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whopper

whopper

Former jolly good fellow
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I've been spending several hours updating my profile.

http://www.linkedin.com/pub/james-cho/43/8ab/512

What's been going on is a psychiatrist I highly respect wants to hire me. If I take the job offer, I'll be the #2 doctor, in administration in a hospital. It'd also puts me in a favored position to be the #1 doctor at that institution if I stay there for years and that other doctor retires but there is no guarantee of that.

So he wanted my CV and since it's basically the same thing as a LinkedIn profile, I decided to update both of them at the same time.

But here's the negatives: I'll be leaving my current job and I get paid quite well here. I get to work with some of the best doctors in the country and a few people in key areas told me I'd be on a track to possibly big things if I stay.

While I'm not interested in doing research right this moment because I got two young kids, I am strongly considering doing it in a few years. Both places can support this though one place will be able to support it on a smaller scale, the other is more likely on a larger one.

It's a good position to be in but it's a headache cause there's no clear direction as to what is the better choice.
 
Which choice are you more likely to regret in 10-20 years?

I'm not speaking from experience here, but personally, the only thing that could keep me from academia is the fact that it may impair my ability to quickly repay my student loans. If not for that factor, I'd be all about the academic job. Since you're saying that you get paid pretty well at your academic job, I'd probably stay there forever. But I haven't experienced administrative medicine, so it might not be as bad as I think it is.
 
I'm only a recent medical graduate, so I hope my opinion isn't untoward.

I've made a few similar choices in my previous career as a computer programmer. I found for my professional development and job satisfaction I was better off working in an environment surrounded by people more knowledgable and experienced than myself. It really wasn't as rewarding to be "the talent" in a smaller shop. I've seen several friends and colleagues make similar choices and reach the same conclusions.

Of course I don't know a thing about academic medicine, I don't have children, and I was likely at an earlier stage in my professional development than you are. Best of luck in making the right decision for yourself and your family.
 
Both places would keep me in academia, but one is in a university department, the other is in a state institution where I'd be given an academic position with a different university.

What's the difference? Place I'm at has some of the best doctors in the country churning out bigger research, but you can't do anything outside the institution. The other place, while smaller, would be an easier job with less control over me. I could, for example, build a very profitable private practice in the state job, still have opportunities in academia, and overall less work.

The way I'm seeing it...
Current job: bigger academic/research opportunities, less control, more work, good pay
Other job: easier, more control, less pay but I could within 1-2 years do side stuff making the on par with the other job.

And then further breaking it down.
Current job: more opportunities, less control, more work, less time with my kids
Other job: easier, more time with my kids, less opportunities.

Still don't know what to do. Raising my kids needs to be a factor in this too.
 
If the #1 person at the new job retires, how good is the #1 person gig?

If a major academic center paid more than a private gig in my area, I'd probably stay put for a long time. Your new job would require you to do side work to match your current gig. That makes me wonder why you are considering it at all.
 
Once you factor in the side work haven't you lost the time advantage?

It sounds like it just turns into less opportunity.
 
", M.D. is a triple-boarded (general psychiatry, forensic psychiatry, disability analyst) attending psychiatrist and assistant professor at the University of Cincinnati's (UC) psychiatric department.

My teaching responsibilities"

A suggestion: you seem to be writing the summary in both the first and third person. You may want to change it to either "I am triple..." OR "His teaching responsibilities..." I vote for the first person "I am triple-boarded.."

I will now retire from the grammar police
 
Not a bad suggestion. If you ever testify on a case, they try to nail you on minor things like grammatical errors. I'll fix it sometime soon.

I usually don't mention my pay but I will
University: About $225K without benefits and no forensic side work. The forensic side work brings in about $15K a year. I could do more than I'm doing now but I've told the university no more for now because the kids. The forensic work could be a big deal because I'd be working directly under the top two forensic guys in the southern portion of the state and would be in a good position to be part of that power team and I'm on very good terms with both of them. They're part of the university and are part of the inner circle that handles forensic psych cases in this geographic area. Work about 50 hours a week, but it's hard work.

State hospital: $180K without benefits. Benefits about the same as the university's. Work 40 hours/week but it's easy work. I know a side gig that'd bring in about $30K a year for almost no work at all, being about 1-2 hrs per week. Add a Suboxone practice about 8 hours a week, that could bring in about $50-75K. I'd be in a good position to become the head guy there with several years there. The forensic side stuff would likely take severe hit because the head of the university psych department doesn't want outsiders doing private cases through the university.

Right now I'm just not going to think about it because the more I do, the more I don't know. Maybe the answer will come to me later.
 
Last edited:
I'm not seeing the allure of the new job either. You're going to work 50 hours a week for only a little more salary and without any of the prestige of the university job.
 
Have you tried the coin flip? Sounds very juvenile, but I've used it. Just let the coin decide and run with it, if you find a sense of relief, you went with the right choice. If you feel reluctance, regret, or dread with the result, your heart was pulling the other direction. It's a great way to get outside your head.
 
notdeadyet said:
Have you tried the coin flip? Sounds very juvenile, but I've used it. Just let the coin decide and run with it, if you find a sense of relief, you went with the right choice. If you feel reluctance, regret, or dread with the result, your heart was pulling the other direction. It's a great way to get outside your head.
Click to expand...

I feel that way now.... :/
 
notdeadyet said:
Have you tried the coin flip? Sounds very juvenile, but I've used it. Just let the coin decide and run with it, if you find a sense of relief, you went with the right choice. If you feel reluctance, regret, or dread with the result, your heart was pulling the other direction. It's a great way to get outside your head.
Click to expand...

