Ortho Chief Interviewing for Jobs, Looking for Tips

[broke-n-hip]

Maybe 5000 / night is high for level 2 call. It might be worth it for as low as 3000/ night at a trauma center. If you can take call at a place with ortho residents then maybe 1500 would be worth it.

Around here, the hospitals employ their own ortho surgeons so, mysteriously, a lot of the ankle fractures, etc. with higher paying insurances end up in their clinics rather than following up with the community private surgeon who was on call. Good luck building your practice with medicaid / homeless patients.

What your ortho group really wants to build patient volume is a popular, busy ortho walk-in/ acute injury clinic.

[Tim]

Maybe 5000 / night is high for level 2 call. It might be worth it for as low as 3000/ night at a trauma center. If you can take call at a place with ortho residents then maybe 1500 would be worth it.

.

Location and situation specific. Major level 1 fully staffed with residents is $1500 per call shift.

The devil is in the details. The county level1 mysteriously gets the majority of low pay/uninsured. All orthos are the same group affiliated with the med school in the other level 1. Interesting how that happens.

If the follow up doesn’t come to you, it’s either location or patient choice.

[Orthocillin]

To piggyback off of this....also a resident in last year of training talking to private groups. What financial documents should I specifically ask to review? And does anyone have experience recently with buy-ins and what metric and multiple it was based on? ie multiples of EBITDA, monthly earnings, yearly earnings, ect. There is plenty of reading out there on these topics, however nothing really provides specifics. Thank you in advance.

[HandFellow]

To piggyback off of this....also a resident in last year of training talking to private groups. What financial documents should I specifically ask to review? And does anyone have experience recently with buy-ins and what metric and multiple it was based on? ie multiples of EBITDA, monthly earnings, yearly earnings, ect. There is plenty of reading out there on these topics, however nothing really provides specifics. Thank you in advance.

The buy in will different for all groups. The real estate buy-in for my group was a simple calculation of the value of the buildings minus the amount owed divided by the number of partners. The buy-in for the business side was even more straight forward. All the partners are paid based only on what they collect, "eat what you kill." So we have a low buy in to participate in the operations of the group.

You need to have a sense that group has their affairs in order, that they know where the money is going to pay their expenses. You could ask to see a partners P&L statement for a month or so. What is the collection % after adjustments, to check to see if they get all the money they are owed.

[Medstud21]

Not sure where level 2 call is paying $5000, or even $3000. Highest I have heard is $2000 for level 2 and $4000 for level 1.

I take trauma call at two level 2 trauma centres and one level 1 trauma center. Level 2 call at one place is unpaid, other pays $1000. Level 1 call is $1500. No residents at any of the three places. I live in a major metro area and it’s very saturated. The busiest trauma center in the state pays $1800 for Ortho trauma call.

[JWeb]

1. Mostly bad advice. Call is a great way to get cases early on. If it's paid, you can make a fair bit of money from call too. Level 2 trauma call isn't that bad. My partners don't do nec fasc, that's general surgery/burn. How often do you anticipate having to rule out compartment syndrome? Hint: not that often. Any really bad poly trauma you aren't comfortable with? Send it to level 1 center and go back to sleep. ER docs can splint wrist fractures and reduce ankles, medicine can admit hip fractures overnight.

Now you certainly shouldn't do it or free... $1500 / 24 hours would be a reasonable expectation. I imagine the $5000 suggestion was being facetious cause nobody's getting paid anywhere close to that for level 2, and probably not level 1 either. I agree it would be even better if your group had a trauma guy to give the more complicated stuff to.

2. Not much private equity in ortho, so you can ask but that probably isn't a huge concern. Asking about the buy-in (how much, how it's structured, what it gets you) is appropriate. It's true that some groups would simply love another person to pay overhead, but it's also very possible they are busy, don't want to open up their schedules more, perhaps patients calling the office are waiting weeks/months and they want to add another surgeon to get more patients into the clinic so they don't go elsewhere.

Tim's point above about referral patterns is something to consider. You may have an open schedule all week and there will still be patients willing to wait 3 months to see your well-known joints guy.

3. Yeah reps are a good source of somewhat honest feedback, at least about who's a good surgeon, and personalities, although they may have no idea how the practice works.

