What subspecialties can have a week on, week off schedule in academia?

[Aldertonghen]

I’ve realised a week on, week off schedule is the most valuable thing for me in terms of being able to visit my family in another country more often. At the same time, I do want to remain in academia (and the low salary isn’t a problem for me as I do have another source of income and don’t have loans). I know stroke and NCC are doable, but are other specialties like epilepsy also possible? At my residency, the epileptologists have a normal clinic schedule and not a week on week off schedule. I do like neurohospitalist as well but my PD told me that a fellowship is still preferable.

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[Telamir]

In my experience—not really. Even the jobs I interviewed for NH in academia that advertised as week on week off implied they expected you to “do something” with your time off, namely clinic or research or some other BS.

 

[Aldertonghen]

In my experience—not really. Even the jobs I interviewed for NH in academia that advertised as week on week off implied they expected you to “do something” with your time off, namely clinic or research or some other BS.

As far as all the other jobs are remote (research/zoom sessions/something else) I would be okay with that too. Is that possible?

 

[Telamir]

I only interviewed in two academic places albeit “nice ones”. They both expected something on the weeks off—namely clinic. Research maybe can be done remote but all in all typically 7 days “off” weren’t a thing in my experience.

There’s still this perception that you work “less” than the clinic folks even though when averaged out per hour assuming 12 hour shifts inpatient works more.

You might find some “privademic” jobs out there. You might be able to teach med students or maybe off service residents if that’s what you want out of an academic job.

Maybe someone else here who is currently in academia might chime in.

 

[Aldertonghen]

I only interviewed in two academic places albeit “nice ones”. They both expected something on the weeks off—namely clinic. Research maybe can be done remote but all in all typically 7 days “off” weren’t a thing in my experience.

There’s still this perception that you work “less” than the clinic folks even though when averaged out per hour assuming 12 hour shifts inpatient works more.

You might find some “privademic” jobs out there. You might be able to teach med students or maybe off service residents if that’s what you want out of an academic job.

Maybe someone else here who is currently in academia might chime in.

I see. In that case can you work out a contract with more weeks of vacation (like 6-8 weeks per year), in exchange for a lower FTE (I’ll work full time when not on vacation ofcourse)? This would also give me the weeks needed to go 4x a year.

 

[Telamir]

I don't know. You'll have to ask around. I'll be honest though this kind of flexibility isn't really academia's thing typically.

 

[neophyte2008]

A well known university in Midwest had a privademic as well as academic neurohospitalist job with 23 weeks of service with no other requirements .So they do exist , but you have to look for them. If a 7 on 7 off schedule is your preference , wouldn’t do clinic branches like 2 year epilepsy, headache , movement or pain.

Would favor no fellowship , stroke , neurophys or NCC.

 

[Aldertonghen]

A well known university in Midwest had a privademic as well as academic neurohospitalist job with 23 weeks of service with no other requirements .So they do exist , but you have to look for them. If a 7 on 7 off schedule is your preference , wouldn’t do clinic branches like 2 year epilepsy, headache , movement or pain.

Would favor no fellowship , stroke , neurophys or NCC.

I see. That would be a good option.

By neurophys do you mean the EMG one, or the EEG one?

 

[neophyte2008]

I see. That would be a good option.

By neurophys do you mean the EMG one, or the EEG one?

Mixed is better , eeg is fine , not emg.

 

[Postictal Raiden]

Mixed is better , eeg is fine , not emg.

Although I agree that mixed eeg/EMG is the most economically sound fellowship decision for outpatient private practice or quasi-academic settings, I’m not sure the EMG component is relevant in the inpatient setting.

 

[Aldertonghen]

Although I agree that mixed eeg/EMG is the most economically sound fellowship decision for outpatient private practice or quasi-academic settings, I’m not sure the EMG component is relevant in the inpatient setting.

This is what I initially thought- but one of our attending neurohospitalists did EMG and basically does inpatient EMGs on anyone who needs it in various hospitals. Now these EMGs aren’t nearly as good as outpatient ones, but this one attending has seemed to fill a niche of sorts in this case and does like 5-7 EMGs on his off week.

That being said, EEG one makes more sense. The issue is because we have epilepsy attendings here, the neurohospitalists never actually get to use the EEG skills here. Is this a problem in most academic hospitals?

 

[neophyte2008]

Suggested mixed as you would be able to do your own basic EMGs in functional folks if it is absolutely needed and also eeg monitoring . Also allows you to be an op doc if you get bored.

In most settings you would be hard pressed to find time to do an emg on your on weeks. I don’t personally read EEGs on my job , but have been asked by numerous Places while interviewing to read continuous EEG. Hence I thought it would be beneficial. I don’t know much about academic NH jobs , but eeg reading would be helpful in pp.

 

[Postictal Raiden]

Suggested mixed as you would be able to do your own basic EMGs in functional folks if it is absolutely needed and also eeg monitoring . Also allows you to be an op doc if you get bored.

In most settings you would be hard pressed to find time to do an emg on your on weeks. I don’t personally read EEGs on my job , but have been asked by numerous Places while interviewing to read continuous EEG. Hence I thought it would be beneficial. I don’t know much about academic NH jobs , but eeg reading would be helpful in pp.

True, and in residency we did have our NM attending occasionally perform EMG on hospitalized patients to help with dx.

However, in most community hospitals, there are logistic issues preventing them from credentialing you to perform EMG inpatient. At least that is what I have been told by one my neurohospitalist colleagues who is trained in EMG-only neurophys.

