not a resident and his actual question was far more in-depth than community vs. academics for international work.

The discussion about buy-down and the realities of funding in academics is broadly useful. Expecting to receive a detailed discussion of academic EM, with an even more detailed focus on international work and how to get funding for same is misusing the forum. An MPH with a focus on international health is a 1-2 year (depending on whether it's done before, during, or after residency) program. Trying to condense that information down into a series of posts on an EM forum is problematic.

To the OP: find someone in your region who is doing international health and ingratiate yourself with them. Use them as a mentor to figure out what your next steps should be and whether you need an MD to accomplish them. Finally, if you're planning to spend months out of the year abroad and to respond to regional disasters as part of a DMAT team, why does your attending job have to be in the Midwest? In terms of international EM fellowships, of the 18 currently in existence only one is in the Midwest (Chicago).

 

[deleted109597]

I am interested in the answer too. just because he is zealous doesn't mean the answers to his questions won't help others.

You're right. The answers will help others in the realization that such a beast does not exist, and for it to become one you have to do it yourself.

I'm sorry, but just because you want to do something doesn't mean someone else wants to pay you to do it. You have to earn them money. Not many places like to hire part-timer's because it is simply easier to schedule a full time person.
Grants for international things are likely to dry up significantly with the next wave of elections, as more fiscally conservative people are voted in. Call me evil if you want, but I would rather my tax money go to fund the shortcomings in this country before they start going to other despots.

 

[UnderwaterDoc]

Call me evil if you want, but I would rather my tax money go to fund the shortcomings in this country before they start going to other despots.

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