Thoughts on this job?

[amyl]

Private practice. Desirable location. New group - 2 years old. Call about 4-5x per month. Call back usually light... Estimated 1/10. Work post call. Cover a few hospitals and surgery centers... Basically follow your surgeon all day. 375k - have to cover your own malpractice and everything else. Eventual possible partnership dependent on bringing in new surgeons. Thoughts?

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[Planktonmd]

Private practice. Desirable location. New group - 2 years old. Call about 4-5x per month. Call back usually light... Estimated 1/10. Work post call. Cover a few hospitals and surgery centers... Basically follow your surgeon all day. 375k - have to cover your own malpractice and everything else. Eventual possible partnership dependent on bringing in new surgeons. Thoughts?

What's the deal with that "follow your surgeon all day" business? not very typical to say the least.

 

[amyl]

.

 

[amyl]

They operate a number of different places in any given day

 

[norwood]

Eventual possible partnership dependent on bringing in new surgeons.

This sounds a lot like "never getting partnership" to me...

 

[Consigliere]

That job sounds terrible (most likely in TX), here's why:

- salary is low. $375k (-malpractice) (-health) (-other expenses) = $325ish base pay
- no guarantee of partnership
- following your surgeon around? like a little lap dog? Screw that. "Your surgeon" may work 12-14 hours/day making this a long hours/day sort of gig
- working post-call - gets old QUICK
- any vacation?

I'd take the ole passerino on this lemon.

 

[Mman]

sounds like a terrible job to me that involves mediocre pay and the requirement of fellating the surgeons to like you and bring in new business.

I'm all for being pleasant to work with. But rule #1 for me is patient safety and comfort. The surgeons feelings are a distant second. And if your job depends on the surgeons always being happy, you will be tempted too much to forgo rule #1.

 

[nimbus]

Is this Vegas or Phoenix? Income is low for either of those locations.

 

[Ignatius J]

sounds like a terrible job to me that involves mediocre pay and the requirement of fellating the surgeons to like you and bring in new business.

I'm all for being pleasant to work with. But rule #1 for me is patient safety and comfort. The surgeons feelings are a distant second. And if your job depends on the surgeons always being happy, you will be tempted too much to forgo rule #1.

Our model is "sorta" this, and I love it. Not being obligated to cover, you can and will elect not to work with surgeons your group doesn't like. As such, there is a mutual respect between surgeon and anesthesiologist in general knowing that you can each fire each other if y'all want. The surgeon will get call cases during the night and on the weekends, so they are somewhat obliged to play nice or else they will struggle looking for coverage. I find that trying to maintain the exclusive contract with the hospital involves the fellating you mentioned.

 

[Hoya11]

Private practice. Desirable location. New group - 2 years old. Call about 4-5x per month. Call back usually light... Estimated 1/10. Work post call. Cover a few hospitals and surgery centers... Basically follow your surgeon all day. 375k - have to cover your own malpractice and everything else. Eventual possible partnership dependent on bringing in new surgeons. Thoughts?

run.

 

[Mman]

Our model is "sorta" this, and I love it. Not being obligated to cover, you can and will elect not to work with surgeons your group doesn't like. As such, there is a mutual respect between surgeon and anesthesiologist in general knowing that you can each fire each other if y'all want. The surgeon will get call cases during the night and on the weekends, so they are somewhat obliged to play nice or else they will struggle looking for coverage. I find that trying to maintain the exclusive contract with the hospital involves the fellating you mentioned.

You completely lost me. In what fashion does "maintaining an exclusive contract" involve fellating surgeons? Personally I don't care if a surgeon thinks I'm the devil incarnate. It's irrelevant to me or my group's contract. As long as we provide safe care in an efficient manner, the personalities are almost irrelevant. The surgeons can whine to administration about whatever they want. So can I. In the last decade we've had surgeons run off by the hospitals but no anesthesiologists. The hospital knows we help them run their money printing machine in a fast efficient manner. They also know the surgeons can't take their business elsewhere because there is nowhere else. The patients live here. Unless you can convince them to go have their surgery 2 hours away, they aren't following the surgeon anywhere and they will have their surgery here with a different surgeon instead.

 

[pgg]

Eventual possible partnership dependent on bringing in new surgeons.

Sounds like a multi-layer marketing scam. It also sounds like "no partnership ever unless you surprise us and can actually bring in a bunch of money for us" ... I would never accept a partnership track that was so nebulously undefined.

