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Late career change to university setting

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  • Late career change to university setting

    It looks like I have about 5-6 years left to practice after a career in private practice and have been offered a position with a university doing mostly clinical work.  No issues with my private practice group but want to work fewer hours and this university position would allow that.


    What have the experiences been like for those in a university setting?  In the vain of the recent VA thread, are staff generally lazy or motivated?  Administration problems?  Does IT get done?  Anything else?

  • #2
    I’m thinking about it.  I don’t need the money but the benefits are compelling.  Potentially guarantee of access to health insurance and pension.  Controlled hours and responsibility.  Not sure it’s worth it for us but considering it.

     

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    • #3
      Many do it either to Kaiser, VA or academic centers.  All of them give great pensions and benefits.  The question is which would fit you the best -- clinic, environment, and bureaucracy.   The hardest part of coming from private practice for many years -- it's the loss of control on many levels.  That's the hardest part of all three.

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      • #4
        Not enough info.

        Field?

        Teaching responsibilities?

        Med school appointment?

        Academic medical centers are as heterogeneous as private hospitals. Some (MGH, Mayo) are internationally known research powerhouses and others are basically just quaternary centers for their geographical region.

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        • #5




          Not enough info.

          Field?

          Teaching responsibilities?

          Med school appointment?

          Academic medical centers are as heterogeneous as private hospitals. Some (MGH, Mayo) are internationally known research powerhouses and others are basically just quaternary centers for their geographical region.
          Click to expand...


          Can't disclose field.

          Very minimal teaching responsibilities.

          Would have med school appointment but practice environment would feel more like private hospital than academics.

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          • #6







            Not enough info.

            Field?

            Teaching responsibilities?

            Med school appointment?

            Academic medical centers are as heterogeneous as private hospitals. Some (MGH, Mayo) are internationally known research powerhouses and others are basically just quaternary centers for their geographical region.
            Click to expand…


            Can’t disclose field.

            Very minimal teaching responsibilities.

            Would have med school appointment but practice environment would feel more like private hospital than academics.
            Click to expand...


            sounds good.

            no idea what to tell you sorry.

            sounds like you are just looking for fewer hours? if that's the case i would just directly confirm with the chair that your hours will be capped at X.

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            • #7
              I have personally found that the nurses are usually more difficult to work with in an academic hospital, probably from having to refuse stupid orders that the residents put in, but sometimes I think that they are more unionized and have more a less is more mentality similar to va employees.    The physicians can also be more difficult to work with, particularly if you are reliant on other specialties to help you take care of the patient, the fellow doesn't want the extra work and the attending wants to get back to the lab.  Obviously these are generalities at the teaching hospitals I have worked at and been trained in.

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              • #8
                Having worked in 2 private hospitals and 2 academic centers, the academic centers also have nursing schools. If you take care of inpatients, then you will have to deal with young inexperienced nurses who may be used to paging the resident for every this and that. I found the private hospital RNs to be better capable of handling minor issues.

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                • #9
                  I think it's hard to answer your question since not all academic settings are the same. My SO works in one and has for 7 years. It's mixed at best. There is the flexibility to cut back when you want. But it can take IT 2 months to get something done. Tons of administrative problems and red tape. Staff are motivated, but the bureaucracy is very prominent and it's slowly depressing her for sure. She was never in PP so she doesn't understand the benefits of PP. I would imagine if that's what you're used to, this could be a tough transition, especially if you are older, as change is harder the older you get. Will the tough transition be muted because you're working fewer hours? Only you can know that

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                  • #10
                    The working environments in various academic medical centers are as different as they are numerable.  Some are very collegial and a pleasure to work in, others are toxic where people claw over one another to gain power and position.  It will typically vary quite a bit even between departments at the same institution.

                    Your question cannot be answered on a forum, but talking to people who are already working where you are considering a position could yield lots of helpful information.  I would ask to meet some of the rank and file in the department you are considering joining.

                    "This is a big move for me at this stage of my career.  I am excited about this opportunity but would love to meet some of my future colleagues before finalizing my decision."

                    Even the response you receive to this type of request could be telling about the culture of the department.

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                    • #11
                      Turnover and physicians that have retired or left for “greener pastures “ are a great source if you can manage any contact. Sometimes that gives a clearer picture of the work environment.

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                      • #12
                        Given that even universities are moving to RVU based models, I would ensure that the shorter hours aren't unhappy hours. Teaching is fun. Quality teaching + RVU output- not as fun.

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                        • #13
                          We moved specifically AWAY from RVU model.  ACOs and capitated risk has brought back Value Based Care in vogue again.

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                          • #14
                            did it for similar reasons you describe.  i enjoy the environment, staff, students, residents & fellows, teaching, grand rounds, conferences, collegiality, etc.  staff is good and happy, but we are private university and not state or VA.  some roadblocks and bureaucratic hoops which are expected, HR and IT are minimal, appointment and promotion process is indeed slow and tedious.  was surprised by similar turnover problems as PP.  but here's the crux of the matter, you are at the mercy of the chief/chair of dept and intra/inter departmental politics.  your relationship with that person has to be solid and click well, as you will not have much, if any, control of your practice & clinic without their support.  don't assume you can just transplant your practice and clinical style over to their academic setting, that can backfire if it's not tuned to their liking.  Also, if & when the chair leaves and a new one comes in (also this could happen with a new dean), everything and anything can change...
                            It's psychosomatic. You need a lobotomy, I'll get a saw.

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                            • #15
                              “HR and IT are minimal” until trouble pops it’s head up. Little things like discrimination and/or harassment complaints (valid or not) REQUIRES the “big guns” to investigate. Then it gets outside of the medical school and the university gets involved. Words like mean, harsh, uncomfortable have a life of there own when used in an investigation interview. Sometimes it creates “camps” with new teams (supporting different narratives). 30 year careers can be tarnished by a couple of 2nd year residents. Much more common in academics than PP. It’s part of our academic institutions now.

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