Switching from academic oncology to private/multispecialty group practice

[Hematologynerd]

Hi everyone,

I have currently been in an academic oncology position for the past 3.5 years. I have been been thinking about making the switch to private practice/multispecialty hospital based practice.

While I enjoy academics and the challenges that come with it, I am at a stage where I need to think about my long term plans. I spend well late into the night every night and even Saturday mornings writing manuscripts, grants, IST applications and CDAs, preparing presentations etc. However, not seeing any financial benefit from this and I am starting to burn out. Clinically I am still seeing ~50 patients a week and inpatient consults every 5-6 weeks. A lot of my patients are complex. After dealing with notes, patient issues, insurance auths, P2Ps etc, the only time I have to do research is either at evening/night or weekends. And the research obligation keeps piling up (god forbid I take a weekend off to spend time with my kids)

I am under no delusion that private practice is not hard or busy. In fact, I'm sure I'll have to work harder than I am now. However, my thought is why I am working just as hard (at the least almost as hard as my amazing private practice colleagues), but getting paid at least 50% less? At least all of my time and focus and go towards patient care, and I wont have the lingering fear and stress about having to complete a grant or manuscript.

I have young kids and ~200K in student loans and a mortgage.

Although there will always be place in my heart for academics, and I truly enjoyed my years in academics. However I now think it is the time to transition to private practice setting. I will need to beef up on the other cancers that I have not treated since fellowship, but I can dedicate time to this.

Wanted to ask this group what private practice is like? And to gather input into my decision and see if anyone thinks I'm making a completely wrong mistake?

Thanks in advance everyone!

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[luckysquid]

Hey! I'm a premed student that's on sdn because I keep checking a med school page, but I happened to see this post. My dad is an oncologist working at a multi-specialty private practice. If you want, I could ask if he would be able to do a call or something with you?

 

[Hematologynerd]

Hey! I'm a premed student that's on sdn because I keep checking a med school page, but I happened to see this post. My dad is an oncologist working at a multi-specialty private practice. If you want, I could ask if he would be able to do a call or something with you?

Hi! Thank you so much! I have messaged you my contact info. Totally ok if your dad is too busy and cannot!

 

[ONC2023]

Wanted to ask this group what private practice is like? And to gather input into my decision and see if anyone thinks I'm making a completely wrong mistake?

Hi! I am a failed MD-PhD who is finishing fellowship and going into private practice this year. The middle of my fellowship was miserable for the same reasons you are miserable right now - underappreciated, overworked, fed up with academic scut work.

Once I quit the lab, dropped all my projects, and went fully clinical, I cannot tell you just how much happier I became. I'm on track to join a subspecialized private practice group where I will easily clear $600-700K years 1-2 and then, if all goes well, close to 900-1 million year 3+. But I will be working hard for it. ~20ish patients a day for 4.5 days a week. Call 1 in 12 weeks.

You are of course an attending, so I'll let the other community practice attendings tell you about their day to day, but as someone who had the same realization about how exploitative academia is and is leaving it, I say - take the jump! The job market is very very good right now - even if you are subspecialized to an extent like me, there are community jobs.

 

[onconc]

Hi everyone,

I have currently been in an academic oncology position for the past 3.5 years. I have been been thinking about making the switch to private practice/multispecialty hospital based practice.

While I enjoy academics and the challenges that come with it, I am at a stage where I need to think about my long term plans. I spend well late into the night every night and even Saturday mornings writing manuscripts, grants, IST applications and CDAs, preparing presentations etc. However, not seeing any financial benefit from this and I am starting to burn out. Clinically I am still seeing ~50 patients a week and inpatient consults every 5-6 weeks. A lot of my patients are complex. After dealing with notes, patient issues, insurance auths, P2Ps etc, the only time I have to do research is either at evening/night or weekends. And the research obligation keeps piling up (god forbid I take a weekend off to spend time with my kids)

I am under no delusion that private practice is not hard or busy. In fact, I'm sure I'll have to work harder than I am now. However, my thought is why I am working just as hard (at the least almost as hard as my amazing private practice colleagues), but getting paid at least 50% less? At least all of my time and focus and go towards patient care, and I wont have the lingering fear and stress about having to complete a grant or manuscript.

