Burned out with academic medicine. When should I leave?

[BlackBantie]

I've been working as a faculty member in a large department associated with a large psych residency, medical school, etc for a couple of years now. Just like any job there are good days and bad days but it seems like recently bad > good.

I'm 100% inpatient and supervise medical students and residents. That's fine and dandy, I guess, but lately our inpatient cross coverage duties have increased unbelievably. We are stretched very thin faculty-wise due to people leaving the department for various reasons so if someone is out sick or on vacation it adds to our load. Normally I see 13 patients a day but then with cross coverage it adds an extra 4-5 patients/day. That would be okay I guess but don't even get me started on all of my academic and educational duties... Basically I'm spending 9-10 hours/day working on patient care and then using weekends and weeknights to take care of my academic ****. At first I daydreamed about getting promoted from assistant to associate prof but eff that, that's going to take too much time. I think I'm actually putting in more hours in my current job than I did as a resident when you take out the hours I spent on call.

What's pissing me off the most is due to "unforeseeable" financial constraints in the hospital (long story) everyone this year is actually getting paid $10k less this fiscal year compared to the previous year. So more work than last year but less pay.

The powers that be keep telling us that it's all going to get better soon, hang in there, blah blah but I think it's just a carrot on the stick.

The only thing that is keeping me here, I think, is my contract with a loan repayment program that averages out to $40k a year. When I look at other job openings throughout the city they average at least approx $20k more than what I'm making at my current gig so I suppose the $40k towards loans is worth it despite all of the extra ancillary educational and academic work??

I don't want to include too many specifics to protect my anonymity. I'm not really sure what the point of my post is but I'm just fed up, burned out, and can't talk about it with anyone at work because politics.

Are these feelings normal? Should I wait to jump ship after I finish the loan repayment program (3 years to go)? Is this just how academic medicine is or am I going to find the same BS at other places?

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[wolfvgang22]

Very good question and what I believe is a frequent scenario in talking with others. Is anything holding you to this job other than money, such as family nearby or kids in school? Do you have to stay in the area?

 

[MacDonaldTriad]

None of what you describe is much of an outlier I'm afraid. Academic careers always lag in pay and it has to be worth it to you to take the pay cut in order to teach and do other than clinical things. Only you can determine if your ego needs the title and if that is worth the effort. You are not in a 40 hour a week job and most physicians work more hours than residency minus call. In a lot of ways, every step does get harder. Maybe not in hours or pay, but certainly in liability and responsibility. The grass will be greener in terms of cash, but not necessarily easier or more rewarding. Market forces do abuse junior faculty. It seems there is an endless supply of young psychiatrists willing to sacrifice time and money to join the academic rat race. Find a mentor who can show you the way up and insulate you from burn out or decide that tedium isn't so bad if you are paid enough.

 

[TexasPhysician]

So you are working 50 hours/week in an academic job and struggling to keep up?

Run fast!!!

The only reason I considered academics was if I could get a very Cush position.

 

[F0nzie]

If you consider taxes you would need to make approximately an extra 70k in salary to match your 40k in loans. And you won't have any med students or residents to help you out. Do you think you can find a job in the community that would be less stressful with less hours and make the same amount?


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[wolfvgang22]

I don't think you will always find the same BS at different places. I would start looking for another position on the down low and see. Keep it close to your vest, and at the same time trying to delegate as much patient care as you safely can. I would consider the politics at your facility and consider if you have any leverage to effect change as they are short handed and may not wish to lose experienced staff.

 

[BlackBantie]

Very good question and what I believe is a frequent scenario in talking with others. Is anything holding you to this job other than money, such as family nearby or kids in school? Do you have to stay in the area?

My husband works here in the city so if I switched jobs we'd probably stick around here. We live in a big enough city where there are plenty of other psych opportunities. Other than that, there isn't anything else tying me to this location.

None of what you describe is much of an outlier I'm afraid. Academic careers always lag in pay and it has to be worth it to you to take the pay cut in order to teach and do other than clinical things. Only you can determine if your ego needs the title and if that is worth the effort. You are not in a 40 hour a week job and most physicians work more hours than residency minus call. In a lot of ways, every step does get harder. Maybe not in hours or pay, but certainly in liability and responsibility. The grass will be greener in terms of cash, but not necessarily easier or more rewarding. Market forces do abuse junior faculty. It seems there is an endless supply of young psychiatrists willing to sacrifice time and money to join the academic rat race. Find a mentor who can show you the way up and insulate you from burn out or decide that tedium isn't so bad if you are paid enough.

