Any benefit staying in academics for a year?

[ERRES2288]

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Ultimately would like to be in a busy private practice (true partnership track if I can find it in the area I'm looking). Having said that, 1st year attendings have said it was a very nice transition staying on as faculty for a year because they knew everyone, who to ask for help, resources for oral boards, etc.. Wondering if others have done this and would recommend it ?

 

[Ronin786]

If there's a partnership track you know you want to be in, you should start that clock as soon as you can. A fair and good group is going to have resources you can look to as far as oral boards, getting you to know the system and helping you out.

Academics are good if you're trying to figure out what you want to do since the pay is usually better than a first year PP position. Or at least that was my experience when you factor in time off and benefits.

 

[deleted162650]

Nope

 

[ethilo]

<-- 1 year out of residency in PP on 2y partnership track

I pondered this question myself, however I ultimately went directly into the busy private practice world you are talking about. It took me maybe a few weeks to get used to being autonomous, a few months to get used to the environment, and maybe a few more extra months to really get settled in.

I think the biggest issue I faced going straight into PP is how to interact with other anesthesia group members that have been doing this for many years. My anesthesia group is "MD only" without supervision. Throughout residency I obviously never worked alongside a coworker who was providing direct anesthesia care unsupervised for a long time. Only residents or CRNAs that were providing the direct care of patients. It was hard / strange getting used to coming fresh out of residency with all this great new current practice technique from my residency to this new world where others had been doing what they do for 20+ years already. Getting used to being comfortable being around others doing things differently than how you trained is weird.

I really don't think an extra year of academics would have helped me prepare for PP. I suggest you do it if you are interested in the fellowship specialization it provides, not solely as a stepping stone to soften the transition. If I do that I would have accumulated waaaay more interest for my student loan debt instead of hacked it down as aggressively as I've been able to with my current salary.

 

[Guillemot]

Eh. I didn't do it, but I can see that there would be some advantages and and also disadvantages to staying on as Jr attending at you residency c/w PP.

 

[ryanjmy]

who to ask for help

You are the one they ask for help

 

[deleted697127]

It’s a reasonable move that people i respect have made. You know the people making the schedule and can likely arrange a schedule/case mix you’d like from a department that likely covers the full spectrum of cases to choose from. If you join a good supportive practice, you’ll have people you can run things by if needed there too.

I didn’t stick around but it was worth considering for me with the goal of saving up money for moving far away from where I did residency.

 

[vector2]

You are the one they ask for help

A sign of a bad practice, either academic or PP, is one in which junior partners don't feel they can rely on their senior partners for reliable anesthetic, financial, or (hospital) political advice.

 

[Mman]

It’s a reasonable move that people i respect have made. You know the people making the schedule and can likely arrange a schedule/case mix you’d like from a department that likely covers the full spectrum of cases to choose from. If you join a good supportive practice, you’ll have people you can run things by if needed there too.

I didn’t stick around but it was worth considering for me with the goal of saving up money for moving far away from where I did residency.

in my experience, most academic departments are going to pigeonhole you into one "division" that has a very limited case mix compared to a private practice setting that has a higher chance of letting you do a wide range of cases. Now obviously there are outliers in either direction but I think that is a fair generalization.

 

[dabears505]

Depending on what kind of set up you have at the academic center, it might actually hinder you if you ultimately want to go into private practice. If all you do is supervise right out of residency, you might be worse off going to a practice where you do your own cases.

 

[2Fast2Des]

Definitely leave the nest, that is how you will truly grow, being on your own in a different setting. One of my seniors in residency stayed as a regional fellow\part time attending, he had a pt he wanted to awake fiber-optic because of a shaky airway in his opinion, but the surgeon didn't accept this, and called the desk to have another anesthesiologist come, who then just induced and intubated, makes my senior look weak and like a jackass. Many other instances where junior staff are made to feel as not the ultimate decision makers. I guess only problem with academic is you're still seen as a resident in a light so you have to really earn your stripes. PP you're expected to perform, hit the ground running and people respect you for what you want to do. You learn on the go, improving or removing stuff you learned in residency, know where to push the limits, or work with hands tied behind your back because you don't have all the fancy tools or drugs available you were spoiled with in academic. I don't regret one bit, just regret not having that amazing PP like others in this group are in that are those one in a million types

 

[aneftp]

It depends on the academic pay as well. If you are talking high 200s academics. Vs low 400s private. Than definitely not worth it.

