Private Practice vs Academic Medicine: What are the fundamental differences?

[KinasePro]

Since US allo schools do a pretty crappy job of exposing medical students to community/private practices, I'm wondering what SDNers perceptions are regarding the main differences between these two paradigms. Here's my general impression (as a know-nothing M1):

Private Practice:

• Better $ overall
• Almost exclusively clinical workload (no research/teaching and very little administration/people management)
• Work hours not very flexible, workload is heavy (well-established docs are an exception)
  • Regular, but longer hours than academia.
• Bread & Butter cases for the most part, risk of "atrophy" means continuing medical education is more important (is this accurate?)

Academic Medicine:

• Less $ overall
• Large variety of practice scenarios, time is typically divided between teaching, research and administration
• Work hours are more flexible, but it depends on your practice scenario (more research/tenure track = worse hours)
  • in general, hours tend to be irregular (expect to work weekends and holidays)
• Cases are more challenging, knowledge is better maintained
• Residents share the call burden
  • does this impact your mal-practice liability?

Is it "harder" to find work in private practice or academics? I know there's plenty of opportunities out there in each path, but is one more competitive than the other?

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[KinasePro]

#bumpingcuz508viewsbutnoreply

 

[auburnO5]

Your OP seems accurate... but I too would like to know more information about this.

 

[officedepot]

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[IlDestriero]

Answers in the quote. I tried to be general, but there's an anesthesia/surgery bias in the comments so they may not really apply to all fields (like private practice psychiatry)

Private Practice:

• Better $ overall- usually, though not always, depends on the job and location generally the more you work the more you make (true in both).
• Almost exclusively clinical workload (no research/teaching and very little administration/people management)- true. Though some PP groups have rotating residents from an academic program, and large groups need admin people.
• Work hours not very flexible, workload is heavy (well-established docs are an exception)- not necessarily, it's job dependent.
  • Regular, but longer hours than academia.- not necessarily, job dependent.
• Bread & Butter cases for the most part, risk of "atrophy" means continuing medical education is more important (is this accurate?)- no, PP groups get plenty of pathology, though usually not the most extreme cases requiring special teams. This is also very job specific.

Academic Medicine:

• Less $ overall- usually, but there are exceptions, very job dependent, money at the top of the academic pyramid can be extraordinary.
• Large variety of practice scenarios, time is typically divided between teaching, research and administration- Yes, but research is not required for everyone, I dont do any. But I funnel ideas to others and wrote some textbook chapters.
• Work hours are more flexible, but it depends on your practice scenario (more research/tenure track = worse hours)- very job dependent, even if you have significant research time, you'll be writing, etc at home. Clinical hours and commitment are job specific and can be much less than PP. Possible better flexibility with not taking call, part time, etc.
  • in general, hours tend to be irregular (expect to work weekends and holidays)- PP folks take call, etc. Usually much MORE than an academic group. Maybe there's no call at all for the PP group. Depends on the job.
• Cases are more challenging, knowledge is better maintained- probably.
• Residents share the call burden. Not exactly correct. You still have to take call, but you're supervising residents and fellows while on call vs doing the cases yourself.
  • does this impact your mal-practice liability? Probably not, though some high risk physicians may have lower rates if they don't do some higher risk procedures.

Is it "harder" to find work in private practice or academics? I know there's plenty of opportunities out there in each path, but is one more competitive than the other? - great academic jobs are competitive, but great PP jobs are more competitive. Great PP jobs can also be very challenging to find because they're not advertised anywhere and generally fill though word of mouth immediately. You don't even know that there is a small anesthesia group working at an unknown surgery center making bank doing all insured patients and taking 12 weeks of vacation/yr.

 

[Mizoodles]

your post only confirms it.. why the hell would anyone choose academic medicine?

 

[flatearth22]

your post only confirms it.. why the hell would anyone choose academic medicine?

prestige + intellectual stimulation > $$$ + independence

 

[surftheiop]

your post only confirms it.. why the hell would anyone choose academic medicine?

I think teaching has a lot to do with, some people gain a huge amount of satisfaction from working with med-students/residents/fellows on a daily basis.

(Obviously similar situation for those who love research)

 

[Gigantron]

prestige + intellectual stimulation > $$$ + independence

It's funny because he's a pre med.

 

[oldbearprofessor]

your post only confirms it.. why the hell would anyone choose academic medicine?

1. For many people, the opportunity to practice, especially a critical care field with relatively little concern about the business side of medicine is appealing.

2. In many fields, the best opportunities to see the most complex patients and a lot of them are in academics. This is not true in all areas, but often is true in pediatric specialties.

3. Academics often provides time not only to do research and clinical education, but to be involved in a number of other activities including public policy advocacy, global health and others.

4. Although in many fields, the salary is considerably lower, the salary/lifestyle ratio may be more favorable and there may be other lifestyle benefits including less night call or less work when on call. As noted, this is highly variable though.

5. The opportunity to conduct clinical research or be part of it, even for those academics who are not primary researchers is appealing to many.

There are others, these are a start as focused on my area of knowledge, pediatrics.

 

[JackShephard MD]

Agreed with above, I think academic medicine could be very rewarding.

 

[oldbearprofessor]

I should have added one more important one to me...

