Pros and Cons of Private Practice vs. Academia

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To me, academia just sucks, especially in pathology. Why would anyone want to do academia? Low pay. If you are working under an unsupportive chair, you are in trouble. Red tape. You need to find grant money to do research, so that adds to lots of pressure to publish. If the chair in the dept. isn't supportive you are doomed. The only reason why anyone should do academic pathology is to train with a big wig and leave after several years.

Private practice is where it's at.

For those who are interested in academics, please pass the crack pipe.

Everyone will eventually flock to private practice driving salaries lower and lower. There will be no academics in pathology in the near future except for the diehards. Making lower 100Ks in academics is ridiculous.

 

[Matte Kudesai]

Its official folks... Pathology is attracting HERDS of TERDS.😀

 

[docbiohazard]

So what gave you this glowing impression of academia, your graduate work or your 4 years at Ross? What of your interest in cancer research? Your posts over time are kind of hard to reconcile with each other...

BH

 

[mrp]

 

[TypicalTuesday]

To me, academia just sucks, especially in pathology. Why would anyone want to do academia? Low pay. If you are working under an unsupportive chair, you are in trouble. Red tape. You need to find grant money to do research, so that adds to lots of pressure to publish. If the chair in the dept. isn't supportive you are doomed. The only reason why anyone should do academic pathology is to train with a big wig and leave after several years.

Private practice is where it's at.

For those who are interested in academics, please pass the crack pipe.

Everyone will eventually flock to private practice driving salaries lower and lower. There will be no academics in pathology in the near future except for the diehards. Making lower 100Ks in academics is ridiculous.

That's what happens when you land in a field you don't really enjoy, all you have to hope for is the $$$$.

 

[microdot]

To me, academia just sucks, especially in pathology. Why would anyone want to do academia? Low pay. If you are working under an unsupportive chair, you are in trouble. Red tape. You need to find grant money to do research, so that adds to lots of pressure to publish. If the chair in the dept. isn't supportive you are doomed. The only reason why anyone should do academic pathology is to train with a big wig and leave after several years.

Private practice is where it's at.

For those who are interested in academics, please pass the crack pipe.

Everyone will eventually flock to private practice driving salaries lower and lower. There will be no academics in pathology in the near future except for the diehards. Making lower 100Ks in academics is ridiculous.

Why are you an IMG with crappy board scores and a failure in CS lecturing people about academic pathology.

You wanted to do rads and your boards did not cut it. Did you scramble into a 6th tier path program?

Why are you concerned about dermpath salaries? From you previous posts it looks like your best option would be to scramble into an FP residency in Fresno or Jersey or Wyoming.
You need to use better bait when you troll.

 

[Nilf]

To me, academia just sucks, especially in pathology. Why would anyone want to do academia? Low pay. If you are working under an unsupportive chair, you are in trouble. Red tape. You need to find grant money to do research, so that adds to lots of pressure to publish. If the chair in the dept. isn't supportive you are doomed. The only reason why anyone should do academic pathology is to train with a big wig and leave after several years.

Private practice is where it's at.

For those who are interested in academics, please pass the crack pipe.

Everyone will eventually flock to private practice driving salaries lower and lower. There will be no academics in pathology in the near future except for the diehards. Making lower 100Ks in academics is ridiculous.

Yaaah, is there a legal ground to ban this guy from our forum?

 

[yaah]

Yaaah, is there a legal ground to ban this guy from our forum?

If you think certain posts cross the line, use the report post function and it will be noted. Sometimes we act on posts without that being done, a lot of times we wait until we see if it bothers people. And, of course, just because something is reported doesn't mean we will act on it.

In this case, this poster is clearly here to preach the gospel of "higher salary trumps all," which can be irritating when conducted in this fashion but if it is limited it doesn't really violate any TOS. Having ignorant opinions isn't a TOS violation unless you get excessive with it.

