Docs Who Cut Back #20: Dr. Academic To Community

crispydoc Uncategorized 13 Comments

Dr. Academic To Community (ATC) is an emergency physician who was on an express track to an academic career when she and her husband started a family. Her goals evolved and she recalibrated her life accordingly.

My fascinating interview with Dr. ATC proceeded in a non-linear fashion. A central theme was the struggle to balance career aspirations and intellectual passion with family commitments - reconciling heart and mind.

Any pearls of wisdom contained below are courtesy of Dr. ATC. Any shortcomings in conveying the richness and depth of the conversation we shared are mine alone.

1. What is your specialty, and how many years of residency/fellowship did you complete?

I am an emergency medicine physician who completed a 3 year residency followed by a 3 year administrative and research fellowship at the academic institution where I had trained.

I had my first daughter during the last year of my fellowship. I began to cut back during my first academic year as faculty after fellowship.

I then left my academic position to work 2 day shifts a week at a community hospital nearby, and I have worked there ever since.

2. What did your parents do for their livelihood?

My mother worked as a teacher. In a striking parallel to my own life, she stepped down from teaching when she started a family. Once my siblings and I grew older, she resumed her education and studied psychology, ultimately becoming a therapist.

My father owns a small electronics business.

I would characterize my upbringing as financially insecure. We were raised in an affluent area of Southern California where we had less income relative to our neighbors. In spite of that fact, my parents were always wise in their spending.

My siblings and I didn't own lots of stuff but didn't feel we needed it. We had healthy food on the table and felt loved and supported. Compared to classmates with all the latest material possessions but absentee parents, we felt wealthy in ways they were not.

This affected my blueprint in two ways. On the negative side, I've never been great at making money because it was never a priority growing up, so I suppose I could have earned a better income if I'd made it a greater priority. On the positive side, since I never felt like money was that important, I didn't miss it as much.

3. What motivated you to cut back?

At the time I cut back I was a full-time attending with a faculty appointment and a newborn at home.

I spent my days teaching residents, conducting research, working clinical shifts overseeing residents and medical students in the ED. I was also moonlighting one shift a week at a local community hospital.

At the time I had my daughter, I had no idea just how much I would want to be present in her life in a way that made sense at an intuitive level.

Every couple of months after becoming a mother, I would reassess how to reduce my commitment to medicine so I could increase my time at home with my daughter until it felt right.

First to go was my moonlighting gig.

I still had full-time responsibilities to my academic institution. I was in the midst of a large research project, with multiple medical students working under me.

I reached out to my faculty mentor and the head of my department to see how I might pare back anything I didn't absolutely need to do so I could spend more time with my infant at home.

We kept adjusting my schedule over the course of a year. I recall expending great effort letting go of any responsibilities that were not crucial. I cut my clinical time to 0.6 FTE. I continued my research. I reduced my teaching responsibilities.

I loved caring for patients, I loved academics, I loved conducting my research, and I loved teaching.

Yet I had no idea how I could be with my daughter in the way I wanted to be with her, and at the same time fulfill the academic responsibilities I'd cultivated over the years.

I had a grant for my research, multiple physician collaborators and medical students as research assistants. I had a number of people depending on me, I had papers to write up, I had a mentor who had invested deeply in ensuring my academic career was on track to succeed.

Somehow I had thought I would give birth, let other people take care of her, and keep doing all the things I was used to doing, and it was going to be okay with me.

I thought I was going to do it all, but I instead felt this unanticipated huge calling to be home and present with her. I spent the better part of a year trying to adjust my schedule so my time at home felt adequate.

I cried.

I questioned myself.

I was all over the place.

I couldn't intellectually understand it, but my heart was calling me to be home more with my daughter. It seemed crazy to leave this position that I had wanted so badly, after the institution had created a position for me.

It made no sense - my career was just starting to gain momentum, I'd been appointed Assistant Professor, all these people had supported me.

Yet if I stayed I felt I was selling out where my heart wanted me to be.

I completed my two research projects and published the results. It was important to honor my research subjects and my colleagues. I knew I couldn’t step down until I finished what I had started.

