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  • Offered a contract 2 years ahead of start date

    Hello, I am a CA3 resident in anesthesiology. I was offered a fellowship job last spring for the 2022-2023 year and then right after that they wanted me to start interviewing for an attending position starting in August 2023. Super exciting! However, the hospital will not know the exact base pay numbers for at least a year but stated it would be between 420-470k in addition to incentives. The department chair of the department stated that "he does not like waiting for answer" aka he wants me to accept soon after I submit my letters of Rec. I really am in love with this hospital and feel comfortable with everyone in it. They treat me like a superstar and feel valued. Would anyone else be a bit skeptical of accepting a job this far out without seeing base pay numbers?

  • #2
    Well I’m no lawyer but anything you sign without salary, expectations and all the other legal mumbo jumbo isn’t a contract. You can sign a letter of intent but those don’t hold as much weight as a contract I don’t think.

    Otherwise as long as you like everything and are happy with the compensation sure sign up.

    Questions you have to ask yourself are, why are they offering you a job so far in advance? Sometimes there’s legitimate reasons. Otherwise if you work at the same place you trained, some may look at you as a trainee instead of a colleague for a while.

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    • #3
      I would want some concrete answers. If I'm reading this correctly you state you love the hospital and they treat you like a superstar but you have even started there or is it the same hospital you're currently in residency at? Wanting to sign someone that far out reeks of desperation and underlying issues. There's no reason he needs an answer right now unless it's really hard to recruit there.

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      • #4
        Originally posted by CordMcNally View Post
        I would want some concrete answers. If I'm reading this correctly you state you love the hospital and they treat you like a superstar but you have even started there or is it the same hospital you're currently in residency at? Wanting to sign someone that far out reeks of desperation and underlying issues. There's no reason he needs an answer right now unless it's really hard to recruit there.
        This is currently the hospital I am at. The department chair stated that he wants to get a plan in place since I am going to head up a newly developed pain service when I start. Currently they are interviewing for 10 new positions for that year

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        • #5
          Id take the fellowship but might slow play the job afterwards. If youre going through the hassle of starting a practice from scratch for them, why not just hang your own shingle?

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          • #6
            Originally posted by 8arclay View Post
            Id take the fellowship but might slow play the job afterwards. If youre going through the hassle of starting a practice from scratch for them, why not just hang your own shingle?
            I dont really have a desire to start my own practice tbh. I will be designing the service, not be the owner of it. I really like the city I am in and dont want to move, my parents live here and my husband is from here. Really enjoy the people at the hospital so I want to trust them but don't want to be screwed in some way. I have asked my fellow attendings and everything the admin is telling me lines pretty well up with the path my attendings took.

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            • #7
              Comp,job, location:
              It is a huge "ego boost". Congratulations. Choosing a fellowship is different than choosing your first attending position.
              Consider that you haven't yet worked as a fellow. A good mentor focuses on training and what career path is best for you.

              This approach intentionally cuts off any other options - advantage hospital
              You need a contract for this offer to actually have validity. And you need a contract review. What happens is one clause is not acceptable?

              It is an ego boost. I would respond that you have a definite interest, but a blank contract is not going to work. There is a process that needs to be finished.
              This is about one year early, advantage hospital. I would not suggest agreeing to a blank check. I would layout a timeline that you can handle. This is a negotiation, the first question is what is the timeline for a contract. Work from there.

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              • #8
                Originally posted by goblue667 View Post

                I dont really have a desire to start my own practice tbh. I will be designing the service, not be the owner of it. I really like the city I am in and dont want to move, my parents live here and my husband is from here. Really enjoy the people at the hospital so I want to trust them but don't want to be screwed in some way. I have asked my fellow attendings and everything the admin is telling me lines pretty well up with the path my attendings took.
                I'd be happy to be the owner of your pain practice and pay you whatever they're going to pay you.

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                • #9
                  Originally posted by Nysoz View Post
                  Well I’m no lawyer but anything you sign without salary, expectations and all the other legal mumbo jumbo isn’t a contract. You can sign a letter of intent but those don’t hold as much weight as a contract I don’t think.
                  This.

