One job or the other?

[whopper]

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Question for all of you, what would you choose?

Current situation: I work for the Court as an expert witness (very good pay, no benefits), state forensic hospital (mediocre pay, good benefits, incredible retirement package), and a private practice (very good pay, no benefits, I can buy a lot of things and use them as tax deductions such as a computer, desk, etc).

Altogether, I'm happy with the job. Overall pay is very good (almost twice what most psychiatrists make), I got a good retirement package set if I stay through the state.

So I got a job offer at, IMHO, one of the best psychiatric institutions in the country. I'd be made faculty in a university, the pay, while lower than the above, is more than what most attendings make but about 25% less than the above situation. I'd be working for one of the top psychiatrists in the country and I could always ask the guy for a second opinion on one of my cases.

This has been on my mind to the point where it hurts. I decided to not think about it for months, but got a call from the institution and told me there's an open window now that I'd need to take in the next few months if I took it.

I'm feeling like Riker.

 

[F0nzie]

Will the new position's contract have an non-complete clause (NCC) that will either prevent you from seeing patients in your private practice or require you to provide a % of your private practice income?

 

[whopper]

The institution has a clause where if you work for them you cannot work for anyone else. Clinically, I'm fine with this because pretty much everything I can think of clinically occurs at this place (even TMS). Monetarily, the pay will not be as good.

 

[Doc Samson]

Question for all of you, what would you choose?

Current situation: I work for the Court as an expert witness (very good pay, no benefits), state forensic hospital (mediocre pay, good benefits, incredible retirement package), and a private practice (very good pay, no benefits, I can buy a lot of things and use them as tax deductions such as a computer, desk, etc).

Altogether, I'm happy with the job. Overall pay is very good (almost twice what most psychiatrists make), I got a good retirement package set if I stay through the state.

So I got a job offer at, IMHO, one of the best psychiatric institutions in the country. I'd be made faculty in a university, the pay, while lower than the above, is more than what most attendings make but about 25% less than the above situation. I'd be working for one of the top psychiatrists in the country and I could always ask the guy for a second opinion on one of my cases.

This has been on my mind to the point where it hurts. I decided to not think about it for months, but got a call from the institution and told me there's an open window now that I'd need to take in the next few months if I took it.

I'm feeling like Riker.

Do you want to be academic faculty or do you want to optimize your earning potential - seems this is what the choice boils down to.

 

[whopper]

I think you're right. Good psychoanalytical skills!

Money vs. being able to work with top faculty.

I do think a little of this is me being "my own man" since my current situation I'm my own boss more so than if I take the new job.

 

[TexasPhysician]

I prefer being able to take deductions and take side jobs/opportunities as I please. I think you have it set up beautifully as is.

Now if this institution would be flexible.......

 

[Manicsleep]

Being your own boss is a very big perk of private practice for some depending on administrative abilities. However, some people are not able to handle the stress and do better when that sort of thing is done for them by others.

There are plenty of headaches in working for someone else. The bureaucracy of academia is gradually becoming more like private practice/HMO bureaucracy in that faculty are paid, at least partially, based on production and utilization managers, business people are ubiquitous in meetings. However, the joy of teaching residents and medical students, if you like that sort of thing, is something that is unmatched. It will also keep you young and on the cutting edge of the field.

If you have kids etc, they will probably grow up in the company of kids whose parents are also like you and that's always good. I like to think that's why my wife remains in academics. The money does suck and even a full, tenured, chaired professor makes very little...relatively. You can grow a goatee and wear a bowtie and be within cultural norms.

 

[whopper]

Now if this institution would be flexible.......

They won't be. I got it good the way it is, but I always wanted to work in a facility like the one mentioned: top faculty, the physical building is specifically designed to treat psychiatric patients, the patients are treated as if money is no object. This is the first place I'd want to send a family member if they were mentally ill and needed inpatient.

Another problem is although the institution is connected to the local university, and the attendings will be given faculty status, the forensic fellowship I graduated from wants me working for them. A mentor from the program on more than one occasion sat down with me telling me he really needs me with him and we had some major research plans laid out that could advance one specific field of forensic psychiatry. Although they're all under the same umbrella, the relationship isn't exactly porous. If I work for the above institution, I might not be able to do any forensic work for the fellowship, and I'd feel like I'd be throwing away all the plans made with my old mentor.