I had some really hard conversations with my department chair and my mentor. Both were supportive, with my mentor continually meeting with me to figure out ways to make my job work.

I recall having the thought that if only my mentor would leave our department, then I would feel free to go - it was a reflection of how deeply he'd invested his time and credibility in helping me to succeed, and how indebted I felt to him for that support and our relationship.

I voiced this thought to him during one of our meetings, and he finally understood how conflicted I felt. To his credit he responded by saying that I needed to step down and he was going to help me do that.

I also felt indebted to my mentor's wife, herself an academic physician. He had invested significant time developing my career that he might instead have spent with her and their children. I was failing to live up to the potential they both saw in me. To my surprise, she responded by telling me I'd never regret my decision.

Intellectually it was hard to accept that I was stepping away from everything I'd worked toward.

Intuitively it made perfect sense.

I loved my institution. I loved teaching. I loved discussing cases. But when I commit to something I can offer no less than 100%. They kept trying to help me carve out a position that offered me less and less responsibility, but I did not feel good participating in this way. I did not feel okay sitting on our faculty and contributing less than everyone else was contributing.

I left my academic position for a community hospital, where I met with the director and explained my situation. We agreed I would work two shifts a week with no additional responsibilities.

I wanted to give 100% when I was working in the ED. When I left work I wanted to be 100% with my daughter.

When I was on the academic track there were always papers to be written, talks to give, always something hanging over my head that I could never set aside. Now when I am with my children I can be present without being distracted by 40 competing priorities.

As if to validate my decision, shortly after I decided to step down I discovered that I was pregnant with twins.

[CD: Sometimes the universe sends messages that are not subtle.]

4. What were the financial implications of cutting back?

When I decided to step down from full-time emergency medicine, we were living in home with a mortgage looming and twins on the way.

We made an explicit choice that love, time and presence were going to be our most valuable inputs in raising a family. Once we acknowledged this, it felt like less of an opportunity cost to lose income because income was not our metric for defining success.

My husband is both a musician and a graphic designer. In order for me to spend more time at home, we agreed that he'd reduce time spent on travel and music and spend more time on his graphic design business. We arrived at this decision as a unit, and there was a shared trade-off.

We did not downsize our home. Our original home was going to be our starter home when we were on plan A. Plan B simply meant we would stay put and make a smaller home work. We downsized the plan rather than the home.

When our twins were born, I took a leave until they were 10 month old. We maintained an emergency fund, but did need to tap into our savings over that time period. In the end we took a 4 year pause in making retirement and 529 plan contributions.

We're careful, but we have enough.

5. How did colleagues react to your decision?

On the whole they very supportive, and they did not openly criticize or judge me.

When my mentor realized the strength of my desire to be home, he changed course from trying to help me remain in a job that could no longer accommodate my needs to helping me depart the job gracefully for one that was a better fit.

At my new community position, I have never felt disrespected. More likely, I am regarded as an oddball. I have a fancy educational pedigree, and when colleagues find out about my unusual career choices, it opens a fascinating dialogue. Other docs who are struggling with how to carve out nontraditional paths that honor their values tend to seek me out.

Perhaps I'm less susceptible to external judgment because I struggled internally with my decision, thinking long and hard about how I would judge myself.

My internal criteria don't make rational sense to most people, and barely make sense to me, but I recognized what felt intuitively right.

Once I accepted that I needed to leave my academic position, I felt great freedom and quickly altered my trajectory.

As a result, when people ask me, "What were you thinking?" I don't grow defensive. To the contrary, I reply with affirmation: "I know, right!"

Since I'd already judged myself, and I am my harshest critic, I can understand and empathize with why others might be baffled by my choices.

I made the decision to leave my position at the end of the academic year. Shortly after announcing my decision I found out I was pregnant with twins. I think it made it easier for colleagues to understand me decision knowing I had a 1 year old at home and twins on the way.

By the time I started my position in the community I was only able to work for a couple of months before I was put on a medical leave due to issues with the twin pregnancy.

