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Learning, Sharing, and Teaching => Ask a Mustachian => Topic started by: Dr. Rosenrosen on September 02, 2013, 10:46:12 AM

Title: Career Predicament
Post by: Dr. Rosenrosen on September 02, 2013, 10:46:12 AM
So hereís the situation: Current resident physician, several years into training, several years left (residency+fellowship), and I canít stand the work. Made the decision naively to get into medicine many years back purely for what it had to offer (good pay, relative stability, some degree of autonomy), without any real interest in the nature of the work. Not surprisingly, it hasnít worked out as planned.  Without digressing into a massive diatribe on working in health care, suffice it to say that my job is 100% hampster-wheeling, in a high stakes, high stress environment, and the worst thing about it is that I derive minimal satisfaction from what I do. 

Iíve felt this way for years, and so have spent a lot of time looking at/for alternatives. First was seeing whether there would be a way to carve out a niche for myself as a physician. Those opportunities, while once available, just arenít there anymore (no private practice wants a guy interested in less than full time, and no hospital administrators are interested in their employees doing anything but pushing ridiculous volume).  Then I checked out other residencies. Different flavors of the same shitsicle. So I went back to the drawing board and tried to figure out where my interests and available opportunities might intersect. I came up with a few options, and have been focusing on one in particular lately: professor at a small liberal arts college.

Hereís what I like about it:
-The chance to create (lectures, curriculum standards, department goals, etc) rather than just Ďget throughí my work.
-Having meaningful human interaction, working with healthy young people excited about life and normal, well-adjusted colleagues who are not hollow shells of their former selves thanks to years of too much work and stress.
-The opportunity to teach (which I really, really like to do).  Would be the cornerstone of my job at a small liberal arts college, none of this publish-or-perish crap.
-Potential for administrative role down the road helping to shape collegeís future.
-Re-gain control over my day and my work (this is big for me). No more walking into the hospital, wondering what kind of shit show awaits me. 
-Tuition remission at several regional institutions for my children (1 currently, at least 1 more on the way). This is big for me. Whatever I end up doing, I want to provide my children with a college education so that they can start their lives debt free.
-Best work/life balance I can find while still being employed. Every holiday off, spring and fall breaks, summer break. Would allow time for the hobbies Iíve neglected, the things Iíve never had the time to learn but have always wanted to, and the opportunity to spend quality time with my wife and kids.
-As luck would have it, there is an opportunity available for me to go do this right now in my hometown, where much of my family still lives (which is a plus for us).

Hereís what I donít like about it:
-Big pay cut: 300-400K currently for people in my specialty in my part of the country.  Will likely be significantly less by the time I get out, but still likely to be comfortably within the 200K range. 50-60K in base salary at small liberal arts colleges. Opportunity is there to augment the salary with summer work, which I would pursue, but still a big pay cut.
-Uncertainty about the future of education at the college level in the face of MOOCs taking off (Coursera, etc), and with Obamaís new federal education aid proposal.
-No real opportunity for increased earning potential down the road. Raises are pretty meager and scheduled.

So, what to do? I really donít think medicine is going to be a viable option for reaching FI. It would take at least 4 more years of training, and several after that to reach FI, and I think that neither my marriage nor I can take that.  My options then are to try and find some other career that I enjoy more that would still allow for a relatively rapid ascent to financial independence OR go the professor route. While the professor route would not allow for early retirement, it would allow a lifestyle with significantly more time off, less stressful hours, less hours worked, a high level of autonomy, and be more fulfilling.  And it would allow me to provide free education to my children, which is a huge priority of mine, and one that is likely to delay FIRE for me anyway.

My wife would stay at home while the kids are young, which we both want, and then would return to her job as an elementary school teacher when theyíre school aged.  So money would be tighter for the next 5 years or so, but we would be socking away at least one entire paycheck thereafter. I would keep the medical license current so that if shit hit the fan I could get back on the doctor train to keep my family from starving if need be.

