Attending life - is there a light at the end of the tunnel?

[propofabulous]

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CA-1 getting a little disillusioned with work, maybe a little burnt out. I realized that I (and my coresidents) don't really have a good understanding of what to expect from attending life. Any of you out there willing to answer some direct questions about what life is like on the other side? I understand this is quite private information to be sharing on a public forum, but I feel there is at least some semblance of anonymity here.

1) Your situation - academic/private practice/outpatient surgery center, fellowship or not, full or part-time, region (north/south, mid/east/west)
2) Estimate of take home pay? Does this typically increase annually, is it fixed, or based on performance?
3) Estimate of average hours worked per week and weekends off a month? Do you have any say in this?
4) Calls per week/month (length of calls, home vs. in house). Do you have any say in this?
5) Vacation time per year
6) Split of day-to-day activity (% of time supervising, own cases, teaching, research, pre-opping for cases)
7) Schedule autonomy - do you feel you have autonomy over your schedule/life? Are your hours fixed (shift-work)? Is there predictability, or do they change every week?
8) What do you hate most about your job?
9) Maybe most importantly - was it worth it? Do you feel you would have chosen to go through medical school and residency based on how happy you are with attending life?

 

[deleted171991]

To answer your title: Yes, it's called Heaven. Or, at least, we hope so, because this daily **** ain't fun.

 

[urge]

To answer your title: Yes, it's called Heaven. Or, at least, we hope so, because this daily **** ain't fun.

LOL

 

[urge]

CA-1 getting a little disillusioned with work, maybe a little burnt out. I realized that I (and my coresidents) don't really have a good understanding of what to expect from attending life. Any of you out there willing to answer some direct questions about what life is like on the other side? I understand this is quite private information to be sharing on a public forum, but I feel there is at least some semblance of anonymity here.

1) Your situation - academic/private practice/outpatient surgery center, fellowship or not, full or part-time, region (north/south, mid/east/west)
2) Estimate of take home pay? Does this typically increase annually, is it fixed, or based on performance?
3) Estimate of average hours worked per week and weekends off a month? Do you have any say in this?
4) Calls per week/month (length of calls, home vs. in house). Do you have any say in this?
5) Vacation time per year
6) Split of day-to-day activity (% of time supervising, own cases, teaching, research, pre-opping for cases)
7) Schedule autonomy - do you feel you have autonomy over your schedule/life? Are your hours fixed (shift-work)? Is there predictability, or do they change every week?
8) What do you hate most about your job?
9) Maybe most importantly - was it worth it? Do you feel you would have chosen to go through medical school and residency based on how happy you are with attending life?

Switch specialty.

You should be tap dancing to work as Buffet says.

 

[Mman]

9) Maybe most importantly - was it worth it? Do you feel you would have chosen to go through medical school and residency based on how happy you are with attending life?

YES.

I love what I do (supervising in ACT model) and am paid well to do it and work reasonable hours (or at least as reasonable as one can get in a specialty that includes nights and weekends.

 

[deleted162650]

Didn’t we just have this exact same thread??

 

[Noyac]

1) private practice-full time
2) everyone gets paid the same in my group. And nobody is complaining
3) average 40-70 hrs/week. This depends on call. Everyone works the same but can trade or give up shifts.
4) one 1st call and one 2nd call every two weeks basically. One weekend (fri-sun) every 7 weekends.
5) a lot.
6) 100% doing own cases
7) schedule is very fair. Some long days (7pm) and some short days (1pm)
8) outside forces. Business of medicine.
9) very content. I’m not sure I could have handled a clinic.

 

[caveat87]

CA-1 getting a little disillusioned with work, maybe a little burnt out. I realized that I (and my coresidents) don't really have a good understanding of what to expect from attending life. Any of you out there willing to answer some direct questions about what life is like on the other side? I understand this is quite private information to be sharing on a public forum, but I feel there is at least some semblance of anonymity here.

