New Attending Advice

[pasto]

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Hi everyone,

Been on these forums for the longest time-- first time posting!

Starting as a new attending shortly. Seeing that there are many sage, experienced anesthesiologists here, was wondering- if you were to start over again as a fresh faced attending, what advice would you give your younger self?

FYI, my practice setting will be part supervision of residents/CRNAs and part solo practice, so really any advice would be appreciated!

Thank you to all who make this an interesting, educational forum.

 

[Noyac]

Don’t be an obstructionist.
Don’t be rigid.
Use your education but don’t act afraid to do cases by coming up with random **** that you use to cancel.
Be nice
Treat nurses with respect
Be social
Learn everyone’s name, even the house keeping. (I struggle with this one)
DO NOT create her impression that you are always looking to get out of the hospital. (Handle this in your own way)
Switch calls and cover partners when you can. Be flexible. And then keep track of those that don’t return the favor.
Ask your senior partners for advice all the time. This will show them that you respect their experience but will also show them that you are dialed and good to go.
Volunteer to participate in the smaller administrative tasks and the occasional staff education lectures or whatever your group is asked to do. The higher level stuff takes more than a few years to get involved in. But this will get you prepped.
Never question your pts in a condescending manner. Always be respectful. Always.
Remember that administrators have 100’s of names to remember. Introduce yourself everytime. Even when speaking up at meetings. They want to know your names ( at least the ones that matter).
Finally, listen listen listen. In meetings be the last to speak if you have something to say. This way yo7 have gathered all the available information and can respond accordingly.

 

[Ezekiel2517]

Yes, and be willing to do all of the above while someone skims off half the paycheck you earned each month

 

[Noyac]

Yes, and be willing to do all of the above while someone skims off half the paycheck you earned each month

And you expect to earn full paycheck after you join a group that has managed to build a practice for the past 5-30years? You want to walk in and reap all the benefits without contributing one single thing to what they have worked so hard to build over the years? You think they are not taking any risks by hiring you?
If this is your view the go elsewhere. You want to climb on either back after all the hard work they’ve put into this and make equal pay? You think they did all of this for “you”? You bring very little outside of clinical acumen to the group. You will be a worker Bee for a few years and if you don’t have issues then you will be offered an opportunity to join a group that has a future. Even if they sell out you can profit if you play your cards right. “Thanks for the first few years we will evaluate you just like you will evaluate us.”

Or you can join and AMC and they will skim off your earnings for many more years.

Don’t be disillusioned people.
And don’t misinterpret your worth.

 

[fakin' the funk]

You were just top dog senior resident or fellow, now you're starting off at the bottom of a new totem pole

 

[deleted87051]

And you expect to earn full paycheck after you join a group that has managed to build a practice for the past 5-30years? You want to walk in and reap all the benefits without contributing one single thing to what they have worked so hard to build over the years? You think they are not taking any risks by hiring you?
If this is your view the go elsewhere. You want to climb on either back after all the hard work they’ve put into this and make equal pay? You think they did all of this for “you”? You bring very little outside of clinical acumen to the group. You will be a worker Bee for a few years and if you don’t have issues then you will be offered an opportunity to join a group that has a future. Even if they sell out you can profit if you play your cards right. “Thanks for the first few years we will evaluate you just like you will evaluate us.”

Or you can join and AMC and they will skim off your earnings for many more years.

Don’t be disillusioned people.
And don’t misinterpret your worth.

It depends on the history of the group. There are groups where new hires have always gotten full pay from the start for over 70 years.

 

[deleted162650]

@Noyac dishin’ out some pearls tonight.

It depends on the history of the group. There are groups where new hires have always gotten full pay from the start for over 70 years.

True. But even in these groups it’s typically at least a year before you really become a “partner”/shareholder in the corporation.

 

[deleted87051]

@Noyac dishin’ out some pearls tonight.



True. But even in these groups it’s typically at least a year before you really become a “partner”/shareholder in the corporation.

Yes but there’s no money skimming.

 

[sethco]

Yes but there’s no money skimming.

Some of these groups don't make enough as full partners to skim off the new hires. I doubt very many groups where partners are making above 75th percentile are offering financial parity from the start, unless it is in a "Austere" location that they are having trouble recruiting to. Not saying they don't exist, but they are few.

 

[Mman]

Yes but there’s no money skimming.

define "skimming"

If you are fresh out of residency, you wouldn't be able to negotiate any good reimbursement with an insurance company anyway. So the rate you are getting billed at, which is probably double to triple what you'd get on your own, really has nothing to do with you. Hell, when we hire people it can take months for them to get credentialed with some insurance companies. Do we withhold their paychecks until we can start billing out for their cases? Of course not. We pay them the salary we all agreed to from day 1.

