Did your residency program attempt to prepare you for private practice?

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Pharmado

PharmaDo
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As I was approaching my CA-3 year I began to look for a practice to join. Perhaps it was naive of me to wait so long, but that was my approach. I realized that at no point during residency did anyone attempt to teach me ANYTHING that would be even remotely helpful for finding a job or determining what separates a good job from a lousy one. In fact, I didn't even understand the basics of anesthesia billing until a PP guy outside of my program explained it to me one day early in my CA-2 year. I consider myself to be the most knowledgeable resident in my program as to how the real world actually works, and everything I learned was from extensive searches on the internet or cornering my attendings or anesthesiologists I've met outside of work and peppering them with questions. To this day there has never been a single lecture or discussion about anything related to real world anesthesia practice during my 3 1/2 yrs of residency. Someone from last years graduating class actually took a 1099 position with no benefits without understanding what that was or that he was required to provide his own malpractice insurance. It wasn't until they specifically asked him for details on malpractice that he realized that it was his responsibility.

After that long intro, my question is whether or not this is the exception or the rule. Do other programs take time to teach you about billing, practice settings, malpractice insurance, retirement benefits or anything else? It has been a source of disappointment to me that my program has left the responsibility to me, but perhaps I'm placing too much blame on them for something that is universally overlooked. Any comments on other training programs would be appreciated.

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You really think a one hour lecture on billing, insurance, or some other BS waste of time would actually help?

We're grown ups, YOU did what everyone should do. Do your own research, ask questions on forums, take the initiative to actually ask people in your program and recent grads. No one is going to hand anything out or give you a blueprint to real life. Sounds like your residents need to grow up.

I have 20+ attendings I could go to (and have) for advice about jobs, finances, 1099 vs W-2, benefits, MGMA data, etc. But no one is going to hand me that information in a lecture.

I think your disappointment that no one handed you a to do sheet on the real world is a little odd.
 
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You really think a one hour lecture on billing, insurance, or some other BS waste of time would actually help?

We're grown ups, YOU did what everyone should do. Do your own research, ask questions on forums, take the initiative to actually ask people in your program and recent grads. No one is going to hand anything out or give you a blueprint to real life. Sounds like your residents need to grow up.

I have 20+ attendings I could go to (and have) for advice about jobs, finances, 1099 vs W-2, benefits, MGMA data, etc. But no one is going to hand me that information in a lecture.

I think your disappointment that no one handed you a to do sheet on the real world is a little odd.

Harsh. Very harsh. I do think Residents should be given a lecture series (5 hours) on this topic. If I was in academia I would be glad to do it for Pizza and beer.

But, I do see your point and fundamentally don't disagree with you. You guys have SDN but back in my day we had nobody.

That said, Programs could easily offer a 5 hour lecture series on the subject to CA-2 Residents.
 
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Harsh. Very harsh. I do think Residents should be given a lecture series (5 hours) on this topic. If I was in academia I would be glad to do it for Pizza and beer.
QUOTE]

I worked with a cardiac surgeon who was asked to do just that...the realities if private practice. It was an honest, forthright assessment and guide to the first 10 years of practice. It wasn't received too well and he wasn't asked back.
 
This isn't anesthesia specific. There's little to no talk of the business side of medicine across ALL specialties. I can vouch for Rads.

You have to wonder if they have a vested interest in keeping us ill informed.
 
I have 20+ attendings I could go to (and have) for advice about jobs, finances, 1099 vs W-2, benefits, MGMA data, etc. But no one is going to hand me that information in a lecture.

They should.

I had a couple lectures on the subject when I was a resident, and that was a military program where everyone already had a "job" guaranteed for July 1st. My (not military) fellowship program has had one seminar on contracts and has another one scheduled.

When I was a resident visiting another institution for a rotation, they had a grand rounds given by some malpractice attorneys that was very good.

I've learned more from this forum, but there's a need and a place for it to happen during training.
 
