Academics vs. Private Practice - what are you doing?

[Sea Otter]

Are you going in to academics or private practice? I know the pros and cons have been discussed in the past (yay search function) but I'd love to hear anyone's personal though process or experience on choosing to go into academic or take the private practice route after residency regardless of specialty. I am in my last year of residency and am currently weighing my options. Cheers!

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[Apollyon]

Doing what, though? Plastics, psych, peds, EM, IM, what?

 

[Sea Otter]

Doing what, though? Plastics, psych, peds, EM, IM, what?

Sorry it wasn’t clear (I have now updated the post for clarity). I am curious individual stories about why people choose an academic or private practice position of any specialty. I am in PM&R so the perspective of a non-surgical specialty may be most helpful to me but I’m curious about any specialty. I find personal anecdotes to be more helpful and inclusive than the cookie-cutter more $$ in private and teaching in academics, though these are major considerations of course.

 

[Balanced Success MD]

Oh, this is such a good topic. My wife and I are both docs, and my wife is in academics. I've been both in private practice and in an HMO setting, and now even have a teaching role in at our University, but wouldn't consider myself to be academic at all.

There are so many considerations when choosing which path, and it's not just about money or teaching. I'm so glad you brought this up and realize that there's so much more depth to it. Truthfully, a lot of it has to do with your practice location and the relationships between the institutions in the area you end up practicing in.

However, your first guiding principle starts with you. If you were being honest with yourself, what's most important to you? This can go in so many ways: teaching, money, flexibility, autonomy, impact, intellectual stimulation, significance, etc.

Once you figure this out, you're definitely on the right path towards figuring out your question.

 

[BoardingDoc]

Oh, this is such a good topic. My wife and I are both docs, and my wife is in academics. I've been both in private practice and in an HMO setting, and now even have a teaching role in at our University, but wouldn't consider myself to be academic at all.

There are so many considerations when choosing which path, and it's not just about money or teaching. I'm so glad you brought this up and realize that there's so much more depth to it. Truthfully, a lot of it has to do with your practice location and the relationships between the institutions in the area you end up practicing in.

However, your first guiding principle starts with you. If you were being honest with yourself, what's most important to you? This can go in so many ways: teaching, money, flexibility, autonomy, impact, intellectual stimulation, significance, etc.

Once you figure this out, you're definitely on the right path towards figuring out your question.

This post sounds exactly like an MLM pitch someone would give a new mark while in line at Starbucks.

 

[mvenus929]

I'm looking for jobs in academia because I have a passion for teaching, and an interest in making the lives of a subset of my patients better through better understanding of their conditions.

 

[Sea Otter]

I'm looking for jobs in academia because I have a passion for teaching, and an interest in making the lives of a subset of my patients better through better understanding of their conditions.

Do you feel academia will allow you to have a better understanding of their condition as opposed to if you were in private practice? Genuinely curious.

 

[Shufflin]

Third option. Hospital work, not connected to an academic institution. I highly recommend working in a hospital setting of some sort (whether academic or non) after graduation because there's so much more you need to learn. You need to see the acute pathology, and you need the colleagues who can teach you. I'm in Psych, and I keep learning new things in my field every year, and have even learned a lot about general medicine and addiction medicine that I would have never had in private practice.

I was in private practice for a time and found my knowledge not being tested or expanded enough.

 

[mvenus929]

Do you feel academia will allow you to have a better understanding of their condition as opposed to if you were in private practice? Genuinely curious.

I'm interested in rare diseases. They tend to get referred to academic centers in higher concentrations than private practice models. And there tends to be more directly collaborative care (i.e. multidisciplinary clinics) in academic than in private practice, which allows a better understanding from different subspecialties (and less fragmentation of care). So yes.

The other subset of the population I enjoy teaching would probably see me in high enough numbers in private practice to not make a huge difference.

 

[QuizzicalApe]

I'm in private practice and predominantly do outpatient with occasional inpatient consults. I show up at 8:30, I am usually out of the office by 4:30. This fits my goal of working to live, not living to work, and actually enjoying seeing patients longitudinally.

My wife is in academia and is very research focused and has a few grants. She'd probably keep working on her research even if nobody was paying her, a stark difference between her and I.

If I won the lottery tomorrow, I'd be gone so fast I'd leave a Loony Tunes-esque cloud shaped like me.

 

[clausewitz2]

Third option. Hospital work, not connected to an academic institution. I highly recommend working in a hospital setting of some sort (whether academic or non) after graduation because there's so much more you need to learn. You need to see the acute pathology, and you need the colleagues who can teach you. I'm in Psych, and I keep learning new things in my field every year, and have even learned a lot about general medicine and addiction medicine that I would have never had in private practice.

I was in private practice for a time and found my knowledge not being tested or expanded enough.

