Another which job would you pick?

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precedexforall

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Hi all,

Trying to pick between two jobs. 7 years out from fellowship. Cardiac trained. Both jobs are MD only, home call only, no OB, W2 employed and the total financial/benefit package are similar. DINK couple and no plans for children in the future due to medical reason. At current hospital doing 1099 after leaving academia to be in the same city as spouse.

option 1: Current hospital. Big city in the Southeast. Home state for me. The hospital is a small facility of a bigger system that is bringing anesthesia in house. 6 calls (no trauma, very rarely work overnight and will have post call day off) per month and 10 weeks of PTO. I generally like the work environment but the complexity/volume of pathology is low. Very good WLB since OR is not very busy. I will not be doing a whole lot of cardiac due to seniority/low cardiac volume. The cardiac program is unlikely to grow in the near future due to competition and recent loss of cardiologists, interventional/EP/gen. Spouse have very good job, but willing to re-locate. The rest of the city is PE owned or have to work with CRNAs, which I have no interest in doing.

option 2: Big city in the Midwest. COL is higher but not outrageous like NY/SF/LA. Close to Spouse's home hence she is willing to re-locate. Busier than current shop with plenty of work. Robust cardiac program. Extra compensation for picking up extra shifts. 9 weeks of PTO. Post call day off but with likely busier calls.

My big dilemma between the options is skill atrophy at my current place (tho I will still do some cardiac work) vs. stability, ie not having to move and learn a new system. I appreciate any insight from the group.
 
precedexforall said:
Hi all,

Trying to pick between two jobs. 7 years out from fellowship. Cardiac trained. Both jobs are MD only, home call only, no OB, W2 employed and the total financial/benefit package are similar. DINK couple and no plans for children in the future due to medical reason. At current hospital doing 1099 after leaving academia to be in the same city as spouse.

option 1: Current hospital. Big city in the Southeast. Home state for me. The hospital is a small facility of a bigger system that is bringing anesthesia in house. 6 calls (no trauma, very rarely work overnight and will have post call day off) per month and 10 weeks of PTO. I generally like the work environment but the complexity/volume of pathology is low. Very good WLB since OR is not very busy. I will not be doing a whole lot of cardiac due to seniority/low cardiac volume. The cardiac program is unlikely to grow in the near future due to competition and recent loss of cardiologists, interventional/EP/gen. Spouse have very good job, but willing to re-locate. The rest of the city is PE owned or have to work with CRNAs, which I have no interest in doing.

option 2: Big city in the Midwest. COL is higher but not outrageous like NY/SF/LA. Close to Spouse's home hence she is willing to re-locate. Busier than current shop with plenty of work. Robust cardiac program. Extra compensation for picking up extra shifts. 9 weeks of PTO. Post call day off but with likely busier calls.

My big dilemma between the options is skill atrophy at my current place (tho I will still do some cardiac work) vs. stability, ie not having to move and learn a new system. I appreciate any insight from the group.
Click to expand...

Option 1; do cardiac as a locums doc on some of your off weeks; can you do a week of nights in a row and get the entire next week off?
 
Is option 2 solo or supervision ?

I would lean toward option 1. 6 calls a month seems like a lot though. It shouldn’t be too bad if it’s not too busy like you say. I would value your wife’s opinion as well.

Also, skill atrophy would be less important to me if I were in your shoes. A DINK and 7 years out of fellowship I imagine you could retire much earlier than other people.
 
GassYous said:
Really? I feel like there must be a reason that they are losing proceduralists
Click to expand...


“small facility of a bigger system”. Could be by design. System may be consolidating services and resources to the mother ship.

7 years out is still early. I’d consider a move.
 
To answer some of the questions raised.

For option 1: calls are 24 hours so can't string them together and get the following week off like a night float system. The calls are truly not busy. The hospital wanted to absorb the cardiologists after the private group decided to disband, but was unsuccessful in retaining all of them. From what I gathered the cardiologists just didn't like the system and left. I don't really know the actual drama.

Option 2: MD only.

The spouse is fully supportive with either. We originally moved here due to her job. I got burned by the academic gig I took and have not been able to find something that meets my criteria in the current city, MD only and no PE/academia. We are not big spenders and doing well financially, house paid off and no student loans etc. I tried some locum stuff but didn't really like it.

At this point in my career, part of me want to continue to work at the highest level of my training but at the same time we really just want some short term stability, ie stay put in a place for a few years to live life instead of moving every 2-3 years. We have enough saved to just coast. I like my current hospital since they haven't had consistent anesthesia coverage since the old group which sold out to PE collapsed and really value my service. I'd like to stay but the limited scope of practice gives me pause. How easy would it be for someone like me to go from a low acuity/low volume center to a busier place in a few years?

Thanks
 
I think it also depends on your spouse’s job. Does your SO still like their job? If so, no good reason to move. I’m sure you will continue to keep your skills. You’re doing your own cases and will do the occasional case you like. Are there no opportunities to pick up shifts at the larger place to do the cases you want?

Option 2 I guess the only downside is working harder if your spouse is willing to move and find a new job they like too.
 
