What are the best/worst regions or states to practice in as an anesthesiologist?

Discussion in 'Anesthesiology' started by TRED1400, Feb 11, 2019.

  1. TRED1400

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    I'm curious about picking a residency in a place that I will eventually practice in, so I have been trying to look at the job market in each state of my top few picks. I understand the job market could vastly change in the next 4-5 years, but I'm not sure if this is something I should be concerned with at this point. Where does everyone think the best locations to practice are for anesthesiologists? The worst? Geared most towards PP and not academics.
     
  2. dr doze

    dr doze To be able to forget means to sanity
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    Define worst. Do you mean lowest income/cost of living ratio? Worst malpractice environment? Least amount of MD anesthesia? Regions with most CRNA autonomy? Highest AMC penetration.

    The reality is that these vary hugely even within states. Not just regions.
     
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  3. caligas

    caligas ASA Member
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    I’ll mark an argument, maybe a weak one, for not worrying about it. A good program will allow you to get a job anywhere. Likewise, the private groups in the town of your residency often don’t know the residents for Adam.

    Why not go somewhere interesting for residency for 4-5 years before you settle down in the $hit -hole where your fiancé grew up.
     
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  4. CUBR

    CUBR ASA Member
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    This is not something that should be on the top of your list of considerations for residency. A good program should be able to get you into any fellowship and have connections to all regions of the country for PP jobs. With that said, is it easier to know and interview with the group that's in the city of your residency...yes. As you said, the market can change. Your intentions and your personal situation can change too.
     
  5. dr doze

    dr doze To be able to forget means to sanity
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    You hit that one out of the park.
     
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  6. SaltyDog

    SaltyDog Homey O'Stasis
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    First off:

    LMFAO. :=|:-):

    But second:

    I will disagree that it doesn’t matter where you train. The best PP’s hire by word of mouth, and you want to be part of the network. I think you are thinking about things the right way. As mentioned above, tell us a little more about what constitutes “best” and “worst” for you and we can be more specific.
     
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  7. sevoflurane

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    -Indiana-

    “Physician Retention” is the uncommon language used by administrators in this state. Def. physician friendly... especially the more BFE you get.
     
  8. abolt18

    abolt18 I regret nothing. The end.
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    Is that where you did your stint in BFE?
     
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  9. 2Fast2Des

    2Fast2Des to become No One, one must be PP slick
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    Isn't indiana a backward maga country?
     
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  10. Man o War

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    One of my friends works in IN. This is true- his contract negotiations are always easy and very favorable to him.
     
  11. narcotics999

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    Southern Indiana? Part of it is close to Chicago; it should not be so bad, I guess.

    I have been thinking about Indiana and Wisconsin due to my spouse's family. But I always live in coastal area big cities and am afraid to go there.
     
    #11 narcotics999, Feb 11, 2019
    Last edited: Feb 11, 2019
  12. Man o War

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    He’s in central IN.
    Indianapolis is their biggest city I think- I’ve never been there so not sure what it has to offer. Are you ok with Midwest weather?
     
  13. sevoflurane

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    Bloomington and Indianapolis are the 2 descent places to live. Outside of that..... pretty awful.
     
  14. SaltyDog

    SaltyDog Homey O'Stasis
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    One of partners used to work in South Bend. Made a killing there. At least you have football.
     
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  15. sevoflurane

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    South Bend isn’t terrible. But they are close to Chicago and have a newly restructured MD only group. ;)
     
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  16. algosdoc

    algosdoc algosdoc
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    Indiana

    The practice environment in larger cities in Indiana is very pro-physician/anti-CRNA in some of the major hospitals since Indiana is the house Stoelting built. Malpractice environment is generally good with a physician panel viewing and voting on whether there was malpractice prior to cases going to trial- this knocks out many frivolous lawsuits. There are caps on malpractice awards unlike in other states like Florida. Asset protection laws are not as good in Indiana as in some other states (e.g. tenancy in entirety ownership of property has no meaning in Indiana).

    The major downside to living in Indiana is the bone-chilling depressing cold weather in the long dark winters followed by a scorching hot summer. Fall and spring are nice, but short seasons. It snows in Indiana- a lot in some places, and the amount is not a mere inconvenience: it is a lifestyle dictating occurrence that causes cancellations of many events and cancellations of surgeries when patients cannot get into the hospitals. South Bend gets 67 inches of snow each year and most of the cities in the rest of the state get 20-35 inches per year.

    Culture? Well there is some in Indianapolis and near Louisville, but otherwise culture may be a tractor pull, a county fair, or dirt track racing. Smaller cities participatory team/group sports for adults are limited to bicycling clubs, softball leagues, and sporadic soccer clubs or volleyball leagues. Road bicycling is difficult in the winter due to the sand and gravel dumped by the county on their roads. Most people in Indiana get very little exercise at all.