The follow-surgeon aspect of the gig might or might not be awful. I knew someone who had that kind of job (in Las Vegas area), but the reason I knew him was because he traveled to my area to locum at my locum gig because the Vegas job didn't pay enough, or have steady enough hours, or something.

 

[mostwanted]

This sounds like Dallas, look elsewhere. The Dallas market seems quite toxic, similar to some other TX markets. Feel free to PM

 

[Ignatius J]

You completely lost me. In what fashion does "maintaining an exclusive contract" involve fellating surgeons? Personally I don't care if a surgeon thinks I'm the devil incarnate. It's irrelevant to me or my group's contract. As long as we provide safe care in an efficient manner, the personalities are almost irrelevant. The surgeons can whine to administration about whatever they want. So can I. In the last decade we've had surgeons run off by the hospitals but no anesthesiologists. The hospital knows we help them run their money printing machine in a fast efficient manner. They also know the surgeons can't take their business elsewhere because there is nowhere else. The patients live here. Unless you can convince them to go have their surgery 2 hours away, they aren't following the surgeon anywhere and they will have their surgery here with a different surgeon instead.

I've worked in both. I don't really care to get into it, but because of a lack of obligation to the hospital (or any surgeon for that matter), there is more freedoms there to pick and choose business. As safe and great as you think your practice is, there is another big group ready to sweep in and promise to hang the moon too. Hospitals want bodies at the head of the bed, and they want surgeons to bring business. That involves keeping surgeons happy and content. Like I've said, I have seen it both ways.

Don't think for a second "following the surgeon" means your crawling behind him on your hands and knees. If he is a good and nice surgeon, sure, as with any business arrangement you will cater to them in certain aspects. If they are malignant or bad surgeons, see ya later. Have fun finding coverage for your 5pm lap chole.

 

[Mman]

I've worked in both. I don't really care to get into it, but because of a lack of obligation to the hospital (or any surgeon for that matter), there is more freedoms there to pick and choose business. As safe and great as you think your practice is, there is another big group ready to sweep in and promise to hang the moon too. Hospitals want bodies at the head of the bed, and they want surgeons to bring business. That involves keeping surgeons happy and content. Like I've said, I have seen it both ways.

Don't think for a second "following the surgeon" means your crawling behind him on your hands and knees. If he is a good and nice surgeon, sure, as with any business arrangement you will cater to them in certain aspects. If they are malignant or bad surgeons, see ya later. Have fun finding coverage for your 5pm lap chole.

I disagree almost completely and say this knowing quite well how major groups in both settings function including most of the Texas market where this is most prevalent.

 

[criticalelement]

sounds like a terrible job to me that involves mediocre pay and the requirement of fellating the surgeons to like you and bring in new business.

I'm all for being pleasant to work with. But rule #1 for me is patient safety and comfort. The surgeons feelings are a distant second. And if your job depends on the surgeons always being happy, you will be tempted too much to forgo rule #1.

We don't have the market cornered on patient safety. The surgeon cares about that too. S/he just needs to be reminded in a tactful way. Sometimes often.

 

[Ignatius J]

I disagree almost completely and say this knowing quite well how major groups in both settings function including most of the Texas market where this is most prevalent.

Not sure how well you know, but I can assure you that unless I've been sleeping for 6 years then I know a little bit more than you.

Not that any advice is totally, 100% wrong here, but the "following the surgeon around" and "kissing his ass" in not genuinely true.

 

[sevoflurane]

Private practice. Desirable location. New group - 2 years old. Call about 4-5x per month. Call back usually light... Estimated 1/10. Work post call. Cover a few hospitals and surgery centers... Basically follow your surgeon all day. 375k - have to cover your own malpractice and everything else. Eventual possible partnership dependent on bringing in new surgeons. Thoughts?

Being efficient in a day is important to you and a group. Following a surgeon may or may not be the best option. Depends on drive time and patient readiness.

375K is OK if all benefits are covered and good vacation.

This package would be ideal if I had 10-16+ weeks (semi retired) with ocean front property along side of lots of palm trees.

 

[IlDestriero]

Sounds like a crappy job with low income. You can bet the partners are making a ton off your sweat.
Look at some academic jobs, you can make that much and more with a good benefit package, security and light call.

