Academics as a career?

[guitarguy23]

Just wondering about the pros and cons in working in academics vs private practice/hospital based work. I understand the hours are better for the most part but salary is generally less.

I guess my question is: What makes the academic setting appealing? Thanks!

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[gutonc]

Just wondering about the pros and cons in working in academics vs private practice/hospital based work. I understand the hours are better for the most part but salary is generally less.

I guess my question is: What makes the academic setting appealing? Thanks!

Teaching. Or at least getting the residents to do most of your work for you.

 

[hotchik]

As someone who is interested in academics, with a research focus, I have found the aspect of being able to leave a legacy behind to be very appealing. sure in private practice you will be known as a good doctor when you die. However, if you're a semi-successful researcher your name will be floating around pubmed for ages to come....with that said, if you can make a bigger impact on the world by becoming the next mark zuckerberg then do that instead...in the end its all about legacy...

 

[gutonc]

As someone who is interested in academics, with a research focus, I have found the aspect of being able to leave a legacy behind to be very appealing. sure in private practice you will be known as a good doctor when you die. However, if you're a semi-successful researcher your name will be floating around pubmed for ages to come....with that said, if you can make a bigger impact on the world by becoming the next mark zuckerberg then do that instead...in the end its all about legacy...

Good luck with that.

With the academic and funding world the way they are right now, you're more likely to be the next Mark Zuckerberg at this point than you are the next James Watson, Eric Kandel or Harold Varmus.

 

[jdh71]

If you like working with students and residents - and only that - you want to be a clinical instructor you might find a good amount of satisfaction from academic medicine. You'll have to be satisfied with a "legacy" of teaching that could very well extend on and on. You will have less *personal* documentation in the medical record which is a plus. But you have to balance that with other paperwork such as evaluation and letters which aren't exactly easy. I think it's hard to be constructive without crushing someone.

Anyway if your goal is a full professorship, sitting on international committees, and maybe making it to a chairman or dean spot one day?? If that is your goal then you will need to enjoy the snake pit. Go to a reptile garden. Look at the rattler pit. If it looks like fun to jump on and show those snakes a "thing or two". You are probably the right fit for the professor track. Or alternatively if you know you are a personality disorder you may also be in good shape.

 

[IMreshopeful]

As someone who is interested in academics, with a research focus, I have found the aspect of being able to leave a legacy behind to be very appealing. sure in private practice you will be known as a good doctor when you die. However, if you're a semi-successful researcher your name will be floating around pubmed for ages to come....with that said, if you can make a bigger impact on the world by becoming the next mark zuckerberg then do that instead...in the end its all about legacy...

Yeah I am just fine with being a good family man, teaching for fun, making a decent living for my wife and (theoretical) children. I could not care less whether there is a device or disease entity or papers named after me. Plus it will mean a lot mostly for your specific subspecialized field of academia. Nobody in the lay public knows who Braunwald is even if he has published over 1000 articles.

Majority I think of folks in academics honestly go into it because they like teaching and/or research. I like teaching but not a huge research person. So hopefully I can find somewhere where that works out eventually.

 

[Crayola227]

If you like working with students and residents - and only that - you want to be a clinical instructor you might find a good amount of satisfaction from academic medicine. You'll have to be satisfied with a "legacy" of teaching that could very well extend on and on. You will have less *personal* documentation in the medical record which is a plus. But you have to balance that with other paperwork such as evaluation and letters which aren't exactly easy. I think it's hard to be constructive without crushing someone.

Anyway if your goal is a full professorship, sitting on international committees, and maybe making it to a chairman or dean spot one day?? If that is your goal then you will need to enjoy the snake pit. Go to a reptile garden. Look at the rattler pit. If it looks like fun to jump on and show those snakes a "thing or two". You are probably the right fit for the professor track. Or alternatively if you know you are a personality disorder you may also be in good shape.

