PP vs. academics - lifestyle?

[gclax30]

Hey folks,

I will be a CA-1 next year and am interested in pursuing either critical care or cardiovascular anesthesia. I think I’m more inclined to do academics because I enjoy basic science research and being in the lab and all that stuff. But my spouse is concerned about the time commitment and work hours (between attending, teaching, being in the lab, writing, etc.) and feels that private practice would be a better “lifestyle” choice.

Which type of practice (PP vs. academics) would give me more day-to-day control over my schedule? i.e. if I need to go pick up one of my sick kiddos from school or something along those lines, or if we want to have family dinner together regularly, which would be more amenable to this? How much autonomy do you have concerning your schedule in PP, especially if you’re the new guy to the group? Do this change over time?

On other hand, are you a slave to the lab/department when trying to advance up the academic ranks?

Any thoughts would be greatly appreciated. Thanks!

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[sevo85288]

It really depends on the practice. In some private practice groups you will work very hard and have little control over your schedule, but you will make a lot more money. In academics you will have some more flexibility and you may still work on occasion; generally better lifestyle with less money. You usually get more vacation in private practice as well.

 

[seinfeld]

grass will always be greener on the other side. If you do academics with the idea of going the route of tenure track youre life style will probably be busy with the publish or perish idea. IN PP when i am home, nothing more to do. no lectures to write, no papers to edit, no resident evals to do. My take when i was deciding b/w the 2 based on lifestyle issues was that if i was working i wanted to get paid (ie dont get paid extra to do lectures, evals, committees, etc). The other main thing which pushed me into PP was the ability to do my own cases.

 

[boggy]

grass will always be greener on the other side. If you do academics with the idea of going the route of tenure track youre life style will probably be busy with the publish or perish idea. IN PP when i am home, nothing more to do. no lectures to write, no papers to edit, no resident evals to do. My take when i was deciding b/w the 2 based on lifestyle issues was that if i was working i wanted to get paid (ie dont get paid extra to do lectures, evals, committees, etc). The other main thing which pushed me into PP was the ability to do my own cases.

There are two types of people in academics. The first type who want to rise through the academic ranks, get grants, write books, publish papers work far harder than in private practice especially when starting out. Generally they need to establish themselves with the lectures, papers etc and this is often done on their own time. Once they become more senior--say 10 years or so into it they may get an easier deal, more money, and can become the people that tend to dominate the societies , etc. The other type of academic is the person on the clinical educator pathway--basically they are the workhorses of the faculty, teach the residents, do the cases, and generally their free time is theirs---PP isn't what it used to be either since evermore of them are really just employee positions of big AMCs with no chance of being a real managing partner. So, in the end unless you plan to be a true professor type their is probably less and less difference between academic practice and AMC employee status. If you can find a true PP where you are a shareholder thats great but these spots are increasingly rare. Also, be careful with physician only delivered anesthesia--if unit values approach medicare rates for all payors that will be a highly unpleasant place to be.

 

[Soon2BENT]

Also, be careful with physician only delivered anesthesia--if unit values approach medicare rates for all payors that will be a highly unpleasant place to be.

I'd like to hear more about this, as I'm finishing my fellowship this year and am in the job hunt. Thanks.

 

[aredoubleyou]

I'd like to hear more about this, as I'm finishing my fellowship this year and am in the job hunt. Thanks.

If rates fall overall to medicare levels, no model will endure that. Even academics would take a hit, probably delayed and bufferred to some small degree.

 

[cchoukal]

As a new asst professor at a large academic center, I can tell you a little bit about how the lifestyle is.

Most academic programs hire you at 80% clinical. This means, on average, you have 1 day per week that you're not working clinically. Many times, that one day will be post-call (and what post-call means is highly program-dependent). Some programs (Northwestern and Sinai in NYC come to mind) hire you at 100% clinical, but the pay is higher.

What you do with your 1 free day is largely up to you, and I certainly knew a handful of people in my training program who used it to F off. What you accomplish during your 20% non-clinical time will determine whether you are granted more non-clinical time and whether you are ultimately promoted to associate. The formula varies by program, but suffice it to say that if you expect to get more non-clinical time and to get promoted, you'd better be doing something that the department and university value (publications, getting grants, etc.). But keep in mind, that doesn't necessarily mean doing research. Excellence can come in research, education, quality, hospital/university service, etc.

At some smaller programs, promotion might be less dependent on these factors; I wouldn't know.

How does this affect your day-to-day flexibility? To some degree, you can control when you're non-clinical time is, if you know you have something you have to do on a certain day, but, again, if you're using that time to run errands, that will have implications on your productivity. As far as getting out early at the last minute when something comes up? It seems kinda hard to do in academics. Someone would have to cover for you, or trade their "first out," "second out" status with you.