One of the partners in our group encouraged me to return once a week for a day shift after my leave. I gratefully accepted this offer and when I returned the group was willing to give me the same day shift each week so that I could set up reliable childcare.

After a few years I returned to working 2 shifts a week. Again the group generously allowed me to work the same two shifts a week which made it possible for me to create a consistent routine for our family. We have chosen an alternative path for educating our children which includes homeschooling and having a predictable schedule has been a huge factor in making this possible.

5b. Was your family supportive or critical?

My parents and siblings were totally supportive. They saw that I felt torn. My mother in particular understood that the way I wanted to be with the kids was not compatible with full-time work.

Thus far, my kids still enjoy being with me and prefer that I don’t leave to work. Since kids thrive on routine, they appreciate the predictable schedule I've been fortunate to work out with my workplace - not an easy feat to pull off in emergency medicine. It helps the kids to know when I'll be gone and when I'll be around. They are very grateful to be able to homeschool and realize that my working part time is what makes that possible.

6. What have been the main benefits of your decision to cut back?

I am able to be with my kids in a way that I deeply value. I feel present without distractions.

I didn't know I'd want this until it happened, but we have the flexibility to choose to do this thanks to my having cut back.

As much as I wanted to be at home with my kids, I also found myself incredibly challenged being at home alone with three small children. I knew I needed support and tools for improving the way I was communicating with them as toddlers.

There were many days that I wondered why I wasn’t leaving them with a “nice” nanny so I could be in the hospital giving orders to people that would actually listen to what I had to say! Despite these self-doubts and challenges I still felt at an intuitive level that being at home was exactly where I was supposed to be.

Luckily I found a co-op where I was able to get the support and education that I needed as a parent. From this experience I decided I wanted to be able to help other parents that were also in need of support. I completed a training program and began facilitating workshops as a parent educator.

Helping others and teaching have always been my calling. I'm grateful that once I left academic medicine I was able to do this outside of the hospital in workshops and group courses.

In a way, I channeled my academic energies into working with other parents. I realized that the same information and support that helps us to communicate more effectively with our children is translatable to all relationships and my work as a facilitator has grown to supporting educators, athletes, business executives, physicians and other groups of individuals interested in well-being and effective communication.

There's some truth to the notion that once I decided not to pursue the standard career track in medicine, I was better able to see possibilities outside of convention in other areas as well.

Being home has also enabled me to pursue an alternative educational path with our children. Prior to having children we bought a home in a neighborhood that was known for its excellent public schools. Little did we know that we would end up homeschooling!

There is solace in knowing that if things aren't working you can seek broader solutions like those I pursued in finding the best educational approach for my kids.

When we decided we wanted to educate our children in a nontraditional way, my career choice made me unafraid to experiment and try a different approach.

If you have different values and needs, it helps to experiment without judgment until you find something that works.

We all want to help others and be of service. Not feeling handcuffed to preconceptions of education or work opened me up to new ways of being more true to my values.

7. Main drawbacks?

Financially, I don't earn full-time salary.

Intellectually, I miss the academic workplace. I miss being on the leading edge of state of the art research. I miss being part of a medical community of thinkers collaborating on creative solutions.

8. If you are honest, how much of your identity resides in being a physician?

Being a physician is a facet of my identity I cherish. I am grateful for the trust my patients place in me, and for the opportunity to serve in a meaningful way. But it's one facet of many.

Depending on the day, I also identify as a math teacher for a group of kids who home school; volunteer at local aquarium; an educator and facilitator for individuals interested in effective communication; and a home schooling parent. Every day, I'm a mother.

Each identity makes me feel gratitude for the opportunity to serve in a new capacity.

Had my identity been 100% wrapped up in being a physician, I could not have made the unconventional choices that have helped me live my most authentic life.

9. If you had not gone into medicine, what alternate career might you have pursued?

I might have pursued psychology, likely teaching within an academic environment. I am passionate about optimizing mental health and well-being.

10. What activities have begun to fill your time since you cut back?

THE KIDS! Home schooling 3 kids takes work. I spend significant time educating myself on theory and practice, and using what I learn to work with others to foster well-being and effective communication.

