I got offered a job straight out of residency in a Big OB/GYN hospital, should I accept?

[Sleeplessbordernights]

CA3 here… so I got recruited to a big OB/GYN center starting in a couple of months. i did like 4 months there as a part of my training and I made a good impresion with the head of anesthesia, but I can’t help but be nervous about my first real job out there. I posted this elsewhere and the feedback I got is that I should just do OB/GYN straight out of residency as my other skills will probably be neglected. This hospital It’s main focus is ob but also has an oncology and laparoscopic surgery department. What do you think?

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[vector2]

CA3 here… so I got recruited to a big OB/GYN center starting in a couple of months. i did like 4 months there as a part of my training and I made a good impresion with the head of anesthesia, but I can’t help but be nervous about my first real job out there. I posted this elsewhere and the feedback I got is that I should just do OB/GYN straight out of residency as my other skills will probably be neglected. This hospital It’s main focus is ob but also has an oncology and laparoscopic surgery department. What do you think?

I think the best thing any new grad could do is get a first job where you do ob/gyn......................plus ortho, cysto, vascular, thoracic, ortho, regional, spines, cranis, bariatrics, healthy peds, IR, EP, and trauma. And that includes at least some time sitting your own cases.

Joining a women's hospital right out the gate seems like a terrible idea unless you're OB fellowship trained and pursuing academic practice/have a deep desire to make OB your life's work (ick).

 

[pocafx]

Is this a serious question? Do you hate yourself?

 

[Urzuz]

What is the pay structure like? If it’s a busy L&D floor with a decent payor mix and it’s eat what you kill, OB can be extremely lucrative.

Of course, all your other skills will erode tremendously as you slowly transform from a big, bad well-rounded CA3 at the top of your game to a hollowed out, husk of an anesthesiologist who is a glorified neuraxial monkey…but I $uppo$e it depend$ on what your motivation$ for choo$ing ane$the$ia were to begin with.

Edit: and if you don’t take the job, would you mind forwarding along my CV to the group? Thnx

 

[amyl]

This is not a good choice first job.

 

[gcc322]

If you’ve already done 4 months there it’s likely you aren’t going to learn/hone any skill from residency that you weren’t already proficient. Unless the money/time off is top notch, I would not want to do exclusively OB/gyn. Ultimately it depends on your priorities…if you can’t see yourself enjoying your work unless it’s 24/7 OB, then this might be your dream job.

 

[DirtDocMD]

Ring, ring....

2:30am—“Yes, is this anesthesia??? My patient in 417 needs a top-up dose! She says she can still feel some pressure, and it’s making it hard for her to sleep during her labor! 🙄Oh, and Dr. Johnson is planning a c-section at 6:45, on the pt in 423, because he’s got a full day at the surgery center starting at 8am, and she’s not progressing as fast as he’d like...”

307am—-“Yes, is this anesthesia?????.....”

402am—-“Yes, is this anesthesia.......???”

Helllllllll, nooooooo........

 

[kidthor]

CA3 here… so I got recruited to a big OB/GYN center starting in a couple of months. i did like 4 months there as a part of my training and I made a good impresion with the head of anesthesia, but I can’t help but be nervous about my first real job out there. I posted this elsewhere and the feedback I got is that I should just do OB/GYN straight out of residency as my other skills will probably be neglected. This hospital It’s main focus is ob but also has an oncology and laparoscopic surgery department. What do you think?

I would never work there for reasons stated above.

Do you want to actually work there or are you just flattered that finally some place wants you? Because there are way more places that will want you too. But if you like OB and like the hospital and want to work there then I suppose it could be ok…

 

[Ronin786]

Such a personal question. Did you enjoy your 4 months there? Do you see yourself doing this forever?

I don't think you'll erode your anesthesia skills assuming it's not just OB. A center like that is probably doing gyn-onc, accretas, cystos and complicated OB. Assuming you're not just an OB monkey, you're going to get a lot of exposure similar to a general job.

What's the money like. What's the work/life balance. The environment.

Too many factors, not enough info.

 

[Ashers]

This sounds awful. But I hate ob more than I like money. And ob made me want to get injured, so I wouldn't have to work my shift, but I really didn't want to repeat a clerkship in school, rotation on residency, and in private practice I quit doing it in less than 2 years.

That being said, you should choose a job where you do as much variety as you can. Then you can cut stuff out. Like I voluntarily cut OB out of my practice before other specialties were cut out for me by hospital choices.