    Colleges located throughout Indiana are frequently extensions of the IU/Purdue system or Ivy Tech system. Notable exceptions include Butler University where basketball rules in an inner city Indianapolis college that is very expensive, Univ of Evansville located in a nice middle sized city that is isolated far away from the rest of humanity in the middle of corn fields, Rose Hulman that is an outstanding engineering college located in a pit of a town Terre Haute, and Notre Dame that is revered but is located in the permafrost of South Bend.

    Indiana ranks 7th nationwide in obesity with entire families being obese from elementary school age throughout the rest of their lives. 33% of the population is obese or morbidly obese, and another 33% are overweight. The population is largely sedentary in Indiana, and all-you-can-eat restaurants are frequented by entire families. This makes for a very unhealthy population with diabetes, knee and hip arthritis, and heart disease complications creating surgical and anesthetic opportunities. Bariatric surgery (frequently ultimately fails) is rampant with more bariatric centers in Indiana than there are plastic surgeons in South Beach. But it also makes for a very unhealthy environment for your kids since corpulent is the norm, with poor dietary choices (but in massive quantities) being pervasive.

    There are but a few jewel cities in Indiana including Carmel (pronounced like the candy, not the California seaside city), Fishers, and Zionsville, all suburbs of Indianapolis. Bloomington is where the main campus of IU is located and is a vibrant community. Many moderate or small cities are industrial rustbelt residual cities whose fortunes rise or fall based on one major factory. Indianapolis the city, has a major crimes rate in the top 20% of the country with a relatively high murder rate (drug related) of 17 per 100k population but this is less than 1/3 of that of Baltimore or Newark. Gary Indiana is a cesspool with an active gun running trade to Chicago. Anderson, Warsaw, East Chicago, Kokomo, Lafayette, Hammond, Elkhart, Jeffersonville, Terre Haute, Seymour, Scottsburg, Greensburg, Clarksville, and many others are small-moderate sized cities that leave much to be desired from a lifestyle standpoint since they are rusted out shells of cities, some of which seemingly have no zoning laws at all.
     
    #16 algosdoc, Feb 12, 2019
    Last edited: Feb 12, 2019
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  17. futurepaindoc234

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    How does Ohio compare to Indiana in regards to practice environment??
     
  18. algosdoc

    algosdoc algosdoc
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    Perhaps someone practicing in Ohio can enlighten us
     
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  19. sethco

    sethco Senior Member
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    I'll throw my hat in for Texas. While not as good as Indiana for MD only practices, some can still be found across the state. My practice is MD only, but we are heavy cardiac and most practices like this in TX do MD only for at least those cases. Besides that, no state income tax, major metro cities with lots to do, relatively good weather year round, good public school systems available, major airports with International access, very good cost of living (Austin is an outlier), malpractice reform with caps on noneconomic damages, and so on. Downside is obviously the explosion of AMCs across the state, but there are still plenty of mom and pop shops still around.
     
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  20. piviti

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    Would like to know this too if anyone could chime in.
     
  21. SaltyDog

    SaltyDog Homey O'Stasis
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    Basically, you want to look for a state that has a combination of low/no state income tax, and tort reform. Ideally west of the Rockies. Try NV, WY, MT, AK.
     
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  22. narcotics999

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    Oh, sounds like a shxxhole.
     
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  23. Twiggidy

    Twiggidy ASA Member
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    I agree with this. From what I hear if finances are a concern then TX is a good place to be.
     
  24. Twiggidy

    Twiggidy ASA Member
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    Indiana is a very typical midwestern state. Like most, if culture is what you're looking for then you need to stick to major cities. Pretty much if a pop star has a tour date there, that's where you want to be but that comes with the downside of the negatives of city living, ie crime. Indiana is special in the sense that it sits in the I-65 corridor so you get the gang activity that works its way up from Atlanta to Chicago. This has been going on for years. The pro is that you'll have a high (er) income and a low cost of living so you can just pick a safe suburb in which to live. The weather situation is accurate. The upper midwest gets significant snow and places like Indiana and Ohio don't handle it as well as states like MI, Wisconsin, and upper Illinois. 6-12 inches of snow will literally shut the state down for a few days.
     
  25. Twiggidy

    Twiggidy ASA Member
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    I don't recommend California for anyone coming out of residency unless you have no school loans and a trust fund. But that's just my opinion.
     
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  26. narcotics999

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    Great places to prepare for civilization meltdown.
     
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  27. somedumbDO

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    DO NOT, I repeat DO NOT WORK IN CHICAGO/COOK “crook” county. Chicago is a mess the city is bankrupt. Medical mal is approaching astronomical levels. Mid levels everywhere and a lot of good groups sold out to amc. Taxes are redic high, and not to mention you are likely to be shot on the freeway headed to work. But they have good food and culture......
     