Any thoughts, questions, criticisms you have to throw my way would be greatly appreciated. Thereís been a lot of time and effort spent trying to sort this all out over here, hopefully Iíve done it justice without boring the hell out of you, but let me know if anything needs clarification.
Title: Re: Career Predicament
Post by: historienne on September 02, 2013, 11:38:47 AM
This post is relevant to my interests!  So much so, that I finally created an account to answer it.  I teach at a SLAC, and love my job.  I have no plans to retire early (although my husband does) because I like what I do so much.  Whether it's the right path for you, though, is a more complicated question.

Some questions - first, I'm not clear on what you mean by having an opportunity available to you to do this in your hometown.  Do you have a job offer on the table?  If so, is it tenure-track?  If you do have a concrete offer, then congratulations! Some of the rest of this post may not be relevant. 

If not, however, I'd think seriously about the following:

What subject do you intend to teach?  SLACS are less likely than other colleges to have nursing and/or specific 'pre-med' programs, because of the nature of the liberal arts mission.  Our premed students major in biology, chemistry, or indeed in any one of a number of traditional disciplines.  These programs are staffed by people with Ph.D.s in the relevant disciplines.  MDs, whatever their other fabulous qualities, are not eligible candidates for jobs in these departments.  I'm sure you will find SLACs with more specific preprofessional programs, and some of these might hire people with MDs rather than Ph.D.s, but this is not the standard model. 

Also, do you have any kind of research agenda?  Not all SLACs would require one, but the job market in most corners of academia (including biology and chemistry) is extremely competitive and getting more so.  As a result, even the 'lower-ranking' SLACs increasingly expect an active research agenda of some sort from new hires, preferably one that allows undergrads to get involved.  If you don't have publications and a track record of active research, you will not be a competitive candidate at many SLACs.  Again, there will be exceptions, particularly down the prestige ladder (and those may be great places to work).  But you would not be a realistic candidate for my 60ish-ranked SLAC, nor any of our peer institutions, without an active research agenda.  And you would need to actually fulfill that agenda to get tenure; while it's not quite 'publish or perish' around here, we do not tenure people who haven't published at all since their hire. If you do have a job offer, be sure you are crystal-clear on what their research expectations are for tenure, and be honest with yourself about whether you are prepared to meet them.

If you do have a job offer on the table, I'd still advise considering the following caveats to your lovely picture of academic life:

1  - at least if you are at a place that expects any research, you shouldn't expect to have vacations free.  I take a reasonable amount of vacation time, sure, but in general spring/fall breaks are for catching up on grading and summers are for getting my research done. 
2 - I, and most of my peers, work more than 40 hours a week during term time.  Achieving work/life balance is probably easier than it would be as a physician, but it's not a utopia in this regard. Don't underestimate the time that class prep, grading, committee work, advising, and other forms of out-of-classroom labor will require from you.  Over time it gets easier as you get your basic courses well organized, but the first few years are a grind for most people, and even after that it's never the kind of job where you can leave work at work.
3 - if you do end up in administration, which generally does pay more, your job will almost certainly be year-round.  You will be on contract and in your office through the summer, over breaks, etc.  You'll get normal-person vacation time, but you will have much more fixed hours than professors do.
4 - Definitely make sure you aren't romanticizing academic culture.  There are also "hollow shells of their former selves" in academia - and because they have tenure, they can hang around for a long long time!  I love some of my colleagues and merely tolerate others, but the time spent in meetings to do curriculum review, run search committees, etc is certainly not my favorite part of the job. 
5 - Similarly, many of our students are "healthy young people excited about life."  But, especially if you are not teaching at Amherst or Williams, some of them are also going to be rich, entitled snots who expect their hefty tuition payments to buy them your undivided attention, and also an A; underprepared students from tragically bad high schools who need massive amounts of hand-holding to write a decent paragraph; and lackadaisical pot-heads who are mostly in college to get drunk/high/laid.  I love working with students, but I definitely teach people who fall into all these categories. It's a lot of work, and sometimes frustrating, especially when students don't give a sh*t about their own education.

Anyway, I don't have much input on the financial side of things.  If you are in a reasonable COL part of the country, you can make it work on an academic salary; because we are in a relatively remote location, most of my colleagues have spouses who stay at home or are minimally employed.  They are fine, if not retiring early.  But I would have a long, hard think about whether you have a realistic image of academic life, and whether you will enjoy the realities of that life enough to justify the financial trade-offs.