                  Perhaps tell them you'd consider doing a letter of intent and state in that letter of intent that you must both agree upon a base within X time of start.

                  Really think about getting locked into something that early though. A lot can change in that amount of time!

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                  • #10
                    If it’s that great of a job, he shouldn’t need an answer that quickly.

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                    • #11
                      Originally posted by HikingDO View Post
                      If it’s that great of a job, he shouldn’t need an answer that quickly.
                      Not necessarily. If its a great job maybe he doesnt HAVE to wait if he doesnt want to. Supply/Demand.

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                      • #12
                        Anesthesia here-
                        most jobs Ive either seen personally or have heard of from friends that were offered like this have major flaws. Perhaps this time is different, but I doubt it. You will likely be overworked and underpaid, especially since they are not even going into details about pay. Hey you don't know the market yet. I was severely underpaid for a chance of a fake partnership for my first 2 years out of training due to this. Desireable city? even worse- The major NYC hospitals were offering 6 figures less than the surrounding area for the "opportunity" to work for them when I first looked. You already told them you dont want to leave the area?- You just signaled that they dont have to offer you as much if they wanted to play hardball.

                        How many cars are truly "about to be sold to someone else today if you leave" when you visit a dealership? Same thing here. If they truly do love you, the opportunity will still be there in a year- perhaps not to head the department, but def to work there.

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                        • #13
                          Originally posted by billy View Post
                          Anesthesia here-
                          most jobs Ive either seen personally or have heard of from friends that were offered like this have major flaws. Perhaps this time is different, but I doubt it. You will likely be overworked and underpaid, especially since they are not even going into details about pay. Hey you don't know the market yet. I was severely underpaid for a chance of a fake partnership for my first 2 years out of training due to this. Desireable city? even worse- The major NYC hospitals were offering 6 figures less than the surrounding area for the "opportunity" to work for them when I first looked. You already told them you dont want to leave the area?- You just signaled that they dont have to offer you as much if they wanted to play hardball.

                          How many cars are truly "about to be sold to someone else today if you leave" when you visit a dealership? Same thing here. If they truly do love you, the opportunity will still be there in a year- perhaps not to head the department, but def to work there.
                          This situation is different. To clarify, this is a supply/demand situation. The hospital I am at is a prestigious academic hospital in a metro area and have lots of applicants/demand every year. they are hiring 15 new staff Anesthesiologist for the 2022 and 2023 academic year due to the fact that we had an higher rate of retirement/burnout resignations due to the pandemic. They are offering me two years in advance because they believe I will be in high demand and since I know the system, they already know what they are getting. There is a verified range of base pay they are offering me year 1 (430-470k) that I found out yesterday(verbally). Currently, since so many retirements have occurred, there are 35 Anesthesiologists for 40 OR's in which the average attending is overworked which is why they are trying to refill their numbers so others are not overworked.

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                          • #14
                            As others have said, if it is just a LOI and not an actual contract you are signing, the only thing you have to lose if you change your mind is the potential relationships you have build. If you feel confident in the job and location, an LOI is not going to bind you to anything legally, but does give you that security. I don't think it's the worst thing in the world, but really depends on when they start pushing you to sign the contract (and what that looks like).

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                            • #15
                              Are you planning on being the pain guy/gal for an anesthesia group? The ability to practice both is appealing, but I offer caution. When I was looking into these positions I found that the pain guy/gal typically got the worst of all worlds

                              -Part of anesthesia group, so you may be taking call, very likely if you join a partnership. Nights, weekends, holidays (none of which you would do if single specialty pain)

                              -Despite you taking call for anesthesia, nobody will be qualified to cover your pain clinic should you decide to take a vacation

                              -If youre doing interventional pain youll likely be a larger revenue generator than you general anesthesia partners

                              -Despite generating more revenue and working more, revenue split could be equal among partners.

                              I would absolutely not sign off on a contract unless its very clear what call/compensation structure is, I dont care how prestigious the system is. Of course, considering its 2+ yrs out they likely wont be able to provide anything iron clad. Like I said, Id jump at the fellowship and drag feet on the job.


                              Related: I strongly dislike when prestige is presented as something of value in a contract negotiation.

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