Post From A Private Practice Dude

[jetproppilot]

Hello Folks,

I came out of residency in 1996 and am in a very comfortable private practice. Very nice paycheck, very nice lifestyle, very nice partners and CRNAs. I guess what strikes me the most about reading posts, not just in the anesthesia section, but in every specialty section, is the degree of competitiveness in your lives right now. MD vs DO, MDA vs CRNA, etc. Thinking back to my chief resident days, I can relate. Who's the best resident? Who landed the highest salary job? Etc Etc.

One facet of education I think residency programs miss is preparing residents for the real world. We all come from the same mold, or we wouldnt be where we are, right? Competition is part of your life right now, but thankfully it becomes a non-issue in the next phase of your life.

Just wanna let you dudes/dudettes know that all of the competition/CRNA worries/MD vs DO worries evaporates for the most part when you go into private practice. Nobody really cares if you are a DO or an MD if you are a skilled clinician. Two anesthesiologists in my previous community were DOs, and they were treated just the same as us MDs. And the CRNA vs MD thing isnt present in most practices. I'm currently in a 4 MD 14 CRNA group, and we all have the same goals: getting cases started on time, providing superior anesthesia care, and running an efficient operating room. CRNAs are not my enemy, they are my colleague- I can start a case with them, go see a couple pre-ops, pop back in the room to make sure everything is OK, go to L&D to put in a labor epidural, come back and check on the cases, give a CRNA a break, etc. My doctor colleagues have my back too...remember no matter how good you are, theres always going to be situations where your partner can help you. My hero days are gone. I consider myself deft with all our specialties' procedures (IJs, subclavians, a-lines, epidurals, spinals, fem-sciatic blocks, interscalenes, axillary blocks, etc) but if I'm having problems with something (rare, but it happens to me, and it will happen to you), I'll call the other doctor and ask him to take a shot. Anesthesia is more enjoyable when a team of people work towards a common goal, and egos are left at the door. Most important, the patient benefits from this approach as well.

Non-confrontational, friendly, happy personalities do the best in anesthesia- one can think of their practice as a hardware store- we have customers: the patients and the surgeons. Keep them happy and you'll be happy too, and you'll have plenty of money and ample vacation if you keep this in mind.

In summary, if you are skilled at your trade, and you are a nice, non-confrontational person, you will be respected by your CRNAs, your partners, and your surgeon colleagues, and you'll have a great time at work. You really have alot to look forward to. Keep this in mind.

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[Gibby Haynes]

Nice post. Its great to have a reality check by someone who has gone through the system and is now in the "real world".

 

[4th year]

Thanks for this post. It was like a breath of fresh mountain air. You are right about these things and I very much look forward to experiencing them myself.

 

[redstorm]

not to be negative but most of the practice groups are homogenous,,, they wont let you in unless you pass the test.. how much they like you doesnt matter if you are the best clinician in the world..

 

[Test Boy]

pass what test?

not to be negative but most of the practice groups are homogenous,,, they wont let you in unless you pass the test.. how much they like you doesnt matter if you are the best clinician in the world..

 

[jwk]

not to be negative but most of the practice groups are homogenous,,, they wont let you in unless you pass the test.. how much they like you doesnt matter if you are the best clinician in the world..

Actually, our group is quite diverse. And liking you, especially in private practice, IS important. You might be the best clinician in the world, but in the world of private practice, where relationships with colleagues DO matter, being a jerk will NOT get you in the door.

 

[gaslord]

Just wondering... when going into private practice, does it matter where you did your residency training? I would think that someone from MGH would get into private practice before someone from Miami or other program that is not as highly recognized.

Any opinions or stories on this one?

 

[jwk]

Just wondering... when going into private practice, does it matter where you did your residency training? I would think that someone from MGH would get into private practice before someone from Miami or other program that is not as highly recognized.

Any opinions or stories on this one?

It's only one of many factors. Just because you're from MGH (or any other Ivy or other assumed "prestigious" program) doesn't guarantee anything.

 

[rhinosp_33]

It's only one of many factors. Just because you're from MGH (or any other Ivy or other assumed "prestigious" program) doesn't guarantee anything.

jwk, correct me if i'm wrong, bout arent you an Anesthesiology Assistant? No intention to make this into a MDA vs etc whatevers but... how would you know the details of job recuritment? are you involved directly in hiring of Anesthesiologist? i wouldn't be surpirsed if you are in the position to offer opinions on personality of applicants, but i'd be surpised if you actually had recuritment knowledge or hiring power for Anesthesiology residents seeking jobs.

 

[UTSouthwestern]

Just wondering... when going into private practice, does it matter where you did your residency training? I would think that someone from MGH would get into private practice before someone from Miami or other program that is not as highly recognized.

Any opinions or stories on this one?

Your ability to demonstrate your work ethic and knowledge base will decide above all else whether or not you get the position. Good programs occasionally produce bad residents just like bad programs occasionally produce good residents. This is a fact that is not lost on the groups and for the most part, your interview and letters of recommendation will decide your fate.

At the private hospital I am currently rotating at, I have been told that they have rejected UCSF, JHU, Duke, Emory, and other candidates from strong programs because of their interview and lukewarm letters of rec. Be smart: Pay attention during your interview, be able to explain why you feel you would make a great partner in the group, and NEVER focus too much on issues that may hint that you aren't working to work as hard as you possibly can ("I want ten weeks vacation, no call, no hearts, no livers, no kids, nothing at the county hospital, etc.").

 

[jwk]

jwk, correct me if i'm wrong, bout arent you an Anesthesiology Assistant? No intention to make this into a MDA vs etc whatevers but... how would you know the details of job recuritment? are you involved directly in hiring of Anesthesiologist? i wouldn't be surpirsed if you are in the position to offer opinions on personality of applicants, but i'd be surpised if you actually had recuritment knowledge or hiring power for Anesthesiology residents seeking jobs.

Do I hire and fire? Of course not. Do I have knowledge about recruiting? You bet. My previous posts stand. UTsouthwestern makes similar points. Oh, and I'm sure the Miami people appreciated gaslord's post. There are some excellent practitioners in, and coming from, their program.

 

[gaslord]

Thanks, guys, for the input. It will definetely affect how I rank my residencies (I'm a 3rd yr now), and I will definetely open up to programs w/ good training even if they're names are not "Ivy League" or ultra-prestigious.

 

[nico05]

RE: Original post:
I think you are right on regarding real world situations. Being a non-trad who has worked in what I guess you can call, the "real world", I feel that personality is overlooked by lots of med school applicants. All else being equal, ultimately, like you've stated, it comes down to customer satisfaction. Competition is fierce though, so it's a matter of being a well rounded human being, much like successes in all fields. Great post

 

[MDEntropy]

At the private hospital I am currently rotating at, I have been told that they have rejected UCSF, JHU, Duke, Emory, and other candidates from strong programs because of their interview and lukewarm letters of rec.

Just curious UT, do you know if all of these rejections of candidates from big name programs took place this year with candidates from the class of 05? Or was this something that has occurred over the last ten years or some other extended period of time. In other words, did all of this happen recently?

 

[UTSouthwestern]

Just curious UT, do you know if all of these rejections of candidates from big name programs took place this year with candidates from the class of 05? Or was this something that has occurred over the last ten years or some other extended period of time. In other words, did all of this happen recently?

Within the last 4 years. This group decided to expand beyond its exclusive rights hospital at that time and hired 4 new associates, one per year.