What to do with my hatred of academic medicine?

[coconutlover]

Essentially, I have grown to despise academic medicine. I see so many problems linked to academic medicine that plague medicine now. Like obsession on specialization (since academic medicine takes cues from academia general idea of phds specializing on really small things, and wasting time doing research). Lot of academic physicians worked on ACA that completely ****ed us over. Academic docs I'm around constantly **** talk private practice. Academic docs I've talked to seem to extremely financially illiterate and do not understand basic money stuff and don't really like talking about money. On top of that so many academic docs I've talked to seem to be in full-throated support for scope creep. I hate this so much, 5% of doctors work for academics and I have to work with these chuds for the next decade.... Community doctors are so much more normal in comparison. Also, the "provider" usage, these academic docs love this verbiage. So many weird things.

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[LucidSplash]

The title was “what to do” with your hatred. This seems like mostly a vent post. You’re entitled to your perspective and feelings. Academics serves a purpose but it isn’t for everyone and both sides of the coin have a particular perspective on their own choice and the choices of others.

But to answer the question of what to do? Don’t go into academic medicine. 🤷🏼‍♀️

 

[Putkernerinthehall]

Essentially, I have grown to despise academic medicine. I see so many problems linked to academic medicine that plague medicine now. Like obsession on specialization (since academic medicine takes cues from academia general idea of phds specializing on really small things, and wasting time doing research). Lot of academic physicians worked on ACA that completely ****ed us over. Academic docs I'm around constantly **** talk private practice. Academic docs I've talked to seem to extremely financially illiterate and do not understand basic money stuff and don't really like talking about money. On top of that so many academic docs I've talked to seem to be in full-throated support for scope creep. I hate this so much, 5% of doctors work for academics and I have to work with these chuds for the next decade.... Community doctors are so much more normal in comparison. Also, the "provider" usage, these academic docs love this verbiage. So many weird things.

Seems like a disparate range of complaints. If there is a central tenet to your post, it seems to be about money and getting yours. Am I right?

 

[Angus Avagadro]

Sometimes academicians can be pedantic. I have worked with arrogant docs in academics and in private practice. Academic centers are stricter when dealing with bad behaving surgeons. Ones in PP bring in money and they are often granted some leeway with behavior. Training in academic centers has positives and negatives. You are on teaching services with residents and fellows, journal clubs to teach you how to critically examine a scientific paper, attending bedside discussions, Morbidity and Mortality conferences, and Grand Rounds. Negatives would include being in the back of the line and not getting much hands on experience. Medical school only lasts a matter of months. You will then be free to move on in any direction that excites you. Good luck and best wishes!

 

[GoSpursGo]

FWIW, plenty of private practice docs also **** talk academia.

For you, it's a necessary evil to complete your training. Suck it up, learn what you need, get out when you can.

 

[operaman]

Ding ding. Get trained and then find the practice that’s right for you.

For me that was a privademic position. I get the parts of academic medicine I like - cool pathology, great hospital and multidisciplinary support, resources, teaching residents and students.

None of what I don’t like- research pressure, bs meetings, other academic responsibilities.

And the pay is stupid good - my second year out of training made more than my last 2 chairmen. Combined.

So you do you and find where you fit once you finish training. I really liked most of the docs who trained me so maybe you’re just in a bad situation with a bad culture. Not everywhere is like that, but you certainly hit some aspects of academia that are universal.

 

[Mr.Smile12]

Congratulations! That's what doing all these clerkships and shadowing is all about. At least you have an idea eyes wide open about what you really don't like and be prepared in case you have to work a few years in those environments (which many people do). No job is ideal until you get the point where you can be your own boss; then whatever problems you get are your own fault.

 

[Med Ed]

Academic docs I've talked to seem to extremely financially illiterate and do not understand basic money stuff and don't really like talking about money.

Good news, once you're in private practice you'll notice that all anyone ever talks about is money.

Actually that's not true. Sometimes they talk about how many weeks of vacation they get per year. After 10-15 years they talk about how they're burnt out doing the same thing over and over, and can't wait to reach financial independence.

The only real winners in this are the people like @operaman who manage to get the best of both worlds.

 

[coconutlover]

Seems like a disparate range of complaints. If there is a central tenet to your post, it seems to be about money and getting yours. Am I right?

Well I talked to one academic doctor (PCP) how if you want to be rich as a doctor you needed to get a sugar mommy or sugar daddy.... Like this level of like ****edness and attitude that if your a doctor your a broke, it makes no sense since so many community docs are pretty well off.

 

[coconutlover]

Ding ding. Get trained and then find the practice that’s right for you.

For me that was a privademic position. I get the parts of academic medicine I like - cool pathology, great hospital and multidisciplinary support, resources, teaching residents and students.

None of what I don’t like- research pressure, bs meetings, other academic responsibilities.