But if you are talking mid 300s (plus their usually generous benefits package) for academics. Vs low 400s private.
Than academics looks more appealing for one year since you aren’t losing that much money.

and yes. There are quit a few state academic places I know that pay between 330-350k base plus incentive. So you can work some extra weekends and make in the high 300s.

 

[deleted697127]

in my experience, most academic departments are going to pigeonhole you into one "division" that has a very limited case mix compared to a private practice setting that has a higher chance of letting you do a wide range of cases. Now obviously there are outliers in either direction but I think that is a fair generalization.

Agreed that you probably won’t get on the cardiac team but would you really be the right person to be teaching residents 3D echo? Doubt that’s what he’s looking for if he’s not doing a cardiac fellowship. Weekends and nights seem to have plenty of trauma, neuro, vascular, and septic train wrecks to go around. Blocks and thoracic epidural skills may suffer. But the main blocks seem to be easier on your own anyways and there are far fewer “difficult” 4 hour lap choles converted to open needing post op epidurals out in private practice.

 

[nimbus]

One benefit of a year supervising in academics is that you’ll appreciate how much easier and less stressful it is to do your own cases in private practice.

 

[deleted697127]

Definitely leave the nest, that is how you will truly grow, being on your own in a different setting. One of my seniors in residency stayed as a regional fellow\part time attending, he had a pt he wanted to awake fiber-optic because of a shaky airway in his opinion, but the surgeon didn't accept this, and called the desk to have another anesthesiologist come, who then just induced and intubated, makes my senior look weak and like a jackass. Many other instances where junior staff are made to feel as not the ultimate decision makers. I guess only problem with academic is you're still seen as a resident in a light so you have to really earn your stripes. PP you're expected to perform, hit the ground running and people respect you for what you want to do. You learn on the go, improving or removing stuff you learned in residency, know where to push the limits, or work with hands tied behind your back because you don't have all the fancy tools or drugs available you were spoiled with in academic. I don't regret one bit, just regret not having that amazing PP like others in this group are in that are those one in a million types

Your reasoning is staying where you did residency allows you to be bullied into doing something you see as unsafe? Come on. I have heard several stories where this exact situation has played out far differently than what you describe where patients were harmed either by the junior attending not taking the airway concerns seriously enough and losing the airway and by the seasoned attending not taking it seriously enough and losing the airway. Avoidable mortality.

You’re the airway specialist. Your senior partners should have your back. It is imperative to develop the skills to identify, communicate, and handle difficult airways in the way you see fit in an efficient manner. Sometimes this requires a second set of skilled hands.

A surgeons lack of identifying the seriousness of a difficult airway like history of high cervical spine fusion or neck radiation is not your scheduling emergency.

 

[Mman]

Agreed that you probably won’t get on the cardiac team but would you really be the right person to be teaching residents 3D echo? Doubt that’s what he’s looking for if he’s not doing a cardiac fellowship. Weekends and nights seem to have plenty of trauma, neuro, vascular, and septic train wrecks to go around. Blocks and thoracic epidural skills may suffer. But the main blocks seem to be easier on your own anyways and there are far fewer “difficult” 4 hour lap choles converted to open needing post op epidurals out in private practice.

if you want a "full spectrum of cases" as you had suggested, the academic centers near me would not be the place to do it. Ortho team does ortho, vascular team does vascular, thoracic team does thoracic, neuro team does neuro. Meanwhile most weeks I will get to do cranis, carotids, joints, OB, gen surg, ENT, maybe some thoracic, etc. I found it very beneficial for board studying purposes as I kept up all my skills and got used to doing a wide variety of cases.

 

[2Fast2Des]

Your reasoning is staying where you did residency allows you to be bullied into doing something you see as unsafe? Come on. I have heard several stories where this exact situation has played out far differently than what you describe where patients were harmed either by the junior attending not taking the airway concerns seriously enough and losing the airway and by the seasoned attending not taking it seriously enough and losing the airway. Avoidable mortality.

