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What do you consider the biggest disadvantages of your practice environment? MB: The biggest drawback of academia is when what one wants to do doesn’t match well with what the institution wants you to do. For example, you want to do basic research and the academic center wants you to spend your time seeing patients and teaching housestaff, or the reverse. JF: Depending on your career goals, private practice tends to require more clinical time, which leaves less time for research. Also, depending on private practice location, you may have limited exposure to other neurointensivists. DG: Academics pays less than private practice, but you typically do much less clinical time. This gives you the freedom to pursue other career interests. CM: In private practice, communicating change and implementing new processes can be challenging since many physicians are not bound in a departmental structure.  Socializing the rationale and details of a plan require dedicated effort, and persistence and consistency. MM: It can sometimes be a little lonely rounding or doing a 3am admit on your own in private practice, when you are used to rounding as a larger team. WZ: There is perpetual competition for your time in academia. At some point you have to say “no” to some of the requests and there’s always a struggle for the best work-life balance. Were there either good or bad aspects of your work environment that you didn’t expect? MB: I think research grants are a little harder to get funded than I expected when I was in graduate school. However, I had ample warning that it would be a high bar to get NIH funding. JF: Getting a new neuro ICU started was a lot of work and the change in culture from academics to private practice was initially difficult. DG: My first faculty position environment was initially more competitive than I expected, and it was hard to navigate without clear mentorship. When looking into an institution, it is important to understand junior faculty support and identify good mentors. CM: My work in a private practice position is very similar to my prior academic jobs.  I conduct research, teach residents and trainees and give lectures.   The clinical patient volume is equal or surpasses many academic centers.   MM: You could easily find yourself never looking back -or others desperately wanting to return to academics. I have been extremely fortunate in finding a great mixture of both: the complexity, acuity and quaternary care capabilities of a University hospital setting and the independence, flexibility and benefits/ compensation of private practice. WZ: The best surprise was that good mentors were truly committed to the research work they were doing. Also, as long as you are willing to do the work, the grant writing will eventually become successful, and great students with great ideas will keep the process fun and challenging. What advice would you give to trainees considering academic or private practice? MB: I cannot stress enough that the decision should rest on your own desire to discover and to teach. If you want to be an academic, decide what you want to research and who you want to teach, and then find a job where there is the institutional will and resources to support you in your career. I not only mean financial, space and protected time, but also mentoring, collaboration availability, and facilities. Finding the academic environment that is perfect for you can take time. If you cannot start writing and getting grants when you start, it will be harder to succeed in the long run. On the other hand, if you take extra time as a postdoctoral fellow or as a clinical researcher, you may be more successful overall. JF: At larger private centers, there is a blurry line between academics and private practice so many can still keep academic interests. It comes down to how much protected time you want. DG: It is important think about whether pursuing research, education or being stimulated by asking hard questions excites you. Academics is not the right path if you are not excited by these things. CM: ​Regardless of practice, I think it is crucial to understand the maturity of the critical care unit at which you are contemplating work and what struggles it may have had in the past.  Does your position displace another intensivist, or does it add to the specialty capability of the hospital in a manner that will be supported by your colleagues? A young clinician can quickly find himself or herself in a leadership role, which while providing opportunity, need to be considered in light of personal pursuits, such as research, physician training, and work / life balance.   MM: Those of us who have spent so many years in the academic setting, often have some bias and hesitancy against leaving the academic setting. Trainees should look outside of academia, have an idea of your personal and professional goals and remember that private practice can mean a lot of different things. WZ: Perseverance and choose the right mentor. Take advantage of outside collaborations early. Seek more than one mentor. The nature of funded research today is fully collaborative and working within networks is the new reality, but also a smart way to do research. 21


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