Academics vs private practice

[TS10]

For those of you in Gastroenterology fellowship or recently graduated- what factors influenced your decision to pursue a career in academics vs private practice. Pros and Cons?

---

Members don't see this ad.

 

[1Cor1557]

For those of you in Gastroenterology fellowship or recently graduated- what factors influenced your decision to pursue a career in academics vs private practice. Pros and Cons?

It's not so much academics vs private practice anymore as It is academics vs hybrid vs employed vs private equity shared vs private practice, lots of pros and cons with all and you can find anybody you want to fit the narrative you wish to fit. I will say this, I was very apprehensive about private equity and private practice pre covid and then covid happened that definitely fit my pre existing skeptic narrative that furthered me along the employed route....there are good private practices out there but the ones that are left are getting consolidated and eaten up by private equity/managed health systems anyway and for the fewer and fewer now that remain traditional private practice, can ask yourself if such respective "guys" are a new grad mill that will dump you in couple years without making partner or even worse they sell off before you become partner to cash in while they are keeping big chunks of your collections for overhead and sweat equity that you never will get to see anyway, so it's hit n miss and do your homework there are good groups trustworthy but stay on your guard, they might not be trying to screw you over but they want their nest egg to hatch and it won't help you, it's all about all your appetite for risk, if youre a 5 star crash rating kinda GI who drives a mini van like me with 2 hands on the wheel and bunch of baby seats doing 3 below speed limit, then perhaps employed may me reasonable medium to collect market value and call it a day, if you want 900k yr then find a good group still private work like a crazed new grad still in fellowship and hope they don't sell off too soon, good luck

 

[cabergoline2]

It's not so much academics vs private practice anymore as It is academics vs hybrid vs employed vs private equity shared vs private practice, lots of pros and cons with all and you can find anybody you want to fit the narrative you wish to fit. I will say this, I was very apprehensive about private equity and private practice pre covid and then covid happened that definitely fit my pre existing skeptic narrative that furthered me along the employed route....there are good private practices out there but the ones that are left are getting consolidated and eaten up by private equity/managed health systems anyway and for the fewer and fewer now that remain traditional private practice, can ask yourself if such respective "guys" are a new grad mill that will dump you in couple years without making partner or even worse they sell off before you become partner to cash in while they are keeping big chunks of your collections for overhead and sweat equity that you never will get to see anyway, so it's hit n miss and do your homework there are good groups trustworthy but stay on your guard, they might not be trying to screw you over but they want their nest egg to hatch and it won't help you, it's all about all your appetite for risk, if youre a 5 star crash rating kinda GI who drives a mini van like me with 2 hands on the wheel and bunch of baby seats doing 3 below speed limit, then perhaps employed may me reasonable medium to collect market value and call it a day, if you want 900k yr then find a good group still private work like a crazed new grad still in fellowship and hope they don't sell off too soon, good luck

is there any scope of remaining entrepreneurial in gi ? let's say a hypothetical fresh grad had 2.5-3 mill to invest in a gi practice , what do you think he would do?

 

[1Cor1557]

is there any scope of remaining entrepreneurial in gi ? let's say a hypothetical fresh grad had 2.5-3 mill to invest in a gi practice , what do you think he would do?

Sure there is, in certain ways, if a PE deal is done right, even alot more money is to be had than traditional PP , if a new grad had that kind of capital they could join the gold rush of PE as well, albeit as long as they are in prior to the acquisition or the second bite ( which has not happened in GI yet, we shall see what comes of it), it would just stress me out knowing the group is flirting with potential suitors while I'm waiting to become to become vested, I'll never know since having that kind of money laying around is not a problem I have

 

[1Cor1557]

@Gastrapathy and @IM2GI are out there somewhere, this might be a dead horse for them but PE has changed the game for newer grads and further accentuated the pre existing generational gap in GI

 

[ShiShiMD]

@Gastrapathy and @IM2GI are out there somewhere, this might be a dead horse for them but PE has changed the game for newer grads and further accentuated the pre existing generational gap in GI

if I had 3 million graduating, I would do pure academics and work on my inventions.

 

[cabergoline2]

very hypothetical question (will sound borderline crazy) .

Is it feasible to maintain an NIH grant while being predominantly in private/semi academic practice ? Lets say I am an advance endoscopist with interest in pancreatic cancer and am investigating interactions of stromal microenvironment with epigenetics of the tumor (very hypothetical example , resemblance to any person living or dead is purely coincidental) ..lets say I have a decent volume eus practice and can provide a lot of samples ...and know surgeons doing a lot of whipples for additonal sample... lets say predmoninantly private with "academic affiliation" (like everyone and uncle have clilincal assistant prof design these days thanks to consolidated mega healthcare systems)...can I in theory be able to maintain an R01 and have PhDs and post docs to do the wet lab part?

apologies if it sounds bathsit crazy scenario written by a drunk gi fellow..

