Which is job would you pick ?

  • Thread starter Thread starter deleted545787
  • Start date Start date
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
D

deleted545787

Hello all,

Having a hard time picking between jobs. Cardiac trained, looking for academic job due to PSLF, both options are academic:

option 1: 525k, no hearts, supervise 4 rooms, short staffed with many locums. m-f general shift with 4 weekday and 1-2 weekend 24hr call shifts. Benefits standard, nothing special. 8 weeks PTO. culture kinda weird, CRNA run sedation practice (scopes, tee, etc)

option 2: 480k, has hearts, with extra compensation if staying past 4pm and holding charge phone. No 24hr calls. maybe 1 weekend day shift every 6-8 weeks. Has a night float system 7 days, 12hr shifts followed by a week off (currently about 6 night floats a year).8 weeks PTO. Heart heavy institute, likely doing hearts 4 days a week. generalist making 465k with less hours than heart people (kind of sour about this).

I'm not crazy about doing hearts everyday, I would like more of a balance...

Whats your take? Whats negotiable in a academic practice?
Members don't see this ad.
 
is academic place true state employed? Lots of issues with loan forgiveness non true state employed (or federal employed)
 
Members don't see this ad :)
#2 all day.

After fellowship I think you should really practice heavily in that area unless you hate it for some reason (e.g. I had a friend do a critical care fellowship and then eject hard into community practice without CCM due to hating it). Otherwise you'll lose out on developing and retaining your skills. Plus cardiac is in such high demand that even if you do job #2 for a bit and don't like it, you'll be highly, highly marketable upon transitioning out. If doing too much cardiac starts to burn you out in #2 you can probably also negotiate for a mixed practice there since they wouldn't want to lose you.

#1 has a bunch of red flags. If they need to sustain themselves on locums it's a bad sign. As it's academic they have an in house pool of graduating residents who'd stay if it were any good. CRNAs running anything is a huge red flag. 1:4 is also an absolute hard no, there's almost no amount I'd take to do that regularly - it's truly awful. Also "weird culture" is yet another red flag... if they can't hide weird culture issues on an interview, be sure there is much more weirdness below the surface.
 
Last edited:
Modoc said:
Hello all,

Having a hard time picking between jobs. Cardiac trained, looking for academic job due to PSLF, both options are academic:

option 1: 525k, no hearts, supervise 4 rooms, short staffed with many locums. m-f general shift with 4 weekday and 1-2 weekend 24hr call shifts. Benefits standard, nothing special. 8 weeks PTO. culture kinda weird, CRNA run sedation practice (scopes, tee, etc)

option 2: 480k, has hearts, with extra compensation if staying past 4pm and holding charge phone. No 24hr calls. maybe 1 weekend day shift every 6-8 weeks. Has a night float system 7 days, 12hr shifts followed by a week off (currently about 6 night floats a year).8 weeks PTO. Heart heavy institute, likely doing hearts 4 days a week. generalist making 465k with less hours than heart people (kind of sour about this).

I'm not crazy about doing hearts everyday, I would like more of a balance...

Whats your take? Whats negotiable in a academic practice?
Click to expand...
I dont do cardiac but I would wonder how often I am hassled after hours by the call beeper with job #2. Might not be worth the extra pay. Might be a huge PIA IMO. I mean the nature of cardiac surgery and take backs is unpredictable.

I think you will find a lot of hospitals in the situation as #1. Easy to judge but its going on everywhere. At least the call there is defined and you are doing a variety of cases. I personally HATE the beeper at home.
 
Modoc said:
Hello all,

Having a hard time picking between jobs. Cardiac trained, looking for academic job due to PSLF, both options are academic:

option 1: 525k, no hearts, supervise 4 rooms, short staffed with many locums. m-f general shift with 4 weekday and 1-2 weekend 24hr call shifts. Benefits standard, nothing special. 8 weeks PTO. culture kinda weird, CRNA run sedation practice (scopes, tee, etc)

option 2: 480k, has hearts, with extra compensation if staying past 4pm and holding charge phone. No 24hr calls. maybe 1 weekend day shift every 6-8 weeks. Has a night float system 7 days, 12hr shifts followed by a week off (currently about 6 night floats a year).8 weeks PTO. Heart heavy institute, likely doing hearts 4 days a week. generalist making 465k with less hours than heart people (kind of sour about this).

