How are specialized surgeons employed in hospitals?

[fourteen12]

I was wondering how different cardiothoracic transplant, neurological, and trauma, etc. highly-specialized surgeons are employed (e.g. on salary at hospital, paid by the hour). Also, are surgeons permitted to do work at multiple hospitals and would it be possible to, say, take one month out of the year and work at a second home in a different state while keeping a job at your home hospital? I know this are pretty specific questions but if anyone can help me out at all- thanks!

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[Winged Scapula]

I was wondering how different cardiothoracic transplant, neurological, and trauma, etc. highly-specialized surgeons are employed (e.g. on salary at hospital, paid by the hour).

There are a myriad of employment models but in general, no one is paid by the hour. Employed surgeons would be paid a salary; sometimes this is a base rate with a sort of "bonus" structure where they could be paid more if they operate more or do more complex surgeries. Others might be purely RVU based. There might also be additional income from being on committees, teaching etc.

Also, are surgeons permitted to do work at multiple hospitals and would it be possible to, say, take one month out of the year and work at a second home in a different state while keeping a job at your home hospital? I know this are pretty specific questions but if anyone can help me out at all- thanks!

If employed, the contract probably has a do not compete clause/geographic restrictions which would typically not come into play for other states. Private practice surgeons often do work at multiple hospitals.

Working out of state can be done but given the nature of surgical work, is a bit impractical. How would you get patients if you're there only one month out of the year? Hard to build a referral network when you aren't available to your referring physicians and patients 11 months out of the year. What if a patient had a delayed post op complication? Who is covering for you the rest of the year/who's seeing these patients? Then you have the issue of having to be licensed, insured, have coverage at every hospital you operate out in another state. Better to take that month and go sailing in the South Pacific.

 

[fourteen12]

Working out of state can be done but given the nature of surgical work, is a bit impractical.

Thank you so much for the help! Would it be any different for trauma surgeons considering that their work is done with the ED and really wouldn’t involve things like referrals, etc?

 

[Apollyon]

Thank you so much for the help! Would it be any different for trauma surgeons considering that their work is done with the ED and really wouldn’t involve things like referrals, etc?

The vast majority of trauma now is non-operative. Also, believe it or don't, trauma patients, unless they're from MVCs, are not very often the most functional, productive members of society, so, they are more likely to be uninsured/no pay. I don't know for sure, but I don't think there are many trauma-only surgeons.

 

[Winged Scapula]

Thank you so much for the help! Would it be any different for trauma surgeons considering that their work is done with the ED and really wouldn’t involve things like referrals, etc?

I presume you are either a high school student or pre-med, correct?

Trauma surgeons don't rely on referrals, it is true. However, as @Apollyon notes, trauma is often non-operative and many (?most) trauma surgeons are also doing general surgery and ICU care.

Perhaps if you clarify what you are thinking about it will help. If you are looking to work in different environments frequently, the option of working as locum tenens surgeon exists. Most people want a home and to stay in one place (and its easier, for your lifestyle, for your tax accountants, etc). I could envision working part time in 2 states that are nearby, but not going somewhere for 1 month out of the year. I simply do not see a practice environment where that would be desirable or feasible. Your malpractice in that state won't be any cheaper just because you're only working there one month a year, so you'll eat up your salary with that, travel, renting a hotel room for a month etc. Just doesn't seem practical to me.

 

[fourteen12]

I presume you are either a high school student or pre-med, correct?

Perhaps if you clarify what you are thinking about it will help.

Pre-med. My friends dad is an ER doctor who also does some business stuff but anyway, they have a house in Wyoming. About 1 month every summer they’ll go out there and he’ll work about 3 days a week and then fly fish or white water raft the rest of the time. I was wondering how this works and how hard it is to be employed at multiple hospitals like this. If it helps to know, both hospitals are HCA hospitals and therefore sort of affiliated with each other.

 

[Smurfette]

Pre-med. My friends dad is an ER doctor who also does some business stuff but anyway, they have a house in Wyoming. About 1 month every summer they’ll go out there and he’ll work about 3 days a week and then fly fish or white water raft the rest of the time. I was wondering how this works and how hard it is to be employed at multiple hospitals like this. If it helps to know, both hospitals are HCA hospitals and therefore sort of affiliated with each other.

ER is shift-work so it's different from surgery. If you operate on someone, you see them in the office a week or two later and make sure they are doing ok. You also manage any complications that arise as a result of their surgery. As a surgeon, you're not going to find a "work a few hours a few days a week" for a month type model, unless it's an unusual locums set up (the vast majority of locums jobs involve covering for entire weekends or entire weeks of time looking for coverage, not just a few random days scattered over a month).

 

[Winged Scapula]

Pre-med. My friends dad is an ER doctor who also does some business stuff but anyway, they have a house in Wyoming. About 1 month every summer they’ll go out there and he’ll work about 3 days a week and then fly fish or white water raft the rest of the time. I was wondering how this works and how hard it is to be employed at multiple hospitals like this. If it helps to know, both hospitals are HCA hospitals and therefore sort of affiliated with each other.

Ah.

As @Smurfette notes, you are comparing apples and oranges.

Emergency Medicine is highly conducive to the setup you have outlined. When you are off, you are off. Surgery is not for the reasons she has outlined.