what are the merits of staying in academia once you are an attending?

[ejay19955]

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I am just a lowly medical student, and have not seen much of medicine outside of a medical school and its university hospital, but I am coming to a realization the ivory tower of academia is not as glorious as it initially looked to me. Salary is like half that of PP. Seemingly less employment benefits. Having to maintain research output, to some degree even if you are tenured. Clinical instructors look overworked than those in PP. etc.

The only things I can see are better in academia are the prestige, resources for research (which only certain people like), slightly better job security? (questionably and only if you get tenured), opportunities for teaching (again which only certain people like). Definitely not better hours or $$$.

Is there any missing part that I am not seeing?
Why do people stay in academia besides prestige?

 

[Espressso]

From mentors of mine... one big reason is because they genuinely enjoy teaching. Also, they prefer working in teaching/learning settings, like a teaching hospital. Where you get interesting cases all the time, have the opportunity to teach the med students and residents and are constantly challenging yourself mentally.

 

[Oso]

I think you hit the nail on the head, OP.

- prestige
- teaching opportunities (anything from medical student lectures/small groups to clinical teaching with residents/fellows)
- research opportunities/chance to be at the 'forefront' of your field/be a leader in your field
- working at a referral hospital -> get lots of cool/weird/interesting things sent to you and rarely have to refer your own interesting cases out
- flexibility*: a lot of academic docs have less clinical duties due to teaching, research, and administrative responsibilities, which provides flexibility and helps prevent burnout, especially later in their career. Lots of people at my institution picked up more teaching and administrative work in order to lessen their clinical duties towards the second half/end of their career.

* granted, this means you are limiting yourself mostly to academic institutions, which limits where in the country you can work to a good extent (aka less flexibility in this sense).


The lower pay for academic clinical work is a real concern, especially when research also does not pay a whole lot and you usually do not get paid for teaching.

 

[Stagg737]

I think you hit the nail on the head, OP.

- prestige
- teaching opportunities (anything from medical student lectures/small groups to clinical teaching with residents/fellows)
- research opportunities/chance to be at the 'forefront' of your field/be a leader in your field
- working at a referral hospital -> get lots of cool/weird/interesting things sent to you and rarely have to refer your own interesting cases out
- flexibility*: a lot of academic docs have less clinical duties due to teaching, research, and administrative responsibilities, which provides flexibility and helps prevent burnout, especially later in their career. Lots of people at my institution picked up more teaching and administrative work in order to lessen their clinical duties towards the second half/end of their career.

* granted, this means you are limiting yourself mostly to academic institutions, which limits where in the country you can work to a good extent (aka less flexibility in this sense).


The lower pay for academic clinical work is a real concern, especially when research also does not pay a whole lot and you usually do not get paid for teaching.

Agree completely with the first 3 points, which I think are typically the big 3 reasons people stay at academic programs. The fourth can be a factor, but I think that kind of falls in line with the second point of teaching. Disagree with the last point though. If you really don't want to do clinical work or only want to do a little, then that may be valid. But mostly I think that gets overshadowed by the amount of administrative work and paperwork that is required in a lot of academic positions. Combine that with the significantly lower pay in most academic positions and it's not hard to understand why so many people transition from academic positions into private practice while few people want to leave private practice for an academic position.

 

[Oso]

Agree completely with the first 3 points, which I think are typically the big 3 reasons people stay at academic programs. The fourth can be a factor, but I think that kind of falls in line with the second point of teaching. Disagree with the last point though. If you really don't want to do clinical work or only want to do a little, then that may be valid. But mostly I think that gets overshadowed by the amount of administrative work and paperwork that is required in a lot of academic positions. Combine that with the significantly lower pay in most academic positions and it's not hard to understand why so many people transition from academic positions into private practice while few people want to leave private practice for an academic position.

I can only speak from my own experience, but I know of several faculty members at my school who spend a significant amount of time teaching all levels of medical students and residents who actively decided not to get too sucked into the administrative side of things. Now one of the downsides of course, is that while some of them have been here for a very long time, they have not really moved up the academic ladder, but they are fine with that. My point about flexibility is essentially paraphrasing several attendings I've talked to about academics vs private practice.

 

[Stagg737]

I can only speak from my own experience, but I know of several faculty members at my school who spend a significant amount of time teaching all levels of medical students and residents who actively decided not to get too sucked into the administrative side of things. Now one of the downsides of course, is that while some of them have been here for a very long time, they have not really moved up the academic ladder, but they are fine with that. My point about flexibility is essentially paraphrasing several attendings I've talked to about academics vs private practice.

