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Does the whole “academic medicine doesn’t pay well” still hold true now that residency programs in community hospitals are rapidly expanding?
Why would it change?Does the whole “academic medicine doesn’t pay well” still hold true now that residency programs in community hospitals are rapidly expanding?
They know that even with terrible pay, people will still go there for the prestige and research. My school is also a major biomedical research center and they pay pretty poorly too.Strange because you would think that it would be higher at these places.
Most teaching is done at bedside so not overly cumbersome. I in general refuse to do anything extra uncompensated, even if that compensation comes in the form of protected time, and it is becoming more acceptable to say no to uncompensated things even if you’re very junior.Regardless of salary, it is pretty much always a massive, huge, gaping pay cut when you include the amount of unpaid time for teaching and working on things for students or research outside of “work.” Cause guess what, that’s still work! It’s just done unpaid and on your off time.
So you never give lectures, do journal club, help a student with a research project, write a letter of recommendation, mentor anyone, answer emails to students, or literally do anything except clinic/hospital?Most teaching is done at bedside so not overly cumbersome. I in general refuse to do anything extra uncompensated, even if that compensation comes in the form of protected time, and it is becoming more acceptable to say no to uncompensated things even if you’re very junior.
That is the 1% -- academia will generally make much less than pp.no
though there are some medical professors at UCLA and Columbia (and I’m sure other places too) making 2,000,000+
Of course I do but I asked for 15% protected time and have another 15% protected from grants , meaning that I am at .70 FTE clinically so that RVU thresholds are of 70% of someone who does not have protected time, but i work clinically 4 days a week which is enough to put me over the 90%ile for productivity because of the lower threshold (for instance if someone needed 10k rvu to get to 90%ile without any protected time, I only need 7K rvu to get to same level), so actually end up making more money than if I was only clinical. To be sure not every person can and wants to get grants, and they do end up doing that stuff for free, but the ones who are only interested in clinical can do just that.So you never give lectures, do journal club, help a student with a research project, write a letter of recommendation, mentor anyone, answer emails to students, or literally do anything except clinic/hospital?
If you answered no to all of that you’re not actually in academics, you just work with residents and/or med students.
I thought new cardiology attending salaries usually start 450k+?It's true that academic medicine pays lower compared to private practice medicine in general, but I wouldn't say that it "doesn't pay well". Moreover you have to look at it in context.
One, in academics you are also doing research on top of clinical work but for the most part you have residents/fellows doing most of the work for you. If passionate about teaching, may be more rewarding to be in academics. Also lifestyle may be better in academics because you are working your butt off in private practice.
Two, depends on the specialty. In cardiology you still earn a pretty good salary in academics. At my fellowship institution, starting salary for a new graduate is $328,000 and you can apply for tenure track in 5-7 years. The more established associate professors and full professors here earn high 300k to low/mid 400k, respectively.
Three, depends on the institution. My fellowship is hybrid academic/community. I've heard that at top tier institutions like Harvard salary is much lower. Strange because you would think that it would be higher at these places.
Not even close bud.I thought new cardiology attending salaries usually start 450k+?
PS- I am totally ignorant to it, that has been through word of mouth.
I meant to say yes. I meant that academics don’t pay well though there are outliers in some some instancesThat is the 1% -- academia will generally make much less than pp.
Not even close bud.
There probably is some response bias but nobody can know if that shifts the average up or down. First you said it was word of mouth, then you said it was based on Medscape. Which is it? And I think there are other problems with using it how you did.
I was more so referring to the medscape physician comp report. They had average at 490k. Do you think response bias is that prevalent in the reports they publish?
Edit: Went through your post history, your acting awfully confident about salaries for an M2 now aren't you bud? lmao
I have talked to maybe a half a dozen cardiology attending, caveat being they are all 40-50 y/o and in the same region (where I am from in the Northeast-- not a MAJOR metro area). They all make well over 400k. That is the word of mouth.There probably is some response bias but nobody can know if that shifts the average up or down. First you said it was word of mouth, then you said it was based on Medscape. Which is it? And I think there are other problems with using it how you did.
(1) You asked about starting salaries, and I don't think Medscape collects that data (correct me if I'm wrong). I don't believe they segregate based on time in practice. So if we're to assume Medscape is accurate, the average overall salary of $490k is likely much higher than the average starting salary (think about how some senior cardiologists making $1M+ could severely skew the average...median would've been more useful but still couldn't be used to estimate expected *starting* salary).
(2) The person you were responding to was saying that their expected starting salary in *academic medicine* was ~ $328k. Medscape doesn't separate individual specialties based on academic vs private practice, so their reported average would be higher than the average for academic medicine.
