Help! I have to find a real job!

[girlwithaknife]

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I've entered the final year of my residency and have finally decided that I am not interested in applying for fellowships. Thus, I must start looking for work as a general surgeon - a REAL JOB. This is frightening. What do I do? Who can I trust to talk to? What if I want to take time off to enjoy the very last of my "youth" and go trek around Europe or something?

 

[Pilot Doc]

http://forums.studentdoctor.net/showthread.php?t=435953 is a decent start.

Contacts with former residents at your program are often a good source.

If it were me, I would avoid any job that is recruited or advertised. My feeling is that they are almost all, by definition, bad jobs. Otherwise, the practice woulnd't have trouble filling them. An exception (if you're not a city-lover) might be jobs in remote/rural areas that go unfilled just because few people want to live there.

 

[Winged Scapula]

While I generally agree that many jobs which are recruited aren't worth your time, most large academic medical centers employ full time physician recruiters and these jobs are routinely advertised. In addition, smaller practices may not otherwise have the resources/time and interest or knowledge without employing a recruiter to find candidates.

Thus, I have received letters from Mayo, Virginia Mason, Sloan-Kettering, Rush and other big names about surgery positions available and seen them advertised in the trade journals. These are not necessarily bad jobs but it is routine for these large centers to advertise for open positions, as they are generally required to include outside candidates in their recruitment efforts.

When you do inquire about a potential job, besides the usual questions, please make sure to ask how long the job has been available. There are generally good reasons why jobs go unfilled for long periods of time...and these reasons are usually not to your benefit.

 

[driedcaribou]

Good job tips - thanks guys!

 

[mdjobexchange]

Average RVU production for a general surgeon is 6500/yr.

An RVU is how cases/clinic visits are billed. Each case/visit is worth so many RVUs.

Medicare reimburses $37 per RVU. If you look at most general surgery practices, with decent insurance reimbursement, you are looking at around $42 per RVU. That means that the average general surgeon salary is about $240,000/yr....that is pretty much on par with the salary surveys.

What does this mean? When you interview for a job, ask them how many RVUs their typical surgeon bills. If they tell you they are going to pay you $250k a year and you will only work 40 hrs a week, they are lying. The number don't add up. Same for if they tell you it is a 40 hr/wk job and they are billing 8000 RVUs a year. That is an 80/hr a week job. You can't bill 8000 RVUs a year and work 40 hrs a week, unless you can do a lap choly in 5 minutes.

Beware of income guarantees, they are generally traps.

Make sure any job you take agrees to pay you malpractice tail if you leave before one year. This puts the onus on them to make sure you are happy.

Also, ask for a letter of intent. This lists, in plain English, what they are offering. This would include salary, buy-in terms, malpractice tail, malpractice cost, geographic restriction, etc. They can give you this before they give you a contract. When the contract finally arrives, have a lawyer make sure the letter of intent matches the contract. Just a minor change in wording (which only a lawyer can tease out) can make a major difference in the contract.

 

[Dr JPH]

How much bargaining power do you have in situations like this?

I guess it would depend on geographic area and demand for your services.

 

[Pilot Doc]

Average RVU production for a general surgeon is 6500/yr.

If you look at most general surgery practices, with decent insurance reimbursement, you are looking at around $42 per RVU. That means that the average general surgeon salary is about $240,000/yr....that is pretty much on par with the salary surveys.

How do you figure that? 6500 * 42 = $273K, but that's gross receipts. That leaves $33K (12%) for overhead. Not many people claim to run a practice that efficient.

As for paying the tail, I'm increasingly of the opinion that you should avoid any contract clause that would have to be enforced. By the time you hire a lawyer to get reimbursed for the $35K tail policy you purchased out of pocket, you've wasted a lot of time and effort. Better to stipulate that you pay tail and negotiate a higher salary.

 

[mdjobexchange]

The number I talked about for the 6500 RVUs are actually work RVUs. An RVU is broken down in to work, practice expense, and malpractice RVUs. Many practices look specifically at work RVUs, because they reflect production and overhead is already accounted for. The work RVU is generally about 45% of the total RVU value. So, since typical overhead for a general surgery practice is about 50%, looking at work RVUs already accounts for overhead. It is basically less math.

The other $33,000 is for health insurance and other benefits, not practice overhead. Typical family health insurance policy costs about $8000/yr and then practices usually offer other perks such as matching 401k contributions, or paid CME