First PP job. How small is too small?

[Green912]

I've started the job hunting process. The area where I'm looking has a good mix of tertiary academic centers, med-lg community centers, and small town hospitals.

Certainly much of my success will simply depend on who's hiring, but given the choice where should a new grad focus their efforts? I'm coming from a large university center and part of me feels like I should go to a bigger hospital (not interested in academics) where I can continue to manage more complex cases. However would a smaller setting, such as ~200bed hospital,give a new grad enough exposure to become well seasoned?

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[seinfeld]

I think you should seek a first job where you have a wide scope of practice. If will make you much more marketable if you ever want to leave. You can always regress but its much harder to start doing complex cases after years of not doing them, especially if you dont start your career that way.

 

[IlDestriero]

I think you should seek a first job where you have a wide scope of practice. If will make you much more marketable if you ever want to leave. You can always regress but its much harder to start doing complex cases after years of not doing them, especially if you dont start your career that way.

The advice I usually give to residents not interested in a fellowship is to find a place where you can do your own cases, at least sometimes, and try to find a place big enough to be full service. You don't want to stop doing neuro and vascular for a few years and than decide you want to go into a practice that does. You might not get hired. Having said that, many smaller hospitals do a significant amount of complex cases. But it is very surgeon dependent.

 

[periopdoc]

I'm coming from a large university center and part of me feels like I should go to a bigger hospital (not interested in academics) where I can continue to manage more complex cases. However would a smaller setting, such as ~200bed hospital,give a new grad enough exposure to become well seasoned?

You can't necessarily judge a hospital by its size. I am in a small 150 bed hospital. I do everything from kids to hearts to pain to heads. I could probably work out some ICU time if I wanted. We are a level III trauma center providing a full range of trauma care including neurosurgical. The closest level II trauma center is 120 miles away. We have some birthing centers and lots of grand multips in the vicinity so that can bring some challenging OB our way.

Avoid the misconception that complex cases are only done at big major hospitals. We do them here, we just don't make such a big deal about it. I don't do transplants, VADs, or congenital heart repairs, otherwise the case load is pretty similar between what I do here and what I did in residency. The patients may not be as thoroughly worked up here when they get to me which means I have to be a little more thorough in my preoperative assessment.

Closer to a major town, a hospital our size would not do half of what we do here, but you really have to look at what each hospital is doing to see if it fits your needs.

- pod