 

[bronx43]

very hypothetical question (will sound borderline crazy) .

Is it feasible to maintain an NIH grant while being predominantly in private/semi academic practice ? Lets say I am an advance endoscopist with interest in pancreatic cancer and am investigating interactions of stromal microenvironment with epigenetics of the tumor (very hypothetical example , resemblance to any person living or dead is purely coincidental) ..lets say I have a decent volume eus practice and can provide a lot of samples ...and know surgeons doing a lot of whipples for additonal sample... lets say predmoninantly private with "academic affiliation" (like everyone and uncle have clilincal assistant prof design these days thanks to consolidated mega healthcare systems)...can I in theory be able to maintain an R01 and have PhDs and post docs to do the wet lab part?

apologies if it sounds bathsit crazy scenario written by a drunk gi fellow..

Very unlikely. One does not simply go from clinician to R01. We are talking millions of dollars for multi year R grant. What track record do you have to convince the NIH to give you that kind of money? What previous data have you collected that supports this level of funding into your area of interest? I don’t know if the “semi academic” practice environment would necessarily prohibit you, but you would have to generate enough data and show a few publications, then get a team of funded mentors to support your K application. IF you get a K grant, then you would have to pump out quality data so you can have a shot at a R01. Keep in mind the vast majority of K grants do not advance to R level funding.

 

[gutonc]

very hypothetical question (will sound borderline crazy) .

Is it feasible to maintain an NIH grant while being predominantly in private/semi academic practice ? Lets say I am an advance endoscopist with interest in pancreatic cancer and am investigating interactions of stromal microenvironment with epigenetics of the tumor (very hypothetical example , resemblance to any person living or dead is purely coincidental) ..lets say I have a decent volume eus practice and can provide a lot of samples ...and know surgeons doing a lot of whipples for additonal sample... lets say predmoninantly private with "academic affiliation" (like everyone and uncle have clilincal assistant prof design these days thanks to consolidated mega healthcare systems)...can I in theory be able to maintain an R01 and have PhDs and post docs to do the wet lab part?

apologies if it sounds bathsit crazy scenario written by a drunk gi fellow..

There are dozens of reasons why this will never work in practice, but there's nothing actually prohibiting it.

The biggest roadblock is that the path to a K-->R01 is arduous at best and is more than a full-time job in and of itself. Who's going to give you the time/support to get to that point while you're off faffing about in the endoscopy suite at your PP job? How are you going to find the time to run that lab to the point that it can support your grad students and post-docs doing the work?

And once you taste that sweet PP money at the end of the scope, you're never going back to the lab.

Now, if you want to get your name on some papers, and be a sub-I on grants/projects in this area, where you're the scope jockey that brings the initial samples to the lab, that's totally manageable. But you're not going to be the PI.

 

[cabergoline2]

Very unlikely. One does not simply go from clinician to R01. We are talking millions of dollars for multi year R grant. What track record do you have to convince the NIH to give you that kind of money? What previous data have you collected that supports this level of funding into your area of interest? I don’t know if the “semi academic” practice environment would necessarily prohibit you, but you would have to generate enough data and show a few publications, then get a team of funded mentors to support your K application. IF you get a K grant, then you would have to pump out quality data so you can have a shot at a R01. Keep in mind the vast majority of K grants do not advance to R level funding.

let's say the said hypothetical person does succeed in getting k01 in fellowship and 1-2 non nih grants (say acg early career).. has 1-2 not nature level but decent tier papers related to such a research (say gastro or gut ) and 3-4 average tier papers (say faseb ,jci) ...lets say he decides to go private post fellowship (after doing a 4th year advance endo)... what would be feasible scenarios to keep doing basic /translational research...

edit : gut onc answered my question..

context of whole thing : seeing sweet pp $$ .. but still wanting to do something valuable w.r.t research... not so much interested in name or being pi as long as i can stay in the loop.. the non physican PhDs are anyday better researchers than I can ever be .. and they should be the ones deserving to be pi in any case..ok with being the sample jockey..

 

[bronx43]

let's say the said hypothetical person does succeed in getting k01 in fellowship and 1-2 non nih grants (say acg early career).. has 1-2 not nature level but decent tier papers related to such a research (say gastro or gut ) and 3-4 average tier papers (say faseb ,jci) ...lets say he decides to go private post fellowship (after doing a 4th year advance endo)... what would be feasible scenarios to keep doing basic /translational research...

edit : gut onc answered my question..

context of whole thing : seeing sweet pp $$ .. but still wanting to do something valuable w.r.t research... not so much interested in name or being pi as long as i can stay in the loop.. the non physican PhDs are anyday better researchers than I can ever be .. and they should be the ones deserving to be pi in any case..ok with being the sample jockey..

