Making the move

[CajunGas]

I just wanted to share my experience in the job market as a recent grad

After 2 years in PP I am making the switch back to academics. I am fellowship trained in Anes/ICU and do both. Im making the switch for a few reasons 1) I have found at least in my search there is not a huge salary difference between academics and PP when everything is accounted for such as benefits and retirement 2) Compatibility- pulm/cc dominates ICU medicine, sure some places will make a flexible arrangement for you but who knows how long it will last 3) security- I don't feel really any danger that an academic group esp empoyed is going to lose its contract 4) CME- I think its easier to stay current and encouraged rather than what I see from my colleagues in PP at my current position.

Also how much money you make is important, but so is what is your "buyout"

---

Members don't see this ad.

 

[bashwell]

Thanks for sharing this CajunGas! I know it's probably hard to give a clear cut answer and it varies from place to place, but if it's cool to ask, how is the lifestyle or how are the expectations hours-wise and colleagues collegiality (e.g. helping cover cases) in academics if that's cool to ask?

 

[CajunGas]

Most of the places I have visited basically give you 1 week a month of ICU maybe a day or 2 off and then OR coverage the rest of the month. The ICU coverage is usually either 12 hrs a day or 24 hrs with home call. My experience as a fellow is that most places rarely call the attenting it follows chain of command and rarely requires a return trip in at night. The OR coverage is without call. 7-4/5. Obviously this all varies widely depending on where yhou are at. Everyone I have met in multiple interviews seems pleasant so far.

 

[Planktonmd]

I think you are doing the right thing and at the right time of your career.
Private practice anesthesia is not what it used to be and it's future does not look good at all.

 

[CajunGas]

Thanks Planktonmd,
I will say I think the choice will be rewarding professionally, but the benefits of academic employment are extensive, if the decrease in pay is tolerable.

 

[aneftp]

Just be careful with academia as well. There are more pressures from hospital admin to do more clinical work. And some places claim to "protect" ur nonclincal time for academic endeavors. But they forget to tell you that ur Saturdays and Sunday's off are ur nonclincal time to do ur academic work!

It's true.

Ideally icu guys have it a lot differently the general or cardiac academic types (like you posted example).

Some places may require you to be the fill in for either the thoracic or cardiac (if tee certified) in addition to ICU duties.

Are you cross covering CT ICU in addition to SICU? Or are they integrated?

 

[Noyac]

I wouldn't stress your decision. Academia has some real perks. It will be interesting to see how long you remain in academics. I hope it is a long time.

It was my impression that academics afforded you less vacation but more time off week in and week out. And also, less pay with less retirement opportunities to save. I would be interested in hearing if this is true or not in your situation.

Is Ragin Cajun country your hometown? That's where I grew up and actually played baseball for the Cajuns back hen it was USL. I even went to that Catholic HS on the south part of town.

 

[G-Man82]

Interesting thread for me especially. I'm coming out of CCM fellowship soon and am still searching for a job. I've interviewed with some PP anesthesia/CCM jobs as well as academic jobs. Still interviewing actually, which scares me a little, seeing as it's already April. I did interview at an infamous central Florida group on the west coast - the group owns most of the ICUs in the hospital, was recently taken over by an AMC, but has a schedule of work for the ICU guys that scares me ... A lot.

I have other interviews lined up still, in both pp and academics. I am leaning towards a job in academics though, because a few of my co-residents who joined pp groups with partnership track ended up losing that track because a few months later the group sold out to an AMC.

Stability? Not sure. I think academics may be the way to go for now.

 

[CajunGas]

So I gave notice at my job today...I will be starting the above position in a few months. I interviewed broadly academics vs PP vs AMC vs employed. I hope I am happy with my decision a few years from now. The job opportunity I took I felt was too good to pass up and my current enviroment was growing ever toxic. Now to sell the house and pay a small amount of tail to get out...

 

[amyl]

I'm two weeks away from jumping my pp gig for academics, too. It'll b less $ but better locale n less work. We are so short staffed here I haven't gotten a sick day in three years... Even food poisoning barfing in the OR garbage I'm there.... I haven't had a lunch break in three years. I've taken call q4 with no post call day off... I thought intern year was the last time I'd work 30 hours straight. Counting the seconds until I leave

 

[Noyac]

So I gave notice at my job today...I will be starting the above position in a few months. I interviewed broadly academics vs PP vs AMC vs employed. I hope I am happy with my decision a few years from now. The job opportunity I took I felt was too good to pass up and my current enviroment was growing ever toxic. Now to sell the house and pay a small amount of tail to get out...

