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June 1, 2013 Volume 77, Number 6
Finding the Right Job Lars E. Helgeson, M.D. Committee on Practice Management

Aparna Ananth, M.D. Committee on Practice Management



Having a job ready after graduation is a major focus for a CA-3 resident. You may have decided if you want to do a fellowship, go into private practice, stay in academia or go military. You probably have a fairly good idea about geographic preferences based on family, climate, social, financial or other factors. Perhaps you are open to going anywhere as long as you get the “right” job.

So what is the right job?
A great job for one person may be a very poor choice for another. It is essential to put some thought and effort into finding a practice that fits your personality, temperament and expectations. Put simply, the practice should be a good match for you and you need to be a good match for the practice.

Before anything else, you need to have an honest conversation with yourself:
1.  What sort of practice and life do you really want?
2.  Do you want to work harder and longer to have a robust income, or would you prefer a lower income with better work-life balance? Would you like to work part-time to accommodate your other commitments?
3.  Do you enjoy the challenge of complex cases on a regular basis, or do you prefer less stressful cases in general?
4.  Is it important for you to have access to certain types of cases, e.g., cardiac or pediatrics?
5.  Do you want to be in a large group or work in a small community hospital?
6. Do you want to do your own cases or supervise CRNAs/anesthesiologist assistants or residents?
7. Are you interested in research and academic pursuits?
8. Are you interested in practice management and administration?

Other issues must also be considered.
1. Spouse considerations are central.
2. For many people, being close to family is vital.
3. For some, cultural and ethnic connections are important.
4. Do you like the big city or prefer small-town life?
5. Are you single and happy, or are you looking for a partner?
6. Climate and regional factors should be considered.
7. Recreational opportunities matter! Do you like the great outdoors, prefer rodeo and barbeque, or is Broadway and fine dining more your style?

These types of questions and issues all need to be considered and prioritized. Keep in mind that you will spend the majority of your waking hours at your workplace. Just finding a job in the perfect city may not be conducive to career satisfaction if the culture of the practice is not in alignment with your values.

When interviewing at a practice, it is a two-way street. Be sure to remember that you are the interviewer as well as the interviewee. Try to meet with different members of the group – both senior and junior members.

What questions should you ask at the interview? It is important to know your income, work hours and number of vacation weeks per year; however, these questions are usually answered without asking.

You should try to get a sense for other factors such as the group’s culture and temperament.

  • Is it a nice place to work, and is the staff helpful and pleasant?
  • Is there underlying stress within the group or problems with the surgeons or hospital administration?
  • Is there a fair system for daily case assignments/call scheduling, or is it done by seniority?
  • Do all members of the group have the same contract, or is it variable and negotiable?
  • It is worthwhile to have the contract reviewed by an attorney who has experience with physician contracting.

  • If possible, obtain the contact information of someone who has recently left the practice. Most people in the group will tell you the best things about their practice when you meet them. Change the perspective by asking what they like least about their group/practice.

    Another good strategy is to ask related questions when the interviewer brings up specific points. With intelligent timing and tact, it may be appropriate to directly ask certain sensitive questions. It is important to pay attention and read between the lines. There is a difference between evasive answers and keeping certain details confidential.

    A lot is changing in the way groups are structured and practice. Smaller groups are merging with others or becoming employees of the hospital system.

    It is important to get a sense of the stability of the group.
  • Does the group encourage its physicians to get involved in hospital committees?
  • Are the anesthesiologists given time/compensation for administrative work?
  • Does the group have regular education sessions?
  • How well do they partner with the hospital to meet patient safety and regulatory goals?
  • Try to understand the “corporate” structure of the group.
  • Who makes the decisions?
  • How are leaders selected?
  • How frequently does the group meet and discuss issues?
  • Often, you may be able to get answers to more awkward (but important) questions from the surgeons, nurses and administrators whom you meet.
  • Are they cohesive and team players?
  • What does the hospital administration think of the group?