You can definitely be a sample jockey. I guess it all depends on your longterm goals...

 

[1Cor1557]

very hypothetical question (will sound borderline crazy) .

Is it feasible to maintain an NIH grant while being predominantly in private/semi academic practice ? Lets say I am an advance endoscopist with interest in pancreatic cancer and am investigating interactions of stromal microenvironment with epigenetics of the tumor (very hypothetical example , resemblance to any person living or dead is purely coincidental) ..lets say I have a decent volume eus practice and can provide a lot of samples ...and know surgeons doing a lot of whipples for additonal sample... lets say predmoninantly private with "academic affiliation" (like everyone and uncle have clilincal assistant prof design these days thanks to consolidated mega healthcare systems)...can I in theory be able to maintain an R01 and have PhDs and post docs to do the wet lab part?

apologies if it sounds bathsit crazy scenario written by a drunk gi fellow..

It can be done, but very tough....The most prominent example of this actually being successfully done in the real world is the Texas liver institute in San Antonio, where Drs Lawitz and Poordad are arguably responsible for the most prominent research in leading to the hepatitis C direct acting agents, But under a private practice model, with an academic affiliation

 

[Elixir6]

Yeah there is no way. You need tons of protected time which is a huge institutional investment and all the support of academic research infrastructure to get a K grant let alone something for independent research.

Maybe a couple of docs in the 70s were able to pull off something akin to this as another poster mentioned, and are still doing research, but I don't think this is possible in the current environment.

The PP money comes from seeing patients every 15 min, not from reading articles and lab meetings. Research success comes from having uninterrupted time to think and institutional support. A total pipe dream to have it both ways.

 

[hemosuccus]

It can be done, but very tough....The most prominent example of this actually being successfully done in the real world is the Texas liver institute in San Antonio, where Drs Lawitz and Poordad are arguably responsible for the most prominent research in leading to the hepatitis C direct acting agents, But under a private practice model, with an academic affiliation

This is debatable. These guys were well established before coming to TX. Poordad was already publishing in NEJM as a Professor at Cedars prior to coming to Texas.

 

[lzzhang07]

Which track has better work life balance to take care of family?
I am in a top GI institution and our facilities are extremely busy, even during weekend / late evening time. While I heard in many GI groups they do 8:00 AM to 5:00 PM 4 and a half days schedule with a few weeks call a year.

The situation seems to be inconsistent with what I heard before, which says academic has more free time and flexibility, and private is busy but have more money.

 

[cabergoline2]

Which track has better work life balance to take care of family?
I am in a top GI institution and our facilities are extremely busy, even during weekend / late evening time. While I heard in many GI groups they do 8:00 AM to 5:00 PM 4 and a half days schedule with a few weeks call a year.

The situation seems to be inconsistent with what I heard before, which says academic has more free time and flexibility, and private is busy but have more money.

usually the folks on service will be the busy ones.. how often are the academic folks on service ? 2 months /12 at most ? rest of the time it's chill..pvt folks are on service every 4-7 weeks depending upon how big the group is. sometimes multiple hospitals...and they have 15-18 op cases on one endo day...

 

[Elixir6]

usually the folks on service will be the busy ones.. how often are the academic folks on service ? 2 months /12 at most ? rest of the time it's chill..pvt folks are on service every 4-7 weeks depending upon how big the group is. sometimes multiple hospitals...and they have 15-18 op cases on one endo day...

I am not an expert, but I think the truth is that it can be very different at different places and how you shape your own career. Not all academic places and not all PP places are the same.

I do want to take offense with the research academics being "chill" though. With a clinical predominate career you have to perform during a set time, the objectives are clear, and the stress is in the moment, but once you are done, you go home and we free. Research is a lot more flexible (you don't have to get up early and you can work from home in the current environment), but performing the research is hard, you're always having to justify your salary and expenses, you have to get grants and publish, and your work and career could fall apart if you can't get grants... The stress follows you home and into nights and weekends.

 

[cabergoline2]

I am not an expert, but I think the truth is that it can be very different at different places and how you shape your own career. Not all academic places and not all PP places are the same.

I do want to take offense with the research academics being "chill" though. With a clinical predominate career you have to perform during a set time, the objectives are clear, and the stress is in the moment, but once you are done, you go home and we free. Research is a lot more flexible (you don't have to get up early and you can work from home in the current environment), but performing the research is hard, you're always having to justify your salary and expenses, you have to get grants and publish, and your work and career could fall apart if you can't get grants... The stress follows you home and into nights and weekends.

"chill" was a specific reference to clinical duties... success in a research career and different facets of that is a whole different beast...