I got a problem most people would want. If I don't take the job, I'll regret it. If I take the job I'll regret it. Maybe I ought to just flip a coin cause the more I think about it, I'm not any closer to a decision, and just frustrated.

You can grow a goatee and wear a bowtie and be within cultural norms.

Not to mention wear a brown jacket with elbow pads and have a pipe. Now there's a real professor!

 

[Chimed]

How do you feel about the teaching aspect of moving to an academic institution? Obviously, there's no way to know someone's personality through a professional forum. However, based on following this forum and reading your threads for the last several years, you strike me as someone who really enjoys conveying information and thinking deeply about issues. IMO, this is someone who would thrive on a personal level in a academic setting.

Also, if you went into academics, even if you ended up not liking it, it seems like you could recreate a similar situation you're in now. In fact, having spend some time at a highly reputable academic institution could really boast your standing in the private sector.

Best of luck!

 

[Chimed]

You can grow a goatee and wear a bowtie and be within cultural norms.

Seriously, is it important to keep a more "business like" appearance in private practice?

 

[Manicsleep]

Seriously, is it important to keep a more "business like" appearance in private practice?

I think it is important. This is where the business side of the medicine comes into play. I think you want to appear inviting but professional. If the first appearance is an untucked half sleeve shirt with jeans, its going to give an impression. That impression is likely going to be wrong but it may alter the confidence the patient has in your judgement. In an academic setting, the name of the institution and your title usually takes care of any impressions.

I pretty much stick with business casual or higher. I have a blazer 50% of the time (I keep 2 in my office) and a suit approx 4-5 days out of the month. In sleep medicine, I often wear a white coat and I notice a big difference when I don't. I occasionally see my psychiatry patients there and its interesting to see them respond to me with a white coat and stethoscope/hammer etc. The biggest change is usually with the family members of the patients.

 

[michaelrack]

would you be a "real" faculty member spending a lot of time with residents/med studs, or would you be a clinical asst prof (honorary faculty member)

Another problem is although the institution is connected to the local university, and the attendings will be given faculty status,

 

[Manicsleep]

Also, if you went into academics, even if you ended up not liking it, it seems like you could recreate a similar situation you're in now. In fact, having spend some time at a highly reputable academic institution could really boast your standing in the private sector.

In forensics maybe, I am not sure. Not in sleep or psychiatry. There are a few enterprising IMG physicians, including psychiatrists, who went to mediocre residencies and are doing very well around here. At the end of the day, its how good you do your job and how hard your work. These guys don't have fantastic CVs but they are great physicians and consequently very successful.

 

[Chimed]

In forensics maybe, I am not sure. Not in sleep or psychiatry. There are a few enterprising IMG physicians, including psychiatrists, who went to mediocre residencies and are doing very well around here. At the end of the day, its how good you do your job and how hard your work. These guys don't have fantastic CVs but they are great physicians and consequently very successful.

Yeah, but I'd imagine it can't hurt and could only help. For example, I'm involved in research as a trainee. I'm still not sure exactly what I want to do when I grow up. However, if I go into private practice I plan on opening a speciality clinic either in ADHD and/or childhood anxiety disorders. I would likely have a webpage for my clinic and would have no problem saying that I have a "research background." I think in some circles, it could still help attract patients and could help establish you as an "expert" in your area. Obviously, I'm still in training, have never practiced outside of my institution, and therefore likely have no idea what I'm talking about. But that's my take.😉

 

[sunlioness]

My only advice is really to follow your heart. I mean, which job is going to make you happy to get up in the morning and go to work? Which job is going to have you looking back at your career at your retirement party and leave you feeling good about yourself? I honestly think we spend too much of our lives working to not love what we do.

It sounds like the money is good in both situations and if each opportunity allows you to meet your obligations and maintain a reasonable lifestyle, I don't know that I would necessarily worry too much about it unless all other factors are equal and you need to make a decision based on something.

To me, the University job sounds like where it's at, but bear in mind that this is coming from someone who couldn't stand private practice.

Good luck! It really looks to be win-win. 🙂

I'm feeling like Riker.