Excellent advice. I remember hearing this for the first time watching Frasier as a kid! If I remember correctly, he was trying to decide between Faye and Cassandra and Niles offers him this advice.
 
Man, wish I could come across a virtually no work senario for an extra 30k/yr.
Click to expand...

It's at a hospital that needs psychiatrists for consult service. The working model on paying the psychiatrist is not so much on what the psychiatrist brings in but how much they save because a psychiatrist doing a consult, they found, can cut the hospital stay.

It boils down to calls on weekends where you end up doing nothing to a few a weekend with doing about 1-2 on average per week but you could have a lot though this is unlikely and a guy I know who's done it for 2 years told me the most he ever got was about 5 and this was a fluke that only happened once. You could have a day where you do a lot, a day where you have nothing. So the real money is simply you having to keep your weekend clear to do this just in case. Brings in about 30K a year.

And I forgot to mention this. When I described the two jobs, both have benefits. I put the pay and then wrote "without benefits" to show the dollar value of the job without the benefits, but both jobs provide benefits that are worth about $50K.
 
whopper said:
It's at a hospital that needs psychiatrists for consult service. The working model on paying the psychiatrist is not so much on what the psychiatrist brings in but how much they save because a psychiatrist doing a consult, they found, can cut the hospital stay.
Click to expand...

That's very interesting! Is there published data on this? (sorry I'm digressing)
 
whopper said:
It's at a hospital that needs psychiatrists for consult service. The working model on paying the psychiatrist is not so much on what the psychiatrist brings in but how much they save because a psychiatrist doing a consult, they found, can cut the hospital stay.

It boils down to calls on weekends where you end up doing nothing to a few a weekend with doing about 1-2 on average per week but you could have a lot though this is unlikely and a guy I know who's done it for 2 years told me the most he ever got was about 5 and this was a fluke that only happened once. You could have a day where you do a lot, a day where you have nothing. So the real money is simply you having to keep your weekend clear to do this just in case. Brings in about 30K a year.

And I forgot to mention this. When I described the two jobs, both have benefits. I put the pay and then wrote "without benefits" to show the dollar value of the job without the benefits, but both jobs provide benefits that are worth about $50K.
Click to expand...

Sounds like I'll be applying for a job at your institution in 3 years...
 
whopper said:
It's at a hospital that needs psychiatrists for consult service. The working model on paying the psychiatrist is not so much on what the psychiatrist brings in but how much they save because a psychiatrist doing a consult, they found, can cut the hospital stay.

It boils down to calls on weekends where you end up doing nothing to a few a weekend with doing about 1-2 on average per week but you could have a lot though this is unlikely and a guy I know who's done it for 2 years told me the most he ever got was about 5 and this was a fluke that only happened once. You could have a day where you do a lot, a day where you have nothing. So the real money is simply you having to keep your weekend clear to do this just in case. Brings in about 30K a year.

And I forgot to mention this. When I described the two jobs, both have benefits. I put the pay and then wrote "without benefits" to show the dollar value of the job without the benefits, but both jobs provide benefits that are worth about $50K.
Click to expand...

But aren't most employment positions with benefits worth a considerable amount, in general? The exception would be loan repayment, etc.
 
That's very interesting! Is there published data on this?
Click to expand...

I don't know of any. I can tell you this. The psychiatrist that came up with this idea is also an astute businessman, has been in administration in three hospitals, and knows how these things work. I had lunch with him, and he told me that with psychiatrists possibly cutting off a day or two from being in the hospital, it does save a lot of money, hence he could pay his psychiatrists well.

But the same guy was not offering the job to everyone. The way this guy operates, he only asks the doctors that he knows from personal experience, or through connections are extremely efficient, well-respected, and get the job done. He operates on a philosophy of wanting the best clinical doctors, but paying them top rates because he knows they'll get the job done.

He also mentioned to me the list of candidates for the jobs he has, and they are psychiatrists that do solid work and for me that would be a huge morale booster because if I called one of these docs, I know I got someone I can rely upon and not do something stupid like give Abilify for Panic Disorder.

He has a second model in the works and he did tell me it is based on published data but I don't know the source. Due to the shortage of psychiatrists, he was going to have a psychiatrist be the head of mental heatlh services for the outpatient providers in his healthcare system. The psychiatrist would tell the PCPs what to do and when not to see a patient and send them over to the psychiatrist for outpatient or inpatient services because the PCPs didn't know how to handle this, but studies show they really are the biggest block of mental health providers whether they like it or not. He mentioned it was based on a model already existing that worked out quite well. He specifically told me he liked forensic psychiatrists for this role becuase we get trainined in presenting to judges and juries, and wanted us to give weekly lectures.

This particular guy did tell me I was open to working full-time with him, and while it was a very good job offer, I'm not entertaining it for now because if I go for it full-time, it's pretty much the end of where my career will go-being a clinical doctor in a big system. The position itself is actually quite good, but the other two job offers leave me in positions where I can take my job to potentially higher highs with opportunities in research, academia, clnical work, and administration.

Sounds like I'll be applying for a job at your institution in 3 years...
Click to expand...
Well that guy, I have referred to him a few friends and colleagues but only the ones that I knew were top-notch. A friend of mine already took one of the open spots for full-time.
 
Is that what it links to for you?

Should be:

Kornfeld DS. Consultation-Liaison Psychiatry: Contributions to Medical Practice. Am J Psychiatry 2002;159:1964-1972

Sent from my GT-N5110 using Tapatalk
 
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