Working In an Academic Medical Center: The Good, the Bad, and the Ugly

Considerations for nurse practitioners and physician assistants

Earlier today, I shared my personal experience evaluating the possibility of working as a nurse practitioner in an academic medical center (more about that here). While the employment option wasn’t a good fit for me personally, for some nurse practitioners a teaching hospital just may be the right opportunity. So, to elaborate on my own experience, I also wanted to share an objective look at the pros and cons of working in such facilities. 

If you are a nurse practitioner or physician assistant interested in working in an academic medical center, here are a few things to consider: 

1. You’ll take a pay cut

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University and other academic healthcare settings are notorious for low compensation. The MGMA Academic Practice and Compensation Survey, for example, found that anesthesiologists working in academic healthcare settings earned on average $240,489 compared with a $317,481 average salary among their colleagues employed in private practice. Anecdotally, the same holds true for nurse practitioners and physician assistants. Hourly pay for NPs and PAs employed in academic settings may even be half that for advanced practice providers working in private hospitals. 

There is a silver lining when it comes to compensation in the academic setting. Often, university hospitals offer excellent benefits and may even discount university tuition for employees and their families. If you’re looking to advance your nurse practitioner education, this benefit could outweigh a lower salary.

2. Opportunities for teaching and research

If your career goals are in line with the mission of academic hospitals dedicated to research and teaching, then this could be the environment for you. These institutions may give nurse practitioners the unique opportunity to pair patient care with clinical research or with bringing up the next generation of NPs. If you seek employment at an academic medical center, make sure your teaching or research arrangement is clearly outlined in your employment agreement to ensure that the vision for and expectations of your research or teaching requirement are met. 

3. Institutional priorities at play

While academic medical centers are certainly dedicated to patient care, they have a number of other concurrent priorities. One such priority is educating students. Medical students and residents are eager to get their hands on patients and have requirements to meet as part of their education. This can mean that nurse practitioners don’t see as much of the action as they might in a private hospital. It can also mean working alongside residents constantly rotating through your department, perpetually placing you in a teaching role. Before jumping in to employment in the academic setting, ask current NPs and PAs how students and residents fit in to the location where you will work. 

4. Unmatched support system

One thing’s for sure – you’ll never be left alone to struggle with a challenging patient at an academic medical center. These facilities are home to a number of specialists and researchers eager to help out with clinically complex patients. Such resources create a valuable clinical support system for nurse practitioners and ensure continuity of care for patients. 

5. Playing politics 

Bureaucracy is prevalent in most major health systems, and especially those in the university sector. Expect to have less control of decisions that affect your department and how you practice. Hiring new employees and conversely firing those who aren’t performing, takes much longer in the political environment of an academic medical center. Implementing changes to systems and processes the facility has in place occur at a snail’s pace as these must be approved by higher ups. Nurse practitioners who value efficiency can find this process immensely frustrating. On the flip side, NPs and PAs with an interest in administration will have opportunities to fulfill this career goal in a larger health system (start with these keys to effective leadership). 

6. Clinical exposure

I’ll never forget my time as a nursing student working in a university hospital. I treated patients with a wide spectrum of rare illnesses from Guillian-Barre Syndrome to necrotizing fascitis. At an academic health center you will have unmatched opportunity as a nurse practitioner or physician assistant to treat patients with rare, complex, or interesting conditions. The clinical know-how you’ll obtain will certainly prepare you well for whatever comes next in your career. 

7. Taking on additional responsibilities

Academic medical centers focus on more than just patient care. Teaching and research are also a large focus of these institutions. Given these components of the facility’s mission, nurse practitioners may be charged with additional responsibilities in their role. This may mean everything from data collection for research to precepting nurse practitioner students. Decide if these responsibilities are something you’re interested in taking on in your career. NPs and PAs should also make sure these responsibilities are clearly laid out in their employment agreement to avoid taking on additional roles without added compensation in the future. 

Are you considering working as a nurse practitioner or physician assistant in an academic medical center?


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