Reality of private practice skull base

[Guest]

Yes, large private groups can essentially do the clinical research. Except, overwhelmingly, they don't.

[Guest]

It doesn't make a lot of sense to do research if you're in private practice unless you really enjoy. You don't get any real professional benefit (since you're not trying to get promoted to associate prof, full prof, etc.) and it either takes away from your cases (salary) or time with your family.

[Guest]

Jim Liu just posted on social media that he's leaving Rutgers and joining a large private group. OP could reach out to him to get some perspective.

[Guest]

I am a hospital employed (non-academic) skull base surgeon. I work for a giant healthcare system with a huge referral base. I have a pure practice, but one of the commenters was correct about the kind of cases you do. I don't see convexity and parasagittal meningiomas. I only see giant skull base tumors in symptomatic patients. My cases take a really long time without RVUs to show for it. I operate 3-4 days a week and am just barely making my RVU cutoff for production bonus. Also, my partners are too scared/unwilling to take care of some of the more complicated stuff when I would like a day off, so I am on call all the time.

An additional consideration is the resident support. It is nice to do these cases with someone who is interested and can help you open and close and give you a break every once in a while. I don't have APPs to help me in the OR, so it is just me doing the whole case. I get tired of closing galea when I am taxed from 10 hours of tumor resection.

I get paid much better than I would at an academic setting, but I feel like I am paying for it with a poor quality of life.

[Guest]

Do you mind sharing your contract breakdown?

[Guest]

This is another very valuable point. Like the poster said above, this whole topic could use another 2-3 separate threads. It's very hard to find the perfect balance between money and quality of life. For some skull base surgeons and perhaps big spinal deformity surgeons, it could be worth it to take a pay cut to have more help. Imagine doing a T2-pelvis with a PSO all by yourself (or a random PA fumbling through an exposure), or a petroclival meningioma vs. a skilled chief resident or spine/skull base fellow. Having motivated residents/fellows shaves at least 4-5 hours of tedious positioning/exposure/closure/wakeup time, nevermind all the rounding, notes, orders, and consults they did for you earlier that morning.

The balance between money and ease of job is tricky and will vary from person to person.