To Those in Academics

[Dawkter]

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Just started as an academic attending recently and wanted to get an idea of what others out there are doing and how things work at your institutions.

Are most of you supervising residents or CRNAs on a daily basis? Anyone doing a large percent of solo cases?

What is your standard case mix?

Any protected time for research, teaching, or personnel committees? Any pressure to publish?

Are you happy with your income in comparison to work/life balance?

Lastly, any consideration for private practice at some point in your career?

 

[IlDestriero]

I’ll reply in a PM

 

[abolt18]

Just started as an academic attending recently and wanted to get an idea of what others out there are doing and how things work at your institutions.

Are most of you supervising residents or CRNAs on a daily basis? Anyone doing a large percent of solo cases?

What is your standard case mix?

Any protected time for research, teaching, or personnel committees? Any pressure to publish?

Are you happy with your income in comparison to work/life balance?

Lastly, any consideration for private practice at some point in your career?

I can tell you a little about what I see with our attendings.

They never do solo cases. Always supervising a crna and resident OR 2-3 crnas.

I get the impression that the attendings all get a pretty diverse case load and do almost everything except peds, Neuro, cardiac, thoracic, and OB - each of those being done by their own select group of attendings.

My impression is that the newer attendings work A LOT, but I've never really talked to them to ask for much they're working.

I can't answer more than that, but these are just the things I perceive from the outside.

 

[B-Bone]

I can tell you a little about what I see with our attendings.

They never do solo cases. Always supervising a crna and resident OR 2-3 crnas.

I get the impression that the attendings all get a pretty diverse case load and do almost everything except peds, Neuro, cardiac, thoracic, and OB - each of those being done by their own select group of attendings.

My impression is that the newer attendings work A LOT, but I've never really talked to them to ask for much they're working.

I can't answer more than that, but these are just the things I perceive from the outside.

That is by definition not a diverse case load.

 

[Planktonmd]

So... you made a conscious decision to work at an academic place, probably the place you did your residency?
Now you have all these fundamental questions you should have asked before you took the position.
I am not saying your decision was bad but wouldn't it be a better idea if people asked questions before they sign a contract?
I am amazed when I hear these stories of people who just signed a contract and did not know anything about the position.

 

[sigrhoillusion]

That is by definition not a diverse case load.

"almost everything except peds, Neuro, cardiac, thoracic, and OB"

Well there's the appendix, the gallbladder, podiatry...

 

[abolt18]

That is by definition not a diverse case load.

Haha fair enough. I guess I should clarify that they’ll do Neuro (spines, for example) but most cranis are done by only a few attendings. A few of them rotate up to OB but not many. They’ll all do some peds, just not sick peds or neonates (since we have peds trained people for that). How diverse can you get in a big academic hospital where so many attendings are subspecialty trained?

 

[thinkorswim]

I'm not really sure what answer you're looking for here since academic practices are highly variable between institutions, even more so than private practices.

My residency and fellowship departments couldn't have been more different, but it seems the only common denominator is they both ate their young. Everything rolls down hill in academics.

 

[Dawkter]

I can tell you a little about what I see with our attendings.

They never do solo cases. Always supervising a crna and resident OR 2-3 crnas.

I get the impression that the attendings all get a pretty diverse case load and do almost everything except peds, Neuro, cardiac, thoracic, and OB - each of those being done by their own select group of attendings.

My impression is that the newer attendings work A LOT, but I've never really talked to them to ask for much they're working.

I can't answer more than that, but these are just the things I perceive from the outside.

This is pretty accurate. I am routinely solo and do cover 4:1 a good portion of the time as well.

 

[Mman]

This is pretty accurate. I am routinely solo and do cover 4:1 a good portion of the time as well.

so you are an "academic" attending but either do your own cases or supervise 4 CRNAs? I would have thought that by definition an academic attending spent most of their day supervising 2 residents.

 

[T-burglar]

A lot Less pay for a lot more work. As a rule.

 

[psychbender]

so you are an "academic" attending but either do your own cases or supervise 4 CRNAs? I would have thought that by definition an academic attending spent most of their day supervising 2 residents.

At places without CRNAs, like Indiana, that may be true. At all of the places where I interviewed a few years ago, that was not the case. Very, very rarely was it two residents. More often one resident and one CRNA. Many days, though, it would be two to four CRNAs to just focus on moving the meat through the ORs or other anesthetizing locations. All places are different, though, so maybe I just interviewed at some **** programs.