Maybe they didn't teach you about it because they themselves don't know the ins and outs of PP. If they've mainly been in academics , why would you expect them to know. The attendings who did have PP experience taught me plenty during residency. But some things you can't learn until you go through it
 
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I guess I just know that for me, I have learned more by reading online and talking individually to folks than I ever could have in a lecture. Or maybe I don't trust anyone who would give it to me, ha.

Probably a little harsh in my wording, though.
 
I personally believe that part of preparing a resident for anesthesiology includes preparing them for things outside of the OR. We've requested lectures on real world topics, mostly at my urging, but they haven't happened. I am currently the person that people come to for advice and knowledge on the topic and I'm still in residency. I was simply curious to know if this was something unique to my program or a more systemic residency problem, which seems to be the case. I'm the type that I will go out and get the information whether people help me or not, but not everyone is as proactive. I guess that I should clarify my point a little bit when I say that I'm a bit disappointed in my program for not preparing us for the outside world. It is not because it hasn't happened specifically, but because we've asked and been promised at least a quarterly lecture, which has never happened. If the program had said, "sorry, go learn this yourself" I would be a little irritated, but I appreciate the direct approach. If they say they will do something and don't, I find that far more frustrating.
 
Truth is, most departments don't teach this because the majority of the folks there have never had to navigate the private world. Only a few programs in the US (including ours at Boston Medical Center) are actively engaged in preparing our residents for both the private and academic practice settings. We have a discussion group for our residents including these topics given every Thursday, led by our chairman, who runs a national symposium that addresses the business of anesthesia.


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Our fellowship has a couple lectures on the business of anesthesia and understanding contracts. I people want more info they can schedule a meeting with the business manager or talk to the attendings that practiced in other places.


--
Il Destriero
 
Our program had (and hopefully still has) separate CA3 lectures for:
1. Contract review & W2 vs 1099 - taught by our department's operations guy
2. Malpractice primer - taught by an anesthesiologist who does fair amount of expert witness work
3. Anesthesia billing basics - taught by operations guy
4. Basics of money management - taught by program director

Most certainly not enough for us to be experts, but I did like the primers, and it gave me an idea of what to delve deeper into.
 
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Our program had (and hopefully still has) separate CA3 lectures for:
1. Contract review & W2 vs 1099 - taught by our department's operations guy
2. Malpractice primer - taught by an anesthesiologist who does fair amount of expert witness work
3. Anesthesia billing basics - taught by operations guy
4. Basics of money management - taught by program director

Most certainly not enough for us to be experts, but I did like the primers, and it gave me an idea of what to delve deeper into.

As do ours, which has been incredibly useful. Most taught by former private practice faculty who have come back for the latter parts of their careers.
 
You really think a one hour lecture on billing, insurance, or some other BS waste of time would actually help?

We're grown ups, YOU did what everyone should do. Do your own research, ask questions on forums, take the initiative to actually ask people in your program and recent grads. No one is going to hand anything out or give you a blueprint to real life. Sounds like your residents need to grow up.

I have 20+ attendings I could go to (and have) for advice about jobs, finances, 1099 vs W-2, benefits, MGMA data, etc. But no one is going to hand me that information in a lecture.

I think your disappointment that no one handed you a to do sheet on the real world is a little odd.

Sorry but you need to climb the f*** down off of your high horse. The purpose of a residency SHOULD be to prepare you for not only the clinical aspects of medicine, but the business aspects of medicine as well. The OP is spot on in his critique of residency programs. Considering we invest ourselves so heavily into medical school and residency, the least we can expect them to do is prepare us for the "real world." Unfortunately, most physicians who stay in academics don't have a clue about what goes on in the front lines outside of their ivory towers.

Our residency program had a private practice guy come give us a lecture or two on the very basics of PP, but it wasn't enough. A whole lecture series, or even a podcast, would have definitely been helpful and would have been well received from everyone. Most people are left to their own devices though and either sink or swim after training.
 
