In the United States, physicians are typically categorized as either academics or private practitioners. However, a case can be made that it is possible to construct a career path that incorporates both professional avenues. I was put in an excellent position to realize this during my fellowship at LSU, which structured some parts of its community medicine program in a way that resembled private practice.
I enjoyed my experience as a hospital and clinical fellow. After my fellowship ended, my love affair with academic medicine quickly soured. My director was a rheumatologist, and physical medicine operated under the umbrella of internal medicine at LSU. We were expected to make grand rounds of presentations to some of the world’s leading experts. Impressing these experts was the bar for success.
One day, I was assigned to conduct grand rounds by my director. I was still very self-conscious about my accent when speaking English at the time. Moreover, I was actively struggling with panic and anxiety disorders stemming from a major past trauma that I had not yet learned to treat successfully.
The result was that I stood before the prestigious audience at grand rounds with my heart pounding and my voice, legs, and hands shaking. To make things worse, some doctors who had written the textbooks I studied in medical school were in the audience. I felt wildly unprepared to teach them anything new, and afterward, I had the sense that I rushed through my presentation just to be done with it. Of course, I was magnifying in my mind what had actually taken place.
But, encounters like this can have a powerful effect on a new doctor or professor’s self-esteem. I felt I failed my director in one of my most important duties as an assistant professor. Later, the medical school dean found me and congratulated me on doing an “excellent job” on grand rounds. I am unsure if I did better than I thought or if he said this to shore up my confidence.
This anecdote exemplifies the pressure academic medicine can place on doctors. However, there were other conflicts. Additionally, I was not overly fond of the competitive environment of academia, which at times felt like backstabbing. I was aware by this point that competition to publish papers and bring in grant money was so fierce that senior professors often claimed credit for their assistants’ work. New research ideas were commonly kept tightly under wraps for fear of being “scooped” by someone who might procure grant money to fund the research before you did. I saw the pernicious effects of “publish or perish” in full display.
Some people thrive on this type of competition, but none of this suited my personality. So, after a few years as an assistant professor, I moved into private practice.
Private practice, of course, came with its own set of challenges. It was now entirely up to me to bring in my salary, and any lawsuits filed would also be my responsibility rather than falling on the School of Medicine’s shoulders. I found myself working more hours with less support. But the pressure to publish and compete with other doctors for publications and grant funding was gone. So I was happy.
Still, I missed a part of academic medicine, and that was teaching students and residents. I had taken pride and pleasure in teaching Fellows the way I had once been taught myself. I decided to do something many few other doctors were doing. I created a private practice fellowship program. In this way, I could give opportunities to young doctors, just as a life-changing fellowship opportunity had once been given to me. For a time, my students and I even worked to conduct on-site research and publish articles.
My students saw what it was to work in private practice medicine and learned that it was possible to incorporate some elements of academic medicine while doing so. This was both exciting and fulfilling to me. I had found a best-of-both-worlds scenario.
Some people thrive in the environment of academic medicine. Others are born for private practice. But for those who aren’t satisfied, remember that you can blaze your career path as a doctor. It is often possible to build a career path incorporating both aspects.
After all, as a doctor, you are the only genuinely essential requirement for the practice of medicine to happen.
I hope that cultural progress in academic medicine will alleviate some of the burdens of “publish or perish” and create a more supportive, collaborative atmosphere where research can happen with the principal focus on advancing knowledge. This may be a panacea. But, while the logic of incentivizing research publications and grant funding makes sense, we all know of the problems in academic publishing and grant funding that can sometimes create a divide between the most medically-essential questions and the most well-funded and well-published topics. The assumption that seminal scientific publications can only be done independently in an academic environment is incorrect. The private practice offers experience, resources, and infrastructure that can enable basic research to be carried out with the proper guardrails and compliance expectations supporting it.
That is a complex and weighty issue for the medical community and colleagues in academic publishing and grant funding to tackle. But for today’s physicians and medical students, remember that alternative and innovative paths are always available to you in your career. These hybrid approaches could accelerate the advances in medical research and understanding. Ultimately, it is up to you to define your career and life direction. What is critical is to understand clearly what is important, relevant, significant, and rewarding to you.
Francisco M. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine and can be reached at Florida Spine Institute and Wellness.