1) Your situation - academic/private practice/outpatient surgery center, fellowship or not, full or part-time, region (north/south, mid/east/west)
2) Estimate of take home pay? Does this typically increase annually, is it fixed, or based on performance?
3) Estimate of average hours worked per week and weekends off a month? Do you have any say in this?
4) Calls per week/month (length of calls, home vs. in house). Do you have any say in this?
5) Vacation time per year
6) Split of day-to-day activity (% of time supervising, own cases, teaching, research, pre-opping for cases)
7) Schedule autonomy - do you feel you have autonomy over your schedule/life? Are your hours fixed (shift-work)? Is there predictability, or do they change every week?
8) What do you hate most about your job?
9) Maybe most importantly - was it worth it? Do you feel you would have chosen to go through medical school and residency based on how happy you are with attending life?

Being an attending is much better than being a resident. hands down. i am happy to mention some of these details if you wish to PM me.

 

[deleted162650]

1) West Coast. PP. Full-time. Full service Level 2 trauma + OB + ASC’s + GI
2) Points based compensation system. Everyone is scheduled the same # of points each month minus whatever days off you request.
3) 45-52hrs/wk. 1.5 weekend call days/month and 2 primary weekday calls/month. Yes you have some say in this but it will affect your income.
4) see above. OB call in house, trauma call from home.
5) As much or as little as you want with your pay affected accordingly
6) 100% own cases
7) Day to day schedule unpredictable but you have a ballpark idea based on your spot in the lineup/peel each day
8) Probably #7
9) Yup. 100%.

 

[anbuitachi]

CA-1 getting a little disillusioned with work, maybe a little burnt out. I realized that I (and my coresidents) don't really have a good understanding of what to expect from attending life. Any of you out there willing to answer some direct questions about what life is like on the other side? I understand this is quite private information to be sharing on a public forum, but I feel there is at least some semblance of anonymity here.

1) Your situation - academic/private practice/outpatient surgery center, fellowship or not, full or part-time, region (north/south, mid/east/west)
2) Estimate of take home pay? Does this typically increase annually, is it fixed, or based on performance?
3) Estimate of average hours worked per week and weekends off a month? Do you have any say in this?
4) Calls per week/month (length of calls, home vs. in house). Do you have any say in this?
5) Vacation time per year
6) Split of day-to-day activity (% of time supervising, own cases, teaching, research, pre-opping for cases)
7) Schedule autonomy - do you feel you have autonomy over your schedule/life? Are your hours fixed (shift-work)? Is there predictability, or do they change every week?
8) What do you hate most about your job?
9) Maybe most importantly - was it worth it? Do you feel you would have chosen to go through medical school and residency based on how happy you are with attending life?

i think the best way to find out is just talk to as many attendings as you can in the area that you plan on staying. you will get a lot of different answers here, and since happiness/burnout varies a lot from person to person i dont know how it'll correlate with you.

i think the biggest determination to all of these is location (rural vs major city, and private vs academic). these guys/girls above may say 13 weeks of vacation getting paid 600k, but live 5 hours away from any major city and if you cant do that it'll be meaningless to you.

 

[GravelRider]

Burnout at various points come with being a physician. It’s a well-documented problem with many reasons. We all go through periods of burnout...it can be short-lived like after a bad week or more permanent. Determine where you are at. February/March was always a bad month for me in both my residencies because I trained in the Northeast and this is when the winter doldrums started to hit.

In terms of attending life, it can be better than residency, but my first attending job out of residency was worse by a mile. Start educating yourself about the job market now. It’s never too early.

It’s important you know what you want out of life. I am not passionate about medicine or anesthesia. It’s a job. I can easily think of 500 things I would rather be doing than giving anesthesia. That doesn’t mean I don’t try to be good at my job or that I hate my job. It’s a means to an end. It pays the bills and allows me to do things that I enjoy in other areas of my life. It has allowed me to pay off a large student loan debt and buy a nice house in a high cost area in under 3 years. From that standpoint, it’s a pretty good job...better than most. There are a lot of things wrong with medicine these days...anesthesiology in particular. I’m not afraid to point them out and I certainly don’t wear rose-colored glasses. However, when I talk to friends in other fields who are constantly dodging rounds of layoffs or working a lot harder to make less than what I make, I consider myself lucky. Once you get over the idealism and realize that this is a job, and not a “calling,” you will be better off. Perspective helps.

