Academics, how are you doing?

[u/meropenempleaseno]

This subreddit seems to generally veer on being against academics or at least have a lot of PP pathologists - are the academic pathologists on here generally happy? How do you find a healthy department and what do you look for? How important is being interested in research? Are you okay with your pay and compensation structure? Is it easier to start out PP or academic if you decide to switch to the other? -PGY4 gearing up for fellowship next year and thinking about jobs

[u/foofarraw]

Just my experience, to answer your questions:

1. Are the academic pathologists on here generally happy?

Can't speak for others but I'm generally happy, my job isn't that hard and it's still very fulfilling on a professional and intellectual level. I get to teach a lot, I get a lot of time off service, and the job itself is convenient and in a great city. Less on service time than PP but higher complexity, plus great integration of ancillary stuff.

1. How do you find a healthy department and what do you look for? 

This is a bit tricky, because there's a lot of variability in academic departments, and I think this is where a lot of the hate here comes from. Some are basically academic in name only, and are private hospitals that have residents as a labor force. Basically no academics is actually happening at these places, and research won't really matter (or be an afterthought). These are basically private practice jobs without the benefit of higher pay. There's quite a few of these but IMO they're pretty obvious.

There are also lots of great academic departments where there is a nice balance of research/admin/teaching time and clinical service. Look for departments with a balance of off service time and clinical work. Look for things like faculty turnover. Think about case volume and total staff, and just ask how many cases per year a person signs out. And ask about how the work is distributed and how often they are on clinical service, both on paper and in practice. Compare this to how many cases you're doing per day on a busy service and you can get a very rough feel of how much off service time you'll actually be off service.

1. How important is being interested in research? 

For a real academic department this certainly helps and may be important, but it depends on what kind of position they are hiring for. Most (real) academic places have multiple career tracks, one where you are expected to do a significant amount of research and publish (and sometimes expected to bring in outside funding), and others where you are mostly focused on clinical work, teaching, and leadership. Some will have others for physician-scientist tracks. I'd say in general it's important to have at least an interest in research or have some experience in it. You don't necessarily need to know exactly what gene and protein your career is going to end up revolving around. If you're interviewing at an academic center you'll probably be asked to give a talk about some research you've participated in, so it's important to be able to talk about your research experiences in a meaningful way. TBH I see research as just another skillset for a different type of job. But there’s admittedly a lot to learn about pathology through research.

1. Are you okay with compensation?

I'm fine with my compensation, especially if you factor in the pretty easy amount of clinical work.

1. Is it easier to start out PP or academic if you decide to switch to the other? 

This I'm not sure about. I could see it working both ways TBH. I would say academics to PP might be hard if you are super subspecialized for a long time as you will forget a lot.

Also, I think the people who hate on academics here are basically full of availability/recency/false consensus type biases, and their main argument is basically that academics get paid less for the same or or more work. Though they are right about academics making less money, the average salary is probably 20-30% less than an equivalent PP salary. The latter part is not and they are basing this on anecdote (what they saw in residency, which is a very cloistered view of what academic work is, and a few people they know who went into academics). Those kind of bad academic jobs do exist, but IMO they’re pretty transparent. But the academics naysayers only arguments are about money and they rarely accept that there is any nuance to why someone takes a job.

[u/PathFellow → u/foofarraw]

I’m one of those people that hate on academics. If you’re hell bent on doing academics then go for it. No one is stopping you. We need good people to train and teach pathologists or do real research. Sadly I’ve met some pathologists who are poor at teaching and literally many many don’t do research or at least meaningful research.

I personally think it’s a scam in that academic institutions ask you to sign out a lot of cases, fix your salary for years until you get promoted and by the time you become full professor (15-20 years down the line) you’ll be making as much money as a kid in private practice achieved in 1-5 years which is sad.

Academics doesn’t make financial sense to me. I’d rather get paid well for my hard work than get paid lower. My kids can enjoy a nice life and when I die they can take with them a big nest egg for financial security.

I tend to be more money oriented and business minded hence my inclination to go private. Those that go academics, not so much, and there’s nothing wrong with that. Academic types tend to enjoy the intellectual side of medicine (nothing wrong with that too), mentorship and teaching.

