why it sucks being an academic attending

[beezar]

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Ok, this is not a private practice is better than academics thread. What this is is my perspective on the parts about being in academic medicine I did not like for those of you considering it. I did academics for a year, and now am in private practice which has its own negatives.

1) Some days are really boring when you have good residents covering easy cases. I always thought I could read books or whatever during that time, but it's still just boring.

2) Residents who whine all the time. Some just complain and whine about how late they work EVERYDAY, how unfair it is, how others get to go home before them ALL THE TIME, how it's basically a conspiracy to keep them late. Suck it up.

3) Watching a resident flail on a procedure which you know you can do in 30 seconds while the surgeon is pushing you to hurry up. Patience is a virtue.

4) Trying to make constructive criticisms to the resident who gets very defensive without making them defensive. For example, I suggested to a resident to tape the eyes before intubation after I clearly saw him poke the patient in the eye with the endotracheal tube before intubating the pt while he concentrated on getting a view (he accidentally flipped the eyelid open and scraped the eyeball with the tube). He proceeded to argue with me that he didn't poke him in the eye. Christ.

5) Walking into a room to check on how a case was going just to find that the resident took the initiative to do something stupid. Like moving the BP cuff to the side with the fresh AV fistula, or running 0.2 of sevo alone (with rocuronium) on a healthy pt for the past 45 mins because her BP was low ("don't worry, I gave scopolamine") Christ.

6) Having other attendings try to dump their work on you or try to get you to rewrite their papers without giving you credit or try to take advantage of you in everyway possible. Though that happens too in private practice but less.

7) Dealing with lazy, disrespectful OR nurses who want to blame others rather than working together to make the system work. Private practice was such a huge refreshing change in this respect.

8) The worst: having your license on the line for trainees who by definition are training and will make mistakes when you are not in the room. I had a colleague get sued because something a resident did that was completely out of my colleague's control. Now that lawsuit follows him everywhere.

That's not to say academics was horrible; it has a lot of positives and fun things to it as well. Just wore me out.

 

[Breezee]

Can you offer a perspective on the good side of academics or conversely, the negative aspects of private practice in your opinion?

 

[Prodigal OU Son]

Can you offer a perspective on the good side of academics or conversely, the negative aspects of private practice in your opinion?

I enjoyed teaching.....and you don't get much of that in private practice.

In all fairness, some of the negative comments above can be translated to private practice IF you change a few names....

Some days are really boring......if you're doing ear cases for example.....

Residents who whine all the time......Nurses, scrub techs, adminstrators....

Watching a resident flail on a procedure.....watching ANYONE flail....

Dealing with lazy, disrespectful OR nurses.....I havn't had as much good luck as you, I suppose....

Certain traits are needed in this environment....the same as certain traits are needed working in oncology day after day.

And you give up significant earning potential.....but it's not all about money, right? 😉

 

[Noyac]

I enjoyed teaching.....and you don't get much of that in private practice.

In all fairness, some of the negative comments above can be translated to private practice IF you change a few names....

Some days are really boring......if you're doing ear cases for example.....

Residents who whine all the time......Nurses, scrub techs, adminstrators....

Watching a resident flail on a procedure.....watching ANYONE flail....

Dealing with lazy, disrespectful OR nurses.....I havn't had as much good luck as you, I suppose....

Certain traits are needed in this environment....the same as certain traits are needed working in oncology day after day.

And you give up significant earning potential.....but it's not all about money, right? 😉

Teaching----In PP you just change the pupil to the surgeon.

 

[Prodigal OU Son]

Teaching----In PP you just change the pupil to the surgeon.

Very "zen"......I like it.

 

[Consigliere]

And you give up significant earning potential.....but it's not all about money, right? 😉

For me it is. 😍

 

[dhb]

Seems like you're a nice guy... maybe too nice:

2) Residents who whine all the time. Some just complain and whine about how late they work EVERYDAY, how unfair it is, how others get to go home before them ALL THE TIME, how it's basically a conspiracy to keep them late. Suck it up.

Tell them to STFU if they finish late it's because they are lazy or inefficient period. I'm rotating at this hospital which everybody told me that the hours were horrible and you'd finish at 7pm on average. I'm out everyday at 5 because i do my job + half of the nurse's.

