Details about academic research + solo cash private practice

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tortuga87

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I have heard about the possibility of having an academic affiliation to do research + having a solo cash part time private practice. This seems like an ideal setup. People say this is not possible at most places, yet there seem to be others who are doing this very well.

My attendings say this was possible back in the day, but it is no longer possible at my institution. I am wondering if I can get the details on how it can be made possible at other places. Where should you go? How do you go about negotiating it and setting it up?

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It would be helpful if you provide more detail. Where you are, how far in training you are, what kind of research you want to do, where you are open to moving to, how much money you want to make, etc.
 
Every institution has different rules. You’ll need to talk with specific ones that interest you. My past institution allows 0 outside work paid to you and doesn’t allow part-time staff. You are all-in or all-out. If you really want to do paid outside work, the institution is paid 100% from the extra work and can bonus you part of it if they wish.
 
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Every institution has different rules. You’ll need to talk with specific ones that interest you. My past institution allows 0 outside work paid to you and doesn’t allow part-time staff. You are all-in or all-out. If you really want to do paid outside work, the institution is paid 100% from the extra work and can bonus you part of it if they wish.
Was your CEO Andre the Giant? Because that seems pretty heavy handed
 
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It would be helpful if you provide more detail. Where you are, how far in training you are, what kind of research you want to do, where you are open to moving to, how much money you want to make, etc.

In the South
Resident
Bioinformatics

Preferably in the South or somewhere else warm, but I am open to wherever (except Alaska)
At least 250K
 
Every institution has different rules. You’ll need to talk with specific ones that interest you. My past institution allows 0 outside work paid to you and doesn’t allow part-time staff. You are all-in or all-out. If you really want to do paid outside work, the institution is paid 100% from the extra work and can bonus you part of it if they wish.
This is the trajectory of the Big Box shops, and yes Academic Institutions count as Big Box shop.
 
In the South
Resident
Bioinformatics

Preferably in the South or somewhere else warm, but I am open to wherever (except Alaska)
At least 250K

Okay this is helpful. Your best next bet is T32/T32-look-a-like postdoctoral fellowship at a top 10. As far as I understand that's where you'll have the best shot for this kind of arrangement.

Be careful tho, your institutional salary will be much lower than 250k. Let's call it around $100k. The rest wil be generated from various "outside activities", including PP, moonlighting, and whatever else you can cook up (consulting, etc).

If you want somewhere warm then it'll have to be California. Your next step is to call T32 directors at UCSD/UCLA/UCSF/Stanford for informational interviews. Stress that you want to go through a period of "research training" to get a K award/K award-look-a-like and is willing to "do whatever it takes and willing to take a lower salary to make it happen", and then discreetly ask if the researchers funded this way is constrained by non-competes if they want to supplement their income elsewhere and try to come up with a compelling reason as to why you'll "work a small amount clinically outside to supplement your research salary" (i.e. it'd be helpful if you have children/family). You should be relatively smooth when you have these interviews when you are asked to explain your global research vision. And if you aren't, using some executive coaching service can be helpful. Your work should be explained in an understandable way to a well-educated layperson.

T32 is also not the only track--there are VA tracks and public/state tracks that are functionally equivalent to T32s. You'll go through the application process and compete with their internal candidates, and should you get picked for one of those T32 spots you'll then be able to continue pursuing this track. This in general means that your institutional salary after graduating from the residency will be ~100k for at least 8 years and very likely longer.

Your total 1040 income can be ... let's just say... quite a bit higher than that.


Outside of the top 10/20 institutions, these arrangements become rarer, but they do still exist. A couple of reasons: local economy doesn't support a lucrative PP; a local school has no track record to sponsor researchers to get through the K/first R01 phase, and entirely don't know what they are doing. Schools like to have researchers to enhance prestige, and are willing to take you on for a number of years for a lower salary, but it won't be forever. Plenty of academic jobs pay 250k if you are willing to work more clinically (nights/weekends), etc.

Make sure you are ready for this -- PP is not for everyone. Some people don't do well in PP and end up going back to pre-packaged 80/20 jobs. OTOH, you don't know if you'll be good at PP until you try.
 
