Academics vs PP...how to choose?

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Ravenclaw90

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If I am unsure of whether I would enjoy academics or private practice more, which should I start out in? Is it easier to move from PP to academics or vice versa? I imagine I would stick with a situation for at least 2-3 years before trying something new.

Can anyone speak to their experiences and satisfaction regarding either setting, especially those who have done both? I am interested in hearing from OR anesthesiologists and chronic pain doctors.
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From what I gather, the most important thing is to do cases yourself. Then whether you are overseeing residents, nurses or doing cases yourself, you have the experience to handle things. Being the guy making the decisions is totally different from being a resident, even though the cases and the patients are the same.

The people I know that went from pp to academics are in the twilight of their careers and sold their practices. Academics to pp are mostly young guys that wanted to get some experience in a familiar setting under their belt before going out into the world.
 
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Just a CA3... but I’ve heard a good amount of people start off with academics with also locum on the side. They have the familiarity of academics working with residents and surpervising etc but also doing own cases at locums. My academic place you rarely have attendings do their own cases fwiw. So then they see both kinda.
 
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Imo nothing wrong with supervising at most academic centers. Always challenging cases, sick patients, trauma, cardiac, transplant, neuro and new and interesting complications
 
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Airway said:
Imo nothing wrong with supervising at most academic centers. Always challenging cases, sick patients, trauma, cardiac, transplant, neuro and new and interesting complications
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Got all this in private practice

except trauma thank god
 
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Get a job at Virginia Mason in Seattle. You have residents and an academic feel, but get paid private practice money. The perfect mixture of both worlds.

Disclosure, I haven't worked their as staff so I could be talking out my butt - but I did my fellowship their and while doing it - I thought "this place would be a wonderful place to work."

The department head is super cool. I don't know if he is good at leading (wasn't the head when I was there), but he is a wonderful person, and I suspect, a great chair.
 
Other posters have hit on some of the clinical differences between the two settings, but it beats mentioning that there are other differences. Chief among them being the “academic” part of “academics.” You would be expected to (want to) do a lot of other things that support the mission of the department, from research, to teaching, to a range of service and administrative tasks/roles. People who thrive in academics are those who go into those jobs BECAUSE of those extra responsibilities, not DESPITE them.
 
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I think you're asking the wrong question.

The question should be: what does @Ravenclaw90 want in life?

Then tailor your job search to that end.

There are plenty of PP that have academic features while there are "academic" places that have the PP perk you want. But all of it begins with what you want in life long term and it varies by each job offer you get.

Also academic chronic pain makes way less money and get all the ****ty pts that get fired from PP pain guys. I don't see much positive in it.
 
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epidural man said:
Get a job at Virginia Mason in Seattle. You have residents and an academic feel, but get paid private practice money. The perfect mixture of both worlds.

Disclosure, I haven't worked their as staff so I could be talking out my butt - but I did my fellowship their and while doing it - I thought "this place would be a wonderful place to work."

The department head is super cool. I don't know if he is good at leading (wasn't the head when I was there), but he is a wonderful person, and I suspect, a great chair.
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Man I would love to live and work in seattle..
 
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These are all great points! Appreciate the experiences of those who’ve graduated before me.

My struggle is it’s hard to know what I want. My inclination is to do PP without fellowship and then if I feel strongly about additional expertise and/or trying academics, I can always go back for fellowship...I’m aware it could be unlikely I want to let go of attending money, however the issue of being uncertain about a “passion” at this juncture seems to outweigh that trade off.

However, bc I’m geographically restricted and want to live in Houston or just outside it, I wonder if USAP would be so miserable to work for, that it would be worth just focusing on academics and doing a fellowship to get there. My next question is if anyone knows what the Houston market is like, if there is anything besides USAP or AMCs.
 
epidural man said:
Get a job at Virginia Mason in Seattle. You have residents and an academic feel, but get paid private practice money. The perfect mixture of both worlds.

Disclosure, I haven't worked their as staff so I could be talking out my butt - but I did my fellowship their and while doing it - I thought "this place would be a wonderful place to work."