 

[deleted50478]

Private practice. Desirable location. New group - 2 years old. Call about 4-5x per month. Call back usually light... Estimated 1/10. Work post call. Cover a few hospitals and surgery centers... Basically follow your surgeon all day. 375k - have to cover your own malpractice and everything else. Eventual possible partnership dependent on bringing in new surgeons. Thoughts?

That's about as bad as it gets. It should be immediate partnership and still wouldn't sound so great.

 

[deleted682700]

Does the location have good school? Can ur significant other get a job?
If you can get at least 12 weeks off, and in 1-2 years u will be full partner with access to all the contract details and the accountant books. Make sure the group does not have a constant anesthesia turn over. Talk to the anesthesiologist who are there as well as who have left that place. Truth will be in the middle. Make sure there are no surgical psychos/ med board offender list. Who is the chief of staff
Do they have kangaroo courts for peer review
Any criminals in the administration. Medicare fraud steers?

 

[Ignatius J]

That's about as bad as it gets. It should be immediate partnership and still wouldn't sound so great.

I agree. Either be an employee or get a defined partnership tract. No need to play reindeer games. Also, not covering malpractice, health insurance, 401K, etc. to me is a red flag.

 

[aneftp]

What's the deal with that "follow your surgeon all day" business? not very typical to say the least.

They do follow ur surgeon in Texas. My friend in Dallas does that. Nevada also has that.

 

[aneftp]

Guys and gals. It all depends on payer mix. And subsidy or no subsidy. If desirable area and poor payer mix (say 20-25% commercial insurance. Rest is Medicaid (medi-cal) and Medicare. And say it's California area where commercial payers don't pay as well per unit compared to other areas of the country.

Even with no one taking anything off the top and doing ur own billing. You will probably be generating only around $400k assuming 6-7 weeks off with that type of California payer mix billing 12-15k units in a blended system

Now if it were Dallas. With same poor payer mix. You probably would be generating close to $500k assuming no subsidy and no one shaving anything off the top.

 

[pgg]

Guys and gals. It all depends on payer mix. And subsidy or no subsidy. If desirable area and poor payer mix (say 20-25% commercial insurance. Rest is Medicaid (medi-cal) and Medicare. And say it's California area where commercial payers don't pay as well per unit compared to other areas of the country.

Even with no one taking anything off the top and doing ur own billing. You will probably be generating only around $400k assuming 6-7 weeks off with that type of California payer mix billing 12-15k units in a blended system

Now if it were Dallas. With same poor payer mix. You probably would be generating close to $500k assuming no subsidy and no one shaving anything off the top.

Be that as it may, that ridiculous "eventual possible partnership dependent on bringing in new surgeons" bit is the only red flag I'd need to walk away from this job.

 

[turnupthegas]

What types of pay, vacation, years to partner are considered good jobs for a new grad?

In the TriState/NYC area. Some of the CA3s who are not doing fellowships seem to be getting around 300k with 4-5 weeks vacation.

Job 1 was 300k at AMCwith 3 late calls and 3 home calls. 4 weeks vacation
Job 2 is 300k 3 home calls and 1 OB I house call. 5 weeks vacation. I think for the partnership track it was 250k and 3 years to partner.

Are these typical for desirable locations?

 

[narcusprince]

How do you bring in new surgeons? I think if anyone has the remote possiblity of recruiting new surgeons it would be amyl. No amount of money is worth fellating a surgeon to get partner.

 

[Consigliere]

What types of pay, vacation, years to partner are considered good jobs for a new grad?

In the TriState/NYC area. Some of the CA3s who are not doing fellowships seem to be getting around 300k with 4-5 weeks vacation.

Job 1 was 300k at AMCwith 3 late calls and 3 home calls. 4 weeks vacation
Job 2 is 300k 3 home calls and 1 OB I house call. 5 weeks vacation. I think for the partnership track it was 250k and 3 years to partner.

Are these typical for desirable locations?

Very.

 

[aneftp]

Be that as it may, that ridiculous "eventual possible partnership dependent on bringing in new surgeons" bit is the only red flag I'd need to walk away from this job.

There are jobs like that. My friend in Dallas does that. He actually switched groups after 8-9 years. Than went to another group. Since he brought in surgeons into the anesthesia practice (big yielding spine surgeons). They made him a partner less than one year.

 

[norwood]

So, I'm not getting something. If you're supposed to follow individual surgeons to different hospitals, and you work with more than one, what happens if more than one of them wants to operate at a given time?

