As an academic who loves being an academic, I will offer a few thoughts:
First, there is a difference between being an academic in an academic center, and being an employee in an academic center. If your primary goal is to see patients (which is a reasonable goal), then academic centers are probably not the best model, since private practice can be more efficient in capturing revenue from seeing patients.
There are some major advantages, though, of working for an academic enterprise:
Financials/Logistics:
- usually have many expenses covered for you, such as malpractice, office overhead, support staff, etc.
- the downside of this is that you may have less control. For example, if you don't like a nurse or a transcriptionist, you may have less influence in whether that person gets fired or not
- the marketing of the greater institution- you can pull in patients from the institution, and not rely on marketing specific to you
- the downside is that they may not do as much marketing specific to you as would be ideal, depending on the institution
- Benefits. The benefits at academic institutions are often better than private practice, sometimes considerably so. Some academic benefits packages can equal 30-40% of your income. I don't know what is the case for private practice, but my impression is that 15% is more typical. once you factor in total compensation, you can actually come out ahead in academics. The main downside is that income is usually capped more in academics than in private practice.
Work environment advantages
- a more intellectually stimulating environment. I have one friend who switched from private practice back into academics, and there explanation was "in private practice, if I saw something interesting, there was no one to share it with. I turned to my left, and turned to my right, and all anyone cared about was the financials."
I certainly talk to my colleagues about marketing, branding, billing, etc., but it's not our primary focus. I usually have several conversations a week that last over an hour, just discussing patients and how to better manage them. I find that extremely fulfilling, and it would be unusual to have that in a private practice. I'd like to think it makes me a better physician, but certainly adds tremendously to my job satisfaction
- makes it easier to explore new clinical approaches. For example, I've developed an interest in exploring the impact of hormone regulation (particularly testosterone) on low back pain. I have a colleague in my department who does research in this area, and another clinical colleague who has looked into in SCI patients. Across the street, I have a friend who is a professor in geriatrics who has an extremely well-funded research history on the topic. These are incredibly valuable resources that have very much informed my clinical judgment.
I think for any clinician, there is tendency to become more conservative the further removed you are from training. Many (not all, but certainly many) private practice docs become extremely proficient at what they do, but still practice similarly 10 years out to what they did in training. And often times the changes they make over time are heavily influenced by commercial interests, with less influence from patient outcomes than is ideal.
I have found that being an academic has fostered an environment where my growth as a clinician has primarily been governed by a desire to improve patient care. I like that.
- interaction with colleagues at other institutions. One thing I've loved about being an academic is the friendships I've made with academics at other institutions. There is no better way to learn than to have a beer with someone who is smarter than you are. For example, at the AAP, I went to dinner with 8 colleagues, and we probably chatted for 3 or 4 hours. Much of it was social, but some of it was just trading ideas about we approached different things, whether clinically or in terms of how to be a better teacher. I think that is often easier to do as an academic than in private practice.
- interactions with medical students and residents. There are downsides of course (they can slow you down, bad ones are an emotional drain, etc), but I would say that 90% of the time, working with trainees is a significant positive. Examples:
- it makes you a better clinician. For example, since I have my residents perform spinal injections with me present, I've had to learn to articulate things that were second nature for me. That process of articulation has forced me to think things through more thoroughly.
- Another example- I've had to develop systematic methods to teach medical students how to do an efficient MSK exam. That process has streamlined the way I collect data, which will serve as the basis for outcomes related research I plan on doing
- They ask questions, which forces me to read and keep up on things
- Sometimes they do things differently than I would, and sometimes they do things better than I do, whether it asking a question in a particular way, approaching an exam maneuver differently, adding something to therapy I hadn't thought of, etc. They are constant source of stimulation
- they are fun. I guess that my residents or medical students make me smile at least 10 times a day. That's nice
- Mentorship- i would say this is, for me, the far and away biggest benefit of being an academic. There is nothing more satisfying than finding out you inspired a medical student to go into PM+R, or inspired a resident to do something they haven't done before, or to watch the growth of a resident as they learn from you. For example, I was teaching the resident EMGs this morning, and watching one of my residents learn how to remove to motor artifact from an ulnar sensory study was incredibly gratifying. It's a small moment, but when you see the summations of moments like that over time, it just inspires you. Similarly, I was watching the resident who worked with me last quarter hold a conversation with a surgeon a few weeks ago, and she blew me away with how well she knew the literature and how comfortable she was explaining why she made the decisions she made. To watch her shine like that and know that I had an impact, however small, was incredibly gratifying.
So, in short, while private practice has many significant benefits, I am perfectly happy being an academic, and think it's something that many residents should consider.
Anyone else want to steal that as a motto?