11. If approaching retirement, what activities have you begun to prioritize outside of medicine so that you retire to something?

I am approaching retirement solely in the sense that time only travels in one direction.

I don't ever want to stop working. I want to produce and learn and be of service until I die.

I expect my productivity will just shift to things I'd do without respect to the paycheck.

I'll likely do more work in well-being and effective communication. I've organically been pursuing work I love, and I'll do that until the day I die because I'm passionate about it. So this part of my life will likely fill more of my time.

12. Did you front-load your working and savings, or did you adopt a reduced clinical load early in your career?

I worked a lot before we had kids, and had no intention to stop.

I wasn't particularly saving for the future because I assumed I'd be working full-time into the future. Hence I did not front-load savings.

I reduced my clinical work early on for the reasons elaborated above.

The advantage is I had the experience with my kids I felt deeply driven to have. I sincerely believe I could not have had it any other way and have been at peace with my choices.

As my kids get older, I have the rest of my life to do more medicine or scale up to full-time if I'm feeling so inspired.

If I were graduating residency today I would not have done anything differently. I had offers out of residency at community hospitals that were financially enticing compared to the lower pay of the academic research path.

I struggled to figure out what was going to make me happy in the long run. In realizing academics offered the right combination of teaching, learning and growth I opted to take a lower salary to pursue the more personally satisfying career path.

I stayed true to my values in my job choice and have no regrets.

My career in medicine has reinforced that as long as I remain honest and authentic about what I value, and choose accordingly, life will be good.

If there's a life change, I can always course correct.

I remember thinking after my daughter was born that my life had been rearranged in an instant in a way that I did not anticipate.

I don’t think we can know for sure how we will feel about having children until the day arrives.

Some of us may have planned to take a long maternity/paternity leave and realize we cannot wait to get back to work.

Some of us may have planned a short leave and wish we had longer.

I don’t believe there is one right way to do anything.

I think we learn and grow by trying to be honest with ourselves at each step of the way.

I think we are of the most service to those around us when we are doing what we truly love and feel called to do.

For some of us that means lots of time at work and less at home.

For some of us that means less time at work and more at home.

I think that the less that we judge each other's decisions and the more that we listen to each individual's experience the better able we are to work together to create solutions that work for everyone.

I am grateful to all of my colleagues that have listened over the years and helped me create a balance between work and home that I never would have dreamed possible.

Having children is only one of the many things that may lead to a major rearrangement of our priorities.

It never ceases to amaze me how once I let go of thinking that things have to look one certain way, I am able to realize that there are an infinite number of ways to solve any problem.

The great privilege of the physician blogger world is the opportunity to meet extraordinary people and engage in conversations that cut to the core of our individual values.

It is a risk for a female academic to admit to feeling conflicted about wanting to spend time with family over career - as someone married to a brilliant female physician I shudder every time I hear a "mommy track" comment made in a disparaging manner about a talented doctor who happened to be born with ovaries.

Dr. ATC was willing to make herself vulnerable by exposing her internal conflict for others to learn from. Among the pearls from her story:

  • I would characterize Dr. ATC's career transition as an introduction to the power of ordering off the menu. When the available range of existing options won't fit your needs, you need to create your own ideal position. In Dr. ATC's case, when neither academic nor community positions suited her need to spend ample time home schooling her kids, she created a unique arrangement in the form of a two consistent day a week position in emergency medicine. Sometimes you have to build the unicorn job you seek.
  • Ordering off the menu as a career strategy pays further dividends by allowing you to envision creative solutions in other facets of life. Dr. ATC applied her intellect and passion to helping other parents to communicate effectively and foster well-being.
  • ATC views the future with the promise of abundance rather than the regret of missed opportunities. This seems congruent with the ordering off the menu mindset. Instead of asking, "Why would they let me?" you ask "Why can't I do it differently? Who better than me to trailblaze this new path?"
  • A key aspect of Dr. ATC's abundance mindset is the ability to recognize that the availability of time varies over the natural history of family life. Just as her mother's second career as a therapist blossomed after she and her siblings grew more independent, Dr. ATC regards that coming stage as an opportunity to return to a deeper practice of medicine.
  • Adaptation is an adult skill. Dr ATC found a field she loved and had developed momentum in pursuing her chosen career. Then she started a family, and new priorities emerged that caused her to alter her trajectory. It's healthy to make continual course corrections to ensure you are spending time in accordance with your values.
  • Adaptation and the growth it brings can also lead to finding your tribe under new circumstances. Dr. ATC left a faculty position she valued for the intellectual and collaborative community it represented. She found a similarly intellectual and collaborative community in the group of dedicated parents and educators with whom she now teaches her children.

