Success in Academic practice?

[blz]

Reading through these forums, it is generally accepted that those in private practice are the ones making the big $$$ and living the dream and those in academics suffer from less pay, worse hours and more pain.

As I wait for match day, I can't help but wonder how I am going to shape my career. I feel I am the type of person that would like to do a fellowship and pursue an academic career; however, given my loan situation (200k+ debt) and having to support my parents, I can't avoid that part of me that knows that private practice is where the easier life is at.

So my questions: is it possible in academics to do well financially, possibly exceeding the expectations of private practice? if possible, which fields are more amenable to this end point and how I would have to structure my academic career? Assuming I match in my top 10, I will likely be at a powerhouse oto program if that changes anything.

What I'm hoping to gather from responses is how I should structure an academic career to be very successful financially. Should I do more research? Should I teach more? Should I operate more? Should I work for a big name university?

Thanks in advance. I hope this doesn't come off as a selfish post. I've just come to realize the reality of my debt situation and the amount of people I will have to take care of post residency.

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[Leforte]

I am in my first year out of residency in an academic practice. I do fine financially. My student loans are close to $200k and I don't worry about the payments - part of the deal of becoming a physician. My residency colleagues who went into private practice do make more than I do, but not insane money more. Probably close to 75k or so - which after taxes, etc, becomes closer to 40k. Some make a lot more, however. We work similar hours. My case volume and complexity level is different than those that went into PP. I enjoy the complex cases, resident teaching, high level support from other academic departments as well as the other benefits that academics offers. I can do research if I want, but there really is no "push" from my chairman to do it. I enjoy it, so I have my fingers in a few projects, but do not feel that it is publish or perish.

I am also less "attached" to the group than I would be in private practice. There is no buy-in. No worrying about making partner. No managing the office staff. I can leave if and when I want without worrying about who is going to buy me out, etc. Residents take call and I rarely go in unless it is an emergency that is going to the OR. I take 5 weeks of call a year, in 1 week blocks. My classmate who went into PP is on Q3 call and goes in for the nosebleed, PTA, etc.

In the end, income is only one part of the equation. You'll do fine in both PP and academics. The question is really what type of practice do you want to do?

 

[resxn]

While I am in PP, I agree with LeForte. The gap between Academics and PP is closing. It's still there and the difference is based on the eat what you kill model. No matter how hard LeForte works, he's salaried and therefore somewhat limited by what he can make. Some academic jobs provide production bonuses, but those are a precentage of income, whereas whatever I make above my margin is 100% mine. I work 60 hours/wk or so, but I take 1/2 day off each week, so it feels far less than residency and is not a killer at all, mostly because I'm an early riser and am in my office often by 6am so about 10 of those hours are just from the morning. My call isn't bad. My main hospital is 1 week in 8 and some of the smaller communities hospitals are more often, but far less busy. On my worst week in 3 years of PP, I had to see 6 ER consults, 3 inpt consults in a week of call. That was easily one night as a resident, so I'm good with it. I've trained my ER how to do PTA's and epistaxis, so I get called on those only once in a blue moon.

I get crazy weird stuff coming to my practice and the beauty is that if I don't want to handle it or if I don't think I can, I've got LeForte to fall back on. I don't need to take every 6cm temporal bone mass or 6th revision FESS that shows up on my door, but I can if I want.

I agree with LeForte, there's good and bad in both, just depends on what suits you. I love PP and am glad I chose that route. I wouldn't worry about the money. There's some serious security in salary and given the current political environment, that looks mighty tempting sometimes.

 

[Leforte]

Resxn has summed up the PP model nicely. Most people I know in PP are happy with their decision. Similarly, most in academics are happy with theirs. When you are choosing a residency, look for ones that offer rotations in many different practice settings. Mine had them all - academics, VA, PP and county. All have their pluses and minuses. When you get out, if you are unhappy with your set-up, you can always switch.

Also, many academic practices are going to an incentive based model. Good if like to work, bad if you want a lot of protected time. A portion of my salary/benefits is set up this way, which is nice.

There are tons of other pay/practice models out there. You can be hospital employed with or without production and/or guarantee, gov't employed, group practice, single specialty, solo, etc, etc. Again, all with the +/-'s.

Then again, who knows where we'll all be in 5 years when you're close to finishing your training. We may all be working for the man.

 

[blz]

Thanks for the input.


Now I'm just counting down the days till the match...