Practicing surgeon to academic physician?

[qwe7791]

What's the process like usually? Is it long and tedious? I want to become a surgeon and then later retire as an academic physician.

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[mmmcdowe]

Well you can be an academic surgeon. A surgeon is always a surgeon unless they go back to residency again. There are plenty of academic positions for people in surgical specialties. It may be a little bit harder to transfer from private practice to academia late in life, but it definitely can and does happen.

 

[Nymphicus]

I don't think "retire" is the word you are looking for.

 

[gyngyn]

In theory there is nothing to preclude this. I haven't seen a private practice surgeon become full time faculty in 27 years, though.

 

[kindasorta]

Not sure what a PP surgeon would have to offer to academia.

 

[gyngyn]

In contrast, "outside" community physicians can help out in the OR even as they slow down in their practices. This is usually designated as "clinical" or voluntary faculty.

 

[ucsfstudents]

The process of becoming a surgeon is long, and at time tedious, but it can be done. One does not retire as an academic surgeon, as it is a big time commitment, but people can go between community practice and university practice if that is what you meant. Good luck!

 

[Gut Shot]

What's the process like usually? Is it long and tedious? I want to become a surgeon and then later retire as an academic physician.

Step 1: Get into medical school.

 

[LizzyM]

I think that the problem here is that the OP has no knowledge or experience that would give him an idea of what an academic physician is or does. I see this quite often in reading medical school applications, too.

Being an academic physician is not like being a college professor but at a medical school.

Here's the deal: some physicians practice in ambulatory care settings and even in community hospitals with no responsibility for the supervision of medical students, residents or fellows. They take care of patients and that's it. This pateint care is often. but not always, in a private practice. Doc takes care of patients, earns a living by billing the patients or a third party (insurance) for the services.

Now some of these physicians might be at a community hospital that has residents in that physician's specialty. Those residents are supervised and trained by practicing physicians in exchange for the assistance that the trainees provide (overnight shifts in the hospital, etc). The private practice physician makes a living providing patient care and voluntarily provides training and supervision to trainees. This usually carries an academic title of "Assistant Professor /Associate Professor/ Professor of Clinical [specialty]". Some of these physicians may also practice at academic medical centers. Regardless of where they practice they are known at the medical school as the "voluntary faculty". They have no income from the medical school but in addition to their clinical duties they may also be expected to serve on medical school committees (such as the adcom!) or provide small group instruction to medical students as a small group instructor of clinical exam skills or problem based learning (e.g. an assignment might be 4 hours wk for 6 weeks once each year).

In addition to voluntary faculty, medical schools have physicians on the payroll although many derive the bulk of their income from clinical care, sometimes provided through a multi-specialty group practice operated by the full-time faculty of the medical school. (Profit from this group practice is sometimes funnelled into the medical school to support such things as the medical libraries and infrastructure.) These facutly may give a few lectures per year in their area of expertise but most of their teaching is done at the "bedside", a short-hand for anywhere one provides patient care including the operating room. A few faculty members may also have some responsibility (and income) from directing a course (coordinating the instruction provided by a number of faculty) but much of the classroom and laboratory instruction in medical school is provided by professors with doctoral degrees in biological sciences, not physicians.

Some of physicians on the full-time faculty derive a portion of their income from research. Grants and contracts provide income to the investigator and to the school itself. The prestige of an medical school is associated in large part with the amount of research funding it is awarded. The usual expectation for a full-time faculty member is some combination of teaching-research-patient care.

Most private practice docs in high paying specialties don't switch to academic medicine because it doesn't pay as much and still carries the expectation that you will provide clinical care to patients. (It isn't as if you can become an academic physician when you are too old to operate anymore.)

 

[FSU2013]

Not sure what a PP surgeon would have to offer to academia.

I really hope this is a joke.

Yea, I can't think of anything someone who ran a successful private practice in gen surg would have to offer med students or residents....not one thing.

 

[Winged Scapula]

In theory there is nothing to preclude this. I haven't seen a private practice surgeon become full time faculty in 27 years, though.