I'm not crazy about doing hearts everyday, I would like more of a balance...

Whats your take? Whats negotiable in a academic practice?
Click to expand...

I say option 2. But if you're deadset against 100% cardiac then maybe take option 2 but ask for the generalist position? You can take generalist call and simply ask if they will let you do enough daytime hearts over the year to keep your cert.
 
We would probably not take a "cardiac-trained" person who didn't do any cardiac straight out of fellowship, and the further away from fellowship you are, the farther you'll fall behind in terms of skills. It's a waste of a year, IMO, since the learning doesn't stop after June 30th. There are nuances to cardiac cases that just can't be taught in a year of fellowship with someone looking over your shoulder the whole time. I've made some tough calls on tough cases, and I've made some wrong calls as well. It's important to experience this when you get out, IMO, and there's nothing else that can replicate doing your own cardiac cases for several years.

Let's say you choose #1 and do zero hearts for three years while you get your PSLF stuff squared away. Now you're looking to move and are looking at cardiac positions as well. Would you feel comfortable doing elective CABGs? Probably. What about aortic dissections, tamponades, advanced heart failure therapies/mechanical support devices, complex valve repairs, minimally invasive/robotic cases, in addition to making the calls on TEE (e.g., RWMAs coming off of CPB, wire placement on dissections, cannula positioning, specific valve defects, volume assessments, etc.) and managing complex cardiac patients needing non-cardiac surgery? I'd say you'd need a lot of time, motivation, and proctoring to re-learn, develop, and refine those skills that were lost in those three years.
 
Modoc said:
Hello all,

Having a hard time picking between jobs. Cardiac trained, looking for academic job due to PSLF, both options are academic:

option 1: 525k, no hearts, supervise 4 rooms, short staffed with many locums. m-f general shift with 4 weekday and 1-2 weekend 24hr call shifts. Benefits standard, nothing special. 8 weeks PTO. culture kinda weird, CRNA run sedation practice (scopes, tee, etc)

option 2: 480k, has hearts, with extra compensation if staying past 4pm and holding charge phone. No 24hr calls. maybe 1 weekend day shift every 6-8 weeks. Has a night float system 7 days, 12hr shifts followed by a week off (currently about 6 night floats a year).8 weeks PTO. Heart heavy institute, likely doing hearts 4 days a week. generalist making 465k with less hours than heart people (kind of sour about this).

I'm not crazy about doing hearts everyday, I would like more of a balance...

Whats your take? Whats negotiable in a academic practice?
Click to expand...
Job number 2 for you or that fellowship has been wasted. This won't be your last job so take number 2 and keep looking for something better down the road.
 
Southpaw said:
If you want more of a balance then keep looking. Job 1 has red flags all over the place and I wouldn’t step foot in the place. An academic place dependent on locums, running 4:1, and CRNA run services is a dumpster fire.
Click to expand...
That’s common at probably 30% of true academic places these days. Locums docs and locums crna’s. Every place is Short staff trying to make money for the hospital. Including academic places
 
Academics pay this much? Is this after call points, etc. or is this salary?
 
#2.
Also do yourself a favor, if you haven’t done it, calculate out how much you’ll actually be forgiven. Since you’ll be back on income based repayment, after fellowship (?). If you’re doing it straight through, you still need five more years, right?


If you can find a job with better conditions in private practice for 600K, how would that compare?

I am allergic to CRNAs at this time in my career. So 1:4 all day, everyday. On top of that without a steady work force?! That’s a he!! No from me.
 
Members don't see this ad :)
Thank you all for your input! Very valuable in my current position.

Heres a update.

#1 increased salary to 572k, no non compete, allowing me to moonlight at other hospitals to retain my cardiac skills. with loan forgiveness, package ~ 620k/ year

#2 holding fast to offer, not being flexible.

Sucks being poor and coming out of fellowship.

It will be a tough decision.
 
Modoc said:
Thank you all for your input! Very valuable in my current position.

Heres a update.

#1 increased salary to 572k, no non compete, allowing me to moonlight at other hospitals to retain my cardiac skills. with loan forgiveness, package ~ 620k/ year

#2 holding fast to offer, not being flexible.

Sucks being poor and coming out of fellowship.

It will be a tough decision.
Click to expand...