To add, though, the OP acts as thought the dichotomy between academics and private practice in regards to salary and publication is something new. It is not. Many people make quite a nice living in academics, many places have far better benefits than in private practice (many do not). It ultimately comes down to a personal choice and desired career. One is ill advised to make assumptions about the personal choices and career paths of others whom they know nothing about. For many, like I presume the OP, making an extra $175k per year, for example, would be reason enough to give up almost anything else. For others, that number would be higher (or lower).

The thing is, you can find anecdotes to back up your personal biases anywhere. I know of people who went into academics and bailed quickly (less than 5 years) for higher salaries or because they didn't like the lifestyle. But I also know people who bailed on high paying private practice jobs after LESS than a year because of work hours or autonomy or whatever.

My other question is how does someone who dichotomizes everything into academics vs private practice classify institutions that are hybrids?

 

[Matte Kudesai]

If you think certain posts cross the line, use the report post function and it will be noted. Sometimes we act on posts without that being done, a lot of times we wait until we see if it bothers people. And, of course, just because something is reported doesn't mean we will act on it.

In this case, this poster is clearly here to preach the gospel of "higher salary trumps all," which can be irritating when conducted in this fashion but if it is limited it doesn't really violate any TOS. Having ignorant opinions isn't a TOS violation unless you get excessive with it.

To add, though, the OP acts as thought the dichotomy between academics and private practice in regards to salary and publication is something new. It is not. Many people make quite a nice living in academics, many places have far better benefits than in private practice (many do not). It ultimately comes down to a personal choice and desired career. One is ill advised to make assumptions about the personal choices and career paths of others whom they know nothing about. For many, like I presume the OP, making an extra $175k per year, for example, would be reason enough to give up almost anything else. For others, that number would be higher (or lower).

The thing is, you can find anecdotes to back up your personal biases anywhere. I know of people who went into academics and bailed quickly (less than 5 years) for higher salaries or because they didn't like the lifestyle. But I also know people who bailed on high paying private practice jobs after LESS than a year because of work hours or autonomy or whatever.

My other question is how does someone who dichotomizes everything into academics vs private practice classify institutions that are hybrids?

Some people may actually want to contribute to science/medical knowledge in an altruistic sense. (If you believe altruism exists)

It is unfortunate that in the USA you have to discourage people from doing academics or trying to become a physician-scientist.

Who would have thought that the NIH budget would get this low...

Anyone going into medical science nowadays might as well tell people they are joining the Peace Corps... or trying to become a successful actor or musician. 🙁

 

[CameronFrye]

To me, academia just sucks, especially in pathology. Why would anyone want to do academia? Low pay. If you are working under an unsupportive chair, you are in trouble. Red tape. You need to find grant money to do research, so that adds to lots of pressure to publish. If the chair in the dept. isn't supportive you are doomed. The only reason why anyone should do academic pathology is to train with a big wig and leave after several years.

Private practice is where it's at.

For those who are interested in academics, please pass the crack pipe.

Everyone will eventually flock to private practice driving salaries lower and lower. There will be no academics in pathology in the near future except for the diehards. Making lower 100Ks in academics is ridiculous.

Not all academic pathologists have grants. Also, lower 100Ks is on the low side for some academic places. You're painting with too broad of a brush.

 

[yaah]

Indeed, all academic places are going to need people to actually do the work, since these are centers of excellence (in general).

 

[Master Chief]

Of the groups I know, the good academics are only on par with the high power private groups and certainly no better. The "not as good" academics are by far the worse.

 

[pathstudent]

Of the groups I know, the good academics are only on par with the high power private groups and certainly no better. The "not as good" academics are by far the worse.

It all comes down to experience.

I have been told by trainees that went into private practice that you wouldn't believe the difficulty of the cases and the sophistication of the operation. One guy said, "the biggest lie they tell you in academics is that you'll be bored in private pracitice". He said that rather than being gallbladder after hernia sac after gallbladder, it was more like "Yes! thank god!... finally a gallbladder".

The big advantage to academics is the fun of working with residents and medical students plus the opportunity to do research. I'm not saying that it is impossible to have that in a private practice, but it isn't protected and guaranteed like it is at the university. Plus the resources to do research are probably not available at most private practice settings. Still you could easily do case reports and small studies if you wanted to.