 

[Sleeplessbordernights]

I think the best thing any new grad could do is get a first job where you do ob/gyn......................plus ortho, cysto, vascular, thoracic, ortho, regional, spines, cranis, bariatrics, healthy peds, IR, EP, and trauma. And that includes at least some time sitting your own cases.

Joining a women's hospital right out the gate seems like a terrible idea unless you're OB fellowship trained and pursuing academic practice/have a deep desire to make OB your life's work (ick).

Not OB trained (tough I considered at some point)

 

[Sleeplessbordernights]

What is the pay structure like? If it’s a busy L&D floor with a decent payor mix and it’s eat what you kill, OB can be extremely lucrative.

Of course, all your other skills will erode tremendously as you slowly transform from a big, bad well-rounded CA3 at the top of your game to a hollowed out, husk of an anesthesiologist who is a glorified neuraxial monkey…but I $uppo$e it depend$ on what your motivation$ for choo$ing ane$the$ia were to begin with.

Edit: and if you don’t take the job, would you mind forwarding along my CV to the group? Thnx

its a very busy L&D with pretty much all complicated cases across the state brought there, plus a healthy GYN onc and lapy gyn departments

 

[Sleeplessbordernights]

Ring, ring....

2:30am—“Yes, is this anesthesia??? My patient in 417 needs a top-up dose! She says she can still feel some pressure, and it’s making it hard for her to sleep during her labor! 🙄Oh, and Dr. Johnson is planning a c-section at 6:45, on the pt in 423, because he’s got a full day at the surgery center starting at 8am, and she’s not progressing as fast as he’d like...”

307am—-“Yes, is this anesthesia?????.....”

402am—-“Yes, is this anesthesia.......???”

Helllllllll, nooooooo........

Not gonna lie that sounds awful and I will be pretty much required to take call

 

[Sleeplessbordernights]

I would never work there for reasons stated above.

Do you want to actually work there or are you just flattered that finally some place wants you? Because there are way more places that will want you too. But if you like OB and like the hospital and want to work there then I suppose it could be ok…

tbh that might be the case, I’m extremely flattered that they want me

 

[Sleeplessbordernights]

Such a personal question. Did you enjoy your 4 months there? Do you see yourself doing this forever?

I don't think you'll erode your anesthesia skills assuming it's not just OB. A center like that is probably doing gyn-onc, accretas, cystos and complicated OB. Assuming you're not just an OB monkey, you're going to get a lot of exposure similar to a general job.

What's the money like. What's the work/life balance. The environment.

Too many factors, not enough info.

Tbh I loved my time there, lots of complicated cases but I really enjoyed it. They have gyn onc, lap gyn, uro. They pay is good, not as good as a rural offer I have but wife is starting residency in the city so that’s a huge facto. The environment not so good, the ob gyn there are pretty toxic but they stay apart from us, plus there will be CA-2 and tbh I love to teach

 

[forchinet121]

tbh that might be the case, I’m extremely flattered that they want me

What’s the pay??

 

[nimbus]

What’s the pay??

We staff a very busy womens hospital (9000+ deliveries/yr). Spots there are highly coveted. People who work there make 2x the average for our group. But they often run around nonstop for the duration of their shifts. High volume OB is one of the few ways you can make bank while doing MD only anesthesia. Still not for me.

 

[nimbus]

Tbh I loved my time there, lots of complicated cases but I really enjoyed it. They have gyn onc, lap gyn, uro. They pay is good, not as good as a rural offer I have but wife is starting residency in the city so that’s a huge facto. The environment not so good, the ob gyn there are pretty toxic but they stay apart from us, plus there will be CA-2 and tbh I love to teach

Is this in USA or Mexico? For some reason, I thought you were in Mexico. If there’s a lot of cash pay OB, it might be worthwhile at least for a couple of years.

 

[thinkorswim]

We staff a very busy womens hospital (9000+ deliveries/yr). Spots there are highly coveted. People who work there make 2x the average for our group. But they often run around nonstop for the duration of their shifts. High volume OB is one of the few ways you can make bank while doing MD only anesthesia. Still not for me.

Yup. It’s no coincidence that the highest earners in most all productivity-based groups are the ones hustling on OB. One 24 hour OB shift at my shop can generate more units than an average week in the main ORs.

The job described above would generate about $1 million per year, even with an average payor mix. The big question is what are they offering in terms of income and call schedule?