 

[Ignatius J]

They do follow ur surgeon in Texas. My friend in Dallas does that. Nevada also has that.

Each city in Texas has a unique set up, from Houston which is almost solely exclusives contracts to San Antonio which is "following the surgeon". Lots of misconceptions about that term though.

 

[Ignatius J]

So, I'm not getting something. If you're supposed to follow individual surgeons to different hospitals, and you work with more than one, what happens if more than one of them wants to operate at a given time?

One misconception is that each individual anesthesiologist is on his own. Generally, we know the surgeons block time and set aside that block of time to be covered by an anesthesiologist. If something comes up, partners are always willing to help.

 

[criticalelement]

this job is most likely in arizona. Phoenix more specifically.

 

[IlDestriero]

One misconception is that each individual anesthesiologist is on his own. Generally, we know the surgeons block time and set aside that block of time to be covered by an anesthesiologist. If something comes up, partners are always willing to help.

The one job I looked at like this in Denver followed the surgeon sometimes, usually to 2 places for a few cases in a hospital and a couple more at an ASC. The only issue was that you are potentially leaving a recovering patient and none of your partners are there if something were to happen. So you had to plan your anesthetic accordingly. They made it sound perfectly workable, but it didn't sound like a great plan. And this was a peds job, so you can't just talk them into a spinal or block and give a couple of versed because you needed to be across town by 1:00 and were running late.
I like more structure and predictability. They did get out early a lot, which would be more appealing later in my career.

 

[Ignatius J]

The one job I looked at like this in Denver followed the surgeon sometimes, usually to 2 places for a few cases in a hospital and a couple more at an ASC. The only issue was that you are potentially leaving a recovering patient and none of your partners are there if something were to happen. So you had to plan your anesthetic accordingly. They made it sound perfectly workable, but it didn't sound like a great plan. And this was a peds job, so you can't just talk them into a spinal or block and give a couple of versed because you needed to be across town by 1:00 and were running late.
I like more structure and predictability. They did get out early a lot, which would be more appealing later in my career.

I often have to do this. You plan your anesthetic accordingly. Generally, I drop the patient off. I may grab a quick bite, go get my things, change scrubs, and swing back by. The patient is usually well on their way to bigger and better things. If there are concerns, I will either stick around and ask for help to cover at the other location (rarely happens) or at the very least let a partner know who is going to be around of the patient and any issues I might anticipate.

During the day, there is personnel around to help if needed and nurses have our cell phone numbers. I've been in the PACU and been called to a patient and I am sure others have had to write orders for my patient. It happens. But don't think there isn't available help in recovery rooms if needed.

 

[aneftp]

I often have to do this. You plan your anesthetic accordingly. Generally, I drop the patient off. I may grab a quick bite, go get my things, change scrubs, and swing back by. The patient is usually well on their way to bigger and better things. If there are concerns, I will either stick around and ask for help to cover at the other location (rarely happens) or at the very least let a partner know who is going to be around of the patient and any issues I might anticipate.

During the day, there is personnel around to help if needed and nurses have our cell phone numbers. I've been in the PACU and been called to a patient and I am sure others have had to write orders for my patient. It happens. But don't think there isn't available help in recovery rooms if needed.

I'd like to know what the anesthesiologist availability is with cases?

Are they available physically within 10 minutes? 30 minutes? after dropping a patient in PACU? When is it safe (legally) for a recovering patient to be left with an immediate MD consult available?

Seems like a big gray area here.

 

[IlDestriero]

At my current hospital, when on call, we don't leave the floor until the patient is in phase 2. Our call rooms are on another floor and they don't want us that far away if there is an emergency in the PACU after the case after hours. I know that is our internal policy.
When we are at our distant ASCs, an anesthesiologist is required to stay in the building until the patient is discharged from the pacu. I'm not sure if that is driven by state regulation or internal policy.

 

[deleted682700]

What are the rules in californiaDo we have to stay in the vicinity till the patient leaves the pacu? Say for general anesthesia or csections spinal anethesia, can we start another case, when the first patient is still in pacu?
I mean state or federal rules
Not hospital rules

 

[pmichaelmd]

I would also be very suspicious of this job. Low pay if benefits are not included and no mention of vacation time.
As far as leaving a patient before they arrive in phase 2, that seems like a bad idea. As a best practice, members of my group tend to remain immediately available before starting another after hours case. If our previous patient codes or loses his/her airway postop (like everybody else, we take care of very sick and fat patients), we are there to treat them. No patient abandonment without our partners present.

