Pro/Con: Academics vs PP

[Nivens]

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I want to get the group's thoughts on this. Previous threads on the topic haven't lead to much discussion, but I think it's worth revisiting given how things have changed, particularly as academic practices increase the production pressure. Selfishly, I am trying to make this decision for myself, and imagine I'm not alone.

One quick anecdote: as a CA-3 I did a rotation in a community PP shop run by a former grad from our program, now nearing the end of his career. He advised me to stay in academics because "Private practice isn't what it used to be- over time autonomy and pay have gone down, while the hours have remained more intense than those in academics".

He trained with my PD, so I relayed the community doc's comments by him the following week. His response: "I'd go PP if I could start over: we have the same production pressure now, but aren't paid nearly as much. Things were different when he and I trained."

Obviously there is a bit of grass-is-greener thinking going on here, but it struck me as interesting that these two peers nearing the end of their careers would switch places if they could.

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For myself, I'm a CT/ICU fellow- my wife is also a physician ahead of me in training. Starting a family is very much on our minds right now. Neither of us have "academic" interests in the traditional sense: we are clinically-oriented people who really don't care much for research (clinical or otherwise). I enjoy a little administrative work, and teaching keeps things fresh, but neither is make-or-break for me. I've been offered a position at a major academic center in a city my wife and I would love to live and work in, but the pay feels relatively low (350ish total for each of us), and the cost of living is extremely high. Comparing this to what my co-fellows are looking to make (500-600k) in PP in other parts of the country has got my wondering if the grass wouldn't indeed be greener. Academics has variety, security, and (maybe?) more complexity, but I get the impression talking to folks the only real way to move up the foodchain is to to do research, and those who don't are treated like second-class citizens (while subsidizing the non-clinical time of those who do).

So I'm trying to decide: do I take my talents to a less-desirable area, make more money, but give up some of the perks I mentioned of the major system? Stop trying to beat 'em and join 'em instead: try to make research, and therefore this system, work for me? Seek out a lesser academic program where I can still teach, but am not penalized for falling asleep in statistics?

Help!

 

[Dam272]

Current CA2 applying for CCM out of personal interest, already decided PP life is for me. Minimal-no interest in research, want to earn decent pay, START a stable life with my physician wife. Am 31, been studying, exams, all my life, multiple researches, presentations. Just want a JOB, go in, do your job, come home with no baggage to go over this study or review that article for presentation or grand round. Want to read an article only out of interest, to improve my practice, improve my knowledge. Just my perspective.

 

[Harpoon1]

I'll rattle off some thoughts..

PP has definitely changed. No, it is definitely not stable like it once was, or is anything compared to the stability of a reasonable sized academic institution. From a personal standpoint, I plan on riding out PP as long as possible but its the nature of the work and still maintaining autonomy that keeps me in this mindset more than a huge pay gap (it is declining from personal experience). I don't like research, I don't like meetings, I don't like meetings about meetings, or requiring a protocol for how I tie my shoes. All depends on the individual institution, but academics is either your cup of tea or not.


If you can rip 500-600 vs 350, my opinion is to at least check that out and at the bare minimum use that as a negotiating tool for your academic offer. EVERYTHING is negotiable, no matter what someone else says, especially if your wife is a desired candidate in her field. I would also disagree about research being the only way to move up, administration/leadership is the way to move up. If you are aggressive about leadership positions then you can dictate whatever professional goals you may have. The only thing about starting a family in PP vs academics is whether the call is more extreme in the PP vs academic environment for you both (but mainly your wife). If you are killing it in PP also it also makes hiring a nanny much easier (just make sure she is not attractive).


good PP jobs are still out there. Check them out and see what speaks to you. Sounds like you already have a solid backup plan.

 

[deleted171991]

I want to get the group's thoughts on this. Previous threads on the topic haven't lead to much discussion, but I think it's worth revisiting given how things have changed, particularly as academic practices increase the production pressure. Selfishly, I am trying to make this decision for myself, and imagine I'm not alone.

One quick anecdote: as a CA-3 I did a rotation in a community PP shop run by a former grad from our program, now nearing the end of his career. He advised me to stay in academics because "Private practice isn't what it used to be- over time autonomy and pay have gone down, while the hours have remained more intense than those in academics".

He trained with my PD, so I relayed the community doc's comments by him the following week. His response: "I'd go PP if I could start over: we have the same production pressure now, but aren't paid nearly as much. Things were different when he and I trained."

