Private Practice Versus Academics: The Family Perspective

❤️ Heeey! Thanks for joining me today! ❤️

So, you may have learned by now that my husband chose a career working in a private practice instead of in academics. But getting to that point, making that decision, was a tug of war with his (our) heads and hearts that drug on for a couple of years.

Today, let’s talk about how my husband came to the decision to work in private practice, and the pros and cons we considered as a family unit!

This one goes out to all of my medical peeps. Are you still deciding which path to take?

And if you’re not in this world, but interested in it, read on! 🎉

Our Decision-Making Process

I’m going to give you the deets about how we got where we got, just in case some of you are in a similar situation. Oh, and also, it’s an interesting story!

To follow the journey without getting TOTALLY lost, you’ll need a little background on what training for a doc looks like. Because it’s weird. For a refresher, I go over the physician training process in this post: The Training of an Orthopedic Surgeon. Hit it up.

But the applicable Cliff Notes version is this: in Medical School, you decide on the specialty you want to pursue (i.e. Orthopedic Surgery, Cardiology, Radiology, etc). You apply to residency programs in that specialty, then (God-willing!) you match in your fav. Then you spend the next 3-6 years learning that specialty as a resident. Next, you can do a fellowship, which is optional for most specialties.

Okay, now that you’re on board with this timeline, let’s back up for a sec. Because sometime in residency, you NEED to decide which 1. Fellowship to pursue, and then, if you’re really prepared, 2. What job you’d like to pursue afterwards.

Let me tell you about our experience. It’ll all make sense, I promise.

During the first few years of residency, my husband was quite sure he wanted to continue along the path of his most trusted mentors and choose a career in academics.  Specifically, his end-game was to be an orthopedic spine or trauma surgeon, and he eventually landed on trauma. So, when the time was right (during his 4th of 5 years in residency), he applied to a few orthopedic trauma fellowships.

After my husband matched into his (first choice – hooray 🎉) trauma fellowship (which, by the way, is the perfect fellowship for working in academics), things changed for him (us).

We had a kid.

Our first spunky lil’ daughter was born about 9 months after the Match, which was about 10 months before his trauma fellowship started. (Side note: she’s 4 now and there are two more of them!)

At this point, he started second-guessing his decision to go into academics for a variety of reasons. He realized he liked, but didn’t LOVE research, he wanted to be home with his family when needed, he didn’t want to feel obligated to travel for work constantly, and he wasn’t really sure if he actually enjoyed mentoring residents and medical students. All pretty great reasons to question a decision to go into academics, if you ask me.

BUT he had already matched in an AWESOME trauma fellowship on an academic track. I mean, let’s be honest, trauma surgeons are needed primarily in academic institutions (hospitals). A trauma-based private practice job isn’t really a “thing.”

So here we were. He was a chief resident. He started talking to a surgeon at a private practice group in our area that he happened to work with at the VA on occasion. That surgeon had heard great things about my rockstar husband and started asking him to come check out his practice as a potential place of employment. He went, and LOVED it.

Right then and there, I knew he was sold. We learned that my husband has, without a doubt, the most “private practice” personality you can possibly have. He was perfect for it. And this job just so happened to be his dream job.

Side note. Confession time. When he asked me if he should go check out the group he eventually joined, I firmly said no. I had literally no desire to stay in Seattle. None. Zip. So, find out how came to a place of ultimate compromise soon (spoiler alert: we made a CONTRACT!) That will be SOON and you won’t want to miss it!!!

Okay, back to this story. Now remember, at this time, he’s approaching his TRAUMA fellowship. Well, this group of surgeons was desperate for a joint replacement surgeon. Super. He had already missed the match for fellowships for the year after. So, that’s when his soon-to-be group helped line up a joint replacement traveling fellowship for him, outside of the match. After he completed the 1 year trauma fellowship he had matched in, we did 3 months at Tampa General, and then 6 months at The Mayo Clinic for Joint replacements. It was crazy, but awesome, with two small children in tow, and I was preggers by the time we headed back to Seattle. Wild.

Even though on the surface it may feel like that trauma fellowship was unnecessary, my husband would certainly tell you that he was glad to have done it. He is now able to handle the most complicated trauma that comes in during call that his group covers for the nearby hospital. It adds diversity to his Joint Replacement practice, and gives him an opportunity to fix complicated fractures, which are some of his favs. He is a carpenter at heart.

When we got back from the traveling fellowship, he started his first “real” job and kicked things into high gear. He’s been working for about a year now, and I’ve talked about that in 1 Year Out of Fellowship: How Life Has Changed.

I am so proud of my husband for following his heart ❤️ and listening as those doubts about academics crept into his mind. He knew he would be sacrificing a lot by changing his path. Particularly, he was risking the disappointment of the faculty he worked with that were encouraging him along an academic path. It was challenging for him to tell them that he was going to go in a different direction (they, too, were pursuing him for a position following fellowship). But he did what was right for himself, and for our family. I’m so glad he did.

