Is it ok for me to ask questions about jobs after graduation here?

[glade]

Or are we only allowed to discuss residency?

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[glade]

Ok I guess I'll just ask.

I'm getting ready to look for jobs and I'm getting freaked out. There are a few big issues that I was hoping I could get feedback with. Please only general surgeons.

- I hear that there is a shortage of gen surgeons. But I also hear that the shortage is really basically only in undesireable areas. So as a gen surgeon you could find work at a big city but only at a pretty low pay. Or you can go to the middle of nowehere and make good money. Is that your experiences? I'm scared because I want to live in a big city but not if I have to be working for like $120k.

- A lot of disgruntled attendings tell me that gen surgeons are basically the servents of the PCPs. If you don't do what they want they just find a different surgeon who will and then only refer to them. My one attending who is just a few years out was forced to come in to the hospital and put in a dialysis catheter at 11 PM once because the PCP paged him and yelled at him for not doing it. Since he's still building up a referral base he had to do it. Is that what things are like??

- Last, any insights on how to find a hospital to work at once you narrowed down the geographic area? Do you just start cold-calling? I was told recruiters were a bad idea.

Thanks so much for any insights!

 

[filter07]

I don't know the answer since I'm just a resident, but I think more discussions like this would be interesting. More interesting than the stuff the med students post here.

 

[JackADeli]

do a search... topics come up fairly frequently each year....
also, scan down on the list of threads, i.e.:

http://forums.studentdoctor.net/showthread.php?t=708449

...There are plenty of GS residents but around 75% will seek fellowship training -a stable figure for many years now. Thus the shortage of real general surgeons.

...I have heard that some smaller community surgical practices are offering up to $350,000 a year for general surgeons, at least in Pittsburgh, because they are hard to come by and desperately needed....

During my GS sub-I this past November, I heard one of the chiefs ...stayed in GS and was offered 350K for a hospital-salaried position. And that wasn't even in a "rural" hospital. Another chief, who moved back to his hometown in rural NM, was offered 400K...

...do google searches & such.... 300k+ income with 20-60k signing and 20k relocation are not uncommon. My last GSurge offer was 350-400K with a 45K signing. I didn't like the set-up and passed on it... have had plenty of similar offers after that one.

 

[glade]

Thank you, sir!

I apologize. I had actually posted this after reading that thread and only because my experiences differed. We had a guy find a place a few years back in gen surgery in the 300+ range but it was in a fairly undesireable location. And many people tell me that the only thing gen surgeons can do these days is appendectomies and cholecystectomies and hernias. For example, if you want a colectomy people go to colorectal guys. If you want an AV fistula they go to vascular guys. And so on. That is why I had asked, since I was hoping for some other opinions.

 

[JackADeli]

...And many people tell me that the only thing gen surgeons can do these days is appendectomies and cholecystectomies and hernias...

Not true. I suspect plenty of gen surgeons would love a predominant appy/chole practice. However, hospitals around the country are recruiting for general surgeons that "do it all" to the extreme.... this includes gen surgeons willing to do periph vasc, AAAs, etc.... The fellowship crew would like you to believe you must have a fellowship... may be true in saturated cities and academia but not necessarily a global truth.

No apologies needed... I was just trying to answer your question.

 

[glade]

May I ask if you used recruiters or some other method in your job search?

 

[Winged Scapula]

Its all about the local flavor.

I live in the 5th largest city in the US and am friends with several general surgeons. Guys who make a LOT of money. This is not a rural environment but it is a heavily private practice town (ie, very little academic rivals). Their practice is mostly choles, appys, hernias, breast, etc. but they do their fair share of colons, thyroids, and other cases that might otherwise go to a specialist.

What you are able to do as a general surgeon depends on the local environment, the competition for those cases, what skills you bring and how you market yourself. Pay is also variable depending on what you negotiate with your practice/employer, insurance companies, EDs (ie, are you paid to take ED call?), and how hard you work.

Finding employment is a function of multiple resources. All the trade journals have ads at the back, surgical organization web sites have listings, there are headhunters and of course, word of mouth and connections. Use whatever will get you what you want (although bear in mind that most headhunters only want to fill the job, as they get paid if they do, regardless if its right for you).

If you are interested in an academic position, these jobs will often be advertised to other academic medical centers or you can cold call and see if they are interested. Otherwise, most hospitals don't employ surgeons. You have staff privileges but in the PP world, you work for or with a surgical group (or in solo practice) not for the hospital.

As noted, there are lots of threads about how to find a job - sounds like your residency program hasn't helped you much...please tell me you are a 4th year and not a 5th year resident (who should have thought about this stuff a year ago).

 

[glade]

No, my place really hasn't done much.

What is confusing is that everyone says that everything is an option. And while I understand that is true, it is not terribly helpful. (I do not mean to put down anyone's advice here.)