4) Trying to make constructive criticisms to the resident who gets very defensive without making them defensive. For example, I suggested to a resident to tape the eyes before intubation after I clearly saw him poke the patient in the eye with the endotracheal tube before intubating the pt while he concentrated on getting a view (he accidentally flipped the eyelid open and scraped the eyeball with the tube). He proceeded to argue with me that he didn't poke him in the eye. Christ.

Tell him to tape the eyes first or next time you'll stick a 14G in his eyeball

5) Walking into a room to check on how a case was going just to find that the resident took the initiative to do something stupid. Like moving the BP cuff to the side with the fresh AV fistula, or running 0.2 of sevo alone (with rocuronium) on a healthy pt for the past 45 mins because her BP was low ("don't worry, I gave scopolamine") Christ.

Do this again a i'll bash your head on the vaporizer.

6) Having other attendings try to dump their work on you or try to get you to rewrite their papers without giving you credit or try to take advantage of you in everyway possible.

Tell them to FO

7) Dealing with lazy, disrespectful OR nurses who want to blame others rather than working together to make the system work.

Get to work or get a report filed.

It's nice to be nice but sometimes you have to step up to the MIC

 

[bobg504]

Seems like you're a nice guy... maybe too nice:

Tell them to STFU if they finish late it's because they are lazy or inefficient period. I'm rotating at this hospital which everybody told me that the hours were horrible and you'd finish at 7pm on average. I'm out everyday at 5 because i do my job + half of the nurse's.




Tell him to tape the eyes first or next time you'll stick a 14G in his eyeball



Do this again a i'll bash your head on the vaporizer.



Tell them to FO



Get to work or get a report filed.

It's nice to be nice but sometimes you have to step up to the MIC

LMAO...I just got my chuckle for today!

 

[invitro]

That sucks man. It seems like you are a good attg....we really need more of them in academics.

Stuff like that sucks...but it's program dependent. Maybe you were at the wrong program?

 

[Breezee]

I guess academics as well as PP has its disadvantages. However, I am wondering if there will be a shift towards graduates taking more jobs in academics given the direction the economy and government are going. To some, it may seem to be a more secure job to be in a university-based setting or other academic setting.

 

[ProRealDoc]

Ok, this is not a private practice is better than academics thread. What this is is my perspective on the parts about being in academic medicine I did not like for those of you considering it. I did academics for a year, and now am in private practice which has its own negatives.

1) Some days are really boring when you have good residents covering easy cases. I always thought I could read books or whatever during that time, but it's still just boring.

2) Residents who whine all the time. Some just complain and whine about how late they work EVERYDAY, how unfair it is, how others get to go home before them ALL THE TIME, how it's basically a conspiracy to keep them late. Suck it up.

3) Watching a resident flail on a procedure which you know you can do in 30 seconds while the surgeon is pushing you to hurry up. Patience is a virtue.

4) Trying to make constructive criticisms to the resident who gets very defensive without making them defensive. For example, I suggested to a resident to tape the eyes before intubation after I clearly saw him poke the patient in the eye with the endotracheal tube before intubating the pt while he concentrated on getting a view (he accidentally flipped the eyelid open and scraped the eyeball with the tube). He proceeded to argue with me that he didn't poke him in the eye. Christ.

5) Walking into a room to check on how a case was going just to find that the resident took the initiative to do something stupid. Like moving the BP cuff to the side with the fresh AV fistula, or running 0.2 of sevo alone (with rocuronium) on a healthy pt for the past 45 mins because her BP was low ("don't worry, I gave scopolamine") Christ.

6) Having other attendings try to dump their work on you or try to get you to rewrite their papers without giving you credit or try to take advantage of you in everyway possible. Though that happens too in private practice but less.

7) Dealing with lazy, disrespectful OR nurses who want to blame others rather than working together to make the system work. Private practice was such a huge refreshing change in this respect.

8) The worst: having your license on the line for trainees who by definition are training and will make mistakes when you are not in the room. I had a colleague get sued because something a resident did that was completely out of my colleague's control. Now that lawsuit follows him everywhere.

That's not to say academics was horrible; it has a lot of positives and fun things to it as well. Just wore me out.

How is this any different when attendings are training CRNAs/SRNAs?

 

[ProRealDoc]

duplicate

 

[maduram]

Interesting thread -- definitely appreciate the insight about academic anesthesia.