 

[levels x3]

Some might consider the lack of research done in private practice to be an advantage. Sure, an interested person could do some case reports or whatever they like, but not having to publish to justify one's existence is great for some of us. Different strokes...as the saying goes.

I definitely agree that private practice jobs are not boring, nor are they necessarily easier. Many private practices in smaller settings are more heavily biopsy focused as patients will often head to the nearest university for their definitive surgery. Anyone who has spent time trying to make diagnoses from itty bitty biopsy fragments can attest to the difficulty. Once the definitive surgery has been done, it's all over. Sure there are margins to assess, staging to be done, etc., but that's just tedious. It's not particularly difficult.

Perhaps the better distinction can be made between large, tertiary care centers (academic or otherwise) and medium/small sized community hospitals. I'm speaking of case make-up, not compensation models.

 

[Master Chief]

Of the groups I know, the good academics are only on par with the high power private groups and certainly no better. The "not as good" academics are by far the worse.

Quoting my own writing, now I feel like a true academician. Actually, I wanted to clarify this previous statement. I do not want people to think I am bashing academic pathologists. There are some GREAT pathologists that have chosen this track. However, there are also those who are escaping to academia because the service load is less or they cannot get a job elsewhere. On the other hand, alot of really talented pathologists go into private practice, either out of training or after an academic stint. And the spectrum is found in this realm as well. So my original statement should be read like this:

Good academic = Good private practice
Bad academic < Good private practice
Good academic > Bad private practice
Bad academic = Bad private practice

 

[LADoc00]

Good academic = Good private practice
Bad academic < Good private practice
Good academic > Bad private practice
Bad academic = Bad private practice

LOL nice matrix. Of course recognizing good vs. bad is a different story.

Add that bad can become good and vice versa almost overnight for some people for added complexity.

 

[KeratinPearls]

LOL nice matrix. Of course recognizing good vs. bad is a different story.

Add that bad can become good and vice versa almost overnight for some people for added complexity.

Man, that is really deep. Reminds me of the movie, "A Beautiful Mind."

 

[gungho]

Man, that is really deep. Reminds me of the movie, "A Beautiful Mind."

so what do LADoc00's "friends" look like?

 

[Arctic Char]

this would be my guess, given the history of entrepreneurial rhetoric . . .

 

[docbiohazard]

Just so long as it isn't this...

🙂
BH

 

[Arctic Char]

Just so long as it isn't this...

🙂
BH

haha, holy $h!t, what on earth did you enter into your google image search to find that gem?

 

[malchik]

So my original statement should be read like this:

Good academic = Good private practice
Bad academic < Good private practice
Good academic > Bad private practice
Bad academic = Bad private practice

So there is no difference between academic and private practice, i.e. your original statement was meaningless?

 

[docbiohazard]

haha, holy $h!t, what on earth did you enter into your google image search to find that gem?

Believe it or not, I found it earlier in the day for a totally unrelated reason... but just had to share. It was the number one image from a GIS of "lucha libre doctor" ... I found it on some blog related to some software company, but it is apparently from a coffee table book on the luchadores... pretty awesome. Not sure why he's holding a speculum though... 😱

BH

 

[Master Chief]

So there is no difference between academic and private practice, i.e. your original statement was meaningless?

Not meaningless, I wanted to emphasize that the good adademics are no better than a good private practice pathologist. After rereading my intial post I felt that someone could easily interpret my post as being anti-academic. Thus my follow-up "matrix" to help clarify. Forums like these are often populated by trainees who see their academic mentors as being the latest and greatest pathologist in their respective field. While this might be true, I saw this scenario all too often during training: Outside consult comes in from a private practice - consultant pathologist makes dynamo diagnosis - makes remark on how easy it was (to boost ego) - trainee thinks academic pathology is better than private practice pathology.

