But more constructively, a lot of the physicians in my medical group cut down to 0.75 FTE status, which still feels like more than full-time work with all of the time spent on patient messages, test, results, coordination of care, etc. Telemedicine has helped, A pay raise this year with RVU rebalancing a little towards better primary care reimbursement has helped. But people are still leaving in droves. it really is a combination of all the factors listed and probably that we are no longer as well respected, as evidenced by a lot of the comments you’ll find on Twitter, frivolous lawsuits, people teeing off on the FDA, Anthony Fauci, etc. It’s a kind of social cannibalism. People will put up with a lot if they feel appreciated, valued, and even revered as the doctors of old seem to have been. Anyway, just dictating so sorry if this comes out garbled!
I can only imagine! I ran to pathology because working daily with pet owners, while rewarding, was super stressful and I’m just innately an introverted lab rat 🤓
I really appreciate excellent family physicians and primary care docs like yourself! As medicine has become hyperspecialized and fragmented, it is often only the overworked and underpaid primary care docs who know what the hell is going on with their long term patients who are on a half dozen drugs provided by a bunch of different consultant docs who focus on just one organ (sometimes less!)
It makes it all the more remarkable that you’re able to find the time to write on substack to educate patients. My hat is off to you, sir 🎩
Ha, just read this from the journal of the American Board of Family Medicine:
Abstract
Purpose: This survey evaluated whether the COVID-19 pandemic was a traumatic stress event for family physicians associated with burnout, changes in life priorities, and intentions to retreat from clinical practice.
Methods: We report on 683 clinically active family physicians surveyed through the Council of Academic Family Medicine’s Educational Research Alliance (CERA) in the fall of 2021.
Results: Overall, 35.2% of family physicians experienced the pandemic as a traumatic stress like event. This was associated with changing life priorities (OR 2.6, CI 1.8-3.9), burnout (OR 1.6, CI 1.1 to 2.4), and withdrawal from clinical practice in various ways. Those who changed their priorities in life were more likely to restrict scope of practice (OR 3.9, CI 2.6-5.9), reduce clinical work effort (OR 3.4, 2.3 to 5.1), relocate (OR 3.1, CI 2.0 to 4.8), retire (OR 2.7, CI 1.4-4.9), reroute their career away from patient care (OR 2.1, CI 1.4-3.1) and less likely to avoid redesigning the practice to improve well-being (OR 0.3, CI 0.2-0.7). Those who experienced burnout were more likely to retire (OR 5.5, CI 2.8 to 10.5), reduce clinical work effort (OR 4.2, CI 2.9-6.1), reroute their career away from patient care (OR 3.9, CI 2.6-5.8), relocate (OR 3.8, CI 2.4 to 5.9), and restrict scope of practice (OR 3.3, CI 2.3 to 4.9). Overall, 48.5% of family physicians expressed some intention to retreat from clinical practice.
Conclusion: The COVID-19 pandemic impacted family physician’s career plans. Remedying burnout is a high-yield opportunity for retaining clinically active family physicians. Physicians retreating from clinical medicine related to changing life’s priorities needs further exploration.
I retired and was well satisfied I had achieved my professional goals but I saw many in academia who were frustrated for a variety of reasons: heavy teaching assignment, especially at the lower division, not leaving enough time to do research, heavy non academic assignments from the chairs. Grant money getting harder to get. Advising and mentoring responsibilities. To a lesser degree personality clashes... The life of research was not as easy to live as they originally hoped. Professional conferences were the great vacation and respite.
Things are definitely getting more challenging, re: research funding and productivity expectations. The rate or NIH grant success is down by about half what it was 20 years ago, and dollar amount funded adjusted for inflation is flat. With the supply of people with PhDs far exceeding available tenure track positions, many of them are doing 2-5+ years of post-docs and it is leading to credential creep. One former editor of Science quipped that the CVs of people applying for assistant professorships now would have gotten people tenure 30 years ago :/
Liz, that may be part of it, although some of those specialties do not have a large pay discrepancy between academia and private practice. Thinking particularly family medicine and critical care/pulmonology. Likewise, in veterinary medicine, many of the pathology departments are short staffed despite roughly equivalent pay between private and public sector. I think a lot of it comes down to management and quality of life concerns
I was just thinking that basic science faculty might have a lower plan to leave not because they have a better situation but because there are fewer alternative careers out there.
