Surgical Career Outside of Academia - What’s That Like?
Have you ever thought about not staying in academia?
I know. Unsanctioned speak while in training. Your mentors will say, “Why wouldn’t you want to have a practice like this?” Your peers will wonder “Why don’t you want to teach?”
I graduated from a general surgery residency back in 2015 after doing a year of research and thinking at the beginning of training that I wanted to be an academic surgeon.
However, as I went through my senior years of training, rotating at community hospitals, and meeting surgeons outside the academic pathway, I realized that this is what I wanted in my life.
The surgeons at these community hospitals appeared happy with their lives. They came in to work and operated. They went home at reasonable hours. They were extremely skilled at operating. When I graduated residency in 2015, I became an attending surgeon at a 150-bed hospital within the same network of hospitals where I had done my residency.
In the process my eyes were opened to a great many things about surgical practice that surprised me. One caveat to note, there are many types of practices out there: physician owned, physician-group owned, non-academic hospital employed, etc., but I’ll be speaking to the non-academic hospital employed model.
Most surgeons coming out of residency end up in a non-academic hospital employed position eventually. Only about 16% of graduates are able to get an academic position coming out of training, even after fellowship. Of those lucky few that do, 38% end up leaving within 10 years.
There’s a great deal of autonomy in terms of your schedule and how you want to set up your practice. If you want to shorten your clinic schedule or even cancel it for the day, it’s up to you. If you want to be less busy overall for the year, you can. As long as you take care of your on-call responsibilities you can be as busy as you want to be or not busy as you want to be (to an extent of course).
Smaller non-academic hospitals tend to be more efficient. What this means for you as a surgeon is that turnover times are faster, and you can frequently get a more favorable block time or more than one room! Everyone’s goal is to get the patients treated safely and efficiently, then be done for the day.
The flip side of that autonomy and efficiency is that it can be quite lonely. It’s not ingrained into the DNA of the system to do more than to just take care of clinical business. There aren’t academic meetings to collaborate at, research to do, or trainees to teach. Your partners and everyone else at the hospital who isn’t a shift worker are generally leaving once their cases are done.
One of the blessings of academic surgery is that you are teaching individuals who want to learn and become a surgeon someday. In many hospitals, your assistants are highly skilled, but often switching across many roles and specialties, such as urology, orthopedic surgery and general surgery. This also contributes to the feeling of loneliness.
These are the things I while outside of academic. You should know that I ultimately decided to come back to academia, and more on that in the future as well.
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Dr. William Yi is a minimally invasive surgeon seeking out the red pills of a surgical life.
The opinions expressed in the article are not affiliated with any institution, company or product. The article should not be interpreted as medical advice.
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