No, you can’t have him. I’ll keep him, thanks. ❤️💋

The Pros & Cons

Alright, now that you know the background here, you see that it was a difficult decision. One would argue that it cost us an extra fellowship year. But the end result ended up being perfect for us.

What’s perfect for your family? Let’s take a look into some of the factors involved from our (admittedly slightly biased) perspective. And it goes without saying, that every institution is different, so these factors may not all be applicable to your situation. (Sorry.)

Academics

Pros

1. Less stress regarding productivity

• Depending on the pay structure, many academic institutions pay a set salary per years of experience. It doesn’t vary as much based on the productivity of the physician, in comparison to private practice.

2. More support for research opportunities, presenting projects, and making a name for yourself in the academic community

• If you love research, this is the best setting to do it in and be supported by your employer.

3. Opportunities to mentor residents and medical students

• Academic positions are a commitment to molding the young minds that come after you into amazing docs themselves.

4. Parts of workload are shared by students

• Because there are medical students, residents, and fellows on the team, they can sometimes be a buffer for attendings. They do more of the “grunt” work, leaving only the most important duties for the attendings.

Cons

1. Work-life balance can be a struggle

• This can vary depending on the specialty. For us, looking at being a trauma surgeon, you take a lot of call and work crazy hours because these surgeries are not often scheduled. They are complicated and come in at any time.

2. Less control over schedule

• Some attendings are available at all times (or close to it), for consulting purposes. Additionally, call is likely to be more frequent than would be seen in a private practice.

3. Research expectations

• Most academic institutions want their faculty to be involved in research. They will often support most of your research endeavors, but the work involved will likely seep over into home/family time.

4. Income starts higher, but plateaus

• You won’t have a practice to “buy into,” which means your salary is your own, from right when you start out. However, unless you’re scaling the chain of command, you’re probably not going to see the numbers that private practice docs (in a successful practice) will reach.

Private Practice

Pros

1. Greater autonomy over your schedule

• My husband can take vacation pretty much when he wants. If given advanced notice, he can block out his schedule to leave early if there’s a family reason he needs to be home.

2. Cohesive team

• He gets to work closely with other like-minded, supportive surgeons that have been hand-picked by the practice, not only for their excellence in clinical and surgical work, but for their personalities and fit as a team member.

3. Family oriented

• It’s easier to make decisions to prioritize family when the other surgeons are doing the same.

4. Be Your Own Boss

• In his situation, my husband will be one of the shareholders of the practice, which means he is a voting member of all important decisions. Hospital administration usually has the final say in academic positions.

5. Accelerated pay structure

• Most private practice positions will start with a lower salary than in academics, but then have a higher ceiling potential.

6. No teaching requirements

• Lack of medical students and residents means that my husband can operate at his own pace without stopping to educate or letting others do parts of his cases. This increases his overall efficiency, which is important to him, personally (as he likes to move quickly when possible).

Cons

1. Greater challenges in building a practice

• Because you’re your own boss, you build your individual practice from the ground up, which can take a while. Academics will have some infrastructure in place.

2. Research on your own time

• If you DID want to participate in research, there is less support for it, but it’s certainly possible.

3. Pressure to maintain a certain level of efficiency

• Your salary depends on how busy you are, so hopefully your patients love you and send their friends your way! If not, you may be hustling a bit.

These were some of the factors that my husband considered when making his final decision. Maybe it will help you better understand the process and give you food for thought.

Just some final thoughts here.

My best advice to those making this decision is to look at your own personality and what you love about residency as objectively as possible (sadly, without the consideration of the feelings of your mentors). Do you love research, educating others, travel and debating papers? Then academics is for you. Are you okay with the pressures of reaching a certain level of productivity and having your pay depend on it? Do you want to have greater autonomy over your schedule and research? Then perhaps its private practice.

If you have a medical spouse (or are one!) tell me what you’re thinking…private practice or academics?! And let me know if any other factors are influencing your decision!

Thanks for diving in to all of this with me today.

Stay tuned, because I’ll be back with you NEXT SATURDAY! I usually post on Tuesdays and Saturdays, but I need to work on some website updates, so I have to skip Tuesday this week. SORRY! But I literally have no time unless I decide to NEVER SLEEP.

In the meantime, come and join me on Facebook or Instagram! I’ll be posting there all week!!!! I am so, so happy to be on this journey with all of you!

So much love to all of you, friends!!!!!!

XOXO!

Honestly,

AM 🙂

More About Me: Hi! I’m Ann Marie, a blogging mama of 3 tiny gals, and a wife to a busy Orthopedic Surgeon. You can find me right here for a weekly smattering of inspiration for your motherhood journey, home, marriage (I see you other medical wives!), style, and beauty. You’ll find me most active on Instagram or Facebook for life between blog posts. And I truly can’t wait to see you there, friend. ❤️💋

To connect, shoot me an email at honestlyannmarie@gmail.com ❤️