The department head is super cool. I don't know if he is good at leading (wasn't the head when I was there), but he is a wonderful person, and I suspect, a great chair.
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How much money we talking about? 600k? 700k?
 
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Ravenclaw90 said:
These are all great points! Appreciate the experiences of those who’ve graduated before me.

My struggle is it’s hard to know what I want. My inclination is to do PP without fellowship and then if I feel strongly about additional expertise and/or trying academics, I can always go back for fellowship...I’m aware it could be unlikely I want to let go of attending money, however the issue of being uncertain about a “passion” at this juncture seems to outweigh that trade off.

However, bc I’m geographically restricted and want to live in Houston or just outside it, I wonder if USAP would be so miserable to work for, that it would be worth just focusing on academics and doing a fellowship to get there. My next question is if anyone knows what the Houston market is like, if there is anything besides USAP or AMCs.
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If geography is your most important variable I would apply around the area and take the job you like the best. There are decent academic jobs around Houston that might compare favorably to USAP. As a pure clinician in academics you can expect some growth in salary, and potentially preferential assignments, with seniority. Without pursuing research or some kind of focused administrative track your job will likely resemble private practice with less money, though.
 
Academics on the west coast will be 300-400k. If you're willing to work over 65 hours a week and take different calls I've seen some academics make 500.
 
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All about what you want. But salary and benefits enter into the equation as well - few places are like Virginia Mason with regards to pay. I love teaching and doing case reviews, etc but when I interviewed at the Ivory Tower in my state I was deeply disappointed at the package. About the same number of hours worked, time off but less overall benefits and a salary ~ 30-40% less post-partnership. This is true for most academic departments around me. Then enter in departmental politics...

I do super complex cases in both a supervisory and solo environment now. No, not the experimental structural cath lab stuff (which let’s be honest, only the most die hards enjoy that crap), but still big time neuro, trauma, OB, etc. I agree that doing some stuff on your own is important to hone your skills. I intervene and take over an airway multiple times a week, for example.
 
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Our crnas made 180k working 36 hours a week with 3 guaranteed breaks a day. Zero calls, zero nights, zero weekends, zero liability. Can you imagine a nurse accepting that kind of garbage job at Virginia Mason?
 
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glassdoor is a useless site. I wouldnt put any stock in their payscale. On the other hand, if we knew some VMU people who could chime in...
 
GandalfTheWhite said:
glassdoor is a useless site. I wouldnt put any stock in their payscale. On the other hand, if we knew some VMU people who could chime in...
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FWIW that salary range is an “employer estimate” provided by the employer. But it can hld still be a typo.

For comparison, this is the listing for USAP Seattle at Swedish which has a “Glassdoor estimate”. The range seems like a plausible ballpark.

www.glassdoor.com

Anesthesiologist Jobs in Seattle, WA | Glassdoor

Search Anesthesiologist jobs in Seattle, WA with company ratings & salaries. 18 open jobs for Anesthesiologist in Seattle.
www.glassdoor.com www.glassdoor.com
 
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epidural man said:
Get a job at Virginia Mason in Seattle. You have residents and an academic feel, but get paid private practice money. The perfect mixture of both worlds.

Disclosure, I haven't worked their as staff so I could be talking out my butt - but I did my fellowship their and while doing it - I thought "this place would be a wonderful place to work."

The department head is super cool. I don't know if he is good at leading (wasn't the head when I was there), but he is a wonderful person, and I suspect, a great chair.
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VM got bought by CHI Franciscan recently. Things are going to change, although I don’t think they ever paid what PP in the area paid. They do pay more than UW system I believe. Also, VM is getting an OB service so nights are going to look a little different moving forward.

They’re hiring if you’re interested! Some more will probably leave as CHI moves in...

GandalfTheWhite said:
How much money we talking about? 600k? 700k?
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half that...
 
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I feel like places in areas like Seattle realize they hold the cards. It is a beautiful (although gloomy) place to live with no state income tax so they know they will find someone. They probably just bank on getting some spouse of a tech worker who wants to keep practicing but their salary isn't the "bread winning" or some are just fine making 300k with the occasional call, and again, living off the spouse benefits from Amazon or Microsoft. They don't offer big money because they know they don't have too.
 