I have young kids and ~200K in student loans and a mortgage.

Although there will always be place in my heart for academics, and I truly enjoyed my years in academics. However I now think it is the time to transition to private practice setting. I will need to beef up on the other cancers that I have not treated since fellowship, but I can dedicate time to this.

Wanted to ask this group what private practice is like? And to gather input into my decision and see if anyone thinks I'm making a completely wrong mistake?

Thanks in advance everyone!

You will be able to pay off your entire student loans in less than a year in PP. And save some after that.

 

[Hematologynerd]

Hi! I am a failed MD-PhD who is finishing fellowship and going into private practice this year. The middle of my fellowship was miserable for the same reasons you are miserable right now - underappreciated, overworked, fed up with academic scut work.

Once I quit the lab, dropped all my projects, and went fully clinical, I cannot tell you just how much happier I became. I'm on track to join a subspecialized private practice group where I will easily clear $600-700K years 1-2 and then, if all goes well, close to 900-1 million year 3+. But I will be working hard for it. ~20ish patients a day for 4.5 days a week. Call 1 in 12 weeks.

You are of course an attending, so I'll let the other community practice attendings tell you about their day to day, but as someone who had the same realization about how exploitative academia is and is leaving it, I say - take the jump! The job market is very very good right now - even if you are subspecialized to an extent like me, there are community jobs.

Thank you so much! I am so happy you realized this in fellowship!

I have decided to take the plunge. I will be leaving academics. I am glad I did it for a few years to realize my mistake, but not going to look back. It is so competitive and unappreciative work. At this point in my life my family comes first and want to provide them with financial security. Being in this field requires us to stay up to date to provide the best, up to date care, that is enough for me.

 

[bobow98]

I have been saying to all my friends and colleagues that they should have ownership of their own work and time. Working for an institution with a suit telling you what to do is the opposite of what our profession was intended to be.

Now with NIH issues, I think we will see a bunch of folks take the same plunge in the next few years.
That said many may just jump ship to industry instead…. Still working for the man.

 

[wysdoc]

@Hematologynerd This is a good thread to read about these kinds of topics, and also some posters in that thread have left semi-academic jobs for private practice.
Heme/Onc Job Offer Discussion

 

[Plutarch02]

I learned in fellowship that I didn't want to do academics. I know our group likes to see that you're board certified in both hematology and oncology because we do get quite a lot of TTP/HUS etc. emergencies on call. Not all groups are like that though and depending on the population size you might even be able to transition to mostly seeing the specialty of patients you were seeing on academic side.

 

[gutonc]

Depending on the type of work you do now (I'm guessing malignant heme, but could be wrong), what you want to do going forward and your geographic interests/limitations, you may be able to find a community based job (PP, MSP or employed) that will continue to let you do that (or at least mostly that) going forward.

If you do wind up choosing a more general practice, I promise that you will get up to speed relatively quickly. Just be humble about what you're not as certain about and read (and ask) when you need to.

 

[Hematologynerd]

Thanks! I'm board certified in both onc and hematology. But will definitely need brushing up.

I'm actually an oncologist (despite my username lol). I am willing to be general and see everything. I will definitely study and brush up on all the disease groups that I did not see in fellowship. And I will definitely ask for help and guidance about cases that I have questions about

 

[checkpointinhibitor]

Thanks! I'm board certified in both onc and hematology. But will definitely need brushing up.

I'm actually an oncologist (despite my username lol). I am willing to be general and see everything. I will definitely study and brush up on all the disease groups that I did not see in fellowship. And I will definitely ask for help and guidance about cases that I have questions about

TBH, it's not that hard to keep up with things. Attend 2-3 important review meetings per year and keep eyes and ears open. There is no need to know the very minute details of all trials. I have kept a database on articles on my computer via software such as Mendeley and can easily reference some numbers if I want to. Also, in a large group, you may get opportunity to subspecialize on a bunch of cancers so that you can exclude other cancers.
Also, if you can, try to join true PP or multispecialty group practice. Avoid large corporate hospitals with million admin layers unless that's what you really find suitable due to geography etc. The MBAs are leeches and feed on the physician blood.

