What are your long term goals for practice?

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TRAMD

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I asked this question of Blade28 and figured it was an interesting one for all. What specialty? Where would you like to work? A small town or a big city? A group practice, employed by a hospital or solo practice?

I personally plan to be double boarded in PM&R and occupational medicine and take over my father's occupational medicine practice in a small city (service area of about 300,000). Ideally I will also be working with some PM&R guys whom do mainly outpatient musculoskeletal and pain. I would like to split my time half and half.

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I'm leaning toward something cancer related ... maybe urology, hemeonc, something like that. That probably means a bigger city for me. However, I like essentially all aspects of medicine, and wouldn't even mind being a family doctor in a small town. I'm pretty open.
 
I'd like to setup my own facility from the ground up. It'll be a group facility with a bunch of physicians who're interested in a paperless (as much as possible) and streamlined, patient centric environment providing care. I'd like leverage my past business experience + technology to build a state of the art facility. Additionally, I'd like to dedicate a portion of time to pro bono work for those who can't afford care.

I say we can build operational structures that can reduce costs yet at the same time provide better care. It's easier to do that considering the inefficiencies of our current health delivery system.
 
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Academic surgery (leaning towards orthopedics) + med school administration (i.e. assistant dean, dean etc).

I've been very fortunate to have some awesome deans that have had a great influence on my life. I'd like to be involved in student's lives like that.

Certainly could change my mind, though.
 
In a big city hopital doing anasthesiology or family med; teaching; projects in developing countries; perphaps a tenure as a field doctor with the military.
 
private practice surgery - whatever pays the most (most likely spine-work). i like money.
 
Private practice Ob/Gyn in a large group
 
Is it possible to do part private practice and part research/academia, or does it have to be one or the other? That's what I would like to do, but I can also see it being unrealistic.
 
private practice surgery - whatever pays the most (most likely spine-work). i like money.

if you're interested in money, stick with derm or plastics. when reimbursements drop (sooner than later), spine will be the first target.
 
Private practice surgery through the years I actually will have a family and then go back and teach when I get old/lose dexterity.
 
if you're interested in money, stick with derm or plastics. when reimbursements drop (sooner than later), spine will be the first target.
says who?
 
says who?

Speculation. But its a very easy target with all the salary information floating around. All docs are going to face reimbursement cuts to keep healthcare costs down (even though this really isn't the problem), spine surgery and rads are the two that I would bet to get cut first.

Cash procedures (PRS, ENT +FPS, Derm) are the answer if you're all about the moolah.
 
Still early, but right now...

Congenital cardiac surgery. Small city, don't want to be a ghost to my own family. I'd gladly sacrifice compensation in favor of being a good husband and father. Would love to work with a small team with tight dynamics between the members (the group at my school's hospital functions this way - surgeons, ped cardiologists, PAs, and scrub nurses all work really well together, its pretty cool).
 
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Still early, but right now...

Congenital cardiac surgery. Small city, don't want to be a ghost to my own family. I'd gladly sacrifice compensation in favor of being a good husband and father. Would love to work with a small team with tight dynamics between the members (the group at my school's hospital functions this way - surgeons, ped cardiologists, PAs, and scrub nurses all work really well together, its pretty cool).

Thats awesome man. Have you read 'Walk on Water'? I think the book was written (very) poorly, but it brought up some interesting points. How do you feel about wanting to work in a small city vs. having the necessary volume to maintain standard of care (the book talks extensively about this)?

Just curious.
 
Is it possible to do part private practice and part research/academia, or does it have to be one or the other? That's what I would like to do, but I can also see it being unrealistic.

People in psych do this all the time. 20 clinical hours with the academic center, residents, etc then another 20-30 hrs of private practice in their own offices. Others will fight hard in academics to land that chairman position and then leverage their chairmanship to get some private patients at $500/hr, and just take a few outside pts, etc.
 
Finish General Surgery residency, then 3-year Cardiothoracic Surgery fellowship. Ideally, I'd like to do both Cardiac and Thoracic at an academic center, working with residents and fellows. I'm really torn between the two fields, even as many attendings tell me I have to pick "one or the other - you can't be good at both!"

I'm also starting to like lung transplantation, against all odds!

I'd like to live in a city that's at least fairly large. Specific location doesn't matter as much to me right now.
 
I waver between working in a city like Boston, San Francisco, Chicago (inner city academics) versus Alpine, Texas pop. 6000 where I can serve the 10 surrounding counties and go hiking in Big Bend in my (limited) free time.

My life is a continual search for new experiences so I can see myself doing both.

I also want to teach, but whether that is as a personal mentor, advice-giver to my patients, or medical school professor doesn't matter to me much.
 
People in psych do this all the time. 20 clinical hours with the academic center, residents, etc then another 20-30 hrs of private practice in their own offices. Others will fight hard in academics to land that chairman position and then leverage their chairmanship to get some private patients at $500/hr, and just take a few outside pts, etc.

Is it possible to do this in Ophth too as well? I'm leaning towards Ophth right now because it has a good balance of clinical and surgical hours.
 
Speculation. But its a very easy target with all the salary information floating around. All docs are going to face reimbursement cuts to keep healthcare costs down (even though this really isn't the problem), spine surgery and rads are the two that I would bet to get cut first.

