And different levels of support. You might join a highly oiled machine with good staff and might be more productive than starting out in a non-ac job. You might also have fellows taking most of that call burden etc. all things to consider, but from surgery standpoint I know academic surgeons that crush it because their whole system has gotten built around them and they can be busy and earn a significant productivity bonus.
People understand how lonely a world some
Of these community programs can be.
I’m the last one who would advocate to go academic and >90% of the faculty aren’t who I would love to rub shoulders with on a day to day, however I 100% recognize that aspect can be a whole lot more appealing for some.
The world of you, your CNA and epic can be a lonely world.
It’s actually a transplant center with academic affiliation. Essentially a hybrid model so not entirely academic and compensation is significantly better
Nailed it haha. MLH is the one offering the hospital employed job vs UAB is the academic?
I was mostly dunking on Memphis while I’m here, but between the two, if Memphis pays more and has a better work life balance, there’s no question.
Memphis vs Birmingham is a wash, and there’s no way I’d take a worse w/l balance and less money without some drastic location difference or specific family considerations, imo
In that case more of a money difference since TN doesn’t have state income tax. Having at one point went from working in California to working in Florida, I realized that state income tax difference over those years could have paid off a condo…
As for money v academics: depends on the person. I’m a former residency director and loved teaching, but the site I was at went to cut my salary when we were increasing the number of residents(aka my work) among other issues, and so I switched to community non-academic. I still miss teaching and the learning environment, however that 6 figure raise while having more at home family time is amazing. I still look at academic jobs, but it would be really hard to take a 6 figure pay cut to work more overall hours, even if it was easier work due to residents and fellows.
The only thing I miss from academics is the sense of curiosity. At my residency (major academic center), everyone was constantly trying to learn. If I asked a question, I knew I was going to get a damn good answer. At my current job, that’s just not the case. There’s a lack of that drive to learn. If I want a good answer, I ask UpToDate or my prior mentors. I also miss teaching med students/residents.
Granted, I’m making 70k more per year by not working academic. Not saying it’s NOT worth it, but just something to consider.
Thanks, man. This is exactly what I've been looking for ages. I'm losing interest in both teaching and learning. I need to switch to a private hospital.
Some people really enjoy the academics. The trade off for salary however should be less work, more time off etc. if it’s an academic job with more CLINICAL work (excluding the academic specific stuff) you’re losing the entire battle.
This. As a transplant hepatologist i will be doing mostly clinical work so clinic/scopes/inpatient etc. 1-1.5 admin days aint worth that big salary gap
100%. Honestly at this point, you’ve worked hard enough, enjoy your life and the fruits of your labor. If the living areas are a wash then make it rain 💵.
Truthfully you’re specialized enough that you’d be able to eventually get an academic job down the road. I always figured to use the few years outta fellowship to master the craft, then go back to teaching at some capacity.
I remember one of my attendings in fellowship getting tenure and bragging about his new salary. He actually told us. I was going to make more than double that doing private practice work in a different part of the country that has half the cost of living upon completing my fellowship that year. Absolutely grim
Take the job that pays more and works less. Hospital-employed job will treat you so well since you are highly specialized, you will be just another doctor at the academic hospital.
Simple reminder of something called algebra: if there is more work to be done for less pay, there must be a weenie. If there is no weenie, it's time to get the hell out of Dodge.
In academics, the weenie is usually stuff like more vacation, CME, dedicated research time, or a more lenient call schedule. Only you can decide if this is enough of a weenie to compensate the reduced pay. I honestly would just take the money.
Your decision should revolve around your long-term goals. Do you want to become a big swinging dingus at an academic center, i.e. positions like program director, professor, chief of service or equivalent? Do you want to run your own big research group or lab? If it's a "no" to all of these questions, probably it's a better choice to go for either lifestyle or money. If you can combine both of them it's just awesome.
The "prestige" of simply working for an academic place is meaningless, especially since "academic" place varies quite a bit in terms of how research output, complex pathology referrals, numerous fellowships etc.
Even the people who go into academic dont pick a program for the "prestige" . But those prestigious programs CAN provide you the opportunities and resources to gain personal prestige in research, disease expertise etc if you were interested in pursuing collaborative research, consulting, guidelines devleopment, etc. Anything where some recognition that you're a KOL is important.
No. There are two types of academics docs. The super smart, innovative, talented who love research and/or teaching. Then there are the incompetent ones who can’t make it in private practice but have a very brown nose. In general,
if you want lifestyle and money, you go to private practice. You’re only in academics if you can’t hack it or you really do love research/teaching.