Awesome.

 

[whopper]

would you be a "real" faculty member spending a lot of time with residents/med studs, or would you be a clinical asst prof (honorary faculty member)

Actually don't know. The institution and the university are fomenting their relationship now. Some things are uncertain. There definitely is research being done at the private institution such as TMS that the university is getting credit for.

One thing I respect about the local university is that if you have a resident or medstudent, it's actually more work than not having one. I've known programs where attendings only joined because they wanted residents doing most of the work and all the attending had to do was sign the note. That's not the case here. The attendings very much give good teaching and individualized attention to students.

 

[Bartelby]

Putting aside the money (which seems good enough in either place) it seems like you should pick wherever gives the most opportunity for personal growth. Will you benefit most from regular grand rounds, teaching opportunities, and zebra cases in the top academic setting or from the autonomy and potentially meaningful forensics research in your current setting? I generally try to envision a regular day (or week) and consider how I would feel if I were going to go do that tomorrow. That's one thing that helped me decide Psych v other specialties. Setting aside all of the abstract 'pro' and 'con' weighing, does one choice feel best?

 

[F0nzie]

 

[strangeglove]

What about location? Is the new job in a place you'd want to live for the next decade and beyond? How does 25% less pay translate in terms of cost of living differences? Will you be supervising residents and med students, or is it more of a research affiliation? If it is mostly research, is that something you are into? If not, then what does it matter for you I they are doing the most amazing TMS research if you aren't doing this yourself? Will you be the medical backup for research studies? That can be a boring job for some, since you don't actually do any research and can sometimes be limited in terms of the treatments you can give. Who is paying for these "as long as needed" hospitalizations?

 

[wholeheartedly]

The only thing I'm qualified to come out from lurking and contribute here is that you seem like someone who would be a good teacher/mentor to trainees. You also seem very dedicated to providing quality care to patients. That makes for a great combo for everyone else. 🙂

Now whether or not that's the best decision for you is a whole different ballgame.

 

[nitemagi]

Have you spoken to other faculty to get the candid skinny?

A lot of top academic institutions have crazy politics behind the scenes, and it's good to find it out before signing up. I know I don't have to say this to a forensically trained psychiatrist, but, make sure you get all aspects of the position in writing ahead of time, including backup phone call, teaching responsibilities, total hours per week and how they're divvied, can they change your assignment without your buy-in, and what is required for promotion/progression through their academic/clinical track.

 

[fiatslug]

Both job situations sound good. I'd personally prefer the one job/academic setting (an academic setting that doesn't pay terribly?? this exists??).

But what you haven't talked about is whether it will involve a move. This is huge, and especially if you have a baby...

do you have family/close friends where you are? Would you be moving closer to or further from family/friends? Because you will never know how much you count on those people until you don't have them around. Especially with a kid. It took us about 2 yrs to feel like we'd socially re-established ourselves, and that was a lonely time. Family never visits as much as they say they will IMHO, and the onus of travel will be on your family, which with a little one is a huge pain in the arse.

Home ownerships/schools/relative cost of living would all be huge factors, as would the relative security of each of your benefitted positions. An academic institution that treats psychiatric patients (the loss leaders in medicine!) like money is no object sounds like a worrisome/unsustainable business model to me.

 

[whopper]

Current situation: I'd have to drive to work to several locations but on average about 1.5 hours a day of driving (there and back)

Possible new job:25 minutes a day (there and back.

The forensic research might not happen with the new job. While it's under the same umbrella, the relationship is not exactly porous. They currently are working on making that relationship different but I could be walking into a job where I might not be able to do research with the old mentor. The two places, financially, are going to be in a few months together, but organizationally there's still divisions.

Will you benefit most from regular grand rounds, teaching opportunities, and zebra cases in the top academic setting or from the autonomy and potentially meaningful forensics research in your current setting?

Yes except possible the forensics. The facility has always been been connected to the university's grand rounds. When I did my grand rounds for fellowship, it was at the university but teleconferenced at the possible new place of employment. Like I said, they're connected, but at the same time there's divisions.

Zebra cases? People from all over the world bring their family to this place because other doctors couldn't solve the case.

