Today’s inane image of the day:
In a previous post/YouTube video, I discuss why I stayed in academic medicine. But with anything in life, where there are benefits, there are downsides. As a medical student, I remember reading and hearing about how academic medicine jobs included a lot of promotion pressures [to apply for professorship; which is why everyone is hustling/stressed to do research] and lower pay. This sounded like a terrible deal, so I never considered staying in academic medicine beyond residency [I knew I wanted training at an academic environment, but it didn’t seem like a good long-term career fit]. Fast-forward over a decade later and here I am… in academic medicine [cue: face-palm emoji]. So even though I heard about the potential downsides of an academic medicine job, I decided it was still a good fit for me.
The 4 downsides of being an academic physician that I go over in the video are:
Academic promotion pressure
As I alluded to above, in most academic medical centers, there is a requirement to work toward promotion within a specified amount of time. There are options for clinical and education tracks that physicians can usually pursue, which make the minimum requirements somewhat manageable. Unfortunately, the academic university I’m affiliated with is notorious for being extraordinarily challenging to get promoted through, so this adds another layer of pressure/stress to the process. Luckily, the set up of my job is such that I don’t have a “requirement” to be promoted. This could always change, but this particular facet of my position is one of the reasons I could stomach staying in an academic position.
While my job is not dependent on promotion, there is still a culture within academic medical centers surrounding promotions. I certainly feel this pressure from colleagues even though that is not my ultimate career goal. This pressure is a downside in my mind because the requirements that need to be met for promotions are not my main priorities [i.e. peer-reviewed publications, research activities, giving presentations, etc]. My main priority has always been to be the best clinician that I can be, to educate students/residents/fellows, and eventually to pursue an administrative position to have the greatest positive impact on patient care that I can. Spending time on research that is not my first passion doesn’t make sense in my mind for my goals.
This all being said… you’ll still see my name on editorials and presentations because as part of my commitment to student/trainee education, I am doing smaller projects as a way to help trainees achieve their career goals. While I do not live/breathe research, I do have clinical questions that I’m willing to dabble into the “research” pool to try to answer.
Nonclinical work
Most academic physicians are involved in various committees or organizations. Additionally, academic anesthesiology is unique because we often schedule a pre-operative phone call [usually the day before surgery when we get our assignments] with the residents in order to discuss the anesthetic plan and direct educational topics for the day [see below]. Lots of academic positions are designed to build in “nonclinical time” [which is what it sounds like – time where you are not scheduled for direct patient care] in order to work on research, committee work, or other administrative tasks. Often, this work takes more time beyond the allotted nonclinical time. One example of a nonclinical assignment could be to prepare a lecture for the trainees or direct education for a particular rotation. Many of us also have administrative titles that require use of this nonclinical time – one of my titles is the “Director of Procedural Sedation,” which means that I oversee and implement the policy our institution has related to procedural sedation. This translates into many additional meetings, pages about clinical care, and also behind-the-scenes analysis of patient safety data.
Trainee education
Somewhat related to the nonclinical work section, many people don’t realize that many academic anesthesiologist have a phone call the night before with our residents to discuss cases for the next day and direct education. I take this role very seriously and try to make the most of these phone calls [after all, both the trainee and attending have lives and the evening is supposed to be sacred], but they can be exhausting. When it is earlier in the academic year, many junior residents haven’t yet had exposure to various cases so I spend more time ensuring my resident has all of the tools to be successful the next day. Sometimes these phone calls can be an hour long… and with two residents, I might be on the phone for two hours preparing for the next day!
Another component of working with trainees is that there is an additional layer of stress that exists when teaching trainees that may be seeing a case for the first time. While I sometimes think my direction is clear to me, I realized quickly as a new attending that what I may describe may not be how it is interpreted by the trainee I am working with. This has taught me to adjust the way I describe particular procedures. One great thing about working with trainees is that they have a “beginner mind” and often ask very thoughtful and pertinent questions that test my knowledge. But there is a cognitive burden that exists when you spend the day trying to answer questions, oversee clinical care, and preparing an education topic.
Lower salaries
An important caveat to this section is that you cannot compare physician jobs on salary alone because the benefits that come with each position can vary tremendously. Additionally, the stress level of the work that is done at various anesthetizing locations can vary. Basically, it’s nearly impossible to actually compare clinical jobs because ultimately a lot of work satisfiers or dis-satisfiers lie within the work environment/culture itself. Putting this aside… if you compare the academic anesthesiologist’s contract and base pay with contracts from private practices or community hospitals, you’ll find that the absolute salary amount tends to be lower in academic contracts. This is a function of the additional flexibility that most academic positions offer. In anesthesiology, clinical work is lucrative; so the more clinical time you spend, the more money you make. Academic jobs usually have a lower clinical time requirement that then translates into a lower salary. But, at face value, this certainly can be seen as a downside.