help choosing a first job out of training

[reanimatore]

---

Members don't see this ad.

Hello.

I am currently in my PGY 5 (fellowship) year in anesthesia training and have been fortunate enough to field a few job offers in my desired geographic location. To be honest, I wasn't anticipating having multiple choices given the current market where I'm looking. I'm definitely not complaining, but now I find myself in a position where I don't want to make the "wrong" decision in selecting my first job.

The two jobs I'm looking at shake out as follows:

Job #1: Perfect location for me (in city). Smaller group, pure incorporated private practice, very fair "pooled units" type of system. Pretty much partner from day 1. Limited clinical scope (no OB, trauma, hearts; sparse thoracic, vascular, peds). Healthier patient population, but not surgicenter healthy. The limited scope means hours and call tend to be pretty great (home call, occasional emergency but usually you sleep). This is a group that doesn't hire often (as in, every 10 years or so when someone retires).

Job #2: Little bit worse location (a bit outside of city). Bigger group. Academically affiliated place, so you work with residents but there's no research obligation and the pay is better than true academics. Salary plus call incentive. Again, immediate partnership. Broad clinical scope, essentially everything excepts hearts. Sicker patients, potentially more stressful cases. Frequent in-house call, more weekend work. Although the people at Job #1 seem great, I think the group overall may be a bit stronger at job #2.

Pay, vacation and benefits are similar. I enjoy working with residents, but it's not an absolute must.

My thoughts are as follows:

1. Part of me thinks it would be wise to take the more clinically challenging job (#1) in order to consolidate my skill set and really come into my own as an attending. That way I will be able to fit into any group from a clinical standpoint if things change in the future and I need to look for a new gig. I'm concerned that limiting my clinical scope fresh out of training will limit my options down the road.

2. On the other hand, job #2 seems like a great lifestyle choice with great people in a phenomenal location. As I mentioned above, it's not a place that hires often because you can work there until you're 70 if you want to. Compared to job #1 it seems much more sustainable over a long career in regards to avoiding burnout, and maintaining a high quality of life.

I am happy that I have this "problem", as I know not everyone has been able to get a job in their desired location. I was just hoping to hear some sage wisdom from those of you making a similar decision or those of you who have been out in practice and have a more veteran perspective to offer.

Thanks

 

[Mac4]

Sounds like you want to take the #1 job (better hours, easier patient etc) but, rightfully, worry about job securtiy down the road. I would be worried too.

 

[michigangirl]

I think you reversed your #1 and #2 when describing your rationale in the second half of the post.

Either way, it sounds like the job in the perfect location with the smaller group which only hires every 10 years is the way to go-- can't really find a down side based on what you've elaborated as what you want. Sounds like an awesome opportunity. Location and lifestyle can't be emphasized enough.

 

[sevoflurane]

3 +1 :

Location, Lifestyle, Money.

+1 = Professional satisfaction (case load, administration, nurses/surgeons/partners you work with day in and day out).

These are things that only you can answer.



Being happy with your day to day life is so very important. 🙂

 

[Frank Rizzo]

A few years ago I was sitting on three options:

1. Do a cards fellowship

2. Take a job I was offered that sounds like option #2... academic, call incentives, broad scope, etc.

3. Take a job I was offered that sounds like option #1... only hire when people retire, successful fair PP group (although no partner until after 2 years, still paid well for first two), clinical case still broad (ob, hearts, vascular, thoracic, minimal heads, no peds, no transplant).

I chose the PP gig. There's a reason why people stay at groups like this forever and never leave... Its awesome. 🙂

 

[aneftp]

Job #1 exists in fantasy land especially if u are looking for a city job.

Only place I have found job number 1 has been in smaller cities (less than 200k population). And maybe 90-120 minutes from major international airport (major as in LAX, SFO, JFK, IAD, DFW, ORD,ATL, IAH)

 

[desflurane]

If you are settled, meaning married with kids (or at least married) and are pretty sure you won't be leaving the area anytime in the next few years then the first job seems like it makes the most sense. Most of these "no turnover" groups are no turnover for a good reason...and vice versa.

I've jumped groups many times since graduating residency and learned all the ins and outs and different practice types and business models. It is indeed a great sign that nobody leaves the group. Says a lot about the way its run, the fairness of the other partners etc etc.

You do have to be sure that your goals are aligned with the existing partners. I left one of these "never leave" groups because my goals didn't align. The partnership was honest and you pooled units and made a large sum depending on how the group did. The problem was that they ware all ok with working 80 hour weeks to get that large paycheck and I wasn't. I needed a life outside of work 80 hours a week was not it.

Sounds like you are also trying to hedge against whatever is coming down the road with health care reform. I wouldn't bother its a crap shoot. Nobody knows, period. Could be single-payor medicine or could be back to fee for service. Most likely neither but nobody has a clue where its going. Even if a Republican gets the White House. Pick the job you like the most.


I'm gonna throw it out there because I'm curious...which fellowship? and which city?

 

[reanimatore]

Oops. That's correct, I did accidentally reverse #1 and #2 in the second half of the post. Sorry.

 

[reanimatore]

Job #1 exists in fantasy land especially if u are looking for a city job.

Only place I have found job number 1 has been in smaller cities (less than 200k population). And maybe 90-120 minutes from major international airport (major as in LAX, SFO, JFK, IAD, DFW, ORD,ATL, IAH)

Well, the job does exist, and in the heart of a pretty desirable city. I will take that as a vote for job #1.
Thanks

 

[Noyac]

I would seriously consider option #2.

 

[Oggg]

If you're sure about settling in your desired geographical location, pick #1 PP.

