No fellowship, as I trained in a residency where I got plenty of trauma and emergency surgery experience and had early operative experience so my chief year wasn't spent learning how to do the basics but instead was a balance between teaching junior residents to do appys and choles and doing bigger cases with the attendings not necessarily scrubbed. I stayed on at my training institution for a year as attending which let me get those first year attending jitters out in an environment I knew and with staff backup that was easy to get. Then I was approached by a prior attending who was out in private practice because he didn't want to take call anymore. It is a kinda unique set up in that there is a surgeon who is very business oriented who offered all the overhead I need (billing, office space and supplies, office staff and an office manager to take care of all the credentialing and admin ****) in return for a percentage of my income or a set salary. I had enough money to make it through the initial lag time between working and actually getting reimbursed by insurance so I chose the eat what I kill option (with paid call) which has been very lucrative and is very flexible in that if I were to not work one month I would owe zero overhead for that month which is pretty cool.
I see patients one half day a week (though lately I have had more new patients so I added a half day here and there as needed so no one has to wait long to be seen) which is mostly postops and quick. The guy that got me this job covers clinic for me when I go away and I return the favor for his trips (plus cover any patient left in house from his Tuesday OR day since he leaves town most every weekend, his schedule is pretty awesome too-no call, two half day clinics, two half days at the surgery center, one day in the hospital OR for bigger cases that I assist him on and we almost always finish by noon and the rest of the time is spent at his condo in Mammoth or the one in Oxnard). The other folks on the call schedule is who I have cover in patients left over when I am going to head out of town.
There are other set ups where you cycle between call, clinic, and off hours and pass people off to your colleagues (surgical hospitalist) which sounded interesting and I probably would have gone for that sort of thing if the alternative was doing the overhead stuff myself. I know I am the kind of person who would agonize over finding the cheapest gauze and whatever else and it would kill me to pay rent and salaries while I am not working.
