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Hi Guest, check out the latest SDN article: Pharmacist Profile: Candice Richard

Message: <blockquote data-quote="surg" data-source="post: 6540563" data-attributes="member: 8951">Just like any other field, the real issue is what you mean by "doing well."  There are plenty of breast focused private practitioners (heck about 45 breast fellows graduate a year, and most of them do not go into academic practice, they must be doing something to put food on the table).  The largest breast surgery society has a large proportion of community based practitioners.However, breast surgery is not a high RVU procedure as a general rule.  (a lumpectomy/sentinel node is about 11-15 RVUs depending on if there is a wire or not, etc.  Compare that to a liver lobectomy which is around 70 and maybe only takes 2-3x as long to do)  Also, breast patients are notorious for needing more "hand-holding" which can eat into your clinic time, and you can really only max out at a level 5 with them.  Top that off with the amount of multidisciplinary care you have to coordinate which is largely uncompensated time, and you start to think... hmmm... that's a lot of work for not as much money as some other surgical colleagues.  On the other hand, if you are well trained in ultrasound, image guided biopsies, offer mammosite, etc.  Breast practice can be at least on par with other general surgery practices.  The added benefit is, there are very few emergencies in breast, very few inpatient consults to interrupt your day, and few inpatients to round on.  Imagine having no one to round on EVERY weekend.  That can be done if you order your OR days correctly.  Volume is definitely the name of the game though.  You can't succeed as a breast only surgeon in private practice and do only a few cases a week.  You need to be busy to cover the overhead. Also, you have to really have a niche in the community.  You are competing against general surgeons who will accept any referral from that primary care doc.  The PCP has to think of you first for breast disease (while not being tempted to send you that fistula-in-ano as well).  Offering as close to one stop shopping is probably the best way to do this.  So while you don't have to own the MRI, you better find a radiologist that will service your patients efficiently and well.  Likewise a good heme-onc experience helps as well.Another alternative is to find a general surgery group full of people who don't like breast cases and who will basically let you join the group and take the breast stuff off their hands.  It is surprisingly easy to find groups of surgeons who don't like breast patients and will give you all sorts of concessions (less call, etc.) to take care of those patients.A multispecialty group practice also works well, as they are often willing to subsidize someone who is doing a good job, even if their RVU output is a little lower than the rest of the surgeons, it is still much higher than the PCPs in the group.Winged Scapula probably has better insight since she just went through this job search for a breast focused job.</blockquote>

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