Can someone give a quick synopsis and the pros and cons of academic surgery vs. private practice.... Lately this seems to be a recurrent question I am receiving when I tell doctors I want to pursure general surgery. However, I don't have enough experience with either realm to make a well thought out distinction between the two.
I tired searching older threads without much success, but I apologize if this is a duplicate posting.
The old argument was that academics work less but private practice pays better.
While this isn't necessarily true anymore, academic physicians will have a team of residents between them and consults, meaning that you don't have to answer pages about IV fluid rates or put in IJ's at 3 am. However, as an academic physician you'll generally have to maintain a research interest, teach residents (which is rewarding, but takes up time), and work your way up the (very political) academic ladder. You also have less control over your hours and which patients you see. You'll see anyone that comes into the university system and operate on them when they need it. However, you can treat your patients worse, and be mean to other physicians because you're not reliant on consults.
As a private practice physician, you pretty much have the opposite situation as above. You generally have more control over which kind of patients you see (i.e. you can very realistically say "I'm never doing a hernia repair again"), and what kind of hours you work (work more, make more; work less, make less). You also still tend to make more money, mostly because whatever you bill goes either to you or to your practice, instead of maintaining a giant university hosptial. However you are very dependant on consults, so if a patient says "well doc I know you want to send me home, but I just feel, I dunno... not good" then you have to keep them in the hospital an extra day or they'll tell the PCP what a jerk you are and they'll stop referring to you. You also must treat your referring doctors very well, even if they send you crap. Also, when you're on call, you do have to answer pages about diet orders and ER consults. You don't ever have to do research, however you will be less respected at national meetings, and prestigious academiae will look down their nose at you. However, instead of doing research, you'll have to spend time maintaining the business that is your practice. Even if you aren't the "administrative partner" or have an office manager, you'll still have to take time to write letters to referring docs, balance your office budget, coordinate collections with billing companies, etc.
Fortunately there are a great many practice environments which span the (huge) range from pure academic to pure private practice. Many PP docs take on rotating residents or med students, and many academics maintain a private practice of their own. Also, you can choose to be employed by a large physician group or hospital, giving up some perks but gaining others (i.e. you have less scheduling control but you don't have to worry about billing).
I've maintained, however, that the decision on which type of practice to enter is one that should be made early. Generally if you don't go to a large university program for residency, it will be very difficult to enter academics. If you prefer a private practice setting, you'll probably be better off training in a more community program where you get to experience more interaction with private practice physicians.
