Switching from community to academics as an attending questions

[la gringa]

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Finished up residency at a 4 year county program in June 2009, planned to only do community. No major awards or big time research, just did what was required and got a job. Due to an injury, my longevity in EM is going to be much better in an academic setting where my brain is more important than my brawn!

What is the best way to go about figuring out what programs are best for me? ie, who is hiring, what places have a higher % of resident coverage, etc. I love love love the "doing" part of EM but unfortunately my body is not going to cooperate w/ me doing that the majority of the time. I am not "unable" to do anything just trying to make a better balance between my health and career.

FWIW I would prefer mid-atlantic and southeast spots... trained in the midwest but am from SE.

I am happy to discuss particulars to an extent on the board and definitely via PM. not too worried about total anonimity b/c my employers are aware.

 

[Apollyon]

Resident coverage doesn't matter - if it's more residents, that means more patients (all of whom you'll have to see), and academics may be just as busy as private practice. If there are fewer residents, you may be seeing patients primarily. Recall that academic places want/need a high volume.

At one hospital where I now work, it's as cush as could be, and nowhere near as busy as academics - EVER. And I don't have to exert myself - EVER. (Well, one shoulder dislocation, I pulled harder than I had to, so that rather tired me.)

 

[la gringa]

volume per se isn't the problem... my problem is more with lifting, bending to do a lot of lacs, etc.... on a consistent basis. also stuff like having the manpower to hold down agitated ppl - being the solo doc in an ED w/ a bunch of small female nurses is horrid for that. and i'm female in case you can't tell from my name!

 

[dchristismi]

I'm a petite female. I occasionally climb up on a bed for a good ol' hip reduction, but overall, my community job isn't terribly physically demanding. As in, I stand there looking pitiful while my team moves people off EMS stretchers. I do lift backboards, but not much more, honestly. When I have a reduction that looks like it's going to be tricky, I call one of my partners for backup. (We generally have 1 doc do the sedation, the other reduce, and I have plenty of muscle-y male partners. Sometimes I make the X-ray tech help too.)

My PAs do the abscesses and the lacs, and there are always male nurses/techs to do restraining until I can shoot them full of geodon. Or rather, a nurse shoots them full of geodon.

We are only solo for a couple of hours at night, and always with a PA/NP. One of my partners is a paraplegic, and we accomidate him quite well. You might be surprised what a well-run community shop could offer, so don't limit yourself!

PM if you have any specific questions.
Danielle

 

[la gringa]

hm maybe i am/was just in the wrong community job... smaller spot w/ solo MD at night and lots of elderly pts that need a lot of physical work.

i guess i really have no idea, and have been having trouble figuring out what one does when you are BC in EM and have a permanent injury... not a disability but a problem that needs maintenance! fwiw it's a disc/arthritis problem, and i'm just 33 w/ a lot of student debt...

 

[bravotwozero]

But going back to the original question...is that doable? Have EM docs ever made a successful transition from community to academia, particularly at older programs? Or do you have to stay with academic medicine right after residency to continue on with it later?

 

[Apollyon]

I do most of my lacs sitting down - preparation is key. Whereas Danielle has an average 100 year old white clientele (many of whom you wouldn't know were 100 years old), mine is 75, and Asian (equally split between Filipino, Japanese, and Chinese). Likewise, the majority of my consultants are Asian, so, when an old Chinese guy needs ortho, and my ortho on-call is a Chinese guy, things are smooth. I'm single covered, all the time. I don't have to lift or hold down the psychs/agitated - and we're a poor department (seriously - hospital just came out of bankruptcy in August).

My point is that community EM doesn't have to mean an inexorable 2.5 patients per hour, 3/4 of whom are level 5/critical care, and/or time sucking psychs and drug seekers.

(And, as far as your name saying you're female, you've been on SDN long enough to know that someone's name, location, or position - like "student" or "resident" has NO bearing - as how many people leave their status as "student", despite having finished residency, have it pointed out, and still refuse to change it - and explain each time that they're not a student anymore; add that to people whose locations are definite, yet definitely NOT where they actually are. I guessed you might be female, but I'm egalitarian - I've seen many a small, weak guy, so just being female doesn't make you less physically able in my mind.)

 

[dchristismi]

One of my favorite attendings in residency had "real world" experience, which is why his input was so valuable... because he knew what it was like out in the trenches. It's certainly doable. I thought I wanted to do academics, but the reality of following behind trainees honestly annoys me. (We sometimes have residents rotate through.)

And speaking of 100-year olds, we had a little 102 year old lady cussing up a storm in triage last night... 😉

While 3/4 of my patients are indeed level5/critical care charts, I certainly don't see 2.5 patients per hour. (My PAs siphon off the easy stuff, so it's a rare day I can snag the family-plans with URIs to pad the numbers.)