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Sorry but you need to climb the f*** down off of your high horse. The purpose of a residency SHOULD be to prepare you for not only the clinical aspects of medicine, but the business aspects of medicine as well. The OP is spot on in his critique of residency programs. Considering we invest ourselves so heavily into medical school and residency, the least we can expect them to do is prepare us for the "real world." Unfortunately, most physicians who stay in academics don't have a clue about what goes on in the front lines outside of their ivory towers.

Our residency program had a private practice guy come give us a lecture or two on the very basics of PP, but it wasn't enough. A whole lecture series, or even a podcast, would have definitely been helpful and would have been well received from everyone. Most people are left to their own devices though and either sink or swim after training.


My residency program actually had a CA3 give the job search, licensing and "what to expect" lectures and differences in PP vs. Academic... lol
Granted there was an attending there to fill in the gaps and ask questions not answered, but that attending had done her residency at the same program and never been in PP... Most of her PP commetns were based on her good friends experience in the PP world and what was relayed to her.

Most of the info I gathered about the job process and PP came from this forum and through private convos.
 
Unfortunately, most physicians who stay in academics don't have a clue about what goes on in the front lines outside of their ivory towers.

Our residency program had a private practice guy come give us a lecture or two on the very basics of PP, but it wasn't enough.

I guess this was my real point, which I admittedly delivered very heavy handed.

My program could have given me the best lecture series in the world, but the REAL work and information for each individual situation you just have to get on your own, whether through personal contacts, online forums, or whoever else necessary.

I've just noticed a lot of my colleagues and younger residents especially are expecting every single bit of information about everything to be handed to them, and this just struck a chord.

BOL to OP!
 
Sorry for the slight thread hijack...just didn't want to make another thread for something like this...

Can anyone comment on how likely it is to land a job in your city of choice; preferably a desirable southern calif. city... OR are you just kind of taking a job wherever you can find one?
 
Talking about earning money or the business aspects of medicine is a very taboo topic during all stages of our education. We're expected to want to do this career for any reason, but money. Frankly, education on the way physicians earn money should begin in medical school and get more specifics during residency.
 
Sorry for the slight thread hijack...just didn't want to make another thread for something like this...

Can anyone comment on how likely it is to land a job in your city of choice; preferably a desirable southern calif. city... OR are you just kind of taking a job wherever you can find one?

It all depends on what that practice is looking for and what you have to offer and what they think you can offer. I interviewed at 5 southern CA private practice places and ended up getting 3 offers. But due to family issues I ended up staying on the East coast.
 
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Sorry for the slight thread hijack...just didn't want to make another thread for something like this...

Can anyone comment on how likely it is to land a job in your city of choice; preferably a desirable southern calif. city... OR are you just kind of taking a job wherever you can find one?

If there's a certain locale where you would really really like to end up, then it would behoove you to train in that area. It greatly increases your chances of landing a gig if you trained where the guys in that group trained. When they need someone they are gonna call up the few programs they know well and ask for the rockstars. You want to be on that list. It's doable without said connections but significantly more of a crapshoot.
 
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If there's a certain locale where you would really really like to end up, then it would behoove you to train in that area. It greatly increases your chances of landing a gig if you trained where the guys in that group trained. When they need someone they are gonna call up the few programs they know well and ask for the rockstars. You want to be on that list. It's doable without said connections but significantly more of a crapshoot.


Gotcha. Thanks for the tip. I'm from SD and am dying to get back there after school. I'm an M2 and I've been getting more and more interested in gas, but part of me is unsure if I should just go for a specialty that is easier to find a job. I've really enjoyed my EM shadowing, and I have a couple psychiatrists in the family, so I have a pretty good idea what goes on in that world.

I think at the end of the day, I'm most intrigued by anesthesia. But, the ability to get back to family, friends, and the beach lifestyle may trump that. I know so many people say you're throwing your money away living in CA, but honestly, I don't care. I love and miss that lifestyle and I'm willing to live in a smaller house and maybe work a few more years to have it again.

