The Physician Philosopher Podcast
Should a Doctor Go Into Academics or Private Practice?
In medicine, there’s a classic debate between academic versus private practice. A lot of it focuses on the financial aspect. Of course, finances are important. But there are other components of this discussion that are infinitely more important than money.
Academic jobs for doctors have their appeal
Many of us doctors have student loans, especially some of the younger doctors, because medical school tuition has skyrocketed and doctors today pay more for their education than in years past. If you’re someone who has student loans, one of the things to consider is whether you’re going to try to get your student loans forgiven.
Because many qualifying academic institutions offer public service loan forgiveness.
Depending on your individual financial status, taking a position in academics could be well worth the time investment when you know potentially hundreds of thousands of loan dollars can be forgiven.
But private practice offers benefits, too
Unless you want to be near a big academic center, a private practice career tends to provide more flexibility in terms of location, because there are doctors’ offices and hospitals all over the country that don’t necessarily exist in big cities.
I tell my residents that academics is about depth and private practice is about breadth. In a lot of specialist fields, the private practice opportunities can provide some of that breadth. What you choose really depends on your preferences and how you feel you can work best in a given environment when weighed against all the factors that are important to you.
But at the end of the day: when choosing a job, make sure you think through the worst-case scenario before saying “yes”.
- A tool I use with my coaching clients to help you think through any job decision
- An in-depth perspective about the benefits (and drawbacks) of going into academics as well as joining private practice
- Physician-specific finance and career factors you should consider as you’re making your job decisions
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With the almost total control of the profession now by administrators who don’t see patients, i.e., the situation of employed physicians, the only factor that would save our profession from total degradation and loss of respect, practice control, and autonomy, etc., is the preservation of the private practice of medicine,
So, I can talk from both sides of the fence about this topic. I was approx 10 years in the private sector and approx 12 years in the academic setting. Also of please note, I am extremely jaded by academia (or at least the academic organization I currently work for).
Going to academia from private practice was the WORST employment decision I have ever made in my life!!! I was promised practice accommodations that never materialized. I took a huge (and I mean huge) pay cut. I am often criticized by my departmental colleagues because of my practice style (aggressive and outspoken). In general I am often considered a non-team player because I put my patients needs over the Department, Medical School and Medical Center needs. I get little respect or even acknowledgement or recognition from other non-departmental colleagues despite having been practicing very successfully in the area for 21+ years.
The thing physicians often don’t realize is that when you are in academia you aren’t just there for the patient, you are there for the “organization” (this could also happen in the private sector, but for me it didn’t). You have to provide not only patient care, but also are expected to teach (residents and medical students) and quite often do research and/or publish. There are also endless number of meetings, rules and regulations, training sessions, evaluations, etc. that are “mandatory” (and time consuming) and don’t “exist” in the private sector. Your time is tied up in more ways than you can believe. In private practice I worked a 50-60 hour week (to include designated OR time). In academia I work a 60-80+ hour week (and have no designated OR time). Academia also requires you to maintain your board certification (not necessarily a bad thing, but just one more pressure).
And don’t think coding, billing and money, money, money aren’t overly important in academia. In the private sector, you “eat what you kill”. In academia, you aren’t just “killing to eat” for yourself, you’re expected to be “killing for multiple folks to eat”. This includes many, many lower-, mid- and upper-level managers who contribute absolute no monetary profit to the organization.
And don’t think non-compete clauses are just for private practice groups. I had a 20 mile non-compete from my private practice group. I have a 50 mile non-compete clause from my current academic organization. The next closest area I could currently practice is 70 miles away from my home.
The academic organization I currently work for is the same organization where I did my residency and fellowship. A lot of the physicians who I work with were my “superiors” when I was a resident. Once a resident, always a resident. Sadly that is how I’m very frequently viewed.
So, yes I am completely jaded about academic medicine. However, I will admit my experience at this one organization should not necessarily reflect on all academic programs. But, I am stuck here for many, many reasons (mainly non-compete)
The one final thing I will say is that with the exception of a few very select specialities, no physician should be (teaching) in academic medicine without first putting in a minimum of 5 years in the private sector. You can’t prepare residents for the private sector if you don’t really know anything about it or how it works / runs in the first place.