 

[T-burglar]

if I could do ACTA and structural heart every day I wouldn’t work a day in my life. Alas i really disliked academics so I have to spend some time in the General OR in a private practice. I watch the clock on those days.

Overall I like my job most days.

 

[deleted171991]

if I could do ACTA and structural heart every day I wouldn’t work a day in my life. Alas i really disliked academics so I have to spend some time in the General OR in a private practice. I watch the clock on those days.

Overall I like my job most days.

To be honest, I feel about the same most days I am in the ICU.

 

[Mr.S]

Every minute I am in the ORor hospital for that matter I look at the EXIT sign with envy

 

[CR7]

1) western mountain region, private, mix of hospital and asc, no fellowship
2) income average for the western US
3) roughly 50-55hrs a week
4) 2 overnight calls per month from home, 8 weekends a year
5) 12 wks
6) 100% own cases
7) schedule varies week to week, little control of this
8) not much. Again looking at other specialties I can’t imagine doing anything else
9) hell yes. I do better financially than nearly everyone else I know and have tons of time off to enjoy it. Plus I’ll retire early.

CA-1 getting a little disillusioned with work, maybe a little burnt out. I realized that I (and my coresidents) don't really have a good understanding of what to expect from attending life. Any of you out there willing to answer some direct questions about what life is like on the other side? I understand this is quite private information to be sharing on a public forum, but I feel there is at least some semblance of anonymity here.

1) Your situation - academic/private practice/outpatient surgery center, fellowship or not, full or part-time, region (north/south, mid/east/west)
2) Estimate of take home pay? Does this typically increase annually, is it fixed, or based on performance?
3) Estimate of average hours worked per week and weekends off a month? Do you have any say in this?
4) Calls per week/month (length of calls, home vs. in house). Do you have any say in this?
5) Vacation time per year
6) Split of day-to-day activity (% of time supervising, own cases, teaching, research, pre-opping for cases)
7) Schedule autonomy - do you feel you have autonomy over your schedule/life? Are your hours fixed (shift-work)? Is there predictability, or do they change every week?
8) What do you hate most about your job?
9) Maybe most importantly - was it worth it? Do you feel you would have chosen to go through medical school and residency based on how happy you are with attending life?

 

[bigdan]

CA-1 getting a little disillusioned with work, maybe a little burnt out. I realized that I (and my coresidents) don't really have a good understanding of what to expect from attending life. Any of you out there willing to answer some direct questions about what life is like on the other side? I understand this is quite private information to be sharing on a public forum, but I feel there is at least some semblance of anonymity here.

1) Your situation - academic/private practice/outpatient surgery center, fellowship or not, full or part-time, region (north/south, mid/east/west

Academic; CCM & CT Anes

2) Estimate of take home pay? Does this typically increase annually, is it fixed, or based on performance

Pre-tax: >$450,000

3) Estimate of average hours worked per week and weekends off a month? Do you have any say in this?

OR:40 - 60 (do Liver transplant call)
ICU: 70 - 130

4) Calls per week/month (length of calls, home vs. in house). Do you have any say in this?

OR: 0 - 1
ICU: 7+

5) Vacation time per year

>7 weeks away from OR

6) Split of day-to-day activity (% of time supervising, own cases, teaching, research, pre-opping for cases)

OR: 100% supervisor
ICU: lobo solo

7) Schedule autonomy - do you feel you have autonomy over your schedule/life? Are your hours fixed (shift-work)? Is there predictability, or do they change every week?

No

8) What do you hate most about your job?

