Career options from excellent programs

[fang]

---

Members don't see this ad.

What do you all think of this?

I'm in an excellent IM program, and in general like what I do and the people I work with. However, after a year of internship, I'm more than a little burned out. I'm tired of living like a college student and want to move somewhere permanently, buy a house, and work on achieving some kind of work-life balance where I might work, say, 60 hours a week and develop some other interests.

I've been considering going back to a smallish town where I spent time in high school potentially as a hospitalist or even primary care-- it's a place I'd like to live though career opportunities are more limited than in a larger area. The problem I have with this is that I feel in part that I'd be "wasting" this education... I'm sure I'd try to become a leader in some way (work on policy? improve local health care outcomes?) but it's a long way from the super-sub-specialized academic careers many of my coworkers are angling for.

I know I'm still feeling the effects of internship and wonder if I'd recover from this in 1-3 years and wish I'd done a fellowship and stayed in an academic center. I do have a fellowship interest, but right now the thought of being a resident for another 5 years is nauseating at best.

Thoughts? Am I wasting a good education/residency?

 

[jennyboo]

I can definitely relate to your situation. I'm a resident at a so-called "excellent" academic program in anesthesiology and I am seeing myself wanting to "just get a job" after finishing residency.

Our program director would call that a waste of an excellent academic opportunity, but I think even he sees the reality that most US MD graduates are not going into research, and admits it is exceedingly difficult to recruit residents who are actually going to stay even in academic clinical positions, let alone research-based careers in academic medicine.

I cannot see myself slaving away at an academic career (though the academic work hours seem shorter than private practice work hours) in the institution where I work for the next 30 years. I do not have strength in research, and although I don't mind the idea of teaching residents or fellows I don't know if I want to have patience to work with the inefficiencies of a major academic center (like four-hour skin tag excisions, six-hour lap appys, lap choles where the surgical residents manage to insufflate the aorta or whack the portal vein). I would be starting at the bottom of the totem pole in a huge department and possibly remaining junior faculty for most if not all of my career (small fish, big pond).

Waste of an excellent education? Some really old-school academics would probably say so, but even they have to admit that most people aren't going to stay in academics or pursue careers with NIH-funded research. I have personal priorities which include family, paying off loans, taking parents on a long-awaited trip before they get too old for it, and so on. I don't think you should feel obligated to remain in an academic rat-race -- far more important to go home if that's your priority (although you still have the private practice rat race to contend with).

 

[elwademd]

when in medicine, always remember the perspective of the storyteller. er's gonna tell you the patient has to be admitted; the interventional radiologist who also does reads may tell you some obscure finding that doesn't have clinical significance, but is amenable to a procedure; the surgeon's going to tell you why he/she can't operate on the patient... the academic attendings will tell you that unless you go into academia, you're wasting your education.

of course its not literally always that way, but it seems like it.

if your education gets you to where you want to go, then it would seem to me that your education was not wasted/squandered/given away.

i think there are pro's and con's to academic medicine, just as there are to private practice. but you have to decide what's important to you, not what others deem important to you.

as sheryl crow said, "if it makes you happy, it can't be that bad".

 

[Ludicolo]

It's hard not to play "what if?", isn't it?

You guys sound like you survived internship and are doing well in good programs. You're obviously doing something right. Eventually you'll make what seems to be the right decision, and if you don't...realize that you have the freedom to change.

Academia is not for everyone, just like private practice is not for everyone. Keep in mind that there are different facets to academia as well – research tracks, clinical educators, private practice but affiliated with a teaching facility. Some people in private practice do research, some people in academia don’t. You can prioritize, and family doesn't necessarily have to take a back seat to career in either academics or private practice. Lots of different permutations. Nice to have options.

 

[BlondeDocteur]

As best as I can tell as an MS4, medical education is exactly that-- training in clinical medicine. I'm at a top school and I think that's by far the main perk to training here-- we actually see the bizarre conditions and diseases most other people only read about; we have incredibly sick patients that we learn to confidently manage; we have sharp colleagues that keep us on our toes and make us read up at night. All of these things make an excellent, confident doctor. I'd think that would be a *major* benefit in private practice, especially if your colleagues trained in places that gave them less exposure.

If you enjoy being a generalist and dream about moving yourself / your family back home, there is no reason to subject yourself to years of misery simply because your residency program wants to boast about its fellowship matches to interviewing applicants.

 

[dragonfly99]

Do not listen to anyone else r.e. your career.
Do not listen to your program director, etc. They have a vested interest in people matching into so-called "prestigious" specialties.
Do what you want, not what THEY want you to do.
Don't worry, you still have a couple of years to decide what you want to do.
Recognize the academic BS and cut through it. Don't be brainwashed.
I think it's awesome that a well-trained doc like you might want to go practice in a smaller town. Those people deserve excellent medical care just like urbanites and suburbanites.

 

[fang]

Thanks for all the great replies. It's honestly a different response than I expected.

 

[roja]

You have gotten excellent advice here.

You are not 'wasting' your education. Your a physician in training. You are training to take care of patients. You love what you do and where you are learning. You will get excellent training and be able to provide excellent care for your patients.

Ultimately, this is your only duty! Provide care for your patients. How, when and where you provide these services is entirely up to you. You won't provide great care if you are miserable where you are. So build your life based on how YOU want to build your life.

Best of luck