Fair enough. I guess, I've just had different experience with academic faculty and the administrative requirements of their jobs.

 

[ejay19955]

Thanks all for the comments.

So on the flip side, what is bad about going outside of academia? I mean anything from employed by a community or rural hospital to partnership, owning your own clinic, etc.

 

[OrthoTraumaMD]

Teaching, and the freedom to not operate on things I don’t think I need surgery. In private practice, you eat what you kill, so you have an incentive to take people to the operating room. It becomes morally questionable when you could potentially treat something without surgery, but choose not to. I didn’t want that for myself.


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[Oso]

Fair enough. I guess, I've just had different experience with academic faculty and the administrative requirements of their jobs.

Yeah, the requirements probably vary a good amount depending on the institution

 

[Neopolymath]

I think what keeps people in academic medicine is the drive to teach at a referral center above all else and that they have never experienced private practice. I don't think many attendings actually want to do admin and research, but they do it so they can work with future of the profession. It seems like a lot of students never experience PP and then go on to an academic residency so they just don't get the exposure to how much better things are in a lot of regards. That's why you have a lot of people say, "F this!" after 10 years and never come back to academics when they realize they can do more than 3 cases a day in the OR and not deal with ****ty ancillary/nursing staff at non-teaching facilities.

 

[DubbiDoctor]

Thanks all for the comments.

So on the flip side, what is bad about going outside of academia? I mean anything from employed by a community or rural hospital to partnership, owning your own clinic, etc.

Constant pressure to see more and more patients - and quicker - can lead to burnout. As OrthoTraumaMD said, private practice medicine is more prone to ethical dilemmas in which you're incentivised to perform unnecessary procedures. Having to refer out your interesting patients to academic centers. Lack of opportunity to teach or do research (maybe you're not interested in that, but pursuing professional interests other than treating patients day in and day out can stave off burnout and contribute to a more fulfilling career).

 

[mistafab]

One thing I don’t think has been mentioned yet is that academia allows you to be the best in the world at a very specific thing if you want to be. Do you want to be the guy that knows X disease and Y intervention? Maybe you researched nothing but X and you came up with Y. Maybe you become the only person in the world who has been successful at doing Y. Doing research and being on the cutting edge allows you to do just that - academia would facilitate being THE expert.

 

[870784]

Constant pressure to see more and more patients - and quicker - can lead to burnout. As OrthoTraumaMD said, private practice medicine is more prone to ethical dilemmas in which you're incentivised to perform unnecessary procedures. Having to refer out your interesting patients to academic centers. Lack of opportunity to teach or do research (maybe you're not interested in that, but pursuing professional interests other than treating patients day in and day out can stave off burnout and contribute to a more fulfilling career).

It's kinda amazing how much you know as a premed lol. Really interesting reading your posts.

 

[IlDestriero]

I’m in academic medicine.
I enjoy the variety of cases that I’m involved with at a major quaternary referral center.
I like teaching the next generation of anesthesiologists.
I like being on the leading edge of research, experimental treatments, etc.
I like the flexibility my career offers.
Not all academic jobs pay poorly. 😉
I work less than most anesthesiologists I know.
I take very little call.
While I don’t do much research, by choice and track, I like participating in research and QI projects.
Did I mention that I work significantly less than many of my PP or Anesthesia Management Company colleagues. And I still make more than the AMC ones. With better benefits.
But, others have different goals. They wouldn’t be happy here, just as I wouldn’t be happy there.


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Il Destriero

 

[colbgw02]

I've done both.

In my case, academics offered teaching, research, a chance to practice in a narrow cross-section, and relatively high compensation per RVU. Some of those, like research, were negatives for me, but obviously others enjoy research. Other things, like teaching, could be great on a Monday and a burden on a Tuesday. Only other academics really care about prestige, so when comparing to PP, that's really a non-factor. I'll list administrative duties/bureaucracy as a universal negative, because I don't know anybody who legitimately enjoys that stuff. Although, it clearly bothers some people more than others.

Private practices offered me overall higher compensation, more vacation, and practicing across a wider breadth of my field. It also offered me a chance to be a worker bee. Sure, there are non-medical duties that come with maintaining a healthy practice, but I found them less burdensome. Basically, PP doesn't have 'homework' the way that academics does.

At least for me, the benefits are a wash. Maybe with a small edge to PP.

 

[doc05]

I am just a lowly medical student, and have not seen much of medicine outside of a medical school and its university hospital, but I am coming to a realization the ivory tower of academia is not as glorious as it initially looked to me. Salary is like half that of PP. Seemingly less employment benefits. Having to maintain research output, to some degree even if you are tenured. Clinical instructors look overworked than those in PP. etc.

