Missing academics yet?

[corpsmanUP]

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My biggest decision during my last year of residency was whether or not to take a staff position in my residency or go into the community practice of EM. I really wanted to do academics, as I had just found my niche in research and junior resident teaching. I was however, nervous about being one of those attendings with little to no real world experience.

I have been in the community only 18 months now, but it already feels like an eternity. The money has been phenomenol. This tax year should be close to 4 bills. But in the end, I don't feel like the community practices much evidence based medicine, and I miss the camaraderie of sitting in the pit with smart people!

I've found administration likes to practice medicine without a license and throw the responsibility for their decisions on the ED docs without hesitation. Not sure how it is elsewhere, but in Texas it seems to be that the way to get promoted is to "win the contract". So it seems that everyone is always backdooring the current medical director and group to try and figure out a way to get the hospital to give them the next contract. Most contract holders in my neck of the woods rarely work and scavange off the work the rest of us do for them...making millions. I'm just not a big fan of the whole set up.

Many a group advertises as democratic when they are nothing similar.

I have decided that I am now going to take an academic position. I do not regret doing community medicine first though as I think the rigor of it will really help me to prepare residents for the real world (at least those that wish to enter it...and most do I believe).

So for those of you having a tough time with the same decision, please think about doing community medicine for a short while. I think it gives a perspective and develops your skills, and certainly your consultant management skills.

I'd love to hear anyone elses thoughts on this. And before anyone feels the need to point out the obvious, yes, I am quite aware that I am taking nearly a 50% pay cut 🙂

 

[yahoomail]

50% pay cut is huge !

 

[WilcoWorld]

Yes 50% is a big pay cut, but if you're making more than twice as much as you need it's doable.😉

 

[EctopicFetus]

There are some high paying academic jobs in EM. Corpus Christi, Peoria (IL), some of the community academic spots in PA too.

Some of those pay 300k+.

On another note, I work in a level 1 trauma center which is Non-academic though 3rd yr em residents rotate with us. I am so happy with my decision I couldnt tell you twice. I was recruited by my residency as well as 2 other academic spots but couldnt be happier with my decision.

 

[gro2001]

.

 

[yahoomail]

Yes 50% is a big pay cut, but if you're making more than twice as much as you need it's doable.😉

Well, what you "need" changes according to how much you get used to !

 

[WilcoWorld]

Well, what you "need" changes according to how much you get used to !

Aint that the truth!

 

[Hamhock]

So for those of you having a tough time with the same decision, please think about doing community medicine for a short while. I think it gives a perspective and develops your skills, and certainly your consultant management skills.

What are your thoughts (or others') about taking "academic" jobs straight out of residency but working 3-4 "moonlighting" shifts in the community?

Most of the academic docs I really respect also seem to grab some extra shifts in the community where it is just them with patients, consultants (restricted), surprising amounts of disease, and Press Ganey. I am sure the extra money is nice, but I think they do it for other reasons too.

Thoughts?

HH

 

[Tiger26]

What are your thoughts (or others') about taking "academic" jobs straight out of residency but working 3-4 "moonlighting" shifts in the community?

Most of the academic docs I really respect also seem to grab some extra shifts in the community where it is just them with patients, consultants (restricted), surprising amounts of disease, and Press Ganey. I am sure the extra money is nice, but I think they do it for other reasons too.

Thoughts?

HH

At our place, apparently the attendings are not allowed to do take outside gigs based on the language in their contracts.

My major question about going straight to a big academic place is no longer getting to do procedures in favor of the residents doing them. As much as I like being around smart people and having the resources of a big-time place, I also like doing lines, tubes, lac repairs, etc rather than watching someone else do them, which I feel like happens all to often in academics.

 

[Greenbbs]

I'm completely happy with my community job. We see an incredibly high volume of patients (over 100k last year), and the hospital, while it doesn't have an EM residency, has a few other programs, and many residents from the teaching mecca in town rotate through the subspecialties (we're also a tertiary care center with a level II ED.) The ED administration is younger and completely allows us to practice how we feel comfortable practicing, with many of us younger guys doing a ton of EBM stuff (including the endless debates over EGDT).

I think it really depends on what kind of setting you look at. Podunkville ED that sees a few grand a year probably won't be doing much EBM, as they may not be set to do things like EGDT or theraputic hypothermia, or things as simple as tPA. But if you go to a larger ED in a hospital that has endless resources, you'll find it's much easier to practice 'academically'.

I think it also helps to find somewhere where you're not at the mercy of a large staffing company overseeing your practice. I'm a hospital employee, so our interest lies in doing the best job we can do for the patient rather than improving some non-medical person's bottom line. We aren't cutting corners to see more and more patients, and in fact, we get bitched at when we don't go balls to the wall on our septic patients (which is refreshing....considering it's what most of us younger guys are doing anyways...we can get by with 2 large bore IV's, but they've got order sets in the computer to remind us to run the whole Rivers campaign, despite whatever flaws there may be). We see incredibly sick patients, so it helps us to stay fairly 'academic' in nature even though we don't directly teach residents.

Just my $.02

 

[deleted65604]

I agree wholeheartedly with the concept of going somewhere else in the community for a while after residency. While you might not practice as much evidence based practice in the community, you learn more real world medicine.

I found a paradox in residency, the most interesting discussion generators in the lectures and M and Ms, were the most difficult to work with clinically. Their complex algorithms in real life tended to break down.

I especially chafed at having attendings that were recent grads. I did not trust those attendings as much and didn't learn half as much from them.

 

[TysonCook]

....I'm in the same boat. I enjoy my job in the community, and am staying on 1-2 shifts per month. Recently I've accepted a position at Carolinas as an attending full time. I did my residency there and agree with the above in that the value of going community first has taught me a TON...but I'll be happy to get back to academics! 🙂

 

[corpsmanUP]

....I'm in the same boat. I enjoy my job in the community, and am staying on 1-2 shifts per month. Recently I've accepted a position at Carolinas as an attending full time. I did my residency there and agree with the above in that the value of going community first has taught me a TON...but I'll be happy to get back to academics! 🙂

That's awesome Tyson! Glad to see I'm not the only crazy one. It was interesting on academic interviews last month, because many an interviewer asked me if I was sure I could afford the pay cut and why I would ever want to. They seemed to be amazed that someone would want to voluntarily come back to academics for a pay cut.