One final thing: on the MOOC/future of education issue - I'm pretty convinced that the top 100 or so SLACs will be find, because we provide an experience and level of personal attention that can't be replicated online.  However, the marketplace is almost certainly going to get more competitive, and lower ranking tuition-dependent schools may be in trouble in the long run.  For insight into these dynamics, you might poke around the archives of the blog Confessions of a Community College Dean (the author also has a book by the same name). 

Good luck on your career decisions, and I'd be happy to answer any other questions you might have about SLAC life.  There's also a wealth of knowledge in the forum at the Chronicle of Higher Education website - be forewarned, though, that folks there will pull no punches if they think you have a naive view of academic life. 
Title: Re: Career Predicament
Post by: CU Tiger on September 02, 2013, 12:20:29 PM
I have a friend who is a Dermatologist. She recently left off seeing patients and is now doing work where she looks at samples (I am sorry, I do not know the name for it). She basically sits in a lab and looks at slides. The money must be good because she still make enough money to support four children. She says the hours are great and not seeing patients is a relief.

Have you considered some sort of career that is medical, but doesn't involve a practice or hospital? Like working for a pharmacological company, laboratory, etc?

Just a thought.
Title: Re: Career Predicament
Post by: rocklebock on September 02, 2013, 12:42:07 PM
Historienne said it a bit more kindly, but I think you're romanticizing academic life. Unless you've stumbled onto an incredibly unique situation and have that job offer on the table now, I think you're looking at: Going back to school to get a PhD; a highly competitive job hunt that will most likely require relocating; and then several years of both teaching and research, probably at less than 50-60k, to reach tenure. Meanwhile, as CU Tiger says, there are so many more things you can do with that MD than the options you're thinking of.
Title: Re: Career Predicament
Post by: Osprey on September 02, 2013, 12:57:49 PM
I have no experience in academia but I wanted to point you towards a thread on the forum. The big difference of course is that you have a family to support and are looking for a stable job in higher education, while I was interested in school-level teaching. But many people on that thread pointed out the versatility of a medical degree, and there is some general discussion about teaching, which I think might be helpful to your situation.
Title: Re: Career Predicament
Post by: Dee18 on September 02, 2013, 01:00:15 PM
Not sure where you got the idea that part time work is not available for physicians.  Two of my closest friends have done that for their whole careers.  One is still in practice, working two days a week as a pediatrician.  I also know that the pediatric office where my daughter has gone has mostly part time doctors.

My other friend, who is now retired, worked for ten years in "doc in the box" situations, working 2 10 hour shifts per week, with several weeks off per year.  When he tired of that, he worked locum tenens, making about $1200/day plus living expenses and just working about 40 days per.  When he was first thinking of getting out of medicine, he got a masters and then phd in biostatistics, planning to work for the CDC.  He changed his mind when he found the salary would be 1/4 what he made working 2 days a week at the doc in the box.  He also found that small town hospitals and clinics were willing to make all sorts of deals to hire him and ended up in NH which was his first choice location. He completely retired at about 50, although he could have afforded to quit earlier.

If you like the idea of working at a small college, check out being the campus doctor.  Ours is on a 9 month contract, working three days a week, with a nurse practitioner covering the other days.

On the other hand, my daughter's private high school had a physician teaching science courses there for 8 years while all her kids went through on free tuition.  When the last one went to college, she went to work part time at the local medical school clinic.

Just some ideas.
Title: Re: Career Predicament
Post by: Daleth on September 02, 2013, 01:09:05 PM
Yes, third vote here for "academics do not get summers off" and also "you would need a PhD to get an academic job, unless you're teaching medicine at a medical school." To my knowledge an MD does not qualify you to be a tenured professor of anything taught at a SLAC, or indeed a tenured professor of anything other than medicine (much as a JD qualifies someone to be a tenured law professor, but not a tenured professor of anything else). What exactly is the opportunity that's available in the town you described? Do you have a job offer in hand for a tenure-track position at a SLAC? That would amaze me, for the reasons above. If so please let us know because that would probably change some of the advice you're getting here.