And the pay is stupid good - my second year out of training made more than my last 2 chairmen. Combined.

So you do you and find where you fit once you finish training. I really liked most of the docs who trained me so maybe you’re just in a bad situation with a bad culture. Not everywhere is like that, but you certainly hit some aspects of academia that are universal.

Interesting, might be a nice angle for me... What is leading to your higher income? Is it more admin work over seeing patients?

 

[coconutlover]

The title was “what to do” with your hatred. This seems like mostly a vent post. You’re entitled to your perspective and feelings. Academics serves a purpose but it isn’t for everyone and both sides of the coin have a particular perspective on their own choice and the choices of others.

But to answer the question of what to do? Don’t go into academic medicine. 🤷🏼‍♀️

What are healthy way to handle these feelings? Like healthy ways to handle the negative sentiments I have? Because I know being negative is a good way to lose energy and get burned out

 

[LucidSplash]

What are healthy way to handle these feelings? Like healthy ways to handle the negative sentiments I have? Because I know being negative is a good way to lose energy and get burned out

What year are you in and how long is your training?

The short version is to realize this is the means to an end. I’m a firm believer in “I can do anything for a defined limited period of time” and residency is by nature a defined limited period of time. My fellowship was absolutely miserable. I cried a lot. But in the end it was 2 years and I got through it by focusing on getting to the other end. It’s a marathon, not a sprint. You focus on the goal and remind yourself of the fact that your life will be your own again in a defined period of time and that you are working towards that goal.

 

[Med Ed]

Lot of academic physicians worked on ACA that completely ****ed us over.

Like this level of like ****edness

What are healthy way to handle these feelings? Like healthy ways to handle the negative sentiments I have? Because I know being negative is a good way to lose energy and get burned out

Reduce exposure to the outrage economy (particularly difficult in an election year) and focus on developing healthy in-person relationships.

 

[operaman]

Interesting, might be a nice angle for me... What is leading to your higher income? Is it more admin work over seeing patients?

For me it’s a combo of overall productivity, efficiency, and compensation per RVU of productivity. For others in truly pp the money comes from that plus ancillary income streams. I don’t really have much admin work at all to be honest.

Academia in general tends to underpay relative to the overall market, though there are definitely exceptions with some academic docs well into the 7 figures. But at least in my field, many academic jobs were paying 30-40% less per RVU than overall market value. I never really cared about that before, but now being accustomed to a high income I look at academic jobs offering $250k and wonder why I ever considered taking such a position.

Generally speaking, outside academics your income is directly related to your productivity. Do double the average volume and you can generally expect double the average comp. The key is to do this through good coding and efficiency rather than sheer number of hours worked so you don’t burn out. For fields like mine, that’s typically achieved either through efficient procedure-heavy clinics, or lots of OR time doing cases that reimburse very highly (this is how spine surgeons can crush it). Mine is mostly the former.

Mine really is kind of a unicorn job and I have no doubt it’s going to change. Admin basically leaves me alone, I make my own schedule, and comp is awesome. At some point I’m sure admin is going to make it suck more, but for now they leave me alone. So I work very hard and do insane volumes but leave the office every day around 3pm with all paperwork done.

 

[IlDestriero]

Not all academic jobs are terrible. I’m in a hybrid anesthesia group, high income, low call, nice gig. They’re out there, and they all have different expectations and tracks. Having said that, if you don’t like teaching, research, etc. maybe private practice is a better fit. Being a partner in a private group that you own has a lot of opportunities for things that W2 academic groups can’t offer.

 

[Hollow Knight]

Go work community like the rest of the people who feel the same as you.

Also, FWIW, not all academics is bad, maybe just your institution. I'd love to be a professor at my school

 

[annoyedpsychiatrist]

i dont work for a school but i work in a hospital based private practice and teach residents/med students and get paid quite well

ultimately people have their own motivations for medicine. You just have to folllow yours. What others do wont stop you from your path.

 

[MadRadLad]

This is not an academia issue, it's an anger management issue. Nobody is forcing you stay in academia when you're done, but if you don't change your approach then you're going to find just as many things to be miserable about in PP. The line between academics and community has also blurred significantly.

 

[Wamuu]

Ding ding. Get trained and then find the practice that’s right for you.

For me that was a privademic position. I get the parts of academic medicine I like - cool pathology, great hospital and multidisciplinary support, resources, teaching residents and students.

None of what I don’t like- research pressure, bs meetings, other academic responsibilities.

And the pay is stupid good - my second year out of training made more than my last 2 chairmen. Combined.

So you do you and find where you fit once you finish training. I really liked most of the docs who trained me so maybe you’re just in a bad situation with a bad culture. Not everywhere is like that, but you certainly hit some aspects of academia that are universal.

