No better way to scare off potential applicants than to tell them they have virtually no shot at a private practice career. Any applicant we, as a field, would want is smart enough to figure out how unsavory academic medical practices can be. For those of you who don't know, the traditional academic career in pathology (or most other medical specialties) goes like this.
- Get an appointment as a clinical track assistant professor with pay at the 25-50th percentile as compared to your private practice peers, but still doing just as much work as them with the added pressure of teaching. While academic departments will say you only have to "participate" in research as it is only a few percentage points of your job's trinity of Service, Teaching, and Research, reality is you have to publish in sufficient quantity (even if you're not tenure-track) to get promoted. You will also be granted the distinction of doing all the things that all your older colleagues don't want to do (i.e. medical school teaching, resident lectures, tumor boards, etc.). You'll also get all of the terrible call schedules that no one wants. Basically, you're the department's work horse and your entry level academic job is to bill waaaaaaaaaay more than what they're paying you to support the inflated salaries of the department chair and full professors (effectively the "partners" of the department).
- After you work as an assistant professor with either no or marginal pay raises for a minimum of 7 years in most departments, you become eligible for promotion to associate professor, which in pathology only adds an additional $20-30k boost in pay from what I see in perusing multiple public academic salary databases.
- Get promoted to associate professor so you can finally buy a house and car that's better than middle middle-class as your student loans are still weighing you down. As an associate professor, you have a little more say in what specialties and services you can (and won't) do - but not by much mind you. Again, even though you're clinical track, guess what - you still have to publish even more (and it helps if you network too). Keep in mind, the promotion requirements vary greatly from dept to dept with sometimes nebulous and/or capricious standards depending on who the chair is and how much they like you.
- After another minimum 7 years of being an associate professor, you can come up again for promotion to full professor. Sounds great in name, but all it means is that you get only another modest boost in pay (anywhere from $30-40k). The real benefit in being professor is you now get the ability to effectively work less than what you're being paid. You've earned the right to subside off another's labor. This is where you can now make a career cataloging toenail diseases and be grossly overpaid for it.
- If you're really, really lucky and have done a good job of networking and making a name for yourself by publishing or as a well respected speaker, you can get a chairmanship which effectively boosts your pay to what an average private practice partner in pathology would make. Candidates for chairmanships have been in the field for 20+ years and have a reputation that usually proceeds them.
For those of you who are reading this and going "Geez, that's a myopic, uninformed, and pessimistic view of academic practice", just ask yourselves how many start out as assistant professors and make it all the way up to full professor. The rate of attrition is horrendous in academia, and for good reason. Most of it has to do with not wanting to be either party or subjected to the megalomaniac designs of department chairs and their chief lieutenants, the full professors. There are of course exceptions to the above - there are always exceptions. But as our field tends to aggregate the rather unexceptional as of late, academic departments don't have to treat new hires with any special privilege or perks.
And if you think I'm painting a bad picture of academia in general, I'm not. I'll give the following anecdote I saw with my own eyes in community practice just recently. A very well established oncology surgeon was not happy in his private practice job and the regional academic center in the same city just happened to be needing someone with this surgeon's experience. The surgeon applied for the job and the conversation with the surgery chair went something like this:
Chair: You're going to do general surgery cases as well as your oncology case load.
Surgeon: Nope. I'm only doing my oncology cases.
Chair: That's not what the posted job description is.
Surgeon: That may be what you're looking for, but that's not what I'm looking for. And last time I checked, no else in 1500 miles with my experience and expertise is looking for that either.
Chair: OK. But you're still taking general surgery call.
Surgeon: Guess again. I'm only doing my cases and call related to them.
Chair: Fine. We'll just adjust your pay to match the work.
Surgeon: Nope. I'm not taking a pay cut either. Figure it out or good luck getting someone else before your accreditation comes under the chopping block.
Chair: Hired.
Now I ask, anyone see that happening in a pathology academic department???
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