  • Answers to these types of questions will give you good insight into the groups’ stability and viability.
    Networking is often a good way to hear about job openings. It is also a good way to determine a practice’s reputation. Solid networking opportunities can be found at the ASA annual meeting every October and at the ASA PRACTICE MANAGEMENT conferences held on the last weekend of every January. Both these national meetings attract anesthesiologists from a variety of practice models all over the country (and internationally). It is very likely you will have a chance to talk to people who are close to where you would like to practice.

    The resident track at the ASA PRACTICE MANAGE-MENT conference can provide you with a bounty of information to help you understand how practices work and enable you to ask pertinent questions at the interview. It is also a great opportunity to get expert assistance for optimizing your CV in addition to networking with leadership-oriented anesthesiologists from all over the country.

    Closer to home, attend your state and regional component society meetings and talk to attendees about their practices and get contact information for the person in charge of recruitment. The most sought-after positions frequently get filled by word of mouth. The more people you talk to, the more likely you will be considered when such opportunities open up.

    On page 36 is a worksheet you can use to collect data on a practice. This will help you keep track of the details in order to compare different practices and make an informed comparison before you commit. Obviously, not all the points are relevant for all practices.

    Be aware that it is fairly common for first jobs to not work out. You can lessen this possibility by approaching your job search as you would any potential long-term relationship. Be objective in looking at all the details. Avoid making an emotional decision based on one or two factors. While there are some red flags, variations between practices are often neither good nor bad; they are merely differences. Just in case, rent for a year before buying a home. Ultimately, it is all about you finding the right fit both professionally and personally.

    Location:
    Date:
    Contact names/title:

    Phone:
    Fax:
    Email:
    Hospital(s):
    Number of beds:
    Number of ORs:
    Non-OR Anesthetizing locations:
    Cases Mix:
  • Excluded cases/Subpanels?
  • Other sites (office/surgi-center/ECT/radiology/GI)
  • Travel between different sites on same day?

  • OR case volume:
    OB coverage:
    Number of deliveries per year
  • High Risk
  • Labor epidural percentage:
  • C-section percentage:
  • VBACs:

  • OB call coverage details:
    Work hours:
    Usual start/end:
    Calls:
    Number per month:
    Home call/In house:
    Response time:
    How busy?
    Back-up availability?
    Off pre-call?
    Off post-call? Stipends for call?
    Call swapping and flexibility?
    Geographically distinct sites covered on call?

    Practice type:
  • All MD
  • CRNA
  • AA
  • Residents

  • Number of MDs:
    Number of CRNA/AA/residents:
    Medical Direction/supervision ratios:
    Interpersonal
    Relationship with each other in Dept. (including CRNAs)
  • Socialize together?
  • Relationship with surgeons (problems?)
  • Relationship with OR staff/nurses
  • Relationship with Administration

  • Compensation Package
    Salary/fee for service:
    Pooled units? (if group)
    Income Guarantee?
    Employee vs. independent contractor
    Partner or non-partner track – how long?
  • Are all partners equal or are there senior and junior partners?
  • Buy in Payer mix (insurance/HMO/ medicaid/ medicare/ self-pay/ bad debt)
  • Case assignments: equal vs. seniority-based
  • Hospital subsidy to group
  • Stipend for CME/ books/ licenses etc.
  • Relocation assistance
  • Retirement funding

  • Benefits:
  • Malpractice Insurance (Occurrence vs. Claims made, Tail coverage)
  • Health and Dental
  • Long Term Disability insurance
  • Specialty specific
  • Type and amount of coverage
  • Portability
  • Need for supplemental policy
  • Vacation:
    How many weeks per year?
    How are vacation assignments prioritized?
  • Sick
  • Military
  • CME
  • br /> Contract:
    Does everyone sign the same contract or are they individualized?



    Lars E. Helgeson, M.D. is Assistant Professor, Compliance Officer, Department of Anesthesiology, Yale University, New Haven, Connecticut.

    Aparna Ananth, M.D. is an anesthesiologist in private practice with Pacific Anesthesia, PC, St. Joseph Medical Center, Tacoma, Washington.



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