Still true overall, but clinical productivity (eg as measured by RVUs) is generally lower in academics, since in most positions you're not practicing 100% of the time. And research and teaching usually don't pay nearly as well as clinical practices in most specialties, unless you are well established and can get a large amount of grant funding to supplement your salary. Salaries for more senior attendings can be quite a bit higher after many years of experience but usually still not PP level.Does the whole “academic medicine doesn’t pay well” still hold true now that residency programs in community hospitals are rapidly expanding?
Probably not in most academic positions ,but can definitely make $450-500k in PP first year if you work a lot and pay is the base salary + RVU structure.I thought new cardiology attending salaries usually start 450k+?
PS- I am totally ignorant to it, that has been through word of mouth.
I worked in clinical research at a reasonably sized community medical center prior to med school - It’s more about networking which academic medicine inherently makes easier. However, it’s very doable outside of academic medicine or only being peripherally affiliated with an academic center as long as you have the interest and desire. That said, depending on how involved you want to be in industry academic medicine can be more conducive with greater flexibility for protected time and being able to negotiate parts of your contract/time being “bought out” by industry.Anyone have thoughts about whether being in academics gives you more opportunity to collaborate with industry? I came from biotech before med school and almost every MD we worked with was at a big academic center. Now thats partially because of their interest and access to research, but talking with my bosses they would often just use their association with a medical school as a barometer for them being smart, i.e. "we've started working with Dr. X from the University of Washington so you know they know this patient population well" or something like that.
Academic medicine refers to the practice where you're seeing patients, operating if you're a surgeon, and have protected research and teaching time. The latter is what lowers your salary. Clinical work always pays better than research or teaching. Since there are a fixed number of hours in a week, doing more teaching/research means more time away from clinical work.
The difference is probably easiest to illustrate for proceduralists. For every hour you're doing research and teaching, that's an hour you're not generating RVUs in the OR. So when you compare an academic surgeon to a surgeon in private practice who's operating as much as they can, the latter is always going to be paid more for their work. But then again, there are non-tangible benefits to academic practice as well, which includes the benefits to the individual of the time for research and teaching. Maybe that's more fulfilling to you.
How exactly does teaching lower your income if you can get med students and residents to beef up your notes so you can bill more for them? Or am I just talking out of my a$$ and have no idea what I’m talking about….
Mostly talking out your ass unfortunately.
With few exceptions, attendings know how to do attending work better/faster/more efficiently than trainees. Using your example, attendings know what exactly needs to be included in a note to bill at X level. A med student putting in a 50 point review of systems and documenting that patient's cousin smokes pot doesn't help up-code the note. The attending should also know what encounters merit a level 3 vs level 5 visit and the corresponding level of detail in the note.
It's no knock on the trainees, it's a function of the system. The attending sees the results of bad/incomplete documentation in addendum requests, rejected pre-auths, lower than expected collections, etc..
Good upper level trainees (e.g. senior residents and fellows) can definitely be a force multiplier if they only need minimal supervision. That is not the case with lower level residents and certainly not with medical students.
How exactly does teaching lower your income if you can get med students and residents to beef up your notes so you can bill more for them? Or am I just talking out of my a$$ and have no idea what I’m talking about…
Mostly talking out your ass unfortunately.
With few exceptions, attendings know how to do attending work better/faster/more efficiently than trainees. Using your example, attendings know what exactly needs to be included in a note to bill at X level. A med student putting in a 50 point review of systems and documenting that patient's cousin smokes pot doesn't help up-code the note. The attending should also know what encounters merit a level 3 vs level 5 visit and the corresponding level of detail in the note.
It's no knock on the trainees, it's a function of the system. The attending sees the results of bad/incomplete documentation in addendum requests, rejected pre-auths, lower than expected collections, etc..
Good upper level trainees (e.g. senior residents and fellows) can definitely be a force multiplier if they only need minimal supervision. That is not the case with lower level residents and certainly not with medical students.
The time it takes an attending to see a patient themselves from scratch < the time it takes them to listen to an inaccurate med student history and physical, give them feedback, then go repeat everything themselves. When you present a new patient's H&P, you are oftentimes presenting to an attending who already went and saw the patient while you were reviewing the chart.
This doesn't apply to senior residents, but while you should keep doing your best and being detailed as a medical student, what you get from the patient likely won't change their medical course.
