Catherine M. Kuza, MD
Although most anesthesiologists report practicing in a private setting1, there are benefits to a career in academia. The appealing qualities of an academic career include: teaching trainees and students; opportunities to lecture at society, institutional, national and international conferences; providing care to diverse patient populations with multiple comorbidities in a number of outpatient and inpatient settings; the ability to focus on a specific area of interest through clinical and basic research, and the opportunity to apply for grants and research stipends; the opportunity to attain leadership positions and administrative roles; less stress of overhead expenses; and receive reimbursement for society memberships, national conferences, continuing medical education (CME) courses, and books.
The transition to an academic practice is fraught with several challenges and drawbacks. One of the major challenges is finding a job that is in a desirable location for the entire family, is aligned with one’s career goals, and has job opportunities for the spouse/ significant other. Compared to the multitude of search engines to find private practice jobs, there are not many for academic practice. Many of the job opportunities for academic medicine are attained by word of mouth (most commonly via alumni), and e-mailing or calling chairs of anesthesiology departments. Additionally, academic jobs in highly- desired locations, such as large metropolitan cities, often provide lower salaries than those in private practice.
The first year of practice in an academic environment may be particularly challenging as providers are not only navigating through a new work environment with new colleagues, but are also faced with numerous stressors such as: assuming a supervisory role as the primary-decision maker in a patient’s management; facing challenging clinical situations for which you may have insufficient training; and assuming the medicolegal responsibility of trainees. The high faculty turnover rates in academic practices often leave academic centers short-staffed, requiring junior faculty to work more clinical hours and take more call. Not all academic jobs guarantee nonclinical time to complete academic activities, and therefore personal time will be required to prepare lectures for trainee education, conduct research, and work on publications. Additionally, the requirement of scholarly activity varies among different institutions; some mandate research and publications, while it is optional at other academic centers. There may be insufficient mentorship and guidance offered to junior faculty who are interested in applying for grants and pursuing research endeavors at smaller, more clinical-based academic institutions. The additional stress of scholarly productivity and long clinical hours may result in job dissatisfaction and burn-out. Tenure is not always guaranteed, and appointments are usually reevaluated on an annual basis.
Academic practices encourage faculty to be fellowship-trained, and they will often be sequestered to their sub- specialty area of anesthesia. This may result in a loss of skills that were developed during residency. For example, regional-fellowship trained faculty are often responsible for performing regional nerve blocks, whereas someone specializing in critical care may not be afforded the opportunity to perform regional nerve blocks. Additionally, the case diversity decreases as one is more likely to perform cases in their sub-specialty area (i.e. cardiac fellowship trained anesthesiologists will provide anesthesia for predominantly cardiothoracic surgeries).
Furthermore, academic anesthetic practice may be dictated by the department chair, school dean, or hospital administrators, which may be frustrating for some practitioners (although similar hierarchies exist in private community hospitals).
The current generation of academic anesthesiologists face unique challenges that were not encountered by older anesthesiologists. There is less funding from the National Institutes of Health for investigators to attain to investigate innovative ideas and there is a high failure rate of investigator applications. Additionally, academic departments are more reluctant to financially support research initiatives that promote provider scholarship1. These factors make attaining academic tenure more challenging.
Some training programs offer “transition to practice” workshops which provide information on applying for jobs, networking with prior alumni, creating curriculum vitae, interviewing strategies, information on billing and reimbursement, negotiating employment contracts, and financial planning2. There are workshops offered through national societies such as the Society of Critical Care Medicine, and other web-based and face-to-face group programs aimed at helping trainees transition to clinical practice3. Access to mentorship might ease the transition to academic practice for new attendings4. Identifying a mentor during residency/ fellowship or in the beginning of the first year of employment is crucial, as they are a source of guidance and advice, and can help junior faculty achieve their professional goals and aspirations.
Additional suggestions that may lead to a smoother transition to practice are provided in the table below.
Advice for a smoother transition to practice:
Questions to ask for potential academic jobs
Differences between academic and private practice settings
1. Kamdar NV and de Gialluly PS. Academic Anesthesia: Innovate to Avoid Extinction. Anesthesiology 2014; 121:421-35
2. Holak EJ, Kaslow O, Pagel PS. Facilitating the transition to practice: a weekend retreat curriculum for business-of- medicine education of United States anesthesiology residents. J Anesth. 2010; 24: 807-810.
3. Laudanski K and Khanna AK. Remarks on the Transition from Training to Practice. ASA Monitor. 2012; 76(8): 80-81.
4. MacMillan TE, Rawal S, Cram P, Liu J. A journal club for peer mentorship: helping to navigate the transition to inde- pendent practice. Perspect Med Educ. 2016; 5:312-315.
Date of Publication: Winter 2018