The key here is, youre already at option 1 and you like it. You're still getting some cardiac so if you wanted to go to a busier place in the future or wouldn't be an issue. Don't underestimate the hassle of moving to a new job. Also you honestly don't know all of the downsides at job 2 like you do with job 1. Sometimes the devil you know is better than the devil you don't.
 
I'd prioritize a good work environment and prefer a good work life balance. I think staying at option 1 is better although if you have kids and your spouse needs help from her family, option 2 becomes more attractive.
 
precedexforall said:
Hi all,

Trying to pick between two jobs. 7 years out from fellowship. Cardiac trained. Both jobs are MD only, home call only, no OB, W2 employed and the total financial/benefit package are similar. DINK couple and no plans for children in the future due to medical reason. At current hospital doing 1099 after leaving academia to be in the same city as spouse.

option 1: Current hospital. Big city in the Southeast. Home state for me. The hospital is a small facility of a bigger system that is bringing anesthesia in house. 6 calls (no trauma, very rarely work overnight and will have post call day off) per month and 10 weeks of PTO. I generally like the work environment but the complexity/volume of pathology is low. Very good WLB since OR is not very busy. I will not be doing a whole lot of cardiac due to seniority/low cardiac volume. The cardiac program is unlikely to grow in the near future due to competition and recent loss of cardiologists, interventional/EP/gen. Spouse have very good job, but willing to re-locate. The rest of the city is PE owned or have to work with CRNAs, which I have no interest in doing.

option 2: Big city in the Midwest. COL is higher but not outrageous like NY/SF/LA. Close to Spouse's home hence she is willing to re-locate. Busier than current shop with plenty of work. Robust cardiac program. Extra compensation for picking up extra shifts. 9 weeks of PTO. Post call day off but with likely busier calls.

My big dilemma between the options is skill atrophy at my current place (tho I will still do some cardiac work) vs. stability, ie not having to move and learn a new system. I appreciate any insight from the group.
Click to expand...

Option 1, easily.
 
Job another situation 3 different jobs
First two jobs pays 500k

1. My job 30 weeks off. 2 weeks q2 beeper with light ob (but ob is picking up again). May go from 500 delivers to 800-900 soon. 3 weeks off. Doc covers ob. So 30 weeks off total. Getting harder to leave the hospital with running epidurals or call backup. Cover every 5 weekends Friday Saturday Sunday. 485k

2. 20 weeks off. Beeper night float (starts 5pm-9/10pm usually) x 10 weeks , 20 weeks total off (leave between 2pm-5pm max each day) q5 weekends (beeper entire weekend) Friday Saturday Sunday. No ob. Low level trauma. Don’t have to be in house. If 30 min or less away. 505k. Crna in house to do the cases.

3. 17 weeks. Call entire week. Usually down by 6pm most days. So 7 days beeper in a row. Has ob but ob volume picking up. Crna covers ob and operating room. 600k
 
aneftp said:
Job another situation 3 different jobs
First two jobs pays 500k

1. My job 30 weeks off. 2 weeks q2 beeper with light ob (but ob is picking up again). May go from 500 delivers to 800-900 soon. 3 weeks off. Doc covers ob. So 30 weeks off total. Getting harder to leave the hospital with running epidurals or call backup. Cover every 5 weekends Friday Saturday Sunday. 485k

2. 20 weeks off. Beeper night float (starts 5pm-9/10pm usually) x 10 weeks , 20 weeks total off (leave between 2pm-5pm max each day) q5 weekends (beeper entire weekend) Friday Saturday Sunday. No ob. Low level trauma. Don’t have to be in house. If 30 min or less away. 505k. Crna in house to do the cases.

3. 17 weeks. Call entire week. Usually down by 6pm most days. So 7 days beeper in a row. Has ob but ob volume picking up. Crna covers ob and operating room. 600k
Click to expand...
2 or 3.

Depends on your bias towards time off. Some people enjoy more time at a facility than 17 weeks. Also 17 weeks is q3 call equivalent. Would you take that in another circumstance regardless of time off?

I lean to 2 with no OB. Most cases are slower starts at night or more warning. The hectic speeding drive for an OB problem overnight means you need a premium.

1 is untenable without CRNA help for OB with that many deliveries.
 
aneftp said:
Job another situation 3 different jobs
First two jobs pays 500k

1. My job 30 weeks off. 2 weeks q2 beeper with light ob (but ob is picking up again). May go from 500 delivers to 800-900 soon. 3 weeks off. Doc covers ob. So 30 weeks off total. Getting harder to leave the hospital with running epidurals or call backup. Cover every 5 weekends Friday Saturday Sunday. 485k

2. 20 weeks off. Beeper night float (starts 5pm-9/10pm usually) x 10 weeks , 20 weeks total off (leave between 2pm-5pm max each day) q5 weekends (beeper entire weekend) Friday Saturday Sunday. No ob. Low level trauma. Don’t have to be in house. If 30 min or less away. 505k. Crna in house to do the cases.