4. Agreed.

This is great advice.

[DynamicHipScrew]

Update:

I interviewed at one of the previously mentioned positions. Wasn't perfect, but I was excited about it. Left the interview not feeling great that I would be offered the position. Well my gut was right and they went with someone who could start sooner. I was a bit bummed and knew that was a possibility, but also put a little bit of a chip on my shoulder (for better or worse). Wondered if they were ever really considering me if they knew they didn't want to wait for me to complete fellowship.

Fast forward to now, I have talked to another practice in the southeast which sounded like a sweet gig (location, call, salary guarantee, ASC), but they were upfront that they're looking for someone 100% general. Over the past few months I'm starting to decide that I would like a more focused practice. Starting to realize that I would like no less than 50% sports/shoulder (if not more) with the other 50% general. So I'll keep in touch with that practice, but it is not really what I'm looking for. Also recently submitted for a couple more practices in the southeast offering 100% sports with low call burden in PP setting. We'll see how that plays out. Good areas with good schools in smaller communities, but 5-6 hours from family.

What I wanted to get some opinions on:

I am visiting with another practice soon that is competition to the practice I previously interviewed with. I assume they will want to show me around the area and hospital on this upcoming visit. Should I keep it to myself or share with them that I have already interviewed with their competition? If I keep my mouth closed, when is the time to share that, if ever?

Thanks.

[BruinBones]

Should I keep it to myself or share with them that I have already interviewed with their competition? If I keep my mouth closed, when is the time to share that, if ever?

Thanks.

You do not need to bring it up yourself, but if they bring it up, you can explain that your goals did not align with yours.

[carpenterofbone]

Hoping I can add a little perspective. I am an orthopedic surgeon 1.5 years in to private practice. What you think you want now and what you will want in two years is almost certainly going to be different. And what I see my partners want at 10,20 years is so completely different.

I started reading this forum a year or two ago and it is truly amazing. There is such good financial advice but also just good life advice. Hoping I can add to the life piece.

Most surgeons leave their job within a few years. Why? Because we have don’t know what actually matters. Money is going to be good. Quality of your time is the variable. Do you have an MA that preps your charts, draws up injections, a schedulers who collects all your preop notes? Do you have someone who does your billing? Who puts patients in your schedule? Are they appropriate visits for you or a waste of time? Is the asc or hospital you operate at efficient? Do you have block time? Do they have all the implants there? Lot of call? Call SUCKS as an attending. I thought it would be cake after doing it for free for so long. Guess what? It’s worse! You have to go in to reduce a wrist. You probably haven’t done that since you were a pgy2. Phone calls at 2am make you furious and you’d pay money to not be called. Partial finger tip amp? You’ll have to go in. Call is so painful
even if it’s minimal. My older colleagues pay 800 for a Pa just to take the calls and see consults! Everyone thinks “sure I’ll moonlight, it pays me 1200/1600/2400 a night!” Guess what when you have a full clinic /OR day the next day and it’s time away from family it actually isn’t worth it.

Bit of a ramble but the perception of a job and what it will be is very different. Don’t me wrong I actually have close to the ideal ortho job but I guess my
point is don’t focus on the salary. Take a job with good

[DynamicHipScrew]

Hoping I can add a little perspective. I am an orthopedic surgeon 1.5 years in to private practice. What you think you want now and what you will want in two years is almost certainly going to be different. And what I see my partners want at 10,20 years is so completely different.

I started reading this forum a year or two ago and it is truly amazing. There is such good financial advice but also just good life advice. Hoping I can add to the life piece.

Most surgeons leave their job within a few years. Why? Because we have don’t know what actually matters. Money is going to be good. Quality of your time is the variable. Do you have an MA that preps your charts, draws up injections, a schedulers who collects all your preop notes? Do you have someone who does your billing? Who puts patients in your schedule? Are they appropriate visits for you or a waste of time? Is the asc or hospital you operate at efficient? Do you have block time? Do they have all the implants there? Lot of call? Call SUCKS as an attending. I thought it would be cake after doing it for free for so long. Guess what? It’s worse! You have to go in to reduce a wrist. You probably haven’t done that since you were a pgy2. Phone calls at 2am make you furious and you’d pay money to not be called. Partial finger tip amp? You’ll have to go in. Call is so painful
even if it’s minimal. My older colleagues pay 800 for a Pa just to take the calls and see consults! Everyone thinks “sure I’ll moonlight, it pays me 1200/1600/2400 a night!” Guess what when you have a full clinic /OR day the next day and it’s time away from family it actually isn’t worth it.