Awesome post. I would say medicine overall is kinda like the little cages of baby snakes they sell as pets at PetCo. Not as bad as the rattlers but they still slither around and some of the cagemates must be fed separately or they eat each other. If you get a big pet snake like a python that don't bite you still have to be careful it doesn't get out of its cage at night or it could choke you to death while you are sleeping.

The classic wisdom is that most people on their deathbed wish they had spent more time with their loved ones than had research papers published. I don't know how generalizable that is tho to your NPD (narcissistic personality disorder) types that abound in medicine. I guess it depends on what fulfills you or your ego best.

 

[CatFactorial]

Awesome post. I would say medicine overall is kinda like the little cages of baby snakes they sell as pets at PetCo. Not as bad as the rattlers but they still slither around and some of the cagemates must be fed separately or they eat each other. If you get a big pet snake like a python that don't bite you still have to be careful it doesn't get out of its cage at night or it could choke you to death while you are sleeping.

The classic wisdom is that most people on their deathbed wish they had spent more time with their loved ones than had research papers published. I don't know how generalizable that is tho to your NPD (narcissistic personality disorder) types that abound in medicine. I guess it depends on what fulfills you or your ego best.

To take your analogy to its logical conclusion, snakes often lead to death beds. And snakes on a plane. Sam Jackson.

 

[4sport]

I found the following qualitative study helpful in thinking about the issue raised by the OP, at least from the academic clinician (not research) perspective.

Advantages and Challenges of Working as a Clinician in an Academic Department of Medicine: Academic Clinicians' Perspectives:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951793/
(btw first author is the PD for the IM residency at Hopkins Bayview)

 

[deleted547339]

To take your analogy to its logical conclusion, snakes often lead to death beds. And snakes on a plane. Sam Jackson.

IM TIRED OF THESE ** SNAKES ON THIS ** PLANE!!!!

 

[Pemulis]

Personally I love to teach, but I found the academic environment to be stifling. There were a lot of great people in it, but even in a fairly happy and functional place like the one I trained at, there was still a lot of annoying politics and passive-agressive behavior. And I didn't enjoy research at all.

My compromise? I went into private practice (outpatient/primary care), but on a volunteer basis I do a lot of work with residents and med students in my office. I also give a few lectures each year to the residents at the nearby hospital where I trained. I feel like I get the best of both worlds: I still get to teach, but I also get to focus my days on the type of clinical work I enjoy, set my own schedule, and be my own boss. Making nearly three times as much as I would in academia doesn't hurt either. What I lose in "prestige" I feel I more than make up for in autonomy, income, time for my family, and great relationships with my patients.

As for legacy, a colleague in my practice passed away recently after a 30+ year career. More than 500 of his patients showed up at his wake. A number of them who I've inherited on my panel have broken down in my office crying when remembering the care and concern he showed for them and their families during his career. If I leave that kind of legacy behind me I'll be content.

On the flip side, I have friends who have really thrived in the academic tract. Like everything else in medicine and life, it ultimately comes down to personal preference.

 

[tartrate]

Personally I love to teach, but I found the academic environment to be stifling. There were a lot of great people in it, but even in a fairly happy and functional place like the one I trained at, there was still a lot of annoying politics and passive-agressive behavior. And I didn't enjoy research at all.

My compromise? I went into private practice (outpatient/primary care), but on a volunteer basis I do a lot of work with residents and med students in my office. I also give a few lectures each year to the residents at the nearby hospital where I trained. I feel like I get the best of both worlds: I still get to teach, but I also get to focus my days on the type of clinical work I enjoy, set my own schedule, and be my own boss.

I've heard this a few times, that people in private practice were turned off by the "politics" of academic medicine. I never really understood what this meant. What are people referring to?

Also, on the flip side, I've hardly met anyone with a strong interest in doing research (in contrast to how much of an interest people suddenly express during application time/interview season). I'm curious for the people who go into academic medicine what drives them, other than teaching. It's also curious that academic institutions seem to promote this attitude, despite most people in most specialties going into private practice. The world of academic institutions is very odd in many ways.

