QI/QC Research and career prospects

[Hokie_Slug519]

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Greetings SDN!

Recently coming to grips with realizing I just don't want to proceed with a grant-funded academic career and looking at alternatives. Thinking about splitting QI/QC research with admin/system improvement duties, but hoping to get insight into this career path from folks more familiar than I.

2nd year heme/onc fellow at a medium-sized academic center.

Cheers!
J

 

[whoknows2012]

Greetings SDN!

Recently coming to grips with realizing I just don't want to proceed with a grant-funded academic career and looking at alternatives. Thinking about splitting QI/QC research with admin/system improvement duties, but hoping to get insight into this career path from folks more familiar than I.

2nd year heme/onc fellow at a medium-sized academic center.

Cheers!
J

Don’t mean to be obtuse but…..why?

Is this something you like and are interested in doing? If you want to be in academics but don’t want to do research just find a gig that is fully supported by your clinical work.

If it’s that you like qi research and are looking for a way to still have light clinical schedule this is AN approach yes. It’s financially feasible. It’s also pretty thankless work especially as a junior faculty.

I have a full clinical job but dabble in admin/qi (non research, mostly committees) and it’s not a ton of fun. I do it as a means to an end as opposed to actually enjoying it

 

[ONC2023]

Hey. Graduating fellow here who decided mid-fellowship, like you, that academia wasn't for me and began looking for an escape plan.

I think every place is going to have someone in a QI position, and so you can try to make yourself the QI person. However, like whoknows wrote above, I just want to emphasize you would almost certainly be taking a big financial hit to take on work that isn't even associated with "prestige."

The deal, as we all know, is that in academics big shot faculty forego some money in exchange for prestige. Other non-hot shot academics get perhaps increased clinic support (NPs, fellows) and easy access to multidisciplinary care (subspecialized tumor boards, clinical trials) in exchange for much lower salary. I don't think QI (or, for example medical education) is going to offer anything beyond just working as a regular academic subspecialist.

If you like QI work, I'm not trying to dissuade you - I'll let others comment on how to get into it. But if you're using QI as an escape hatch because you don't want to do traditional academics, I think there are definitely better options.

(As an aside, I'm at a roughly 100 faculty academic cancer center. I know who does the QI work here, and it confers absolutely zero benefits to the faculty who do it)

 

[Hokie_Slug519]

Great follow ups all -

The subspecialty im going for is BMT/cell therapy. For starters with my 300K loans and 3 years left for PSLF payout, it does make financial sense to stay in academics for at least 3 years. Originally, I was pretty confident in a grant focused career but at my institution very few faculty (essentially none) are safely funded (which should have been red flag 1) and I found that for the work I’ve been putting in for early career grants, the lack of return and uncertainty was not worth the consistent stress it put on myself and my family, even if the work was stimulating.

I do enjoy teaching and being in the academic space overall so I need to figure out where the rest of the FTE I get though my institution will go (it’s roughly 60/40 clinical/research). Most of my research was intended to be computational so I felt like QI/QC didn’t need high start up costs and in the process of doing this for the next few years I’ll likely be able to find my way to administrative FTE in the process of doing qi/qc stuff.

I do think there’s value to the work - there’s plenty of waste and safety issues related to how a system employs transplant and cell therapy, and I figure I’ll either come into my own over the next 3 years or I won’t and will transition out of academics.

Hopefully that makes sense….
I’m curious what keeps people in those spaces with how thankless it seems ..

 

[whoknows2012]

Great follow ups all -

The subspecialty im going for is BMT/cell therapy. For starters with my 300K loans and 3 years left for PSLF payout, it does make financial sense to stay in academics for at least 3 years. Originally, I was pretty confident in a grant focused career but at my institution very few faculty (essentially none) are safely funded (which should have been red flag 1) and I found that for the work I’ve been putting in for early career grants, the lack of return and uncertainty was not worth the consistent stress it put on myself and my family, even if the work was stimulating.

I do enjoy teaching and being in the academic space overall so I need to figure out where the rest of the FTE I get though my institution will go (it’s roughly 60/40 clinical/research). Most of my research was intended to be computational so I felt like QI/QC didn’t need high start up costs and in the process of doing this for the next few years I’ll likely be able to find my way to administrative FTE in the process of doing qi/qc stuff.

I do think there’s value to the work - there’s plenty of waste and safety issues related to how a system employs transplant and cell therapy, and I figure I’ll either come into my own over the next 3 years or I won’t and will transition out of academics.

Hopefully that makes sense….
I’m curious what keeps people in those spaces with how thankless it seems ..

Ok hearing a bit more how you’re thinking about it is helpful.

First off, from my perspective the less output that is required or expected of you the better. I think there are probably a couple things you want to avoid in these types of roles. For example, the admin aspect can be the sell not necessarily the research output. This protects you so that if your pursuits aren’t fruitful you don’t have people breathing down your neck for grants publications etc. Sell yourself as a clinician + admin in the qi space you’re interested in. This can be achieved in several ways but an obvious one for BMT would be to spend more time than usual inpatient. There are many oncology specific and non specific admin/qi roles that could be paired naturally with your work on BMT.