I've seen it multiple times and it is becoming more and more common with the stressors in PP.

As noted above, there is absolutely nothing precluding a surgeon from taking a job as faculty at an academic medical center. During my residency we had 2 community surgery subspecialists (Colorectal and MIS) leave practice and become full time academic surgeons; both claimed that the hassles of PP were no longer worth it. Here in my community, general surgeons especially are leaving PP for the (presumed) benefits of an employed position with medical centers. To be honest, PP may be a relic sometime in the near future.

I admit to being stymied by the comment about PP surgeons having nothing to offer academia. First, many PP surgeons, myself included, do have medical students and residents rotate with them; this is not the sole province of the surgeon employed by an academic medical center. Secondly, as I've been told by those who rotate with me and their respective schools/programs, the rotation is very popular because they learn a great deal about practice management (ie, billing and coding, malpractice issues, job opportunities, etc.) that they don't necessarily get in a more academic setting.

I trained in a traditional academic medical centers for medical school, residency and fellowship and I can tell you that my attendings had NO IDEA about how much malpractice was, whether they got paid for what they billed, what their reimbursement rate was, how many cases they needed to do and patients to see to make X salary and most importantly, how to find jobs outside of academia. Not to toot my own horn, but I must be doing something right to be running a successful, large PP in this day and age and I think students and residents can benefit from that.

 

[FSU2013]

I've seen it multiple times and it is becoming more and more common with the stressors in PP.

As noted above, there is absolutely nothing precluding a surgeon from taking a job as faculty at an academic medical center. During my residency we had 2 community surgery subspecialists (Colorectal and MIS) leave practice and become full time academic surgeons; both claimed that the hassles of PP were no longer worth it. Here in my community, general surgeons especially are leaving PP for the (presumed) benefits of an employed position with medical centers. To be honest, PP may be a relic sometime in the near future.

I admit to being stymied by the comment about PP surgeons having nothing to offer academia. First, many PP surgeons, myself included, do have medical students and residents rotate with them; this is not the sole province of the surgeon employed by an academic medical center. Secondly, as I've been told by those who rotate with me and their respective schools/programs, the rotation is very popular because they learn a great deal about practice management (ie, billing and coding, malpractice issues, job opportunities, etc.) that they don't necessarily get in a more academic setting.

I trained in a traditional academic medical centers for medical school, residency and fellowship and I can tell you that my attendings had NO IDEA about how much malpractice was, whether they got paid for what they billed, what their reimbursement rate was, how many cases they needed to do and patients to see to make X salary and most importantly, how to find jobs outside of academia. Not to toot my own horn, but I must be doing something right to be running a successful, large PP in this day and age and I think students and residents can benefit from that.

To piggy back on that, my med school uses almost exclusively PP attendings and I love it. There are four big benefits that i see to it:

1) The attendings get paid a paltry salary for teaching a med student, so it's practically volunteering (that is to say that the salar they recieve is no where near commiserate with the income lost by being slowed down in the OR or clinic). This leads to only motivated teachers being in staff. They generally only have students for about half of the year, so they have a lot of flexibility to avoid burnout.

2) Almost everyone goes into private practice, beit independent or hospital employment. I am basing my decision on my career based on what I will most likely be doing for the rest of my life, not just based on what I see I'm academic medicine.

3) I don't fight for procedures. I was first assist on every surgery on that rotation. I lined and tubed every patient that needed it on ICU and EM.

4) I know my attendings very well. I have a great work environment. My ICU attending took my wife and I out to the nicest steak house in town and my IM attending gave my wife and I a really nice wedding gift.

My point is just that I hate the attitude that "if you're not in academics, you're a dumb community doc."

 

[Winged Scapula]

My point is just that I hate the attitude that "if you're not in academics, you're a dumb community doc."

Those who say that are not only short-sighted but they're also missing the oft-quoted (but of dubious veracity), "those who can DO, those who CAN'T teach." In the surgical world, this is a common statement.