Since you both brought up the topic of the usefulness of senior residents, I had another question in mind. Is it obvious to discern between an intern who clearly blew off their 4th year taking bull$hit electives vs. interns who legitimately took 4th year rotations seriously and learned and improved on their clinical skills? And as an attending, do you trust their judgement more? Or is the difference so small that you don't notice it?
What you’re describing is individual inherent drive/motivation and skill set. It doesn’t matter what electives someone takes, if the motivation isn’t there the quality of skill set is unlikely to change. Interns all start at different levels and come with varying sets of strengths and weaknesses, which is multifactorial and not just a function of quality of 4th year electives. Unless considerable concern emerges, putting different weights on trust of interns’ clinical judgement doesn’t really start to become apparent until the later half of the year.Since you both brought up the topic of the usefulness of senior residents, I had another question in mind. Is it obvious to discern between an intern who clearly blew off their 4th year taking bull$hit electives vs. interns who legitimately took 4th year rotations seriously and learned and improved on their clinical skills? And as an attending, do you trust their judgement more? Or is the difference so small that you don't notice it?
How exactly does teaching lower your income if you can get med students and residents to beef up your notes so you can bill more for them? Or am I just talking out of my a$$ and have no idea what I’m talking about….
Since you both brought up the topic of the usefulness of senior residents, I had another question in mind. Is it obvious to discern between an intern who clearly blew off their 4th year taking bull$hit electives vs. interns who legitimately took 4th year rotations seriously and learned and improved on their clinical skills? And as an attending, do you trust their judgement more? Or is the difference so small that you don't notice it?
Echoing my colleagues that you can absolutely tell who is strong and who is weak. I think back to July of my intern year and we had 4 interns on our service, and within a few days it was clear one of us was objectively terrible. They had a pristine pedigree, ivy league schools, prestigious research fellowships, etc, but they were just a terrible physician. They ended up not completing residency. As a PGY2 I had an off-service intern rotate with us who - in MARCH - did not know how to write a daily progress note. No I'm not kidding. They did not complete their initial residency either.Since you both brought up the topic of the usefulness of senior residents, I had another question in mind. Is it obvious to discern between an intern who clearly blew off their 4th year taking bull$hit electives vs. interns who legitimately took 4th year rotations seriously and learned and improved on their clinical skills? And as an attending, do you trust their judgement more? Or is the difference so small that you don't notice it?
Echoing my colleagues that you can absolutely tell who is strong and who is weak. I think back to July of my intern year and we had 4 interns on our service, and within a few days it was clear one of us was objectively terrible. They had a pristine pedigree, ivy league schools, prestigious research fellowships, etc, but they were just a terrible physician. They ended up not completing residency. As a PGY2 I had an off-service intern rotate with us who - in MARCH - did not know how to write a daily progress note. No I'm not kidding. They did not complete their initial residency either.
This experience carried on in future years too - it's immediately obvious who is good and who isn't. You still don't trust anyone because they're interns and don't have much experience, but you do start to build that trust with the better ones over time. You learn to trust them in the things that they are qualified to do. I may not trust their assessment of an acute airway enough not to see it myself, but I may start to trust that they've carried out my plan without too much double checking behind the scenes.
I'm not sure if the 4th year rotations really determine this. I suspect it does to some extent simply in that we get good at what we do often. I definitely get rusty in clinic and the OR after a long vacation, and I can't imagine how bad I'd be if I did nothing clinical for 6 months straight.
UCLA?Varies widely, but true in general. I know some academic ents making 7 figures, and I know others with similar titles and practices at other institutions making 300-500k for the same work.
Having recently been on the job market, academic starting comp was usually in the 250-350 range, but one place started assistant profs at 700k. Many do an rvu productivity bonus system and some academic shops were offering 35-45 per wrvu while others were 50-70. The 7 figure guys are at a place with an uncapped rvu bonus and higher end per-rvu comp.
Some of those numbers beat PP, but good PP docs have the potential for other established income streams that academic docs make lack. One PP I talked to started new associates at 175 for two years and then if you made partner you got collections minus overhead plus a share of ancillaries. Partners total comp ranged from 700-1.5. The 1.5m pp guy is probably working less than the 1.5m academic guy because the academic guy is making that off productivity while the PP is making a lot of that off ancillaries. Obviously that can vary quite a bit.
Yeah. Also a couple east coast programs as well.UCLA?
Since you both brought up the topic of the usefulness of senior residents, I had another question in mind. Is it obvious to discern between an intern who clearly blew off their 4th year taking bull$hit electives vs. interns who legitimately took 4th year rotations seriously and learned and improved on their clinical skills? And as an attending, do you trust their judgement more? Or is the difference so small that you don't notice it?