 

[dchz]

Yup. It’s no coincidence that the highest earners in most all productivity-based groups are the ones hustling on OB. One 24 hour OB shift at my shop can generate more units than an average week in the main ORs.

The job described above would generate about $1 million per year, even with an average payor mix. The big question is what are they offering in terms of income and call schedule?

Are you two in the same group?

 

[nimbus]

Are you two in the same group?

Used to be. He ditched us for greener pastures. Jerk!

 

[Twiggidy]

I personally wouldn't be able to stomach it, but on the other hand, there are people who probably can't stomach 24/7 cardiac and that would be a dream world for me.

I echo what vector said. The only caution I would say is that the skills you've learned in residency to be a well rounded anesthesiologist may erode quickly just doing GAs in the OR and epidurals/spinals on the floor. You don't want to forget how to handle neuro, vascular, ortho/spine, etc.

 

[pgg]

The environment not so good, the ob gyn there are pretty toxic

Say no more.

Life is short.

I would advise the lower paying but pleasant job, over the higher paying but toxic job, always.

As someone who just did the job hunt thing a year ago and made a major move, I can tell you that many, many jobs pay enough. Don't torture yourself to make $550K instead of $450K. Just don't. The marginal utility of the extra $60K post tax isn't as great as you think. JMHO, of course.

Almost all jobs pay enough, but not all jobs are tolerable, much less enjoyable. The #1 thing that makes any place good or bad are the people there, and a close #2 is how brutal/frequent the call is. Sounds like your OB job offer is 0 for 2 there ...



Also, agree with everyone else who said that new grads should go to a diverse practice. (Excepting those that are peds/CT/pain/CCM fellowship trained who want to be pigeonholed in those subspecialties - there will always be places they can go later to do the same. OB-only jobs are scarce.) A generalist who goes to an OB-only practice for a few years is going to be in an awkward state when the hospital burns down, or the group implodes, or the spouse demands a move to a different city, or it gets to be too much and you just can't take it any more.

It's rare for a first job to be your only job. Taking that job might close some doors a few years later.

 

[Twiggidy]

Say no more.

Life is short.

I would advise the lower paying but pleasant job, over the higher paying but toxic job, always.

As someone who just did the job hunt thing a year ago and made a major move, I can tell you that many, many jobs pay enough. Don't torture yourself to make $550K instead of $450K. Just don't. The marginal utility of the extra $60K post tax isn't as great as you think. JMHO, of course.

Almost all jobs pay enough, but not all jobs are tolerable, much less enjoyable. The #1 thing that makes any place good or bad are the people there, and a close #2 is how brutal/frequent the call is. Sounds like your OB job offer is 0 for 2 there ...



Also, agree with everyone else who said that new grads should go to a diverse practice. (Excepting those that are peds/CT/pain/CCM fellowship trained who want to be pigeonholed in those subspecialties - there will always be places they can go later to do the same. OB-only jobs are scarce.) A generalist who goes to an OB-only practice for a few years is going to be in an awkward state when the hospital burns down, or the group implodes, or the spouse demands a move to a different city, or it gets to be too much and you just can't take it any more.

It's rare for a first job to be your only job. Taking that job might close some doors a few years later.

Amen to everything PGG just said here.

 

[nimbus]

Say no more.

Life is short.

I would advise the lower paying but pleasant job, over the higher paying but toxic job, always.

As someone who just did the job hunt thing a year ago and made a major move, I can tell you that many, many jobs pay enough. Don't torture yourself to make $550K instead of $450K. Just don't. The marginal utility of the extra $60K post tax isn't as great as you think. JMHO, of course.

Almost all jobs pay enough, but not all jobs are tolerable, much less enjoyable. The #1 thing that makes any place good or bad are the people there, and a close #2 is how brutal/frequent the call is. Sounds like your OB job offer is 0 for 2 there ...



Also, agree with everyone else who said that new grads should go to a diverse practice. (Excepting those that are peds/CT/pain/CCM fellowship trained who want to be pigeonholed in those subspecialties - there will always be places they can go later to do the same. OB-only jobs are scarce.) A generalist who goes to an OB-only practice for a few years is going to be in an awkward state when the hospital burns down, or the group implodes, or the spouse demands a move to a different city, or it gets to be too much and you just can't take it any more.

It's rare for a first job to be your only job. Taking that job might close some doors a few years later.