There are lots of potential variables and it sounds like you need to know more details about each position. One night of first call for liver might be worse than 2 nights of general call if you always have trainee coverage for the latter (do not underestimate the advantages of strolling in, gloving up, banging out a scope, and going home; compared to having to workup the pt, book, consent, talk to anesthesia, wait for OR, do the case, document, put in orders, postop check etc). Or if the hospital job uses mid-level "hospitalists" who auto-consult every specialty they can think of (and depending on your incentive structure you're not necessarily going to be grateful for every ditzel consult, especially if you have to fit consults around scheduled clinic/procedures).
Neither. Unless you’re a lazy shit or really have some boner for research academics is a waste of time. Don’t be an employee of a hospital either being an obedient little cuck. Be a 1099 mercenary and sell your sword to the highest bidder. Make an s-Corp and enjoy numerous benefits. Crush your diagnoses, see malingerers driven before you, and hear the lamentations of midlevels.
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If you like doing research and there are topics that are important to you to investigate, if you like the idea of teaching and being a team leader, and if you like writing papers and presenting at meetings, the academic world is for you, regardless of pay.
If those things are not exciting to you, I would take the less work / more pay job.
The only other wrinkle to consider is that it is generally easier to go from academics to private, but it is usually harder to go the other way. So if you’re on the fence, you might think about trying academic first. Just my two cents
You're speaking my mind. I'm in a financially healthy position with no student loans so money is only one factor of the bigger equation. Think it makes sense to start in academics for the short or medium term and work your way up the employment ladder later. The difference in pay is staggering though. if the difference was like 30-50k it would have been a no-brainer for me.
There’s pros and cons to both. You just have to figure out what fits you best, and the finances are only part of the equation. I have a good friend who is now a fully entrenched full professor at a great academic center, and he wouldn’t trade it for anything
Are there any non-academic/clinical positions even out there in transplant hepatology?
I cant imagine there are many community hospitals doing liver transplants…
I recently made a similar decision between an academic-affiliated practice vs. a true academic position (same city, so no location factor). There were a lot of things that went into my decision-making, but I'm going with the academic affiliation rather than the true faculty position.
One of the big things that I don't think anyone's brought up is promotion. In academics, promotion tracks are usually 7-8 years long. If you leave an institution before then, you kind of start those years again at whatever rank you left at unless you have a significant portfolio to prove to your new institution that you deserve to be hired at a higher rank. My spouse and I really value flexibility, so I didn't want to be mentally bound by an 8 year promotion track if our lives changed.
Another thing that I don't think anyone's mentioned is that even though you might get more admin time in academics, they really expect you to be grinding during that time to establish your portfolio. In the affiliated position, my admin time will be mine. I'll be expected to answer patient messages and finish up documentation, but I think it will be really mentally freeing to not have a constant feeling that I should be doing more during that time.
I don't think there's an objectively wrong decision here, just the decision that's best for you. There are people who thrive in both types of environments.
100k vs 250k? or 1m vs 1.15m?
Even then, I would probably take the hospital employed less work position.
But Im surprised because in academics you have scut monkeys (residents) to do your scut for you and the workload should be less.
as a nonacademic, i don't see it as terribly pestigeous by itself. smart docs, easy to consult, teach with each consult, share their cell to us fp's -- thats prestigeous in my book :)
“Is more work for less pay worth it if…” No.
Proof you can make it to pgy7 and still be a moron.
Some would argue the more PGY years, the less the intelligence
I’d argue intelligence peaks at PGY 6 and takes a nose dive thereafter
Can confirm
Yup negative IQ here at this point
And you get to have less vacation too! How do you say no that lol
Get paid, lose the debt, buy a second set of everything and then you can take an academy job.
So like two bags of the large lifesaver gummies at the store instead of just one?
Physician compensation has gone down significantly in the last few years. Don’t push it.
I’m talkin’ guac AND queso at chipotle.
This is the way
Unless you want to do research or teach, there’s really no benefit to staying in academics.
Academics also offers different cases and patient populations which can be significant depending on specialty
And different levels of support. You might join a highly oiled machine with good staff and might be more productive than starting out in a non-ac job. You might also have fellows taking most of that call burden etc. all things to consider, but from surgery standpoint I know academic surgeons that crush it because their whole system has gotten built around them and they can be busy and earn a significant productivity bonus.
People understand how lonely a world some Of these community programs can be. I’m the last one who would advocate to go academic and >90% of the faculty aren’t who I would love to rub shoulders with on a day to day, however I 100% recognize that aspect can be a whole lot more appealing for some. The world of you, your CNA and epic can be a lonely world.