 

[paleman]

I saw this scenario all too often during training: Outside consult comes in from a private practice - consultant pathologist makes dynamo diagnosis - makes remark on how easy it was (to boost ego) - trainee thinks academic pathology is better than private practice pathology.

though i am in pp i totally disagree with this. rather than spending all day on bread and butter like most pps do, consultants see far more interesting/unusual cases, are typically subspecialists, have commitments to teaching/training, have eager trainees they need to be better than, probably dabble in some clinical research. all these factors make them better pathologists in their ROI. look, there is a price to pay in exchange for the pp$$: manymany more routine cases. of course you may argue that the pp pathologist is more of a generalist - show them a slide from any organ and they may have a better answer than a subspecialist but even this is eroding away as more pp gps demand subspecialists.

 

[Celiac]

Right now, one does indeed need a few hits off of the crack pipe to be able to look towards a career in academics. Pay aside (I personally am willing to make a relatively low salary to have autonomy, creative freedom, and the ability to make a contribution to the knowledge base), it is pretty bleak these days. NIH funding is brutal, pay increases are stagnant, and building has stopped. However the best and most ambitious will make it. And at least they won't be some bean-counter's beeatch.

 

[Matte Kudesai]

Right now, one does indeed need a few hits off of the crack pipe to be able to look towards a career in academics. Pay aside (I personally am willing to make a relatively low salary to have autonomy, creative freedom, and the ability to make a contribution to the knowledge base), it is pretty bleak these days. NIH funding is brutal, pay increases are stagnant, and building has stopped. However the best and most ambitious will make it. And at least they won't be some bean-counter's beeatch.

This is unfortunate is it not?

Even the best and most ambitious are not making it...

It has become more of a crap shoot and luck.. like having talent but being in the right lace at the right time when gunning for an acting gig.
Making it has more to do with longevity and luck.

Another analogy to acting... how many years are you willing to wait tables until you get the right gig?

 

[Celiac]

This is unfortunate is it not?

Even the best and most ambitious are not making it...

It has become more of a crap shoot and luck.. like having talent but being in the right lace at the right time when gunning for an acting gig.
Making it has more to do with longevity and luck.

Another analogy to acting... how many years are you willing to wait tables until you get the right gig?

It's true. I have a couple of friends who are on the market right now. They have published in tier 1 journals, trained in prestigious labs, and have really done things "the right way". Both came up empty this year, one with no offers, the other was one institution's second choice and with no other offers. The primary candidate refused the offer, went somewhere else, and then the institution's admin wouldn't allow the department to make the offer to the second choice. Quite depressing really.

One wonders whether China will force the hand of the government over here to put the money back into the NIH. China now matches annual research funding in the US, dollar for dollar, and will triple research expendiures to 90 billion per year by 2020. The reason they don't go to 90 billion right away.....they don't know how to reasonably distribute that kind of extra cash in a way that would be effective so they need to develop infrastructure to manage it. Crazy. Goodbye asian postdocs, goodbye discoveries, and goodbye development. I hope that the Feds will at least realize the economic losses implicit in this situation if more money, and a lot of it, isn't put back into the system. I try not to think of it too much, but it is hard to talk to people that are on the market looking for the academic/research type posts.

 

[news2]

I am very interested in research track and academia as well. However, the above posts make me nervous🙁. To celiac, if you don't mind sharing, are your two friend publishing in first tier journal like Nature Cell Science? What type of institutions are they looking into? Also, when they go on the job market, are they also offering part-time clinical service to the department? What is the academic job market like for pathologists who have solid basic science training + residency? If anyone else has any comments, I would really appreciate it! Quite frankly, I also enjoy the satisfaction from being creative and able to publish my work🙂. Unfortunately, since I also have a family, I need to worry about job security and finance as well.

 

[Celiac]

Yes, they are published in tier 1 journals, first author too. I think the main problem is that the areas in which they are respectively working are not 'hot' right now. If you're not working on the as-yet-to-be-demonstrated-in-actual-tissue cancer stem cells, or like, chromatin remodelling...it is pretty rough out there right now.

