Questions to ask hospital employed first anesthesia job?

[Sriddymopboi]

Hey All,

Have some interviews coming up. The majority of places I'll be interviewing at are hospital employed. Salary, benefits, are relatively straightforward and explained pretty well in the benefits package. What are some of the other real important questions you wished you asked on some of your first job interviews? I'm going to focus more on the culture of the group, who makes the call schedule, how fairly cases are assigned, etc. Correct me if I'm wrong but I would imagine a lot of the questions about reimbursement, insurance aren't really necessary to ask about since mostly everybody would be getting paid the same as a hospital employee. Thanks!

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[Dr. Rude]

At what point will my pay, hours worked, time off be, call responsibilities be comparable to others in the group doing comparable work?

 

[SRYSPAC]

Hey All,

Have some interviews coming up. The majority of places I'll be interviewing at are hospital employed. Salary, benefits, are relatively straightforward and explained pretty well in the benefits package. What are some of the other real important questions you wished you asked on some of your first job interviews? I'm going to focus more on the culture of the group, who makes the call schedule, how fairly cases are assigned, etc. Correct me if I'm wrong but I would imagine a lot of the questions about reimbursement, insurance aren't really necessary to ask about since mostly everybody would be getting paid the same as a hospital employee. Thanks!

A lot of places' contracts are boilerplate, but you can probably get them to modify any sign-on/reocation bonuses.

I would question them about any non-competes and how they view the recent ban.

Regarding PTO, is it guaranteed or is the hospital allowed to, for example, tell you only 8 weeks are allowed (when you should have 10), and say they will pay you instead to make up for it? I heard that from someone recently hired to my place, and this person used it to keep their full sign-on bonus despite leaving early as the hospital/PE group did not meet their terms of the contract.

 

[Sriddymopboi]

At what point will my pay, hours worked, time off be, call responsibilities be comparable to others in the group doing comparable work?

Hopefully this is immediately!

 

[Sriddymopboi]

A lot of places' contracts are boilerplate, but you can probably get them to modify any sign-on/reocation bonuses.

I would question them about any non-competes and how they view the recent ban.

Regarding PTO, is it guaranteed or is the hospital allowed to, for example, tell you only 8 weeks are allowed (when you should have 10), and say they will pay you instead to make up for it? I heard that from someone recently hired to my place, and this person used it to keep their full sign-on bonus despite leaving early as the hospital/PE group did not meet their terms of the contract.

Is it relatively difficult to negotiate for increased vacation? I would imagine at most places everybody gets the same number of vacation days while it might increase with more seniority at some places

 

[Dr. Rude]

Hopefully this is immediately!

It often ain't so.

 

[IDGARA]

Is it relatively difficult to negotiate for increased vacation? I would imagine at most places everybody gets the same number of vacation days while it might increase with more seniority at some places

In my experience, a 1.0 FTE was paid ~ $500K for a certain amount of work each quarter. If you wanted to be a 0.9/0.8/etc, then you'd just get less base pay in exchange for more time off. You could try to negotiate for more time off for the same pay, but good luck.

You also want to find out how call/****ty shifts are doled out. Does everyone in the group have an equal share of them or do some people get out of it somehow.

How exactly will you be paid? It should be spelled out in a way that a 9th grader can understand it.

I would also fight any sort of non-compete, regardless of what the FTC is doing at the moment. I interviewed at an academic place with a three year 50 mile non-compete. When I asked that they remove it, they just said, "Well it's not enforceable in this state so it doesn't matter if it's in there or not." Whether something is enforceable or not has nothing to do with them playing hardball with you when you inevitably try to leave for a better gig in town.

Kinda related: I had a contract that stipulated you couldn't work anywhere else while working for the hospital without their permission. I'll never sign something like that again.