For me personally, I do most of my clinical work at an outpost of the main university, so there's only 4 or 5 of us in the OR on any given day, and when I leave each day is HIGHLY variable and seems to bear zero correlation to what my status is that day (first out, second out, etc), so it's actually pretty hard to plan or be flexible if stuff comes up.

hope that helps.

 

[seinfeld]

There are two types of people in academics. The first type who want to rise through the academic ranks, get grants, write books, publish papers work far harder than in private practice especially when starting out. Generally they need to establish themselves with the lectures, papers etc and this is often done on their own time. Once they become more senior--say 10 years or so into it they may get an easier deal, more money, and can become the people that tend to dominate the societies , etc. The other type of academic is the person on the clinical educator pathway--basically they are the workhorses of the faculty, teach the residents, do the cases, and generally their free time is theirs---PP isn't what it used to be either since evermore of them are really just employee positions of big AMCs with no chance of being a real managing partner. So, in the end unless you plan to be a true professor type their is probably less and less difference between academic practice and AMC employee status. If you can find a true PP where you are a shareholder thats great but these spots are increasingly rare. Also, be careful with physician only delivered anesthesia--if unit values approach medicare rates for all payors that will be a highly unpleasant place to be.

I agree with most all you say. The number of self preformed cases is going down in order to maintain income. I probably do 90% supervision, with only cardiac, some vascular, and regional being solo cases. But even with cardiac it kills our bottom line to have an attending sitting alone in a 5 hour case. I also agree that many anesthesia groups are moving toward AMC or employee based. Rules, regulations and decreasing reimbursement make being a managing partner less appealing and more painful to keep up.

Having said all that still would rather be in PP. If i stayed in Academics i would have been treated like a pgy 4 instead of a new attending with fresh ideas and great skills. I saw that happen to a number of residents who became attendings in the years before me. Also i did not want to be pigeon holed into just a few types of anesthetics. I wanted a broad spectrum practice. Plus i never wanted to be the attending who was telling a resident to do X,Y or Z but who has never done it themselves. IN a year and a half or PP i have done 3 stat GA C-sections, by myself. I have done Circ arrest Open heart cases with TEE by myself.

I really wish the last year of Residency would be year of independent practice. I would have much rather had some of these experiences in an environment where people are immediately available to help and give you better mentoring. Some time being on an island is a very lonely feeling, especially when you have never been there before.

 

[sevoflurane]

Lifestyle is highly dependent on the type of practice you are in. For me, I am not interested in academic days. My passion is for clinical anesthesia. You will find some PP practices that work very hard and some that don’t.

PP groups where MD’s run their own cases are still out there and some are still lucrative. Usually you have to give something up if you are going to be in PP and be appropriately compensated:

1. You work with CRNA’s running multiple rooms.
2. You work with minimal to no CRNA’s and work harder in a nicer city.
3. You work “avg” hrs/week w/o CRNA’s and live in a small community.

Usually smaller communities that have traditionally been MD only, are more resistant to change. They will lag behind national trends.

If you want lifestyle, you can still have it in nice areas of the country:

17 weeks on 35 weeks off: You will get paid less however.

http://www.gaswork.com/post/120030

Always a blance of

1. Lifestyle
2. Income
3. Location

 

[sevoflurane]

BTW, I view MD only PP groups a lifestyle choice.

 

[gclax30]

As a new asst professor at a large academic center, I can tell you a little bit about how the lifestyle is.

Most academic programs hire you at 80% clinical. This means, on average, you have 1 day per week that you're not working clinically. Many times, that one day will be post-call (and what post-call means is highly program-dependent). Some programs (Northwestern and Sinai in NYC come to mind) hire you at 100% clinical, but the pay is higher.

What you do with your 1 free day is largely up to you, and I certainly knew a handful of people in my training program who used it to F off. What you accomplish during your 20% non-clinical time will determine whether you are granted more non-clinical time and whether you are ultimately promoted to associate. The formula varies by program, but suffice it to say that if you expect to get more non-clinical time and to get promoted, you'd better be doing something that the department and university value (publications, getting grants, etc.). But keep in mind, that doesn't necessarily mean doing research. Excellence can come in research, education, quality, hospital/university service, etc.

At some smaller programs, promotion might be less dependent on these factors; I wouldn't know.

How does this affect your day-to-day flexibility? To some degree, you can control when you're non-clinical time is, if you know you have something you have to do on a certain day, but, again, if you're using that time to run errands, that will have implications on your productivity. As far as getting out early at the last minute when something comes up? It seems kinda hard to do in academics. Someone would have to cover for you, or trade their "first out," "second out" status with you.

