This is a guest post from VagabondMD, an interventional radiologist who I befriended through The InterWebs.  Vagabond is sharing insights into what led him away from academic medicine, aka The Ivory Tower.

Vagabond and I trained at the same institution, though at different times and in different fields.  I stayed, he left. 

Today, read about why he left and did not come back. Next week, read the first in a series of posts describing my own experiences and views on academic medicine.

If you haven’t already, vote for the charity that the blog should donate to in 2018. It will only take a few seconds, and there are 6 great choices.

Update: the first in my own series of articles — can be found here, whereupon I discuss how money matters are discussed amongst those of us IN The Ivory Tower.  All entries in this series will be able to be found here.

The formative years of my medical educational and residency were carefully groomed and crafted to launch me into an academic career. From bench research at my medical school and at the NIH, to an academic-oriented residency at an Ivory Tower with 20+ publications on the CV by the end of my fellowship, it was clearly the path that I favored. Ed note: For those not familiar, 20+ publications before completing training is incredible.

However, graduating into an adverse job market, with nothing available at my Ivory Tower, I took a job at a local community hospital-based private practice. I always stayed connected with the folks at the Ivory Tower, secretly hoping that one day they would call on me.

In the ensuing eight or ten years that I was in private practice, toiling in the “minor leagues” at a community hospital, I worked hard to build a reputation, at my institution and in the community.  I became involved in leadership, and was in the on-deck circle to be the Chairman of the group and my department.

Then, the Majors called. Did I want to return to my Ivory Tower?  Where I trained, where I had fond memories, where there was so much excellence, reputation, and …?

I decided that I had to give this strong consideration, unexpected as it was, and I agreed to a meeting with my old colleagues and friends. I wish that I could say that the nausea I felt as I entered the Ivory Tower for the first time in years did not affect my decision, but there were other more tangible reasons to stay on the private practice path.  My meeting felt like an interview, and I ultimately chose not to return for several reasons.

Money

This was not the most important reason, but it certainly contributed. The academic compensation package was about 60-70% of the private practice compensation that I was earning at the time.

When we talked about the money, it was clear that the expectation was that I would be banging out the same (or more) RVUs in academics, but there were lots of mouths to feed. Ivory Tower U employed rheumatologists and ID docs and these and other specialties required a subsidy contribution from the higher paid specialists.

The secretaries and various administrators within the department needed to get paid, too. And did you see all of that marble in the CEO’s department chair’s single floor office…and his team of secretaries and assistants?

In private practice, there were fewer mouths to feed, no endocrinologists to subsidize, no secretaries, and no marble.

It’s “no frills.” The corporation exists to benefit the partners, so all that is earned is deployed to the partners.

TheWork

Having toiled in a community hospital for years, the challenging cases of the tertiary care environment were a relic of my past. While quite proficient at my trade, a move to Ivory Tower U would require me to “bone up” my skills to meet new challenges, learn new procedures, and establish new relationships.

At the time they were offering the position, they were under-staffed and needed another body or two to get the work done. That said, it was expected that I would get involved with teaching and research, as well.

I questioned whether I had the mettle and motivation to do so. I also considered that the “attending physicians” who trained me would now be partners.   Would we be able to develop a healthy relationship based on me being an equal?

I worried quite a bit about the culture difference. In private practice, it seems less hierarchical.  Docs do their jobs, take care of patients, working together, and while there are some turf wars, the politics do not enter your mind on a daily basis.

My only experience working at the Ivory Tower was as a student and trainee, years earlier.  As a foot soldier, I felt that the system ran with military-style chain of command. People seemed to be looking over their shoulders to make sure that they were primarily pleasing their leaders, and since promotions and tenure were in demand, a cut-throat spirit of competition was often on display. My impressions may have been naive and mistaken, but these memories may have been what provoked the nausea on the escalator!

Vacation

A four-week vacation was typical of the Ivory Tower jobs, and meeting time was given with limitations. A voice from my training rang in my head, “It is a sign of weakness to use all of your vacation…” and when I asked the other docs, most did not use it all.

In private practice, we usually had at least eight weeks of vacation, with additional allocated days off, and they were scheduled and completely used by everyone.  There was no guilt for taking a rightfully earned day off.

Professional Allowance

The Ivory Tower provided a $5000 allowance for licensure, society dues, and meetings. If you could not spend it all (ha!), you lost it. Realistically, licensure and dues ate about $2500 per year, and it would be hard to get to a meeting for $2500. In private practice, we allowed ourselves $20,000, and if you did not spend it all, you could take it as salary. (This private practice allowance model may be out of compliance with current regulations.)  Ed: $20k blows my mind.  Most medical conferences cost $2k to attend by yourself; what I receive doesn’t approach was Vagabond was offered a couple of decades ago.

Parking

While seemingly trivial, this was perhaps emblematic of the Ivory Tower vs. Private Practice dichotomy. At the Ivory Tower, I would have to pay for parking, about $250/month, and park a 15-minute walk (or a short bus ride) from the parking garage to my office. At the community hospital, parking was free, and my walk was 3 minutes from the parking lot to my office.

The extra time parking/walking at the Ivory Tower would steal 2 hours from my week — time I could be exercising, walking dogs, or interacting with my children, not to mention the $3000 per year from my wallet.  Ed note: my parking fee isn’t as high as Vagabond’s would have been, but my parking setup is about the same as his would have been.

Workday and flexibility

This was the deal killer.  It could not be negotiated away, and once known, it made my return to the Ivory Tower impossible.

Our home life balance, with two working parents, required that I was available to wake the kids, start their morning routines, and usually drive one or more to school on most days. Since my workday in private practice typically started at 8:00A (occasionally 7:30A), I was able to exercise three mornings per week and easily complete these morning tasks for my family.

At the Ivory Tower, most days started at 6:45 or 7:00A, which would have had me waking earlier to exercise and have me out the door by 6:30A, before my children were awake, thereby leaving all of the morning responsibilities to my wife.  While many of my friends and former colleagues made this sacrifice on the altar of career advancement, it was not one I was willing to make.

Had I stayed on after training at the Ivory Tower, I expect I would have had a rewarding and meaningful career, highlighted by interesting research and publications, the joy of teaching and developing young colleagues, and the thrill of being on the cutting edge of medical knowledge and practice.

Our family life would have evolved to accommodate the requirements of the Ivory Tower. Once I left, however, my life turned down a different path.

It now seemed very difficult, if not impossible, to return to the Ivory Tower. Most importantly, the desire to work there had faded over the years, and my return to the Ivory Tower was not meant to be.

Do you have your own Ivory Tower experiences to share?  Comment below, or if you want to submit a short guest post, please contact me at roguedadmd @ gmail.com.  Next week check back for the first in my own series of posts on this topic.