You can find prior interviews with other docs who cut back here.

Want to be interviewed? Email me at crispydocblog (at) gmail (dot) com.

Comments 13

  1. Great interview. It contains elements of my own narrative. It’s interesting to see “the Mom’s” POV since in my case I was the Dad and became responsible to make the finances work out. We homeschooled not for alternative reasons but traditional reasons. I wanted my children to come out of their educational years with the broad range of traditional western thought and a Socratic style of learning. We used a curriculum at an Academy called The Angelicum and the lectures were done online so my kids were with students from all over the world, some traveling with their families in different countries. The teachers were PhD scholars and the education was rigorous but like the frog in the water my kids didn’t know the difference between rigorous education and public education because they grew up in the rigorous lane. They got the same course work English History Language Science Math. I taught them Chemistry Physics Biology Anatomy Astronomy. They had plenty of “socialization”. We were involved with 30 other home school families. My wife was prez of the organization and we had all kind of outings an camp outs and bon fires etc. My kids danced ballet and tap, did gymnastics learned music especially piano. They became photographers and each of them owns a money making photography business. Very different takes on how to organize a business. They spent time in Europe studying. One kid is in grad school the other in college both Dean list students with no problem self starting. They have intimate friendships and make good relationship choices.

    The cost? My wife’s career. She had a successful fee for service private practice Occupational Therapy business but like Dr ATC went in another direction. We didn’t make as much money though I made plenty of money, and instead came out with very rich lives and I came out with 2 adult kids who are exactly who I hoped they would be. I learned as much on the road as they did. “Don’t you ever ask them why, if they told you, you would cry and know they love you.”

    This is the best thing about America. You don’t have to live a standard format script like academic physician or 2 income family with kids in day care from age 1, in hoc up to your eyeballs. American life is plastic and mold-able. It’s completely amenable to you making it into whatever you want it to be.

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      I was very much reminded of your choice to home school as I conducted this interview. Out of curiosity, did you wife experience similar struggles with deciding to leave her practice?

      1. Not really. She decided to build a “nest” and populate it with children as her ambition and then educate them in a classical way. She wanted it so I was on-board with that. My life is about creating environments where things like this can happen. Creating boundaries for my kids so as they matured they could push through the boundaries into a new and bigger play ground with more responsibility but concomitantly more freedom, so my task was creating the architecture for all of this to occur. At age 1 we started teaching our kids sign language. We taught them to say and sing prayers in Latin at age 3 and formerly enrolled them in online Latin at age 4 which was a playing class with a teacher out of KY like preschool. They ate it up. By then the Home school community was happening and they had a ton of friends and activities, so the deal was sealed.

        I took my wife on a date last night to go see a movie but the movie was 21/2 hours away in Tampa. Part of the reason we went to Tampa is there is a Hot Dog store called Portillo’s in Tampa and Portillo’s a local chain in Chi and was one of the places we would go when I was a resident in Chicago. It was loved by her, Italian Beef on a croissant with roasted sweet pepper, french fries, and a root beer, do not forget the damn root beer. It was totally the same as the place in Chicago and the food was exactly the same. Watching her light up was a hoot. We talked about my daughter and how she’s making her life. She’s in grad school for Choir directing plays organ and piano professionally, has a photography business and teaches Montessori school where she is well loved by her little ones, but her goal as well is to be a Mom. Her goal is to teach her kids sign language. Her goal is to be a wife. She has a ton of skill and has sung at the Vatican twice and played the Organ at Mass at St Patrick’s in NYC and knows everybody in that end of the music biz at age 22 but her pah is clear to her same as it was clear to my wife. This is America and you get to be who you want. I became who I wanted to be. The trick is to compare yourself to yourself as a measure of progress, not compare yourself to other people. If you compare to others,you have to live their narrative not your own. Living someone else’s narrative is a very dissatisfying experience