With regard to the job market for academic pathologists interested in doing research....it's hard for me to really say as I am just about to start my residency. I think that overall however, it is relatively safe to say that if one wants a post where you can devote >75% of your time to research, that one will really, really, really want to, after/during the clinical years, go to a lab where one can be pretty confident that the research will lead to a K08, Burroughs-Wellcome, or some other form of transitional award that will provide a few years of funding in the new faculty position. My impression is that folks that have those type of awards really seem to have very few problems finding a position.....how hard it is for them to get their first R01 however seems another matter entirely.

It also probably depends on the type of research you will want to do at the end of the day. If you want to rip cells apart and sort out what goes on in there....it seems like that is one thing (will need R01s and a lab with post-docs, students, etc. for support). If it is to identify biomarkers and do transcriptional profiling....some departments seem like they will fund this type of work from within and one could probably do quite well just from picking up a few foundation grants.

Sorry I can't really offer anything much more than that....I feel your pain though.

 

[docbiohazard]

One strategy is to look for a residency with a nice research track that includes guaranteed support (ie. a transitional research position) when you finish your residency. They come in a lot of different flavors, anything from just some "support money" to a boosted salary + seed money + money to hire a tech. The idea being that you identify a mentor in your residency, start doing some work towards the tail end and then snag that K08 or similar transitional grant during the first couple of years out of your residency.

This beats the hell out of, say, going someplace without a research track, finishing residency, having to take a salary cut to go postdoc for umpteen million years while you try to score that K08.

So if you're strongly interested in research, I would say you should look for programs with research tracks and compare and contrast the structure and benefits of each one, as they are highly variable. Some places will only offer you a research track if you go AP or CP only, and I wasn't willing to make that jump at the offset. PM me if you want more details / opinions...

BH

 

[news2]

Many thanks to the comments above! It really seems that being able to secure transitional funds, and of course publish well, are keys to finding job position at major institutes. I will definitely look into the different tracks and research support options that each place offers when I look for a residency spot! I am also a bit unwilling to jump into AP or CP only research tracks at this point. If doing AP+CP (or AP+subspecialty) is what prepare you well for pathology in the various job markets, I think it would be a great idea to offer at least combined AP+CP short tracks. I wonder what programs think of this. From what I hear, it seems that the IM specialties are offering better research track options and prepare trainees so that they can become subspecialized in a shorter period of time (ie 2 yr IM + subspeciality+ 3-5 yrs of postdoc research). This way, you can focus on a niche of medicine and advance research in that particular niche. I know someone at a top 5 institution completing the clinical part of IM+subspecialty in 3.5 yrs!! He then moved on to do a 5 yr postdoc (subspecialty-related) and published very very well. Given that being a physician scientist requires such a long time commitment, it would be really nice if academic programs can help out the young trainees to shorten this track a bit. Are there programs that offer AP+CP short tracks or thinking of moving to this direction? Is this something negotiable?

 

[Matte Kudesai]

It's true. I have a couple of friends who are on the market right now. They have published in tier 1 journals, trained in prestigious labs, and have really done things "the right way". Both came up empty this year, one with no offers, the other was one institution's second choice and with no other offers. The primary candidate refused the offer, went somewhere else, and then the institution's admin wouldn't allow the department to make the offer to the second choice. Quite depressing really.

One wonders whether China will force the hand of the government over here to put the money back into the NIH. China now matches annual research funding in the US, dollar for dollar, and will triple research expendiures to 90 billion per year by 2020. The reason they don't go to 90 billion right away.....they don't know how to reasonably distribute that kind of extra cash in a way that would be effective so they need to develop infrastructure to manage it. Crazy. Goodbye asian postdocs, goodbye discoveries, and goodbye development. I hope that the Feds will at least realize the economic losses implicit in this situation if more money, and a lot of it, isn't put back into the system. I try not to think of it too much, but it is hard to talk to people that are on the market looking for the academic/research type posts.

The only people I have seen getting hired in a ny type of tenure track have already secured funding. Not sure if this is true everywhere.