 

[deleted50478]

At places without CRNAs, like Indiana, that may be true. At all of the places where I interviewed a few years ago, that was not the case. Very, very rarely was it two residents. More often one resident and one CRNA. Many days, though, it would be two to four CRNAs to just focus on moving the meat through the ORs or other anesthetizing locations. All places are different, though, so maybe I just interviewed at some **** programs.

It’s probably common to have 1 resident and 1 CRNA with CA-1s who need the most active supervision. It’s also common for 1 attending to have 2 upper level residents so that fewer attendings are needed. 4 attendings can only staff 8 rooms with 1 resident and 1 CRNA each but can staff 12 rooms if the resident rooms are combined (2Res + 2Res + 4CRNA + 4CRNA). Or, looking at the same math another way, if there are only 8 rooms one attending can go home if resident rooms are combined.

 

[AdmiralChz]

Academics is so highly varied across the country it’s almost impossible to make generalizations. My subjective experience of attendings in residency:

Unhappy. It had more to do with a weak department and poor leadership, coupled with a exodus of huge names to other places. They didn’t readily replace the folks that left so there was a shortage of attendings meaning people had to work a LOT - the CCM crew got ONE day post ICU week off, then back in the OR saddle for example. It’s slowly improving but when I was there, it was palpable how upset they all were. Overworked and not much pay. It was easy to say “no thanks” when they asked if I’d consider coming back.

There wasn’t much academic time for new hires, given how short they were. Heck, new folks didn’t even get a (shared) office. But on the other hand there wasn’t a huge expectation for research productivity unless you were on that track.

The sub specialists (cardiac, peds) almost exclusively worked with residents 1:2 even with AA/CRNAs the ratio didnt change there. Cardiac was often 1:1 until late afternoon. Regional had the best setup, with the block attending only doing blocks and covering no rooms - other regional staff and fellows also helped making that a Cush position.

Interestingly, as a group they overwhelmingly refused to work 4:1 in GI meaning 2 staff had to be over there. A select few (mostly new hires) did and ONLY there. I never saw 4:1 in the main OR but then again the lion’s share of our work force was residents, especially after 3 PM.

In fellowship it was VERY different more of a PP model with folks much happier - but that was cardiac, never more than 1:2 but we only had a handful of AAs to support anyway.

 

[Radar26]

When people say “a lot more work for less money” I wonder how so? Is PP the same work/more work but just more money so it’s easier to accept the work?

I ask because at my residency, Attendings notoriously would watch Netflix in the attending work room, not be present for wake up with junior residents, leave CRNAs to be a solo practitioners (while using late shift residents to give said CRNAs lunch and bathroom breaks). I’m pretty sure they took lovenox shots for the amount of sitting around they did...

 

[hununuh]

When people say “a lot more work for less money” I wonder how so? Is PP the same work/more work but just more money so it’s easier to accept the work?

I ask because at my residency, Attendings notoriously would watch Netflix in the attending work room, not be present for wake up with junior residents, leave CRNAs to be a solo practitioners (while using late shift residents to give said CRNAs lunch and bathroom breaks). I’m pretty sure they took lovenox shots for the amount of sitting around they did...

Wow... sounds like a had training place. How were those lazy faculties able to keep their jobs and not get fired?

 

[deleted50478]

Wow... sounds like a had training place. How were those lazy faculties able to keep their jobs and not get fired?

No offense but for future reference:

Is it faculty or faculties?

Answer (1 of 3): Faculty can refer to the academic staff at American universities, and as such is a collective noun. The usual rules thus apply (i.e. one university has one faculty, but the faculties of different universities are obviously plural) If you use faculty in the sense of sub-divisions ...

www.quora.com

Faculty vs Faculties

According to this site, faculty can be expressed in both singular and plural forms depending on which one you use. Then when I search up faculties, it exists. Why? Why is there the need of faculties

ell.stackexchange.com

 

[ambiturner]

I’ve been an academic attending for 4 years.

Compensation is rank and experience based. In the beginning, I worked easily as hard as people in private practice, albeit with less overnight call. About a third of my billing was kicked up to the top levels of the group and the hospital. Now the numbers are slightly less obscene since I make more and have some admin and academic time, but I still generate more than I take. The upper associates and full professors take more than they generate and take little to no call. So to make this a good deal, you need 1) longevity and 2) a niche. Without that, you’ll be slumming in the general ORs for life, and I’ve seen that happen to many people (you can probably think of some from your own training). Interestingly, some of the more prestigious institutions tend to be more egalitarian with their NC time from the start, albeit with lower pay.