 

[amyl]

Beware the wording “call shared equally amongst anesthesiologists”

 

[Sriddymopboi]

Beware the wording “call shared equally amongst anesthesiologists”

What are some pitfalls with this statement? is this a dog whistle for call isn't actually shared equally? How can I make sure it really is shared equally?

 

[cchoukal]

It’s a dog whistle for “all the call will be covered by the group for no extra pay, no matter how few of you stick around.”

 

[cchoukal]

I think what people are getting at here is that salary and weeks are just the beginning of the discussion. How many days/hours/shifts/calls does that dollar amount actually buy, and what happens when they ask you for an additional day/hour/shift/call because volume goes up or staff leaves.

My last gig, granted, a VA, everything was "shared equally," but we lacked the technology to show everyone how much everyone else was working, so you kind of had to take their word for it. Someone out sick or on extended parents leave? Everyone took more call for free. Hospital wanted to run 11 rooms instead of 10 sometimes? Everyone worked more for free.

 

[amyl]

Beware the wording “call shared equally amongst anesthesiologists”

It sounds good…. Until the admin pisses off half the anesthesiologists and you’re taking q3 call

 

[Sriddymopboi]

It sounds good…. Until the admin pisses off half the anesthesiologists and you’re taking q3 call

Doesn’t seem like there would be any protection from this unless the contract states that it’s for 40hrs/week base and if you’re forced to pick up calls and more shifts the compensation would have to be spelled out, right?

 

[GassYous]

Doesn’t seem like there would be any protection from this unless the contract states that it’s for 40hrs/week base and if you’re forced to pick up calls and more shifts the compensation would have to be spelled out, right?

Yeah you'd think that being written down on paper in a contract would mean something right? Covid has already shown otherwise.

 

[amyl]

Wording specifying 5 calls a month or q5 call is preferable

 

[GassedOut12]

I think what people are getting at here is that salary and weeks are just the beginning of the discussion. How many days/hours/shifts/calls does that dollar amount actually buy, and what happens when they ask you for an additional day/hour/shift/call because volume goes up or staff leaves.

My last gig, granted, a VA, everything was "shared equally," but we lacked the technology to show everyone how much everyone else was working, so you kind of had to take their word for it. Someone out sick or on extended parents leave? Everyone took more call for free. Hospital wanted to run 11 rooms instead of 10 sometimes? Everyone worked more for free.

At a VA? How long were you there?

 

[GassYous]

At a VA? How long were you there?

Only until 3 pm

 

[cchoukal]

Only until 3 pm

That’s funny. But no, we were a real hospital with cases going into the evening every day. I was there for 12 years, splitting time between there and the local university.

 

[mmag]

That’s funny. But no, we were a real hospital with cases going into the evening every day. I was there for 12 years, splitting time between there and the local university.

Just like a real hospital the CRNAs all left at 3pm and the residents got to stay into the evening.


Back to the OP, ask if there's a system for assigning late rooms and reliefs. Do the new people get the privilege of staying to finish cases?

 

[cchoukal]

Just like a real hospital the CRNAs all left at 3pm and the residents got to stay into the evening.

Our CRNA shifts went til 5 or 7, not 3.

 

[AKMD_1984]

Beware the wording “call shared equally amongst anesthesiologists”

100%.

What Amyl is implying is that - lets assume maybe you're the 10th anesthesiologist they hire. Your call is 3-4x a month for X amount of pay. All of a sudden two people stop taking call and one leaves. That changes from q10 to q7. That has significant implications for weeknights and weekends.

Of course the hospital makes money on this because they are getting the same work done but having to pay 7 docs vs 10.

Technically your income should increase if the workload is increased. Will it?
What if they go to 5 anesthesiologists? Your call burden is double. Are you going to be making 1.5x-2x?
Other more important questions to ask:

1) who makes the schedule and how. is it understandable, simple, logical or manipulated?
Is a working or non-working anesthesiologist making the schedule? Is there cherry picking?

2) what is the distribution of labor and is it with 15-20% of everyone?