 

[Noyac]

It depends on the history of the group. There are groups where new hires have always gotten full pay from the start for over 70 years.

Yes, that is the case in my group. But we are employed.

 

[deleted87051]

define "skimming"

If you are fresh out of residency, you wouldn't be able to negotiate any good reimbursement with an insurance company anyway. So the rate you are getting billed at, which is probably double to triple what you'd get on your own, really has nothing to do with you. Hell, when we hire people it can take months for them to get credentialed with some insurance companies. Do we withhold their paychecks until we can start billing out for their cases? Of course not. We pay them the salary we all agreed to from day 1.

When I started working with my group it took several months for my collections to ramp up. However, I also had accounts receivables which came on for several months from my previous job. When I leave or retire, I’ll have accounts receivables coming in for several months after I stop working.

Not skimming means getting 100% of the groupwide blended unit value for the work performed starting on day one.

Since no one in the group has ever paid a “buy in”, there’s no reason new hires should pay one either.

 

[deleted162650]

Since no one in the group has ever paid a “buy in”, there’s no reason new hires should pay one either.

Correct me if I'm wrong, but I believe your group does a "buy-in" albeit a relatively nominal one.

 

[deleted87051]

Correct me if I'm wrong, but I believe your group does a "buy-in" albeit a relatively nominal one.

Correct...but it’s nominal, about 2weeks collection for 1 share of the Corp when you become partner. You get it back when you leave. It’s not the 6-7 figure buy ins people usually talk about.

I’m just saying not every place requires a hefty period of “paying your dues” and we’re not in the middle of nowhere or have trouble recruiting either. If we can do it there’s no reason others can’t.

 

[pasto]

Yes, and be willing to do all of the above while someone skims off half the paycheck you earned each month

I'm an employee so salaries are essentially the same across the board, with minimal increases for seniority.

Don’t be an obstructionist.
Don’t be rigid.
Use your education but don’t act afraid to do cases by coming up with random **** that you use to cancel.
Be nice
Treat nurses with respect
Be social
Learn everyone’s name, even the house keeping. (I struggle with this one)
DO NOT create her impression that you are always looking to get out of the hospital. (Handle this in your own way)
Switch calls and cover partners when you can. Be flexible. And then keep track of those that don’t return the favor.
Ask your senior partners for advice all the time. This will show them that you respect their experience but will also show them that you are dialed and good to go.
Volunteer to participate in the smaller administrative tasks and the occasional staff education lectures or whatever your group is asked to do. The higher level stuff takes more than a few years to get involved in. But this will get you prepped.
Never question your pts in a condescending manner. Always be respectful. Always.
Remember that administrators have 100’s of names to remember. Introduce yourself everytime. Even when speaking up at meetings. They want to know your names ( at least the ones that matter).
Finally, listen listen listen. In meetings be the last to speak if you have something to say. This way yo7 have gathered all the available information and can respond accordingly.

Great advice, thank you!

 

[deleted171991]

All you need to know, @pasto, is in this thread: Are You Ready For Private Practice?

 

[kidthor]

jet prop as his finest...

 

[IMGASMD]

Reading parts of it. I feel whatever is discussed, still being talked about here daily.

 

[Twiggidy]

Don’t be an obstructionist.
Switch calls and cover partners when you can. Be flexible. And then keep track of those that don’t return the favor.

Underrated advice. You’d be surprised how many of the worst aspects of a gig come from within your own shop

 

[DrAmir0078]

Don’t be an obstructionist.
Don’t be rigid.
Use your education but don’t act afraid to do cases by coming up with random **** that you use to cancel.
Be nice
Treat nurses with respect
Be social
Learn everyone’s name, even the house keeping. (I struggle with this one)
DO NOT create her impression that you are always looking to get out of the hospital. (Handle this in your own way)
Switch calls and cover partners when you can. Be flexible. And then keep track of those that don’t return the favor.
Ask your senior partners for advice all the time. This will show them that you respect their experience but will also show them that you are dialed and good to go.
Volunteer to participate in the smaller administrative tasks and the occasional staff education lectures or whatever your group is asked to do. The higher level stuff takes more than a few years to get involved in. But this will get you prepped.
Never question your pts in a condescending manner. Always be respectful. Always.
Remember that administrators have 100’s of names to remember. Introduce yourself everytime. Even when speaking up at meetings. They want to know your names ( at least the ones that matter).
Finally, listen listen listen. In meetings be the last to speak if you have something to say. This way yo7 have gathered all the available information and can respond accordingly.

Let's write this sentiment in our heart, mind and soul ! !
I loved the way you were talking, make everyone friend, and no one enemy !