Generally rooms are divided into complex cases with felllows or senior residents and then the bread and butter are done solo or with CRNAs. As a result I get a pretty good mix. Typically 2:1 with one busy room and one room with long or a complex case. 3 or 4:1 reserved for busy times and easy rooms.

Residents have a lot of power now and good programs have been put on probation for work hours and perceived lack of teaching. As such, most places now rely less on residents for day to day work and more on attendings and CRNAs (this has been the case throughout medicine).

To be honest, I would probably be happiest in a solo private practice. I like teaching, but I don’t like supervising CRNAs and I see no conceivable future where that isn’t more a part of the job. The academic chair of the future will be more of an MBA bean counter than a researcher, and even the researchers salivate at the idea of doing their research all day while ‘supervising’. I have seen this in all of the surgical fields at our institution as well and many depts have gone from having no NPs to using them as a primary workforce in just 3 years.

So to conclude, academics makes sense if you have a niche and can self promote to turn yourself into ‘the airway guy’, ‘the liver guy’, etc. To get there, though, expect to do a lot of writing and publishing in your free time for no additional compensation. After a few years it will hopefully pay off. If you just want to teach and do cases, there may be better options. Lots of good private practice groups have resident rotations with better compensation packages.

 

[Dawkter]

I’ve been an academic attending for 4 years.

Compensation is rank and experience based. In the beginning, I worked easily as hard as people in private practice, albeit with less overnight call. About a third of my billing was kicked up to the top levels of the group and the hospital. Now the numbers are slightly less obscene since I make more and have some admin and academic time, but I still generate more than I take. The upper associates and full professors take more than they generate and take little to no call. So to make this a good deal, you need 1) longevity and 2) a niche. Without that, you’ll be slumming in the general ORs for life, and I’ve seen that happen to many people (you can probably think of some from your own training). Interestingly, some of the more prestigious institutions tend to be more egalitarian with their NC time from the start, albeit with lower pay.

Generally rooms are divided into complex cases with felllows or senior residents and then the bread and butter are done solo or with CRNAs. As a result I get a pretty good mix. Typically 2:1 with one busy room and one room with long or a complex case. 3 or 4:1 reserved for busy times and easy rooms.

Residents have a lot of power now and good programs have been put on probation for work hours and perceived lack of teaching. As such, most places now rely less on residents for day to day work and more on attendings and CRNAs (this has been the case throughout medicine).

To be honest, I would probably be happiest in a solo private practice. I like teaching, but I don’t like supervising CRNAs and I see no conceivable future where that isn’t more a part of the job. The academic chair of the future will be more of an MBA bean counter than a researcher, and even the researchers salivate at the idea of doing their research all day while ‘supervising’. I have seen this in all of the surgical fields at our institution as well and many depts have gone from having no NPs to using them as a primary workforce in just 3 years.

So to conclude, academics makes sense if you have a niche and can self promote to turn yourself into ‘the airway guy’, ‘the liver guy’, etc. To get there, though, expect to do a lot of writing and publishing in your free time for no additional compensation. After a few years it will hopefully pay off. If you just want to teach and do cases, there may be better options. Lots of good private practice groups have resident rotations with better compensation packages.

Excellent post, I agree with a lot of what you said above.

 

[sanityonleave]

As a poster above said, it's hard to generalize academics - it seems to be vastly different in different places.

As someone in academics at a big teaching institution, I would say my workload is slightly less than an average PP job, with the hours being similar but with less call and more daytime hours. We start with 1 NC day per week, so FT is 4 days a week (7-5). Call 2x/mo, 24h call on weekends/holidays. Average about 1 weekend 24 every other month.

I think when I am at work I'm working less hard than an average PP doc. I am almost always 2:1 with a variety of resident-CRNA combos (yes, we supervise CRNAs 2:1 commonly). 3:1s are uncommon and we almost never do 4:1s except evening coverage for cases already in motion and rarely in GI. Some days are harder in terms of acuity (open aortas, thoracic, livers) but rarely super high volume as it is academic so everything moves pretty slowly.

The upshot to all this (pretty favorable call, 1 NC day/week, moderate workload) is our pay isn't great - I'm earning ~2/3 of what my PP colleagues are, depending on location and volume.