But there are no hard and fast rules; there are technically great academic surgeons and awful PP surgeons. In the latter however, you can count on losing referrals if your complication rate is high or you have a lot of complaints so there is some external pressure to be good. The same is not true in academics; practice is not as highly referral dependent.

When I needed my carpal tunnel repaired, I purposely did NOT choose an academic surgeon; I wanted someone who did them often and did a lot of them. Same goes if I ever need an appendix or gallbladder done. I would prefer the community general surgeon who does them over and over, in an expeditious manner.

However, if I need a Ivor Lewis esophagectomy, I'll go to the Tertiary Care hospital where these things are done much more commonly. Then again, one of the best hepatobiliary surgeons in the country is in PP here in town; so for my Whipple I'd go to him rather than Mayo.

 

[kindasorta]

I really hope this is a joke.

Yea, I can't think of anything someone who ran a successful private practice in gen surg would have to offer med students or residents....not one thing.

Sounds like you don't know what academics means.

 

[Winged Scapula]

Sounds like you don't know what academics means.

Could you clarify what you meant above? How do you define academics and why don't you think PP surgeons have anything to offer?

 

[kindasorta]

Could you clarify what you meant above? How do you define academics and why don't you think PP surgeons have anything to offer?

Academics refers to those that spend a portion of their time involved in research. The whole "working at a hospital with residents covering your call and med students writing your notes" thing is not academics. PP surgeons aren't excluded from obtaining a position in academics, but how they would spring up a research career out of nowhere is a little puzzling.

 

[LizzyM]

Academics refers to those that spend a portion of their time involved in research. The whole "working at a hospital with residents covering your call and med students writing your notes" thing is not academics. PP surgeons aren't excluded from obtaining a position in academics, but how they would spring up a research career out of nowhere is a little puzzling.

That's another confusion between academics in university settings (outside of medicine) and academics in medical centers. Many physicians holding appointments in medical school faculties never do research or have not done research for decades. Their contribution is in education and patient care. It is easy to see where someone in private practice could switch over to an academic role, if they didn't mind a loss of productivity and a pay cut.

In some cases, these clinicians might be involved in clinical trials of new treatments for a disease they specialize in but this often means accepting a protocol prepared by others, obtaining their patients' consent to participate in the trial, following the protocol and sending the data to the research sponsor for analysis. Again, someone in private practice or switching from private practice to academic medicine can be recruited into serving as a physician-investigator in a clinical trial of a new drug or device.

 

[Winged Scapula]

Academics refers to those that spend a portion of their time involved in research. The whole "working at a hospital with residents covering your call and med students writing your notes" thing is not academics. PP surgeons aren't excluded from obtaining a position in academics, but how they would spring up a research career out of nowhere is a little puzzling.

Fair enough (your definition) although I would define it differently. Academic surgeons are required to spend the majority of their time in the OR and clinic, not the lab. An 80-20 or 70-30 split would be typical. The vast majority of physicians in "academic medicine" do not devote their career to research but rather may serve as PI, while the PhD exists in the "publish or perish" environment we are all familiar with from undergrad and graduate school.

However, I would suggest that perhaps you are not familiar with PP. Myself, as well as many surgeons and radiation oncologists in PP, are involved in research and publish our results. Several of us are involved in the T-Gen translational investigations into Triple Negative breast cancer in African American women, familial non-BRCA breast cancers and the genetic origins of Inflammatory Breast Cancer as well as the NSABP B-39 protocol. We also refer patients to trials that we do not personally participate in (usually adjuvant chemotherapy ones).

Admittedly, research is not a significant portion of my practice or for most in PP but it may be more than you and most realize.

 

[oldbearprofessor]

Many physicians holding appointments in medical school faculties never do research or have not done research for decades. Their contribution is in education and patient care. It is easy to see where someone in private practice could switch over to an academic role, if they didn't mind a loss of productivity and a pay cut.