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  28. Man o War

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    My friend who works in IN told me not too long ago when I saw him that both an AA school and a CRNA school opened around where he works recently. Should make for some interesting politics in a state that has been traditionally MD only, at least in the bigger cities.
    There was a time I considered IN, so he echoed much of what’s written here to me when I inquired- crap weather, little to no culture/diversity, and very unhealthy patient population. He said the roads are fairly terrible maintenance wise too. But taxes are low, med mal excellent, and salaries high.
     
  29. GravelRider

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    When we are talking BFE money, what are some numbers that we are talking about? Given that honest and thorough description of Indiana above, it just doesn’t strike me as the kind of place that is going to have the right combination of payer mix and volume to make big money. Am I wrong? Are there subsidies from the hospitals to attract physicians? Is the big money in BFE more a function of lower cost of living?
     
  30. Mr.S

    Mr.S Probationary Status

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    Its all bad. Buuuuttt, if it absolutely does not matter, find a state where the malpractice laws are the friendliest.
     
  31. SaltyDog

    SaltyDog Homey O'Stasis
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    With extremely rare exception, you are spot-on with BFE = craptastic payer mix. The $$$$ is in the subsidies these places offer. As @sevoflurane mentioned: physician retention.
     
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  32. FFP

    FFP Wiseguy
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    That's Indiana. It should be the inspiration for federal malpractice laws. 90+% of state malpractice laws seem absolutely ridiculous to any immigrant physician. Even the so-called "physician-friendly" ones. When, on average, every physician gets sued at least once every 10 years, that's a f-ed up system.

    The other good options to avoid malpractice harassment are the VA, and state-owned hospitals with sovereign immunity (as their employee).
     
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    #32 FFP, Feb 13, 2019
    Last edited: Feb 13, 2019
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  33. Mr.S

    Mr.S Probationary Status

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    The VA has all sorts of other problems to contend with not the least of which is the massive red tape and bureaucracy thats inherent in a governmental system. Howard Schultz pointed out last night in his Town Hall that the VA has a 200 Billion dollar budget. That is absolute insanity. Moreover, if the VA pays anything out oh your behalf you go right to the databank. You may not be sued but your name WILL appear in the databank.
     
  34. anbuitachi

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    Wow NY sounds like it has them all..
    Low income, high cost, awful malpractice environment, a thousand AMCs here, tons of CRNAs
     
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  35. chocomorsel

    chocomorsel Senior Member
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  36. dr doze

    dr doze To be able to forget means to sanity
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    There is still a decent amount of MD Anesthesia in and around the NY metro area.

    Upstate NY is a different planet. Just like central PA is a different planet than Philadelphia.
     
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  37. zizzer

    zizzer ASA Member
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    Does anybody practice in Missouri and want to share about it? Or a bordering state?
     
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  38. ranvier

    ranvier I can't anesthetize a rumor.
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    Can anybody tell me more about Michigan? I've got the bone chilling depressing winter down....the practice environment.
     
  39. GravelRider

    GravelRider SDN Lifetime Donor
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    This is true. There is a misconception that the Northeast is all 4:1 supervision jobs. There are plenty of MD only and 50-70% solo jobs within commuting distance of the big cities. The 4:1 jobs are actually not the rule in the northeast at the moment. Average salary outside the downtown cities is also more in line with the rest of the country. The big academic programs in the cities have pathetic salaries, though. There are a ton of AMCs and sleazy private practices littered throughout the northeast, but you can still do your own cases and find some reasonable jobs.
     
  40. Twiggidy

    Twiggidy ASA Member
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    Can you elaborate on that part a bit if possible?
     
  41. Gas

    Gas Member
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    I've been in Upstate NY since finishing residency in NYC. We moved here for proximity to family, quality of life, reasonable housing costs, reputable public schools, and most importantly, a great practice. We are small community hospital, bread and butter cases, about 70% CRNA supervision, 30% solo cases (pretty much whenever on call). We are independent, one hospital, solid relationship with surgeons/administration, and overall I'm very happy.

    Our winters are long and cold, but probably nothing compared to the midwest. NY taxes are high - both state income taxes as well as property taxes. Nice to be 3 hours from NYC - it's there when we want it, but we don't have to deal with the crowds, congestion, and insane cost of living.
     
  42. Psai

    Psai This space for lease
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    And city tax
     
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  43. d2305

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  44. ERRES2288

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    AMCs galore.
     
  45. FFP

    FFP Wiseguy
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  46. chocomorsel

    chocomorsel Senior Member
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    Surprising that TX doesn't have an economic cap. Guess this is true with most states.
    FL sucks. Don't think I will go there since their cap was scratched.
     
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