Private Practice Job Advice - Case Mix

[Multifidus]

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I'm a CA-3 and will be starting PP in August. I have a couple of options. The one I like the most (mostly because of lifestyle) doesn't have the best case mix. In fact, it it mostly ortho and neuro. The cases aren't really B&B, just not very varied. I have an option to join a practice with much more variety. Basically every kind of case you can think of including OB and trauma. I am clearly more interested in the first practice, though.

What do you guys think about starting out of residency at a practice with little case variety? Am I going to be hurting myself in the long run? I am a firm believer that I have only completed a small portion of my anesthesia training in residency and have much to learn as an attending. Any advice would be greatly appreciated!!

Thanks.

 

[nlfru]

I'm a CA-3 and will be starting PP in August. I have a couple of options. The one I like the most (mostly because of lifestyle) doesn't have the best case mix. In fact, it it mostly ortho and neuro. The cases aren't really B&B, just not very varied. I have an option to join a practice with much more variety. Basically every kind of case you can think of including OB and trauma. I am clearly more interested in the first practice, though.

What do you guys think about starting out of residency at a practice with little case variety? Am I going to be hurting myself in the long run? I am a firm believer that I have only completed a small portion of my anesthesia training in residency and have much to learn as an attending. Any advice would be greatly appreciated!!

Thanks.

Advice you are hoping to hear: "When I was a CA3, I took a job at a surgicenter with no variety, no weekends and no call. I made out just fine and so will you"

Advice you will ACTUALLY hear: "Take a job with as much variety as possible taking care of ASA 4 and 5 patients. Make sure there are lots of heads, hearts, trauma and high risk OB. It would be best if this job is Q2 inhouse call"

As a current CA3 who has talked to a lot of attendings, I have figured out that there is no right answer. Take the job where you are going to be happy.

 

[rsgillmd]

I agree with nlfru -- go with where you are happy. There's obviously more to life than just work. If you've had decent residency training, you'll be fine. Don't forget -- in the end you are a clinician who can think his way through challenging situations, not a procedure monkey unlike some who shall remain unnamed.

Some simple examples from my experience: I hadn't taken care of a burn patient since I was a 4th year medical student, and never from the anesthesia side. The first day I went to the Burn OR (it's literally only one OR), once I figured out the layout of the equipment I was totally comfortable. I knew the general principles of taking care of these patients and had enough general experience to be able to handle the situation.

I also hadn't done any facial trauma cases in residency. We get a lot of Lefort type fractures in my current institution. But I had done plenty of nasal intubations in my peds dental cases, and plenty of awake fiberoptics. So when I was tossed in a mandibular fracture case with a new CRNA I was comfortable, because I new the general principles to take care of such patients.

Also there is no harm in asking questions to the surgeon or your anesthesia colleagues if you don't know something. I've done it, and I've reciprocated. Don't forget the end goal: taking good care of the patient.

So, assuming you've had good training and are comfortable with most cases, if you run across something you haven't seen before or not in a long time, you may have some initial jitters but I can pretty much guarantee you won't fumble.