        The movie was called “Playing with FIRE” put on by some Tampa FI group. I found the movie very disturbing. I found it a cross between Tony Robbins, a time share pitch, Amway and Cross Fit and had little to do with the reality of FIRE. It was loaded with FI luminaries all pitching their rap. The story was about a husband a wife and a baby living in SoCal in San Diego in a beach community with a 1.5M house 2 luxury cars spending 2K/mo on food bla bla bla. The husband discovered FIRE and got a hard on. He convinced his wife to rip up their lives and go live on their parents couches for a year while they “saved money”. His parents lived in rural farm country in IA. The wife was a telecommuter and the bread winner so she would disappear into her office every day for 8 hours, but her goal was to hang with her kid. Her husband was kind of a dead beat who pretty much hung out trying to figure out something to do. I think he was into making video in SoCal before the couches in IA. So he made a video. Went around filming Vicki Robbins JL Collins JD Roth MMM riding his bike Mad Fientist and half a dozen other FIRE marketers who all dutifully sold their soap. Plenty of drone shots of Vicki Robbins’ (who “retired at 26” or some nonsense) multi million estate on an island in WA. They finally got a few bucks together and moved to freakin Bend Oregon and bought a 2 BR crib for half a million that was their idea of downsizing, oh and the wife went from her Beemer to a Honda and nearly had a hernia in the process. The guy did buy a bike and a trailer and rode 2 blocks to the food store to shop to “save money”. So cliche’. One thing for sure the baby was adorable.

        Tampa is home to USF and the place was loaded with kids all greedily eating up the HOW TO of retire by 30 but no HOW TO was provided except “save half” make a emergency fund and stuff some dough into VSTAX and “never sell!” If the 20 yo me was presented with living in a half a mil crib with 2 cars in Bend Oregon being retired I would consider signing up too, but in reality this is nonsense. If they telecommute, why not just buy a crib for $25K in rural IA and really sock away some dough. It was my wife’s first formal introduction to FIRE and she wasn’t impressed either having lived both accumulation and now retirement with me. It’s too bad really, because the essential core of FIRE is the dominant American spirit of building your life with your own 2 hands and the 2 hands of your mate. There is something almost sacred about that. This FIRE movie was just huscksterism but I’m sure the joker got a payday enough to make up for his dead beat nature and to spur on his FIRE ambitions. It’s legit.

        I guess I’ll never be a TRUE BELIEVER like the soap salesmen/women in the movie, but that’s OK because I compare myself to myself and have plenty of money for hamburgers. I wonder has there ever been an instance where FIRE has failed? Never read about it.

        1. Post


          Apologies for the late reply, just returning from trip abroad with all the stamping out of small fires on my return that have taken days to work through.

          Sounds like your wife was able to match meaningful work raising the kids with her ambitions.

          Re: Film – this is disappointing to hear. Although I have yet to see it, I chipped in $20 bucks to help fund the film after FINCON thinking it might be a good message to get out if spread in the right way. It sounds like the messenger/edits/presentations were flawed in pretty large ways.

          Do you think, flaws notwithstanding, it has the potential to turn people onto financial savvy as a gateway drug – or do you fear the audience will be too unsophisticated to pursue it in a manner that reduces risk and makes a realistic appraisal of the possible?

          I guess it’s a fine line between true believer with an incomplete sense of risk versus woke and ready to undertake the lifelong learner commitment to assuming control of your finances.



  2. When I almost finished my residency, I realized that waiting for others to make my schedule would not work for our two doc family. I chose to work in private general practice instead since I could make the same working half the time since I was efficient.

    I prefer control of my schedule rather than academic or institutional career ladders. Those would ring hollow to me.