 

[osprey099]

Hi! I am a failed MD-PhD who is finishing fellowship and going into private practice this year. The middle of my fellowship was miserable for the same reasons you are miserable right now - underappreciated, overworked, fed up with academic scut work.

Once I quit the lab, dropped all my projects, and went fully clinical, I cannot tell you just how much happier I became. I'm on track to join a subspecialized private practice group where I will easily clear $600-700K years 1-2 and then, if all goes well, close to 900-1 million year 3+. But I will be working hard for it. ~20ish patients a day for 4.5 days a week. Call 1 in 12 weeks.

You are of course an attending, so I'll let the other community practice attendings tell you about their day to day, but as someone who had the same realization about how exploitative academia is and is leaving it, I say - take the jump! The job market is very very good right now - even if you are subspecialized to an extent like me, there are community jobs.

These numbers seem a bit inflated, unless you are living in rural area or undesirable location. I'm private practice employee, make about half of that with similar workload and call. Desirable location on the coast though

 

[ONC2023]

These numbers seem a bit inflated, unless you are living in rural area or undesirable location. I'm private practice employee, make about half of that with similar workload and call. Desirable location on the coast though

I won't be in the most undesirable area, but no one is exactly flocking to this area. Agreed the coasts aren't going to be this generous.

 

[checkpointinhibitor]

These numbers seem a bit inflated, unless you are living in rural area or undesirable location. I'm private practice employee, make about half of that with similar workload and call. Desirable location on the coast though

Initial sweat equity may be high but generally in PP after becoming a partner, the ceiling should be much higher compared to Hospital Employed. Even if in desirable geographic location (compared to the hospital salaries in that area). Plus, always keep in mind, you are your own boss and are running the show. That itself has a lot of intrinsic value IMO.

 

[MD46]

issue is that majority of places I heard of usually find a way to hold off on making you partner, so in the end may or may not be worth it. Gamble ?

 

[Hematologynerd]

Thanks everyone for all the advice.

If it helps, at least all these options better than seeing ~50-60 patients a week and making $260,000/year in academics (with no bonus)

Also, for anyone current or in the future undergoing a similar dilemna as me, Dr. David Squires (previously in academics and currently runs a multispecialty group in Augusta, Georgia) is willing to personally speak to anyone on this forum and give you his insight and advice. He took the time to call me and go over exactly what to ask and look for in different practice settings. This was very helpful as I've never had anyone personally explain how private/group practices work since I was consumed in academia. Dr. Squires personally gave me his permission to post this on SDN. If you want to reach out to him, please private message me and I will give you his contact information.

 

[ONC2023]

If it helps, at least all these options better than seeing ~50-60 patients a week and making $260,000/year in academics (with no bonus)

At a conservative estimate of 2.2 RVUs per patient working 46 weeks a year at an average $90 per RVU, that should be $455,000 in any other job.

I'm sure you are also supervising NP's but aren't paid for their RVUs, which would boost that a bit.

Congrats on leaving. As someone who already has experience, you should be very desirable to many hospitals and practices.

 

[Hematologynerd]

At a conservative estimate of 2.2 RVUs per patient working 46 weeks a year at an average $90 per RVU, that should be $455,000 in any other job.

I'm sure you are also supervising NP's but aren't paid for their RVUs, which would boost that a bit.

Congrats on leaving. As someone who already has experience, you should be very desirable to many hospitals and practices.

Thank you, definitely puts things in perspective.

To make yall feel even better, no NP/PA support yet (because it was "too soon" and wanted to make sure my panel filled up), also have to order our own labs and images and coordinate with infusion center regarding scheduling. Our nurses literally just forward in-basket messages to us, minimal effort of triaging.

I'm sure not all academic practices are like this and many have great ancillary support system. But hope my story can be used as a cautionary tale (just like many of you have similar stories/experiences)