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  • Anesthesiology Job advice

    Hi there,

    I am applying for my first job out of residency and was hoping for a some advice. I have offers from three very different practices and was hoping for some insight.

    Job 1: Private Practice in semi-rural area. Two years to full partnership. $325k to start, 8 weeks vacation. Partners make 475 to 550k. All partners make same amount. Weekday call 3 times a month, one weekend call a month. Doing own cases. Hospital a little run down with poor support staff.

    Job 2: AMC in desirable location but with very happy anesthesiologists. Start at 350k, with compensation increasing to 500 in 4 years. 1-2 overnight calls a month. Excellent support staff and good facilities. 8-10 weeks of vacation.

    Job 3: Academics in desirable area. Complex reimbursement system but averages out to about 420k plus very generous benefits. 1 week CME, 4 weeks vacation, 2 non academic days a month.

    any thoughts on what job to take? Any other questions I should be asking?

  • #2
    What do you want to do? What’s important to you? Those are 3 vastly different situations.

    Comment


    • #3
      Step 1- decide between academic vs private- is teaching residents or research important to you? Or would you rather work on your own (not sure if any private job you listed has crnas). First decide that, then can compare the remaining jobs. That being said, 350-500 for only 2 calls/month w good support staff is good- is this flyover country? Or are there more calls that are "home call"

      Comment


      • #4
        Agree with the other posters. Decide between academic or private.
        Now looking at each job, #1 is a no go. If rural, no buy-in. pay should start higher and calls 4-5 times is too much. Doing residency hours for that initial salary is not even AMC money in a big city.

        Job 2 is intriguing and I am not a fan of AMCs.Academics has its own benefits and so does private. Pick which aligns with your ideal practice. Best of luck



        Comment


        • #5
          Compensation, Job, Location
          The only potentially glaring negatives were Job #1. Equal split of comp is double edged sword. It’s great if the work distribution is also equal and compatible with your desires. Comment regarding hospital and support staff can definitely impact your job. You are part of the team. Some are motivated doing good work where it’s needed.
          Do you have enough info on the jobs?
          AMC- some are content to be a cog in the machine and some come to resent it.
          Academic- many different flavors. Complicated comp might mean competing demands on your time. Some like the variety and some prefer just to practice medicine.
          Do you have enough info on comp?
          retirement plans, healthcare, malpractice (claims made or occurrence), non-competes, relo/signing bonus, student loan assistance and other contract negotiation points. Some call coverage is easier than others. Didn’t see mention if it in the academic. Call is a source of potential problems. make sure you understand the impact on your life.

          I would focus first on the job, then use comp and location. Use a contract review so at a minimum you completely understand and potentially negotiate away negatives or improvements.
          A contract is important when things don’t work out.
          https://www.whitecoatinvestor.com/co...on-and-review/

          Congrats on your success in three different types of jobs. Now the hard part, figuring out what you really want to be. Flexibility is great, but it complicated the decision making process.
          Search the Forum and you will find many job/contract posts.






          Comment


          • #6
            Originally posted by Cx2277
            thank you for the responses.



            In terms of academics, I enjoy research and teaching but unwilling to take a paycut to do them. The academic job offer is pretty generous.
            Money is not the end all/be all, but if you are unwilling to take a pay cut, dont do academics- even if pay was exactly the same (its not in what you listed), you are losing on vacation. Compare the whole comp package. That being said since you enjoy research, do the 2 days/month of non academic mean non clinical also so you can use them for research purposes?

            Also, a fair warning- if you stay at your institution, you will still be looked at as a junior by those who trained you, and possibly even by the surgeons. That may or may not bug you enough to matter. I wanted to leave my training place so I can learn other ways of doing cases.

            Many benefits of being part of a democratic private practice. Hate to say it but I see red flags in the group you described though. Really low starting salary (buy in I guess), but more importantly the potential for abuse- I foresee you doing all the tough cases while the senior partners do the cush cases yet your pay is the same. I may be wrong, but go in with eyes wide open. Any way you can find out when the last partner was made, or group turnover, how many quit in the first two years prior to making partner, or the year after they got partnership? What's the age range of the group? Top heavy in terms of years out of training?


            Comment


            • #7
              Job 2 stands out to me - very happy physicians is a positive indicator (assuming they are genuine about their job satisfaction). A few questions come to mind:
              1. What is the COL comparison in these 3 areas?
              2. Are you married and does your spouse have a strong location preference?
              3. Do you have kids and how do the schools in the area of the city you would prefer to live rate?
              Working to protect good doctors from bad advisors. Fox & Co CPAs, Fox & Co Wealth Mgmt. 270-247-6087

              Comment


              • #8
                Originally posted by jfoxcpacfp View Post
                Job 2 stands out to me - very happy physicians is a positive indicator (assuming they are genuine about their job satisfaction). A few questions come to mind:
                1. What is the COL comparison in these 3 areas?
                2. Are you married and does your spouse have a strong location preference?
                3. Do you have kids and how do the schools in the area of the city you would prefer to live rate?
                Just picking up on the COL:
                Not just the Employer contribution, but the pretax options impact taxes. The housing is impacted not only by the area, but by the location of your practice. Your commute desire can impact the housing and schools.
                Three pretax options, healthcare and housing could easily make #2 and #3 competitive comp.
                You actually need to run the numbers.

                8-10 weeks vacation is variable. Which is it?
                Does everyone take them? A lot depends on the specific group and management of each employer.
                One item to check is turnover, rather than your impression of happiness. Your description of that in job #2 stands out.

                Comment


                • #9
                  I just went through same scenario after fellowship( peds anes). I was gung-ho PP until decision time. Your first job likely won't be your last. Find a good group( academic or pp) that has a supportive environment to flourish as being an attending is not the same as a resident.
                  Minimum 6 weeks vacation is necessary and support staff even when doing your own cases is essential.

