You’re done with residency/fellowship. Now what?

You have devoted the last decade of your life to medical school, residency, and fellowship. It’s time to get out into the real world for a REAL job. Where do you want to live? What type of practice would you like?

workhoursdoc
From AMA

Timing is everything.  Start early!

I started my fellowship in August.  During my elective pediatric hearts rotation, I met a team of physicians who were very encouraging and asked if I had a job yet (this was October).  I told them I didn’t have a job yet, but I wanted to stay in California.  Maybe it was my lucky day, but one of the lady docs I worked with sat on the application committee for my current job.  She encouraged me to apply to their anesthesia group.  After going through the proper channels, I got a phone call from the anesthesia group saying they would like to interview me for a position.  I had my interview in November and heard back in December that I had a job.  Everything happened in such quick succession.  When I left residency, I knew I wanted to be in southern California.  Thank goodness I matched into a fellowship spot in Southern California!  It makes it easier if you know what area/region/state you want to practice in.  Keep in mind that some states are more friendly to physicians than others.

2018 Best States to Practice Medicine

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Source: WalletHub

 

After you’ve decided on a location to practice, figure out the type of practice options that are available in the area.

Luckily, I was working in the city that I wanted to be in, so I could easily survey the hospitals and find out who was hiring.

Physician Group Practice Trends: A Comprehensive Review. Journal of Hospital and Medical Management. 2016.

Do your research. 

What type of practice works for you?  Do you want a large academic center with a physician-led team approach to healthcare?  Do you want to practice in a private practice setting in a team or solo?  There are so many practice models out there — I wish residencies explored/explained more of these options.  Fortunately, I knew a solo-practice physician-only model would work best for me.

10 Ways private practice differs from academic anesthesia

Keep in mind the number of hours you want to work.  What are the opportunities for working more or less?  How many vacation weeks will you get?  Is there paid-time-off?  Will you have a salary or productivity-based income?  How many calls/month will you take?  Is there a discrepancy between new hires vs. senior partners in access to vacation/salary/calls/etc.?  Is there fairness in scheduling?  How long will it take to make partner?  What’s the buy-in amount?  Is there a buy-out when you leave/retire?  I didn’t know to ask these questions when I was going through the process of looking for my job.  Don’t forget to ask about retirement options and health insurance coverage.  Also, ask if it’s possible to work at another hospital or surgery center in the area or if there is a non-compete clause in the contract.

The Interview

Bring your best self to the interview.  The people who are interviewing you want to know more about you.  Tell them about your hobbies, lifestyle, goals for the group, plans for the future.  Engage your interviewer and ask them how long they’ve been with the group.  How do they enjoy their time?  Keep in mind that they’re interviewing you because you look great on paper.  They want a chance to get to know you better.  Show them your best self, especially all your hobbies and interests outside of medicine.  Keep the conversation casual and inviting.

The Contract

Read over the contract carefully.  My group has a one year contract that is revisited yearly and is the same for every member of our 250+ physician group.  Before I started, some people recommended a contract attorney specializing in medical contracts to read it over.  I didn’t find it necessary in my case as my contract was the same for every physician in my group and the language was very clear to understand.  Use your own judgement.  If you don’t understand the contract, get some help.

 

What recommendations did you find helpful in your job search and interview?

What additional help can I include in this post?

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Interested in Medical School? Start Early.

A friend of mine’s son is just about to graduate from high school.  He’s interested in medical school, and his mom asked me what advice I would give to help him pick a college knowing that he has an interest in medicine.

Keep in mind: I am not a counselor or an advisor.  I am a physician, and this is what worked for me.

My advice:

  1. If you’re interested in medicine…. start early.
    • The college and medical school application process are getting more competitive.  Students are bright, prepared, and eager.  Let’s start with the basics.  Are you sure you’re interested in medicine?  Like really interested?  Sure, the media portrays some glamour lifestyles for physicians… but it’s not all glitz and glam.  You’ll put in at least a decade of extra work vs. your peers who get a job right out of college.  While they’re building their nest egg, you are not.   
    • Luckily, I stumbled upon my interest in medicine at an early age when my family practice physician encouraged me to pursue it.  He proved to be a great mentor as I was able to shadow him and really get a feel of his day and what he does.
  2. Once you’ve decided medicine in your passion… solidify that decision.
    • Volunteer at the hospital.  Observe your physician.  Volunteer to help people.  If this excites you, you’re on the right track.  Put yourself in situations where you can get involved in medicine.  Read and research what medical school is like.  Reach out to a medical school and see if you can get more information: chat with a medical student, find out if anyone needs help with a research project.
  3. Do well in school.
    • This is a must.  Applicants are incredibly competitive and intelligent with tons of extracurriculars on their resumes.  Get good grades.  Do well on your SAT/ACT and then do well on the MCAT.  Your grades and your test scores are the most basic comparison tool for schools to compare applicants.  Doing well gets you noticed.
  4. Get involved and signup for extracurricular activities.
    • Once you’ve put in the work for good grades and test scores… get involved.  This could be anything: sports, clubs, arts/music, babysitting/caring for loved ones, volunteering, job in a lab, travel/cultural growth.  The key is to show that you’re well-rounded and multifaceted all while achieving the good grades.  Once the colleges and med schools have seen your test scores, they’ll next use your extracurricular activities to help separate out the different applicants.  The key is maintaining good grades while all these other activities are happening.  AAMC fact sheet for medical schools.

