Academia vs. Private Practice

I recently worked with a senior SRNA who had asked my opinion regarding employment in these two arenas as he was trying to figure out which route he wanted to take upon graduation. The last two years I’ve had the opportunity to work in both environments. In this post, I’ll be covering the pros and cons of each environment (with an upcoming post that’ll compare the salaries between both private and academia). I do want to preface that this is only through my limited experience and by no means are the opinions and views I’ll be expressing are neither comprehensive in nature nor reflective of other work environments. I’m just sharing what my experience has been like since I’ve started my career as a CRNA along with the thought process behind what led me to choose my primary gig to be in academia.

The decision of deciding whether to work in one of these 3 categories should be based off of the following criteria:

  • Professional goals
  • Professional skill
  • Professional experience

Professional Goals

Now what I mean by professional goals is what exactly are you looking to achieve in the workplace? There are no right or wrong answers to this. It really comes down to comfort level. What are you comfortable doing and how will that help you achieve your professional goals?

Some graduates want to get a job doing bread and butter cases to get themselves more comfortable with adjusting from being a student to becoming a full-fledged nurse anesthetist. They don’t want to be placed in an environment where they’re expected to do crazy, wild tough cases that can challenge them to the extreme, while others want those kinds of experiences. Some graduates want to work in the main OR, while others want to work in a variety of different settings (e.g., off-site, offices, etc.). Whatever your goals are, think long and hard whether you think you will feel fulfilled with going into work performing that responsibility day in and day out.

Furthermore, you also want to think whether you want to seek out additional opportunities for growth as a CRNA? Do you want to work in an environment that places a premium on intellectual growth through the promotion of evidence-based practice? Do you want to work in an environment that allows you the greatest number of opportunities to develop and enhance your clinical skills (e.g., central lines, epidurals, regional, etc.)?

Unfortunately, in the city that I live in, you can’t really choose both. It’s either one or the other. You either choose intellectual stimulation or you choose developing clinical skills. That may not be the case elsewhere in the country, but where I went to school and the jobs that were available to me, I had to choose one over the other.

Professional Skills

As an extension to the previous paragraph, this assessment comes down to how confident are you in your clinical skills. Did you go through a program, more specifically, have clinical rotations that provided you with robust opportunities to develop and expand your skillset? How confident are you in being able to place a central line at the drop of a dime? What about regional blocks? If you had to, are you able to place an axillary block if needed? If you feel like it’s still a challenge, are these skills that you even want to develop as a CRNA? How comfortable are you with your skillset and more importantly, are you okay with working in an environment that might result in you not being able to practice certain skills? Would you rather work in an environment that allows you perform in the manner with which you were trained? Again, where I come from, there are certain places that allow you opportunities to develop and nurture all of the skills you learned in school, but unfortunately, they are far and few between in an urban setting. In this setting, you have to make a decision with regard to which skills you’re okay with not developing and allowing to atrophy. There is a workaround to this and it will be discussed later in this blog post.

Professional Experience

Much like professional skills, your professional experience comes down to what have you experienced in school and how prepared are you (rather, how you feel) with being able to deal with a variety of different clinical scenarios? Everyone has a different threshold with what they’re okay with. Yes, every new graduate has developed a basic competency, but that doesn’t necessarily mean every graduate is comfortable performing the same types of cases. So, you really have to think about your disposition (i.e., comfort level) and how your clinical experience has prepared you to deal with different scenarios.

So, how did I come to the decision to work in an academic setting while supplementing my full time work with private practice?

My goal was to work in an environment that promoted intellectual growth and I can’t think of a better place than an academic environment. As a professional, nothing is worse to me than professional stagnation. Anesthesia is always changing and I think it’s important remaining informed of the latest clinical practice updates. Yes, I get that I can read the latest journals (and I do), but there’s something to be said about working in an environment full of individuals who are motivated and interested in learning how to push the field forward. It’s a stimulating dynamic to be surrounded by specialists who are interested in teaching/sharing their latest research findings. It keeps the work that we do interesting and I place a high premium on that.

Additionally, I wanted to work in an environment that required me to work in a variety of settings. I rotate through 6 different facilities and provide anesthesia in a number of different settings (e.g., main OR, L&D, medical procedures unit, CT, MRI, IR, cath lab, sedation rooms, hospital floors, ICU beds, etc.). I enjoy traversing different settings because it keeps me on my toes and I like thinking on my feet.

I felt that my program did an excellent job of preparing me to work as an independent provider. I had a lot of experience inserting arterial lines, placing neuraxial blocks and regional blocks. Unfortunately, I only placed a central line once, but it was never something I really cared to develop.

In terms of my experience, I actually rotated at this site for 6 months during my time in grad school so I had a first hand opportunity to see what it’s like to provide anesthesia at this institution. Contrast that with my experience at the private hospitals I rotated through, I mainly stayed within the main OR and I knew that that just would not fly with me. I like being able to float through different places. The thought of being in one place and working was not something that appealed to me.

Overall, I chose to work in an academic environment because it was stimulating from an intellectual and a clinical practice standpoint. I’ve had opportunities to develop a website for the department. I’ve written journal articles for publication. I’ve collaborated with several colleagues on multiple projects for the department. The great thing about al of these activities is that my manager along with the department both encouraged and supported such activities, which to me, is a huge positive.

However, the downside to working in this environment, which I knew before arriving, was that the opportunities to work on certain skills would be nil to none; central lines and regional blocks. Unfortunately, residents take precedence where I work, which makes sense since they’re training, so opportunities to perform the aforementioned skills are essentially non-existent. However, I made the decision that losing the ability to place a central line (for which that ability was never there in the first place) was a tradeoff I was willing to make. Unfortunately, that also included regional. I really enjoyed it, but by going into academia, I knew that those opportunities would be far and few between.

Enter private practice. Now, when I say private practice, I just mean as a contractor. Private practice can encompass a whole range of definitions but since this blog is about my experience, I’m just describing it from a hired hand perspective. What do I think about private practice? I absolutely love it. Why? 2 reasons: 1) complete independence and 2) the ability to practice certain skills like regional!

Complete provider independence. What’s there to say that you haven’t already picked up on? You’re making decisions on your own and you’re developing an anesthetic plan of care on your own and that’s great! You’re an independent provider. What’s the downside? You’re an independent provider. As I’ve already expressed in another blog post, you’re by yourself and have to be reliant on your skills alone to get your patients out of whatever complications that might arise while undergoing a procedure. It’s initially a scary experience, but you get used to the feeling over time and it really helps bolster your confidence as a provider making decisions on your own. With complete independence means the ability to work on skills that no one else can take from you (like a resident). So, as one can see, each environment has its own unique way of fulfilling my professional needs.

But if you’re practicing independently and able to work on your skills, why not make the jump to private practice as a full time contractor?

Well, I’ll refer you to my previous post, but the gist of it is:

  1. I just like being in the comfort of a hospital setting. I feel safer there because of the institutional support that allows me to make clinical decisions that promote patient safety. That’s not entirely true in private practice. For those who have worked in private practice, you know exactly what I mean by that versus being in a hospital setting providing patient care.
  2. You lose out on the fringe benefits that a W2 employer provides (e.g., health insurance, retirement, disability insurance, vacation/sick time). You have to pay for it yourself as an independent contractor. Say I make $200K with my W2 employer, I’d have to make ~$250K in order to make up for the lost benefits, but more importantly, it’s an eat what you kill kind of mentality in private practice. If you’re sick, you don’t get paid. If you go on vacation, you don’t get paid. You basically have to hustle and I’m a per diem hustler, not a full time.

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