What exactly is "privademic" and how do you even achieve that?

 

[operaman]

What exactly is "privademic" and how do you even achieve that?

Lots of ways. In my case, hospital employed position at a public safety net hospital that is also the defacto university hospital in my area. I also have a faculty appointment at the university but the university doesn’t run the hospital nor do they pay my salary. That means I get cool cases, resources, teaching students and residents, but nobody gives a rats patoot how much I publish or present or whether I serve on bs committees.

Other ways are straight PP where you have an adjunct faculty appt and have students/residents rotate with you, or university employed but a satellite site with a fully clinical appointment.

Basically it’s looking to have the best of both worlds, whatever that means to you. Obviously if you want a heavy research track and R01 funding, you usually have to go straight academic. But if you’re like me and want to do bigger interesting cases and have the resources to handle them safely, and you enjoy teaching, then privademic can be a nice option.

I think the key thing to look for is where the money comes from because that will determine what truly matters. Privademic is going to be employed or group PP positions at heart where you are primarily a clinical entity. They don’t expect research and they don’t really give you paid protected time to do it either.

 

[Wamuu]

Lots of ways. In my case, hospital employed position at a public safety net hospital that is also the defacto university hospital in my area. I also have a faculty appointment at the university but the university doesn’t run the hospital nor do they pay my salary. That means I get cool cases, resources, teaching students and residents, but nobody gives a rats patoot how much I publish or present or whether I serve on bs committees.

Other ways are straight PP where you have an adjunct faculty appt and have students/residents rotate with you, or university employed but a satellite site with a fully clinical appointment.

Basically it’s looking to have the best of both worlds, whatever that means to you. Obviously if you want a heavy research track and R01 funding, you usually have to go straight academic. But if you’re like me and want to do bigger interesting cases and have the resources to handle them safely, and you enjoy teaching, then privademic can be a nice option.

I think the key thing to look for is where the money comes from because that will determine what truly matters. Privademic is going to be employed or group PP positions at heart where you are primarily a clinical entity. They don’t expect research and they don’t really give you paid protected time to do it either.

Do you normally have to be approached by the school in order to get a faculty role? I've never really heard of any medical programs that don't have some form of affiliation with a hospital or their own system.

 

[operaman]

Do you normally have to be approached by the school in order to get a faculty role? I've never really heard of any medical programs that don't have some form of affiliation with a hospital or their own system.

I think it varies. I reached out when I took the job here and just made it happen. Truth is, if it’s just an adjunct clinical role and they aren’t actually paying you, it’s especially easy!

You see this in many VA academic jobs - you’ll get hired full time by the VA but have an adjunct faculty appt with the affiliated university. You’ll have residents and students rotate and you can even do research if you want, but you primarily work for the VA and get paid by them.

 

[Karlington]

Essentially, I have grown to despise academic medicine. I see so many problems linked to academic medicine that plague medicine now. Like obsession on specialization (since academic medicine takes cues from academia general idea of phds specializing on really small things, and wasting time doing research). Lot of academic physicians worked on ACA that completely ****ed us over. Academic docs I'm around constantly **** talk private practice. Academic docs I've talked to seem to extremely financially illiterate and do not understand basic money stuff and don't really like talking about money. On top of that so many academic docs I've talked to seem to be in full-throated support for scope creep. I hate this so much, 5% of doctors work for academics and I have to work with these chuds for the next decade.... Community doctors are so much more normal in comparison. Also, the "provider" usage, these academic docs love this verbiage. So many weird things.

You say they "**** talk private practice," and you do the same about academic medicine, so I guess you're two sides of the same coin.

Jokes aside, what you do is go work somewhere else. Simple.

 

[SurfingDoctor]

Essentially, I have grown to despise academic medicine. I see so many problems linked to academic medicine that plague medicine now. Like obsession on specialization (since academic medicine takes cues from academia general idea of phds specializing on really small things, and wasting time doing research). Lot of academic physicians worked on ACA that completely ****ed us over. Academic docs I'm around constantly **** talk private practice. Academic docs I've talked to seem to extremely financially illiterate and do not understand basic money stuff and don't really like talking about money. On top of that so many academic docs I've talked to seem to be in full-throated support for scope creep. I hate this so much, 5% of doctors work for academics and I have to work with these chuds for the next decade.... Community doctors are so much more normal in comparison. Also, the "provider" usage, these academic docs love this verbiage. So many weird things.

Welcome to the politics of academics...

Fundamentally.... the delineating feature of academics... "Do you want to actually figure out why some patients have an outcome of Y" or "Do want to publish X in the hopes it promotes your career"? You won't be able to delineate the two until its too late.

Private practice can't answer that. Academics may be able to, if you're lucky... but only if you're smart and interact with the right people. But there are a lot of duds in academics.

Good luck.