Whiny surgeons
Call ins from home for ICU bull****

9) Maybe most importantly - was it worth it? Do you feel you would have chosen to go through medical school and residency based on how happy you are with attending life?

1 Billion percent worth it. F’in love it. Baking low draft pick bread for helping to save lives.

 

[partydoc]

Where do you work and are you looking for more dual people?

 

[okayplayer]

Damn Dan. Nice gig buddy. You deserve it.

 

[anbuitachi]

70-130 hrs in the ICU? im guessing that includes home call time? or are you in the hospital for 130 hrs a week sometimes in the ICU. but 19 weeks off damn

 

[sethco]

1) Your situation - academic/private practice/outpatient surgery center, fellowship or not, full or part-time, region (north/south, mid/east/west)
Private Practice in an "undesirable" AMC. Cardiac Fellowship trained. Full time in the Southwest
2) Estimate of take home pay? Does this typically increase annually, is it fixed, or based on performance?
>90th percentile MGMA but varies among my partners based on how much vacation they take
3) Estimate of average hours worked per week and weekends off a month? Do you have any say in this?
45-60 hours per week. Average 4-5 calls per month with 1-2 of those being first call. 1 weekend call every 6 weeks. Guess I can cut back on number of calls, but pay would be cut too. Don't think I am overworked at all though
4) Calls per week/month (length of calls, home vs. in house). Do you have any say in this?
All calls from home. This has its pluses and minuses, but we cover lots of hospitals, so it is what it is
5) Vacation time per year
Varies in my practice from 2-12 weeks among partners. I take 5-6.
6) Split of day-to-day activity (% of time supervising, own cases, teaching, research, pre-opping for cases)
100% own cases. No CRNAs
7) Schedule autonomy - do you feel you have autonomy over your schedule/life? Are your hours fixed (shift-work)? Is there predictability, or do they change every week?
No predictability in my schedule. Sometimes long days, sometimes short. This isn't the specialty for schedule autonomy, as you are dependent on a surgeon to make a living
8) What do you hate most about your job?
Sure to the number of hospitals that we cover, my job can involve a lot of driving even to multiple hospitals in the same day. That is not fun in a high traffic area
9) Maybe most importantly - was it worth it?
100% happy with my specialty and practice

 

[Frogger27]

@bigdan seems like you have a great job. Excuse me for being a naive medical student, but is this an extremely niche position you have given your two fellowships (or is this somewhat common)?

 

[chocomorsel]

@bigdan seems like you have a great job. Excuse me for being a naive medical student, but is this an extremely niche position you have given your two fellowships (or is this somewhat common)?

In academics, you can find gigs like this with just a CCM fellowship. Obviously you won't be doing the CT room but the regular OR.
There's one place in the midwest that's expanding quite a bit and has this kind of schedule that I have heard. Lots of vacation and good money.

 

[anbuitachi]

from what i understood, OR work generate more $$ for the hospital compared to ICU work for anesthesiologist. but its good to see ICU docs getting paid really well. i think all of the above posts have salaries > median MGMA lol. reminds me of how SDN posters all have >90 percentile on tests

 

[pgg]

reminds me of how SDN posters all have >90 percentile on tests

Handsome and witty too.

 

[<(^_^)>]

from what i understood, OR work generate more $$ for the hospital compared to ICU work for anesthesiologist. but its good to see ICU docs getting paid really well. i think all of the above posts have salaries > median MGMA lol. reminds me of how SDN posters all have >90 percentile on tests

If 130 hours a week in the ICU doesn’t get you >90 percentile idk what would lol. There are definitely people hustling here, good on them.

 

[MoMD]

@bigdan join me....

 

[Mman]

i think all of the above posts have salaries > median MGMA lol. reminds me of how SDN posters all have >90 percentile on tests

"Well, that's the news from Lake Wobegon, where all the women are strong, all the men are good-looking, and all the children are above average."

