Early career CT surgeon: High case-volume or work-life balance?

[12-Blade]

What do you feel the most important factors are in looking for a practice early in your career?

I am an early-career (<5yrs out) private practice CT surgeon looking to move because of admin/volume issues.

Have an opportunity in upstate NY at a high-volume place with great variety of cases, good call schedule 1:4. Have another opportunity in the South at a good hospital system but lower volume place. Great area near the coast with great lifestyle potential; although call is 1:2.

The CT surgery arena is changing. I think we will be doing more complex stuff in the future (digging out VIV TAVRs, even more complex coronaries, complicated lobes following COVID PNA etc).


As an early-career surgeon, When do you make the decision to follow work-life balance/reward yourself for surviving it this far versus tons of exposure honing your craft and being really good at complex stuff?

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[ThoracicGuy]

What do you feel the most important factors are in looking for a practice early in your career?

I am an early-career (<5yrs out) private practice CT surgeon looking to move because of admin/volume issues.

Have an opportunity in upstate NY at a high-volume place with great variety of cases, good call schedule 1:4. Have another opportunity in the South at a good hospital system but lower volume place. Great area near the coast with great lifestyle potential; although call is 1:2.

The CT surgery arena is changing. I think we will be doing more complex stuff in the future (digging out VIV TAVRs, even more complex coronaries, complicated lobes following COVID PNA etc).


As an early-career surgeon, When do you make the decision to follow work-life balance/reward yourself for surviving it this far versus tons of exposure honing your craft and being really good at complex stuff?

Do either of the places have senior guys that are willing to help out with some of the tougher cases should you need it?

 

[12-Blade]

Do either of the places have senior guys that are willing to help out with some of the tougher cases should you need it?

Yes. Both of those places. The larger place has all senior guys (50-65yo) and the smaller place I would have a senior partner (? 55yo).

 

[ThoracicGuy]

Yes. Both of those places. The larger place has all senior guys (50-65yo) and the smaller place I would have a senior partner (? 55yo).

Sounds like both have some good upside to them. I'd say look at which ones do the cases that you want to do and which may do more than you do if you want the chance to learn more things. Having 1:4 call would be fantastic. I'm currently on 1:2 call, but it's not too bad overall. Upstate NY and coastal Carolina are very different areas as well. Do you have any preferences to the towns?

 

[12-Blade]

Sounds like both have some good upside to them. I'd say look at which ones do the cases that you want to do and which may do more than you do if you want the chance to learn more things. Having 1:4 call would be fantastic. I'm currently on 1:2 call, but it's not too bad overall. Upstate NY and coastal Carolina are very different areas as well. Do you have any preferences to the towns?

Good points about cases. The lower volume place will ship most complicated stuff out to their “mother ship” hospital.

Yeah. I mean. Not many people wouldn’t like living on the coast. I grew up in the South so moving upstate would be an adjustment. Not to mention the taxes up there are brutal.

 

[ThoracicGuy]

Good points about cases. The lower volume place will ship most complicated stuff out to their “mother ship” hospital.

Yeah. I mean. Not many people wouldn’t like living on the coast. I grew up in the South so moving upstate would be an adjustment. Not to mention the taxes up there are brutal.

Chances are if you start at a place that ships the really complicated stuff out, you'll probably not end up at a place in the future that will take that complicated stuff. Your comfort factor with these cases will go down over time. If you don't want to lose that part yet, go for the NY job. And yeah, NY taxes don't look like fun.

 

[LucidSplash]

As someone who grew up in Upstate NY and now lives in the south for a reason, you really need to go visit Upstate NY in like January/February before deciding if you want to live there.

 

[deleted50541]

It depends on your career experience so far and what your future goals are, including how a family/life works into that equation.

The southern practice sounds like it might be a good fit, but I'd certainly want to know about the prospects for volume growth. Was there a prior partner, and if so, did they leave or retire? Would there be enough volume to support a third surgeon in the future? Is there an opportunity for you to go to the mothership and see more complex cases or even have surgeons from there assist you at your homebase?

1:4 call is definitely a sweeter gig with the opportunity to have much more support and see more complex cases. But as someone who also lived in upstate NY for almost half my life, no amount of money in the world could drag me back there.

 

[GassYous]

As someone who grew up in Upstate NY and now lives in the south for a reason, you really need to go visit Upstate NY in like January/February before deciding if you want to live there.

Eh in like 5 years it will be a nonissue.

 

[12-Blade]

Eh in like 5 years it will be a nonissue.

Explain this?

 

[Medstart108]

Explain this?

Probably a reference to global warming although the pace of that even in the worst case scenario won't actually affect temperatures that quickly.

 

[LucidSplash]

Probably a reference to global warming although the pace of that even in the worst case scenario won't actually affect temperatures that quickly.

Agreed. I assume they were being facetious 😂. That said, even my mother says that the winters aren’t as bad as they used to be 30 years ago when I was a kid (oof I’m old). But it is still grey and overcast and the sun still doesn’t shine about 8 months a year. SAD is a real thing in my experience.

Besides, I strongly suspect “not as bad” to someone who has lived in Western NY for 65 years and experienced the Buffalo blizzard of 1977 and Rochester Ice Storm 1991 is going to be a lot different than what someone who is from south of the Mason-Dixon Line thinks. 😬

 

[12-Blade]

Agreed. I assume they were being facetious 😂. That said, even my mother says that the winters aren’t as bad as they used to be 30 years ago when I was a kid (oof I’m old). But it is still grey and overcast and the sun still doesn’t shine about 8 months a year. SAD is a real thing in my experience.

Besides, I strongly suspect “not as bad” to someone who has lived in Western NY for 65 years and experienced the Buffalo blizzard of 1977 and Rochester Ice Storm 1991 is going to be a lot different than what someone who is from south of the Mason-Dixon Line thinks. 😬

I was wondering if previous post was in reference to global warming but didn’t want to believe it. 🤦‍♂️

Yes. A lot different.

And yes, SAD is a real thing. I used to live in a place that didn’t have the best weather with a moderate winter/snow and can certainly appreciate that.

 

[deleted50541]

I'm from the south and it was a huge bummer my first year in Western NY over 20 years ago. That intial 7-8 months of overcast/grey skies was horrible. I had SAD big time and probably still do to some degree.

Winters did seem to vary by year and it wasn't crazy blizzards every season. I was there for the "October Surprise" storm that took out power for a week and the "Snowpocalypse", which produced some of the most amazing cloud formations off the lake I've ever seen as I drove into work. But I'd had enough after 15+ years and moved to warmer climates for fellowship and my current job.