In my job, far removed from the START of my attending years, I am very involved in public policy on a national and global level related to my areas of interest. Although there are certainly private practice pediatric specialists involved in this area, the level and degree of involvement I have in public policy is most commonly and readily done via academics.

 

[tiedyeddog]

I think I would get bored in private practice.

 

[Charles_Carmichael]

your post only confirms it.. why the hell would anyone choose academic medicine?

Teaching and clinical research.

 

[kautionwirez]

I'm interested in CT surgery. Are there any PP for CT?
Is there a difference in pay for this specialty PP vs Academic? (in general terms)

 

[surftheiop]

I'm interested in CT surgery. Are there any PP for CT?
Is there a difference in pay for this specialty PP vs Academic? (in general terms)

If your interested in CT I would be more concerned about choosing carefully when you marry b/c the divorce will cost you more than the difference in salaries your thinking about

 

[kautionwirez]

If your interested in CT I would be more concerned about choosing carefully when you marry b/c the divorce will cost you more than the difference in salaries your thinking about

planning to tie knots soon.

 

[IlDestriero]

your post only confirms it.. why the hell would anyone choose academic medicine?

1. For many people, the opportunity to practice, especially a critical care field with relatively little concern about the business side of medicine is appealing.

2. In many fields, the best opportunities to see the most complex patients and a lot of them are in academics. This is not true in all areas, but often is true in pediatric specialties.

3. Academics often provides time not only to do research and clinical education, but to be involved in a number of other activities including public policy advocacy, global health and others.

4. Although in many fields, the salary is considerably lower, the salary/lifestyle ratio may be more favorable and there may be other lifestyle benefits including less night call or less work when on call. As noted, this is highly variable though.

5. The opportunity to conduct clinical research or be part of it, even for those academics who are not primary researchers is appealing to many.

There are others, these are a start as focused on my area of knowledge, pediatrics.

I would agree with the old grey mare, I mean old bear professor.
I work at a large Children's Hospital. From one day to the next, and often from one case to the next, you can go from the most bread and butter case to an extraordinarily complex one requiring precise planning and attention. Combine that with the fact that we are on the tip of the spear providing cutting edge and/or experimental treatments that are offered at only a handful of hospitals in the world and you get some interesting days. The depth and breadth of experience here is extraordinary. Working with recognized leaders in their fields and having the opportunity to teach the next gereration of anesthesiologists is a privilege and offers a great deal of professional satisfaction. I could bust my hump elsewhere for 50% more money, supervising several CRNAs at a time in PP land, doing adult and peds cases, taking more call, being bored to death. That's not why I went into medicine. If I change my mind in the future, those jobs will be there. But for now, I wouldn't want it any other way.

 

[KinasePro]

I would agree with the old grey mare, I mean old bear professor.
I work at a large Children's Hospital. From one day to the next, and often from one case to the next, you can go from the most bread and butter case to an extraordinarily complex one requiring precise planning and attention. Combine that with the fact that we are on the tip of the spear providing cutting edge and/or experimental treatments that are offered at only a handful of hospitals in the world and you get some interesting days. The depth and breadth of experience here is extraordinary. Working with recognized leaders in their fields and having the opportunity to teach the next gereration of anesthesiologists is a privilege and offers a great deal of professional satisfaction. I could bust my hump elsewhere for 50% more money, supervising several CRNAs at a time in PP land, doing adult and peds cases, taking more call, being bored to death. That's not why I went into medicine. If I change my mind in the future, those jobs will be there. But for now, I wouldn't want it any other way.

Is it common and/or easy for doc's to switch between the PP and academics? I imagine it'd be easier to go from academic to PP than vice versa.

Also, thanks for the response

 

[officedepot]

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[IlDestriero]

Is it common and/or easy for doc's to switch between the PP and academics? I imagine it'd be easier to go from academic to PP than vice versa.

Also, thanks for the response

1/3 the people that left my academic group over the last few years went into PP. I do my own cases more than 1/3 of the time, do all the lines, blocks, etc. I could transition to PP supervision or 1:1 care without any problem. Someone with many years at a supervision only practice might have trouble selling themselves to an MD only group. My only limit is that I don't want to do adults anymore. Those jobs are there, just much less common than adult and peds jobs.

On topic: If you want to make money do private practice. If you want to teach, pontificate, have a big ego, research, see some "cool" stuff then do academics and be readly for a significantly lower salary (probably 1/2 of what you could make).

Not all academic groups pay poorly, it's hospital and specialty specific. I think I'm fairly paid for the time that I work, and I know that the productive surgeons that I work with are competitively paid. You might be very surprised by what I've been offered in academia, and surprised what some PP people are earning. You won't make 90th percentile+ numbers, but you can certainly beat the mean. It's not all roses out there in private practice. Of course, some academic programs pay a ridiculously low salary, but those very low numbers are usually for 3 days/wk. It's worth adding that some also pay extra for call and late time, extra days worked, etc. It can add up to a considerable amount of money. Take a look before you dismiss it if you have an interest in teaching down the road.
Cheers.

 

[JackShephard MD]

The better question would be are those jobs really going to be there if CRNAs get more power to practice on their own.

On topic: If you want to make money do private practice. If you want to teach, pontificate, have a big ego, research, see some "cool" stuff then do academics and be readly for a significantly lower salary (probably 1/2 of what you could make).

I think we'll see that PP/academic gap close significantly in the next decade.