PMM

 

[Ignatius J]

I'd like to know what the anesthesiologist availability is with cases?

Are they available physically within 10 minutes? 30 minutes? after dropping a patient in PACU? When is it safe (legally) for a recovering patient to be left with an immediate MD consult available?

Seems like a big gray area here.

Not sure I get the question. Are you asking when an anesthesiologist could be available in PACU if an emergency arises?

 

[aneftp]

Not sure I get the question. Are you asking when an anesthesiologist could be available in PACU if an emergency arises?

Yes. Exactly the question.

Say you move onto ur next surgery center 20 minutes later (patient is obviously aWake) but complaining of chest pain. Since no MD is in surgery center 20 minutes after recovery. I know this is not a likely situation.

But suppose ur patient is having cardiac issues 20 minutes after pacu drop off. U are already one ur way to your next place. Who will take care of situation of chest pain?

Reason I ask. Is this guy (anesthesiologist) at Tampa Florida area surgery center had plane to catch. No exactly the same situation. But similar in that he dropped off pacu. Usually center requires him to stay till last patient is dressed and ready to go home. But he left about 10 minutes after dropping off last patient. Patient ended up having chest pain. Last case of the day. It's 4pm. He's gotta a fight to catch. So instead of waiting the full 1 hour or so after patient ready to go home. He left after patient was fully awake.

Than patient has chest pain after he leaves. He does answer the phone. Tells nurses to admit the patient to ER for further evaluation.

Well. He ends up being fired from contract because he left early. N

 

[Mman]

Yes. Exactly the question.

We are nearby (no more than 60 seconds away) at all times until patient meets PACU discharge criteria. Once they meet criteria, it isn't on me to stay til they actually leave because they are already discharged. If they have chest pain 3 hours postop and were D/C from PACU 60 minutes ago but haven't gotten out the door it isn't officially my problem.

 

[nycitygas]

Sounds like Dallas. Also, it's funny how the older guys are talking about how terrible the job is, while the CA-3/Fellows out there are thinking "Damn I only got offered 250K in Dallas"

 

[Ignatius J]

Sounds like Dallas. Also, it's funny how the older guys are talking about how terrible the job is, while the CA-3/Fellows out there are thinking "Damn I only got offered 250K in Dallas"

They say happiness is the difference between expectations and reality. Who says it is the younger generations that are entitled? ;-)

 

[Planktonmd]

We are nearby (no more than 60 seconds away) at all times until patient meets PACU discharge criteria. Once they meet criteria, it isn't on me to stay til they actually leave because they are already discharged. If they have chest pain 3 hours postop and were D/C from PACU 60 minutes ago but haven't gotten out the door it isn't officially my problem.

This depends on the local policy because there are many places that consider any patient who is physically in PACU to be the anesthesiologist's patient.

 

[Mman]

This depends on the local policy because there are many places that consider any patient who is physically in PACU to be the anesthesiologist's patient.

Obviously up to local policy. Ours is PACU D/C by criteria because sometimes patients can be made to stay in the physical location for other reasons and at that point they are considered back to floor or outpatient or whatever. For example some of our same day outpatient surgery patients might have a drain placed and need the nurse to chart drain output for 4 hours before they can leave the building according to the surgeons orders. If they are the last case of the day and d/c from PACU by our criteria at 4 PM (after coming out of OR at 3PM), I'm not obligated to stay and stare at them til 7 PM nor am I the person the nurse will call with questions.

 

[Ezekiel2517]

Sounds like Dallas. Also, it's funny how the older guys are talking about how terrible the job is, while the CA-3/Fellows out there are thinking "Damn I only got offered 250K in Dallas"

This 1099 job at 375 is not much different than a W2 250 job.

If TX had better jobs it would be a nice place to practice given the no state income tax

 

[turnupthegas]

And here I was thinkin Texas was where all the money is at!

 

[IlDestriero]

Dallas area used to be good for 5-600k easy. Either something changed or people are getting robbed.
I'm thinking the latter.

 

[Ignatius J]

This 1099 job at 375 is not much different than a W2 250 job.

If TX had better jobs it would be a nice place to practice given the no state income tax

There is a hefty real estate tax though to somewhat compensate.

As far as jobs, having a limited liability ceiling is fantastic. Tort reform has been good to Texas. As a result, it's an attractive place for jobs for a lot of physicians.