It is not always the case that physicians who accept a full-time academic appointment after being in private practice have a decrease in productivity, whatever that means. Not having to deal with administration and other issues can lead to an increase in time available both for education and patient care, assuming one considers both to be "productive" endeavors. I am aware of quite a few of our faculty who moved from private practice to an academic appointment for these reasons. Many do more clinical activity than they did in private practice since the med school is handling much of the paperwork.

The pay cut issue is also more complex and it is not always a cut or at least doesn't have to be a major cut. Note that I am discussing my experience with pediatric faculty, not surgeons, but your statement was not specific to surgeons.

 

[mcloaf]

The pay cut issue is also more complex and it is not always a cut or at least doesn't have to be a major cut. Note that I am discussing my experience with pediatric faculty, not surgeons, but your statement was not specific to surgeons.

Is it even always a pay cut for surgery? It's possible to use state employee salary searches and find numerous academic surgeons making 600k-1m; is that really so far below what a comparable PP would be making? Or is that comparison really apples and oranges since these academics are at the apex of their fields, whereas a PP doc making a similar salary doesn't necessarily have to be a nationally known physician at the top of the food chain?

Hopefully I'm not embarrassing myself with these questions. Just some things I've been wondering about as an incoming MS1 interested in academic surgery.

 

[Winged Scapula]

Is it even always a pay cut for surgery? It's possible to use state employee salary searches and find numerous academic surgeons making 600k-1m; is that really so far below what a comparable PP would be making? Or is that comparison really apples and oranges since these academics are at the apex of their fields, whereas a PP doc making a similar salary doesn't necessarily have to be a nationally known physician at the top of the food chain?

Hopefully I'm not embarrassing myself with these questions. Just some things I've been wondering about as an incoming MS1 interested in academic surgery.

Those surgeons making that kind of money tend to be in leadership roles; it is not the assistant and associate professors in most cases. Then again, if you bring in the $$, you have far more negotiation power.

ACGME produces a book which lists the average salaries based on academic ranking and location. For example, a junior assistant fellowship trained surgeon at my residency program started at $153,000 per year, far below what a similarly trained surgeon in PP would make. Now that salary includes malpractice (which is highly variable based on geography and specialty) other benes and office staff, something you would have to pay for in PP. I know what the offers are for my specialty and even with these expenses, I make more in PP (but nowhere near 1 mil/year ).

YMMV.

 

[biophysicianai]

Academics refers to those that spend a portion of their time involved in research. The whole "working at a hospital with residents covering your call and med students writing your notes" thing is not academics. PP surgeons aren't excluded from obtaining a position in academics, but how they would spring up a research career out of nowhere is a little puzzling.

I'm a student at one of the largest research-oriented medical centers in the country, and I can tell you that many of my professors do little to no research. There are, of course, plenty of faculty members who spend most of all of their time in the lab, but they are often PhDs or MD/PhDs.

Some of the pathologists around here rotated on-and-off of being on service (i.e., being involved with clinical duties) and being in the lab, so they spend X months a year doing one, and Y months a year doing the other. However, they are the exception, not the rule, as pathology can be a particularly research-friendly field.

As far as the comment a previous poster made regarding how much they enjoyed their rotation through the PP offices in their community, a definitely see the benefit of this. I had a similar experience, and it was eye-opening, as most of my other rotations were within medical academia. Billing and management are huge aspects of PP that med schools don't make an effort to teach you. Additionally, some of the PP docs I worked with were better teachers than some of the academics, perhaps because of their need to explain diseases and treatments to moms and pops from the community, as opposed to explaining molecular pathophys at a lab meeting or in a lecture hall.

If TL;DR, then cliffnotes: everyone has something different to offer and teach you.

 

[FSU2013]

Sounds like you don't know what academics means.

Academics refers to those that spend a portion of their time involved in research. The whole "working at a hospital with residents covering your call and med students writing your notes" thing is not academics. PP surgeons aren't excluded from obtaining a position in academics, but how they would spring up a research career out of nowhere is a little puzzling.

Lol. There's more to academics than research.