I'd mostly be doing clinical work, but I could pursue research. Personally, and I know myself on this because I did research completely for one year, I like clinical work better, but if I'd rather do mostly clinical with some research.

An academic institution that treats psychiatric patients (the loss leaders in medicine!) like money is no object sounds like a worrisome/unsustainable business model to me.

Hmm, correcting myself, money is an object at times, but it's much less so than most places. In fact, out of every single place I've ever seen, or even heard of, it's less. I was incorrect in making an absolute statement, though on the spectrum it's usually not of concern. What's going on here is a very generous benefactor contributed a lot of money. This individual is extremely wealthy and wanted to see such as facility built for the mentally ill. Patients there are charged a lot of money, though I do know of cases where the institution did everything they could to help someone without the money and worked out something that person could afford.

But on a clinical end, it's not a situation where as an attending I'm going to get daily pressure to discharge someone I don't think should be, or things to that effect because of the money.

 

[Chimed]

Current situation: I'd have to drive to work to several locations but on average about 1.5 hours a day of driving (there and back)

Possible new job:25 minutes a day (there and back.

The forensic research might not happen with the new job. While it's under the same umbrella, the relationship is not exactly porous. They currently are working on making that relationship different but I could be walking into a job where I might not be able to do research with the old mentor. The two places, financially, are going to be in a few months together, but organizationally there's still divisions.



Yes except possible the forensics. The facility has always been been connected to the university's grand rounds. When I did my grand rounds for fellowship, it was at the university but teleconferenced at the possible new place of employment. Like I said, they're connected, but at the same time there's divisions.

Zebra cases? People from all over the world bring their family to this place because other doctors couldn't solve the case.

I'd mostly be doing clinical work, but I could pursue research. Personally, and I know myself on this because I did research completely for one year, I like clinical work better, but if I'd rather do mostly clinical with some research.



Hmm, correcting myself, money is an object at times, but it's much less so than most places. In fact, out of every single place I've ever seen, or even heard of, it's less. I was incorrect in making an absolute statement, though on the spectrum it's usually not of concern. What's going on here is a very generous benefactor contributed a lot of money. This individual is extremely wealthy and wanted to see such as facility built for the mentally ill. Patients there are charged a lot of money, though I do know of cases where the institution did everything they could to help someone without the money and worked out something that person could afford.

But on a clinical end, it's not a situation where as an attending I'm going to get daily pressure to discharge someone I don't think should be, or things to that effect because of the money.

I don't know, whooper, this academic position sounds like a pretty sweet gig, the more details you give. Other then a slight decrease in pay and not being your own boss, it seems like the academic position is a place someone could really thrive in on a personal and professional level. I say go with the academic position. You could always go back to what you were doing, or something close to it, if things don't turn out as good as you'd like. Plus, it seems like that academic position gives you much more room to grow professionally.

I only hope that something like that is open when I'm applying!

 

[atsai3]

Do you have a sense for whether you could "try out" this new opportunity for a bit (eg., 5 years), and if it doesn't work out, quit and go back to your old situation where you can do research with your former mentor, make more money in private practice with your now-improved academic standing, and continue building up your state hospital retirement package?

In any case you should be congratulated for having an embarrassment of riches! Both options sound great.

For me, this just about sums it up:

Current situation: I'd have to drive to work to several locations but on average about 1.5 hours a day of driving (there and back)

Possible new job:25 minutes a day (there and back.

http://scienceblogs.com/cortex/2010/03/commuting.php

7.5 hours of your life lost per week, considering a regular 50 hour work week, is 15% of your effort. Seems like that should chip away a bit at the 25% pay advantage of your current job.

 

[Ibid]

What's going on here is a very generous benefactor contributed a lot of money. This individual is extremely wealthy

Anyone who has followed your posts can see just who this guy is a well. Looks well connected to the financial services and insurance industry. Looks like they run the show so you better be up for some serious kiss arse.

Good Luck anyway it looks like a nice place to be fair.

 

[michaelrack]

Jobs with an opportunity for an academic affiliation are a dime a dozen (and even if it's not part of a job, academic affiliations are not that hard to get). With your reputation and references, it should not be difficult for you to get a volunteer academic appointment wherever you practice. Psychiatry depts are usually eager to have someone teach/research for free.