Perhaps if I am more specific, it will help. One of the places I am interested in is Philadelphia and its suburbs. The thing is that the city is dominated by big academic university hospitals. I'm not really interested in research, but otherwise I'd be thrilled to be at one of those programs. I do hear that people at university programs are usually salaried (and underpaid). But I don't know if they'd even look at me without an interest in research. Or I could go productivity and try for a community hospital. But I'm not sure how to go about finding groups and I also hear lots of horror stories about people suckered into joining groups that keep you as the junior partner to cover weekends and holidays.

 

[Winged Scapula]

No, my place really hasn't done much.

What is confusing is that everyone says that everything is an option. And while I understand that is true, it is not terribly helpful. (I do not mean to put down anyone's advice here.)

Perhaps if I am more specific, it will help. One of the places I am interested in is Philadelphia and its suburbs. The thing is that the city is dominated by big academic university hospitals. I'm not really interested in research, but otherwise I'd be thrilled to be at one of those programs. I do hear that people at university programs are usually salaried (and underpaid). But I don't know if they'd even look at me without an interest in research. Or I could go productivity and try for a community hospital. But I'm not sure how to go about finding groups and I also hear lots of horror stories about people suckered into joining groups that keep you as the junior partner to cover weekends and holidays.

Frankly, I'm not sure how someone survives as a general surgeon in PA, let alone Philly, given the malpractice environment.

But yes, there are many academic hospitals and you would be salaried. As for being underpaid, it is true that the salary is generally less than in PP, your health insurance, disability, malpractice is paid, you may have administrative staff all paid for. You may have less control over your call schedule and work hours, research obligations and the like.

In PP the potential for making more is certainly there but in a state with greater than $100K in malpractice per year for GS, you have to work a lot to cover the overhead. There are horror stories to be sure, although I'm not sure that taking more call as the junior group member is necessarily horror. What you negotiate and accept is entirely up to you. The less "special" you are and the less in demand your skills, the less you can negotiate.

So I know it seems vague, I know it seems like we're telling you that anything and everything is possible, but its because its true. The way you go about finding these groups is the same way you find jobs elsewhere - I get ads EVERY day in my mailbox for general surgery positions, both academic and PP. Look at websites like Cejka Search, Practice Link, etc. check out the trade journals, talk to groups in your town. Some hospitals have funds to help support a new grad in practice as a loan. Pick up this book to start learning some more.

 

[JackADeli]

Its all about the local flavor.

...What you are able to do as a general surgeon depends on the local environment, the competition for those cases, what skills you bring and how you market yourself...

Finding employment is a function of multiple resources. All the trade journals have ads at the back, surgical organization web sites have listings, there are headhunters and of course, word of mouth and connections. Use whatever will get you what you want (although bear in mind that most headhunters only want to fill the job, as they get paid if they do, regardless if its right for you)...

...Look at websites like Cejka Search, Practice Link, etc. check out the trade journals, talk to groups in your town. Some hospitals have funds to help support a new grad in practice as a loan. Pick up this book to start learning some more.

Pretty much sums it up.

Numerous hospitals will have head hunters for themselves. One thing to do is look at the area/s of interest to you and see if there is any major hospital system... i.e. HCA/Memorial Health/etc... Check their websites and they will often have listings/etc...

As for practice fit... it is like residency. It is all roses when they are selling to you and a surprise in the cracker-jack box when you actually start. Contract clarity does limit some of the surprise. Another aspect is this.... Look at the practice demographics. How old are your potential partners.... are they looking to establish a legacy as they twilight into retirement over the next 5-10 years or are they highering yound bucks, with high turnover, to be hemorrhoid specialists? What is their partnership track and what exactly are they going to try and bleed out of you for buy in... if there is a buy in? Plenty of practices partner without "buy in"... especially if there are no tangible assets, i.e. they don't own the building.

Spend some time with the hospital CEOs when you do interview and get an idea what groups in town are doing what, hospital CEOs have this data. They will often share it too. Hospitals have no vested interest in helping the black sheep practice in town violate a new grad. Hospitals want good surgeons in town even if they are not employed by the hospital.

 

[Winged Scapula]

What is their partnership track and what exactly are they going to try and bleed out of you for buy in... if there is a buy in? Plenty of practices partner without "buy in"... especially if there are no tangible assets, i.e. they don't own the building.

Don't be foolish like I was and fail to contract this up front.

It has led to a lot of stress, hurt feelings and expensive lawyers trying to sort out the financials now...it has worked out, but had we contracted it up front there would have been a lot fewer problems. Once you're in a practice, earning a good salary and have settled in, it becomes very difficult to extract yourself if you don't like the terms of partnership or the buy in.