Just a quick question, but do academic attendings get dedicated non-clinical time for research?

I've heard that one of the perks of being an academic attending is that there is a substantial amount of support for research -- i.e. dedicated non-clinical days for research, departmental grants for research projects, etc. I'm curious whether it's possible to do publication-quality clinical research in private practice without all the support that academic attendings get from their home institution.

 

[DO Anes]

How is this any different when attendings are training CRNAs/SRNAs?

CRNA's/SRNA's far, far less whiny than residents. No comparison; not even close. No surprise that CRNA profession so powerful. They do their job, within defined parameters and generally don't whine or complain nearly as much. Sad but true. Residents looking for lifestyle and the job is just that, a job, never a profession or calling. Say anything different and the residents will be at the GME office complaining about how they are "mistreated".

 

[dhb]

It's hard to whine when you're a clock puncher...

 

[Prodigal OU Son]

Interesting thread -- definitely appreciate the insight about academic anesthesia.

Just a quick question, but do academic attendings get dedicated non-clinical time for research?

I've heard that one of the perks of being an academic attending is that there is a substantial amount of support for research -- i.e. dedicated non-clinical days for research, departmental grants for research projects, etc. I'm curious whether it's possible to do publication-quality clinical research in private practice without all the support that academic attendings get from their home institution.

From the places I've been....there are two paths you can take....one research focused...one more clinical. A program (depending on size) may have 2-4 attendings heavy on teaching/research...they run mock orals,etc....the clinical guys are usually the ones you get your hearts and heads from.

Some dabble in both.

Most places are flexible on what path you want to take....and I've known some who have changed paths after a few years.....

Nothings ever set "in stone"

 

[ProRealDoc]

CRNA's/SRNA's far, far less whiny than residents. No comparison; not even close. No surprise that CRNA profession so powerful. They do their job, within defined parameters and generally don't whine or complain nearly as much. Sad but true. Residents looking for lifestyle and the job is just that, a job, never a profession or calling. Say anything different and the residents will be at the GME office complaining about how they are "mistreated".

Then you are not working with the type of CRNA who wants to go home 2 hrs before their shift is over and whines and complains when this does not happen. Besides if they whine, do you think they will say it in your face? Come on.

I agree with the fact that some residents are also lazy but by self-selection, most medical students/residents are hard working people.

 

[guitarguy09]

It's hard to whine when you're a clock puncher...

👍

 

[ssmallz]

CRNAs get paid 3-4x what reisdents get pair/hr, work far less hrs/week, have more time off, and essentially do the same job. Who do you expect to complain more? CRNAs also get treated w/more respect b/c they can leave at anytime and find another job. Residents have no such option. This is just not a fair comparison IMO

 

[Jalopycat]

It's hard to whine when you're a clock puncher...

Ding ding ding! We have a winner, folks!

 

[lfesiam]

Medicine is a noble profession.

Teaching is a noble profession.

Teaching Medicine = noble X 2.

Educating, inspiring future generations, shaping young minds and lives...leaving a life long legacy to those you have taught.

If it wasn't for the anesthesiology Attendings who helped me through out my medical school career, I won't be where I am today.

👍 for the Academia folks.

 

[foxtrot]

CRNAs get paid 3-4x what residents get pair/hr, work far less hrs/week, have more time off, and essentially do the same job. Who do you expect to complain more? CRNAs also get treated w/more respect b/c they can leave at anytime and find another job. Residents have no such option. This is just not a fair comparison IMO

Not to mention, when I was a resident, the SRNA's took maybe one night of call per month, if it was more, it was elective. And they got out much earlier than the residents, so really your comparison is b.s.

 

[ThinkTooMuch]

sounds like to me most med students are still babies. no wonder they complain so much in the other sections. glad ive been out of undergrad for 3 years and working full time.

 

[Saladin MD]

CRNAs get paid 3-4x what reisdents get pair/hr, work far less hrs/week, have more time off, and essentially do the same job. Who do you expect to complain more? CRNAs also get treated w/more respect b/c they can leave at anytime and find another job. Residents have no such option. This is just not a fair comparison IMO

Excellent post.

Pay a CRNA $40,000/yr, call every fourth day, and 60+ hours per week. Then we might have a proper comparison.