 

[la gringa]

apollyon, i wasn't less physically able before my injury... even w/ a bad back i was often the largest person in the room w/ agitated pts... i'm tall and an ex-swimmer. we had no big strong male nurses and the night tech is useless! most of the female nurses were not physically able AT ALL and often not willing to get physically involved w/ anyone.

part of my question too is how other academic spots staff things... i trained at a resident-run ED and the attendings really were mostly supervising/expediting unless there was a slow resident in their area. they worked mostly 8's, which is another issue for me.

i'm extremely frustrated b/c literally the week after i got my oral boards results, this back nonsense started. it's a problem that was misdiagnosed after an injury during residency. i'm trying not to make it a deal killer b/c i love clinical medicine and taking care of sick folks. i've always been on the brainy side, so i figure i could find a good niche in academics if i so desired.

and bravotwozero - it is done, i just don't know how to go about the process... all of the attendings where i trained who went from community to academia returned to where they trained, which is not an option for me.

 

[Apollyon]

apollyon, i wasn't less physically able before my injury... even w/ a bad back i was often the largest person in the room w/ agitated pts... i'm tall and an ex-swimmer. we had no big strong male nurses and the night tech is useless! most of the female nurses were not physically able AT ALL and often not willing to get physically involved w/ anyone.

As I look back, the error was mine, as I see it was Danielle that described herself as smaller. No offense intended. Besides security and the doc in the ICU, I'm the only guy in the hospital at night (+/- one male nurse in the ICU). Maybe it's the culture thing - the most physical restraint we have to do is put up the bedrails.

 

[WilcoWorld]

I work in a busy academic ED. We work 8's and I have to pick up a few patients on my own every shift unless I'm working with an absolute superstar senior resident.

From my experience, the 2 most important factors in getting an academic job are: 1) Being Board Certified in EM 2) Being willing and able to take the job that is available. Perhaps at a few particular programs they may want some specific credentials (I suspect it's hard to get hired at Harvard with a public school pedigree, for instance) but I know plenty of academic docs who came into their positions from community jobs.

It may seem "beneath" you, or the job you're looking for, but I found my job in the back pages of Annals of EM. Every month there seems to be at least a half a dozen academic places advertising open positions...


I'm not in your specified region, but I'd be happy to answer questions if you want to PM me.

 

[WilcoWorld]

Also, has anyone else noticed that nobody who posts here seems to actually see 2.5 patients/hour? Everyone either seems to say that he/she rarely sees that many patients or they report regularly seeing 3-4 or even more/hour.

I guess that's why 2.5 is reported as an average, but it seems like it's less of a variable between individual docs and more between different departments.

 

[Apollyon]

Also, has anyone else noticed that nobody who posts here seems to actually see 2.5 patients/hour? Everyone either seems to say that he/she rarely sees that many patients or they report regularly seeing 3-4 or even more/hour.

I guess that's why 2.5 is reported as an average, but it seems like it's less of a variable between individual docs and more between different departments.

There was one guy with whom I worked at my last gig who averaged 3.5 pph. However, at the same hospital, working the same shifts, no one else topped 2.8. I'm not sure how he did that, without the rest of the docs always, always being neck deep. At the same time, at the same place, there was a guy that saw 46 - I Am Not Making This Up - in 12 hours on one shift. I asked him about it. He said he didn't talk to them too much.

 

[la gringa]

i don't consider anything beneath me... but the region is pretty important. am learning the hard way about putting work before health and personal life!

anyone know how tied academic jobs are to the residency cycle? if i decide to go that route, i'll be very off that. unfortunately my residency program keeps a lot of folks in house so talking to my old attendings is not getting me too far!

 

[southerndoc]

There was one guy with whom I worked at my last gig who averaged 3.5 pph. However, at the same hospital, working the same shifts, no one else topped 2.8. I'm not sure how he did that, without the rest of the docs always, always being neck deep. At the same time, at the same place, there was a guy that saw 46 - I Am Not Making This Up - in 12 hours on one shift. I asked him about it. He said he didn't talk to them too much.

I've had shifts where I've seen 4+ per hour. I routinely see 3 per hour and we have a separate fast track area (so it's all high acuity). The lowest I've seen in a 12-hour shift was 17, but I intubated 7 of those 17.

 

[Mighty Mouse]

Disclosure: Attending at major academic center

I think the gigs are out there. I think it starts with picking the state, city, or region you want to be in and seeing what academic facilities are there. A cold call or an email with your CV to the director might be a nice second move.

What hasn't been touched on so far is that the academic jobs aren't so much about the clinical shift. Its implied you'll be there to work and teach in the department. But, if you want to secure a position there, you'll need to show that you'll have some sort of niche or specialty to the table. For me, it was all about that, less about where I came from.

There are other jobs that aren't necessarily at academic centers, but at community shops were residents rotate through. May not be EM residents, more likely off service residents (TY, FM, IM, etc) doing a month there. Although they may be doing some of the work, not likely to be seeing all the patients. Very possibly just slowing you down and making you do twice the work to be sure they don't kill anyone.

 

[la gringa]

Mouse - that's part of my problem... my CV is very basic except that I am fluent in Spanish and trained at a pretty well respected program. Guess I'll just see what's out there and consider doing an education fellowship if that's a problem....?