Why I Don’t Work in an Academic Medical Center

Nashville, TN where I live and work happens to be a vibrant healthcare community. Home to multiple multi-state healthcare organizations as well as a handful of universities, Nashville has a wealth of employment options for nurse practitioners. NPs in the city may work in solo private practices, community health clinics, specialty practices, public hospitals, private hospitals and, yes, academic medical centers. The number of options was exciting for me as I embarked on my nurse practitioner career

In my early years working as a nurse practitioner, I thought I one day may want to take my career in the direction of academic medicine. I enjoy learning as well as mentoring those less experienced than myself. The ability to see patients all while advancing my skills in a facility that top specialists call home seemed ideal. That is, until I discovered what working in an academic medical center would look like for me personally. 

Investigating employment opportunities at the nearby Vanderbilt University Medical Center, I quickly realized this was not the career choice for me. To start, the hospital’s hourly rate for nurse practitioners working in the emergency department was exactly half of what I would make working at local private hospitals. Furthermore, nurse practitioners working in the emergency department at the medical center let me know that their opportunities to learn were actually somewhat limited compared to those at other area hospitals. Given that the medical center was dedicated to teaching medical students and residents, these individuals in training performed most of the procedures and saw the majority of the department’s patients. Nurse practitioners and physician assistants on staff were assigned to care for lower acuity, run-of-the-mill patients presenting to the department. 

Talking with other providers working at the academic medical center further impacted my career decision. Several physician friends of mine worked at the hospital and quickly became frustrated with administrative problems that affected the way they saw patients. Many academic medical centers are facing difficult times financially, and Vanderbilt was no different. Healthcare reform resulted in a loss of or redistribution of federal dollars academic health institutions once received affecting staffing and resources at such facilities. Vanderbilt University Medical Center, for example, chose to freeze pay and vacation time for its employees.

Finally, the bureaucracy of working within a large system was difficult to manage for nurse practitioners I talked with who worked at academic medical centers. While the day-to-day of performing one’s job went relatively smoothly, enacting changes NPs wanted to see in their departments seemed nearly impossible. Modifications to systems and processes had to be approved by layers of administration, which made adapting to trends in healthcare and the community a frustrating process. 

Overall, I quickly realized in my conversations with other healthcare providers that academic medical institutions carry with them a unique set of challenges. My idealized vision of working at a respected institution and weaving the education of future NPs into my patient care responsibilities wouldn’t look quite like I imagined. Teaching hospitals are the perfect setting for some nurse practitioners, but for me the job description and timing were off. I opted for a private hospital with a different set of challenges. 

Do you work in a teaching hospital? What challenges do you face?


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