                  Comment


                  • #10
                    Originally posted by Cx2277
                    For the PP job, the vast vast majority have made partner. The group skews younger. All partners make the same amount of money and take the same amount of call. I can probably negotiate the starting salary up without too much difficulty. My concern with the job is the lack of support personnel, the higher call burden, the fact that the facilities aren’t as nice, and that the other two jobs pay roughly the same as the partner pay after a few years for less work and with more support.

                    The COL for the academic and AMC job are about the same. The COL for the pp job is about 10% less.

                    Currently single but planning on having kids soon. PP and AMC jobs have good schools. Academic job does not.
                    Position with access to good schools is important if there are kids in your future. That would make the academic job less appealing unless you could easily commute in from a better neighborhood if you needed to.

                    PP concerns are valid. While I am old-school and personally prefer a democratically-run PP group where I have an equity stake in ownership I understand the appeal and simplicity of an employed position such as the AMC group. Not saying you should take a job with plans to leave, but if you took the AMC job and wanted to leave in the future could you stay in the area if you wanted to? Are there other potential opportunities in the area? What does “non-competes are reasonable at all three” mean? If the non-compete isn’t unreasonably onerous Job 2 seems like a good first and hopefully long-term position.

                    Comment


                    • #11
                      I am a little surprised there is so much resistance on this board against that PP offer. I thought it sounded pretty good: 8 weeks of vacation as PP associate is good. 325 associate salary for anesthesia also seems extremely solid especially since you are not taking much of a pay cut relative to AMC. The fact that the AMC isn’t starting you at a much higher salary relative to PP....I guess I am only one who finds that notable. But I’m a novice!

                      Comment


                      • #12
                        Originally posted by GastroMastro View Post
                        I am a little surprised there is so much resistance on this board against that PP offer. I thought it sounded pretty good: 8 weeks of vacation as PP associate is good. 325 associate salary for anesthesia also seems extremely solid especially since you are not taking much of a pay cut relative to AMC. The fact that the AMC isn’t starting you at a much higher salary relative to PP....I guess I am only one who finds that notable. But I’m a novice!
                        I am not resistant to PP per se, I would in fact prefer this model. My concerns for this offer in particular would be: 1) the equal slice of the pie compensation model for the partners 2) the relatively greater call burden compared to the other positions 3) the “hospital a little run down with poor support staff”.

                        1) works if everyone works equally, cases assigned equitably, and everyone wants to work this way. It breaks down if someone wants to work more or less, works harder or is lazier, cherry-picks “good” cases/surgeons or always assigned “difficult” cases/surgeons. A compensation model with some type of work unit payment scheme evens out some of these issues.

                        2) since compensation for all positions are relatively in the same ballpark, the greater call burden leads me to believe the payer mix skews significantly towards Care/Caid. I don’t know this for a fact but that it what I suspect. Whether the PP is willing to share that info, maybe or maybe not but certainly worth inquiring about it.

                        3) is what really worries me. How financially stable is this facility? Is it a struggling independent or a distal branch of a regional system? If part of a regional system, are there plans for improvement/upgrade or could they “merge” an underperforming facility into the next closest unit.

                        Comment


                        • #13
                          Originally posted by GasFIRE View Post

                          I am not resistant to PP per se, I would in fact prefer this model. My concerns for this offer in particular would be: 1) the equal slice of the pie compensation model for the partners 2) the relatively greater call burden compared to the other positions 3) the “hospital a little run down with poor support staff”.

                          1) works if everyone works equally, cases assigned equitably, and everyone wants to work this way. It breaks down if someone wants to work more or less, works harder or is lazier, cherry-picks “good” cases/surgeons or always assigned “difficult” cases/surgeons. A compensation model with some type of work unit payment scheme evens out some of these issues.

                          2) since compensation for all positions are relatively in the same ballpark, the greater call burden leads me to believe the payer mix skews significantly towards Care/Caid. I don’t know this for a fact but that it what I suspect. Whether the PP is willing to share that info, maybe or maybe not but certainly worth inquiring about it.

                          3) is what really worries me. How financially stable is this facility? Is it a struggling independent or a distal branch of a regional system? If part of a regional system, are there plans for improvement/upgrade or could they “merge” an underperforming facility into the next closest unit.
                          DITTO. This PP group happens to have red flags noted above. Things that would make me less concerned if true: a steady rise in partners ages so not heavily skewed old or young; a system already in place for assigning cases fairly- tracking units/caseload every month and using that when making next months schedule for instance, with rotating types of cases among the partners. Yes certain surgeons will have favorites that you need to accomodate, but unless one is being otherwise compensated for it its not fair for one partner to be doing all the fast paced ortho cases, or cabgs for instance while another does cataracts all day every day.

                          Comment


                          • #14
                            Originally posted by GasFIRE View Post
                            1) works if everyone works equally, cases assigned equitably, and everyone wants to work this way. It breaks down if someone wants to work more or less, works harder or is lazier, cherry-picks “good” cases/surgeons or always assigned “difficult” cases/surgeons. A compensation model with some type of work unit payment scheme evens out some of these issues.
                            This. Good luck making that fair

                            Comment


                            • #15
                              As all job offers are over 300K, I would just be looking at location, location, location. You want a job where your commute won't be over 30 minutes in a neighborhood where you want to raise your kids. There have been studies suggesting that quality of life doesn't improve after you make more then 70K? in many years ago dollars, so I suspect that 300 K will be well above the threshold of whatever you need to be making so you don't focus on salary. I would look at the number of hours you will be expected to be in house for whatever job you pick and probably put that above whatever monetary compensation the job is offering as the fewer hours you are expected to be in house, the better your quality of life will probably be.

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