Tail coverage!
My biggest mistake was paying that.
Obviously, because I never had a case brought against me.
What's the cost? What's the limit? Statute of limitations?

 

[RedAnesthesia]

Tail coverage!
My biggest mistake was paying that.
Obviously, because I never had a case brought against me.
What's the cost? What's the limit? Statute of limitations?

I think that's ballsy given how litigious we are as a society. While I think is low probability I don't see why one would put themselves at risk.

Red

 

[Noyac]

I think that's ballsy given how litigious we are as a society. While I think is low probability I don't see why one would put themselves at risk.

Red

I think that's ballsy given how litigious we are as a society. While I think is low probability I don't see why one would put themselves at risk.

Red

I agree Red, but honestly even with our litigious society it is very rare. I've been at this for over ten years and never had a case.

 

[criticalelement]

I agree Red, but honestly even with our litigious society it is very rare. I've been at this for over ten years and never had a case.

Please say you were kidding when you wrote this. Thats like saying, I dont need home insurance because ive never had a fire. Why wear seatbelts, ive never needed them.
Just because youve never had a case doesnt make them rare.

And to the op, i wish you luck but academics isnt for everyone. Bunch of blowhard anesthesiologists trying to one up each other. Thats a brutal environment to be in.

 

[Noyac]

Not kidding!

OP should have a very good idea whether any cases might be coming his/her way.

I agree it's a gamble.

 

[pjl]

30k or so now, vs potentially ~2 mil then...Agree it is pretty low risk, but I certainly wouldn't gamble that much of a retirement plan etc on not having to defend a suit.

 

[CajunGas]

I do 50% icu care currently so there are sometimes patients families who do not like the outcome, funny thing is that when i gave notice my company here said they would pay the tail. Shocked. Will have to pay back some studnst loan repayment but i feel pretty lucky.

 

[IlDestriero]

Not kidding!

OP should have a very good idea whether any cases might be coming his/her way.

I agree it's a gamble.

I wouldn't make that gamble if you do much Peds, (I wouldn't make it at all actually, there's just too much at risk) they can wait until they're 18 and then decide to sue you themselves. I also don't think we have much idea about what happens to some of these patients after the POD1 check.
I had a kid die POD2 after a complex procedure from a known surgical complication, and I didn't find out about it until about 3 weeks later when one of my PICU buddies noticed I wasn't asked to the M&M and sent me an email. He was fine when I checked on him remotely before leaving ~6 hours after the case. The fellow I worked with that day went off service and nobody looked into his chart the next day. I was on vaca. It wouldn't have mattered, but I was out of the loop and forgotten about.
If a patient isn't satisfied with something that happened and never comes back, has a second procedure elsewhere, goes to an outside ER, etc. we may never hear about their outcome either.

 

[Twiggidy]

This thread, especially with all the discussion of "tail" has become very eye opening. Guess I have more money to save. And also.....

Will have to pay back some studnst loan repayment but i feel pretty lucky.

Wow. Kind of stinks that a job that paid your loans didn't workout. Good luck in your move. I personally think you made the right decision. I need to make some smarter ones here in the future.

 

[pjl]

Tail may be eye opening, but for me every job I looked at was occurrence based coverage, so there is no such thing as tail.

 

[Noyac]

I wouldn't make that gamble if you do much Peds, (I wouldn't make it at all actually, there's just too much at risk) they can wait until they're 18 and then decide to sue you themselves. I also don't think we have much idea about what happens to some of these patients after the POD1 check.
I had a kid die POD2 after a complex procedure from a known surgical complication, and I didn't find out about it until about 3 weeks later when one of my PICU buddies noticed I wasn't asked to the M&M and sent me an email. He was fine when I checked on him remotely before leaving ~6 hours after the case. The fellow I worked with that day went off service and nobody looked into his chart the next day. I was on vaca. It wouldn't have mattered, but I was out of the loop and forgotten about.
If a patient isn't satisfied with something that happened and never comes back, has a second procedure elsewhere, goes to an outside ER, etc. we may never hear about their outcome either.

I understand IlD. It's a gamble. But the academic scene is somewhat different from the private scene. I am "usually" made aware of any issues or complications with my pts if I haven't already known of it.
Nonetheless, it's a risk. But it is is an option to consider.
I said earlier that I did t go this route and I paid my tail. I was told by my older partners not to pay it but I could muster the cajones to take the chance. Now I wish I would have.