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Okay this is helpful. Your best next bet is T32/T32-look-a-like postdoctoral fellowship at a top 10. As far as I understand that's where you'll have the best shot for this kind of arrangement.

Be careful tho, your institutional salary will be much lower than 250k. Let's call it around $100k. The rest wil be generated from various "outside activities", including PP, moonlighting, and whatever else you can cook up (consulting, etc).

If you want somewhere warm then it'll have to be California. Your next step is to call T32 directors at UCSD/UCLA/UCSF/Stanford for informational interviews. Stress that you want to go through a period of "research training" to get a K award/K award-look-a-like and is willing to "do whatever it takes and willing to take a lower salary to make it happen", and then discreetly ask if the researchers funded this way is constrained by non-competes if they want to supplement their income elsewhere and try to come up with a compelling reason as to why you'll "work a small amount clinically outside to supplement your research salary" (i.e. it'd be helpful if you have children/family). You should be relatively smooth when you have these interviews when you are asked to explain your global research vision. And if you aren't, using some executive coaching service can be helpful. Your work should be explained in an understandable way to a well-educated layperson.

T32 is also not the only track--there are VA tracks and public/state tracks that are functionally equivalent to T32s. You'll go through the application process and compete with their internal candidates, and should you get picked for one of those T32 spots you'll then be able to continue pursuing this track. This in general means that your institutional salary after graduating from the residency will be ~100k for at least 8 years and very likely longer.

Your total 1040 income can be ... let's just say... quite a bit higher than that.


Outside of the top 10/20 institutions, these arrangements become rarer, but they do still exist. A couple of reasons: local economy doesn't support a lucrative PP; a local school has no track record to sponsor researchers to get through the K/first R01 phase, and entirely don't know what they are doing. Schools like to have researchers to enhance prestige, and are willing to take you on for a number of years for a lower salary, but it won't be forever. Plenty of academic jobs pay 250k if you are willing to work more clinically (nights/weekends), etc.

Make sure you are ready for this -- PP is not for everyone. Some people don't do well in PP and end up going back to pre-packaged 80/20 jobs. OTOH, you don't know if you'll be good at PP until you try.

Won't this arrangement be limited to the time you're on the T32/in fellowship? I got the impression there were limits to how long you could be on a T32. I get the vibe OP is interested in something which lasts longer.
 
Honestly if you want to make money on the side while engaged in an academic job it's easier to just moonlight in-house.

IME as an attending you would get $3K-$4K/weekend to cover the psych floors and/or C/L service (total about 6-8h of work depending on how quickly you round/write notes). I notice a lot of attendings with college-aged kids like to pick up these weekend shifts. One weekend per month covers tuition for the year.

It doesn't have the potentially unlimited price ceiling for people who can both leverage their academic reputation and have the sheer cojones to charge thousands of dollars per intake in their private practice. But it avoids the headaches of private practice (i.e. being always personally on-call for your stable of high-functioning patients who expect total availability for the price they're paying, as well as overhead/billing hassle etc), and also avoids bad blood with the administrative higher-ups.
 
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But now you are doing IP & C/L which ... isn't for everyone.
Fair enough, but you're also avoiding high-end cash private practice, which also... isn't for everyone.

I would so much rather do my rounds for IP or C/L, head home and leave the hospital at the hospital, vs dealing with entitled OP cash pay patients flipping out because they can't reach me on a Friday night and they want their sleeping meds adjusted. Never mind scheduling/billing/working out what I owe the IRS. The admins can have that crap.
 
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Never mind scheduling

Literally a google calendar


If you were just charging cash and not taking insurance, literally signing up for a Square account

/working out what I owe the IRS.

Unless you have strong philosophical objections to small unintentional temporary loans to the IRS, sending 30% their way each quarter will generally get the job done (well enough to avoid underpayment penalties, at least).

The admins can have that crap.

And the money. They would like you to believe this stuff really is rocket science so you think you are getting some huge benefit from them doing it for you.

Me, I like weekends.
 
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Literally a google calendar



If you were just charging cash and not taking insurance, literally signing up for a Square account



Unless you have strong philosophical objections to small unintentional temporary loans to the IRS, sending 30% their way each quarter will generally get the job done (well enough to avoid underpayment penalties, at least).