 

[Jeff05]

umm, yea.
if i got paid 150k for working 4 days a week and no weekends without any real liability as a NURSE, i wouldn't b1tch much.

 

[somedumbDO]

Excellent post.

Pay a CRNA $40,000/yr, call every fourth day, and 60+ hours per week. Then we might have a proper comparison.

or call Q3 and 70+ hours per week. staying till 515 pre call to relieve said CRNA so they can go home to their families.....

 

[Lonestar]

life's a bitch. I have heard plenty of CRNAs whine. Thats all they do. so the above arguments are null and void.

It comes down to personalities. And medicine has a lot of those A type slackass personalities.

Get to work you little nerds. Your daddy attendings need you to kiss their *****es. 😀

 

[sweetalkr]

start hiring AA's (anesthesiology assistants)
and start promoting them. even as residents (when u are a CA-3 and ur job/fellowship is locked up)
then slowly watch the crna salary drop over the next 10 years. laugh. do a fellowship. work in the post/pre-op phase or pain/critical care, and laugh some more. get paid more.
and continue to lobby for AA
the AA students actually join the ASA for the most part. we are big proponents of them now!

 

[Lefty]

Man, those reasons from the original post are exactly why I decided not to do academics.

CambieMD, are you reading this thread?

 

[CambieMD]

Ok, this is not a private practice is better than academics thread. What this is is my perspective on the parts about being in academic medicine I did not like for those of you considering it. I did academics for a year, and now am in private practice which has its own negatives.

1) Some days are really boring when you have good residents covering easy cases. I always thought I could read books or whatever during that time, but it's still just boring.

2) Residents who whine all the time. Some just complain and whine about how late they work EVERYDAY, how unfair it is, how others get to go home before them ALL THE TIME, how it's basically a conspiracy to keep them late. Suck it up.

3) Watching a resident flail on a procedure which you know you can do in 30 seconds while the surgeon is pushing you to hurry up. Patience is a virtue.

4) Trying to make constructive criticisms to the resident who gets very defensive without making them defensive. For example, I suggested to a resident to tape the eyes before intubation after I clearly saw him poke the patient in the eye with the endotracheal tube before intubating the pt while he concentrated on getting a view (he accidentally flipped the eyelid open and scraped the eyeball with the tube). He proceeded to argue with me that he didn't poke him in the eye. Christ.

5) Walking into a room to check on how a case was going just to find that the resident took the initiative to do something stupid. Like moving the BP cuff to the side with the fresh AV fistula, or running 0.2 of sevo alone (with rocuronium) on a healthy pt for the past 45 mins because her BP was low ("don't worry, I gave scopolamine") Christ.

6) Having other attendings try to dump their work on you or try to get you to rewrite their papers without giving you credit or try to take advantage of you in everyway possible. Though that happens too in private practice but less.

7) Dealing with lazy, disrespectful OR nurses who want to blame others rather than working together to make the system work. Private practice was such a huge refreshing change in this respect.

8) The worst: having your license on the line for trainees who by definition are training and will make mistakes when you are not in the room. I had a colleague get sued because something a resident did that was completely out of my colleague's control. Now that lawsuit follows him everywhere.That's not to say academics was horrible; it has a lot of positives and fun things to it as well. Just wore me out.

Academics is not for everyone. I have to deal with a million different scenerios
and personalities every day. Most residents are hard working and bright.

Some days are more challenging than I want them to be but I enjoy my job.
# 8 can occur supervising crnas.

The interpersonal issues like lazy nurses are found in all settings. Some of your reasons for leaving academics are present in PP.Troublesome issues exist in all practice settings they merely change based on your given practice environment.


Cambie

p.s difficult block today, Lefty?

 

[Nuriko]

Medicine is a noble profession.

Teaching is a noble profession.

Teaching Medicine = noble X 2.

Educating, inspiring future generations, shaping young minds and lives...leaving a life long legacy to those you have taught.

If it wasn't for the anesthesiology Attendings who helped me through out my medical school career, I won't be where I am today.

👍 for the Academia folks.

It would seem that nobility comes with ALOT of bullsh!it!

 

[countingdays]

This was the best academic vs PP thread I could find. I know it's mostly old.

Anybody else have an opinion about academic vs private practice jobs? I'm having a hard time choosing between two jobs, both in my prefered city.