Whopper, whether or not you are paid for your academic activities (whether it is part of the job or something you are expected to do on your own time) at the new position is an important detail when considering the new position.

 

[Sneezing]

Go where there are less meetings.

 

[Doc Samson]

I can't imagine any academic institution would prevent you from collaborating with your old mentor. I work on multi-institution collaborations all the time and no-one has any problem.

BTW, I want my jacket back.

 

[Manicsleep]

Jobs with an opportunity for an academic affiliation are a dime a dozen (and even if it's not part of a job, academic affiliations are not that hard to get). With your reputation and references, it should not be difficult for you to get a volunteer academic appointment wherever you practice. Psychiatry depts are usually eager to have someone teach/research for free.

Whopper, whether or not you are paid for your academic activities (whether it is part of the job or something you are expected to do on your own time) at the new position is an important detail when considering the new position.

When I realized this, now very obvious fact, I skipped out on academics and went private. Having experienced both, I can't say that I have the best of both worlds but I have the best of the private and enough of the academic to keep me happy.

 

[whopper]

I can't imagine any academic institution would prevent you from collaborating with your old mentor. I work on multi-institution collaborations all the time and no-one has any problem.

Yeah, I know it's weird. I've been talking to some people here and there. There certainly are some office politics, and it's a quite strange and new phenomenon for me to hear guys who have authored textbooks and have been built in my mind as more of icons that actual human beings have debates on the same order that I've seen my fraternity brothers had about division of manpower. My relative newbie status in this thing just makes me feel more strange.

The relationship, like I said, isn't without walls. I'm going to meet with a bunch of people in the next few days over this. All of this is stressful. I know it's a good problem but it's still bugging me.

I told one of my bosses today what's going on and that I might be moving on. He wasn't happy. I hate saying this but as a word of advice to you residents, when you're an attending, if you do good work, and then you let it be known you can go to other places, they'll want to keep you and do things they might not have done had you tried to be too nice and keep your mouth shut. Don't overdo it. Remember the point is you want to keep yourself looking like they want you. An employee playing this card too much can turn into the guy that is just too much of a headache for them.

All this hubbub made me sit down and on paper compute everything I could think of. So far I tallied that I got about 7K in yearly expenses that I'd have to do anyways that I can use now as a tax deduction that I couldn't should I join the university (e.g. cell phone bills, car maintenance, internet usage, lawn maintenance, house insurance, computer stuff). I also did some math and figured out the private practice I work at is actually paying me more than I thought per hour, way more. Leaving that private practice is sounding more and more painful!

 

[st2205]

I'll go ahead and second what was said before about commute time. A long drive really cuts into the prime of the evening where you'll see your wife and kids. The way I understand it is that you're married with a young child. You can do whichever you prefer professionally, but when all is said and done I'm not sure you'll give much a damn about the difference in professional satisfaction.

 

[digitlnoize]

Ok, doomsday questions first:

Would the pay at the University gig be Salary only, or Production bonuses?
What is the payor mix like at the University (and at your current gig)?

I ask because the budget crunch is going to come eventually. Uncle Sam can't afford to keep up the spending rate and if you have a high Medicaid/Medicare percentage, they could be in for a significant hit. Obviously, those systems will likely survive (somehow), but it won't be what it is today, we simply can't afford it...unless we cut defense spending big time, which isn't' going to happen.

I've seen this happen over and over again in the private sector my dad works for. When the budget crunches comes, everyone does more work for less money, or they get axed. Medicine likely won't be any different, if your income is largely dependent on federal funds. If you're mostly private then there's probably less to worry about...I hope.

Other than random doomsday prophecy, I don't have much to offer. It seems like it's ultimately a choice of:

Freedom + Money vs. Less Freedom + Less Money + Intellectual Stimulation

If you find your current work even halfway interesting, I would (personally) stay there. You seem to have a good setup that allows you to have a varied clinical practice, a good income, a low number of headaches despite doing your own thing, and flexibility.

Giving all of that up with a pay cut, seems like to big of a loss to me...but, I highly value my independence and dream of having the freedom you currently have. I would stay, do your Awesome Forensics Research, and call it a day.