Your point regarding having the option to switch to outpatient is a very valid reason to do EMG training.

 

[mrbreakfast]

I am an academic neurohospitalist at a large center. I work 7 on/7 off on average. No one actually works a true 7 on/7 off (sometimes 14 on/14 off, etc), but we all work 25-27 weeks per year. In our hospitalist group some people do other things, like stroke or epilepsy or tele consults, so work fewer hospitalist weeks - here, "hospitalist" basically means consult service. You can also hold a clinic on your "off" weeks, and have a few fewer inpatient weeks, but not worth it in my opinion.

You are not going to have time to perform inpatient EMGs while on service at a busy center. If you want to do EMGs, you're doing it in your off weeks. Also, there might be credentialing issues. You likely also won't be able to bill for reading EEGs while on service. I do read EEGs not infrequently, though typically just the sections of interest (e.g. a few hours) and don't bill for it. Ideally, you will ask the epilepsy team for an expedited read and see another patient while they look at it.

What you do all depends on your center and what you can do. For example, I serve as backup coverage for resident clinic (few weeks/year), help with residency and med school interviews, and am involved in quality improvement. I am compensated for each of those, but none are "required" by my contract.

Outside of quality improvement, none of the hospitalists do any serious research.

 

[Aldertonghen]

I am an academic neurohospitalist at a large center. I work 7 on/7 off on average. No one actually works a true 7 on/7 off (sometimes 14 on/14 off, etc), but we all work 25-27 weeks per year. In our hospitalist group some people do other things, like stroke or epilepsy or tele consults, so work fewer hospitalist weeks - here, "hospitalist" basically means consult service. You can also hold a clinic on your "off" weeks, and have a few fewer inpatient weeks, but not worth it in my opinion.

You are not going to have time to perform inpatient EMGs while on service at a busy center. If you want to do EMGs, you're doing it in your off weeks. Also, there might be credentialing issues. You likely also won't be able to bill for reading EEGs while on service. I do read EEGs not infrequently, though typically just the sections of interest (e.g. a few hours) and don't bill for it. Ideally, you will ask the epilepsy team for an expedited read and see another patient while they look at it.

What you do all depends on your center and what you can do. For example, I serve as backup coverage for resident clinic (few weeks/year), help with residency and med school interviews, and am involved in quality improvement. I am compensated for each of those, but none are "required" by my contract.

Outside of quality improvement, none of the hospitalists do any serious research.

For those in your group that are epilepsy trained- how are their hospitalist weeks and epilepsy-specific practice (clinic, EMU, case management perhaps) scheduled? Or have they mostly left the field of epilepsy to practice essentially as hospitalists? Do they have weeks off where any commitment they have is virtual only (like admin zoom meetings that one can attend from anywhere in the world)? I am not opposed to working while I’m away, it’s just that I would be away physically to visit my family maybe 6 weeks in a year so it would need to be virtual (and most places only offer 4 weeks of vacation).

 

[mrbreakfast]

For those in your group that are epilepsy trained- how are their hospitalist weeks and epilepsy-specific practice (clinic, EMU, case management perhaps) scheduled? Or have they mostly left the field of epilepsy to practice essentially as hospitalists? Do they have weeks off where any commitment they have is virtual only (like admin zoom meetings that one can attend from anywhere in the world)? I am not opposed to working while I’m away, it’s just that I would be away physically to visit my family maybe 6 weeks in a year so it would need to be virtual (and most places only offer 4 weeks of vacation).

There are two: one does basically a 60-40 split between hospitalist work and EEG reading (almost zero clinic) and the other does 100% hospitalist work. Several other epilepsy people do a week or two of consults/year.

I would note that the person who splits their time is a special case. I'm not sure how many places would let you do that.

Anyone who does hospitalist work is going to have weeks off. Factoring in call, an academic hospitalist week at a busy center is like two weeks of clinic work rolled into one. You still have to answer emails and take random zoom meetings, but people travel and stuff. If someone has to miss a chunk of time unexpectedly, coverage can be arranged.

You can also do teleneurology. We have some people who do a lot of tele time. It's not quite as lucrative as private practice, but the compensation model isn't bad, and a number of the cases are second opinions.

You could probably arrange a schedule where you are off six weeks in a row, though that wouldn't be simple.

 

[Aldertonghen]

That’s actually a very encouraging reply. I don’t need 6 weeks off in a row- just 6 weeks total (in 3 weeks blocks)- is that more feasible? And I am open to attending random zoom meetings and doing remote work in that period.

What subspecialties would an academic center find useful then in such a neurohospitalist job? I assume most centers already have dedicated stroke and NCC coverage. I do like stroke as a career but sometimes it’s not varied enough I feel.

 

[mrbreakfast]

It depends on what the center likes, but it seems moreso about people who had strong residency training at busy centers; these are the people who basically completed the equivalent of a neurohospitalist fellowship during their PGY4 year.

Our core group is mostly people with no fellowship, who exclusively do neurohospitalist work. The "part-timers" who do majority neurohospitalist work are stroke or epilepsy trained. Among the "part-timers" who do mostly clinic, there are a lot of neuro-immuno and some movement people.

If you are 100% certain you want to be a neurohospitalist for your career and are undecided on academic vs private practice, stroke fellowship is probably the best. A number of larger community hospitals are preferentially hiring vascular-trained folks for their general neurohospitalist positions.