3. 17 weeks. Call entire week. Usually down by 6pm most days. So 7 days beeper in a row. Has ob but ob volume picking up. Crna covers ob and operating room. 600k
Click to expand...
2 and it’s not close
 
As to the previous post of job choice it’s a tough one because it is a balance of good work environment/balance vs skill atrophy in someone who is fellowship trained. The less hearts you start doing it becomes harder to get another heart job somewhere else, especially any centers with real prestige, because they’ll simply say you’re out of practice. This is coming from a friend. Literally had a buddy get rejected from 2 heart gigs that weren’t academic because they felt he hadn’t done enough hearts in the past 2 years.

I also don’t like this “hearts based on seniority” business. Everything should be distributed equally so that’s a bit of a red flag for me
 
Twiggidy said:
As to the previous post of job choice it’s a tough one because it is a balance of good work environment/balance vs skill atrophy in someone who is fellowship trained. The less hearts you start doing it becomes harder to get another heart job somewhere else, especially any centers with real prestige, because they’ll simply say you’re out of practice. This is coming from a friend. Literally had a buddy get rejected from 2 heart gigs that weren’t academic because they felt he hadn’t done enough hearts in the past 2 years.

I also don’t like this “hearts based on seniority” business. Everything should be distributed equally so that’s a bit of a red flag for me
Click to expand...
I totally agree.

Also the "hearts based on seniority" thing has got to be a harbinger for other versions of some being more equal than others in the group. A major red flag...
 
aneftp said:
Job another situation 3 different jobs
First two jobs pays 500k

1. My job 30 weeks off. 2 weeks q2 beeper with light ob (but ob is picking up again). May go from 500 delivers to 800-900 soon. 3 weeks off. Doc covers ob. So 30 weeks off total. Getting harder to leave the hospital with running epidurals or call backup. Cover every 5 weekends Friday Saturday Sunday. 485k

2. 20 weeks off. Beeper night float (starts 5pm-9/10pm usually) x 10 weeks , 20 weeks total off (leave between 2pm-5pm max each day) q5 weekends (beeper entire weekend) Friday Saturday Sunday. No ob. Low level trauma. Don’t have to be in house. If 30 min or less away. 505k. Crna in house to do the cases.

3. 17 weeks. Call entire week. Usually down by 6pm most days. So 7 days beeper in a row. Has ob but ob volume picking up. Crna covers ob and
Click to expand...

If option 2 was in any sort of desirable area, especially warmer area south, I’d jump all over that !
aneftp said:
operating room. 600k
Click to expand...
 
jthedestroyr said:
If option 2 was in any sort of desirable area, especially warmer area south, I’d jump all over that !
Click to expand...
It’s 18 min/10 miles from my house in sunny Florida.

My own fault is I’m trying to juggle 3-4 different jobs simultaneously in addition to the regular w2 job.

My plan is to work 5p-10pm isih (30% call back rate) weekends but 10% call back rate m-Thursda weeknights

Roll to another 7-3p job to make extra on the week I’m working night float to optimize work for the week.

That leaves my other 20 weeks wide open. I will take 10 weeks off. And figure what to do with the other 10 weeks off to do full locums.
 
aneftp said:
Job another situation 3 different jobs
First two jobs pays 500k

1. My job 30 weeks off. 2 weeks q2 beeper with light ob (but ob is picking up again). May go from 500 delivers to 800-900 soon. 3 weeks off. Doc covers ob. So 30 weeks off total. Getting harder to leave the hospital with running epidurals or call backup. Cover every 5 weekends Friday Saturday Sunday. 485k

2. 20 weeks off. Beeper night float (starts 5pm-9/10pm usually) x 10 weeks , 20 weeks total off (leave between 2pm-5pm max each day) q5 weekends (beeper entire weekend) Friday Saturday Sunday. No ob. Low level trauma. Don’t have to be in house. If 30 min or less away. 505k. Crna in house to do the cases.

3. 17 weeks. Call entire week. Usually down by 6pm most days. So 7 days beeper in a row. Has ob but ob volume picking up. Crna covers ob and operating room. 600k
Click to expand...
Why is CRNA in house for job 2? No reason for 2 anesthesia people if there’s no OB
 
AppTrail said:
Why is CRNA in house for job 2? No reason for 2 anesthesia people if there’s no OB
Click to expand...
That’s just the arrangement. I don’t ask. The hospital is paying for it.

They used to have ob but stopped it a couple of years ago. It has stroke coverage and low level coverage. So crna can get things setup and even started by the time I get there.

But let’s be real. Almost any case that comes in takes at least 30 min outside of super bad trauma that they divert anyways and stat cs
 
aneftp said:
That’s just the arrangement. I don’t ask. The hospital is paying for it.

They used to have ob but stopped it a couple of years ago. It has stroke coverage and low level coverage. So crna can get things setup and even started by the time I get there.

But let’s be real. Almost any case that comes in takes at least 30 min outside of super bad trauma that they divert anyways and stat cs
Click to expand...
we’ll that’s awesome then. If you pass on job 2 or 3, I’d love to get details/contact info.
 
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