Even with the salary bump that first job is a dumpster fire. It'd have to pay 7 figures before I'd consider a job with rampant locums, 1:4 all the time, and CRNAs running academic Endo/Nora cases solo.
 
vector2 said:
Even with the salary bump that first job is a dumpster fire. It'd have to pay 7 figures before I'd consider a job with rampant locums, 1:4 all the time, and CRNAs running academic Endo/Nora cases solo.
Click to expand...

I just saw an email, something about a RRNA doing his doctoral project.
GTFOH.

I just had a conversation with my SO. I would gladly take a 20% pay cut, if I NEVER have to deal with a crna again in my career.

OP, you can
1. Show them your other offer. (They may not care, nor have the money to bump up your pay…)
2. Negotiate something within the practice. Less call, more general days, more vacation. Or like someone else mentioned, be a generalist in the group and “cover” cardiac for a fee. Or maybe buy some cardiac days.
Sometimes a group may have separate pot of money or separate goals. (General vs cardiac vs pediatrics vs pain vs OB). It’s not inconceivable different division heads will have different needs. If you have the skill sets that can help out both, maybe that’s your way in.

The first job really sounds like a dumpster fire. If I wasn’t clear in my other post. When you have a locum revolving door, with very unstable workforce, it’s dangerous. No one really “knows” anything for sure, policy, politics or culture of the place. On top of that you’re supervising 1:4? Don’t kid yourself…. The crnas will come to you, (if they actually bother to come), and say I’ve been here longer than you have. I know the “leadership” and the surgeon better than you.
You are doomed from the getgo.
 
Do as much cardiac after fellowship as you can and negotiate some general rooms so you can maintain being a "well rounded cardiac anesthesiologists". You'd be surprised how fast you can manage to lose skill both cardiac and general skills (sic mostly regional blocks). Plus, sometimes it's a breath of fresh air to not have to line every patient up and drag them off pump and just site and do a room full of lap choles.
 
pgg said:
Does job #2 do transplants and VADs?

That's the stuff that makes cardiac call hurt.
Click to expand...
they do , but I wouldn't consider them high volume.
secretasianman said:
Number one sounds toxic. Makes me wonder what messed up politics led to 1:4 all the time and ceding sedation completely. That is, it’s no sedation until it hits the fan and you get paged to gi for bad aspiration or massive gib. Then it’s “I’m just a nurse.”
Click to expand...
sounds like a nightmare.

yeah I hear what you all are saying. Sounds like the consensus is pretty uniform. I'm in a undesirable region for people to move to / live in, the university hospital lost several anesthesiologist (>10) in the last three months. So the system is desperate on recruitment. SO is still a resident and also busy, im at a point were im unsure if I should just work a ton to make a lot of money before moving back home (HCOL) or just kick it and take #2 for what it is.

I appreciate all your insight. Been very helpful.
 
Modoc said:
Yeah, that's #2.
Click to expand...


Yet they won’t negotiate pay 🤔. $480k is not competitive for 4days/week of hearts.
They’re not desperate enough yet. They will likely lose more people in the coming months. Wait a few months and maybe there will be a better offer. They will still have many vacancies.
 
Last edited:
nimbus said:
This thread was just 2 years ago.

Amazing how the market has changed.
Click to expand...
i know in our neck of the country all the small hospitals are getting gobbled up by the big hospital systems. i wonder how much that's effecting the market
 
Twiggidy said:
i know in our neck of the country all the small hospitals are getting gobbled up by the big hospital systems. i wonder how much that's effecting the market
Click to expand...
In Florida. The crnas are crying foul when Orlando health took over a (bayfront) St. Petersburg hospital and gave Crnas 4 days to sign a new contact suppose for 185k last week (whether that’s true or not, I have my suspicions it’s not). Like my Crnas friends claims they get paid $105/hr according to their pay check n yet they work 7 days month plus get 11 weeks paid off for 220k. That’s because the state and feds calculate 220k/2087 work hours without factoring in paid benefits and time off
 
You must log in or register to reply here.

Similar threads

P
Another which job would you pick?
Replies
29
Views
2K
Twiggidy
Twiggidy
B
Would you take this job?
Replies
30
Views
3K
ASA6
A
patriot6
Another "which job" question
Replies
22
Views
2K
aneftp
A
TheLoneWolf
How much is this job worth?
Replies
38
Views
3K
TheLoneWolf
TheLoneWolf
Timeoutofmind
What is this job worth?
Replies
8
Views
2K
dabears505
D
Top