For me the tradeoff works - I'd rather have more time off and make less. I enjoy the acuity, and there's not a ton of move-the-meat pressure (there's always a little, but eh). Teaching has both high and low points. We have a great relationship with our CRNA group and since we're mostly 2:1 we're actually supervising, not just signing charts for their solo practice. YMMV.

 

[physicsnerd42]

My residency institution: in the main OR mostly doing cases solo, sometimes covering residents 1:1 or 1:2. There are >20 times as many MDs as CRNAs so you will occasionally cover 1-2 CRNAs (never more than covering 1:2 of any configuration of resident or CRNA except at the eyeball outpatient center where it’s 1:3 CRNAs). Most of the CRNAs here are for the eyeball surgicenter and they otherwise are assigned to the lower educational value rooms.

There are no CRNAs in any of the subspecialty rotations (none at the children’s hospital, OB, cardiac, etc). On cardiac it’s 1:1 with a resident or fellow with occasional double covering later in the after/overnight. On peds, it’s either solo or 1:1 with a resident or fellow with double covering usual reserved for call, but even then it’s somewhat rare. Peds cardiac is always 1:1 with a resident or fellow in the pump rooms and non-cardiac surgery for cardiac patient rooms, very rarely solo/double covering in EP or cath lab.

There are no SRNA or AA students.

Full time on the clinical track is 40 regular hours (7-5) + 5 call hours per week (anything on a weekend or after 5 pm). Anything that’s a call hour counts more than a regular hour so you could take a bunch of later shifts and not work much during the day and still reach your clinical commitment. If you work above your commitment you either get paid extra or get more time off, whatever you choose.

Pay is not quite private practice money but it’s what most people consider to be good and is better than what I’ve heard for comparable institutions elsewhere, though you’re in a high COL area.

 

[Twiggidy]

A lot Less pay for a lot more work. As a rule.

Arguable.....at least where I did residency, though the pay part is correct.

 

[Twiggidy]

When people say “a lot more work for less money” I wonder how so? Is PP the same work/more work but just more money so it’s easier to accept the work?

I ask because at my residency, Attendings notoriously would watch Netflix in the attending work room, not be present for wake up with junior residents, leave CRNAs to be a solo practitioners (while using late shift residents to give said CRNAs lunch and bathroom breaks). I’m pretty sure they took lovenox shots for the amount of sitting around they did...

And this is why I would say arguable. In my experience, academic attendings accepted that lower pay scale because they were a lot less hands on. Sure there were occasional disasters where they had to always be in the room (or a disaster resident you had to watch like a hawk) but that was rare. Even on OB they would just stand in the corner and fill out the paper work unless the resident was really struggling. That was a while ago and maybe things have changed as surgical volume of many hospitals have increased but I would argue in PP you earn that higher paycheck, especially when working solo, because you personally take on every stress that comes with being an anesthesiologist.

I know babysitting 2-4 rooms also has it's headaches, especially with new residents or bad CRNAs, but that's why I said it's arguable.

 

[Twiggidy]

Wow... sounds like a had training place. How were those lazy faculties able to keep their jobs and not get fired?

Because they don't kill anyone and the reality is outside of a few institutions no one really cares about "teaching" in anesthesia and when you're covering 2-4 rooms, that teaching comes in like 10-15 spurts, usually and induction and emergence. The best teaching you'll get is on cardiac, and maybe peds, where there are teaching points littered though out the case. Quite honestly, it it's beyond first few months and I'm covering a resident during a lap chole, there isn't much to teach outside of "don't do anything stupid".

 

[gasman2014]

Academic attending happy with my OR load for the most part. I am ICU trained so I do get a post-call week for every week I cover the units (base ICU time guarantee is 12 weeks/year). I still get vacation and academic time on top of that. Compensation package is actually pretty decent. I won't argue it's better than the surrounding urban PP groups, but it's not far too far off in the scheme of things. Coverage is typically 1:2, though in the afternoons that can get to 1:3 if covering CRNAs; 1:4 if in the ambulatory center. Residents plus some SRNAs. Decent case mix. The caveat is that I don't know if I'd enjoy it as much being a generalist as, as mentioned previously, the sub specialists tend to get selected cases. I've done it all so far here with the exception of cardiac (our cardiac anes group is large compared to our case volume), however I've done many sick cardiac patients having non-cardiac surgery (vascular, hepatic, thoracic, etc- though i'm definitely not saying this is abnormal for anyone else). Trauma volume is high, OB volume is decent, good thoracic volume. I've done non-sick pedi cases, etc etc. I've managed to do a few of my own cases here, though that isn't the norm. Southern university, level 1 trauma center. Research is there if you want it. I have my complaints, as I'm sure I would with any job. Overall, I'm pretty happy at the moment. I would consider a move to PP later on depending on where life takes me and opportunities available, though I could see my self staying here for a while as long as the job stays generally how it is now.

