What is the appeal of working at large academic centers?

[garceyues]

Maybe I am missing something, but unless one is passionate about research or teaching, what are the draws for working at a large academic center? My understanding is that pure clinicians/community physicians are generally better compensated and have more flexible hours (controlling for specialty of course). While large academic centers are generally situated in desirable locations, I would presume that large cities have community job alternatives outside of certain hyperspecialized or intrinsically academic specialties. I also recognize that not everyone working at a large academic center is necessarily super involved with academics, but with the competition for these positions in desirable locations I'm not sure how any newly graduated resident could hope to attain a position without strong research. 

I can't imagine wanting to work as an attending at a high-patient volume quaternary care center while also being encumbered with the pressure to publish, all while being paid less than my clinician counterparts. A lot of the discussion I have seen on this topic has been on the American side of things, but I would think that the picture is similar in Canada.

 

[bearded frog]

I wanted to work at a tertiary care centre because I am interested in tertiary care medicine. I like being the higher level of care, and seeing the complex and rare conditions, and generally being on the cutting edge of practice (at least in Canada). I like working alongside subspeicalist colleagues (in peds this usually means working at a tertiary care centre). And I really enjoy working with learners but I guess that falls under passionate about teaching. I think you're correct that rural medicine may get paid more, but it is not accurate to say that community jobs in big cities make more than academic medicine. Myself and a lot of my colleagues work both in tertiary care centres and in the community.

[shikimate]

1) IMGs who needs visa sponsorship

2) your spouse and/or kids don't wanna move 

3) you are hesitant (aka afraid, don't feel competent, worried, scared) to do general cases or doing cases without the help of fellows and residents 

Also I should add that your statement about "large academic centers are generally situated in desirable locations" will draw a lot of ire. Like most people don't wanna pay 2 million for a shack, 75K for a condo parking spot, 25$ for a burger and have your SUV stolen while you go grocery shopping lol

 

[1D7]

Aside from the very valid reasons already listed above (popular location, liking the complexity & access to subspecialty colleagues, shackled by spouse/family, sponsored IMG, dependent on learners)...

1. Working in academics isn't always a money loser. In some specialties residents speed up your workflow and you can come out even. This means you have to trust the residents, let go of small errors here and there, and spend less time teaching (not what I advocate for but we've all had staff like this). Though if you want to do a good job teaching, it will definitely slow you down at least a bit.

2. Working in academics does not always require significant publishing. In some smaller academic sites you can get sufficient academic credit just by teaching, doing rounds, the occasional easy retrospective case series, etc.

3. Lifestyle can be better for specialties where residents/fellows cover overnights and some of the day-time work essentially independently.

4. You like working with learners a lot.

5. You like academic accolades/prestige a lot (not a great reason but whatever floats one's boat).

6. Your subspecialty or niche can only be supported in an academic environment.

Also going back to location, in many smaller cities the academic sites comprise of most or all hospitals within the city proper (e.g. Queens, McMaster, Western). If you're a hospital-dependent specialist, you may have no other option.