OR days per week as attending

[Peruano]

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I'm looking at different job offers for starting out of residency next year in a surgical specialty. I found one job that's ideal in every factor except that it's just one OR day a week, and 4 days of clinic. I'm modestly concerned that my surgical dexterity wouldn't continue to grow into attending-hood if I'm just operating one day a week, or that I could get really back-logged with cases. Would anyone let this be a game changer for an otherwise great position? Is it terribly difficult to acquire more OR/Procedural block time at the average surgery center or hospital if I'm eventually demonstrating a need for such?

 

[Wordead]

I'm looking at different job offers for starting out of residency next year in a surgical specialty. I found one job that's ideal in every factor except that it's just one OR day a week, and 4 days of clinic. I'm modestly concerned that my surgical dexterity wouldn't continue to grow into attending-hood if I'm just operating one day a week, or that I could get really back-logged with cases. Would anyone let this be a game changer for an otherwise great position? Is it terribly difficult to acquire more OR/Procedural block time at the average surgery center or hospital if I'm eventually demonstrating a need for such?

It obviously depends on the situation and availability at the hospital. I will say that in my situation, due to onboarding new surgeons and huge backlog from the last couple years OR time is at a premium and I cannot get additional OR time to save my life and am booked out 3 months or so (which results in unhappy patients). If I could do it over I would get it in my contract in writing to have set block time.

 

[forchinet121]

It obviously depends on the situation and availability at the hospital. I will say that in my situation, due to onboarding new surgeons and huge backlog from the last couple years OR time is at a premium and I cannot get additional OR time to save my life and am booked out 3 months or so (which results in unhappy patients). If I could do it over I would get it in my contract in writing to have set block time.

That seems nuts shouldn’t they build more ORs then? Aren’t they the biggest money maker in the hospital?

 

[DoctwoB]

I'm looking at different job offers for starting out of residency next year in a surgical specialty. I found one job that's ideal in every factor except that it's just one OR day a week, and 4 days of clinic. I'm modestly concerned that my surgical dexterity wouldn't continue to grow into attending-hood if I'm just operating one day a week, or that I could get really back-logged with cases. Would anyone let this be a game changer for an otherwise great position? Is it terribly difficult to acquire more OR/Procedural block time at the average surgery center or hospital if I'm eventually demonstrating a need for such?

Is it a hospital employed job? If it's private, you could easily take your cases to another surgery center/hospital. Even if you are hospital employed, technically its illegal to prevent you from taking cases elsewhere, though it may not endear you to your higher ups.

 

[Wordead]

That seems nuts shouldn’t they build more ORs then? Aren’t they the biggest money maker in the hospital?

The OR room isn't the problem, it's the lack of trained OR staff - that's a nationwide issue. Scrubs are paid garbage. One left to go to engineering school, another went to do her etsy business. I don't really blame them.

Is it a hospital employed job? If it's private, you could easily take your cases to another surgery center/hospital. Even if you are hospital employed, technically its illegal to prevent you from taking cases elsewhere, though it may not endear you to your higher ups.

That would be a ballsy move as a hospital employed doctor.

 

[anonperson]

That seems nuts shouldn’t they build more ORs then? Aren’t they the biggest money maker in the hospital?

Building an OR is pretty expensive and time consuming.

The amount of regulation and inspections is staggering and makes even simple projects lengthy.

This is coupled with the current shortages in qualified OR staff.

Scrub techs, circulating nurses and anesthesiologists are all in high demand and short supply.

Trying to operate with a new scrub tech is painful and having a bad circulating nurses is just as bad.

 

[HighPriest]

In my state, if you want to build an ASC, the certificate of need process takes 12-18 months (or it did pre-COVID), and you can’t start building a structure until you have the CON. And you can’t get a CON if you can’t prove that not only can you not provide adequate care, but that no one in the community can. And none of that includes actually hiring an architectural firm that can make the building up to code, paying for it, buying the property, and then building it.

Your only other option would be to actually expand your hospital, which I have to imagine is even worse.

And then, as mentioned, you have to staff the ASC or new ORs, and right now no one can staff the ORs that they already have. COVID really @&$ked an already nearly @$&ked system. A lot of people who were only hanging around because it was convenient and they got benefits just retired or started doing something else when those things both became untrue.