On the other hand, I've met a couple (more than a handful actually) that have given up private practice to go back into an academic environment (although these are more clinical positions than anything, and it seems primarily motivated by a desire to work in a setting that is less demanding and where people do things at a slower pace).

 

[Pemulis]

I've heard this a few times, that people in private practice were turned off by the "politics" of academic medicine. I never really understood what this meant. What are people referring to?

Also, on the flip side, I've hardly met anyone with a strong interest in doing research (in contrast to how much of an interest people suddenly express during application time/interview season). I'm curious for the people who go into academic medicine what drives them, other than teaching. It's also curious that academic institutions seem to promote this attitude, despite most people in most specialties going into private practice. The world of academic institutions is very odd in many ways.

On the other hand, I've met a couple (more than a handful actually) that have given up private practice to go back into an academic environment (although these are more clinical positions than anything, and it seems primarily motivated by a desire to work in a setting that is less demanding and where people do things at a slower pace).

Since "showing is better than telling," here are a few examples from Pemulis’ case files in academia:

• An excellent primary care internist who quit her academic job in frustration after nobody in her institution showed the least bit of interest in her ideas for getting her very poorly run office (long check in lines, doctors always running behind, phone calls not returned to pt's promptly, etc) to work better.
• A subspecialist who was fired after another doc with whom he had a personally contentious relationship was promoted to chief of his division
• A subspecialist who did 50% clinical time and 50% research time about "disease x". He admitted to me in private conversation that his research was not all that meaningful or interesting, but he kept at it. Why? Because his division needed an expert on "disease x" and he was it. So keeping his job basically required that he continue to do research that he personally felt was of little value.
• A subspecialist who was pushed out of his department because his research conclusions contradicated those of his boss.
• A fellow who faked an interest in a particular global health issue so that he could get an all expenses paid trip for several months to a location abroad to conduct his research. (He was pretty open in off the record conversation about the fact that he had no interest in global health - just wanted a chance to take a vacation abroad).

I could go on. But it really comes down to this difference: in private practice, by almost any metric you can think of (income earned, quality of care provided, respect from your colleagues, affection from your patients) your career advancement is largely up to you. In academia, your career advancement is largely in the hands of others. Getting a job, keeping it, or being promoted are all basically dependent on how well those above you on the chain think of you, or what niche you can fill for the institution. Often that will correlate with how good and hardworking of a physician you are, but in other cases it can be affected by a multitude of other factors that may not be in your control. There are lots of great things in academia, but if you go into it you need to understand this basic concept first.

 

[FutureInternist]

I'm in private practice but teach the PA & ACNP students from the local school, since the medical students get preferentially placed at the home institutition
Gives me the best of both worlds
You can also sign up to given lectures to 3rd & 4th year students on particular specialty related topics

 

[tachycore]

With some exceptions, most institutions try to pigeonhole current "academic" MD's as either purely clinical or research tracked. With the latter becoming a rarer, and rarer breed. Sure, education is thrown in and expected (i.e., an educational track). But, it's often a minor third pillar for an academic MD career. My source? A formal lecture, complete with handouts, by my institution's promotions comittee chair to promising fellows and junior faculty. On how exactly academic institutions do these professor tracks. The argument back then was that the "triple threat" clinician (i.e., a faculty member who exceled at clinical, research, AND education) was mostly impossible for modern day clinicians.

Taken to an extreme, the pigeonhole setup is toxic to creating and maintaining genuine physician scientists. Many institutions are clamping down on enforcing such tracks. And yet, the NIH keeps crying over the last decade that physician scientists are vanishing. I can see firsthand why.

If you asked me about going academic 5 years ago, I would have given a perspective full of hope. Now, I don't know what to think except exclusive of anything positive.

Only time and some impending life decisions will tell for me which way that perspective will head.