 

[anbuitachi]

If 130 hours a week in the ICU doesn’t get you >90 percentile idk what would lol. There are definitely people hustling here, good on them.

im guessing it includes home time? otherwise its 19 hours a day 7 days a week. my guess is being on call for 5 days or so, but not necessarily have to be in house. which may not be that bad if not a very busy ICU or has good staff. i could be wrong but when i rotated on ICU nights, when the attending was called in at night, they stayed shorter than if an anesthesiologist had to come in at night to do a case

 

[bigdan]

Ya.

My ICU week starts Monday at 0800 and ends the following Monday at 0800. A good week is 70-80h in house; a bad week is a VERY bad week. My Jan 2019 week was 134 hrs in house. Worst week in my tenure.

I can leave “when it’s safe”. Even on “good weeks”, I get called at home; I don’t really count the calls at home as work hours, per se. Bad weeks, I sleep in house. Downside: potentially working the entire week in house. Upside: I’m the doctor in that unit, and the surgeons (and administration) see me as such.

There’s nothing unique about my job based on dual fellowships. We have an Anes-CCM guy (without CT fellowship) that has the same arrangement.

 

[jw3600]

Ya.

My ICU week starts Monday at 0800 and ends the following Monday at 0800. A good week is 70-80h in house; a bad week is a VERY bad week. My Jan 2019 week was 134 hrs in house. Worst week in my tenure.

I can leave “when it’s safe”. Even on “good weeks”, I get called at home; I don’t really count the calls at home as work hours, per se. Bad weeks, I sleep in house. Downside: potentially working the entire week in house. Upside: I’m the doctor in that unit, and the surgeons (and administration) see me as such.

There’s nothing unique about my job based on dual fellowships. We have an Anes-CCM guy (without CT fellowship) that has the same arrangement.

Maybe you answered you this above but what's your split OR vs ICU (weeks per year of each)?

 

[bigdan]

ICU x 12 weeks

 

[thinkorswim]

I'll bite. I just graduated last year from a very busy cardiac fellowship and life definitely got better.

1) West coast private practice.
2) Eat what you kill, blended units, equal access to cases. It's pretty fair.
3) 40-50 hours per week. You can always pick up or give away work depending on what you want.
4) Usually work 1 weekend and take 1-2 overnight in-house calls per month. You can always give or trade away your calls.
5) As much or as little as you want, you'll just make less or more, respectively.
6) 100% doing own cases.
7) Some autonomy, but not much predictability. It all depends on how busy the ORs are on a given day and what number in line you are.
8) Probably #7 with regards to predictability. Also wouldn't mind living in a city with a lower cost of living, but you can't have it all I guess.
9) Yep, it was totally worth it. I'm not sure there's anything else I would rather do. I love my job!

 

[noise115]

1.) Private Practice - level 1 academic trauma center with no anesthesia residency
2.) $400,000ish after taxes and benefits removed- based on units earned, call shifts/weekends/holidays come with bonuses - easy to get rid of call shifts because of this
3.) 55-60hours/week , 1 weekend every 5ish weeks. I have a largely customizable schedule within reason. Call is where the money is, though.
4.) All different calls, both home and in house. I have say in this
5.) 6 weeks vacation minimum - can take up to 12 if needed. Only get paid when I am working.
6.) 80% own cases, 20% supervision. I do about 1 week/month running our regional/APS service. 1 day/week at surgical centers with blocks/supervision. The rest at our main hospital.
7.) If I need to be out for an appointment, I can be out. I try not to make a habit of requesting off too often. We typically get post-call off.
8.) I wish I had more say in which cases I could do, but that is a typical anesthesia practice.
9.) Absolutely. I love my job - both the lifestyle aspects, but more importantly I love what I do in the hospital.

I had some doubts during residency as well- overall I am much happier as an attending for multiple reasons- more autonomy in your practice, ability to customize your practice (Fellowship/finding a niche - something I think is important for both job satisfaction and job security in the future), pay, more time off/flexibility in schedule, etc. Keep at it.