As for your last question; I think it depends. One of the things an admin or qi role can do is provide financial support outside of research funding which allows you to do whatever it is you enjoy clinically and therefore it’s a bit of a trade off. Additionally, some of these roles that a junior faculty member would land in lend themselves to other roles that have a bit more clout and give you a bit more decision making power on things of importance. A natural role for inpatient heavy mal heme (ie bmt/cell therapy/leukemia) would be some sort of operational director for inpatient services or being involved in bringing important new drugs to inpatient formulary or proposing and leading some QI type initiative (faster time to abx for neutropenic fever, reviewing near misses or major medical errors etc).

Anyway there’s definitely more to say but this is a good overview

 

[ONC2023]

Hey - totally understood where you're coming from. Just want to comment on this one thing:

For starters with my 300K loans and 3 years left for PSLF payout, it does make financial sense to stay in academics for at least 3 years.

From my job hunt experience over the past 12 months, salaries out in the community are high enough to make up for any loan forgiveness you will lose out on if you leave academics. I don't know how PSLF works, so perhaps there's more to it than I understand, but from a purely financial perspective, three years of academics salary + 300K loan forgiveness is not worth losing out on the opportunity cost of 3 years of community-level salary. Especially if you're in one of the lowest paying large cities (Boston, NYC, etc), it is an even worse deal.

Good luck!

 

[Hokie_Slug519]

First off, from my perspective the less output that is required or expected of you the better. I think there are probably a couple things you want to avoid in these types of roles. For example, the admin aspect can be the sell not necessarily the research output. This protects you so that if your pursuits aren’t fruitful you don’t have people breathing down your neck for grants publications etc. Sell yourself as a clinician + admin in the qi space you’re interested in. This can be achieved in several ways but an obvious one for BMT would be to spend more time than usual inpatient. There are many oncology specific and non specific admin/qi roles that could be paired naturally with your work on BMT.

This makes a lot of sense. I think with the way I know our institution offers OP/IP clinical time, I'll probably skew toward an extra day in clinc vs inpatient (0.1 FTE = 1/2 day of clinic/week OR 3 weeks IP).

As for your last question; I think it depends. One of the things an admin or qi role can do is provide financial support outside of research funding which allows you to do whatever it is you enjoy clinically and therefore it’s a bit of a trade off. Additionally, some of these roles that a junior faculty member would land in lend themselves to other roles that have a bit more clout and give you a bit more decision making power on things of importance. A natural role for inpatient heavy mal heme (ie bmt/cell therapy/leukemia) would be some sort of operational director for inpatient services or being involved in bringing important new drugs to inpatient formulary or proposing and leading some QI type initiative (faster time to abx for neutropenic fever, reviewing near misses or major medical errors etc).

Overall, all that makes sense - I think an operational role where I can integrate some of my informatics/coding skills would be compelling. Good to know this way of thinking translates to what people are actually doing.

From my job hunt experience over the past 12 months, salaries out in the community are high enough to make up for any loan forgiveness you will lose out on if you leave academics. I don't know how PSLF works, so perhaps there's more to it than I understand, but from a purely financial perspective, three years of academics salary + 300K loan forgiveness is not worth losing out on the opportunity cost of 3 years of community-level salary. Especially if you're in one of the lowest paying large cities (Boston, NYC, etc), it is an even worse deal.

I'm not in one of the big-big metropolitan areas - with where we are I think the calculation is a little tricky. My family goals have been pretty clear about home ownership (or at least upsizing our home) to allow for another kiddo and the financial lift required to do all that plus pay down those loans in the same amount of time (300K in 3 years) would require pretty high salary to pull off. There's always room for some compromise (I bet I could get my spouse to buy into a 5-year payment plan vs 3), but at that point, especially if there's any element of academic culture I enjoy, it seems the most reasonable for us to just go for loan forgiveness in the three years remaining in academics while I give this route a try.

 

[dozitgetchahi]

Hey - totally understood where you're coming from. Just want to comment on this one thing:



From my job hunt experience over the past 12 months, salaries out in the community are high enough to make up for any loan forgiveness you will lose out on if you leave academics. I don't know how PSLF works, so perhaps there's more to it than I understand, but from a purely financial perspective, three years of academics salary + 300K loan forgiveness is not worth losing out on the opportunity cost of 3 years of community-level salary. Especially if you're in one of the lowest paying large cities (Boston, NYC, etc), it is an even worse deal.

Good luck!

Also, in the current political climate re: Trump, I think it’s entirely possible that PSLF will not exist in 3 years. Also, what Trump et Al are doing to the NIH is likely to decimate a lot of American academic institutions. I anticipate a mass exodus of docs leaving academia in the near future, and scrambling to find community/PP jobs. You want to beat the rush and have one of these jobs before they become hard to find.

Go PP and make money…you have tremendous income potential (possibly >$1m/year) in onc, and you only have $300k in loans…don’t waste time in academia.

(Also, if you still want to try for PSLF, just go get a job at a community nonprofit hospital…you will make a lot more money and will still qualify for PSLF.)