Yeah, I'm not sure if it's worth it to me or not. I'd be okay if I was just seeing patients all day but I don't think I'm altruistic enough to continue taking time out of the day in order to teach, work on lectures, write letters of rec, etc. It's nice getting thanks from residents from time to time but that doesn't pay the bills nor does it give me more hours in the day to relax and enjoy myself.

I have a good mentor who has been helping me along the way but even then I don't feel like it's enough.

So you are working 50 hours/week in an academic job and struggling to keep up?

Run fast!!!

The only reason I considered academics was if I could get a very Cush position.

I like working inpatient and I consider myself a very efficient person but with all of the responsibilities it's just taking up too much time. I worry that cutting responsibilities will make me look bad.

If you consider taxes you would need to make approximately an extra 70k in salary to match your 40k in loans. And you won't have any med students or residents to help you out. Do you think you can find a job in the community that would be less stressful with less hours and make the same amount?


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That's a really good point and the answer is likely no. This is what will likely keep me here until I finish off the loan repayment.

I don't think you will always find the same BS at different places. I would start looking for another position on the down low and see. Keep it close to your vest, and at the same time trying to delegate as much patient care as you safely can. I would consider the politics at your facility and consider if you have any leverage to effect change as they are short handed and may not wish to lose experienced staff.

Thanks, that's a good idea.

All in all I'll probably stick around for the loan repayment since that IS a lot of money that I need for my loans and try not to take on more academic/educational responsibilities and then jump ship once I'm done with the loan repayment OR if the loan repayment program goes under.

 

[Shikima]

My husband works here in the city so if I switched jobs we'd probably stick around here. We live in a big enough city where there are plenty of other psych opportunities. Other than that, there isn't anything else tying me to this location.

Yeah, I'm not sure if it's worth it to me or not. I'd be okay if I was just seeing patients all day but I don't think I'm altruistic enough to continue taking time out of the day in order to teach, work on lectures, write letters of rec, etc. It's nice getting thanks from residents from time to time but that doesn't pay the bills nor does it give me more hours in the day to relax and enjoy myself.

I have a good mentor who has been helping me along the way but even then I don't feel like it's enough.

I like working inpatient and I consider myself a very efficient person but with all of the responsibilities it's just taking up too much time. I worry that cutting responsibilities will make me look bad.

That's a really good point and the answer is likely no. This is what will likely keep me here until I finish off the loan repayment.

Thanks, that's a good idea.

All in all I'll probably stick around for the loan repayment since that IS a lot of money that I need for my loans and try not to take on more academic/educational responsibilities and then jump ship once I'm done with the loan repayment OR if the loan repayment program goes under.

You can find better jobs that give you more in revenue, less work, more freedom of choice and include lots of reimbursed perks. The need is out there. Just check around before you commit one way or another.

 

[michaelrack]

If you are actually seeing managing 17-18 patients a day by yourself, that is alot. However, if there is a resident assigned for each patient that does the psych eval, d/c summary, etc; then I don't see how come you are spending more than 6 hours a day on those patients and associated teaching during rounds

 

[SeniorWrangler]

Your job will never get any easier because medicine in general and psychiatry in general is getting harder and less well compensated and so life is getting harder for everyone. The ship is sinking for everybody and psychiatry started close to the waterline.
Consider getting extra certification, fellowship, MBA, etc. so you're not just another random attending. Or alternatively, start moonlighting and cutting costs to speed up your loan repayment.

 

[BlackBantie]

If you are actually seeing managing 17-18 patients a day by yourself, that is alot. However, if there is a resident assigned for each patient that does the psych eval, d/c summary, etc; then I don't see how come you are spending more than 6 hours a day on those patients and associated teaching during rounds

No, we don't have residents covering all patients.

I don't want to give too many details away because I need to protect anonymity. There is a very busy service here in the hospital that was pretty much covered by PGY4s but they've just recently pulled the residents from the service because it was non-educational for them, which I get and agree with. But now that service is spread out to all of the inpatient faculty and residents aren't allowed to cover any patients on that service. We cover this service in shifts and if you're doing a shift that day you can pretty much forget about getting any of your own inpatient work done during that shift.

