How long did it take to build your practice/patient base and what was your lifestyle like during?

[sadgeboi]

My understanding is that for a lot of new attending surgeons, lifestyle can be similar or worse than residency for at least the first few years while building up your practice. I've also heard that it's common for many groups/places to make new attendings take heavy call loads until they are more established and that, in general, it can be hard to find employment if you are someone who prioritizes lifestyle after residency.

I know that practice settings are REALLY variable, but just curious to hear about different experiences have been like, regardless of if it's private practice, employed, academic, etc.

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[Smurfette]

My understanding is that for a lot of new attending surgeons, lifestyle can be similar or worse than residency for at least the first few years while building up your practice. I've also heard that it's common for many groups/places to make new attendings take heavy call loads until they are more established and that, in general, it can be hard to find employment if you are someone who prioritizes lifestyle after residency.

I know that practice settings are REALLY variable, but just curious to hear about different experiences have been like, regardless of if it's private practice, employed, academic, etc.

Honestly, I always had way more time on my hands when first starting out/relocating. Hours are better because you just don't have patients to see. There's some orientation type stuff and hopefully some planned meet and greets (go to PCP offices and meet them over lunch, introduce yourself, etc.), but otherwise your days are far from packed when you have minimal patients on your OR and clinic schedule. Maybe hang out with your partners in the OR to learn the hospitals or assist them if you want.

It is reasonable to take call to try and establish yourself, or to accept some patients from your partners to lighten their load and build yours. But call as an attending (outside of academics/big referral centers) is home call and a completely different experience than call as a resident. I generally only go in at night if I'm operating. Otherwise the consult waits until the next day.

But yes, if your idea of lifestyle is vastly different from your partners, you could find yourself in a less than ideal situation. No one wants a new partner who doesn't pull their weight or dumps onto everyone else. But there is a spectrum in most groups as far as how they prioritize their time. If you are hospital employed and heavily prioritize lifestyle over work, your income will reflect it.

 

[operaman]

New attending here - one year out. Employed privademic. Been great so far. Hours way better than residency though call is worse ( took only 4 weekends of call my chief year and have 7 weekends now).

First clinic was on a Monday, by that Wednesday was booked pretty solid. Now booking new patients 3-4 months out. OR probably took the longest to ramp up - maybe 3 months to fill my block time consistently. Just too much lag time to get people through the various steps needed to get to the OR. Now it’s the opposite problem - next available OR block slot is 3 months out which is a long time to wait. Trying to cut back some clinic time now to add OR time.

I found a pretty special situation where there’s a huge need, I’m the only sub specialist in my niche here and the next closest one is 6 hours away. And I have a couple near retirement non-op partners funneling me good operative cases. It’s led to some pretty tough weeks though - had a couple recently that felt like residency 2.0 with late nights and early morning rounds. Not fun!

So now I’m adjusting my schedule to be more lifestyle friendly while maintaining my volume. Now my clinic days are stopping at 1pm so I can either finish notes and be done around 2pm and/or add on smaller operative cases. I tweaked the template so I see only 1-2 patients less than I do now while increasing my OR volume. I’m one of the most productive docs in the hospital so they’ve been very understanding and giving me leeway.

So within one year, should have a schedule that sees me home by 3 most days, maybe 4-5 sometimes. Will see how it goes, but I think that should let me have a nice balance.

 

[Lem0nz]

New attending, one year out. Work worse hours than at any point in residency with perpetual call and poor quality of life, but I am a solo practice HPB/surgical oncologist which I would never, ever, ever do again. If I stay at this institution it will likely pay massive dividends over the course of my career but I do not think the 'investment' to build the program from scratch alone was worth it at present. Again, if I stay here, we will see if my opinion changes ~5 years from now. Or even one year from now once I have hired a partner.

Short version, 10/10 would not start a surgical practice from scratch with no partners fresh out of training. Was super stupid.

 

[DoctwoB]

Joined a 3 man group. Was busy more or less from the get go (though they set it up for longer appointment slots at first), though I lucked into a good setup with a lot of retirements in the area.

Some OR volume picked up quickly (the stuff with less lead time, e.g stones) some took longer like prostatectomies, since it takes a while to go from PSA to biopsy to surgery.

Edit: One thing to note for those starting out is that it will depend a TON on how your scheduling works. If you are in the community and referrals are sent specifically to Dr. X, it will take you a while to build up as you will need to network with PCPs, etc. to get them to refer to you, unless your partners are backed up and hand you the new referrals.

Alternatively, if you are part of a larger system and there are a lot of "referral to urology", or "referral to general surgery", then you will get busy much, much faster as you will have the soonest availability and those slots will fill up fast, assuming you have the referral base in the first place

 

[deleted50541]

I'm just starting my fourth year at my second job (4+ years out from training). I share essentially q2 call with my partner who's been established in the system for almost a decade. He's kinda the go-to guy for referring providers since he used to be the only game in town, so I've had to work hard to network and demonstrate good outcomes. But my partner has been great and is very supportive of my development. I've created my niche doing most of the thymectomies for myasthenia, sympathectomies, and even VATS arrhythmia procedures that the cardiac guys wanted help with. I still do plenty of lung resections, which my partner and I split up, while he focuses on benign and malignant foregut disease. We also tag team on a lot of complex cases, the last I recall requiring a clamshell for a huge mediastinal liposarcoma.

In general, I'm not as busy as he is, but the work has been steady and my volumes/referrals have increased over time. Despite the excessive call (which my partner and I agree it definitely is), we are paid well and have prioritized our well-being and family life as much as possible. Our latest move was to have all first calls go to a single number for our PAs (with extra compensation of course). It's been a life changer. He burned out hard when he was solo and is all about tailoring our practice to be lifestyle-friendly when possible.

My life is definitely better as an attending than it was as a trainee. Most nights I sleep in my own bed, I see my kids everyday, and things feel reasonably balanced.