Obviously there is a bit of grass-is-greener thinking going on here, but it struck me as interesting that these two peers nearing the end of their careers would switch places if they could.

---

For myself, I'm a CT/ICU fellow- my wife is also a physician ahead of me in training. Starting a family is very much on our minds right now. Neither of us have "academic" interests in the traditional sense: we are clinically-oriented people who really don't care much for research (clinical or otherwise). I enjoy a little administrative work, and teaching keeps things fresh, but neither is make-or-break for me. I've been offered a position at a major academic center in a city my wife and I would love to live and work in, but the pay feels relatively low (350ish total for each of us), and the cost of living is extremely high. Comparing this to what my co-fellows are looking to make (500-600k) in PP in other parts of the country has got my wondering if the grass wouldn't indeed be greener. Academics has variety, security, and (maybe?) more complexity, but I get the impression talking to folks the only real way to move up the foodchain is to to do research, and those who don't are treated like second-class citizens (while subsidizing the non-clinical time of those who do).

So I'm trying to decide: do I take my talents to a less-desirable area, make more money, but give up some of the perks I mentioned of the major system? Stop trying to beat 'em and join 'em instead: try to make research, and therefore this system, work for me? Seek out a lesser academic program where I can still teach, but am not penalized for falling asleep in statistics?

Help!

Choose the best overall PACKAGE you get, whether it's academic or PP. Both of your advisors are right, because the sh-t is piling up both in academia and in PP. There is no general rule; every place is different. Forget ICU if dropping it leads to a better life.

 

[vector2]

Current CA2 applying for CCM out of personal interest, already decided PP life is for me. Minimal-no interest in research, want to earn decent pay, START a stable life with my physician wife. Am 31, been studying, exams, all my life, multiple researches, presentations. Just want a JOB, go in, do your job, come home with no baggage to go over this study or review that article for presentation or grand round. Want to read an article only out of interest, to improve my practice, improve my knowledge. Just my perspective.

You might need be prepared for a harsh reality if you're definitely expecting to get a PP job after doing CCM. Those jobs are out there but they tend to be the exception, not rule.

 

[deleted171991]

Current CA2 applying for CCM out of personal interest, already decided PP life is for me. Minimal-no interest in research, want to earn decent pay, START a stable life with my physician wife. Am 31, been studying, exams, all my life, multiple researches, presentations. Just want a JOB, go in, do your job, come home with no baggage to go over this study or review that article for presentation or grand round. Want to read an article only out of interest, to improve my practice, improve my knowledge. Just my perspective.

You would be better off without any fellowship, than with CCM in PP. PP anesthesiologists don't trust intensivists for long-term commitments, and there are VERY few combined PP jobs. Actually, there aren't enough combined academic jobs either.

I (and a few others who post here) did CCM because of loving it, but it requires some serious sacrifices (including being taken for one of those people who do it just to have a fellowship), and it's definitely not a PP subspecialty.

 

[Dam272]

You would be better off without any fellowship, than with CCM in PP. PP anesthesiologists don't trust intensivists for long-term commitments, and there are VERY few combined PP jobs. Actually, there aren't enough combined academic jobs either.

I (and a few others who post here) did CCM because of loving it, but it requires some serious sacrifices (including being taken for one of those people who do it just to have a fellowship), and it's definitely not a PP subspecialty.

I get that. I LOVE CCM so want to give it a shot. If not for that love, would not be doing any fellowship for sure. I’ll see what life has in store for me, but don’t want to look back 10 years from now not having even given CCM a try. Regarding job, yup, can’t do academics, with the pressure of researches and the presentations. Maybe ccm will help me in my career, maybe not, but I’ll never regret it

 

[Dam272]

You might need be prepared for a harsh reality if you're definitely expecting to get a PP job after doing CCM. Those jobs are out there but they tend to be the exception, not rule.

Yeah. I am totally prepared for that. On the contrary will take up an academic-ish post if the demand of research or talks and all is not forced upon me, though I know I might not have choice in that.

 

[dchz]

Which part of the country are your co-fellows making 500-600 right off the bat? I'd look into that more if I were you.

 

[Nivens]

Which part of the country are your co-fellows making 500-600 right off the bat? I'd look into that more if I were you.

Working in AMC gigs with good reps that don’t advertise. East coast cities.

As people have pointed out, they’re going to work hard for that money, but my position as a dual-physician house changes the math and gives me some flexibility to maybe make a little less in exchange for a better QoL.

 

[okayplayer]

Working in AMC gigs with good reps that don’t advertise. East coast cities.

so many problems with this statement.

