Two jobs what to do?

[murphles]

So I am currently employed by an orthopedic practice as a physiatrist. Current contract was base + 1/2 of selected ancillary share which has led to nice comfortable amount. Two year contract. Ends in September no partnership tract. Practice has problems with overhead but is profitable as a whole. I am a "new service line" for them. I am completely full with two procedure days. In their sugary center.

Major rough start with not clear this would work out this summer. Started looking.

Have second job offer with hospital based anesthesia group. Pay would be mgma midline for physiatrists (which always pisses me off) but secure. My boss would be great. Hospital owned so petty yanking around less. Real opportunity to improve pain practice here.

Group 1 wants me to stay but no written offer (verbal commitment). Group 2 wants me to come.

My priorities are autonomy, security, ethics and reasonable income. I would like some intellectual stimulation too but we make that ourselves. I don't know what security looks like in this era of health care reform but being mid career and two kids in college I can't f--- around with this. And I think that I am a bit of a Pollyanna when it comes to these things then am surprised when all does not go well.

Oh and this is a very desirable area with pain providers falling off trees. I realize that I would be a tool in either of these opps but it is too late for me to start private practice. My spouse has a small business and on in the family is enough!

Devil I know or the devil I don't?!?!

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[SSdoc33]

So I am currently employed by an orthopedic practice as a physiatrist. Current contract was base + 1/2 of selected ancillary share which has led to nice comfortable amount. Two year contract. Ends in September no partnership tract. Practice has problems with overhead but is profitable as a whole. I am a "new service line" for them. I am completely full with two procedure days. In their sugary center.

Major rough start with not clear this would work out this summer. Started looking.

Have second job offer with hospital based anesthesia group. Pay would be mgma midline for physiatrists (which always pisses me off) but secure. My boss would be great. Hospital owned so petty yanking around less. Real opportunity to improve pain practice here.

Group 1 wants me to stay but no written offer (verbal commitment). Group 2 wants me to come.

My priorities are autonomy, security, ethics and reasonable income. I would like some intellectual stimulation too but we make that ourselves. I don't know what security looks like in this era of health care reform but being mid career and two kids in college I can't f--- around with this. And I think that I am a bit of a Pollyanna when it comes to these things then am surprised when all does not go well.

Oh and this is a very desirable area with pain providers falling off trees. I realize that I would be a tool in either of these opps but it is too late for me to start private practice. My spouse has a small business and on in the family is enough!

Devil I know or the devil I don't?!?!

devil you know. things seem to be stable and/or improving with your current situation. you'll always be able to find some sort of job, so unless you are in love with or blown away by the new job, i dont see a compelling reason to leave.

things can always get worse (hello, back surgery patients), and it seems like it usually takes a few years just to get things the way you want them in a practice

 

[Tenesma]

their sugary center sounds quite sticky

hospital based anesthesia group tends to be dicey... would circumvent them and interact directly with the hospital to set up pain/run pain center.... over time the anesth get pissed off that they have to cover OR and that you don't and will always act like they are doing you a favor versus the other way around... i have seen way too many hospital based anesthesia groups with pain services fall apart... not to mention, in 4 years, the hospital kicks out the anesthesia group in favor of another anesthesia group, and all of a sudden the pain practice gets replaced...

the ortho practice will definitely be more stable in the long run - but i am concerned about your comment re: overhead... pls explain

 

[drusso]

Devil you know. Anesthesia groups seems to want to low-ball you. Negotiate with orthopods for more ancillaries and/or autonomy and support. Are you doing EDX for them too?

 

[Jcm800]

having been the pain part of an hopsital-owned anesthesia practice, i can tell you that the anesthesiologist get pissed that you dont come to OR and assume that you are up "playing" in the pain clinic, sipping coffee, and watching stocks, when in actuality this is what THEY are actually doing while the CRNAs are doing cases...ironic huh?

anesthesia groups and pain managements are not sustainable when the are the same entity, neither party remains happy. I know this from experience. Even if you go and get the contract for pain management from the hospital, they conflict can still persist. if you do whant tenesma sas, make sure the departments are DIFFERENT, not subsets or divisions

their sugary center sounds quite sticky

hospital based anesthesia group tends to be dicey... would circumvent them and interact directly with the hospital to set up pain/run pain center.... over time the anesth get pissed off that they have to cover OR and that you don't and will always act like they are doing you a favor versus the other way around... i have seen way too many hospital based anesthesia groups with pain services fall apart... not to mention, in 4 years, the hospital kicks out the anesthesia group in favor of another anesthesia group, and all of a sudden the pain practice gets replaced...

the ortho practice will definitely be more stable in the long run - but i am concerned about your comment re: overhead... pls explain

 

[painchas]

I was part of the anesthesia/ pain group for 17 years doing pain along the way for the big group as well as the anesthesia call. I would get calls on Fri 2pm from partners at the gym wanting to talk while I still had 10 blocks to go. They will not understand I assure you. No doubt trouble will ensue. We were going to be different but guess what it always turns out the same despite sincere attemp to make it go. "Just do more blocks" will be the line. Save yourself the headache. Anesthesia groups are under much pressure today due to the crna issue. There is much change over here with hospital contracts that have been in place for many years. Hospitals are feeling the heat trying to save money and they are flipping anesthesia groups, even the large ones, to save money with the crna cost. There is not much stability here. You may not want to link your future to an uncertain anesthesia enviroment. Lastly dont underestimate the effect of hard competition in a community as it relates to your traction. In essence if it aint broke I dont know if I would try and fix it. Out of the frying pan into the fire. Sorry for the analogy.
Regards,

 

[PMR 4 MSK]

Stay where you are. The new offer does not offer you what you say you are looking for.

 

[murphles]

I ended up staying with the Devil I know. I think it is a good decision. I have negotiated for some ancillaries and I am much more secure than I was due to negotiated guarentees. And I like coming to work.

 

[drusso]

I ended up staying with the Devil I know. I think it is a good decision. I have negotiated for some ancillaries and I am much more secure than I was due to negotiated guarentees. And I like coming to work.

You need to give feedback to the anesthesia group about your decision; especially the midline MGMA salary issue.