 

[4sport]

From what I can judge as a lowly med student, it looks like academic medicine is under pressure overall due to revenue shortfalls from reduced reimbursements as well as reduced federal research funding - plus greater competition from consolidated health care systems that are increasingly keeping their complex patients and not referring them to the AMCs.

@tachycore, you mention the specific difficulties of the research track. I’m curious about your (or others’) perspectives on the status of the academic clinician track. According to the study I posted a link to earlier in this thread, “Concern has been increasingly raised that the rewards systems at most academic institutions may discourage those with a passion for clinical care over research or teaching from staying in academia.” However, does the current environment mean that academic clinicians would become relatively more attractive to AMCs (compared to pure research types) as the AMCs strive to raise more clinical revenue? And hence do you see the promotion criteria or other reward systems within AMCs changing over time in favor of academic clinicians? (I’m not mentioning teaching because I take that as a given.)

 

[tachycore]

Many academic institutions currently favor clinical practice over research. Dr. Pam Douglas, an eminent cardiologist, once told a session for aspiring academic clinicians that institutions view clinical roles as 120+% of a faculty member's time. Research is on our own time, after hours. A "hobby," if you will. Money-wise, it makes sense in terms of income priority.

The flip side is that the environment becomes very corporate. You become an employee MD with a set term. Fail to bring in enough RVU's, don't expect to stick around long. And considering many academic institutions are located in highly desirable cities, they wouldn't think twice about replacing you.

At my institution, the turnover has been quite high. I've rarely seen junior clinical faculty stay longer than a couple years, much shorter than grant-funded faculty. If you happen to end up in a county / government health system where it's impossible to fire anyone, that's a different ball game entirely. An exit strategy I've often seen used by the same.

The last strategy (and proven by some posters in this thread) involves private groups that arrange an affiliation with an academic institution. That affiliation also has a set term and must undergo periodic renewal. With multiple competing groups for a given specialty in play, you'd think wading through academic politics might be easier.

Reward systems for encouraging clinicians at academic institutions??? How 'bout letting you keep your job?

 

[bubabugster]

If you like working with students and residents - and only that - you want to be a clinical instructor you might find a good amount of satisfaction from academic medicine. You'll have to be satisfied with a "legacy" of teaching that could very well extend on and on. You will have less *personal* documentation in the medical record which is a plus. But you have to balance that with other paperwork such as evaluation and letters which aren't exactly easy. I think it's hard to be constructive without crushing someone.

Anyway if your goal is a full professorship, sitting on international committees, and maybe making it to a chairman or dean spot one day?? If that is your goal then you will need to enjoy the snake pit. Go to a reptile garden. Look at the rattler pit. If it looks like fun to jump on and show those snakes a "thing or two". You are probably the right fit for the professor track. Or alternatively if you know you are a personality disorder you may also be in good shape.

OMG-this is brilliantly summarized. Seriously, people in academic sometimes freak me out- very sociopathic personality types.

 

[bubabugster]

Since "showing is better than telling," here are a few examples from Pemulis’ case files in academia:

• An excellent primary care internist who quit her academic job in frustration after nobody in her institution showed the least bit of interest in her ideas for getting her very poorly run office (long check in lines, doctors always running behind, phone calls not returned to pt's promptly, etc) to work better.
• A subspecialist who was fired after another doc with whom he had a personally contentious relationship was promoted to chief of his division
• A subspecialist who did 50% clinical time and 50% research time about "disease x". He admitted to me in private conversation that his research was not all that meaningful or interesting, but he kept at it. Why? Because his division needed an expert on "disease x" and he was it. So keeping his job basically required that he continue to do research that he personally felt was of little value.
• A subspecialist who was pushed out of his department because his research conclusions contradicated those of his boss.
• A fellow who faked an interest in a particular global health issue so that he could get an all expenses paid trip for several months to a location abroad to conduct his research. (He was pretty open in off the record conversation about the fact that he had no interest in global health - just wanted a chance to take a vacation abroad).