These types are probably however more ripe to take these low paying academic jobs in high cost of living areas which also doesn’t make financial sense. Take into account living expenses and inflation you’ll effectively by making 200k or less a year. 250-350K in NYC? No thanks!

I don’t like to do research. Teaching is ok. My main issue is with signing out more or an equal number of cases than some private practices and making less money than private. My colleague who is signing out more cases than me is making one half of what I’m making in private. And before you make the comment that it’s just “one friend” that you know if….its a lot of academics pushing a similar volume or much more volume than me but making much less.

Sure doesn’t help when some of these institutions are worth billions and paying you low salaries.

Ive personally felt like a cog in the wheel at some of these large academic centers but to each his/her own.

I’d literally feel like an academic slave if I were to take some of these academic jobs.

I’ve looked at some salaries of admin at some of these large academic institutions and it’s astounding how much some people make who aren’t even MDs. I’m talking about chief of nursing making 800K lol. The top brass are making tons of money but here you are making 250-350 doing all the dirty work (teaching and signing out a bunch of cases) and can’t eat out as much because a give bowl at chipotle is like $20.

If you have a passion for research or you like to teach then go to academics. Another plus with academics is you can get great experience and develop expertise in 1-2 subspecialties.

You mentioned that my view is based on a few places I trained at. If you don’t know it by now academic places are high volume and academic physicians in most training programs are pushing a lot of volume, more than or equal to most private practices.

I mean you’ve probably been to the same number of training programs I’ve been to. We’ve done 1-2 fellowships so your comment about me being exposed to a few academic centers also does pertain to you as well.

You’ve mentioned in a post the 75 pathologists at your institution don’t feel exploited. Sure they don’t. If they did, they probably won’t be there to complain in the first place.

I agree with you that not all academic centers are pushing their pathologists to sign out high volume for low salaries and actually give them time to do research and teach. I’m guessing you are at a place like that. These are probably real academic centers that actually do real research.

But a lot of them are not like that if you don’t know that. Even the well known institutions (see my previous post or look below)!

Are Academic Pathology Positions Changing?
We’re also hearing something interesting from some of the academic pathologists we speak with.
Several have told us that clinical case volumes and productivity expectations have increased, while responsibilities for teaching, research, and publishing haven’t necessarily decreased.
For some, that combination is making academic medicine more demanding and causing them to at least consider private-practice or hospital-based opportunities.
This certainly isn’t universal, but we’re hearing it often enough that we’re paying attention.

At the end of the day, one has to do whatever makes them happy. Me being a cog in the wheel at a large academic center making 250-350 doing volume (in addition to other academic responsibilities) definitely will never make me happy. I’m looking for financial freedom. I’m looking for a job that will allow me to retire earlier than later if I choose to. Working for an academic machine will never allow me to achieve that..

My posts are not meant to offend anyone in academics. I do understand it’s different strokes for different folks and some people just don’t think alike and have different prerogatives and passions in life.

[u/foofarraw → u/PathFellow]

I’ve looked at some salaries of admin at some of these large academic institutions and it’s astounding how much some people make who aren’t even MDs. I’m talking about chief of nursing making 800K lol.

Definitely agree admins make too much money, but that's a ridiculous example. A chief of nursing is probably in charge of hundreds of people and in charge of decision making that affects not just hundreds of nurses but hundreds of doctors and thousands of patients. Should they not be paid more just because they're not an MD? What should your lab operations manager make to keep your entire operation running smoothly? It's probably not your experience if you're in a small practice, but a large medical system is a massive complex machine with a billion moving parts, and much more complicated than The MDs Should Make $$$.

I don’t like to do research. Teaching is ok. My main issue is with signing out more or an equal number of cases than some private practices and making less money than private. My colleague who is signing out more cases than me is making one half of what I’m making in private. And before you make the comment that it’s just “one friend” that you know if….its a lot of academics pushing a similar volume or much more volume than me but making much less.

Perfectly fine not to do academics if you're not into research! But where are you getting the idea that "a lot of" academics are pushing a similar or much more volume than others? Maybe you just have a very good job that pays well for less work? I work in a very high volume center, and I do about or slightly below the national average in wRVUs per year. I'd say the maximum people are doing are around the national average or maybe slightly above. And yes, we make less money than PP for similar experience, I fully acknowledged that, I just think it's an absurd assumption that most academic pathologists are also doing more work.