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I would be curious the cases they get given that Harborview is just down the street.
 
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agammaglobulin said:
VM got bought by CHI Franciscan recently. Things are going to change, although I don’t think they ever paid what PP in the area paid. They do pay more than UW system I believe. Also, VM is getting an OB service so nights are going to look a little different moving forward.

They’re hiring if you’re interested! Some more will probably leave as CHI moves in...



half that...
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That's peasant money...
Scraps...
 
Twiggidy said:
I feel like places in areas like Seattle realize they hold the cards. It is a beautiful (although gloomy) place to live with no state income tax so they know they will find someone. They probably just bank on getting some spouse of a tech worker who wants to keep practicing but their salary isn't the "bread winning" or some are just fine making 300k with the occasional call, and again, living off the spouse benefits from Amazon or Microsoft. They don't offer big money because they know they don't have too.
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Seattle has some of the best paying jobs in the country. But a lot are as you say.
 
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MonteChristo said:
Seattle has some of the best paying jobs in the country. But a lot are as you say.
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Had. USAP and other AMC takeovers turned some exceptional groups into... well, not so much. Maybe there are smaller single-site shops, but the majority of the work is not great these days.
 
AdmiralChz said:
Had. USAP and other AMC takeovers turned some exceptional groups into... well, not so much. Maybe there are smaller single-site shops, but the majority of the work is not great these days.
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USAP took over just one group, Swedish First Hill. I don't think there are any other AMCs in Seattle.
 
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I did a spit take when I heard a rumor that Evergreen in Seattle pays $90/unit. That's enough $ to make me consider moving back to a place that looks like the Upside Down 8 months out of the year
 
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DaisyBuchanan said:
I did a spit take when I heard a rumor that Evergreen in Seattle pays $90/unit. That's enough $ to make me consider moving back to a place that looks like the Upside Down 8 months out of the year
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First, I'm surprised someone would let that information slip. Let's assume it's true. Make sure you give a practice like this a thorough evaluation because it's a mighty high value in a desirable place to live, which means (likely) there's a "gotcha" somewhere. Second, I bet that practice rarely hires new people unless they get a big string of retirements or deaths. Places with unit values like that will run lean for a while until they absolutely need someone, or they'll just us a locum which is all around cheaper.
 
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Ravenclaw90 said:
If I am unsure of whether I would enjoy academics or private practice more, which should I start out in? Is it easier to move from PP to academics or vice versa? I imagine I would stick with a situation for at least 2-3 years before trying something new.

Can anyone speak to their experiences and satisfaction regarding either setting, especially those who have done both? I am interested in hearing from OR anesthesiologists and chronic pain doctors.
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Coin toss
 
DaisyBuchanan said:
I did a spit take when I heard a rumor that Evergreen in Seattle pays $90/unit. That's enough $ to make me consider moving back to a place that looks like the Upside Down 8 months out of the year
Click to expand...

With that unit value, one could make $1mil/year working a very reasonable amount doing your own cases. Even if they have 100% commercial payors with zero Medicare and zero Medicaid, $90/unit seems unlikely. I could see a zero Medicare practice paying something like $70/unit. Why would the insurance companies give them a higher rate than they give everybody else?


13F26984-536E-432F-8BD2-F4D0B3D3E77B.jpeg


ASA Survey Results for Commercial Fees Paid for Anesthesia Services – 2019 | ASA Monitor | American Society of Anesthesiologists

The official news publication of the American Society of Anesthesiologists, the ASA Monitor delivers the latest specialty and industry news, and
pubs.asahq.org pubs.asahq.org
 
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nimbus said:
With that unit value, one could make $1mil/year working a very reasonable amount doing your own cases. Even if they have 100% commercial payors with zero Medicare and zero Medicaid, $90/unit seems unlikely. I could see a zero Medicare practice paying something like $70/unit. Why would the insurance companies give them a higher rate than they give everybody else?


