Feeling trapped by academia. How can I get out?

Discussion in 'Psychiatry' started by CLpsycho, Dec 3, 2017.

  1. CLpsycho

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    What are some post-fellowship career options for psychiatrists who want to escape from academia and put together a work-life balance that allows one to focus on family? This question has been eating away at me for months now, and I hope someone can share a bit of wisdom with me. Apologies for the long post that follows; I have, shall we say, a lot of feelings about this.

    I am currently a CL fellow at a rigorous academic medical center in a major city in the Northeast. I completed a very academic residency in that same city.

    Most of our fellowship graduates continue on in academia but more and more I am feeling that this path is not for me. The reasons are many: a desire for work/life balance, planning to start a family, and wanting to escape the “publish or perish” world that has surrounded me for the past 4.5 yrs.

    These feelings are making it difficult to begin applying for jobs as all I have had exposure to is academia and the overwhelming majority of faculty in my programs are lifelong academics. Additionally, the culture of my program is very much the traditional “ivory tower” mentality, with a pervasive belief you are a sellout, or somewhat “less than,” should you choose to leave academia. This makes it hard for me to even begin conversations with senior leaders in my program about other options.

    As a result of all this, I know next to nothing about the world outside of university-affiliated medical centers, and I don’t know where to begin looking for jobs, or even what kinds of jobs exist that might make me happy.

    This lack of knowledge is making the job hunting process incredibly stressful and anxiety-provoking. The thought of a lifelong career in academia makes me feel anxious, exhausted, helpless, and trapped… but I literally do not know what to look for or who to talk to about alternative career paths.

    My dream job might include the option for flexible/reduced hours (32 hour weeks, 4 days a week, perhaps even half-time), being able to help underserved patient populations, and working in collaborative teams consulting in the inpatient, outpatient, or mixed setting. Does this job actually exist anywhere, or am I fantasizing??

    Can anyone help me see beyond the walls of the ivory tower and understand what life, and career, can look like on the outside??

    Thank you for reading through this wall of text, and for any wisdom you can share!
     
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  3. nexus73

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    I think first decide where you want to live, or what type of place...metropolitan vs mid-sized city vs large town vs small town...vs boondocks. And then where you're willing to move, as in, are you willing to move to the southwest to find you ideal job, or will you want to stay within the radius of your current city?

    After that decide if you want to work in the hospital or outpatient, or maybe a mix of the two. I think there are definitely lots of jobs available for someone wanting to do inpatient/consults plus/minus outpatient clinic. And I think a lot of these jobs aren't advertising because that costs money and it's incredibly hard to recruit psychiatrists right now so why waste the money?

    I'd then search online to find the hospitals or clinics in an area you'd be interested in living. Then you should call the medical director (psychiatrist in charge) and introduce yourself. Almost certainly they will be overjoyed you have called them and they will have you in to interview and will offer you a job doing whatever you want. Seriously. If you want to do part time inpatient consults, part time clinic, and consult part time at local nursing homes, they will probably make it happen for you. If you want 32 hours a week, with every Wednesday off, let them know.

    I think it's worth emphasizing that just because no job listing is posted does not mean the hospital is not in dire need of more psychiatrists.
     
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  4. splik

    splik Professional Cat at Large
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    Well, firstly if you aren't a tenure track person, you're not really an academic anyway. everyone looks down on clinician educator track people.

    Secondly, the culture is very differently at different institutions. Publication is not a requirement for advancement/promotion in my series at my institution.

    Thirdly, you don't have to work full time - there are plenty of people working part time in academics (though beware taking on so much that you work full time for less pay).

    Fourthly, just because you take a job in an academic setting doesn't mean you'll be stuck there forever (it's usually a marker of failure or inertia if you stay at the same place forever) and younger generations tend not to believe in the idea of staying in the same type of thing forever. Some people take a job for a year or two until they find something better or go into private practice etc.

    Fifthly, you can always get a volunteer clinical faculty appointment and continue to teach students/residents/fellows etc even if you aren't employed by the university.

    you don't have to please people who may have their own self-serving motives. you might find it quite liberating to explore the different options that exist.

    There are huge number of different jobs, practice settings, populations etc that are important. I always tell people you can get 2/3 of your criteria of ideal location, ideal job type, and ideal pay for your first job. But start by picking by either choosing a type of job OR choosing a location and searching in that way. I can't there aren't any graduates from your residency program who did not carve out their own path. talk to them. also it's perfectly legit to call up volunteer faculty in private practice, have them take you to lunch and tell them how things work in their world etc.

    check out: Psychiatry Jobs - APA JobCentral
    indeed.com
    and for academic jobs that might be more up your alley: HERC Jobs
     
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  5. CLpsycho

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    Thanks for the reply, nexus73! It has been disheartening looking at job listings as they are quite sparse in my desired location so it is helpful to hear that I should inquire about positions regardless of posting.

    Thanks for the thoughtful response, splik! It's helpful to get some perspective from outside of the bubble I've been in for the past few years.
     
  6. Doc1401

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    A lot of people feel trapped in academia because the pay is so bloody low compared to what is being offered out there.
     