On our inpatient teams we don't have residents covering all of the patients due to a patient cap for them and our usual patient load on that team (11-13) exceeds their cap.

 

[TexasPhysician]

No, we don't have residents covering all patients.

I don't want to give too many details away because I need to protect anonymity. There is a very busy service here in the hospital that was pretty much covered by PGY4s but they've just recently pulled the residents from the service because it was non-educational for them, which I get and agree with. But now that service is spread out to all of the inpatient faculty and residents aren't allowed to cover any patients on that service. We cover this service in shifts and if you're doing a shift that day you can pretty much forget about getting any of your own inpatient work done during that shift.

On our inpatient teams we don't have residents covering all of the patients due to a patient cap for them and our usual patient load on that team (11-13) exceeds their cap.

How many do u typically see without resident support?

 

[SeniorWrangler]

I'm old enough to find it hilarious when they pull residents away from awful non-educational scutwork because it's awful and non-educational.

 

[LasVagus]

I'm a PGY-4 at a residency that has had a revolving door of attendings the entire time that I have been here. One thing the OP mentions that definitely rings true over here is how much extra coverage the attendings have to do. They are "capped" at 12, but they are always covering extra patients for someone else. There is always someone who is out on vacation or sick or just quit. It would not surprise me at all if attendings with a cap of 12 have some months where they have an average daily census of 15 for the entire month. And then hospital leadership can't figure out why everyone keeps leaving. Hmmmm...

 

[Shikima]

I'm a PGY-4 at a residency that has had a revolving door of attendings the entire time that I have been here. One thing the OP mentions that definitely rings true over here is how much extra coverage the attendings have to do. They are "capped" at 12, but they are always covering extra patients for someone else. There is always someone who is out on vacation or sick or just quit. It would not surprise me at all if attendings with a cap of 12 have some months where they have an average daily census of 15 for the entire month. And then hospital leadership can't figure out why everyone keeps leaving. Hmmmm...

More along the lines of poor leadership from dept Chair.

 

[Stagg737]

If you are actually seeing managing 17-18 patients a day by yourself, that is alot. However, if there is a resident assigned for each patient that does the psych eval, d/c summary, etc; then I don't see how come you are spending more than 6 hours a day on those patients and associated teaching during rounds

Is that really a lot? I've done 3 pysch rotations so far and on each one all of the attendings were covering at least 15 patients without resident support and they didn't work much more than 7-8 hours a day. I could see why having other duties in addition to the 15+ patients would be a lot, but having only that many patients as a responsibility really doesn't seem like all that much to me unless you're getting a bunch of new admits.

 

[splik]

Is that really a lot? I've done 3 pysch rotations so far and on each one all of the attendings were covering at least 15 patients without resident support and they didn't work much more than 7-8 hours a day. I could see why having other duties in addition to the 15+ patients would be a lot, but having only that many patients as a responsibility really doesn't seem like all that much to me unless you're getting a bunch of new admits.

we are talking about academic medical centers. no one in their right mind is going to work at an academic medical center caring for 15+ inpatients a day without resident assistance. This is because you get paid significantly less, have additional teaching/curriculum development, research, administrative, and service/committee responsibilities in addition to patient care, have more complex patients, are expected to spend more time with patients/have more detailed records, have less support staff in general etc. You must not have done these rotations at an academic medical center or hospitals affilitated with a medical school/residency program.

Regardless 15+ is a lot of patients to be seeing on an inpatient unit. One should expect significant renumeration for that, you have greater liability for the inevitably poorer care provided, and it takes the fun out of it. I have covered 26-28 patients on inpt units while moonlighting and having half that many pts for a regular day is not something I would do by choice. The exception would be on a geriatric unit where the length of stay is typically long or at a state hospital/forensic unit where again many patients are long stay and don't need to be seen every day or even every week.

 

[SmallBird]

we are talking about academic medical centers. no one in their right mind is going to work at an academic medical center caring for 15+ inpatients a day without resident assistance. This is because you get paid significantly less, have additional teaching/curriculum development, research, administrative, and service/committee responsibilities in addition to patient care, have more complex patients, are expected to spend more time with patients/have more detailed records, have less support staff in general etc. You must not have done these rotations at an academic medical center or hospitals affilitated with a medical school/residency program.