 

[pd4emergence]

I can kinda of see your dilemma. One group where you are afraid your skills will lag because of lack of case variety but what sounds like a great group in the place you want to be, or another group where you kinda do everything and you may keep your current skill set sharp. With the pp job with limited case variety, it may not be around for a while, if they truly only hire every ten years, there is probably a reason. The other job will probably be available intermittently every few years. If you think there is a chance that you would be happy doing what sounds like pp bread and butter maybe you should try it out. Give it a couple of years and if you are bored to tears and feel strongly enough about changing paths you can. If you have a strong desire to do the types of cases that the one group doesnt and feel that without those cases your job satisfaction can't be complete without doing complex cases then you probably should not take a job where those cases aren't available for you to do. Good luck.

 

[IN2B8R]

Take job #1, live well below your means, work there for ten years, pay off any outstanding debt and save as much money as you can, then move on to where your heart desires.... Do not make decisions in "vacuum": consider what will make sense and will jive with life's other obligations, i.e., debt, kids, wife, etc.... Good luck!

 

[reanimatore]

I would seriously consider option #2.

Would you mind expanding on this a bit? I'd be very interested in hearing more from you, given your private practice experience. Thanks

 

[Noyac]

Would you mind expanding on this a bit? I'd be very interested in hearing more from you, given your private practice experience. Thanks

I could go on forever on this one. I'll try to keep it brief and you can ask questions as they come to mind. No matter what program you grad from you are just beginning to learn what it takes to become a good anesthesiologist. you are mostly a safe anesth at grad but you will learn a tremendous amount in the next few years. Some say we peak at around 10 yrs out. I say that depends greatly on the practice you join initially out of training. Everyone feels as though they have stumbled on the "once in a lifetime practice" and must join it for fear that they may never have the opportunity again. When in reality many will leave their "dream" practice within a few years for one reason or another. If you choose a practice with lesser acuity right out of training, it will take longer for you to reach your peak if at all. You will always be a bit more stressed in the rare/riskier cases. Your comfort level will never be as great as it can be and possibly your pts may suffer ( there is no way to know this but most of us know this is more than likely true, you just cant design a study to prove it). There are many people that go to their dream practice and never leave and never feel like they are missing anything, but I ask, How do we know? Also, some of us are not driven to be exceptional within our own limits and that is fine. But others are, and going to a lesser acuity practice right out will delay this greatly.

I frequently see people come and go thru my practice which is only moderate in acuity (which is worse since it comes less often therefore, you must be even more experienced since there may be long periods between disaster cases) who are very uncomfortable with certain cases and have been out of training for a few years. They say, "I haven't done a case like this since residency." They look to cancel cases more and for no good reasons. You want to separate yourself from the competition, you want to be the "go to" guy or gal then dont take the easy road. I believe it is the difficult road in the long haul.

Think about this. If you are doing a fairly larger case at your training program, you also take into account what attending is going to be with you for the case, right. You will adjust your plan based on that attending. If you have 10 attendings possible you are sure to have at least 5 different approaches if not more. Well, this is how your first few years will be, adjusting to you own style that you were not really able to do while in training. And for good reason. I've been out 10 yrs now and I still change how I do things to this day. This isn't different in a slower practice its just not nearly as effective.

So now, all those that have gone to the slower practices can fire away. but before you tell me how FOS i am let me say that I believe you are probably the best that you can be so enjoy it.

 

[myg]

I am curious as someone who will be entering the job market soon; how did your fellowship experience help/hurt in you getting the job offers you want? What fellowship was it (Peds/Cards/CCM)?

MYG

 

[cleansocks]

Don't "what if" your life away. Do what you want to do.

 

[sevoflurane]

Here is my perspective:

I’m only in my 3rd year of PP. We passed up the cush semi-ambulatory PP gig for one that has an active cardiac, vascular, general-oncology, and ortho heavy departments in a community hospital with 250 beds and no CRNA’s. I still do 4 y/o’s or younger on a weekly basis, have plenty of OB experience and do robotic prostates, hysters and as of recently robotic thoracotomies. From a professional point of view, I can say that this was the right thing to do. I’ve taken care of a lot of left mains in the middle of the night, ruptured AAA’s, nasty GSW’s, crashed onto bypass from a thoracotomy gone bad, dealt with laryngospasm in a <1 y/o, put patients asleep for total laryngectomies and nasty AW’s, and I have far exceeded the number of blocks I placed in residency during my first 1.5 years out. The list goes on and on. Additionally, this has been done without midlevel provider help. All done completely solo... we don’t even have a board runner helping out. This type of practice makes you grow as the experience is so totally different from the semi-ambulatory gig with medical direction/supervision. I find it mentally stimulating most every day.

I will be looking for another gig in the not too distant future as I’ve accomplished what I have set out to do in my first years of PP. When I do get into my new gig, I will enter it with confidence and piece of mind with regards to my clinical skills. The hardest part will be finding my way around a new hospital, remembering the names of staff and remembering in what drawer the oral airways can be found.

The beauty of it is that now I have time on my side. There is no rush to find a good job based on location, lifestyle and money and professional satisfaction as I’m very content at my current gig except for location. For now, I can be patient and wait for the perfect gig to come along. Of course, I’m not getting any younger. 40 y/o is coming faster than I ever imagined it... and is right around the corner. 😱 Yet, from a profesisonal stand point, I’ve had sooooo much fun these last couple of years.

Of course there are some groups that have it all. Location, lifestyle, income and professional satisfaction and good support system for new grads. These groups are money, but I imagine are pretty popular.

Bottom line is that a gig that lets you grow as an anesthesia provider is good to have early on in your career. Of course... you have to be happy with your decision. If not, then all bets are off.

Good luck man, it’s always nice to have choices.