 

[deleted162650]

If you have no burning desire to do research, and no passion for teaching, then go PP. Residents need good teachers who like to do it, not just some guy who didn’t like the PP offers available at the time.

This isn’t a knock on you in any way OP, just a general statement.

 

[hununuh]

If you have no burning desire to do research, and no passion for teaching, then go PP. Residents need good teachers who like to do it, not just some guy who didn’t like the PP offers available at the time.

This isn’t a knock on you in any way OP, just a general statement.

How about if you have the passion for teaching (and making money), but have no real interest in research? Would academics still be a better option?

 

[deleted162650]

How about if you have the passion for teaching (and making money), but have no real interest in research? Would academics still be a better option?

You don’t need to be interested in teaching and research to be a good academic. One is sufficient. Then it comes down to what offers are available and a myriad of other personal preference items. I just don’t like seeing academic attendings who don’t really contribute much to the department. (I realize there are non-teaching positions available in academia as well - not really talking about those).

I thought about academics for a bit, until the first 2 weeks of my CA-3 year when we were paired 1:1 with brand new CA-1’s. Wanted to blow my brains out every day.

 

[ToKingdomCome]

Current CA2 applying for CCM out of personal interest, already decided PP life is for me. Minimal-no interest in research, want to earn decent pay, START a stable life with my physician wife. Am 31, been studying, exams, all my life, multiple researches, presentations. Just want a JOB, go in, do your job, come home with no baggage to go over this study or review that article for presentation or grand round. Want to read an article only out of interest, to improve my practice, improve my knowledge. Just my perspective.

I want to do CCM. I’m a CA1. I too would prefer private practice over academics. How is this going to work out doing a split OR/CCM in private practice?

 

[deleted162650]

I want to do CCM. I’m a CA1. I too would prefer private practice over academics. How is this going to work out doing a split OR/CCM in private practice?

Very few such jobs exist.

 

[psychbender]

I want to do CCM. I’m a CA1. I too would prefer private practice over academics. How is this going to work out doing a split OR/CCM in private practice?

If you don't know of one that already exists, it can be quite difficult to create one.

In general, you have your OR time, and likely some measure of call responsibilities akin to the other partners (but reduced, commensurate with you reduced OR time). Then, you have some ICU time carved out. If both critical care and anesthesiology are employed by the same entity, then it should be relatively simple. If one or both are private, it can get tricky. My group loans me to the hospital for critical care. The hospital pays the group, and my group pays me.

If enough people in the group can cover the unit, then perhaps the hospital would provide the group with a stipend for unit coverage, which is then split amongst the intensivists.

Sent from my SM-G930V using SDN mobile

 

[Nivens]

If you have no burning desire to do research, and no passion for teaching, then go PP. Residents need good teachers who like to do it, not just some guy who didn’t like the PP offers available at the time.

This isn’t a knock on you in any way OP, just a general statement.

I don't disagree with you. "Passion" is a word that gets used a lot in medicine, but I'm not sure it's terribly common. I really enjoy teaching- as I said I think it keeps things fresh- but at the end of the day I'd be willing to give it up if it put me and my family in a great situation. Just trying to balance everything. *shrug*

 

[anes121508]

I want to get the group's thoughts on this. Previous threads on the topic haven't lead to much discussion, but I think it's worth revisiting given how things have changed, particularly as academic practices increase the production pressure. Selfishly, I am trying to make this decision for myself, and imagine I'm not alone.

One quick anecdote: as a CA-3 I did a rotation in a community PP shop run by a former grad from our program, now nearing the end of his career. He advised me to stay in academics because "Private practice isn't what it used to be- over time autonomy and pay have gone down, while the hours have remained more intense than those in academics".

He trained with my PD, so I relayed the community doc's comments by him the following week. His response: "I'd go PP if I could start over: we have the same production pressure now, but aren't paid nearly as much. Things were different when he and I trained."

Obviously there is a bit of grass-is-greener thinking going on here, but it struck me as interesting that these two peers nearing the end of their careers would switch places if they could.

---

For myself, I'm a CT/ICU fellow- my wife is also a physician ahead of me in training. Starting a family is very much on our minds right now. Neither of us have "academic" interests in the traditional sense: we are clinically-oriented people who really don't care much for research (clinical or otherwise). I enjoy a little administrative work, and teaching keeps things fresh, but neither is make-or-break for me. I've been offered a position at a major academic center in a city my wife and I would love to live and work in, but the pay feels relatively low (350ish total for each of us), and the cost of living is extremely high. Comparing this to what my co-fellows are looking to make (500-600k) in PP in other parts of the country has got my wondering if the grass wouldn't indeed be greener. Academics has variety, security, and (maybe?) more complexity, but I get the impression talking to folks the only real way to move up the foodchain is to to do research, and those who don't are treated like second-class citizens (while subsidizing the non-clinical time of those who do).