Academic- better cases, nicer pace maybe, resident interaction, 2 rooms
Private- better pay, more vacation, no non-clinical responsibilities, 4 rooms

I know that in the end I just have to decide what kind of career I really want, but hearing other peoples opinions can help, even if we don't always agree.

 

[Narcotized]

Ok, this is not a private practice is better than academics thread. What this is is my perspective on the parts about being in academic medicine I did not like for those of you considering it. I did academics for a year, and now am in private practice which has its own negatives.

1) Some days are really boring when you have good residents covering easy cases. I always thought I could read books or whatever during that time, but it's still just boring.

2) Residents who whine all the time. Some just complain and whine about how late they work EVERYDAY, how unfair it is, how others get to go home before them ALL THE TIME, how it's basically a conspiracy to keep them late. Suck it up.

3) Watching a resident flail on a procedure which you know you can do in 30 seconds while the surgeon is pushing you to hurry up. Patience is a virtue.

4) Trying to make constructive criticisms to the resident who gets very defensive without making them defensive. For example, I suggested to a resident to tape the eyes before intubation after I clearly saw him poke the patient in the eye with the endotracheal tube before intubating the pt while he concentrated on getting a view (he accidentally flipped the eyelid open and scraped the eyeball with the tube). He proceeded to argue with me that he didn't poke him in the eye. Christ.

5) Walking into a room to check on how a case was going just to find that the resident took the initiative to do something stupid. Like moving the BP cuff to the side with the fresh AV fistula, or running 0.2 of sevo alone (with rocuronium) on a healthy pt for the past 45 mins because her BP was low ("don't worry, I gave scopolamine") Christ.

6) Having other attendings try to dump their work on you or try to get you to rewrite their papers without giving you credit or try to take advantage of you in everyway possible. Though that happens too in private practice but less.

7) Dealing with lazy, disrespectful OR nurses who want to blame others rather than working together to make the system work. Private practice was such a huge refreshing change in this respect.

8) The worst: having your license on the line for trainees who by definition are training and will make mistakes when you are not in the room. I had a colleague get sued because something a resident did that was completely out of my colleague's control. Now that lawsuit follows him everywhere.

That's not to say academics was horrible; it has a lot of positives and fun things to it as well. Just wore me out.

Gypsy, I'll take the bait and answer this post.
1) I was far more bored in private practice. Most days academic tertiary center patients are sick as crap and surgeries complicated as Hell.
2) Can't comment without knowing the environment. Maybe your program is malignant for all I know. Have some empathy. Residency sucks even at the best places. You forget already? Some are whiners. Most are hardworking and worn out.
3) Honestly don't think teaching is for you. You were that identical flailing resident a while back if you think about it.
4) Judging from your entire post you could be that guy on everyone's ass all day, so being defensive after a while is a natural reaction.
5) Judging from comments 1, 2, 3, 5, and 6, you might just be at a really crappy program and need to go elsewhere.
6) Where the Hell do you work?
7) Where the Hell do you work? Private practice was worse.
8) Yeah, gotta agree, that's a bitch. Goes with the territory of teaching novices, unfortunately.

 

[checkov]

This was the best academic vs PP thread I could find. I know it's mostly old.

Anybody else have an opinion about academic vs private practice jobs? I'm having a hard time choosing between two jobs, both in my prefered city.

Academic- better cases, nicer pace maybe, resident interaction, 2 rooms
Private- better pay, more vacation, no non-clinical responsibilities, 4 rooms

I know that in the end I just have to decide what kind of career I really want, but hearing other peoples opinions can help, even if we don't always agree.

Just putting this out there based on your posting history, but GypsySongman, you definitely seem like a cool person to work with / someone who enjoys teaching. Based on that presumption, I'd say that you'd be a great fit for an academic institution.

Just out of curiosity, may I ask what the percentage difference between the pay offer at the academic vs private hospital is?

 

[countingdays]

[OQUOTE=checkov;10630810]Just putting this out there based on your posting history, but GypsySongman, you definitely seem like a cool person to work with / someone who enjoys teaching. Based on that presumption, I'd say that you'd be a great fit for an academic institution.