You’re the airway specialist. Your senior partners should have your back. It is imperative to develop the skills to identify, communicate, and handle difficult airways in the way you see fit in an efficient manner. Sometimes this requires a second set of skilled hands.

A surgeons lack of identifying the seriousness of a difficult airway like history of high cervical spine fusion or neck radiation is not your scheduling emergency.

I think you misinterpret what I said. I say that staying in residency can be trying in that your opinion may be undermined because you're the young fresh guy. It was not the necessity of having a second pair hands to facilitate something the individual was able to handle (he was supervising a CRNA), but that because the surgeon didn't want an awake foi to delay him that he would rather disrespect the physician he has assigned to him, wanted to get things done the way he thought it right (even though he has no clue as a surgeon). And that other Anesthesiologist instead of backing up the junior does what the surgeon demands, so it doesn't breed confidence when you're in that scenario. How can you be the "boss" ?

That's just my perspective, I'm sure others have their own experience.

 

[kidthor]

I think you misinterpret what I said. I say that staying in residency can be trying in that your opinion may be undermined because you're the young fresh guy. It was not the necessity of having a second pair hands to facilitate something the individual was able to handle (he was supervising a CRNA), but that because the surgeon didn't want an awake foi to delay him that he would rather disrespect the physician he has assigned to him, wanted to get things done the way he thought it right (even though he has no clue as a surgeon). And that other Anesthesiologist instead of backing up the junior does what the surgeon demands, so it doesn't breed confidence when you're in that scenario. How can you be the "boss" ?

That's just my perspective, I'm sure others have their own experience.

What you describe is a poor workplace with a toxic culture - it isn't an academics vs PP thing.

The young fresh guy might be undermined in a PP group too. It all depends on the environment.

Having been the young fresh guy not too long ago... I'd have discussed this case with my colleagues and they would have fully backed me whether I decided on FOI or something else. And they would have provided an extra hand. That includes an extra hand for surgeon pushback if needed. Nobody would have undermined me and the surgeon requesting another anesthesiologist would have been dealt with appropriately.

A good group hires you because they trust you, support you, and will back you. They want you to be a part of their team. A bad group hires you because you're a warm body to exploit and they'll undermine you if it benefits them.

Luckily I'm in a very good group and it happens to be in academia.

 

[rakotomazoto]

If you know that your final destination is PP, then get out of academia ASAP. The sooner you leave, the sooner you start to learn how to succeed in PP. There are some important differences versus academia. If you were well-trained, an extra year at the mothership is completely unnecessary. Get out there and get to work. As someone else mentioned, you want to start the partnership clock. Sounds like there is some regional variation on what you can make as a first-year attending, but I definitely made out better in PP than I would have by staying where I trained.

 

[T-burglar]

I couldn’t wait to get away from all the people who would never see past me as a resident

 

[Hork Bajir]

FWIW I stayed at my residency institution for a year as an attending, and learned more that year than any other year of my anesthesia training. I got to do some gnarly cases, built a ton of confidence, had some unfortunate outcomes and complications, and was glad to be in a setting where I had people I could ask for help who I knew had my back. I felt like my residency training was outstanding, and I definitely could have hacked it in a private practice if that had been my goal... But without a doubt I was a way better doctor at the end of that year than I was at the start.

Can’t tell anyone else what to do, and of course regional/personal variations apply (for example I think I was seen as a “strong resident”, which made it easier for me to spread my wings and be respected as an attending during that year). But even still, learning doesn’t stop after CA-3 year, and I think many would agree that you learn more in your first year as an attending than you do during all of residency. Could I have done the same thing at a good supportive PP? Sure, probably. For me I could bust my hump with incentives and negate the difference in academic/private pay in my region. YMMV.

 

[Mman]

I couldn’t wait to get away from all the people who would never see past me as a resident

I confess to some bias in that regard. I will work with surgeons that I saw as a med student and a resident and now they are an attending. To me I still see them as that med student they were when I first met them as opposed to a surgeon that was hired from somewhere else and is an attending the first day I met them.

I mean I'm aware of that bias in my head so I consciously try to not act differently based upon it, but that first impression is definitely something that hangs around the back of your head forever.