Academics vs community practice

If you don't already know about the amazing site ERCast by Dr. Rob Orman (Portland, Oregon), you need to take a look. The most updated podcast is on how one decides between an academics versus community practice setting. Guest speakers include Dr. Rob Rogers (Univ of Maryland, EM-RAP Educator's Edition podcasts) and Dr. Scott Weingart (Elmhurst Hospital/Mount Sinai, EMCrit podcasts).

Rob Orman's great website of podcasts:

http://www.ercast.org/

Click on the small "Pod" icon

Academic physician
Rob R. and Scott talk about how academic faculty positions have evolved from a very teaching-centric opportunity towards those where faculty need to "do it all" -- teach, focus on patient through-put, see some patients primarily, do administrative work, and conduct research. Furthermore, you need to deal with a constantly rotating, army of consultants and off-service residents in the ED who may pose as challenging personalities.

In academics, there are traditionally 2 types of tracks - Clinical-Educator and Clinical-Research. Keep a lookout for a new trend where departments are hiring physicians for a pure Clinical track. This track allows physicians who love to do bedside teach but don't really want to participate in other didactic or research projects. Those in the pure clinical track may be a new track in the future.

What academicians find surprising is just how hard it is to balance all of the job responsibilities which may or may not receive protected time from shifts. This includes:

• Working shifts
• Attending administrative committee meetings
• Troubleshooting departmental issues
• Teaching at residency conferences
• Giving national lectures
• Traveling to national meetings
• Trying to get published so that you can get promoted, AND -- oh, by the way -- 
• Balancing life

One thing mentioned that I was also surprised by is that there are different criteria for promotions in academia depending on where you work! Some hard-core institutions require rigorous, original research publications to get promoted. Others require more loosely-defined academic work, which may include lectures or review publications.

Community physician
Rob O. talks about how a community emergency physician is a stressful experience because all decision points need to filter through the emergency physician -- doing procedures, handling administrative hurdles, and seeing ALL the patients primarily. There are no residents to help see patients primarily or help with procedures. It's all YOU. On the flip side, it's all you when it comes to procedures. For those who enjoy doing procedures (and not giving them up to the residents), the community practice setting is terrific.

Bottom line
Both types of positions have unique stressors. For a graduating resident, the question will be deciding what set of pros and cons best fit your interests and lifestyle.

Listen to this great 60-minute panel discussion for more nuggets of wisdom.