  7. Salpingo

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    You can PM me with more specifics around your situation if you want more specific advice, but I think "academic" C/L is the perfect place to do everything you mentioned, although it might be institution specific. I know many people who have C/L jobs that are part-time, although not necessarily right off the bat (they may have started in a full-time position, demonstrated their worth, and then requested various accommodations as they started a family). I put academic in quotes, because in the northeast most academic institutions are willing to employ a good clinician who isn't pumping out millions of dollars worth of grants or publications, maybe with the exception of MGH or Columbia. I think everyone realizes there just aren't enough resources/funding for everyone to have a huge lab or research project. I also think C/L happens to be a more practically-mind subspecialty in that regard, and the most young family friendly for that reason.

    Yes, the hardcore research types may look down on you for not being intellectually rigorous, but given that we're all psychiatrists, its sort of like the drama club calling the chess team a bunch of nerds.

    Keep in mind, the last stretch of any training is the prime time for burnout. Looking to the future feels overwhelming, to the past makes you feel like you've already invested too much to back out. The present is also hard to deal with, since it feels like you already have one foot out the door anyway. I'm sure you heard it all before, life gets better after residency/fellowship (even if it gets harder). You get just a little more autonomy, a greater responsibility, and the work dynamic changes.

    All that being said, I've heard community outreach programs are a great way to do part-time/flexible community health work in a collaborative setting.
     
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  8. TexasPhysician

    Moderator Physician

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    Most hospitals can’t find psychiatrists to do consults for them as the pay is more academic-like. It would be easy to find areas with multiple hospitals and contract for consult work. You could then round whenever you want during the day and still work with teams. I expect that will be my “retirement” job.
     
  9. fpsychdoc

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    What do people think about the quality of patient care at strong academic institutions? Is it generally better than non-academic hospitals/institutions, even though the pay is less?
     
  10. WisNeuro

    WisNeuro Board Certified Neuropsychologist
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    I can only speak anecdotally for mental health and neurology type services, but I've noticed better care at academic institutions/places with providers who also have academic appointments. I think being involved in research keeps you better versed as to the current data on interventions. Less people just sitting stuck in their ways, unchanging for decades.
     
  11. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    Come to the Midwest and we'll happily help you leave those cultic cognitive distortions behind.
     
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  12. tyrionlannister00

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    Sounds like you made the classic mistake of drinking the cool-aid, sorry to hear. One thing that helped me was just talking to colleagues that don't work in academia... there are tons of private docs out there, VA docs, contract gigs, emergency room docs... just gotta talk to people. If you are at a program that has so walled you off from normal society I suppose it may be more difficult for you to see the other side... but trust me, there is an other side to medicine and it is glorious... where people actually get treatment outside of the ivory tower. Let me tell you how life is outside of the ivory tower: IT IS AMAZING.
     
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  13. SeniorWrangler

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    Remember there is no institutional loyalty and you are instantly replaceable, unless you're one of the 5-sigma guys who is pulling in massive grant money.
    If you're not committed to the research track, why no stay on in academic medicine, but at a place with a schedule that suits you better? There are a ton of training programs that need young energetic faculty all over the country. Admittedly, you're still pulling an academic salary but it gives you a good basis to then either stay in academics or jump ship once you know some people, as long as you don't sign a non-compete.
     
  14. Blitz2006

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    Correct me if I'm wrong, but for what the OP is looking for (32 hr weeks, 4 days/week), is most likely only going to fit academia jobs, no?

    I can't imagine too many community hospitals (especially in the NE) that will let you work less than 40 hrs/5 days a week in CL....(unless the OP decides to do just ER psych, which I hear is 3 x 12s/week).

    What I would suggest is switch to a less hard-core academic setting, one where you can work 4 days/week and you're not under pressure to publish/perish, speak at grand rounds, etc. There are lots of academic places that don't have rigorous requirements...sure, you may lose the prestige, but you personally will probably be happier...
     
  15. TexasPhysician

    Moderator Physician

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    Most hospitals do not have the volume for FT psych C&L. You can approach these hospitals as a contractor. As you essentially work for yourself, you decide your own rounding hours. You may need 2-3 to have enough daily volume. Make your rounds and collect a % of billings or collections.
     
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  17. OldPsychDoc

    OldPsychDoc Senior Curmudgeon
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    Find a large health care system that's looking for more Integrated Care in its outpatient settings--become an outpatient C/L doc.
     
    #15 OldPsychDoc, Dec 4, 2017
    Last edited: Dec 4, 2017
  18. Doc1401

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    What good is prestige if you are poor?
     
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  19. Blitz2006

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    Interesting..did not know this

    Sent from my SM-G955U using Tapatalk
     
  20. Nasrudin

    Nasrudin Apropos of Nothing

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    Wow. The lack of independent hustle is palpable.

    I don't know what to say about where you are. Except that I'm glad I ain't there.

    Remember... C/L, academic, hoity-toity, whatever....you're a shrink. All you need, is a room, some chairs, a script pad, a phone, a laptop, and some patients. The world is our oyster. It's only scary because you're wanting to cut the cord of an insular, rarified, culturally inbred, environment.

    You sound like a prostitute who can't imagine what the streets would be like without Sweet Daddy to bail you out. Lay a hot backhand across your stinging cheek. And then tell you, you're still his special sweet thing.
     
  21. wholeheartedly

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    My small town community hospital is so desperate for someone in psych you could probably make any number of ridiculous requests and they'd do their best to accomodate it.
     
  22. tyrionlannister00

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    Amazingly well put.
     

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