The only things I can see are better in academia are the prestige, resources for research (which only certain people like), slightly better job security? (questionably and only if you get tenured), opportunities for teaching (again which only certain people like). Definitely not better hours or $$$.

Is there any missing part that I am not seeing?
Why do people stay in academia besides prestige?

These "better" things are actually a big deal. Not to mention resident/fellow support. $$ isn't that much less than private practice.

Plus in private practice you're running a business, so you end up overtreating patients so that you can increase billing.

 

[ejay19955]

These "better" things are actually a big deal. Not to mention resident/fellow support. $$ isn't that much less than private practice.

Plus in private practice you're running a business, so you end up overtreating patients so that you can increase billing.

When you say it isn't that much, are you looking at like 80% of what PP makes? I go to a public school, so everyone's salary is available to the public. On that list all the med school attending salaries are basically capped at $200k, except for like the department heads, so idk what's going on there. One of the attendings is an endocrine surgeon who he said he makes $350-400k during a surgery interest group meeting, but his salary is still showing up as $200k. Given that it's likely impossible everyone gets the same salary, I believe that he actually makes ~$400k.

So it makes me wonder, how does compensation even work in academia?

 

[libertyyne]

When you say it isn't that much, are you looking at like 80% of what PP makes? I go to a public school, so everyone's salary is available to the public. On that list all the med school attending salaries are basically capped at $200k, except for like the department heads, so idk what's going on there. One of the attendings is an endocrine surgeon who he said he makes $350-400k during a surgery interest group meeting, but his salary is still showing up as $200k. Given that it's likely impossible everyone gets the same salary, I believe that he actually makes ~$400k.

So it makes me wonder, how does compensation even work in academia?

RVU, side hustle, etc.

 

[RinShanKaiHo]

So those compensation is not reported online?

RVU, side hustle, etc.

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[libertyyne]

So those compensation is not reported online?


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Im assuming it is only reporting salary and not bonus income or benefits package. I would look through the definitions of what is reported online to get that answer.

 

[RinShanKaiHo]

Im assuming it is only reporting salary and not bonus income or benefits package. I would look through the definitions of what is reported online to get that answer.

Yeah it was strange when I saw every assistant professor at an ent program had 165,000 exactly as salary. Probably didn't include bonus

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[joeschmoejohndoe]

Yeah it was strange when I saw every assistant professor at an ent program had 165,000 exactly as salary. Probably didn't include bonus

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I think that's because they only report their salary from their teaching/research/other responsibilities that get paid through the institution. They get paid separately for their clinical duties and that income doesn't get reported bc the state isn't paying that part of the salary, it's usually the physician group or what ever "coroporation" is running the hospital.

 

[IlDestriero]

When you say it isn't that much, are you looking at like 80% of what PP makes? I go to a public school, so everyone's salary is available to the public. On that list all the med school attending salaries are basically capped at $200k, except for like the department heads, so idk what's going on there. One of the attendings is an endocrine surgeon who he said he makes $350-400k during a surgery interest group meeting, but his salary is still showing up as $200k. Given that it's likely impossible everyone gets the same salary, I believe that he actually makes ~$400k.

So it makes me wonder, how does compensation even work in academia?

Every place is going to be somewhat different What they report is probably state dependent.
My set up-
Academic pay from the U based on rank.
University benefits.
Group additional benefits.
Clinical income.
Annual productivity bonus.
Annual late/call pay.
Any special individual bonuses.
Special pay from the hospital (usually paid to the group, not individually).
Side hustles 😉

Academic programs vary a great deal with regard to income. You really have to look at all the details to make a fair comparison. Some offer more $$, others better retirement. Some are PP like hours, others 3.5 days a week is full time. Research requirements vary by university, program, and track.
So is the guy making 250 doing worse than the one that makes 400? It depends. Maybe he’s working clinically 25% or 50% less. Maybe he gets out at 3 vs 6. Maybe he has a real pension plan vs 403b. Details. Maybe it is a horrible job and he’s an idiot trapped there because of location and/or laziness. They’re definitely out there too.


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Il Destriero

 

[Bloxorz]

They like research and teaching

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[sliceofbread136]

I’m in academic medicine.
I enjoy the variety of cases that I’m involved with at a major quaternary referral center.
I like teaching the next generation of anesthesiologists.
I like being on the leading edge of research, experimental treatments, etc.
I like the flexibility my career offers.
Not all academic jobs pay poorly. 😉
I work less than most anesthesiologists I know.
I take very little call.
While I don’t do much research, by choice and track, I like participating in research and QI projects.
Did I mention that I work significantly less than many of my PP or Anesthesia Management Company colleagues. And I still make more than the AMC ones. With better benefits.
But, others have different goals. They wouldn’t be happy here, just as I wouldn’t be happy there.