Dee18 has phenomenal advice for you. Also, with your love of teaching, have you looked into the CV's of doctors who are professors at medical schools? On top of the fact that you'll be qualified for that without a PhD (though many do have MD/PhD combos), they get paid a hell of a lot more than SLAC professors. Other possibilities easily open to you with a bit of retraining include going into private practice (I've heard of a new trend where doctors do this and don't take insurance--rather they serve wealthy people who keep the docs on retainers), combining the MD with some kind of interesting alternative-health qualification (I've known MD's who were certified holistic practitioners, certified acupuncturists and a few other things) and setting up a private practice based on that...

An advantage of this kind of "niche" private practice, whether your niche targets rich people or people into alternative medicine, is that there's *minimal paperwork* and your patient base is more motivated/self-directed when it comes to healthcare--one thing I've heard from burned-out doctors is that they get an endless parade of, for instance, obese people with terrible diets who want the doctor to magically cure their diabetes without them having to change anything about the way they live. The doctor gives them advice which they then ignore and a year later they're in a major health crisis that they had the power to prevent...

In private practice you could set your own vacations, of course, though sometimes it works better to operate as a partnership (if you can find a responsible person with the right credentials), because then you can cover for each other.

Long story short, I'm agreeing with the others that you're romanticizing academia, and I'm suggesting that you need to think outside the box--there are a ton of ways to use your MD without encountering the problems you've encountered. The unusual ways aren't as easy--the paths haven't been worn smooth by generations of doctors before you--but they do exist. Would you feel different about your current situation, your residency I mean, if you had a vision of how finishing the residency would serve some alternative vision of your life as an MD (Dee18's "doctor in a box" or part-time ideas, for instance), rather than a vision of a completely different career? I think it might help, especially since having this overly romantic idea of what academia would be like is probably making it seem like the residency is getting in the way of something wonderful.

What's your student loan situation?
Title: Re: Career Predicament
Post by: Dr. Rosenrosen on September 02, 2013, 01:14:17 PM
I should clarify. There is a tenure track offer on the table. Sort of a rare opportunity currently for a guy with the wrong letters after his name, but it sort of fell into my lap.  I understand the tendency to assume that romanticizing is taking place, and I want to stress that I'm not attempting to offend anyone by trying to paint academia as a cakewalk or something like that. I anticipate having to work quite hard even during the 'breaks', but am hopeful it would be toward something I find more enjoyable in an environment that is more to my liking. Perhaps without an offer on the table I'd be romanticizing the likelihood that I'd find employment. But, now with an offer out there, I'm trying to parse out the pros and cons of the nature of the job itself.  This has been a long time in the making and there have been several conversations with former college professors who are friends, etc, but I'm interested in what those of you think about the move from a mustachian POV. Hopefully clearing up the situation will help. I want to be careful not to come across as some disgruntled resident fantasizing about everyone else who has it so much better. Those days were for the beginning of intern year. I believe I've made a naive career choice and am serious about not becoming one of the many unhappy doctors who couldn't see a way out, but want to solicit as much input on the issue as I can. Thanks again everyone, I appreciate the feedback.
Title: Re: Career Predicament
Post by: Daleth on September 02, 2013, 01:24:00 PM
I should clarify. There is a tenure track offer on the table. Sort of a rare opportunity currently for a guy with the wrong letters after his name, but it sort of fell into my lap.

Then go to the forums at (the Chronicle of Higher Education) and ask for advice there. It's teeming with academics in all disciplines. If you want to know what an academic job is like, what to look for, what to watch out for, etc., that's the place to go. You obviously will need to find out what the requirements for tenure are--how many years do you have before you go up for tenure, how many articles/books must you publish or have in press before then, yada yada--because if you fail to get tenure your academic career is basically over, especially as someone "without the right letters after his name."