Cash procedures (PRS, ENT +FPS, Derm) are the answer if you're all about the moolah.

OH, I did not know that. How much less do you think spine surgeons will make? and how soon do you suppose?

Wait cash procedures are : Can you explain I dont know what those symbols mean.

BTW- I am not all about money but it plays a big role in my specialty decison!
 
Thats awesome man. Have you read 'Walk on Water'? I think the book was written (very) poorly, but it brought up some interesting points. How do you feel about wanting to work in a small city vs. having the necessary volume to maintain standard of care (the book talks extensively about this)?

Just curious.

I strongly dislike the book. Think it portrays a very negative image of large percentage of congenital cardiac surgeons in this nation... that we settle for less than best and have to with no acknowledgment of the good will or hard work put in by the "less than stellar" surgeons out there. Yes, we should always strive for the best outcome, but not every place is going to have a >95% outcome rate. I feel like the author had a bit of an infatuation with Dr. Mee and would have him do every heart surgery in the world if he could. But yeah, it did raise some interesting questions. Does a car dealership ask the best salesman to do 99% of the sales? No, they assemble a team and hope for a certain quantitative outcome. While it may be unfair to compare child's lives to cars, the idea unfortunately remains the same. We train a select number of surgeons in this country, a select number of CT surgeons, and a select number of congenital cardiac surgeons. We require so much training to require a certain level of excellence. Some are going to exceed about that level of excellence, some are going to be right at that level. To expect the "better" surgeons to burden the majority of the load disregards to simple fact that (1) the field does require and demand such excellence from its practitioners (2) diminishes the successes and demands put on the less successful surgeons and (3) conveys unrealistic expectations of outcome from our HUMAN surgeons. Pediatric surgery is risky. To expect too much does a disservice to others in the field who may not have that naturally "talent" in the field only a few possess.

For my aspirations of practicing, I guess it comes down to a definition of small city. The surgeons in the congenital cardiac team at the hospital at my school are a two man team. The population base for the whole population area is around 2 million. Since its a two man team, they take call every other night (about 15 nights a month) and get called in about 5 times. 5 nights a month of hospital call a month isn't bad. The population base in big enough to support a fairly solid patient base (they're never too bored and never too busy, though often busy). Reimbursement is nothing they'd be making in Cleveland or Boston, but enough to support a more than comfortable lifestyle. The elder surgeon travels the country and gives talks with his wife about how to have a healthy marriage with busy lifestyles. They're a pretty admirable team, and are both pretty "unconventional" cardiac surgeons. But its refreshing to see that you CAN accomplish certain things that you would normally think you would sign away with a life in cardiac.

Maybe I'm a bit optimistic about my goals in cardiac, but these guys are so down to earth and inspirational its made me believe I can make the type of compromises I hoped I'd be able to in my professional life (which was my one main and only hesitation about going CT). Like many successful busy professionals have said, its not about the quantity of time you spend with your spouse/family, but the quality.
 
Wait cash procedures are : Can you explain I dont know what those symbols mean.

PRS = Plastic and Reconstructive Surgery
ENT + FPS = Otolaryngology with a Facial Plastic Surgery Fellowship
Derm = Dermatology
 
PRS = Plastic and Reconstructive Surgery
ENT + FPS = Otolaryngology with a Facial Plastic Surgery Fellowship
Derm = Dermatology
Awesome thanks. Wow did not know plastic surgeons made alot of money. I did a salary search from the AAMC and it said they only made around 223k per year. So maybe they arent cash procedure anymore.
 
Awesome thanks. Wow did not know plastic surgeons made alot of money. I did a salary search from the AAMC and it said they only made around 223k per year. So maybe they arent cash procedure anymore.


That's the low end for plastic. Average I've heard (though its tough to get surgeons to talk about how much they make) is about double that. Plastics salary also seems to vary more by where you choose to practice than other specialties (which should seem intuitive since the majority of plastic surgeries in this nation are cash based and elective). 7 figures is still possible in plastics if you want to sell your soul, but the plastic surgeons I talk to focus on reconstructive surgery and seem to have highly gratifying careers (though I'm sure the money plays into that)
 
That's the low end for plastic. Average I've heard (though its tough to get surgeons to talk about how much they make) is about double that. Plastics salary also seems to vary more by where you choose to practice than other specialties (which should seem intuitive since the majority of plastic surgeries in this nation are cash based and elective). 7 figures is still possible in plastics if you want to sell your soul, but the plastic surgeons I talk to focus on reconstructive surgery and seem to have highly gratifying careers (though I'm sure the money plays into that)
How exactly can you sell this? By using ebay? (it is really a serious quest cuz I want the moolah!)
 
For about 10 years of my practice (maybe more) I see myself practicing general surgery overseas, probably in one of the African countries. Its always been my dream to do something more substantial than just a summer mission. When/if I come back to the states, I would probably work in a city hospital, maybe academic, so I can teach (and take medical students and residents with me on intermitant mission trips).
 
Emergency medicine, working for a group of physicians and contracting with hospitals. I'd like to be able to work 9 months out of the year (3-4 12hr shifts per week) and do several missions with MSF during off time. We're talking dream schedule, right?

Mom keeps hoping I'll come around to FP and take over her rural solo practice but no way am I interested in her schedule and the crap she takes in primary care.
 
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