    Furthermore, your kids stay young for a brief period of time but you could work FOREVER if you want. Just sayin’.

    Unfortunate you had to spend so much energy stressing out about all this. I am always grateful that I seriously lack ambition.

    1. Post

      There’s a thoughtful FI blogger who writes at, and while his last post is years old, the material still rings true – you final comment brought back the memory of it.

      The key for Dr. ATC seemed to find the authentic response to her dilemma, which she fortunately pulled off with aplomb. She has no regrets, and continues to see the world as full of possibility in future stages of life.

      In your case, Dr. MB, owning your medical business seems to have empowered you to not only control your schedule but also reap the rewards of your work ethic – both big wins. I doubt that you lack ambition – you simply understood earlier than most how to harness it on your terms.

      My brother-in-law is fond of saying, “Work is for suckers.” I’m starting to understand what he means is being exploited by others for their benefit at your expense. If you can practice medicine on your terms in a manner authentic to your needs, it can be very rewarding far beyond the paycheck.

  3. That is wonderful that she was able to have a supportive family as well as colleagues that really went beyond the call of duty to help her get a shift schedule she was comfortable with.

    It is good for the medical group as they have a doctor that will likely go beyond herself to show gratitude as well as avoiding a doctor who would have been forced to work and not have her heart in it if they didn’t allow this flexibility.

    1. Post

      Your latter point is well-taken, Xrayvsn. Creating a culture where people feel loyalty to the group because their needs are met and they feel heard and cared for also means under strain your group members are more apt to rise to the occasion in support of the group.

  4. This post especially resonates with me, but for slightly different reasons. I am a year out of training working in an academic community program. It has been an enriching year, but also has illuminated to me that, while I love teaching and academics, the academic lifestyle is probably not for me.

    I have ultimately decided to transition into private practice. This decision was complicated by remaining in the same area (small town) and working for the same organization in which I’ve been working for the residency program. Interestingly, and unusually, I will likely initially make a bit less money in private practice than in academics. It has been an especially difficult decision as I feel I’m abandoning a growing residency program at which I trained and likely would have been in a leadership position shortly into my career, and entering a practice that seems like it will be fulfilling, but which I’m not certain it will be. I, too, have felt out of balance, and that I wasn’t spending nearly enough time with my family, and I think this will help do that.

    Maybe it’s burnout, or maybe it will end up being exactly the right decision. I guess time will tell. Anyway, this is a great blog, and I appreciate you doing these interviews.

    1. Post


      So grateful to read your comment – you are far from alone in feeling that academic medicine isn’t always the fit we thought it would be. I give you credit for sacrificing both the academic position and (at least in the short-term) income to do what feels right. Perhaps once you get the lay of the land you can carve out a niche that feeds you but doesn’t claim time you are unwilling to give.

      Both Dr. Mo and Doc G worked a few years in private practice as employees before they went out exploring ventures where they ran their own businesses or assembled their own diverse way to practice medicine on more favorable economic terms. Don’t sell yourself short, and use the new position as a way of understanding the business of medicine so you can someday own a piece of that business, whether the practice you are entering or a future version of a solo practice.

      It took several years for my wife and I to lose the sense of ambivalence about giving up our academic positions…after which, we have felt only gratitude for our new freedom to live as we choose. I expect a similar sense of loss followed by a sense of having narrowly dodged a bullet may be in your future.

      Thanks for reading, and I hope I can keep writing things that are worthy of your time.



    1. Post

      They are rather unmagical, which is why they are not favored by most of us.

      Within emergency medicine they include per diem jobs where you only offer to work days and consequently have to assemble shifts at several places to get sufficient shifts to make ends meet; jobs where a significant differential exists between day and night shifts – where you pay so dearly for only working days that most folks request some nights as well for the superior remuneration; and urgent care, where the cases are far less interesting and acute but the hours are better.

      Few of us opt to sacrifice skills or money for better hours.

      For those willing to pay dearly for the privilege, there are magical day shift only jobs we can cobble together.

      We’ve probably seen these job listings, we’ve just passed them up because we felt more exploited by the work than rewarded by the lifestyle benefits.

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