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Il Destriero

Say I want to work at an academic center and do mostly clinical and teaching with not too much qi or research. How easy is that to pull off

 

[IlDestriero]

That’s entirely dependent on the particular department.
The U will have several different tracks available for faculty. One would be for clinicians with little or no required academic productivity. They would be responsible for clinical excellence and education and likely some admin. However that doesn’t mean that the department wants many or any people in that track. My department has many people in that role, other departments here, GI for example, have few people in that track and want most of the faculty engaged in research. So the answer is, it depends. It’s possible, but maybe not where you want to be.


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Il Destriero

 

[MSTPlease]

When you say it isn't that much, are you looking at like 80% of what PP makes? I go to a public school, so everyone's salary is available to the public. On that list all the med school attending salaries are basically capped at $200k, except for like the department heads, so idk what's going on there. One of the attendings is an endocrine surgeon who he said he makes $350-400k during a surgery interest group meeting, but his salary is still showing up as $200k. Given that it's likely impossible everyone gets the same salary, I believe that he actually makes ~$400k.

So it makes me wonder, how does compensation even work in academia?

They gave us a lecture on how physician salaries can vary based on the contract setups, and I feel like I heard something along the lines of a physician's base salary could be as little as 1/3 of their take-home pay from the hospital after all the production/performance/quality bonuses get added in. Wouldn't be surprised if the public reporting is only the base pay.

 

[MSTPlease]

Say I want to work at an academic center and do mostly clinical and teaching with not too much qi or research. How easy is that to pull off

go to an academic program that is less research oriented. If you mainly care about teaching residents/fellows and are less interested in lecturing pre-clinical students, there are a lot of hospitals out there that would fit your bill.

 

[doc05]

Say I want to work at an academic center and do mostly clinical and teaching with not too much qi or research. How easy is that to pull off

Depends on your specialty too. But keep in mind you won't get tenure or move up the ranks if you avoid research.

 

[IlDestriero]

Depends on your specialty too. But keep in mind you won't get tenure or move up the ranks if you avoid research.

If you’re in a non research dependent track, your research productivity or lack there of does not affect your promotion.


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Il Destriero

 

[colbgw02]

If you’re in a non research dependent track, your research productivity or lack there of does not affect your promotion.


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Il Destriero

But how common is that?

From what I've seen, if you give up on research (or are just nominally involved), it means waving goodbye to tenure and promotion to full professor.

 

[IlDestriero]

But how common is that?

From what I've seen, if you give up on research (or are just nominally involved), it means waving goodbye to tenure and promotion to full professor.

Tenure track is a research heavy track, 75%+. If you’re not planing on a career as a serious researcher, getting grant funding, etc., tenure isn’t the track you want.
How common a non research clinical track is depends on who the Chairman is recruiting and the nature of the job. In my department non research track folks are the majority. That’s a choice and to some degree a necessity in anesthesia. You need 20-30 faculty working clinically every day, you can’t just have a single faculty member covering the entire service for a week at a time while everyone else is in the lab or in the clinic. In another department non research faculty may be the significant minority.
Your promotion in a non research track evaluates you on teaching excellence and clinical excellence, and to some degree your administrative contribution as it relates to the other two things. You still need to hop on the lecture circuit, develop special interest expertise, gain some prominence in your field, etc. In my track, research has zero value in my promotion algorithm, unless it relates to education and clinical excellence. Something like setting up and running a multi institutional database to improve clinical outcomes in some uncommon disorder, etc. would qualify.


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Il Destriero

 

[mimelim]

These "better" things are actually a big deal. Not to mention resident/fellow support. $$ isn't that much less than private practice.

Plus in private practice you're running a business, so you end up overtreating patients so that you can increase billing.

Eh, the money is substantially different in every specialty I have come across here. Obviously everyone has their own definitions and job markets vary, but... Staying academics for me means a 20-40% initial paycut on day 1 and 4-5 years down the line closer to a 50-75% paycut.

 

[Oso]

Eh, the money is substantially different in every specialty I have come across here. Obviously everyone has their own definitions and job markets vary, but... Staying academics for me means a 20-40% initial paycut on day 1 and 4-5 years down the line closer to a 50-75% paycut.

Your pay would go down as time goes on? Is this assuming increasing administrative/research/teaching responsibilities and decreasing clinical work?

 

[mimelim]

Your pay would go down as time goes on? Is this assuming increasing administrative/research/teaching responsibilities and decreasing clinical work?