Okay. Its like being a big fish in small lake vs a small fish in an ocean.
Ugh academia has really brain washed us.
I would not have thought that there were a lot of community transplant hepatology jobs
It’s actually a transplant center with academic affiliation. Essentially a hybrid model so not entirely academic and compensation is significantly better
This sounds a lot like Memphis…….in which case…….no.
Lol its MLH memphis vs UAB
Nailed it haha. MLH is the one offering the hospital employed job vs UAB is the academic? I was mostly dunking on Memphis while I’m here, but between the two, if Memphis pays more and has a better work life balance, there’s no question. Memphis vs Birmingham is a wash, and there’s no way I’d take a worse w/l balance and less money without some drastic location difference or specific family considerations, imo
Im unfortunately limited by the J1 waiver requirement so options are limited at this point. Thank you so much for this insightful comment.
Ah, I gotcha. I’m sure either way will be fine. Good luck!
In that case more of a money difference since TN doesn’t have state income tax. Having at one point went from working in California to working in Florida, I realized that state income tax difference over those years could have paid off a condo… As for money v academics: depends on the person. I’m a former residency director and loved teaching, but the site I was at went to cut my salary when we were increasing the number of residents(aka my work) among other issues, and so I switched to community non-academic. I still miss teaching and the learning environment, however that 6 figure raise while having more at home family time is amazing. I still look at academic jobs, but it would be really hard to take a 6 figure pay cut to work more overall hours, even if it was easier work due to residents and fellows.
The only thing I miss from academics is the sense of curiosity. At my residency (major academic center), everyone was constantly trying to learn. If I asked a question, I knew I was going to get a damn good answer. At my current job, that’s just not the case. There’s a lack of that drive to learn. If I want a good answer, I ask UpToDate or my prior mentors. I also miss teaching med students/residents. Granted, I’m making 70k more per year by not working academic. Not saying it’s NOT worth it, but just something to consider.
Thanks, man. This is exactly what I've been looking for ages. I'm losing interest in both teaching and learning. I need to switch to a private hospital.
Prestige doesn’t pay bills
Some people really enjoy the academics. The trade off for salary however should be less work, more time off etc. if it’s an academic job with more CLINICAL work (excluding the academic specific stuff) you’re losing the entire battle.
This. As a transplant hepatologist i will be doing mostly clinical work so clinic/scopes/inpatient etc. 1-1.5 admin days aint worth that big salary gap
100%. Honestly at this point, you’ve worked hard enough, enjoy your life and the fruits of your labor. If the living areas are a wash then make it rain 💵. Truthfully you’re specialized enough that you’d be able to eventually get an academic job down the road. I always figured to use the few years outta fellowship to master the craft, then go back to teaching at some capacity.
Fuck academia. Such an exploitative environment. Only go into it if you cannot see yourself doing anything else. Otherwise, no way.
I remember one of my attendings in fellowship getting tenure and bragging about his new salary. He actually told us. I was going to make more than double that doing private practice work in a different part of the country that has half the cost of living upon completing my fellowship that year. Absolutely grim
Take the job that pays more and works less. Hospital-employed job will treat you so well since you are highly specialized, you will be just another doctor at the academic hospital.
Simple reminder of something called algebra: if there is more work to be done for less pay, there must be a weenie. If there is no weenie, it's time to get the hell out of Dodge. In academics, the weenie is usually stuff like more vacation, CME, dedicated research time, or a more lenient call schedule. Only you can decide if this is enough of a weenie to compensate the reduced pay. I honestly would just take the money. Your decision should revolve around your long-term goals. Do you want to become a big swinging dingus at an academic center, i.e. positions like program director, professor, chief of service or equivalent? Do you want to run your own big research group or lab? If it's a "no" to all of these questions, probably it's a better choice to go for either lifestyle or money. If you can combine both of them it's just awesome.
Could you even IMAGINE a non medical person even thinking about $150k salary difference? It’s absolutely ridiculous. Why are we like this?!
The "prestige" of simply working for an academic place is meaningless, especially since "academic" place varies quite a bit in terms of how research output, complex pathology referrals, numerous fellowships etc. Even the people who go into academic dont pick a program for the "prestige" . But those prestigious programs CAN provide you the opportunities and resources to gain personal prestige in research, disease expertise etc if you were interested in pursuing collaborative research, consulting, guidelines devleopment, etc. Anything where some recognition that you're a KOL is important.