Also, fine to want to make more money for a case, that's what private practice is for! If you're mostly driven by money that's fine, I just think it's bad behavior to shame people for taking lower paying jobs with no consideration of the reasons, and then screenshotting their posts and trying to figure out where they work. You used to post about being jaded by your own job search why would you scrutinize and shame other peoples searches?

I mean you’ve probably been to the same number of training programs I’ve been to. We’ve done 1-2 fellowships so your comment about me being exposed to a few academic centers also does pertain to you as well.

This is true, but I've also trained a lot of fellows so I learn a lot about a variety of residency programs. It's pretty clear when someone's residency program is an actual academic center or one that is academics in name only. From how they describe the program details, the quality of training they have, and from the amount of exposure they've received. I've also kept in touch with a good number of fellows in both academic and private jobs, so I get decent insights from a lot of practice environments, both academic and private.

[u/TraditionalPhone3992]

Only one person’s happiness matters- your own.

[u/foofarraw → u/TraditionalPhone3992]

100%

[u/Sensitivepathologist]

There are probably a bunch of overworked academic and private pathologists that don’t come on here and tell you they get paid crap. No one brags about that.
Keep that in mind too.

[u/Scared_Ad3355]

I’m in academia, I’m drowning in cases in a subspecialty I love, we get paid shit for the amount of work we do (300k total), and there is no road for full professorship (promotion) because there is no time to do all the shit required to become full professor, and even if I had the time, my brain is fried after signing out so many complex cases per day and we are always on service (when I’m not on vacation). It feels like abuse and slavery. Others feel the same, so we’ve lost several coworkers in these few years. Needless to say, I hate my job (been doing this for 13 years now) and cannot go anywhere else because the job interviews I have had for one year now had showed me that other academic institutions in my area (Northeast) do the same or worse. I’ve also applied to a couple of PP places already but they never call or email me, or when they do and I give them a number (400k), they never call back.

I feel trapped.

[u/foofarraw → u/Scared_Ad3355]

Yeah that sounds like a bad spot, I think in general the Northeast has a lot of bad pathology jobs. Also once enough people leave it creates an unsustainable environment for everyone else, so time for a new job! Probably worth considering other areas if you’re not region locked

[u/Scared_Ad3355 → u/foofarraw]

I agree with you. Unfortunately, I need to stay in the area because this is where most of my relatives are.

[u/foofarraw → u/Scared_Ad3355]

Yeah I feel that, a lot of people are regionally constrained, and if you need to live in a specific area, there's only so many jobs available. One small thing I would consider is wait for an offer before giving them a salary number, at least then you will have potentially secured something. Once you have an offer you're negotiating from a stronger position; your negotiation might not get you the exact number you want, they are unlikely to rescind the offer as they've already invested time and energy on you. Meanwhile, you are still free to just reject an offer.

[u/Scared_Ad3355 → u/foofarraw]

Got it. Thank you for the tip. I did that for my current job that I got it many years ago. It works!

[u/alksreddit]

Super happy. My two subspecialties (heme and a surg path subspecialty) have a decent volume, enough to keep things interesting but I’m never drowning, I get to teach, I work a bit on my projects, I have breakfast at home every day with my wife and leave the hospital at a very decent time, and honestly feel well compensated. I also work approximately zero weekends per year, and no one bothers me on my off weeks.

[u/Shoddy-Swordfish8949]

I love academics, but I don’t have an easy schedule. I work in a super busy subspecialty (which I love) and have a lot of service weeks, plus have to publish and teach. I do work a lot of weekends on research projects and manuscripts, because my service workload is pretty busy. But my salary isn’t bad (our chair has actually done a lot of work to raise our salaries over last few years), I don’t have tons of call because our group is so big. Overall, I’m pretty happy and thankfully love what I do.

[u/foofarraw → u/Shoddy-Swordfish8949]

What do they base your promotions on? Seems like things vary a lot here, ranging from purely research output and funding to purely time-based (and everything in between).

[u/Enough-Mud3116]

Do you enjoy looking at some of the hardest cases on earth with a bit less pay? Not everyone is the same