I could go on. But it really comes down to this difference: in private practice, by almost any metric you can think of (income earned, quality of care provided, respect from your colleagues, affection from your patients) your career advancement is largely up to you. In academia, your career advancement is largely in the hands of others. Getting a job, keeping it, or being promoted are all basically dependent on how well those above you on the chain think of you, or what niche you can fill for the institution. Often that will correlate with how good and hardworking of a physician you are, but in other cases it can be affected by a multitude of other factors that may not be in your control. There are lots of great things in academia, but if you go into it you need to understand this basic concept first.

Exactly- and I have a personal horror story in academic medicine as an example of politics. I ended up getting an academic job after fellowship but instead of being able to interview for faculty-I only had one choice at XXX university as that is where husband matched into for residency. I had all the right ideals going in: working with trainees, liked high acuity etc. and loved research. Prior to signing the contract I was promised I would be allowed to apply for research grants as a means to protect my time for research (internal as well as NIH-level grants). Guess what? I was absolutely blocked by the division chief and department head from being allowed to apply to internal research grants and K08 (as needs departmental approval) in order to be kept as a clinical work horse. They only allowed their internal trainees and soon to be attendings posh access to grants and protected time central. I was trapped at this dumb university for 5 years (due to non-compete agreement) until my husband finished his residency and we got the F out of that place. Needless to say, my research career was artificially destroyed. Stay away from the ****show that is academic medicine. I left to private practice.... Go into academics only if you love snakes as previously stated or have a severe personality disorder +/- lack of conscience.

 

[Mehena]

These replies are astounding. They really highlight the sorry state and fragility of academic medicine as evidenced to some extent in the current COVID pandemic. In my three years of Hem-Onc fellowship only, I witnessed a handful of established academic physicians with each having decade worth of expertise leave academic Hematology/Oncology medicine to either the industry or other non-academic settings than the reverse. This needs a huge overhaul ASAP for the future generations.

 

[bronx43]

These replies are astounding. They really highlight the sorry state and fragility of academic medicine as evidenced to some extent in the current COVID pandemic. In my three years of Hem-Onc fellowship only, I witnessed a handful of established academic physicians with each having decade worth of expertise leave academic Hematology/Oncology medicine to either the industry or other non-academic settings than the reverse. This needs a huge overhaul ASAP for the future generations.

There will be no overhaul from within until the whole termite-infested house of cards collapses.

One word shall then be etched onto the tombstone of "academic" medicine: Hubris.

 

[rokshana]

You woke up a 6 year old thread for this?

 

[bronx43]

You woke up a 6 year old thread for this?

? Not sure who you are sniping at but the poster who did had a pretty compelling story and I’m sure people appreciate he/she sharing it

 

[rokshana]

You’re anti academia, so…
But to wake up a thread to give kudos to an old post…not really compelling to blame others for their failures…what non compete is five years that is enforceable? And if she had to rely on in house grants, well how great a researcher was she? As ever, I’m sure there is more to that story… always in when they take no ownership in why maybe they failed.

 

[bronx43]

You’re anti academia, so…
But to wake up a thread to give kudos to an old post…not really compelling to blame others for their failures…what non compete is five years that is enforceable? And if she had to rely on in house grants, well how great a researcher was she? As ever, I’m sure there is more to that story… always in when they take no ownership in why maybe they failed.

Um… ok? why are you even here? Why even comment about this bumped thread?

If you don’t find his/her (you’re assuming peoples genders) post to be of value then don’t read it. Don’t comment. Just scroll away or click back on your browser. It’s not that hard.

 

[rokshana]

Um… ok? why are you even here? Why even comment about this bumped thread?

If you don’t find his/her (you’re assuming peoples genders) post to be of value then don’t read it. Don’t comment. Just scroll away or click back on your browser. It’s not that hard.

Why are you commenting on my ability to post… you can ignore me just as easily… In fact, please do.