Or you can take a job with a group where everybody else hates OB and just do OB all the time. I know a couple of people who have done that.

 

[Drwine]

Or you can take a job with a group where everybody else hates OB and just do OB all the time. I know a couple of people who have done that.

It can be turned into a win-win. The group I just retired from carves out OB as an "internal moonlighting" situation. Those doing it get a low hospital stipend for carrying the pager and get 95% of the collections which covers the billing cost. I did 2-3 shifts a month for about 20 years. It was a good contrast to cardiac and thoracic cases but I learned to finally put the word "enough" in my vocabulary. Nothing else in anesthesia financially tops 5 insured epidurals running concurrently. Capitalism at its best.

 

[Angus Avagadro]

I agree with the above comments with respect to night work, research, and lack of case diversity by working at a Women's Hospital. Only thing to add is that it might be a stepping stone to a better job. I know someone who did that for a couple years, then transferred within the university system to their Level 1 hospital, then later in to lucrative private practice job where they were the director of OB anesthesia, yet worked in the OR with a diversity of cases.
Secondly, if the spouse wants a change of scenery, an anesthesiologist with an ob backround can be attractive to certain groups, as others have pointed out. Today, in most cases, I would not recommend a new grad starting out in a specialty hospital as they have not yet honed many skills needed for most practices. Diff airway, regional pain management, TEE, etc.

 

[sevoflurane]

You REALLY need to love OB.
It is our least popular panel at my job yet generates the most revenue. There is a lot to learn in that last sentence.

 

[IMGASMD]

What’s the pay??

Most important question.

 

[Planktonmd]

This is a terrible idea!

 

[OptionOffense]

Yup. It’s no coincidence that the highest earners in most all productivity-based groups are the ones hustling on OB. One 24 hour OB shift at my shop can generate more units than an average week in the main ORs.

The job described above would generate about $1 million per year, even with an average payor mix. The big question is what are they offering in terms of income and call schedule?

I thought OB was poorly re imbursed? How are you making money? Labor epidurals? C sections?

 

[Southpaw]

I thought OB was poorly re imbursed? How are you making money? Labor epidurals? C sections?

Depends on payor mix. Commercial pay OB (United healthcare aside - they’re generally crap and getting far worse….) is some of the best anesthesia business out there. And Medicaid OB is some of the worst (with the highest risk patients also). It’s a tale of two stories.

 

[aneftp]

A women’s only hospital may work if they cover surgery centers on the side.

But u are mainly dealing with 60-70% asa 1-2 patients at women’s only hospital.

 

[DocVapor]

A women’s only hospital may work if they cover surgery centers on the side.

But u are mainly dealing with 60-70% asa 1-2 patients at women’s only hospital.

What promised land is this?

 

[IMGASMD]

I thought OB was poorly re imbursed? How are you making money? Labor epidurals? C sections?

?!
Depends on your payer mix and how you negotiated with the insurance company.

 

[thinkorswim]

I thought OB was poorly re imbursed? How are you making money? Labor epidurals? C sections?

Both. As mentioned above, payor mix on OB is everything. A hospital in an upper-middle class suburban area can have over 90% commercial OB patients ($70+/unit) and very little Medicaid (under $20/unit). If volume is high enough, it can even make up for all the Medicare patients in the main OR of the hospital.

 

[IMGASMD]

Both. As mentioned above, payor mix on OB is everything. A hospital in an upper-middle class suburban area can have over 90% commercial OB patients ($70+/unit) and very little Medicaid (under $20/unit). If volume is high enough, it can even make up for all the Medicare patients in the main OR of the hospital.

It also depends on how it’s billed. I know for a while we billed per epidural, regardless how long it runs.
We were getting 1800 per. And our billing company told us we were under-billing. But I suppose when you add the Medicaid 50 per. It all balances out….

 

[anaesthetic]

n=1, but I know a practice that does exclusively Ob. They get paid very well, have been doing it for at least two decades, and are almost completely useless outside of their Ob enclave, so much so that they ship us their C-hyst patients because they suddenly forget how to do anesthesia when the uterus needs to come out.

 

[OptionOffense]

n=1, but I know a practice that does exclusively Ob. They get paid very well, have been doing it for at least two decades, and are almost completely useless outside of their Ob enclave, so much so that they ship us their C-hyst patients because they suddenly forget how to do anesthesia when the uterus needs to come out.

This is definitley California right?