 

[glade]

Pardon my asking another question, but when I look in the back of throw-away journals I do see job opportunities. But they're usually in what I would consider undesireable locations. This is not intended as an insult to anyone in those areas, so please do not be offended. But I do not have an interest in living in Wisconsin or Idaho or Oklahoma. Again, I know there are many fine physicians and hospitals in those areas, I am only saying that I personally do not wish to work there.

So is my best bet to just cold-call a hospital HR department? I apologize because I know this sounds ignorant but I really don't know how to get started.

 

[JackADeli]

Pardon my asking another question...

So is my best bet to just cold-call a hospital HR department?...

Again, no apologies necessary. You obviously failed to comprehend what was previously stated. So, I am reprinting it:

...Finding employment is a function of multiple resources. All the trade journals have ads at the back, surgical organization web sites have listings, there are headhunters and of course, word of mouth and connections. Use whatever will get you what you want (although bear in mind that most headhunters only want to fill the job, as they get paid if they do, regardless if its right for you)...

... Look at websites like Cejka Search, Practice Link, etc. check out the trade journals, talk to groups in your town. Some hospitals have funds to help support a new grad in practice as a loan. Pick up this book to start learning some more.

...Spend some time with the hospital CEOs when you do interview and get an idea what groups in town are doing what, hospital CEOs have this data. They will often share it too. Hospitals have no vested interest in helping the black sheep practice in town violate a new grad. Hospitals want good surgeons in town even if they are not employed by the hospital.

There is no magic bullet and no best answer.

 

[glade]

Yes, sir. I was just hoping that I could benefit from the experience of others who had done this before. I will definitely check out that book.

 

[SLUser11]

Yes, sir. I was just hoping that I could benefit from the experience of others who had done this before. I will definitely check out that book.

I would say that your advisors have tunnel vision, and apply their limited localized experience to the entire country. However, you may share that tunnel vision. If you only want to practice in big cities in the Northeast where there's already an oversaturation of surgeons, then you're really limiting your earning potential.

If anywhere besides Philly and New York is considered by you to be undesirable, then we really have no advice for you. However, I find it sort of ridiculous that you consider big cities outside your comfort zone, some with millions of people, as the "middle of nowhere."

Anyway, you don't have to practice in Smallville, OK to make good money. You can probably find a job 45 minutes outside your favorite city with a similar earning potential. If you really have no leads, then I don't see a problem with using a head hunter. Honestly, I'm surprised you haven't been frequently accosted by them the way I have for the last couple years.

 

[glade]

I apologize, as I said before I'm not trying to put down other parts of the country. My family is in Philadelphia and so that's one of the reasons I want to work there. It's simply a personal choice and not intended as an insult to people who work or live in other parts of the country. If you took it that way, I'm sorry.

I heard head hunters are not a good option because they just try to put you in any location so they get their commission. That's why I asked. Yes, I can find a head hunter but I wanted to see if there were other ways.

This is what is confusing to me. I often hear that physicians are fleeing Philadelphia due to malpractice. But I also often hear that the area is oversaturated with physicians. And at the same time I often hear that there is a need for gen surgeons there. But on the other hand people say that you can't be a gen surgeon in a large city due to the sub-specialists who will crowd you out. Everything seems to contradict itself. So I was hoping to also get some opinions on the job market there in general.

 

[JackADeli]

I am honestly feeling a little confused.

My impression is "the question" has been asked and answered repeatedly in this thread. I can not imagine anyone senior resident or soon to be graduating resident to be so incapable of grasping what has been posted to this point.....

repeating the question with "Sir, ...." is frankly obnoxious. WS listed numerous resources and/or options; others too. There is no magic bullet... translates to there is no "my best bet is..." answers. Our apologies you are just not getting the answers you want to get. Get over it, grow-up, and move on. Just get off your arse and start looking for a job. Use whatever resource you want.

and, enough with the apologies and not wanting to insult, and etc.... because it is becoming insulting!!!

 

[Dimoak]

So is my best bet to just cold-call a hospital HR department? I apologize because I know this sounds ignorant but I really don't know how to get started.

Some hospitals have special physician recruiters who would be of much greater help in the situation you describe. If you're going to cold-call facilities, just call their operator and ask to be connected to their physician recruiter(s).

 

[PostCall]

.....

 

[Winged Scapula]

I apologize, as I said before I'm not trying to put down other parts of the country. My family is in Philadelphia and so that's one of the reasons I want to work there. It's simply a personal choice and not intended as an insult to people who work or live in other parts of the country. If you took it that way, I'm sorry.

Philly is close to a number of other cities - I have a few friends who work "over the border" in NJ because of the more favorable malpractice environment, but commute home to Philly environs to home. There are other cities close by as well; Harrisburg for example is 90 mins away and it is possible to practice as a true general surgeon there. So consider, as others have suggested, places close to Philly.