Just out of curiosity, may I ask what the percentage difference between the pay offer at the academic vs private hospital is?[/QUOTE]

Well the difference in yearly pay is minimal starting out, less than 10%, but my expectation of the pay in 5 years is probably 60% different with vacation of 3 weeks vs 9 and similar call. The numbers strongly favor private practice though I'd probably enjoy the average work day more working with residents in academics.
Academic attendings may give up millions in income over the course of their careers. I think it'd be helpful to see why some of them were able to make that decision. To some extent it's comparing apples and oranges since the jobs may not be that similar, but are they really THAT different?
It helps that you make a good living either way.

 

[sevoflurane]

I can't comment on being an attending in an academic institution as I never was one.

As for PP, I am very happy. I don't supervise and I think that makes a huge differnce in the day to day grind. Yeah... you may find yourself doing 2 appy's, a couple of gallbladders and even some ERCP's on any given day. Boring....? Yes... that day. But that is OK. I enjoy the chill time. You could have a ruptrured AAA, followed by a stat c/s, follwed by an emergent heart, culminating with an I&D of a butt abscess. Sure, trhat isn't everyday... but it does happen.

If you work in a 300+ bed hospital, you are going to get some variety- that is the key. If you go PP, go for a place that does everything so that YOU can do everything... from peds to cardiac to regional to vascular etc.

As for academics. Well, that's where the liver/heart/lung tx, high risk OB, kiddie syndromes, , ASA V patients are hanging out. But that is not to say you will do all these cases. A lot of academics institutions are partitioned into cardiac, peds, ob, liver teams.

What I can say is that I def. miss some of the big cases like hemipelvectomies, livers, (my personal favorite case of all time) etc... and well, having an academic day once a week sounds pretty sweet.

You can always do PP for some time and then go into academics as a seasoned gas passer.

Good luck. Tough decision for some.

 

[johncunningham]

If you are faced with a choice between a good private practice group in an area you like and an academic place in the same area I think the decision is an easy one. Go to the private group. They won't be hiring every day and if you find that you love it well then you are set. If you are unhappy then the job at the academic place will still be there. In my limited experience it seems that the academic places have a fair amount of churn and are nearly always hiring. A good private practice may only hire once every few years.

John

 

[cchoukal]

Someone pointed it out above, but it deserves repeating: The two types of jobs are completely different and it's really difficult to compare. They're so different, in fact, that it's hard to imagine a person could be all that torn between the two, unless they were having a hard time being honest with themselves about what they REALLY wanted and what was truly important to them.

I'm an academic and I love it. I work hard, do interesting cases, teach curious, intelligent people about physiology, pharmacology, politics, and patient care. I get to attend in two different ICUs. I get to dabble in research (for now). I have mentors that help me navigate the icy waters of academia. My colleagues, for the most part, are supportive, and, unlike what some of my PP friends are experiencing, they are willing to help with a difficult case.

I'm not sure if it's more/fewer hours than PP. Maybe I spend less time in the OR, but there's more time in the ICU, writing notes, conferring with consultants, dealing with issues after hours, the occasional death certificate and discharge summary, etc, not to mention the other stuff that helps promote your career. You'll certainly spend more than your meager non-clinical time allotment on such things if you want to get promoted. Maybe the PP correlate is that if you want to make partner, you have to volunteer to take more call, or switch days when your partners want it.

I could certainly make more money in PP, but I'd be doing a very different job. Invariably, I'd be in the OR 5 days a week, with no teaching, no research, and no ICU. That's neither good nor bad, it's just either what you want or not.

 

[cchoukal]

As an additional aside, I think it's really hard to be honest about what you REALLY want. Partly, we get tought that medicine is noble and that academics is the highest form of such nobility, that going into practice is somehow selling out. Our mentors in medical school and residency don't help matters. They have no experience in anything other than academics, and so they have no perspective or ability to mentor in that way.

Anyway, so I think that's the core issue, to figure out what you truly want and then be willing to own it and do it. If you can do that, the decision will make itself.

 

[C.P.]

This was the best academic vs PP thread I could find. I know it's mostly old.

Anybody else have an opinion about academic vs private practice jobs? I'm having a hard time choosing between two jobs, both in my prefered city.

Academic- better cases, nicer pace maybe, resident interaction, 2 rooms
Private- better pay, more vacation, no non-clinical responsibilities, 4 rooms

I know that in the end I just have to decide what kind of career I really want, but hearing other peoples opinions can help, even if we don't always agree.