So I'm trying to decide: do I take my talents to a less-desirable area, make more money, but give up some of the perks I mentioned of the major system? Stop trying to beat 'em and join 'em instead: try to make research, and therefore this system, work for me? Seek out a lesser academic program where I can still teach, but am not penalized for falling asleep in statistics?

Help!

Dude you did icu fellowship!?!?

Unless I Am confused and have the screen names mixed up, I did not see that coming!

 

[anes121508]

Working in AMC gigs with good reps that don’t advertise. East coast cities.

As people have pointed out, they’re going to work hard for that money, but my position as a dual-physician house changes the math and gives me some flexibility to maybe make a little less in exchange for a better QoL.

Take the QOL and less $ especially if you aren’t in the HCOL city. Don’t be a Slave to the AMC. No matter what the academic folks say, I doubt they are covering 2 hearts, and 2 joint rooms and endo simultaneously. The AMC wants you doing that.

 

[AdmiralChz]

So a couple things here:

1) Unless you are at a NE ivory tower-type place, most places honestly don’t harp you too much for research. Indeed many hire you at a “Clinical track” pathway, rather than a “Research” or “physician scientist” tenure positions.

2) From what I have seen, departmental leadership can have a huge impact on your job. Plus, “ladder climbers” can come and go (including chairs) so things can somewhat drastically change as new leadership inevitably comes up. This isn’t much the case in PP (we aren’t hiring some dude/gal from across the country to be our group prez), so in some ways academics can actually be fairly volatile.

 

[dchz]

So a couple things here:

1) Unless you are at a NE ivory tower-type place, most places honestly don’t harp you too much for research. Indeed many hire you at a “Clinical track” pathway, rather than a “Research” or “physician scientist” tenure positions.

2) From what I have seen, departmental leadership can have a huge impact on your job. Plus, “ladder climbers” can come and go (including chairs) so things can somewhat drastically change as new leadership inevitably comes up. This isn’t much the case in PP (we aren’t hiring some dude/gal from across the country to be our group prez), so in some ways academics can actually be fairly volatile.

This is understated in the conversation. so i'm gonna emphasize it again.

I thought about taking an "academic" position at my old residency until I met the new chair and realized he's not what i'm about. even though in my case the academic job actually paid more than the PP job i'm about to sign.

 

[jthedestroyr]

Very few such jobs exist.

Very true, can second this.

Niven's I thought you were doing pain. I ended up doing CCM and considered CV too (job market is hot for CV), but I'm over doing a second fellowship. I have a classmate that got an excellent CV job, but you've got to be willing to be location flexible.

 

[anbuitachi]

I think it really depends on what you value. You are married to another physician, your joint income is going to be high regardless of whether either one does PP or not. From a money standpoint i think you will be fine but it really depends on what you want

 

[GravelRider]

Whichever job provides the best pay:workload ratio in a location you are comfortable living in. Who cares about anything else?

 

[Twiggidy]

Academics for longevity
PP for the money

As Salty said, if you go academics being good at research or teaching or if possible, both. If PP is you jam then be ready to work. I don't care what anyone says, but PP is about making money, whether for yourself or the organization in general. In one way or another, in both setups you're there to PRODUCE (Academics = research or graduates capable of working by themselves, PP = earnings)

 

[jthedestroyr]

This is understated in the conversation. so i'm gonna emphasize it again.

I thought about taking an "academic" position at my old residency until I met the new chair and realized he's not what i'm about. even though in my case the academic job actually paid more than the PP job i'm about to sign.

I can second this coming from a residency that had a huge change in leadership as I graduated and going to a fellowship that also had a leadership change.

I can tell you one is in free fall flames from turmoil, while the other appears the ship is correcting. It really showed me, I have no desire to stay in academics since there is constant peacocking to impress whoever is at the top and admin changes. It's surprising how some private practice groups (a good group) is at keeping things pretty stable.

 

[Gasville]

Working in AMC gigs with good reps that don’t advertise. East coast cities.

As people have pointed out, they’re going to work hard for that money, but my position as a dual-physician house changes the math and gives me some flexibility to maybe make a little less in exchange for a better QoL.

Which cities??