Bit of a ramble but the perception of a job and what it will be is very different. Don’t me wrong I actually have close to the ideal ortho job but I guess my
point is don’t focus on the salary. Take a job with good

I guess there’s no certain way of predicting this? My search has been made with location the primary criteria to decide if I should pursue or not. I’ve finally positioned myself where there could be upcoming opportunities in locations that my wife and I consider to be the dream. I hope that if I’m lead by geography and happy in the community then the rest can be dealt with.

To your point, and since your post, I spoke with a practice over the phone a couple of times and emailed back and forth a couple of times. They were very upfront with their numbers which I found to be eye-popping for a 2 year guarantee straight out of training. No other private practice I’ve communicated with has been that forward. I was eventually able to speak with a partner over the phone and quickly realized the job is not what I am looking for. I appreciated him being upfront about that too.

[ACN]

Hoping I can add a little perspective. I am an orthopedic surgeon 1.5 years in to private practice. What you think you want now and what you will want in two years is almost certainly going to be different. And what I see my partners want at 10,20 years is so completely different.

I started reading this forum a year or two ago and it is truly amazing. There is such good financial advice but also just good life advice. Hoping I can add to the life piece.

Most surgeons leave their job within a few years. Why? Because we have don’t know what actually matters. Money is going to be good. Quality of your time is the variable. Do you have an MA that preps your charts, draws up injections, a schedulers who collects all your preop notes? Do you have someone who does your billing? Who puts patients in your schedule? Are they appropriate visits for you or a waste of time? Is the asc or hospital you operate at efficient? Do you have block time? Do they have all the implants there? Lot of call? Call SUCKS as an attending. I thought it would be cake after doing it for free for so long. Guess what? It’s worse! You have to go in to reduce a wrist. You probably haven’t done that since you were a pgy2. Phone calls at 2am make you furious and you’d pay money to not be called. Partial finger tip amp? You’ll have to go in. Call is so painful
even if it’s minimal. My older colleagues pay 800 for a Pa just to take the calls and see consults! Everyone thinks “sure I’ll moonlight, it pays me 1200/1600/2400 a night!” Guess what when you have a full clinic /OR day the next day and it’s time away from family it actually isn’t worth it.

Bit of a ramble but the perception of a job and what it will be is very different. Don’t me wrong I actually have close to the ideal ortho job but I guess my
point is don’t focus on the salary. Take a job with good

I'm 5 years into practice and I do not go into reduce anything. What kind of terrible hospital do you take call at?!? The ERs job is to reduce and splint things. I don't know of anyone who currently has a ortho job that comes in to reduce fractures. That includes PP, ivory academic and employed.

Partial finger amp? Punt to hand call or washout and dressing by er and fu in office next day or add to OR schedule for am. The only thing I go in for is compartment syndrome. Open fractures at 2am can be added on. My call covers 4 hospitals typically ranging from rural to level 2 at the same time.

My classmate also in PP takes similar level call and covers multiple hospitals. Made $300k in call pay last year... Mine was $160k. He also rarely goes in.

But you make very valid points on what to ask for. My trauma and arthroplasty reps are phenomenal. We have 3 major ortho companies that can provide implants, so something is always available. My reps always answer and are ready to go all the time.

[DynamicHipScrew]

Is it appropriate to send hand written thank you notes after an interview?

[GasFIRE]

Is it appropriate to send hand written thank you notes after an interview?

A thank you note is always appropriate. A hand written one is more likely to be remembered so if that’s what separates you from the equal candidate who just sent an email so much the better.

[abds]

Is it appropriate to send hand written thank you notes after an interview?

No. I’d find it a little weird actually. Short email.

[DynamicHipScrew]

See I just didn’t want to seem like too much of a kiss as*.