Ah yeah, that makes sense. It would actually be interesting to study whether "Intention to Leave" is similar between clinical and non-clinical faculty, but only the former leave at a high rate due to outside opportunities. I know people with PhDs in STEM can work in industry, but don't have a sense what the magnitude of that opportunity looks like. Do you know of any peer-reviewed studies looking at, say biology PIs and QOL/career satisfaction/burnout?
This is so interesting. How much of this is driven by ever increasing adjuncts? I ask because I am an adjunct at a laughable rate of pay. I do it because it allows me to have a Big Name Research University on my resume.
Also..Tufts/Foster is advertising a clinical postion in community medicine. The pay tops out at $135K. If I wanted to do that...I would need to take a 6 figure pay cut and still live in the very expensive Pioneer Valley of MA.
The math of academic jobs just doesn't math. Add on academic politics and who the heck needs it?
I'm not sure, that is an interesting question, re: adjuncts. I think of that as more applying to teaching courses than clinical services (I.e. locum tenens), though I know that impacts the job market in some sectors (seems like it is more of the big "prestigious" R1 universities that exploit adjuncts to teach undergrads so their research stars don't have to). When I provide locum services at various VTHs the objective pay is decent, though it is not that stable, lacks benefits, and many of the schools don't reimburse travel/lodging.
"Also..Tufts/Foster is advertising a clinical postion in community medicine. The pay tops out at $135K."
It is definitely true that academia can't compete on salary in many places. That is similar to the range for multiple academic clinical pathology jobs right now, although sadly there is little to no difference between that and a private diagnostician unless you want to reads hours of extra cases a day :/
In my case, I actually am looking at a possible return to academia for multiple reasons, including missing teaching/research, wanting to see the more complex medical cases, greater sense of community impact, a full suite of benefits, Public-Service Loan Forgiveness (PSLF) eligibility, and flexibility on consulting. It's all a trade-off, but universities have not always done themselves favors in terms of marketing and management.
All I can say, is yup.
But more constructively, a lot of the physicians in my medical group cut down to 0.75 FTE status, which still feels like more than full-time work with all of the time spent on patient messages, test, results, coordination of care, etc. Telemedicine has helped, A pay raise this year with RVU rebalancing a little towards better primary care reimbursement has helped. But people are still leaving in droves. it really is a combination of all the factors listed and probably that we are no longer as well respected, as evidenced by a lot of the comments you’ll find on Twitter, frivolous lawsuits, people teeing off on the FDA, Anthony Fauci, etc. It’s a kind of social cannibalism. People will put up with a lot if they feel appreciated, valued, and even revered as the doctors of old seem to have been. Anyway, just dictating so sorry if this comes out garbled!
I can only imagine! I ran to pathology because working daily with pet owners, while rewarding, was super stressful and I’m just innately an introverted lab rat 🤓
I really appreciate excellent family physicians and primary care docs like yourself! As medicine has become hyperspecialized and fragmented, it is often only the overworked and underpaid primary care docs who know what the hell is going on with their long term patients who are on a half dozen drugs provided by a bunch of different consultant docs who focus on just one organ (sometimes less!)
It makes it all the more remarkable that you’re able to find the time to write on substack to educate patients. My hat is off to you, sir 🎩
Ha, just read this from the journal of the American Board of Family Medicine:
Abstract
Purpose: This survey evaluated whether the COVID-19 pandemic was a traumatic stress event for family physicians associated with burnout, changes in life priorities, and intentions to retreat from clinical practice.
Methods: We report on 683 clinically active family physicians surveyed through the Council of Academic Family Medicine’s Educational Research Alliance (CERA) in the fall of 2021.
