I agree with everything said. When in academia, there was also less support infrastructure to do the work than there is in the private sector, so I was prepping injections, checking in my own patients at times, typing all my consulting letters (when we did things on paper), all valuable time that could be put towards other endeavors. I also personally would say that I have achieved levels of ‘academic’ fulfillment in industry while still being able to contribute to my academic institution and trainees in my adjunct position. Lastly, teaching is not really remunerated and doesn’t satisfy the bean counters that have also invaded the academic space. Physicians in academia are always being asked to accomplish more and more with less and less. For rheumatologists too, the number of patients out there that need to be seen just once leads to packed clinic schedules and burnout. Those that are successful getting research funding increasingly leave the clinical duties behind such that the few left in the clinic are even more burdened. Lastly rheumatology has become an incredibly competitive specialty and yet we are not training enough rheumatologists.