View attachment 320983

ASA Survey Results for Commercial Fees Paid for Anesthesia Services – 2019 | ASA Monitor | American Society of Anesthesiologists

The official news publication of the American Society of Anesthesiologists, the ASA Monitor delivers the latest specialty and industry news, and
pubs.asahq.org pubs.asahq.org
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They wouldn’t. The only way this is possible as @okayplayer said is to skim off the other associates. This was somewhat common in the past for multi-tiered, malignant PPs. They don’t much exist anymore as the super senior partners sold as they approached retirement (see: Tampa, FL). I’d be surprised if this is the case for this group, at least currently.
 
nimbus said:
With that unit value, one could make $1mil/year working a very reasonable amount doing your own cases. Even if they have 100% commercial payors with zero Medicare and zero Medicaid, $90/unit seems unlikely. I could see a zero Medicare practice paying something like $70/unit. Why would the insurance companies give them a higher rate than they give everybody else?


View attachment 320983

ASA Survey Results for Commercial Fees Paid for Anesthesia Services – 2019 | ASA Monitor | American Society of Anesthesiologists

The official news publication of the American Society of Anesthesiologists, the ASA Monitor delivers the latest specialty and industry news, and
pubs.asahq.org pubs.asahq.org
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Everyone should keep this chart in mind. Recruiters are going to call you and tell you that you can make 500k working good hours and then toss in a unit value of $30. We all took calculus....do the math.
 
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Start in academics. When you get tired of the beaurocracy, politics, and academic surgeons, and you've exhausted the teaching thing, then move on to private practice. Typically a few years is about all it takes.
 
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Twiggidy said:
First, I'm surprised someone would let that information slip. Let's assume it's true. Make sure you give a practice like this a thorough evaluation because it's a mighty high value in a desirable place to live, which means (likely) there's a "gotcha" somewhere. Second, I bet that practice rarely hires new people unless they get a big string of retirements or deaths. Places with unit values like that will run lean for a while until they absolutely need someone, or they'll just us a locum which is all around cheaper.
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So you are making a big chunk of change and then you want to run lean?
Shouldn’t be the opposite? So that you can really keep your surgeons and administrators happy and not potentially lose a contract by having tired, haggard, grumpy people working all the time?
I must be missing something here.
 
I’m a new grad that recently went through the job hunt. When it comes time for you to start looking, rather than fixating on pp vs. academics, I would suggest investigating what job opportunities are available in your ideal location. If you are looking at a desirable city, you may find that academic sites and certain practices are only looking for hires with a specific fellowships or folks with x years of experience. Once you start interviewing, you can compare jobs and get a better sense of what sounds appealing to you. Salary, hours, supervision, partnership opportunities, and call all factor in. Good luck
 
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Realgassy said:
I’m a new grad that recently went through the job hunt. When it comes time for you to start looking, rather than fixating on pp vs. academics, I would suggest investigating what job opportunities are available in your ideal location. If you are looking at a desirable city, you may find that academic sites and certain practices are only looking for hires with a specific fellowships or folks with x years of experience. Once you start interviewing, you can compare jobs and get a better sense of what sounds appealing to you. Salary, hours, supervision, partnership opportunities, and call all factor in. Good luck
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I agree with what you’re recommending. Ask around before talking directly to practices. I think residents often have unrealistic expectations of what their interview process may look like. Groups want to lock you in. Sure you can delay a decision and play hard ball but if groups are competitive they are likely able to find other candidates. It is fairly common to hear people weren’t able to interview everywhere they had scheduled due to spacing out their interviews too much and groups pressuring them to get back to them. Figure out what you want, network, and interview early.
 
chocomorsel said:
So you are making a big chunk of change and then you want to run lean?
Shouldn’t be the opposite? So that you can really keep your surgeons and administrators happy and not potentially lose a contract by having tired, haggard, grumpy people working all the time?
I must be missing something here.
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Agree. I feel like a practice should always be a bit fat so that it can take on extra work on the fly or deal with unexpected leaves/sicknesses easily.

Worse case scenario you are fat while waiting for the asc expansion to finish and therefore take more time off.
 
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