Working @ an academic hospital vs. 'regular' hospital

[cbrsmurf]

For those of you that have worked at an academic hospital (usually associated w/ a university, lots of research/studies being done) and a 'normal' community hospital, how do the two compare? Prefer one over the other? Pros/cons?

[marilynpac]

One issue stands out. At a teaching hospitals doctors are used to teaching therefore if they are looking for a midlevel they are usually willing to accept new grads. You can see an ad "willing to train". At a community hospital the ad might say "at least 2yrs experience required", in that field.

[Joelseff]

Caveat: I never "worked" at a teaching hospital but this comes from my rotation experience k? so dont sue...:D

I would imagine some specialties though especially surgical, would not be a good position at a teaching hospital. I did my rotations at a teaching hospital. My Inpt was awseome and we were treated really well and I felt that our opinion mattered. But I couldnt imagine working surgery there. i mean as a PA student, I had to FIGHT for scrub time because we had a big team (3 attendings, 1 fellow, 1 NP, 2 R3's 1 R1, 2 MS3's and 1 Transfer MS4-who thought he was an attending BTW to a point it was comical-and 1 PA student-ME! ) Now if you worked there as a PA I would imagine you not getting ANY scrub time! The NP on our team relegated herself to clinic everyday vs trying to squeeze in scrub time. Just my thoughts...

[Moonwalk]

I agree that a PA in an academic medical center will have to compete with residents and fellows for choice work assignments. I personally have generally preferred working in the community hospital setting.

 

However, if your personal interests lean toward research or education (as opposed to strictly clinical work/patient care) then an academic medical center might be a good fit for you.

[physasst]

Exactly as Moonwalk said. Personally, I have only a little interest in clinical practice anymore. I still practice of course, but my interests primarily lie in health services and health economics research. I cannot imagine not practicing at a large, tertiary, academic, referral center. Both of the places I have worked have been such institutions, one in Cleveland, and one in Minnesota.

 

Education and Research are heavily focused on, and part of large academic centers. Will you compete with residents? Yes, to some degree, but eventually, you'll be teaching them as well, and it's always fun to have residents you taught become attendings.. But, you will also see things, treat illnesses, and perform surgeries that might you might not ever have the opportunity to be involved with anywhere else. But everyone's personality is different, and you will really have to think long and hard about where you will fit in the best.

[EMEDPA]

For me the further from academia the better.

my ideal is solo coverage of a rural critical access hospital. no one to steal the procedures and the cool cases. yes, you get every code in this scenario but you also get every 3 am " I think I lost a tampon up there...."...

[medic25]

There are definitely pros and cons to both; if you get the right position you can do both. I've worked in a large academic ED for almost all of my career, and for the most part I enjoy it. Yes, there can occasionally be competition with residents for procedures, but as a tertiary care center we see enough volume that there is plenty to go around. We also get to see tremendous pathology, as the community hospitals frequently transfer us their sickest patients. It is also invaluable to work alongside some of the leaders in the field of Emergency Medicine; coming here as a new grad I was able to learn EM the right way from tremendous attendings who took their positions knowing that teaching is a part of their job. As previous posters have said, the chance to participate in research and education is also rewarding, and can give you a nice break from being strictly clinical. I've had the chance to work in the community setting with a couple of per-diem positions, and there seems to be a much bigger emphasis on moving meat, which sometimes seemed to lead to less than evidence-based medicine. On the other hand it can sometimes be nice to not deal with the layers of residents and politics that go on in an academic setting.

 

If you look around, you can sometimes find a way to combine academic and community medicine. Our hospital opened a free-standing ED in a neighboring town several years ago, staffed only by ED attendings and PA's (i.e., no residents). We take turns grabbing the next patient on the board, and see all comers to the ED. Logistically it is set up like a community hospital, but the staff are the same physicians and PA's who work in the academic ED, so the learning opportunities are still there. It is also nice to still have available all of the consulting resources of the mothership, since we are functionally still a part of the main hospital. If I need dermatology to see my patient at 3am on New Years Eve, it's a matter of picking up the phone; after hearing some of my friends horror stories about getting consultants at some community hospitals I consider this to be a big plus.

It's easy to generalize about academic vs community, but you also have to consider the individual hospitals you are applying to; there are a wide spectrum of ED's out there, and you will find community hospitals with a lot of the benefits of academic centers, and you might find "university hospitals" that function like inner-city public hospitals.

[coloradopa]

For those of you that have worked at an academic hospital (usually associated w/ a university, lots of research/studies being done) and a 'normal' community hospital, how do the two compare? Prefer one over the other? Pros/cons?

I'll put in my two cents. I worked as a CST in a community level one hospital and and a community/academic hospital. As a PA I worked in private practice groups in community hospitals (with and without residents). I now work in a large tier I teaching hospital. The differences:

Training: Its a mixed bag. Some programs give very little thought to training and orientation. Most on the other hand are used to orienting residents or have a large block of PAs that can do the training. Our area provides as much orientation as needed. Minimum four months for experience. 9-11 months for new grads. In private practice there is definitely an emphasis on getting up and being productive. The reason that you don't see a lot willing to train new grads. On the other hand when you have 90 PAs and NPs its easy to take as much time as they need.

 

Resources: In private practice for the most part the hospitals are very responsive to private practice. They are much more efficient and cater to their needs. In academia it a weird mix of politics and power. In GI we used to run rooms all weekend in the GI lab. In a larger academic center all the weekend endoscopies are done in the ICU since there is only one GI nurse and they can't recover the patient. Weird things like the ability to get in depth HLA testing done at 2am but it takes 3 hours to do a stat chest Xray at 2pm. It depends on the relative power of the department chairs and who can get one done.

 

Other resources: Academics - you have pretty much any resource you need. Weird disease that you never heard of - they probably have an expert on it right down the hall. Research - again depends on the department but if you want to do it, its usually encouraged. Lots of help including top level statistics IRBs etc.

 

Population: Once again its the difference between moving the meat and high acuity. In the community hospital where I worked, it was rare to do a whipple. Here we do 10 or so a week. 3-4 fibular free flaps, 14 hour pelvic debulking cases are all the norm. You learn to take care of very sick very interesting patients. In private practice you have an opportunity to develop your own patient base but the acuity will be much less.

 

I worked in two great private practices where I had great physician mentors. I now work in a academic center where I am valued for the contribution I bring and am encouraged to do research with tremendous resources. The first two practices were a good fit at that time in my career. I moved here specifically for the academic environment. With work hour restrictions the number of PAs employed by academic centers will continue to expand. For new grads and people looking for a change it can be a tremendous opportunity. It will not be for everyone.