 

[operaman]

I forget where I first heard it, but it’s often said that there’s no doctor more miserable than a mediocre academic.

if you’ve got the chops to have a well funded lab and do quality work while also having a small clinical practice where you do mostly interesting academic level cases, then you may find yourself very happy there and even thriving.

Personally I just couldn’t get on board with the uncompensated demands on my personal time that a fully academic position would require. I don’t want to spend my evenings and weekends writing grants or revising manuscripts. I want to do interesting and meaningful things at work, and then I want to leave and have a full life outside of medicine.

 

[Goro]

For academics, whether PHD or MD/DO, one has to have the fire in the belly.

 

[Kierkegaard's Bud]

One must imagine Sisyphus writing grants!

 

[Wamuu]

I think it varies. I reached out when I took the job here and just made it happen. Truth is, if it’s just an adjunct clinical role and they aren’t actually paying you, it’s especially easy!

You see this in many VA academic jobs - you’ll get hired full time by the VA but have an adjunct faculty appt with the affiliated university. You’ll have residents and students rotate and you can even do research if you want, but you primarily work for the VA and get paid by them.

That sounds like a very cool gig. I know that one day I would love to teach/be involved academically but not have research obligations. Do you get paid per resident/student at all or is that not how adjunct faculty roles work?

 

[operaman]

That sounds like a very cool gig. I know that one day I would love to teach/be involved academically but not have research obligations. Do you get paid per resident/student at all or is that not how adjunct faculty roles work?

Oh yeah no extra pay - the one small drawback of such an arrangement. But the overall pay is so far beyond what I would make in pure academics that I don’t mind.

If my role expanded, like if I were to take on a larger admin role like being a PD or something, then my overall FTE would likely change a bit, probably from 1.0 to 0.9. I doubt I would change my volume much but my bonus threshold would decrease and thus I’d probably get paid a little bit more.

Really it’s a labor of love for most of us I think. I also want to make sure students have great experiences especially in my field. We are so desperate to recruit more good docs so part of me hopes that maybe one of these students will reach out for a position when they finish training in a few years because they felt comfortable and liked the working environment here. Time goes by so fast - I’m only 3 years out of fellowship myself and already some of my early students are PGY2s and graduating residency in 3 more years!

 

[IlDestriero]

Some hospitals or individual departments in those hospitals are affiliated with major medical centers and/or medical schools but are financially separate from them. In my case I’m a real professor at the medical school down the street, and the university pays me, gives me benefits, etc. but really all my income comes from my clinical work at a private hospital that they don’t get any part of. We also give ourselves some better benefits/perks that the university doesn’t offer. Being in the clinical track, I have no publication requirements, but I’ve participated in lots of research over the years and have lectured about my area of interest and expertise nationally and internationally. That’s the appeal for me. I get to work at a quaternary hospital system, teach residents and fellows, lecture peers, etc. All while practicing cutting edge medicine with other leaders in their fields, across many disciplines, determining best practices that we then publish and share with the world. That means a significant percentage of very complicated patients from all over that come here specifically for the specialized care that we can offer.
That gets me up in the morning, inspires me, and gets me through the hard times. I’ve been doing this 20 years and I still see syndromes I’ve never heard of, or perhaps have long forgotten, and pretty often, and get challenged with complicated surgical plans. But being on the pointy end of the spear definitely isn’t everyone’s jam, and even though we have a good gig, if you’re all about the dollars, you can go find a high paying eat what you kill PP job, work hard, and make the mad loot.

 

[Wamuu]

Oh yeah no extra pay - the one small drawback of such an arrangement. But the overall pay is so far beyond what I would make in pure academics that I don’t mind.

If my role expanded, like if I were to take on a larger admin role like being a PD or something, then my overall FTE would likely change a bit, probably from 1.0 to 0.9. I doubt I would change my volume much but my bonus threshold would decrease and thus I’d probably get paid a little bit more.

Really it’s a labor of love for most of us I think. I also want to make sure students have great experiences especially in my field. We are so desperate to recruit more good docs so part of me hopes that maybe one of these students will reach out for a position when they finish training in a few years because they felt comfortable and liked the working environment here. Time goes by so fast - I’m only 3 years out of fellowship myself and already some of my early students are PGY2s and graduating residency in 3 more years!

I like this way of seeing things. I will keep this in mind for when the time comes in a matter of years, thank you for your insight my friend.

 

[VincentAdultman]

Good news, once you're in private practice you'll notice that all anyone ever talks about is money.

Actually that's not true. Sometimes they talk about how many weeks of vacation they get per year. After 10-15 years they talk about how they're burnt out doing the same thing over and over, and can't wait to reach financial independence.

The only real winners in this are the people like @operaman who manage to get the best of both worlds.

We talk about cars, but they may be more of an ortho specific thing.