I heard head hunters are not a good option because they just try to put you in any location so they get their commission. That's why I asked. Yes, I can find a head hunter but I wanted to see if there were other ways.

That may be true, but you don't have to accept any job they give you information on do you? Headhunters are simply a means to an end - they may have jobs that you are interested in, they may not. You choose what to do with the jobs they find for you. Only you can decide whether or not the job is right for you. As Dimoak notes, hospitals will have physician recruiters on staff as well.

This is what is confusing to me. I often hear that physicians are fleeing Philadelphia due to malpractice. But I also often hear that the area is oversaturated with physicians. And at the same time I often hear that there is a need for gen surgeons there. But on the other hand people say that you can't be a gen surgeon in a large city due to the sub-specialists who will crowd you out. Everything seems to contradict itself. So I was hoping to also get some opinions on the job market there in general.

Philly is oversaturated with physicians - subspecialists and academic physicians. It is not oversaturated with general surgeons. Here is a list of general surgeons in Philly (note that some are in academics, some may not be truly general surgeons). Here is another list. Here's a group in Cherry Hill that does a broad based practice. Why not contact some and see what they think the market is like?

 

[Guile]

And please report back with what you find out and how the research went...to help posterity.

 

[PostCall]

just work locum. there was a surgeon at one of the hospitals i rotated at who did that and he said he makes 2K per shift and 3K at another hospital he also locums at. dude works 3-4 days/wk, can take off for vacation whenever he wants cuz none of the patients are "his" as he's not on faculty. no administrative duties, no research duties, no teaching obligations...just a hired gun who operates like a machine/covers the SICU and makes mad money.

 

[Svidrillion]

just work locum. there was a surgeon at one of the hospitals i rotated at who did that and he said he makes 2K per shift and 3K at another hospital he also locums at. dude works 3-4 days/wk, can take off for vacation whenever he wants cuz none of the patients are "his" as he's not on faculty. no administrative duties, no research duties, no teaching obligations...just a hired gun who operates like a machine/covers the SICU and makes mad money.

What's the downside?

 

[PostCall]

What's the downside?

i suppose the respect thing, as in you won't be as respected cuz you're not part of the faculty but rather seen as an "outsider" of sorts. for example the other attendings wud often refer to him as "the locum". also cuz he wasn't faculty he got no resident coverage, meaning when he was on his shift he did all his own floor work (dressing changes, blood draws, discharge summaries, other "scut work") that are usually handled by interns/residents for attendings.

 

[JackADeli]

just work locum. ...can take off for vacation whenever he wants cuz none of the patients are "his" ...just a hired gun who ...makes mad money.

What's the downside?

Do a web search on the issue of "itinerant surgery". There is a line between locums and what you propose....

http://oig.hhs.gov/oei/reports/oai-07-88-00850.pdf

http://archsurg.ama-assn.org/cgi/content/extract/138/3/264

 

[PostCall]

Do a web search on the issue of "itinerant surgery". There is a line between locums and what you propose....http://

i'm not trying to "propose" anything per se. just telling how it works with that particular surgeon i met. seems like a decent gig for somebody starting out after residency or winding down towards retirement. or for somebody who doesn't want to put up with the BS that comes with moving up the hiearchy. no having to do research you don't care about, no having to sit through meetings/committees/conferences you don't want to be at but are obligated to, no having to teach med students/residents if it isn't your thing.

 

[Winged Scapula]

...or for somebody who doesn't want to put up with the BS that comes with moving up the hiearchy. no having to do research you don't care about, no having to sit through meetings/committees/conferences you don't want to be at but are obligated to, no having to teach med students/residents if it isn't your thing.

This is called private practice.

 

[PostCall]

This is called private practice.

but don't you still have to kiss primary care azz to get referals/consults?

locums seem not to have to answer to anybody except maybe their locum placement agency.

 

[Winged Scapula]

but don't you still have to kiss primary care azz to get referals/consults?

Depends. If you're the only game in town (ie, a niche practice) then the PCPs have little other options. That doesn't mean you can be an ass as other options may become available and then your SOL. I don't mind showing my referrers some love although I drew the line at the office staff who expected me to bring lunch for the whole office or wouldn't let me talk to the pcp without an appointment.

locums seem not to have to answer to anybody except maybe their locum placement agency.

True although there are drawbacks to locum work namely living out of a suitcase, no pets, etc.

 

[JackADeli]

i'm not trying to "propose" anything per se...

OK, I guess I was just misreading....

just work locum. there was a surgeon ...

...locums seem not to have to answer to anybody except maybe their locum placement agency.

Not exactly accurate interpretation... you do have some answerability to the practice you cover and/or hospital you work out of.... in addition, you can be very accountable to the payers beyond your agency. There may be some liberties... the accountability can often arise with the unexpected mal-occurence or occasional billing audits, etc....