 

[criticalelement]

I understand IlD. It's a gamble. But the academic scene is somewhat different from the private scene. I am "usually" made aware of any issues or complications with my pts if I haven't already known of it.
Nonetheless, it's a risk. But it is is an option to consider.
I said earlier that I did t go this route and I paid my tail. I was told by my older partners not to pay it but I could muster the cajones to take the chance. Now I wish I would have.

It's not a gamble. Its pure stupidity not paying your tail or going bare. Do you have any idea how many whackos are out there? You can get sued for anything. You can get sued for something someone else did. Im certain you dont have an umbrella policy because they would never allow you going bare/

 

[Noyac]

Hey, it's a counter point. It's something to consider. I would bet that most people here have never been sued. At least, as far as my group goes,we have 11 Dr's. That's a total of over 100yrs of practice. I know of 1 partner with one suit and this case was one that you would have known was coming. That's it.
Odds are WAY in your favor.

 

[criticalelement]

Hey, it's a counter point. It's something to consider. I would bet that most people here have never been sued. At least, as far as my group goes,we have 11 Dr's. That's a total of over 100yrs of practice. I know of 1 partner with one suit and this case was one that you would have known was coming. That's it.
Odds are WAY in your favor.

Means nothing. Pay the tail. ALways be covered. Never practice bare.

 

[Docuronium]

Can't* imagine a future in which one wouldn't pay the tail---the potential loss can be life altering

-edit for having the totally wrong sentiment conveyed

 

[deleted50478]

I was close to leaving my job a year ago. My tail was going to be 7-8k. Not lunch money, but not a huge fortune either.

 

[RedAnesthesia]

I was close to leaving my job a year ago. My tail was going to be 7-8k. Not lunch money, but not a huge fortune either.

It totally depends on what state you are in and how long been in current job. I'm leaving a group that I have been with for 11 months and tail would be 10.5k. My another group member checked to see what his would be as he has been with group for 9 yrs and it would be 45k tail for him. Talk about some serious cash to fork out. My recommendation is get new group to pay a nose for you.

 

[deleted162650]

Instead of paying a tail, could you just elect to keep your coverage for a few years and pay monthly premiums as usual? Seems like the total amount would be similar and would be way less painful than paying 10-40K in one lump sum.

 

[deleted50478]

Instead of paying a tail, could you just elect to keep your coverage for a few years and pay monthly premiums as usual? Seems like the total amount would be similar and would be way less painful than paying 10-40K in one lump sum.

Or can you shop around for tail coverage with other insurers? I'd imagine that tail coverage is very low risk if no lawsuits are filed already. I've never heard of it being done, but I also don't see any reason why you couldn't buy tail from a different insurer than you had coverage with.

 

[CajunGas]

I would say that with some exceptions, I have learned that most jobs that will pay loan repayment have some strings or thats the only way they can recruit. In my case it was was both. With regards to tail you can buy the insurance from any company. There are a lot of other things invovled with the job switch, selling a house, buying a house, moving. It adds up. I attended a conference once upon a time and the speaker said that the average anesthesiologist will go though 3.6 jobs before they find the right one. Hopefully here that ends at 2.

 

[pgg]

Instead of paying a tail, could you just elect to keep your coverage for a few years and pay monthly premiums as usual? Seems like the total amount would be similar and would be way less painful than paying 10-40K in one lump sum.

Tail is usually 250% or so of the last year's premium. If you're just going to keep paying premiums for a few years ... the tail is the better choice.


I have an individual liability policy for my part time moonlighting job. No bad outcomes since 2009 (a periop PE/MI in a dying cancer patient; grateful family, no lawsuit). For the last couple years, I've probably only done 100 cases on that policy. Just today I renewed it for another year. I'll probably do less than 40-50 cases at that job in the next year.

It may be tempting in a couple years if/when I quit that job for good to go tailless. Coughing up 240% of my final annual premium is awfully steep for that small risk. I don't know what I'll do when that day comes. I may try to negotiate a lower tail with my carrier or look elsewhere for a tail.

 

[Noyac]

Oh
So my point is not as crazy to everyone as some would think!

 

[pgg]

Oh
So my point is not as crazy to everyone as some would think!

I don't think it's crazy to consider.

I'll probably still buy tail (or nose) when I'm done with that gig.

