What is the difference between working in academics vs community as an attending?

[MasterDoc]

Why are academic positions more desirable than community? Do they pay more? I am a bit confused as to why people are willing to do multiple fellowships + masters + phd to get these positions. 

In the US its the exact opposite as academic positions are not desirable at all, unless you enjoy teaching.

[offmychestplease]

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[BigM]

It’s field dependent. In the community you show up, do your clinical work and that’s largely it. There’s not much pressure to take on additional non-clinical work. The pay is generally better because patient care usually pays better than teaching/admin. The downsides are often higher clinical volumes as there’s less people to spread the work around, less access to other specialities (if you’re at a teaching hospital and a resident is available with every specialty you will likely reach out more), less resources/specialized programs and higher call frequency. At an academic Center these are largely all flipped. You generally get a stipend/AFP but it comes with a lot of strings attached and the renumeration for your time is generally quite a bit lower than with clinical work. You teach medical students which can be enjoyable when they are actually interested, but if they aren’t interested then it slows you down and is more just checking off a box (teaching hours). Residents are generally helpful and become even more so with every year of their training. Overall academic jobs often involve more work, but it’s not always the case. 

[rmorelan]

58 minutes ago, offmychestplease said:

It is not desirable. Those people you are referring to are probably doing the fellowships and graduate degrees because they need to to get "a" job in their field with limited jobs.

You can make literally 2-3x more in community.

The only reason someone would wanter to enter academic med is because of the perceived clout or if they need to due to the nature of their field (ie. Rad Onc, Cardiac, NSx, etc) or if they don't care about money and want to work less hours.   

well one other reason - part of it is simply the city those centres are in. 

If you want to work in Ottawa, Hamilton, London, Kingston or numerous places in Montreal/Vancouver/TO as starting examples then you are going to be at an academic centre (it can be even worse in other provinces) You may not want to do all the academic things but those are your options. Plus of course as you point out some fields are highly academic by nature - we simply don't have proportionally as many cardiac surgeons in non-academic places as would would say general surgery as an example. Rad onc, many sub-fields on internal medicine, a lot of other types of surgery, would be other examples. 

In there are community vs academic positions in your field often the academic one will pay less, and involve different types of things. I wouldn't say it is 2x3 times in general although there probably is someone that has figured out how to do that for some fields etc. 

[ACHQ]

24 minutes ago, rmorelan said:

well one other reason - part of it is simply the city those centres are in. 

If you want to work in Ottawa, Hamilton, London, Kingston or numerous places in Montreal/Vancouver/TO as starting examples then you are going to be at an academic centre (

I'm assuming you meant downtown Toronto (in which case you're not necessarily wrong). But in *GTA* (including Toronto proper: Etobicoke, Scarborough, East York, North York and downtown Toronto), then definitely won't be at an academic centre. There are actually more community hospitals in Toronto/GTA than fully affiliated academic teaching hospitals (No I don't count the community-academic hybrid hospitals as academic, they are mostly still community). 

Also although commuting can suck a bit, you don't have to live next to where you work, I still live downtown for now and commute to the community.

[rmorelan]

Just now, ACHQ said:

I'm assuming you meant downtown Toronto (in which case you're not necessarily wrong). But in *GTA* (including Toronto proper: Etobicoke, Scarborough, East York, North York and downtown Toronto), then definitely won't be at an academic centre. There are actually more community hospitals in Toronto/GTA than fully affiliated academic teaching hospitals (No I don't count the community-academic hybrid hospitals as academic, they are mostly still community). 

Also although commuting can suck a bit, you don't have to live next to where you work, I still live downtown for now and commute to the community.

absolutely - it is just that a proportion of them are (as opposed to say other places where it is a 100% community). Some people just don't want to reduce the odds at all of living near one of the major urban centres. (plus the other ones I mentioned it is flipped - nearly 100% academic). Some people are for whatever reason are seriously restricted in where they can or want to go. Again though you are right - if you want community and live in TO that is completely possible. 

 

 

[Snowmen]

As mentioned, some fields are dependent on academic centers because of the need for specialized equipment or interdisciplinary teams/programs. For instance, my specialty could be done in the community but this would be severely restrictive (no access to anything beyond simple bedside procedures in a financially sustainable way, no inpatient component possible, no infrastructure for sub-specialized outpatient clinics, etc.) so the vast, vast majority (90% or so?) end up practicing in academic hospitals and have affiliations with a medical school.

[LittleDaisy]

23 hours ago, offmychestplease said:

It is not desirable. Those people you are referring to are probably doing the fellowships and graduate degrees because they need to to get "a" job in their field with limited jobs.

You can make literally 2-3x more in community.

The only reason someone would wanter to enter academic med is because of the perceived clout or if they need to due to the nature of their field (ie. Rad Onc, Cardiac, NSx, etc) or if they don't care about money and want to work less hours.   

You definitely make more in the community, you get paid for what you work for.

In academic, they have some sort of agreement of submitting their billings to a pool, and re-distribute the money among the staff. They do this intentionally, so clinician-researchers, program directors could be compensated fairly. 

I think that most academic staff physicians do it because they love teaching; or loving have residents doing calls for them. 

If you work in a community hospital with a small call pool, your life can get brutal.

[blah1234]

5 hours ago, LittleDaisy said:

You definitely make more in the community, you get paid for what you work for.

In academic, they have some sort of agreement of submitting their billings to a pool, and re-distribute the money among the staff. They do this intentionally, so clinician-researchers, program directors could be compensated fairly. 

I think that most academic staff physicians do it because they love teaching; or loving have residents doing calls for them. 

If you work in a community hospital with a small call pool, your life can get brutal.

Some of my friends have call schedules comparable to residency. I suppose at least you get paid properly for your work instead of the stipend we got as residents.

[shikimate]

There are some people I've met who really, truly want academia from the bottom of their heart. Money is not a priority for them. They truly like research and/or teaching and would happily accept most arrangements universities give them.

There are some people I've met who "pretend" they enjoy their academic positions, but in reality dream of doing the same job in a community setting. You can spot those "restless" attendings if they are junior, or "deflated" attendings if they are senior. 

There are some people I've met who is in academia because they are IMG, or have some kind of visa or license issue whereby they require institutional sponsorship. They are mixed bag, some are in academia because they like it, some are there for the expediency of visa, some are indifferent and just wanna get a job.