Job opportunities for a breast surgeon

[kudeta]

I'm a PGY2 interested in learning about a career in breast surgery. I've done my homework reading the forums, looking at job ads online, and asking a few breast surgeons what their practices are like. I know practices vary, but I wanted to get a general idea of what's available out there.

Would anyone be able to describe what a practice is generally like at the following places (in terms of research demands, teaching, general surgery call, in-office procedures, work hours, anything else you can think of):

1. Breast cancer center at an academic institution

2. Breast cancer center at a community hospital (no residents/teaching responsibilities)

3. Breast cancer center at a community hospital (with residents)

4. Private practice

A specific question about private practice: So you're offered a job in an established practice with a starting salary of XXX. Is there a discussion of how many cases/procedures you need to do each year? How can you tailor the number cases/procedures you want to do, if you want to find a work-life balance that suits you? If you are offered a salary of XXX, and you are very aggressive and perform many procedures, is there a bonus of some sort? Or does your salary depend on your yearly performance? I'm confused on the matter (have absolutely no experience in this) and apologize if I come off ignorant.

Any comments greatly appreciated!

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[maxheadroom]

Good questions, but those are almost all "negotiable" items in your contract. High guarantees usually equal high expectations for billing. High guarantees are also frequently there to mask something undesirable about the job. The most important thing for any resident who is looking at jobs is to get an attorney who specializes in physician partnerships to read your contract and help you negotiate. It will be expensive, but well worth the investment.

 

[kudeta]

Thanks so much for your input, very helpful!

In my personal situation, my partner and I are looking to find our way back to California where our families are. He is a surgery fellow in a challenging and demanding field, so I plan to be primarily responsible for taking care of our family. I would prefer a career with reasonable hours (45-55 hrs/wk) and no general surgery call but have never seen this type of job opportunity in California as I see in other parts of the country. It is just as important for me to be near my family and be available for my family as it is to take care of patients. It's important to me that a practice understands these needs, although I understand that a practice may care more about the bottom line.

Will it not be possible to find what I'm looking for? Instead of researching jobs in breast, should I be looking at another specialty altogether? Anyone know of breast surgeons in CA that I could contact for advice?

To share a little about what I've learned about breast surgeons I've met:
1. She's a director of a breast center who started out spending many years taking GS call. Very busy, never home before 8pm. Divorced. Extremely high salary.
2. Works at hospital-affiliated breast center. No GS call. No office-based image-guided procedures. Good pay despite only doing cases in the OR. Not in an area I'd consider living. (Does performing office-based procedures only matter if you're out in PP? If employed by a hospital, how important is this?)
3. At university hospital. Changed priorities (fellowships) after having children. Also does image-guided biopsies and wire locs. Must teach and write papers. No GS call. In rural area.

 

[maxheadroom]

I can't speak to Breast surgery in particular, but what you're going to find is:

1. The California market tends to be tight in the metropolitan areas (LA, Bay Area, San Diego, Orange County). Job opportunities tend to not pay as well. There tends to be less wiggle room in negotiations in those jobs as they are considered desirable.

2. Almost anything is possible if you're willing to give up compensation. Want to work four days a week/no call/no weekends? You can probably find it, but your compensation will stink.

3. Frequently the "best" opportunities for this type of job are the ones that you create.

I'm sure that Winged Scapula will chime in at some point to give a bit more detailed information.

 

[Winged Scapula]

My sense is that you may be attempting to micromanage something that cannot be done. There are as many practice experiences as you can conjure up; there is not "one" way to do private practice, community hospital employed practice, academic practice. Thus, you could speak to 100 breast surgeons and they will give you 100 different answers.

If I may break this down:

1) geography: as maxheadroom correctly notes, the desire for positions, in any field, often outstrips the availability. Thus, in a competitive market like California you may find that the opportunities are not to your liking.

I'm a Californian and wanted to (but didn't need to) return home as well. The opportunities that I found were underpaid (especially given COL), often required GS call or other such icky factors. It is also well recognized that because of the number of breast fellowships in California most jobs are snapped up by the graduating fellows and are never even advertised. Therefore, it may be the case that the ones you do hear about have been left in the dust by the local fellows for good reason.

However, if your heart is set on California you need to draw up "walk away" points and decide what you are willing to give up in terms of call, income, etc.

2) skill set: in PP, I consider it a mistake not doing your own biopsies, needle locs, placement of brachytherapy catheters, etc. These are core skills and not only vastly enrich your pockets but also patients and PCPs prefer these to be done by surgeons, at least here in my community. Patients want procedures to be done by someone they know and someone they know will manage any complications.

In academics, it is true that most of these procedures are done by radiologists and radiation oncologists, or at least that is the case at many centers. Perhaps it wouldn't be an important skill set. But what if you were to want to/need to leave academics? Are you as employable as you would like in the community setting without those skills?

3) lifestyle: it is what you make of it. 45-55 hours a week in private practice is tough. None of my partners work that little (if you count hours outside of patient care, doing paperwork, lectures, etc.). Yes it is important that a future employer understand your family needs but potential employers also have the right to want someone whom they feel will be available to patients and who pulls their weight. This is more of an issue when dealing with patients with malignancies:are you willing to stay late or come in early to see the newly diagnosed breast cancer because you have no new openings for several weeks?

4) contractual agreements: there are a myriad of income/salary structures out there. Our new fellow has a salary guarantee paid by a local hospital for 1 year. After that is up, we (the partners) guarantee her a base salary plus a scaled production bonus for anything earned above that. Once that is up (1 year), she is on her own: she makes whatever she makes minus expenses and as partner, shares in profits.

As max notes, you can negotiate anything. If I can't pay you what you want, perhaps you ask for more vacation time. Or more sick leave or CME monies. If you want to work 45 hours/week but the partners are working more, then I pay you less. You need a contract attorney when the time comes because there are many nuances.

 

[maxheadroom]

It sounds like your best bet would be in an employed setting. Kaiser would probably be your best bet, but those jobs can be hard to land.