I mentioned it on another forum, but I had a patient angry that I couldn’t get her husband in to the OR for three months who later told me that she was an OR nurse until COVID and then she retired early. And that’s why we can’t get her husband to the OR for three months.

We just broke ground on an ASC that planning started for in 2019. Which is actually pretty amazing considering the COVID delays. I have no idea where they’re going to get people to work in it.

 

[DoctwoB]

The OR room isn't the problem, it's the lack of trained OR staff - that's a nationwide issue. Scrubs are paid garbage. One left to go to engineering school, another went to do her etsy business. I don't really blame them.



That would be a ballsy move as a hospital employed doctor.

Indeed it would be, though if they tried to stop you you would be a very rich man after the whistleblower lawsuit (of course they can make your life miserable in other ways).

If delays are that severe though, you could easily sell it to your higher ups though, by telling them that patients will/are leaving for other docs and facilities and this is the only way to keep them in the fold.

 

[Dr.LeoSpaceman]

I'm looking at different job offers for starting out of residency next year in a surgical specialty. I found one job that's ideal in every factor except that it's just one OR day a week, and 4 days of clinic. I'm modestly concerned that my surgical dexterity wouldn't continue to grow into attending-hood if I'm just operating one day a week, or that I could get really back-logged with cases. Would anyone let this be a game changer for an otherwise great position? Is it terribly difficult to acquire more OR/Procedural block time at the average surgery center or hospital if I'm eventually demonstrating a need for such?

Depends what surgical subspecialty you're talking about, but that seems like an impossible mix unless you're in something where it is heavy on office-based procedures. Sure, you can ask for more time, but as others suggested, so is everyone else and as the "new person" you may be at the bottom of the list. What's realistically going to happen is you'll be scrounging for open/unused time and putting it wherever you can find it. That's something many people have to deal with early on, but I'm not sure how that will work if you're being expected to be in clinic the other 4 days.

As for volume to continue your growth, yes, you absolutely need that.

 

[Smurfette]

To be fair, our ENTs and ophthos seem to have less OR time than the other surgical subs, but really bang out a lot of cases on their days. If someone brought a lot of volume, we'd give them another day. But usually ortho/GS/urology have the most block time here.

 

[TheLesPaul]

I also doubt ENT/ophtho are bringing their cases to the main hospital routinely. Operating at a main OR when you are used to an ASC is a special kind of torture.

 

[operaman]

New ent attending here. I have one full day of block OR time per week, 3 days of clinic, half day of awake procedures.

This is a fairly standard average ratio - 3 clinic days to 1 OR except for H&N that is the opposite. My partners do one clinic day and 3.5 OR days.

Unfortunately it’s not quite enough for me - I’m booked out through October right now and so working to switch a half day of clinic into OR block time and see if that ratio is better. I have a couple surgically retired ENTs feeding me operative cases so my surgery hit rate is higher than expected. So far the hospital has been very accommodating as I’m one of the busiest docs here now, so extra block time looks like it will be doable (fingers crossed!).

 

[Lem0nz]

I'm looking at different job offers for starting out of residency next year in a surgical specialty. I found one job that's ideal in every factor except that it's just one OR day a week, and 4 days of clinic. I'm modestly concerned that my surgical dexterity wouldn't continue to grow into attending-hood if I'm just operating one day a week, or that I could get really back-logged with cases. Would anyone let this be a game changer for an otherwise great position? Is it terribly difficult to acquire more OR/Procedural block time at the average surgery center or hospital if I'm eventually demonstrating a need for such?

Which surgical sub? You don't lose anonymity by sharing and we can be more specific. Like Opera said, that seems normal for ENT. I've seen gyn-onc approximate that because of chemo. For urology 1-2 operative days seems very standard with one day in the cysto room and the rest in clinic. Ortho that's not realistic probably. NSG... I have no idea. Plastics, no - should be 2 OR/3 clinic or 3 OR / 2 clinic probably.

In most places it is difficult to acquire more dedicated time but you generally will always succeed, it just may take a year or two. It is generally pretty painful to acquire more block time in probs like 75% of main ORs. In surgery center, I would imagine much less so.

Do you have a referral base large enough to require/justify 4 days of clinic? That sounds like absolute torture man. But I'm living the one clinic four OR day life so I'm a different sort of masochist.