No one can speak to the mustachianism of this idea without you saying what your student loan situation is. Also, if you have finished your residency and are now into a fellowship, it may be a different situation than if you haven't finished your residency yet--correct me if I'm wrong but I think you basically can't practice as a doctor in the normal scheme of things until you've finished your residency, whereas a fellowship is more of an "icing on the cake," perhaps necessary or desirable for certain specialties but not necessary for just straight-up BEING a practicing doctor? If you've finished your residency and are qualified to practice as a doctor, you're taking MUCH less of a risk by going off on a different path, because you can still come back onto the MD path if you want. But if you go off the path before finishing your residency, who is going to give you a residency in the future if you change your mind?
Title: Re: Career Predicament
Post by: Albert on September 02, 2013, 01:25:05 PM
If you have a real job offer in a town where you want to live with a decent chance of attaining a tenure at the end of it plus you like to teach then absolutely go for it. Academic life in a small school is not all roses as explained above, but it's still one of the nicest career paths available particularly for those not overly obsessed about money.
Title: Re: Career Predicament
Post by: Dr. Rosenrosen on September 02, 2013, 01:33:04 PM
No debt. Very fortunate to have a spouse working throughout school and generous family. Sorry about that. Thought I had that in the original post, but it's not there.
Title: Re: Career Predicament
Post by: historienne on September 02, 2013, 03:15:33 PM
Congrats on your job offer!  Some questions to think about in evaluating it:

- what's the teaching load?  At a SLAC, this can vary from about 4-4 down to 2-2 at the most elite schools.
- what's the research expectation?  Again, it will vary.  What you want to watch out for is a place that expects more research than it is willing to support (both financially and in terms of teaching load).
- have you met your close colleagues, and if so, do you like them? This can make a huge difference in quality of life!
- sounds like a somewhat non-traditional job opportunity.  Do you have a sense of how committed the administration is to the program you'll be in?  What about other faculty?  At most SLACs, you will need the support of both the admin and a faculty committee for tenure.
- how stable are the school's finances?  What is the endowment?  Did they have to cut the budget a lot during the recession (this would be a bad sign).  How selective are their admissions (more selective = less chance of getting caught out by a downturn in overall college applications)?
- are you pretty sure that this is a location you'll be happy in for the rest of your career?  It's great that you have family there - most academics are not so lucky - but you want to keep in mind that this may be the job you have for the rest of your life.  If you do go into admin, there's more mobility there. For faculty, the place you get tenure is usually the place you stay until retirement.
- what is the tenure rate in general?  Is this a place where you can reasonably expect to get tenure if you meet a clearly stated set of expectations, or are there stories of people being surprised after thinking they have done everything right?

Financially, it sounds like you know what the trade-off is.  This is not a career path that will lead you to early retirement, but that may be worth it for the quality of life.  It certainly is for me.
Title: Re: Career Predicament
Post by: MrsPete on September 04, 2013, 08:05:38 PM
As I was reading the original post, I was thinking, "He's romanticizing teaching." And I see that others have totally said everything I would've said -- even used the same word i was thinking.  You are seeing teaching as a low-stress, simple little creative job. You're underestimating the time that goes into planning and grading, the difficulties of dealing with difficult students.  And you're assuming that teaching = little more than the classroom time.  I agree that it'd be great for your kids to get free tuition, but if they want to attend a different school or study a major that your school doesn't offer, you might never collect that benefit. 

You've put significant effort into one career.  Don't jump into another without thoroughly investigating this choice.  Can you give it a try by picking up just one class?  Any other way to gain practical knowledge before you commit? 
Title: Re: Career Predicament
Post by: theSchmett on September 05, 2013, 05:17:32 AM
What is your criteria for financial independence, and what would you do with it once you got to it?

400k, 200k, those are both huge numbers (although I assume you've got some education loans).  I know what its like to work on a hamster wheel, and for far less money. I've got to think that with a strong goal of FI in mind, and the potential to reach it, it becomes more palatable.

That said, nothing is more important than your mental health. If you are truly miserable at this job, the pay cut won't bother you in the end.  Not sure where you are, or what your significant other's work status is, but 60k is decent money in most of the USA, and the shot at a free education is a pretty sweet benefit.
Title: Re: Career Predicament
Post by: sassy1234 on September 05, 2013, 07:21:30 AM
A healthcare recruiter here...

Don't even think about becoming a professor.  There are so many other great options for a physician that does not want to practice medicine. 

