My Ivory Tower – I Loved You But Had To Stay Away
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.
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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.
I enjoyed reading your post @VagabondMD.
I also joined a community practice after my fellowship. Things have worked out well. I have no regrets, but as I reflect back on my younger self, I do sometimes wonder how my life would be different now if I had chosen a different fork in the road earlier in my career.
Thank you NeuroDoc. There are lots of forks along the road. It’s amazing how different life would be if a coin toss decision or two went the other way.
I was groomed for academics but could not handle the politics. One attending at my Southern Ivy told me you will be back because you will be bored by private practice. I think this happens no matter what the job is.
Similar experience here. It cracks me up as I treat way more unusual cases in the community than my friends at academic centers. I am not bored.
That must be specialty dependent because for peds you really have to be at an academic center to see most of the interesting cases
When work gets boring, I can find lots of other stuff to keep me interested. For some of my academic friends, work becomes the hobby, too.
“Hey, do you wanna see my Kaplan-Meier curves?” — said an old friend to me once when we were hanging out.
I do have lots of interests outside of work, but I rarely outside of work discuss my research efforts. But that sounds like a great pickup line for an academic conference
The politics will be a discussion during my post next week. It is real, however how much it impacts you depends a bit on your goals.. but yes I do think it exists everywhere
Thanks for sharing this story. I think this is very dependent on the institution’s culture and the comfort of staying in the same place. A good or bad experience carries a lot of weight for this decision-making; at least it has for me.
At my current institution, the pay isn’t great, but in the grand scheme of things, it’s pretty darn fair considering the work volume is well below a regular pathologist’s work day. I think the politics and uneven work distribution is what is really driving my decision to go into private practice. Obviously, I’m not blind to the fact that this happens anywhere regardless of academics vs private, but similar to the author, you go with your experiences and what you value.
There are lots of trade offs in life, and this is but one. In this case, at least for me, there was no trade back. Occasionally, I saw people bounce back from PP to academics but not as much as I once did.
I hear echoes of that from other people as well. I think any model that isn’t a pure “eat what you kill” approach makes politics more likely to emerge a play a role.
The donate button the site brings back memories. I tried one of those once. I’ll bet it works out about as well for you as it did for me. 🙂 You’ll notice it isn’t on my site anymore aside from the scholarship page, where it doesn’t do much either. People want their interwebs for free it turns out, even if it means selling their eyeballs or even like Facebook, their information.
Lol — after the PayPal fees I think I am net 66 cents so far. Take out the 10% to charity and it’s 60 cents. That and a 5 dollar bill will buy some Starbucks 🙂
It might come as a surprise to you guys, but there are a couple of sites that I regularly contribute via the PayPal donate button. One, in particular, is dedicated to my favorite football team, and if it did not exist I might die. So it’s good for my health to keep contributing. 🙂
But where’s my donation?
There is good and bad. For a call heavy field like Cardiology it is nice to have fellows and trainees. Plus more diversity in activities, possibilities, etc. In academia than private practice.
For me it is more about control. In academia, you cede it to many more levels than in PP.
I think trainees can add a lot depending on the field. For me working with fellows adds significant enjoyment to the job. And yes it can make it easier as well 🙂
Great Post Vagabond. Central Pillars: Money – Decision/Control – Work/Life Balance – Career Satisfaction, that affect career decisions across all work sectors does separate into clearer lines in healthcare with University Academia on one side and the Small Business Owner small group practice. Of course there’s a lot of choices in between those two polar differences and lots of flavors within each one like the VA, DoD, Kaiser, Mayo Clinic, large multispecialty groups, and super IPAs. Each have their own pro/cons and advantages/warts.
As healthcare has been commoditized over the past decades, this differential has shrunk significantly, as I am a prime example of it. After nearly 15 years in the VA and spending the last years in the ‘promoted’ middle management, was burned out on the lack of control and questionable decision making marching orders made by Central Office and in-between. I moved over to the clinical side of University Academia. It was 20% less than Kaiser or Private Practice and still political and control issues, — but did find more balance in logic where dollars drove decisions while maintaining a core idea of a greater good to all SES levels that was important to me and allowed some level of freedom of choice within the exam room.
To each their own. Most docs find their own path eventually. I wish it were easier to do during residency, but the training system simply doesn’t promote thinking beyond itself.
I think there’s a huge spectrum both inside and outside of academia. Even inside a single medical school certain departments can be run very differently, but the institutional culture definitely permeates through all of them
Hello ,
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I love pets. I have two beautiful thai cats called Tammy(female) and Yommo(male). Yommo is 1 year older than Tommy. He acts like a bigger brother for her. 🙂
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I have subscribed to your newsletter. 🙂
Keep up the good work on your blog.
Regards
Wiki
I have a mix of experiences: 5 years in private practice. 5 years in academia. 10 years at a community hospital. I thrived and was successful in all of those environments. But they all have strong pros and cons.
Would you be willing to share a guest post comparing and contrasting? 🙂
Academic hospital in my experience acted like you should feel lucky they even let you be there. The parking fees are part of that arrogance. The attitude permeates these places. I recall asking for a sphygmomanometer to double check a patient’s BP and a nurse or nurse’s aide waving vaguely down the hall and telling me to find it “down there somewhere.” Fast forward to my first such experience at a community hospital when my request was met with a nurse hurrying off to measure the BP for me and saying eagerly, “I’ll get that for you, Doctor.”
I bribed the ER nurses with pizza and cookies so they would stop heckling me
All the best the next time you need an endocrine consult.
Vagabond is a radiologist— not sure he will have to consult an endocrine doc anytime soon. Do radiologists even get that option or is it grayed out in the EMR?
This is my first visit to RogueDadMD, and I enjoyed reading this post very much. My surgical subspecialty career path has been somewhat circuitous. I started out in academic surgery (4 years), with a basic science animal lab, learning how to do western blots, northern blots, and any which way blots, also applying for NIH grants and getting to present my data in Europe and Australia, etc.
For family reasons, I made a cross-country move and started my own group (4 years). Although a mostly positive experience, there were a few downsides, like driving back and forth and taking call between 3 hospitals. Also, I was getting a little bored with routine surgeries. Then, my state’s academic med center (AMC) started recruiting me, and I’ve been back in academic surgery for the past 14 years. This may sound crazy, but I have enjoyed the really challenging cases, and I love working with the residents and med students. In addition, there were a lot of opportunities to advance my career (paid masters degree, leadership positions, entrepreneurship, etc.). Although the pay is a little lower than PP, the generous pension is definitely going to add security in retirement. Yes, I do have to pay for parking at the AMC, while it was free at the community hospital. Irritating, but not a deal breaker.