And the money. They would like you to believe this stuff really is rocket science so you think you are getting some huge benefit from them doing it for you.

Me, I like weekends.

OK, something to think about, maybe someday. I think outside private practice is verboten at my current institution.
 
OK, something to think about, maybe someday. I think outside private practice is verboten at my current institution.
You can do inside private practice at your current institution. If you increase your fees to cover the institutional overhead, it sort of becomes equivalent again.
 
Bumping this thread to ask the following related question: any advice for M4 applying to research track residencies in terms of figuring out the rules at specific institutions regarding side PP at various levels (T32 fellow / Instructor / full-time Faculty)?

As mentioned above, it is often desirable for those pursuing a K or first R to supplement income during the academic transition period (think late 30's MD/PhDs with families)... Internal moonlighting, yes, ok, but having a lucrative cash PP, often in the evenings, seems almost a given for T32 fellows, instructors, and faculty at elite coastal psych departments. The situation in non-elite or non-coastal universities (many of which do have formal research tracks) is unclear to me. But this actually matters quite a bit to some applicants that would not want to move again after residency... Is asking about this during interviews ok? Safer to e-mail program alumni?
 
Bumping this thread to ask the following related question: any advice for M4 applying to research track residencies in terms of figuring out the rules at specific institutions regarding side PP at various levels (T32 fellow / Instructor / full-time Faculty)?

As mentioned above, it is often desirable for those pursuing a K or first R to supplement income during the academic transition period (think late 30's MD/PhDs with families)... Internal moonlighting, yes, ok, but having a lucrative cash PP, often in the evenings, seems almost a given for T32 fellows, instructors, and faculty at elite coastal psych departments. The situation in non-elite or non-coastal universities (many of which do have formal research tracks) is unclear to me. But this actually matters quite a bit to some applicants that would not want to move again after residency... Is asking about this during interviews ok? Safer to e-mail program alumni?
You need to know the institution policies where you are interviewing. All are different. Some will not allow outside work, and requires everything be through *institution group* where you get only 1/5th of all collected fees, for example. Some will restrict ability to moonlight externally. You cant just get this data from this forum. Ask on the interviews to allow yourself room to make an informed decision.
 
Bumping this thread to ask the following related question: any advice for M4 applying to research track residencies in terms of figuring out the rules at specific institutions regarding side PP at various levels (T32 fellow / Instructor / full-time Faculty)?

As mentioned above, it is often desirable for those pursuing a K or first R to supplement income during the academic transition period (think late 30's MD/PhDs with families)... Internal moonlighting, yes, ok, but having a lucrative cash PP, often in the evenings, seems almost a given for T32 fellows, instructors, and faculty at elite coastal psych departments. The situation in non-elite or non-coastal universities (many of which do have formal research tracks) is unclear to me. But this actually matters quite a bit to some applicants that would not want to move again after residency... Is asking about this during interviews ok? Safer to e-mail program alumni?

You should do some research and ask people who have gone through this and seem to be working the system. Do some research and they will give you informative answers. It'd always be hard to get complete answers. Even within a single department your answers can be HIGHLY variable because different people try different ways of making things work.

I think it's hard to get a standard 80% research 20% clinical packaged job these days that pay 250k+ as a junior faculty. If you are willing to settle for between 200k and 250k, it may be easier to find a "non-costal/non-elite" university job that comes pre-packaged. This is typically achievable at any number of institutions that have a number of NIH-supported research faculty. Still, the long-run assumption is that you'll need to bring in sufficient salary support to cover a large part of your research salary, though depending on the place this percentage is variable. Some department heads might be willing to "lose money" on you if you can bring in prestigious awards that are somewhat unusual for the department (large R01 grants from NIH, etc).

The problem here is that last few years salary level in the private world is starting to push 375-400k! With inflation and everything the academic track regardless of the existence of in-house or moonlight PP options are increasingly less attractive.
 
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Glad that my thread is helping out the next set of residents. At the end of the day, I am just applying for a K award next year and seeing what happens. I am also simultaneously applying to a few good industry and national lab jobs as they pop up. These are highly competitive as well because way more people want them than available spots. The positive side is that the salary differential makes it easier to start a private practice if none of those options pan out.
 
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