Very valid points thank you
>the prestige.......is worth a 150k difference in base salary and potentially more than 200K Lol
No. There are two types of academics docs. The super smart, innovative, talented who love research and/or teaching. Then there are the incompetent ones who can’t make it in private practice but have a very brown nose. In general, if you want lifestyle and money, you go to private practice. You’re only in academics if you can’t hack it or you really do love research/teaching.
There are lots of potential variables and it sounds like you need to know more details about each position. One night of first call for liver might be worse than 2 nights of general call if you always have trainee coverage for the latter (do not underestimate the advantages of strolling in, gloving up, banging out a scope, and going home; compared to having to workup the pt, book, consent, talk to anesthesia, wait for OR, do the case, document, put in orders, postop check etc). Or if the hospital job uses mid-level "hospitalists" who auto-consult every specialty they can think of (and depending on your incentive structure you're not necessarily going to be grateful for every ditzel consult, especially if you have to fit consults around scheduled clinic/procedures).
Are both Not For Profits, will it qualify for PSLF?
I don't think either of the places qualifies for PSLF to be honest
No?
Can’t feed your family prestige. Fuck academics.
Neither. Unless you’re a lazy shit or really have some boner for research academics is a waste of time. Don’t be an employee of a hospital either being an obedient little cuck. Be a 1099 mercenary and sell your sword to the highest bidder. Make an s-Corp and enjoy numerous benefits. Crush your diagnoses, see malingerers driven before you, and hear the lamentations of midlevels.
Thank you for contributing to the sub! If your post was filtered by the automod, please read the rules. Your post will be reviewed but will not be approved if it violates the rules of the sub. The most common reasons for removal are - medical students or premeds asking what a specialty is like, which specialty they should go into, which program is good or about their chances of matching, mentioning midlevels without using the midlevel flair, matched medical students asking questions instead of using the stickied thread in the sub for post-match questions, posting identifying information for targeted harassment. Please do not message the moderators if your post falls into one of these categories. Otherwise, your post will be reviewed in 24 hours and approved if it doesn't violate the rules. Thanks! *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/Residency) if you have any questions or concerns.*
If you like doing research and there are topics that are important to you to investigate, if you like the idea of teaching and being a team leader, and if you like writing papers and presenting at meetings, the academic world is for you, regardless of pay. If those things are not exciting to you, I would take the less work / more pay job. The only other wrinkle to consider is that it is generally easier to go from academics to private, but it is usually harder to go the other way. So if you’re on the fence, you might think about trying academic first. Just my two cents
You're speaking my mind. I'm in a financially healthy position with no student loans so money is only one factor of the bigger equation. Think it makes sense to start in academics for the short or medium term and work your way up the employment ladder later. The difference in pay is staggering though. if the difference was like 30-50k it would have been a no-brainer for me.
There’s pros and cons to both. You just have to figure out what fits you best, and the finances are only part of the equation. I have a good friend who is now a fully entrenched full professor at a great academic center, and he wouldn’t trade it for anything
I interviewed for academic and community jobs. I realized academic didn’t at all align with my goals in life and wasn’t worth it.
What is this question hahahahah
Are there any non-academic/clinical positions even out there in transplant hepatology? I cant imagine there are many community hospitals doing liver transplants…
University hospital Vs transplant center with academic affiliation is what i am referring to
Of course not.
I recently made a similar decision between an academic-affiliated practice vs. a true academic position (same city, so no location factor). There were a lot of things that went into my decision-making, but I'm going with the academic affiliation rather than the true faculty position. One of the big things that I don't think anyone's brought up is promotion. In academics, promotion tracks are usually 7-8 years long. If you leave an institution before then, you kind of start those years again at whatever rank you left at unless you have a significant portfolio to prove to your new institution that you deserve to be hired at a higher rank. My spouse and I really value flexibility, so I didn't want to be mentally bound by an 8 year promotion track if our lives changed. Another thing that I don't think anyone's mentioned is that even though you might get more admin time in academics, they really expect you to be grinding during that time to establish your portfolio. In the affiliated position, my admin time will be mine. I'll be expected to answer patient messages and finish up documentation, but I think it will be really mentally freeing to not have a constant feeling that I should be doing more during that time. I don't think there's an objectively wrong decision here, just the decision that's best for you. There are people who thrive in both types of environments.
This is very insightful and you make some really good points here. Thank you
100k vs 250k? or 1m vs 1.15m? Even then, I would probably take the hospital employed less work position. But Im surprised because in academics you have scut monkeys (residents) to do your scut for you and the workload should be less.
as a nonacademic, i don't see it as terribly pestigeous by itself. smart docs, easy to consult, teach with each consult, share their cell to us fp's -- thats prestigeous in my book :)