I troll around this forum a lot, and have been doing so over the past several years (I'll try and be a bit more helpful form now on).

Take the private job.

You've never done private practice through your training, it's hard to get a solid feel for it until you're in it, and you can always go back to academics.

If you were looking at an academic appointment where you trained, they'll still want you back a year or two later, and then, you'll have gotten your feet planted, refined your skills, learned a bit more about medicine and anesthesia than just the way your training institution does things.
. . . and you'll be coming back as an attending, not the resident that everyone's known for the last 3-4 years.
You'll also have more leverage to negotiate your academic contract, since you've already got a job when you're applying.

Think of it as a "fellowship in private practice anesthesia," but a fellowship that pays much better than any other fellowship offered.

I know some people are going to say "it's a waste of time," "you'll be sacrificing years in a partnership tract that you won't end up using in the end," but that's not true.

You're getting a chance to see a totally different aspect of "practicing" anesthesia, instead of just administering it.

If you signed up to a practice, didn't like it, and are considering going back to academics, then you would have been leaving the group anyway, whether it was to go to academics or simply another group.

Go private, at least for a year.
It's good experience and may be a career choice in the end you'll stick with.

 

[countingdays]

As an additional aside, I think it's really hard to be honest about what you REALLY want. Partly, we get tought that medicine is noble and that academics is the highest form of such nobility, that going into practice is somehow selling out. Our mentors in medical school and residency don't help matters. They have no experience in anything other than academics, and so they have no perspective or ability to mentor in that way.

Anyway, so I think that's the core issue, to figure out what you truly want and then be willing to own it and do it. If you can do that, the decision will make itself.

Oh I know what I want- to take the academic peds job but to get more than 3 weeks of vacation and to have a better income. 👍 Unfortunately what I really want isn't one of the options. 👎
Actually I'd be totally happy with the academic income, it's just when I compare them side-by-side that it doesn't seem so great. I'd even be willing to loose some income to get a couple of more weeks of vacation, but I don't think that's an option either. I think that in academics, people view time off as a sign of laziness while PP views time off as a positive. I don't know what those guys are doing on their computers all the time (SDN???), but I'd rather take my kids to the park or something.

 

[Frank Rizzo]

If you are faced with a choice between a good private practice group in an area you like and an academic place in the same area I think the decision is an easy one. Go to the private group. They won't be hiring every day and if you find that you love it well then you are set. If you are unhappy then the job at the academic place will still be there. In my limited experience it seems that the academic places have a fair amount of churn and are nearly always hiring. A good private practice may only hire once every few years.

John

This is very true, at least in my area/market. People STAY if they're in a good group, making available positions in said groups few and far between. That group may not need to hire again for a couple of years. I would say take the PP job and give it a try. Like somebody else said, you may think you know what PP is about from some sort of ambulatory exposure that you had, but it doesn't even skim the surface. At least, thats what I have personally experienced. If you don't like it, the academic job will more than likely still be there.

Also, don't let anyone talk you into believing that its all ASA I-II's out here. My cases today: pericardial window with RA collapse on echo, followed by emergent CABG cuz the cards cath jockeys dissected the LM, followed by an appy on a 22 yo kid. I'm not ashamed to admit I didn't mind doing the appy!

I won't get into the whole 'do your own case vs supervise' debate, as it sounds like both jobs you listed would involve supervision. I'm lucky enough that I get to do both where I work... some days I do my own rm, some days I supervise 4. I believe both models have their advantages and disadvantages.

 

[Frank Rizzo]

Oh I know what I want- to take the academic peds job but to get more than 3 weeks of vacation and to have a better income.

3 weeks, huh? i think walmart starts people out at 2 weeks a year. And your fellowship/residency position, which pays you less than the walmart hourly wage for the amout of hours you work, gives you 4 a year.

 

[michigangirl]

Yes- 4 weeks should be the minimum at academic institutions. agree with everything cchouka1 said above. on the money. Yes, academics is usually a pay cut, but there are important advantages-- flexibility, ability to dabble in research or get funding and primarily do research, do the cases that are only done in academic centers, teach, and dabble in a little administrative stuff if that tickles your fancy. For example, at our institution, full time is 3 days/week. Yes, you're expected to do research/administrative stuff at least one of those two non-clinical days but that means no early morning, wearing normal clothes, and getting to do something not involving the operating room that you might enjoy.

