How important is your first job out of residency?

[Foodie]

I've been losing sleep for the past few weeks, tossing and turning, trying to pick an 1-to-possibly-2 year stint (spouse stuck here for another year or so for work) from the following three offers. I know I'm lucky to even have choices.

1) a large PP group doing thoracic, cardiac, neuro, vascular, OB along with bread and butter cases at three well-staffed urban and suburban hospitals (working with residents and CRNAs), likely will be working like a dog for $275K, but within a system that I know well since I worked there as a resident. Might be weird to be working side by side with attendings that I've been calling "Dr.____". This offer is for one year only.

2) $350K+ in a small community hospital in my neighborhood doing my own bread and butter cases + OB. Hospital employed. Great benefits, malpractice, etc. No CRNAs or residents. Lifestyle likely much better than #1. They would prefer that I stay 2 years at least, which is fine. I'm in my early 30's and can dish it out hard elsewhere afterwards.

3) A university hospital working with residents getting paid $220K. Instructor level as a board eligible anesthesiologist. **** pay, I know. Plus to work there I would have to move (is it worth moving when I know I will be leaving after 1 or 2 years?) No OB, no cardiac.

From what I've read, up to 70% of physicians change jobs within their first 3 years out of residency/fellowship. I would really appreciate the expert guidance of the practicing anesthesiologists on SDN, because I have no idea how significant a role the first job out of residency plays. Of the three positions I stated, which would increase my value as a candidate for the next job? Would my "hey, I was making $375K at my last job" give me a leverage for negotiating with my next employer? Or would my experience doing big cases? Or holding an academic position?

Will I be doing a disservice to myself if I were to stop doing the big cases that residency has made second nature? Meaning... will I be rusty if I spend 1-2 years doing bread + butter cases only? Has any of you been in a similar situation as mine?

Seeing where Obamacare is headed, is it most prudent to take the position with highest pay? Having written this, I don't think I'll even consider #3 in the running.

Please help.

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[desflurane]

First off congrats on the multiple offers. In this market thats a real achievement.

The right answer is the one that makes sense to YOU. Sorry, not a great response but the truth.

I was given all sorts of advice when I was in your position. I've changed positions way too many times in my 10-ish year career and have yet to find a perfect place because it doesn't exist.

The advice I give all of my residents is to go out there and do the biggest cases you can comfortably do and do them alone. Then, if and when that gets old, supervise. Learning to supervise a resident or crna is an important aspect of what we do but it pales in comparison to spending time solidifying your knowledge base in practice. Your first ruptured AAA on call by yourself will be the scariest valuable experience you can have as a newb.

 

[cincincyreds]

I would do the one that makes you most happy. If you are most happy at the 220k job, do that, if you are most happy at the 375k job, do that.

I say this because money doesn't buy happiness.

 

[BLADEMDA]

I've been losing sleep for the past few weeks, tossing and turning, trying to pick an 1-to-possibly-2 year stint (spouse stuck here for another year or so for work) from the following three offers. I know I'm lucky to even have choices.

1) a large PP group doing thoracic, cardiac, neuro, vascular, OB along with bread and butter cases at three well-staffed urban and suburban hospitals (working with residents and CRNAs), likely will be working like a dog for $275K, but within a system that I know well since I worked there as a resident. Might be weird to be working side by side with attendings that I've been calling "Dr.____". This offer is for one year only.

2) $350K+ in a small community hospital in my neighborhood doing my own bread and butter cases + OB. Hospital employed. Great benefits, malpractice, etc. No CRNAs or residents. Lifestyle likely much better than #1. They would prefer that I stay 2 years at least, which is fine. I'm in my early 30's and can dish it out hard elsewhere afterwards.

3) A university hospital working with residents getting paid $220K. Instructor level as a board eligible anesthesiologist. **** pay, I know. Plus to work there I would have to move (is it worth moving when I know I will be leaving after 1 or 2 years?) No OB, no cardiac.

From what I've read, up to 70% of physicians change jobs within their first 3 years out of residency/fellowship. I would really appreciate the expert guidance of the practicing anesthesiologists on SDN, because I have no idea how significant a role the first job out of residency plays. Of the three positions I stated, which would increase my value as a candidate for the next job? Would my "hey, I was making $375K at my last job" give me a leverage for negotiating with my next employer? Or would my experience doing big cases? Or holding an academic position?

Will I be doing a disservice to myself if I were to stop doing the big cases that residency has made second nature? Meaning... will I be rusty if I spend 1-2 years doing bread + butter cases only? Has any of you been in a similar situation as mine?

Seeing where Obamacare is headed, is it most prudent to take the position with highest pay? Having written this, I don't think I'll even consider #3 in the running.

Please help.

Job 1 seems pretty good for 12 months and sharpening your skills. What you earned at your last job has no relevance to your next employer. But, he does care about your skills, case experience, interpersonal skills and attitude.

I'd say go with job 1 but try for $300K. It can't hurt to ask them. Job 2 doesn't develop your skills well as a new graduate but sounds decent if it suites your needs/goals.

Job 3 sucks

 

[Foodie]

First off congrats on the multiple offers. In this market thats a real achievement.

The right answer is the one that makes sense to YOU. Sorry, not a great response but the truth.

I was given all sorts of advice when I was in your position. I've changed positions way too many times in my 10-ish year career and have yet to find a perfect place because it doesn't exist.

The advice I give all of my residents is to go out there and do the biggest cases you can comfortably do and do them alone. Then, if and when that gets old, supervise. Learning to supervise a resident or crna is an important aspect of what we do but it pales in comparison to spending time solidifying your knowledge base in practice. Your first ruptured AAA on call by yourself will be the scariest valuable experience you can have as a newb.

Thanks for the congrats. At the beginning of my job search all I wanted was just one offer. Now that I have options, I feel like I'm holding my future in my hands, and I am afraid to make the wrong choice. You are right that there is no perfect job out there.

I also completely hear what you are saying about doing difficult cases alone in the beginning of my career. While that sounds awfully scary, it will happen at one point in my career and it might as well happen earlier than later when I'm fresh out of residency.

 

[Foodie]

Job 1 seems pretty good for 12 months and sharpening your skills. What you earned at your last job has no relevance to your next employer. But, he does care about your skills, case experience, interpersonal skills and attitude.

I'd say go with job 1 but try for $300K. It can't hurt to ask them. Job 2 doesn't develop your skills well as a new graduate but sounds decent if it suites your needs/goals.

Job 3 sucks

Thank you for your thoughts. With #1, part of me is concerned that I won't be doing the cases on my own (i.e. skills getting rustier...). But I guess it's time to let go of my OCD demons and start supervising. Perhaps I should ask if I can be in a room by myself a few times a month.

Funny thing is I think #1 offered $275K knowing that I have a standing $350K offer because I told them that I didn't want to work in a community hospital letting my skills die. I just hate it when I ask for more and employers come back with a typical "but this is what we typically offer new graduates in our group." But I agree that there is nothing to lose by asking.