3) how (or am i) being compensated for extra productivity?

e.g. 500k salary is nice for a normal schedule. its clearly not adequate if you're doing q4 24hr shifts and every other Friday/Sat/Sunday.
Look at weekly, biweekly and monthly hours worked. Look at off hours worked. Calculate and compare using local market based locums and independent contractor rates for similar work at similar sites.

4) Ask them to send you last 3 months and last 1 year's OR schedule and assignments.

5) Ask them to send you the shift schedules. Ask questions if you see something fishy.

6) Time off during busy season and holidays? One of the jobs I took, the chairman used to take thanksgiving to first week of January off. There were 8 docs in the group.
7 People would fight for vacation during holiday season since only two people could be off. And he would take 6-7 weeks off straight during busy and holiday season.
And it was very busy at that time of the year.
Of course no one communicated that with me. I worked XMAS + TKG year 1, was post call NYE. TKG 2nd call, XMAS Eve and NYE year 2, and TKG off, XMAS call, NYE call year 3. Its f*c'd up.

7) Moonlighting and extra work restrictions. Make sure that this is removed from your contract. Its none of their business what you do in your spare time.
Moonlighting and doing locums is quite important for young docs, so they network, make extra money and experience life outside of employed W2 jobs with fixed contracts. Often really good long term opportunities come from locums work.

8) Dont be suckered into benefits, retirement etc from employment. Those are all golden handcuffs. Ask them if they will pay you as an independent contractor.
You can shop for health insurance if you are an independent contractor/1099. Of course there are massive tax breaks for 1099 via SEP and solo 401k plus access to pre-tax income to deduct many expenses.
Avoid 457F for instance.

I think its important for new grads to take good stable jobs with steady income and good environment and senior colleagues around. But do not be suckered into **** contracts and do not let some anesthesiologist tell you whats right for you and sell you something its not.

 

[caligas]

Wording specifying 5 calls a month or q5 call is preferable

I take your point but that’s too much call for a long term job

 

[DirtDocMD]

The “wording” that amyl mentions, is important. There should be some acknowledgment of what “normal” call and work expectations, at normal staffing levels, will be (“shared equally” doesn’t help when you are “sharing” with fewer people, or “sharing” increased work volume, and not getting paid EXTRA).

“Call will be shared equally, with current expectation of q5-q6 frequency.” Or—“Call will be shared equally, based on current staffing level of 4 Anesthesiologists and 6 CRNA’s, with one MD as primary call and one CRNA as backup, each day.”

AND—“Pay will be adjusted if frequency goes above aforementioned amount.” or “Pay will be adjusted if staffing drops below aforementioned levels.”

This protects you if several folks quit, or if the hospital/group increases the number of folks needed for call coverage, each day.

Buddy of mine is currently the director of a suburban/bedroom community group. He joined thinking they were going to hire an extra .5-1 fte, which would allow the other 3 Docs to back off to .8 fte, if they wanted. Well….that hasn’t happened, PLUS they’ve had 2-3 CRNA’s quit. Guess WHO they expect to “take up the slack”??

Oh, and do you think the group (run by a “non-profit health system “) is sharing any of the $500k they AREN’T currently paying to the 2 missing CRNA positions, to any of the remaining Docs/CRNA’s who are picking up the slack??? Heck, no…

Make sure you’re “covered” if the slice of pie/work you have to do gets bigger, either due to attrition (pie is divided into less, thus bigger, slices), or the whole “pie” gets bigger (more rooms/call slots due to increased case volume, and group is slow to hire additional staff to cover).

 

[aneftp]

Our CRNA shifts went til 5 or 7, not 3.

Than they are off 1-2 days a week. Less crnas available daily.

 

[aneftp]

100%.

What Amyl is implying is that - lets assume maybe you're the 10th anesthesiologist they hire. Your call is 3-4x a month for X amount of pay. All of a sudden two people stop taking call and one leaves. That changes from q10 to q7. That has significant implications for weeknights and weekends.