Regardless 15+ is a lot of patients to be seeing on an inpatient unit. One should expect significant renumeration for that, you have greater liability for the inevitably poorer care provided, and it takes the fun out of it. I have covered 26-28 patients on inpt units while moonlighting and having half that many pts for a regular day is not something I would do by choice. The exception would be on a geriatric unit where the length of stay is typically long or at a state hospital/forensic unit where again many patients are long stay and don't need to be seen every day or even every week.

I agree with this - 8 to 10 is a good number of academic inpatient given what you have highlighted.

Also, while I appreciate the OP wanting to be anonymous, it is a big problem that there is a lack of high quality gossip about which institutions are abusive to junior faculty. The 7-figure earning bureaucrats benefit from this, as they can always rely on being able to recruit a new grad who for 2 or 3 years won't know how good/bad they really have it.

 

[BlackBantie]

Your job will never get any easier because medicine in general and psychiatry in general is getting harder and less well compensated and so life is getting harder for everyone. The ship is sinking for everybody and psychiatry started close to the waterline.
Consider getting extra certification, fellowship, MBA, etc. so you're not just another random attending. Or alternatively, start moonlighting and cutting costs to speed up your loan repayment.

I really wish they had told us in residency but oh well. That's a good idea though.

How many do u typically see without resident support?

Depending on cross coverage, it has ranged anywhere from 6-15 patients. Also we have to physically sit in with the residents when they interview the patients so really the only benefit in terms of having a resident when it comes to the work load is they can type up the note for the patient that they interview. I know that there are some places where the attendings just have to staff the patients via a discussion with the resident but not here.

I'm old enough to find it hilarious when they pull residents away from awful non-educational scutwork because it's awful and non-educational.

I know, they're in for a bad surprise.

I'm a PGY-4 at a residency that has had a revolving door of attendings the entire time that I have been here. One thing the OP mentions that definitely rings true over here is how much extra coverage the attendings have to do. They are "capped" at 12, but they are always covering extra patients for someone else. There is always someone who is out on vacation or sick or just quit. It would not surprise me at all if attendings with a cap of 12 have some months where they have an average daily census of 15 for the entire month. And then hospital leadership can't figure out why everyone keeps leaving. Hmmmm...

That's exactly how it is here. Everyone is excited when we're fully staffed but then inevitably someone quits, gets sick, pregnant, dies, etc and the cycle continues.

More along the lines of poor leadership from dept Chair.

I agree.

we are talking about academic medical centers. no one in their right mind is going to work at an academic medical center caring for 15+ inpatients a day without resident assistance. This is because you get paid significantly less, have additional teaching/curriculum development, research, administrative, and service/committee responsibilities in addition to patient care, have more complex patients, are expected to spend more time with patients/have more detailed records, have less support staff in general etc. You must not have done these rotations at an academic medical center or hospitals affilitated with a medical school/residency program.

Regardless 15+ is a lot of patients to be seeing on an inpatient unit. One should expect significant renumeration for that, you have greater liability for the inevitably poorer care provided, and it takes the fun out of it. I have covered 26-28 patients on inpt units while moonlighting and having half that many pts for a regular day is not something I would do by choice. The exception would be on a geriatric unit where the length of stay is typically long or at a state hospital/forensic unit where again many patients are long stay and don't need to be seen every day or even every week.

Yes yes yes.

I have formal lecture teaching responsibilities for residents and medical students. I also am very involved in the resident education, curriculum, etc. I have medical students with me during rounds and am expected to do bedside teaching. I've been "voluntold" to join various hospital committees that have regular meetings and extra work that needs to be done.

By myself I am an efficient person with interviewing and making treatment decisions, but that is not educational for residents and students. We have to explain our thought process, decision-making and really make sure we are doing thorough interviews to teach them interviewing skills. Doing that and answering questions for the students really takes up a lot of time.

I also forgot to mention that we work in an acute inpatient unit and we average anywhere from 2-5 new patients a day so there is a lot of turnaround.

I agree with this - 8 to 10 is a good number of academic inpatient given what you have highlighted.

Also, while I appreciate the OP wanting to be anonymous, it is a big problem that there is a lack of high quality gossip about which institutions are abusive to junior faculty. The 7-figure earning bureaucrats benefit from this, as they can always rely on being able to recruit a new grad who for 2 or 3 years won't know how good/bad they really have it.