Have you thought about getting into quality improvement?  This is the biggest topic in healthcare right now and there are so many jobs.  This is a more business focused job.  MDs are in demand in this field.  Look into Lean or Six Sigma training and start checking out some jobs. 

What about public health? 

Or working for a medical association? 

There are many small non profit health organizations that desperately want a physician as their CEO.  I am doing a search for one now.  The person does not have to have a ton of business/leadership experience and it pays $170,000. 

Start doing more research on non clinical health careers and you will find a lot!  DONT BECOME A PROFESSOR!  Bad job security, bad pay, and you will be really throwing your education away.  Go find a healthcare business position where you can leverage your medical degree. 
Title: Re: Career Predicament
Post by: Argyle on September 05, 2013, 03:47:28 PM
As I understand it, you have a job offer in academia, and that is indeed surprising.  What you'll want to find out is what the college requires to get tenure -- publishing what amount, in what kind of journal?  Is this something you're prepared to do?  And what kind of course load do the offer?  4 courses per semester is quite heavy and will make it a challenge to publish.  If the load is lighter, the job is less onerous. 

I personally would look into the other opportunities for MD's, as mentioned by the poster above.
Title: Re: Career Predicament
Post by: Dr. Rosenrosen on September 08, 2013, 08:24:29 AM
These are great responses. Sorry for my delayed acknowledgement, it was a crazy week. After reading everyone's responses, it seems pretty blatantly obvious that despite my best efforts, I'm viewing this whole professor path through some pretty thick rose colored glasses. Really glad to have had the perspective of others on that, particularly those of you who are members of academia.

I'll admit I'm still interested in education, but perhaps need to pull back on the reins a bit. I've done a decent bit of lecturing and tutoring, but have yet to be solely responsible for a course from inception to completion. Might be worthwhile to try and do that on a limited basis (community college, maybe?) before I dive in IF I end up deciding to go that route.

As for other's suggestions that I could do much better parlaying my medical degree into another health care related career: that was my original plan, but I just could not find the opportunities. In my experience, the only type of physician desired by consulting firms, non profits, healthcare think tanks, healthcare related trade associations, and the insurance industry were those with several years of clinical experience after residency. My impression, after a little over a year of barking up every tree I could find, was that an M.D. without the post residency clinical experience was worth little to people outside of residency programs. Thats why I started looking at alternate paths. Maybe I'm not looking in the right places. Anyone out there, sassy1234 in particular, have personal experience (friends, family, co-workers, clients) with doctors leaving medicine before they've practiced for years?

Thanks again to everyone who has responded, I really appreciate having everyone's perspective on this issue. It sure seems like the adage "people see your problems more clearly than you do" is at play here.

By the way, if you're unfamiliar with the origin of Dr. Rosenrosen, do yourself a favor and google it. Then watch Fletch in its entirety, multiple times. (feel compelled to point out that the handle was chosen for comedic effect, not out of self congratulatory lameness)

Title: Re: Career Predicament
Post by: Self-employed-swami on September 08, 2013, 08:54:57 AM
What about family medicine?
Title: Re: Career Predicament
Post by: djulian529 on September 08, 2013, 11:39:03 AM
I am having a similar predicament.  Last June (2012), I lost my job as a school social worker, a job that I very much enjoyed.  I have not been able to obtain a school position since.  In September 2012, I started with Prudential Financial selling life insurance and such.  I remained there until this past June when I was able to get a position back in the field of Social Work as a Program Supervisor for a Psychiatric Community Home for girls ages 13-17.  Although I love the position, there is so much  I don't like.

-Being on call 24/7
-Silly after hour calls
-Level of responsibility with lack of pay
-No OT for the extra hours I am putting in each week

I have become very burnt out and unhappy very quickly.  However, I also know that money is not everything.  I have been part time police dispatching since 2007 and LOVE it.  I now have to decide if I try a FT position in a PD, which would be an initial pay cut, but with the possibility of OT would possibly end up being more? 

Trust me, I can feel your pain!
Title: Re: Career Predicament
Post by: Dee18 on September 08, 2013, 06:10:52 PM
Check out:
He was in a position similar to yours.