Mind you I have no private practice experience. The above plus what cchouka1 said is why I will most likely always be in academics. for me its somewhat of a lifestyle choice-- the flexibility and time are worth it to me for the paycut.

3 weeks, huh? i think walmart starts people out at 2 weeks a year. And your fellowship/residency position, which pays you less than the walmart hourly wage for the amout of hours you work, gives you 4 a year.

 

[cchoukal]

Yes- 4 weeks should be the minimum at academic institutions. agree with everything cchouka1 said above. on the money. Yes, academics is usually a pay cut, but there are important advantages-- flexibility, ability to dabble in research or get funding and primarily do research, do the cases that are only done in academic centers, teach, and dabble in a little administrative stuff if that tickles your fancy. For example, at our institution, full time is 3 days/week. Yes, you're expected to do research/administrative stuff at least one of those two non-clinical days but that means no early morning, wearing normal clothes, and getting to do something not involving the operating room that you might enjoy.

Mind you I have no private practice experience. The above plus what cchouka1 said is why I will most likely always be in academics. for me its somewhat of a lifestyle choice-- the flexibility and time are worth it to me for the paycut.

Wow, where are you that full time is 60%?

 

[FutrrENT]

Then you are not working with the type of CRNA who wants to go home 2 hrs before their shift is over and whines and complains when this does not happen. Besides if they whine, do you think they will say it in your face? Come on.

I agree with the fact that some residents are also lazy but by self-selection, most medical students/residents are hard working people.

Well said, my good man!

Even the laziest medical student is almost guaranteed to have a half-way decent work ethic and be reasonably smart . You don’t get to medical school without being able to kick some ass when push comes to shove.

 

[pencan]

I'll tell you how its different. When I was an SRNA I kept my mouth shut and did what I told whether it was by a CRNA or a doc. I was a guest in their house and they made the rules. It's a priveledge being at a facility willing to train an anesthesia student especially a new student on their first rotation. You stayed late and showed up early and if there was a really good case you stayed later just to do have the privilege of doing it. You didn't complain, you didn't take a break unless it was offered. You learned what the other providers preferred for their cases from other students before you even met them. You showed enormous initiative and flew under the radar. And lastly you addressed everyone as sir or maam and called the physicians doctor so and so even if everyone else called them by their first name.

How is this any different when attendings are training CRNAs/SRNAs?

 

[deleted126335]

I'll tell you how its different. When I was an SRNA I kept my mouth shut and did what I told whether it was by a CRNA or a doc. I was a guest in their house and they made the rules. It's a priveledge being at a facility willing to train an anesthesia student especially a new student on their first rotation. You stayed late and showed up early and if there was a really good case you stayed later just to do have the privilege of doing it. You didn't complain, you didn't take a break unless it was offered. You learned what the other providers preferred for their cases from other students before you even met them. You showed enormous initiative and flew under the radar. And lastly you addressed everyone as sir or maam and called the physicians doctor so and so even if everyone else called them by their first name.

That is the recipe for success for any trainee- anesthesia resident or CRNA student. I would add reading up on a case or a drug or technique before seeing it or doing it in the OR. You would be amazed how many people don't prepare for a new rotation.

 

[countingdays]

I guess academics as well as PP has its disadvantages. However, I am wondering if there will be a shift towards graduates taking more jobs in academics given the direction the economy and government are going. To some, it may seem to be a more secure job to be in auniversity-based setting or other academic setting.

duplicate

 

[ProRealDoc]

I'll tell you how its different. When I was an SRNA I kept my mouth shut and did what I told whether it was by a CRNA or a doc. I was a guest in their house and they made the rules. It's a priveledge being at a facility willing to train an anesthesia student especially a new student on their first rotation. You stayed late and showed up early and if there was a really good case you stayed later just to do have the privilege of doing it. You didn't complain, you didn't take a break unless it was offered. You learned what the other providers preferred for their cases from other students before you even met them. You showed enormous initiative and flew under the radar. And lastly you addressed everyone as sir or maam and called the physicians doctor so and so even if everyone else called them by their first name.

So am I to assume that you represent the majority of SRNAs out there? You are likely the exception, at least where I trained you would be.