 

[cchoukal]

Post-icu WEEK?! Lord, I’m lucky to get a day.

 

[MoMoGesiologist]

Academic attending happy with my OR load for the most part. I am ICU trained so I do get a post-call week for every week I cover the units (base ICU time guarantee is 12 weeks/year). I still get vacation and academic time on top of that. Compensation package is actually pretty decent.

For your ICU week, what are your hours and number of patients and complexity and intensity? You get a whole week off after!? I get one post call day after my week on 🙁

 

[gasman2014]

For your ICU week, what are your hours and number of patients and complexity and intensity? You get a whole week off after!? I get one post call day after my week on 🙁

On average 12-15 patients (highest was low 20s so far). Varying levels of complexity: trauma, transplant, varied shock states, ECMO, etc. Some weeks are definitely busier than others. Typical week is 12-16 hours/day.

 

[Tuohy]

Academic attending for past 10 years (in two different departments)-first and foremost, if you are thinking academics, make sure you have a niche (FELLOWSHIP!!!). If you don't, it is commonplace to get dumped in the worst places (off-site remote anesthesia (trainwreck GI suite, ECT, MRI)). Also, say NO to working at a place that is seniority based for compensation. My first academic job was a set up like this. Plenty of dead weight full professors around at that hospital not taking call and making at least 100K more than me-quite frankly, I wouldn't want these "gurus" taking care of me or any of my family. They were clinically weak and lazy. So, then I switched to current department. Much more transparent re: compensation and equity. Want to make more? Work more! A fair productivity based system with a sold base salary as well. This was not the case at my first job where you worked your ass off as a new attending and they threw a small carrot at your feet (not equitable at all). Hope this helps.

 

[kidthor]

Just started as an academic attending recently and wanted to get an idea of what others out there are doing and how things work at your institutions.

Are most of you supervising residents or CRNAs on a daily basis? Anyone doing a large percent of solo cases?

What is your standard case mix?

Any protected time for research, teaching, or personnel committees? Any pressure to publish?

Are you happy with your income in comparison to work/life balance?

Lastly, any consideration for private practice at some point in your career?

I'm in the ivory tower... for better or worse.

I do a balanced mix of supervising residents, fellows, CRNAs, and solo work. I don't do a lot of solo cases (maybe 15%) but I always enjoy doing so.

As for case mix - I'm in peds with a smattering of adults - probably 80/20. The case mix tends to be high acuity on all fronts.

We have a lot of protected time for research and such (e.g. generally slacking off if desired). But it's uncompensated and our overall salary is on the very low end. On the upside I have extremely good schedule flexibility and could take time off whenever I need/want. Moderate pressure to publish here...

Again as for income our pay is very, very low comparatively speaking. Think 1/2 to 2/3 what one could make in PP, but basically I'm ok with things on balance (begrudgingly) because everyone is equally oppressed. If we're all underpaid collectively it's less offensive than comparing academic haves to have-nots.

As for PP - I wouldn't rule it out. But I like my current setup. Also I'd worry that it'd be hard to get back into academics if I went into PP and changed my mind later. Sure people do make the transition back but academia seems to be getting much more competitive. I doubt my current group would hire someone out of PP these days because of the abundance of top tier options they have.

 

[psychbender]

For your ICU week, what are your hours and number of patients and complexity and intensity? You get a whole week off after!? I get one post call day after my week on 🙁

I remember when I was interviewing for a spot at University of Kentucky, the CCM guys did two weeks M-F 7-5 (no call) in the OR (usually 2:1 resident/CRNA) followed by one week M-Sun 8-8 ICU, followed by a week off. I think there was some vacation/CME time thrown in there. There was also the option to pick up evening shifts and liver call on post-ICU weeks for extra cash. I think my colleagues at KUMC had a similar schedule, and a few other chairs I spoke with on the phone described similar setups. Where I did my fellowship, though, the attendings got thrown back into the OR a day or so after the unit, even after a block of nights. Brutal.