 

[Twiggidy]

Again, probably the most important thread on here for med students, residents, and new grads. All stuff no one taught us in residency. With all the other stuff anesthesiologist have to worry about, we also have to worry about paying to quit or switch jobs. Im sure other specialties have this issue, but seems a bigger issue in our field.

Side note: 7-8k, I'd pay just to have piece of mind. 40k? if my record was clean i'd take the gamble. that's a downpayment on a freaking house

 

[RedAnesthesia]

Again, probably the most important thread on here for med students, residents, and new grads. All stuff no one taught us in residency. With all the other stuff anesthesiologist have to worry about, we also have to worry about paying to quit or switch jobs. Im sure other specialties have this issue, but seems a bigger issue in our field.

Side note: 7-8k, I'd pay just to have piece of mind. 40k? if my record was clean i'd take the gamble. that's a downpayment on a freaking house

40k vs potential millions in lawsuit and settlement? You may have thought you had a clean record but there are always going to be those patients that are never happy looking for the money. Even if it's a frivolous lawsuit it will take money for lawyer, time, etc

 

[Man o War]

One of my best friends is a surgeon who decided 6 years into private practice to go back for a fellowship. He paid almost $100,000 for tail coverage. If it only costs me 10K, I consider that a bargain I guess.

 

[Twiggidy]

40k vs potential millions in lawsuit and settlement? You may have thought you had a clean record but there are always going to be those patients that are never happy looking for the money. Even if it's a frivolous lawsuit it will take money for lawyer, time, etc

Personally, I think you'll see the million dollar lawsuit coming. You'll know who that patient is. I guess I should talk to a few old guys around where I work (2 who have retired and one about to retire) and see what they say and maybe find out what they're paying.

 

[IlDestriero]

40k vs potential millions in lawsuit and settlement? You may have thought you had a clean record but there are always going to be those patients that are never happy looking for the money. Even if it's a frivolous lawsuit it will take money for lawyer, time, etc

Yes! He could spend more than 40k just defending against a frivolous lawsuit.
My friend who does some work for a local med mal group gets $5k just to look over a case, and that's the minimum. If you send over 5 boxes of records that span months of inpatient care it will be much more. Who do you think would have to pay for that?

 

[Twiggidy]

Yes! He could spend more than 40k just defending against a frivolous lawsuit.
My friend who does some work for a local med mal group gets $5k just to look over a case, and that's the minimum. If you send over 5 boxes of records that span months of inpatient care it will be much more. Who do you think would have to pay for that?

So you're saying I should go to law school? Seriously, I see what you guys are saying and I'll likely cough up the dough for piece of mind. When I blow this joint, I don't want to look back

 

[Noyac]

My tail was $19k to remain in the La Patient Compensation Act coverage which is a state supported insurance of sorts that controls settlements or limits the payout in some way. I don't remember the details since I left that state over 10 yrs ago. Maybe someone here has the details.
The problem was that I needed to carry my own tail in order to remain in the Pt Compensation Act coverage and that tail costs another $19k. So my total was $38k.
I ended up paying it because my group gave me a bonus of $50k. So it wasn't like I paid anything but I would have had about $35k in my pocket after taxes if I had not paid it.

If my tail was only $10k I guess I would pay that.

 

[Oggg]

You can get retroactive coverage from your new insurance company. It's sometimes called a nose. You get it instead of a tail. Your new policy will start out more expensive than if you paid your tail, but generally the nose is cheaper than the tail.

 

[PainDrain]

When I started I looked over my mal policy and talked to the company. My policy is for 2/6mill and it is "event occurrence", which I was told is an "auto tail" so I am covered for the period I was on the policy. My question is do you need any additional tail coverage with this policy?

 

[Noyac]

When I started I looked over my mal policy and talked to the company. My policy is for 2/6mill and it is "event occurrence", which I was told is an "auto tail" so I am covered for the period I was on the policy. My question is do you need any additional tail coverage with this policy?

I'm not an expert on this because it's been a while since I've looked into it but I don't believe you need additional tail coverage with this policy. I have the same policy.

 

[pjl]

Occurrence based means every occurrence (lawsuit/case) you have while insured is covered forever so you dont have to pay tail, but premiums are a bit higher. Upside, can leave without paying tail.
This is my type of insurance, and is preferred except for the slightly higher premiums. Try to get it though, especially if you are an employee, since they will be paying anyways, and it saves you on the back end.

 

[PainDrain]

Yah. When I read over the policy I was very pleased that it was occurrence based.

 

[PainDrain]

Amyl. I sent you a PM.