In your (what may be limited opinion), do you feel there are other fields, like EM or psych, that would have a much easier time landing a job back in socal as compared to anesthesia? Do you think pursuing a specialty that is second or even third preference is a decent move if the end goal is to be back in socal?
 
It all depends on what that practice is looking for and what you have to offer and what they think you can offer. I interviewed at 5 southern CA private practice places and ended up getting 3 offers. But due to family issues I ended up staying on the East coast.

I'm guessing you trained on the east coast? Did you find it difficult to land those offers not being from the area (I'm assuming)?
 
I'm guessing you trained on the east coast? Did you find it difficult to land those offers not being from the area (I'm assuming)?

Honestly, I just cold called or e-mailed as many places as I could. But if you look around this forum you'll see the same info from other people, in that finding a job can be a crapshoot especially private places. A lot of time openings or need for work are not advertised, or you have to have contacts. I didn't know anyone on the West Coast, but like I said I just e-mailed and called. Probably contacted about 10-15 places (private and academic) in SoCo and got around 6 interviews. Surprisingly I had more success getting interviews there then I did locally.
 
Honestly, I just cold called or e-mailed as many places as I could. But if you look around this forum you'll see the same info from other people, in that finding a job can be a crapshoot especially private places. A lot of time openings or need for work are not advertised, or you have to have contacts. I didn't know anyone on the West Coast, but like I said I just e-mailed and called. Probably contacted about 10-15 places (private and academic) in SoCo and got around 6 interviews. Surprisingly I had more success getting interviews there then I did locally.

Also, I applied for my CA license as I was finishing training, so not sure if that helped or not. I was hoping if they saw that I had my license it showed that I was interested in being there and it would save time for credentialing. (But don't quote me on that, more an assumption) It's also cheaper to apply for the CA license as a trainee. I think it's around 2/3 the cost.
 
Gotcha. Thanks for the tip. I'm from SD and am dying to get back there after school. I'm an M2 and I've been getting more and more interested in gas, but part of me is unsure if I should just go for a specialty that is easier to find a job. I've really enjoyed my EM shadowing, and I have a couple psychiatrists in the family, so I have a pretty good idea what goes on in that world.

I think at the end of the day, I'm most intrigued by anesthesia. But, the ability to get back to family, friends, and the beach lifestyle may trump that. I know so many people say you're throwing your money away living in CA, but honestly, I don't care. I love and miss that lifestyle and I'm willing to live in a smaller house and maybe work a few more years to have it again.

In your (what may be limited opinion), do you feel there are other fields, like EM or psych, that would have a much easier time landing a job back in socal as compared to anesthesia? Do you think pursuing a specialty that is second or even third preference is a decent move if the end goal is to be back in socal?


SoCal is a big place. You can get a job here if you want to. But there are good jobs and bad ones. It's easier to get a good job if you train locally or at a big name. Best thing you can do for yourself right now is to kill your step 1 so you can match at top residency program with many alums in socal.
 
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Most of what I know of private practice, billing, and documentation for billing was taught in light conversations with members of the two private practice groups we trained with. There was a little OJT when I was doing locums, but nothing really formal.

It was very piecemeal, but looking at where I am working/teaching right now, it was still miles above what residents around me have.

It would be nice to have a "Private Practice for Academic Dummies" (I put myself in the Dummies group as well,) cliffs notes in the private forum.
 
Billing knowledge maybe the only thing that saves this field. My first gig I was being whored out to a company model GI gig...21 cases a day for just over a grand.

Realized the hard way I could do a couple of insured endos in a fee for service private gig, be done by 10 and make twice that.

My own fault for not being more informed. Know your worth and refuse to take bad deals...especially new grads/younger attendings.
 
In small solo private practice, beware you are by yourself. You don't have a lounge nearby full of colleagues or residents who you can call for help in an emergency or difficult case or just for advice.

Some academic attendings in my residency would be completely unfunctional if they didn't always have help available or a junior attending to dump cases on.
 
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