You are so close to completing your medical training: Congratulations! You worked and studied hard through grade school, college, and medical school. You completed—or are about to complete—residency training or perhaps a subspecialty fellowship. You gained valuable skills and knowledge, but—more importantly—you also grew to realize that your MD (or DO) stands more for “making decisions” than medical doctorate! In brief, you are now close to another finish line, and more significantly, closer to another decision point: Should you choose an academic career or join a private medical practice?

You are likely disciplined, methodical, and scientific, so you decide to look for articles and search the literature on this decision. You conduct your search only to find that most published guidance deals with financial aspects, side benefits, lifestyle, and expectations. You cannot help but feel unsatisfied, considering that you chose the medical field because you were driven by higher values than finances, and by aspirations beyond benefits and perks.

Through years of training, you became increasingly aware of the negative impact of stress, work-life imbalance, and burnout. Perhaps you also realized that remedies for these silent killers start with choosing wisely, including finding a career path that matches your values and a role that fulfills the best of your talents. You also note that the wider context of this issue is much bigger than material benefits or financial rewards. What you are really searching for is a guide that helps you reflect on and decide the best fit for the “specific” you—whether academic medicine or private practice aligns with talents and aspirations!

The following framework represents an attempt at sharing the general expectations and skills needed at both academic and private, non-academic practices, followed by recommendations on how to find the best fit for your own talents, skills, and values.

Academic medicine

Key skills and talents needed to succeed, flourish, and rise through the ranks in academic medicine settings include:

1. Inclinations towards perfectionism. Academic medicine is more about depth than breadth. Detail-oriented perfectionists and “hair splitters” will feel more satisfaction than less meticulous “lumpers.” Complex cases, rare conditions, and challenging diagnoses are likely to end up at academic medical centers, and these require extensive work, resources, patience, and dedication. The common impression that the most complex 10 percent of cases often consumes 90 percent of an academic physician’s day is not an exaggeration.

2. Teaching skills. Academic physicians require an ability to communicate complex concepts and situate them among simpler issues and their broader context. It is even better to find enjoyment in teaching, perfecting, and repeating the pedagogical process.

3. Public speaking and broad communication skills. These are needed for teaching, lecturing, sharing knowledge, and presenting research results. A combination of natural talent, practice, and preparation are all needed to create a good public speaker.

4. Inquisitive curiosity and collaborative skills. Important for research endeavors.

5. Writing skills. Together, a solid linguistic foundation, talent, and practice can make an exceptional writer stand out among the rest. Reading—including critical reading—is also important. Excellent writers are usually voracious readers!

6. Networking skills. Medical practice decisions, medical policies, teaching, clinical trials, and research endeavors are all organized and offered through hierarchical medical institutions and organizations. Networking skills are important to navigating these institutions, and a professional demeanor coupled with an engaging personality can serve you well.

Private medical practice

Key skills and talents needed to succeed and flourish include:

1. Motivation and gratification in providing services focused more on the breadth than the depth of medical care.

2. Patient and small-group interaction skills and the ability to accept that some days will involve repetition of the same drill. Enjoyment of simple, repetitive tasks is a virtue.

3. Social skills that project compassion, sensitivity, and advanced emotional intelligence. These social skills need to be tailored and adapted to different patients’ educational backgrounds and to their unique needs.

4. Work adaptability, mobility, and adjustment to change. Private practices are more likely to experience major changes such as mergers, transformations, and acquisitions. A successful private practice physician will need to accommodate such changes and grow with them.

5. Business skills. Minimizing expenses and maximizing profits are more important for the survival of non-academic practices compared to often better-funded and usually larger academic institutions.

6. Negotiation skills. The smaller the practice, the less uniform the practice, contract details, and benefits are. This means that a physician in a small private practice would benefit from careful contract review, an inquisitive attitude, and negotiation skills.

Recommendations

Deciding on a type of practice can be easy for some and difficult for others. Some may feel qualified and comfortable practicing either track. For many, a focused effort of soul-searching, exploration, and consultation may be needed. Review the above guidelines and decide the best fit for you based on the above list of skills and talents. If your set of skills and goals fit no obvious favorite, consider trying an academic career for 3 to 5 years before making a final decision. If issues arise, switching from academic to private practice can be a relatively easy adjustment. The reverse is not as easy.

Samir Kahwash is a pathologist.