Need help re: post-residency decisions!

[PizzaButt]

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I'm a CA-3 getting ready to interview for my first few job opportunities. I've got some questions for the attendings out there. When I started this process, I was very confused about what it is I wanted to do next -- fellowship, private practice, or academics. I first ruled out the fellowship option, mainly because there really wasn't one area of anesthesia that I would want to devote myself to, and I wasn't too keen on pain, peds, or ICU. That left PP vs. academics. Still not really sure, I sent out a whole bunch of cover letters and CVs to both private jobs and academic departments last month. I got some decent responses from both (more from PP than academics).

After much deliberation, I've decided to give academics a shot, for many reasons. While I don't think I'll stay in academia forever, I'd like to do it for a couple of years and get it out of my system, since I do have an interest in it. I see myself in private practice eventually. I've got some interviews lined up at teaching hospitals next month.

Here is my dilemma. One of the reasons why I'd like to do academics for a few years is because I want to move around and live in another region of the country for 2 years and then move again. I figure that academics would provide greater flexibility for this without having to worry about paying the tail. But I'm really confused about this whole tail thing! Can one of you guys explain it? If I joined a PP group next year, and then moved in 2 years, would I have to pay an enormous tail? Does the whole tail thing prevent anesthesiologists from moving around to different jobs?

Another concern. Since I've decided to interview for academics now, what should I tell these PP guys who are emailing and calling me about my CV? I don't want to blow them off completely, but I'd kinda like to keep 'em on the back burner in case I can't find a good academic faculty to join. What should I tell them? Should I just go interview at them anyways? I'm so confused!

 

[jetproppilot]

I'm a CA-3 getting ready to interview for my first few job opportunities. I've got some questions for the attendings out there. When I started this process, I was very confused about what it is I wanted to do next -- fellowship, private practice, or academics. I first ruled out the fellowship option, mainly because there really wasn't one area of anesthesia that I would want to devote myself to, and I wasn't too keen on pain, peds, or ICU. That left PP vs. academics. Still not really sure, I sent out a whole bunch of cover letters and CVs to both private jobs and academic departments last month. I got some decent responses from both (more from PP than academics).

After much deliberation, I've decided to give academics a shot, for many reasons. While I don't think I'll stay in academia forever, I'd like to do it for a couple of years and get it out of my system, since I do have an interest in it. I see myself in private practice eventually. I've got some interviews lined up at teaching hospitals next month.

Here is my dilemma. One of the reasons why I'd like to do academics for a few years is because I want to move around and live in another region of the country for 2 years and then move again. I figure that academics would provide greater flexibility for this without having to worry about paying the tail. But I'm really confused about this whole tail thing! Can one of you guys explain it? If I joined a PP group next year, and then moved in 2 years, would I have to pay an enormous tail? Does the whole tail thing prevent anesthesiologists from moving around to different jobs?

Another concern. Since I've decided to interview for academics now, what should I tell these PP guys who are emailing and calling me about my CV? I don't want to blow them off completely, but I'd kinda like to keep 'em on the back burner in case I can't find a good academic faculty to join. What should I tell them? Should I just go interview at them anyways? I'm so confused!

Lose the stress, dude/dudette. Remember, you are in the driver's seat in today's anesthesia market. Congratulations. Enjoy it, drink a margarita with an extra shot of Don Julio, and enjoy your good fortune of your vast opportunity. Take it from a dude that literally just made it out of a hurricane/looting city by the skin of his chinny-chin-chin. Life is too short to stress this kind of crap.

I respect your decision to try academics. To tell you the truth, I'd probably be happier in an academic environment, cuz I like to teach, and feel I could make a big impact on their notoriously inefficient systems. Problem is I'm not willing to work for 50% of what I make now. If they ever equalize, I may be Professor Jet, although I'd rather be called Dude.

There is no insult to the groups that are recruiting you if you take a job other than theirs. Communication is the key. Find a job you like? Call the other groups, tell them your decision and why (closer to family, you wanna teach for a while, staying academic will give you more motivation to study for boards, the institution you took a job at is close to a tennis court and you think you have a shot at Andre Agassi, etc etc etc). Anyway you get my point. They'll appreciate the followup phone call even if you dont take the job...remember its best not to burn any bridges since you never know what the future will bring...(F^CKING HURRICANES!!!!)
End the conversation with "Hey Dude, I really appreciate the opportunity. Really. Your group rocks, but I'm gonna take this other job for now. Thanks alot!"
I'm now in the city of my first gig after residency and the ARCHIVAL group to my old group wants to hire me. Know why? Despite the stupid-ass rival stuff between the 2 groups here, I was always a proponent of both groups uniting...which in my opinion is better anywhere...but anyway, the point is, I didnt burn any bridges, I'm back in a city where I didnt think I'd ever be again, and I've got a job offer from my old "enemy" group. Moral=dont burn bridges.

Moving on, heres malpractice 101:
Basically there are 2 types of malpractice. Claims Made and Occurrance.
Claims made policies cover you only while you have the policy. Cancel the policy and move to another job that doesnt use the same malpractice carrier and you are screwed if a case comes up unless you have a tail. Paying for a tail ensures that even after you leave, you are covered, even if a case doesnt arise for a year (or whatever the time-cap is) later. Tails increase commensurate to time practiced...i.e. moving after a year wont cost as much tail wise as moving after 5 years. EXAMPLE: I changed gigs after 7 years and my malpractice tail was 27K.
Claims made policies are more prevalent with anesthesia groups because they are cheaper.

Occurrance malpractice policies cover the OCCURRANCE, regardless of when the case arises. So if you have an occurrance policy, leave to another group with a different malpractice provider, you don't have to buy a tail. But (of course) these policies are more expensive. Occurrance policies are good if you want to go work somewhere temporarily.

My advise is to take that academic job if it makes you happy. Just find out the details of their malpractice before signing on the dotted line, so you know if you are OR are-not required to get a tail when you leave.

Best of luck. 👍

 

[Gimlet]

Damn, another informative, insightful, straightforward, and spot-on post from JPP! Dude, you should print out all of your posts, staple 'em together, and send them to a publisher...you'd have a #1 bestseller (at least among anesthesia residents and med students interested in the field.) 👍 👍

BTW, I'm still waiting to read that post you mentioned a while back (after all the hurricane hoopla) that you were planning to make about how to protect yourself financially, and some of the insurance pitfalls that you've run into with this whole experience... 🙂

 

[bigdan]

Ditto Andy, Jet.

Nice post (maybe sticky-worthy if there isn't a clear and succinct one, Vent?)

Any additional info you have on protectin' the cheddar would be much appreciated.

And Mil and UTSW - you guys give us the goods too!!!!

dc

 

[militarymd]

Jet made it quite clear. I have absolutely nothing to add.

Now if you're really serious about moving after every few years, the US military may be for you. You will literally move every 2 to 3 years...including places overseas...the pay sucks, and you have to deal with BS, but you move after every 2 to 3 years, and whoever is giving you BS also moves every 2 to 3 years.

Although, I must say, I prefer private practice much better.

 

[beezar]

how about locum tenens if you want to move around a lot?