This is a good point, although it's worth noting the extent to which you will need to be in a specific practice setting to keep learning is going to vary from person to person. If you are a big ol' nerd who tends to fill downtime at work by reading through the latest issues of the top 10-ish journals in your field and has an Amazon wishlist of textbooks a mile long, where you work is not going to be the rate-limiting factor on your learning.

No, uh, of course that's not me. Nope.

I personally am split between private practice and working in a multidisciplinary team in an agency setting with a very niche population on a part-time basis. That's much more common in psych than in other specialties, I recognize. I also have a volunteer faculty appointment with my former Mothership so that I can feel all fancy/still give a few lectures to residents per year. It's a pretty happy medium overall. I am strictly an 8-4 type m*******ker these days.

 

[sloh]

Sorry it wasn’t clear (I have now updated the post for clarity). I am curious individual stories about why people choose an academic or private practice position of any specialty. I am in PM&R so the perspective of a non-surgical specialty may be most helpful to me but I’m curious about any specialty. I find personal anecdotes to be more helpful and inclusive than the cookie-cutter more $$ in private and teaching in academics, though these are major considerations of course.

PM&R here. I used to be a W2 doing outpatient MSK 830-5 M-F. Also had to tend to inbox messages and phone calls. Patient satisfaction scores was the **** cherry on top. I barely lasted a year.

I’m now a 1099 doing SAR work. I make 150-200k more and work half the hours. The work itself isn’t glamorous (and I prefer outpatient MSK) but the hours and compensation make up for it. I have enough off time to pursue hobbies and interests and much prefer this setup.

 

[Apollyon]

Ah, "sub-acute rehab". I was thinking, "what does search and rescue have to do with physiatry?"

 

[FrkyBgStok]

After fellowship, I signed to go back to a community hospital that has a small residency in my umbrella specialty. It is mostly private practice with some teaching. The reason I chose this is for a few reasons. 1) Money is way way better outside of academia. 2) With academic jobs, you have less clinical time, but you have a ton of non-clinical time. I don't want to do that crap like research, committees, lectures, etc. If I do a lecture, it is because I want to do a lecture. If I do a research project, it is because I want to do that. In theory, you get that in academia as well, but in reality, research is more political than people realize. And 3) the community/private practice setting is much more efficient. I am good at efficiency and doing things quickly and correctly is how my brain works. I want to teach some times, but other times I want to have residents leave me alone and stay out of my way so I can crank some patients out.

 

[Neuronix]

Apply all over the country to anything you can find and take whatever offer you get.

What forum am I in again? Oh gen res. Not rad onc. Ok carry on.

 

[Oso]

After fellowship, I signed to go back to a community hospital that has a small residency in my umbrella specialty. It is mostly private practice with some teaching. The reason I chose this is for a few reasons. 1) Money is way way better outside of academia. 2) With academic jobs, you have less clinical time, but you have a ton of non-clinical time. I don't want to do that crap like research, committees, lectures, etc. If I do a lecture, it is because I want to do a lecture. If I do a research project, it is because I want to do that. In theory, you get that in academia as well, but in reality, research is more political than people realize. And 3) the community/private practice setting is much more efficient. I am good at efficiency and doing things quickly and correctly is how my brain works. I want to teach some times, but other times I want to have residents leave me alone and stay out of my way so I can crank some patients out.

You’re in PICU right?

Did you have an idea about which type of practice you wanted to do when entering fellowship? And did you exclusively look at private practice or did you look at some academic jobs too? Just curious!

 

[FrkyBgStok]

You’re in PICU right?

Did you have an idea about which type of practice you wanted to do when entering fellowship? And did you exclusively look at private practice or did you look at some academic jobs too? Just curious!

I am actually in PEM. And I knew that I loved the community setting how I did residency, but I wanted to keep my eyes open to academia. And it lasted a month. I knew I would ideally work with residents and do some teaching, however I also knew that those were lower on my priority list.

 

[Oso]

I am actually in PEM. And I knew that I loved the community setting how I did residency, but I wanted to keep my eyes open to academia. And it lasted a month. I knew I would ideally work with residents and do some teaching, however I also knew that those were lower on my priority list.

Gotcha, thanks for sharing. I'm glad you found a job that's a good fit!

 

[disorder]

Oh, this is such a good topic. My wife and I are both docs, and my wife is in academics. I've been both in private practice and in an HMO setting, and now even have a teaching role in at our University, but wouldn't consider myself to be academic at all.

There are so many considerations when choosing which path, and it's not just about money or teaching. I'm so glad you brought this up and realize that there's so much more depth to it. Truthfully, a lot of it has to do with your practice location and the relationships between the institutions in the area you end up practicing in.

However, your first guiding principle starts with you. If you were being honest with yourself, what's most important to you? This can go in so many ways: teaching, money, flexibility, autonomy, impact, intellectual stimulation, significance, etc.

Once you figure this out, you're definitely on the right path towards figuring out your question.

One hundred percent.