General Surgery Job Search

[argama]

Hello All,

Apologies if this has been posted in the past. I completed General Surgery residency in June 2024 and I'm doing a non-ACGME "fellowship" in MIS/EGS/ACS at a busy academic name-brand institution (Not SCC/Trauma) right now. The position ends at end of July 2025. I am not sure on how to start the job search. I have literally been googling "general surgery job opportunity in [insert city/region]". A ton of recruiters have emailed and called me for random jobs in obscure locations.

The best case scenario, my current institution recruits me, but they've only known me 2 months and I am not sure how to approach asking if they would consider hiring me for next year as an attending. I really like the people, the residents, the patients, the hospital, and the location here. However, I am expanding my search to my home state (CA) and the general PNW as well. I guess my questions for advice are:

1. Am I late on starting the job search if I hope to have a job lined up for Sept 2025? My spouse and I really like this area but I cannot seem to find any other nearby hospitals or health systems hiring any general surgeons in the city.
2. I have asked a couple attendings for references, but I have not asked all of them. Should I have done this way earlier?
3. What advice do you have for asking my current institution if they would consider hiring me as an attending? I am not sure if they're looking to hire for another general surgeon but I do know one of the senior surgeons is moving into an administrative position this year with reduced clinical activity.

Thank you

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[operaman]

I came out of training at the height of Covid so my job search was a bit bumpy. I had been working on my academic dream job starting around pgy4 year with plans to start after my fellowship pgy6 year. That was going well until Covid and the whole institution went on a hiring freeze.

I would definitely ask around at your current place. They must like you enough to have hired you as a fellow and if they’re good people they should be honest with you. My fellowship program had just hired 2 new faculty in my area right as a started so they didn’t have anything for me then. There was a potential VA position though but it too kept running into funding/covid issues.

I got lots of not great options from recruiters and searching job ads.

I think the best jobs just aren’t posted. The job I ended up in and now hope to stay forever came from me cold calling someone I’d met at a conference a year earlier. Also got good leads from past programs grads but none as good as where I ended up.

So definitely start asking around your fellowship. Ask your former residency. Reach out to recent grads. Ask faculty for intros to other former grads. The best jobs really are a word of mouth kind of thing.

 

[cpants]

There are a limited number of institutions that would be able to employ ACS-trained surgeons in your region of interest. I would start by making a spreadsheet listing these institutions in your preferred geographic location and start doing some research on them. I think you need to narrow it down a lot more than CA or the PNW. Try to get a list of 10-20 places that you think could potentially be good fits, and reach out. See if they might be looking and request a meeting or phone call with the chief. Just because they might not have a job "listed", they still might be interested in hiring you.

 

[argama]

Thanks all for the advice. I decided to start mass applying for jobs in the general urban/suburb regions to see who bites (being a bit vague bc I'm not like applying to middle of nowhere places that I have no roots in). So far I have received a couple interviews (jeez reminds me of residency applications and fellowship apps) and phone calls from potential places...

Do you guys have a list of important questions I should ask at each surgery attending positions? What are things I should ask that does not seem obvious? I think everyone wants to know Call schedule, Trauma coverage vs not (b/c im not SCC), Pay/Compensation, Benefits, Tail Malpractice, Days Off, etc.

One important thing I have heard is to always have a senior mentor in the beginning and I'm not sure how to ask that...don't want to come off as "unqualified" or "weak" for asking that in the interview

 

[operaman]

oh my so many things.

1) these are maybe the first interviews where you really need to be truthful because this will actually be your job. It’s not like med school where everyone pretends to want a career in global health and rural primary care only to wind up another dermatologist in the Bay Area. Be honest about what you want/need.

2) block time. I’ve got a decent amount and it makes the life a bit more predictable. I know folks who have to struggle to squeeze things on and they end up going at weird hours, hard to plan, etc. Having your own reserved time is awesome.

3) clinic staffing. How many. Workflow. How much autonomy do you have in changing it to suit your style. Also clinic space - how many rooms, etc. Your ability to be productive will hinge largely on your clinic and OR availability so you’ll want to know it’s adequate. This also tells you if they’re really invested in you and helping you build your practice, or whether you’re just call filler.

4) setting your own schedule. Huge one here. Can you decide when and how hard you work or is someone else doing that? Like I have most of my days as just long mornings so I have afternoons off or open for extra OR cases. Some places may not allow you that flexibility.

5) Do you decide what you see or don’t see? When you see it?

Mainly these all boil down to making sure you’ll have adequate resources as well as enough autonomy to build the practice that fits you (if that’s important to you).

Senior surgeon partner is nice but not essential. You should have mentors from training you can call. I bounce tough cases off others all the time and you should too.

Whatever you do, play it safe for the first 5 years. Nothing outside the box, just good solid dependable outcomes for a few years. Nobody talked about this in training, but I’ve already seen a number of new surgeons get shown the door for poor outcomes, even ones that were extremely productive drawing comp in the $2-3m range. So whether it’s a senior partner or fellowship mentor, don’t be shy about asking for help and feedback early on.

 

[DoctwoB]

A few other things to add to the list:

Where are your patients coming from? Plenty of hospitals/groups would love an extra surgeon to spread call around, but don't have the volume to support it. While some expectation that you will market and build your practice is reasonable, you can't draw blood from a stone. What I mean is if you are in a region where all the pcps are part of big networks like kaiser, sutter, academic center NOS, etc there can be a very limited pool of patients for a private practice to draw from. If you are joining a big system that employs a ton of PCPs that is generally less of an issue.

Call time? How much? How busy? How are you paid for it?

What kind of cases do you want to do? What kind of cases do your future partners do? If you want more complex cases at a reasonable volume you'll need some partners feeding them to you, which doesn't work if they want to do those cases themselves. If you want a true do-it-all gensurg practice this is less of an issue.

 

[argama]

Wow great advice thank you! So first few years stick to probably bread & butter General Surgery which is totally ok with me. My residency experience was very heavy in operative trauma (Level 1, took Q4 trauma call for half of residency with 25-30% penetrating supposedly) in a county system, and while I don't love trauma (don't hate it as much as others) and I am not SCC trained, would it be a bad idea for me to join an ACS group that covers Level 2 Traumas? I am not sure if I'm exposing myself to too much risk taking on trauma call at smaller community Level 2 or 3 hospitals as a "non-SCC trained" surgeon..

Ultimately I just want to do bread and butter general surgery, chole, appy, hernias, lumps & bumps and if I find a niche I like that's great. In my current fellowship year I am trying to pick up all sorts of cases from Disaster Choles to CBDE to Robotic hernias to feeding tubes to even gastric pacing. I've sort of carved a weird niche of being the "surgical feeding tube guy" (PEGs, Stamm G-Tube, Lap & Open J Tubes) in my fellowship since I picked up a couple of those cases in my current fellowship. Historically other services (GI, IR) did them before I came here and no one told me....