Of course the hospital makes money on this because they are getting the same work done but having to pay 7 docs vs 10.

Technically your income should increase if the workload is increased. Will it?
What if they go to 5 anesthesiologists? Your call burden is double. Are you going to be making 1.5x-2x?
Other more important questions to ask:

1) who makes the schedule and how. is it understandable, simple, logical or manipulated?
Is a working or non-working anesthesiologist making the schedule? Is there cherry picking?

2) what is the distribution of labor and is it with 15-20% of everyone?

3) how (or am i) being compensated for extra productivity?

e.g. 500k salary is nice for a normal schedule. its clearly not adequate if you're doing q4 24hr shifts and every other Friday/Sat/Sunday.
Look at weekly, biweekly and monthly hours worked. Look at off hours worked. Calculate and compare using local market based locums and independent contractor rates for similar work at similar sites.

4) Ask them to send you last 3 months and last 1 year's OR schedule and assignments.

5) Ask them to send you the shift schedules. Ask questions if you see something fishy.

6) Time off during busy season and holidays? One of the jobs I took, the chairman used to take thanksgiving to first week of January off. There were 8 docs in the group.
7 People would fight for vacation during holiday season since only two people could be off. And he would take 6-7 weeks off straight during busy and holiday season.
And it was very busy at that time of the year.
Of course no one communicated that with me. I worked XMAS + TKG year 1, was post call NYE. TKG 2nd call, XMAS Eve and NYE year 2, and TKG off, XMAS call, NYE call year 3. Its f*c'd up.

7) Moonlighting and extra work restrictions. Make sure that this is removed from your contract. Its none of their business what you do in your spare time.
Moonlighting and doing locums is quite important for young docs, so they network, make extra money and experience life outside of employed W2 jobs with fixed contracts. Often really good long term opportunities come from locums work.

8) Dont be suckered into benefits, retirement etc from employment. Those are all golden handcuffs. Ask them if they will pay you as an independent contractor.
You can shop for health insurance if you are an independent contractor/1099. Of course there are massive tax breaks for 1099 via SEP and solo 401k plus access to pre-tax income to deduct many expenses.
Avoid 457F for instance.

I think its important for new grads to take good stable jobs with steady income and good environment and senior colleagues around. But do not be suckered into **** contracts and do not let some anesthesiologist tell you whats right for you and sell you something its not.

Agree with most of ur points. But if u work for a govt entity. The benefits at most places are extremely generous. Like free healthcare essentially. And u mention 457f which can be bad. But govt 457b is rock solid options. My place also has pension and 30k retirement contribution from employers. These are not bad “golden handoffs “. You are talking about 80-100k value here.

Now free healthcare , pretax 401a/403b/457b (comes out to around 55k pretax) for those under age 50 and 75k pretax for those over age 50 are pretty good in my opinion. Plus 3 months paternity or maternity paid leave. Plus option to use more time off. (That’s a 120k paid benefit as well)

 

[AKMD_1984]

Agree with most of ur points. But if u work for a govt entity. The benefits at most places are extremely generous. Like free healthcare essentially. And u mention 457f which can be bad. But govt 457b is rock solid options. My place also has pension and 30k retirement contribution from employers. These are not bad “golden handoffs “. You are talking about 80-100k value here.

Now free healthcare , pretax 401a/403b/457b (comes out to around 55k pretax) for those under age 50 and 75k pretax for those over age 50 are pretty good in my opinion. Plus 3 months paternity or maternity paid leave. Plus option to use more time off. (That’s a 120k paid benefit as well)

Vesting periods are handcuffs
Someone else holding on to your retirement funds are handcuffs

 

[pastafan]

Research and ask about hospital financials. Are they strongly in the black? Hospitals can and do go out of business or lack the resources to fulfill existing commitments.