For me personally, I do most of my clinical work at an outpost of the main university, so there's only 4 or 5 of us in the OR on any given day, and when I leave each day is HIGHLY variable and seems to bear zero correlation to what my status is that day (first out, second out, etc), so it's actually pretty hard to plan or be flexible if stuff comes up.

hope that helps.

Thanks for the great posts everyone, certainly appreciated!

 

[LeverArm]

Bump. I was wondering with all this increasing concern of AMCs and the decline of smaller PPs, along with increased CA residents pursuing fellowships that places them in cases that are more likely to be seen in academic centers, if the balance is tipping towards academics? If it is, how are academic positions changing? If it's not, why not? Is the lifestyle really that much worse that all these people would still prefer AMCs or is it just more competitive to get into an academic center?

 

[pjl]

In private practice, as well as academics you have to remember one thing. You are there so that the institution and everyone else involved can make money. So as to whether or not you can drop everything and pick up your kid at the last second...doubtful in either case. The only option is to hope the schedule is light enough that the "first out" coworker is able to be done, AND that they take pity on you and are willing to let you leave work instead of them. OR to cancel cases for whatever time it takes for you to leave.
Obviously, this differs among groups and there are PP groups where this would be easy, but I would think you are more likely to be able to accomplish this in academics by stealing someone's non-OR clinical time.
If you are not in a room doing cases, or supervising so that cases can be done, you are costing the surgeons and hospital money. There are always exceptions where it may be necessary to stop the OR so you can be with your family, but those better not be every time little Timmie has the sniffles, or you will likely be looking for a different job.
As to the time you leave daily, I am sure there are places where it is a little more shift oriented, but this is one of the major issues with our jobs as anesthesiologists. Someone has to be there to do the cases, and you are not in charge of when they are scheduled. That means the first out on Monday could leave at 9 am, and the first out on Tuesday could leave at 6 pm. In an eat what you kill group, you can be at dinner almost every night by simply sacrificing those cases and that money. In a more common employee model (or academics), you are probably more likely to trade off who is there late every day, and miss dinner once in a while. That said, most places I have seen tend to slow down the OR at ~330 because this is when all the 8 hour shift people (nurses/scrub techs) are done.

Edit: Nevermind, this is from 2010...

 

[LeverArm]

I am not sure if 2010 was a long time ago or too recent to bring this up again. I was thinking about starting a new thread on the topic but figured most of it hasn't changed all that much. The only thing I noticed is how few people talk about academics these days yet everyone points to fall in pp.

 

[michigangirl]

There are two types of people in academics. The first type who want to rise through the academic ranks, get grants, write books, publish papers work far harder than in private practice especially when starting out. Generally they need to establish themselves with the lectures, papers etc and this is often done on their own time. Once they become more senior--say 10 years or so into it they may get an easier deal, more money, and can become the people that tend to dominate the societies , etc. The other type of academic is the person on the clinical educator pathway--basically they are the workhorses of the faculty, teach the residents, do the cases, and generally their free time is theirs---PP isn't what it used to be either since evermore of them are really just employee positions of big AMCs with no chance of being a real managing partner. So, in the end unless you plan to be a true professor type their is probably less and less difference between academic practice and AMC employee status. If you can find a true PP where you are a shareholder thats great but these spots are increasingly rare. Also, be careful with physician only delivered anesthesia--if unit values approach medicare rates for all payors that will be a highly unpleasant place to be.

Being in academics I think this post from 2010 still applies. Except the tenure track has gotten harder with funding getting tighter (paylines are at their lowerst), so it's a lot easier to be a part of the perish part of the "publish or perish" mantra. You work VERY hard as junior faculty trying to establish your research career. But the point from boggy about the clinician educator pathway is true as well-- the academic center still has to make money by doing cases, and the clinical work is always there, especially in anesthesia. So you'll see more clinical associates and clinician educators in anesthesia vs. internal medicine or pediatrics for example.

 

[gasdoc77]

Assuming I ever make partner in my group that is aging by the day, I hope to assign monetary values to each call position at some point in the future, be it near or far. That way, if people want to trade positions with one another they can do so and allow our business office to make an adjustment for the difference. Since each person is assigned a number from 1-15, we could find an average daily rate for the 8 spot and adjust it accordingly for each number ahead and behind it. The older docs (of whom there are many) could sell call or low numbers to the young and hungry docs (of whom there are not so many). If someone needs to get out for their kids, ,etc, just find someone that wants the money and pay the difference between the numbers. Anyone that doesn't want to participate doesn't have to and their bottom line won't change. more flexibility=more control=greater job satisfaction

 

[IlDestriero]

Just change to eat what you kill +/- blended units and you achieve the same goal. More work gets more pay, leave early and someone else gets "your" money. No hassle with the business office, tracking trades, etc. Jack did 1000 units in Dec and Jill did 900 units. Done.