No, the gap would increase. Your salary generally rises at a regimented pace in academics. Every private practice job is different in terms of pay structure, but if you start to build your practice, there is an expectation that you are going to see a sizable pay jump 3-4 years in.

 

[colbgw02]

Tenure track is a research heavy track, 75%+. If you’re not planing on a career as a serious researcher, getting grant funding, etc., tenure isn’t the track you want.
How common a non research clinical track is depends on who the Chairman is recruiting and the nature of the job. In my department non research track folks are the majority. That’s a choice and to some degree a necessity in anesthesia. You need 20-30 faculty working clinically every day, you can’t just have a single faculty member covering the entire service for a week at a time while everyone else is in the lab or in the clinic. In another department non research faculty may be the significant minority.
Your promotion in a non research track evaluates you on teaching excellence and clinical excellence, and to some degree your administrative contribution as it relates to the other two things. You still need to hop on the lecture circuit, develop special interest expertise, gain some prominence in your field, etc. In my track, research has zero value in my promotion algorithm, unless it relates to education and clinical excellence. Something like setting up and running a multi institutional database to improve clinical outcomes in some uncommon disorder, etc. would qualify.


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Il Destriero

I get all of that. You said earlier that getting on a non-research tract won't affect promotion. I'm contending that it does by putting a ceiling on how far you can go, but that's only the little corner of the world that I've seen (2 institutions). Are you familiar with universities that will promote, for example, clinical faculty to full professor?

 

[IlDestriero]

I get all of that. You said earlier that getting on a non-research tract won't affect promotion. I'm contending that it does by putting a ceiling on how far you can go, but that's only the little corner of the world that I've seen (2 institutions). Are you familiar with universities that will promote, for example, clinical faculty to full professor?

Yes, of course.


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Il Destriero

 

[colbgw02]

Yes, of course.


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Il Destriero

Your response makes me think that I didn't ask my question clearly enough. Are you familiar with universities who will promote non-tenure track faculty, who focus almost entirely on clinical duties (at the expense of research, administration, etc.), to full professor?

 

[mimelim]

Your response makes me think that I didn't ask my question clearly enough. Are you familiar with universities who will promote non-tenure track faculty, who focus almost entirely on clinical duties (at the expense of research, administration, etc.), to full professor?

Yes, I am familiar with universities who will promote faculty who are almost exclusively clinical to full professor.

 

[IlDestriero]

Your response makes me think that I didn't ask my question clearly enough. Are you familiar with universities who will promote non-tenure track faculty, who focus almost entirely on clinical duties (at the expense of research, administration, etc.), to full professor?

Yes. You can get promoted to full professor in that non research track. You wouldn’t be tenured of course as that’s a separate track, but you could be a full Professor. If the university didn’t want to support that mission for its faculty, it wouldn’t offer the track. I’ve been on the faculty at two of the most research heavy big name universities and even they offer this track recognizing the changing times. Each track offers a pathway to promotion for that track. Associate is obtainable for pretty much anyone who wants it, but full professor would involve significant work and effort to show recognized and demonstrable clinical and educational excellence. It’s not as simple as time in the job.


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Il Destriero

 

[FlowRate]

Teaching, and the freedom to not operate on things I don’t think I need surgery. In private practice, you eat what you kill, so you have an incentive to take people to the operating room. It becomes morally questionable when you could potentially treat something without surgery, but choose not to. I didn’t want that for myself.

I'll take back pain decompressive laminectomies with spacer implants for $80,000, Alex.

Your response makes me think that I didn't ask my question clearly enough. Are you familiar with universities who will promote non-tenure track faculty, who focus almost entirely on clinical duties (at the expense of research, administration, etc.), to full professor?

Well, Harvard does it, so I'm sure a lot of places do, too.

 

[colbgw02]

Yes, I am familiar with universities who will promote faculty who are almost exclusively clinical to full professor.

Yes. You can get promoted to full professor in that non research track. You wouldn’t be tenured of course as that’s a separate track, but you could be a full Professor. If the university didn’t want to support that mission for its faculty, it wouldn’t offer the track. I’ve been on the faculty at two of the most research heavy big name universities and even they offer this track recognizing the changing times. Each track offers a pathway to promotion for that track. Associate is obtainable for pretty much anyone who wants it, but full professor would involve significant work and effort to show recognized and demonstrable clinical and educational excellence. It’s not as simple as time in the job.


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Il Destriero

Well, Harvard does it, so I'm sure a lot of places do, too.

Thanks, guys. Apparently this is a lot more widespread than my N of 2 led me to believe.