How Do I Choose the Type of Anesthesia Practice for Me?

This question is as easy (or hard) as choosing a spouse….and just as important. Most of us will spend over 40 hours per week working as an anesthesiologist, so it is critical that we prepare ourselves to choose our practice carefully. We don't want to choose without determining if the group is a good fit.

Just as in dating…..knowing what you want starts with taking a long hard look at  yourself and what you want in the next phase of your career and knowing yourself. What are your goals? What is important to you? Sadly, there is no dating process to let you kiss the frogs first, so you will need to prepare yourself with research and questions.

Knowing Yourself

What are you looking for?

  • Research or Clinical
  • Teaching residents/fellows or doing your own cases all thetime
  • Supervising CRNA or Doing your own cases or a Mix of the two
  • Specialty Practice (Pain, OB, Cardiac, ICU, Pediatric) or General Practice
  • High Intensity (cardiac, trauma) or Low Intensity (Bread and Butter, Surgery Center)
  • Maximum Income or Maximum Quality of Life
  • Leadership Opportunities or Following others
  • Are you looking to put down roots or is this a 3 year transition

What is important to you?

  • Where you want to live
  • Practice Amenities
  • Ability to take a sabbatical
  • Work hours
  • Call frequency
  • Family / Maternity Leave

Needless to say, these are personal questions, and they can funnel your interviews.

This Is A Buyer's Market

Our nation's population is growing much faster than the supply of doctors, specifically anesthesiologists. I bring this up so that you are unafraid of knocking on the door of anesthesia practices where you might like to work. I can't imagine anyone that won't want to interview you.

Just because it is a buyer's market doesn't change the economics of each practice. You can't expect established doctors to pay you more than they make for the same work. You can learn if there are opportunities for more income for more work. You can learn about the practice finances.

  • How open are the books for anesthesiologists to see?
  • How is money distributed?
  • How is income calculated?
  • How are expenses apportioned?
  • Is income paid as W2, 1099 or K1?

This Is A Seller's Market

Good practices can always command a premium, because they are desirable. However, just because it is a good practice doesn't mean that you can't expect openness to your questions.

Consider a good practice to be like a car that is in high demand. The seller wants to get the best price, but will want to demonstrate the reason why the car is worth the asking price. You may find that, after doing you due diligence, that the value provided by the practice justifies the ask.

An old adage that stills hold true are that the most popular and highly desired cities pay less than the practices or cities that are not as highly desirable …..this certainly holds true in medicine in general and particularly anesthesiology.

Income is not usually commensurate to cost-of-living so bear that in mind….Anesthesia salaries do not differ widely across regions in the United States, whereas cost of living and tax structure can be highly variable.

Practice History

  • When did the last doctor leave the practice?
  • Why did they leave?
  • Who was the most recent hire? Are they still here? Are they a Partner yet?
  • Can you talk to them?
  • Is the practice growing?
  • How many hospitals?
  • How many surgery centers?
  • How many doctor's offices
  • What is the practice reputation in the community?
  • How tight knit is the group?
       Are they incorporated together?
       Are they a tight knit group?
       A loose group of individuals?
  • What are the threats to the group?
       What is the current relationship with the hospital administration?
       If the hospital is part of a chain, how are relationships between physicians and the larger entity?
       Is there the possibility of a hostile takeover?
       Is there a possibility of a practice sale? How will this affect new hires?

How Do You Find a Practice? – ALSO SEE the “FINDING AN ANESTHESIA GROUP” article!

This echoes where we started. Finding a practice is like dating. The good news is that to find your perfect practice, there is a much more finite universe to search! Nonetheless, you still need to look. Just like dating, you can use modern tools like online job boards run by GasWork and the ASA, Websites of large anesthesia companies (Vituity, Envision, TeamHealth, Somnia, Anesthesia Partners, Kaiser, Mednax, etc.),ads in the back of journals or recruiters. Or you can go old school, getting involved with the California Society of Anesthesiologists (or other state societies), subspecialty societies or the American Society of Anesthesiologists(Society of Cardiovascular Anesthesiologists, SAMBA, etc). You can also attend community events, such as Pharmaceutical Company Sponsored dinners or Grand Rounds where community physicians attend, and reach out to the "town" Anesthesiologists. You can connect with former residents from your program to find out their experiences.

The common theme is that finding a job that matches your needs and desires requires effort and networking. Even if you locate a group you want to join (for example, Anesthesia Service Medical Group in San Diego or Kaiser Permanente), you may still need to find the base practice that fits your needs.

Good advice is to start looking early. Let the practices get to know you, while you get to know them.

Making The Decision

You've texted, surfed, emailed and face-timed all the information you can. Now it's time for a site visit. Spend a day or two in the community. Get a tour from the hospital recruiter. Spend an hour with a real estate agent. Tour the hospital. Talk with Anesthesiologists, nurses, surgeons, administrators about the Anesthesia Group and the Hospital itself. You are making a big commitment. You want to know who you are saying yes to!

When my kids were choosing a college, we would spend a weekend walking the campus of the finalists. We would talk with students as they ate lunch, walked into the library and moved between classes. We ate in the dorm cafeterias, were invited into dorm rooms and got a feel of what it was like on campus.

When we left the campus, I would hear phrases like, "these kids are just like me", "I can see myself going here", "I hate the way those sorority girls looked me over" and "I don't think I would fit in here." There is a lot to be said about listening to the little voice whispering in our ear. Don't be afraid to tap into it.

Conclusion

Finding the right job is time consuming and requires extroverted behavior we are not always comfortable with. Yet the time invested pays dividends in having the right atmosphere for large chunks of our professional lives.