Results: Overall, 35.2% of family physicians experienced the pandemic as a traumatic stress like event. This was associated with changing life priorities (OR 2.6, CI 1.8-3.9), burnout (OR 1.6, CI 1.1 to 2.4), and withdrawal from clinical practice in various ways. Those who changed their priorities in life were more likely to restrict scope of practice (OR 3.9, CI 2.6-5.9), reduce clinical work effort (OR 3.4, 2.3 to 5.1), relocate (OR 3.1, CI 2.0 to 4.8), retire (OR 2.7, CI 1.4-4.9), reroute their career away from patient care (OR 2.1, CI 1.4-3.1) and less likely to avoid redesigning the practice to improve well-being (OR 0.3, CI 0.2-0.7). Those who experienced burnout were more likely to retire (OR 5.5, CI 2.8 to 10.5), reduce clinical work effort (OR 4.2, CI 2.9-6.1), reroute their career away from patient care (OR 3.9, CI 2.6-5.8), relocate (OR 3.8, CI 2.4 to 5.9), and restrict scope of practice (OR 3.3, CI 2.3 to 4.9). Overall, 48.5% of family physicians expressed some intention to retreat from clinical practice.
Conclusion: The COVID-19 pandemic impacted family physician’s career plans. Remedying burnout is a high-yield opportunity for retaining clinically active family physicians. Physicians retreating from clinical medicine related to changing life’s priorities needs further exploration.
I retired and was well satisfied I had achieved my professional goals but I saw many in academia who were frustrated for a variety of reasons: heavy teaching assignment, especially at the lower division, not leaving enough time to do research, heavy non academic assignments from the chairs. Grant money getting harder to get. Advising and mentoring responsibilities. To a lesser degree personality clashes... The life of research was not as easy to live as they originally hoped. Professional conferences were the great vacation and respite.
Things are definitely getting more challenging, re: research funding and productivity expectations. The rate or NIH grant success is down by about half what it was 20 years ago, and dollar amount funded adjusted for inflation is flat. With the supply of people with PhDs far exceeding available tenure track positions, many of them are doing 2-5+ years of post-docs and it is leading to credential creep. One former editor of Science quipped that the CVs of people applying for assistant professorships now would have gotten people tenure 30 years ago :/
These numbers are staggering! Do you think some of this is because of a high availability of non-academic positions, in private practice?
Liz, that may be part of it, although some of those specialties do not have a large pay discrepancy between academia and private practice. Thinking particularly family medicine and critical care/pulmonology. Likewise, in veterinary medicine, many of the pathology departments are short staffed despite roughly equivalent pay between private and public sector. I think a lot of it comes down to management and quality of life concerns
I was just thinking that basic science faculty might have a lower plan to leave not because they have a better situation but because there are fewer alternative careers out there.
Ah yeah, that makes sense. It would actually be interesting to study whether "Intention to Leave" is similar between clinical and non-clinical faculty, but only the former leave at a high rate due to outside opportunities. I know people with PhDs in STEM can work in industry, but don't have a sense what the magnitude of that opportunity looks like. Do you know of any peer-reviewed studies looking at, say biology PIs and QOL/career satisfaction/burnout?
Not offhand. I'll have to look!
This is so interesting. How much of this is driven by ever increasing adjuncts? I ask because I am an adjunct at a laughable rate of pay. I do it because it allows me to have a Big Name Research University on my resume.
Also..Tufts/Foster is advertising a clinical postion in community medicine. The pay tops out at $135K. If I wanted to do that...I would need to take a 6 figure pay cut and still live in the very expensive Pioneer Valley of MA.
The math of academic jobs just doesn't math. Add on academic politics and who the heck needs it?
I'm not sure, that is an interesting question, re: adjuncts. I think of that as more applying to teaching courses than clinical services (I.e. locum tenens), though I know that impacts the job market in some sectors (seems like it is more of the big "prestigious" R1 universities that exploit adjuncts to teach undergrads so their research stars don't have to). When I provide locum services at various VTHs the objective pay is decent, though it is not that stable, lacks benefits, and many of the schools don't reimburse travel/lodging.
"Also..Tufts/Foster is advertising a clinical postion in community medicine. The pay tops out at $135K."
It is definitely true that academia can't compete on salary in many places. That is similar to the range for multiple academic clinical pathology jobs right now, although sadly there is little to no difference between that and a private diagnostician unless you want to reads hours of extra cases a day :/
In my case, I actually am looking at a possible return to academia for multiple reasons, including missing teaching/research, wanting to see the more complex medical cases, greater sense of community impact, a full suite of benefits, Public-Service Loan Forgiveness (PSLF) eligibility, and flexibility on consulting. It's all a trade-off, but universities have not always done themselves favors in terms of marketing and management.