Yeah, I really wish I had known what I knew now and probably would have thought twice about coming here.

 

[TexasPhysician]

10-15 inpatients can easily be 300k+ in the real world. Unless your job is paying $230k+ $40k loan support, you could easily do better out of academics.

 

[Stagg737]

we are talking about academic medical centers. no one in their right mind is going to work at an academic medical center caring for 15+ inpatients a day without resident assistance. This is because you get paid significantly less, have additional teaching/curriculum development, research, administrative, and service/committee responsibilities in addition to patient care, have more complex patients, are expected to spend more time with patients/have more detailed records, have less support staff in general etc. You must not have done these rotations at an academic medical center or hospitals affilitated with a medical school/residency program.

Regardless 15+ is a lot of patients to be seeing on an inpatient unit. One should expect significant renumeration for that, you have greater liability for the inevitably poorer care provided, and it takes the fun out of it. I have covered 26-28 patients on inpt units while moonlighting and having half that many pts for a regular day is not something I would do by choice. The exception would be on a geriatric unit where the length of stay is typically long or at a state hospital/forensic unit where again many patients are long stay and don't need to be seen every day or even every week.

Thanks for the response. I figured it had to do with other duties of the academic center, but I wasn't sure.

One of my rotations was an independent private psych hospital (considered the best in the city it's in by a lot of psychiatrists I've met or talked to), one was mixed but was mostly at a state hospital, the third was at a VA hospital that is affiliated with a major academic program in the area and has residents rotate through. Also, why would seeing 15-20 patients a day be "inevitably poorer care" than seeing 10-12 or less assuming that seeing patients is the sole responsibility of the attending? How much time are you really spending with each patient? I get that some patients take a while to see, especially new patients, but after the first 2 or 3 days are you really spending more than 15 minutes of face-time with f/u patients? Also, how long is the average patient staying for stabilization? Because the rotations I've been on the attendings are more focused on recovery than just stabilization and patients are on the unit for 5-7 days on average (as opposed to 2-4 like I've heard some other places do).

Sorry to hijack the thread, just curious as I obviously have limited experience right now and the attendings I've worked with sound like they have very different responsibilities overall than OP.

Also, @BlackBantie do you feel like the institution you're at is good for residents and just sucks for attendings, or do you think the residents are overworked/aren't taught adequately as well?

 

[michaelrack]

assume a psychiatrist is on an inpatient unit and is expected to carry 15 patients/day, with an average Length of stay of 5 days. That would equate to about 20 admissions/discharges per week. If you assume that an admission takes 1 hour, and a discharge 30 minutes- that's 30 hours per week for just admissions and discharges. This example simplifies things a bit, but demonstrates why a 15 patient load is a lot for an inpatient psychiatrist.
So when evaluating a potential job, a key thing to look for is the average Length of stay on the unit you will be assigned to

 

[masterofmonkeys]

If you consider taxes you would need to make approximately an extra 70k in salary to match your 40k in loans. And you won't have any med students or residents to help you out. Do you think you can find a job in the community that would be less stressful with less hours and make the same amount?
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My (medianish for academic) offer was 100k or more under what all my fellow graduates went off to make in private, all of whom have much less arduous schedules. Making up this difference should not be hard at all to do. I'm Child, but the general graduates reported similar differentials.

 

[SeniorWrangler]

It's not a hostile conspiracy, honest. It's kind of a funnel effect that happens in academic medicine, similar to what happens in fashion, publishing, and other industries where there's some intangible sense that it's a cool and prestigious job beyond the pay and benefits. Lots of people sign up and work in the position for a while, and after 3 or 6 years realize that the job is not getting any easier and there is no light at the end of the tunnel and they move on to a different institution or private practice, and they are replaced by new bright-eyed junior faculty. Those who stick around find some special niche or compensating factors or get involved in research.

 

[BlackBantie]

Also, @BlackBantie do you feel like the institution you're at is good for residents and just sucks for attendings, or do you think the residents are overworked/aren't taught adequately as well?

I think it's good for residents but sucks for attendings.

Thank you all for your responses and contributions! I'm not sure what I'm going to do yet but venting here was cathartic and I have received a lot of good information to think about.