 

[Twiggidy]

n=1, but I know a practice that does exclusively Ob. They get paid very well, have been doing it for at least two decades, and are almost completely useless outside of their Ob enclave, so much so that they ship us their C-hyst patients because they suddenly forget how to do anesthesia when the uterus needs to come out.

That’s wild

 

[Twiggidy]

This is definitley California right?

Seriously?

 

[2Fast2Des]

The fact that there is an OB specialist is already laughable. Someone who wants to deal with the OB patients, and the endless pager that goes off in the middle of the night for a top off or pull call, on an every day basis, the pay better be spectacular for the ensuing brain drain and drama

 

[Twiggidy]

It also depends on how it’s billed. I know for a while we billed per epidural, regardless how long it runs.
We were getting 1800 per. And our billing company told us we were under-billing. But I suppose when you add the Medicaid 50 per. It all balances out….

Yeah. Let’s say you places a block as soon as you arrive for shift and it’s runs 12 hrs
5 units insert
4 units first hour (and I mean the entire hour)
2units/hr for 11 hrs

31 units x $70/unit = $2170
And we know a one block and do nothing else day is not often so maybe add a section and another block or two you picked up or placed. Easily a 5k shift

Now this is mostly just if you’re in a group that can stand up to an insurance company in negotiations. If we’re being conservative with a diverse payor mix/well run group it’s probably close to $45-$50/unit. In that’s case, $1800 for a block isn’t that bad especially if they deliver under 12 hrs

 

[thinkorswim]

31 units x $70/unit = $2170
And we know a one block and do nothing else day is not often so maybe add a section and another block or two you picked up or placed. Easily a 5k shift

This sounds like your average shift at an average volume OB hospital. A 12 hour shift at a high volume OB hospital (5,000+ deliveries per year) would look more like 5-10 epidurals and 2-3 sections, totaling on average about 150 units per 12 hour shift.

Two OB shifts plus two to three days in the main OR, you’re looking at 350-400 units in a week. That’s over $800k per year with an above average unit value, not even including any hospital stipends. This is why it matters how you get paid.

 

[aneftp]

What promised land is this?

Have u been at a tertiary women’s hospital? You aren’t doing major vascular thoracic or hearts.

How many valvular pregnant patients will you have? Out of 100 pregnant patients. Chances are less than 1%. It’s simple.

Same
With hysterectomy or other gyn onc patients. Most do it have significant co morbidly. Unless you are counting every bmi greater than 35 as Asa 3.

 

[DocVapor]

Have u been at a tertiary women’s hospital? You aren’t doing major vascular thoracic or hearts.

How many valvular pregnant patients will you have? Out of 100 pregnant patients. Chances are less than 1%. It’s simple.

Same
With hysterectomy or other gyn onc patients. Most do it have significant co morbidly. Unless you are counting every bmi greater than 35 as Asa 3.

I'm not following. Are you saying it takes valvular problems to qualify for ASA 3?

Edit:. No, I haven't been to a tertiary women's hospital. If what you're saying is that they ship out all the BMI >45 (and no, I don't give a BMI 35 otherwise healthy an ASA 3), poorly controlled diabetics, poorly controlled epileptics, acutely intoxicated and chronic drug abusing, pre-eclamptics with severe features, etc, then I'll take your word for it.

 

[sevoflurane]

This sounds like your average shift at an average volume OB hospital. A 12 hour shift at a high volume OB hospital (5,000+ deliveries per year) would look more like 5-10 epidurals and 2-3 sections, totaling on average about 150 units per 12 hour shift.

Two OB shifts plus two to three days in the main OR, you’re looking at 350-400 units in a week. That’s over $800k per year with an above average unit value, not even including any hospital stipends. This is why it matters how you get paid.

At least.
Usually 5 c/s per day plus 10-15 epidurals.
Currently 7 hrs down and 17 to go. ☹️

 

[sevoflurane]

OB can be the most lucrative subspecialty of anesthesia…. but it also beats you down like no other.

 

[sevoflurane]

I think I did 9 c/s and 14 epidurals one shift a few years ago.
Absolute misery.
High volume centers will give you uterine ruptures, percretas, exit procedures, amnio embolisms, peripaetum cardiomyopathies, amongst others. So you do need to be on your game at those centers.

Had a hypoplastic left heart yeaterday.

 

[Hiram Coggin]

21 epidurals in 24 hours one time. Misery although most of them were during the day.