 

[anbuitachi]

1.) Private Practice - level 1 academic trauma center with no anesthesia residency
2.) $400,000ish after taxes and benefits removed- based on units earned, call shifts/weekends/holidays come with bonuses - easy to get rid of call shifts because of this
3.) 55-60hours/week , 1 weekend every 5ish weeks. I have a largely customizable schedule within reason. Call is where the money is, though.
4.) All different calls, both home and in house. I have say in this
5.) 6 weeks vacation minimum - can take up to 12 if needed. Only get paid when I am working.
6.) 80% own cases, 20% supervision. I do about 1 week/month running our regional/APS service. 1 day/week at surgical centers with blocks/supervision. The rest at our main hospital.
7.) If I need to be out for an appointment, I can be out. I try not to make a habit of requesting off too often. We typically get post-call off.
8.) I wish I had more say in which cases I could do, but that is a typical anesthesia practice.
9.) Absolutely. I love my job - both the lifestyle aspects, but more importantly I love what I do in the hospital.

I had some doubts during residency as well- overall I am much happier as an attending for multiple reasons- more autonomy in your practice, ability to customize your practice (Fellowship/finding a niche - something I think is important for both job satisfaction and job security in the future), pay, more time off/flexibility in schedule, etc. Keep at it.

wow which part of the US is this? 400k after tax?! thats like 750k pretax

 

[<(^_^)>]

wow which part of the US is this? 400k after tax?! thats like 750k pretax

If he’s married to a stay at home spouse in a tax-free state it’s actually “only” 550k. Tax rates are still pretty low to be honest, although that may be changing soon :/.

I do hope that new brackets are inserted at say 1M+ exclusively, but realistically there’s a decent chance that they increase taxes on people that are “rich” where rich is defined as >200k.

 

[anbuitachi]

If he’s married to a stay at home spouse in a tax-free state it’s actually “only” 550k. Tax rates are still pretty low to be honest, although that may be changing soon :/.

I do hope that new brackets are inserted at say 1M+ exclusively, but realistically there’s a decent chance that they increase taxes on people that are “rich” where rich is defined as >200k.

thats only 28% tax. where is this dream land

 

[<(^_^)>]

thats only 28% tax. where is this dream land

If you are a couple - anywhere in Texas, Florida, Nevada, Alaska, Washington, South Dakota, Tennessee or New Hampshire.

https://smartasset.com/taxes/income-taxes

 

[abolt18]

1.) Private Practice - level 1 academic trauma center with no anesthesia residency
2.) $400,000ish after taxes and benefits removed- based on units earned, call shifts/weekends/holidays come with bonuses - easy to get rid of call shifts because of this
3.) 55-60hours/week , 1 weekend every 5ish weeks. I have a largely customizable schedule within reason. Call is where the money is, though.
4.) All different calls, both home and in house. I have say in this
5.) 6 weeks vacation minimum - can take up to 12 if needed. Only get paid when I am working.
6.) 80% own cases, 20% supervision. I do about 1 week/month running our regional/APS service. 1 day/week at surgical centers with blocks/supervision. The rest at our main hospital.
7.) If I need to be out for an appointment, I can be out. I try not to make a habit of requesting off too often. We typically get post-call off.
8.) I wish I had more say in which cases I could do, but that is a typical anesthesia practice.
9.) Absolutely. I love my job - both the lifestyle aspects, but more importantly I love what I do in the hospital.

I had some doubts during residency as well- overall I am much happier as an attending for multiple reasons- more autonomy in your practice, ability to customize your practice (Fellowship/finding a niche - something I think is important for both job satisfaction and job security in the future), pay, more time off/flexibility in schedule, etc. Keep at it.

You guys hiring next summer? Seriously...

 

[dabears505]

It actually really depends on your residency and job. I am working a lot more as an attending as I did a resident.

 

[GA8314]

Private practice doing quite well. Work life balance is very good. I'm happy with my career and life/lifestyle.