If you’re in high school and interested in medicine:

  • Get good grades and do well on SAT/ACT (consider college prep courses to help)
  • If you’re able to take honors classes or AP classes and do well, definitely sign up for these.  It’s another way to separate yourself from other applicants.
  • Volunteer at your local hospital and/or doctor’s office
  • Get a job at a research lab or hospital
  • Get involved in extracurricular activities
  • Talk to your high school counselor about career paths
  • Attend career fairs (my school offered a career night in medicine where we got to go into the operating room) and college fairs on getting into medical school
  • Ask a college pre-med what they’re taking and how to do well in college
  • If you’re torn between two schools on your college list, consider taking a good look at the college that may also be linked to a medical school.  There’s a good chance that some of the medical school professors will be teaching some of the upper level physiology or anatomy college courses.  Some of the professors may also sit on the admissions committee to medical school.  Lastly, it may be easier to get involved in clinical research or scientific studies that the medical school professors are working on… and that would be a great way to introduce yourself to medical school staff as well as get a stellar recommendation letter to show off your work ethic and dependability.

If you’re in college and interested in medicine:

  • Get good grades and do well on the MCAT (consider prep course to help)
  • Get a major in something you’re interested in (you do NOT have to be a pre-med major… you just have to take the pre-med prerequisites to take the MCAT and apply for medical school).  Even though I majored in biomedical science (a pre-med major at Texas A&M), I would have done biomedical engineering if I had a do-over.  Science and math have always been my interests…the engineering major would have given me a nice background beyond my pre-med major.
  • Talk to your college counselor/advisor early (freshman year)
  • If you get into an honors program in college (usually based on your SAT/ACT scores), go for it.  Typically the honors classes are smaller and are a fantastic way to build report with your professor as well as get deeper into the subject matter.  Plus, being in the honors program will further help you standout on your application to medical school.
  • Volunteer at the local hospital.  Although you may start out as a volunteer, see if you can get into the OR (operating room) as well as outpatient clinics.  This will expose you to a wide variety of practices: surgery, anesthesiology, pathology, internal medicine, family practice, OB/GYN, specialties, etc.
  • Get involved in extracurricular activities in college.  There are a ton of clubs and interest groups in college.  If you don’t find one you like, start your own!
  • Need a job in college?  Consider getting one in the research lab or at a medical school or in a hospital.
  • Consider doing summer school to get some credits out of the way.  When I was in college, 12 credits was a full-time student.  I always took 15 credits because I thought I could handle it.  (Now I cannot recommend the following…) My junior year in college, I signed up for 21 credits to see if I could handle a medical school work load.  It was a tough semester, but I did it and got a 4.0.  I wouldn’t recommend that route because you need to focus on grades… but it worked for me.
  • Apply to a lot of medical schools (in-state and out-of-state).  I grew up in Texas and at the time they had a Texas match with 7 medical schools.  I only applied to the Texas (in-state) medical schools because I knew that was all I could afford.  Keep in mind your debt burden: a $9,000/yr education vs a $30,000/yr is a big difference.  I chose an option that made the most sense to me — I didn’t want to be in debt forever.  In fact, I highly recommend reading this book: The White Coat Investor: A Doctor’s Guide To Personal Finance And Investing.  If I had that available to me, I would’ve read that in high school… re-read it in college… read it again in medical school… and read it again throughout life.  Yes, I’m constantly revisiting this book because it is that good.
  • Interviews: honestly, I can’t remember if I interviewed for medical school or not (geez that makes me sound old!).  If you do have interviews… put your best foot forward and practice interviews with your friends/parents/professors/etc.  Be positive, engaging, and professional.  Interviewers DO judge a book by its cover.
  • Once you’ve applied to medical school, sit back and wait for your results to roll in.  Honestly rank the schools you would like to go that caters to your learning style/goals/etc.  My medical school (UTMB) was one of the first in the country to incorporate systems-based learning and problem-based learning.
    • Systems-based = learn subject material based on the different organ systems vs. separate anatomy, physiology, pharmacology, pathology, etc.  (I learned based on the cardiovascular/gastrointestinal/genitourinal/neurological system, which included the anatomy, physiology, pharmacology, pathology, etc related to that system.  I thought it was a more intuitive way to learn medicine) .
    • Problem-based learning involved small groups where we would discuss medical cases, labs, clinical problems, etc.  It was a nice environment to express yourself as well as work together in a team.  This is how the real-world works where you talk to your colleagues to work through various medical issues.  It supports professionalism and engages a teamwork mentality.
  • Lastly, thank the people who helped you get here.  It’s easy to overlook your mentors, friends, professors, and family.  As you enter the medical school/medicine world, your family will learn along the way that you made a commitment to a profession that will take priority over them.  You will miss weekends, evenings, date nights, holidays, anniversaries, etc.  Not only will you sacrifice a lot to get to medical school… you’ll continue making sacrifices once you’re out practicing medicine in the real world.

AAMC fact sheet for medical schools

My Training:

My Job:

24 hours with an anesthesiologist

A piece I’d like to submit for: CNN Money 24 hours With….an anesthesiologist

About Kris:

I grew up in a small west Texas town called Abilene, TX. My mom was a standard tiger mom in that she encouraged me to pursue multiple activities while nudging me to do my best. After drama lessons, tennis lessons, basketball, volleyball, piano, violin, band, taekwondo, pageants, and just life, I left Abilene and pursued a biomedical science degree at Texas A&M University.  My earliest memory of wanting to be a doctor started when I was in the third grade.  I hadn’t been feeling well and was diagnosed with pneumonia — I had been reading a book called This is the Child.  My family practice physician Dr. Lawson was about to prescribe me prednisone, and I immediately got worried because that was the same medication used to help with the child’s leukemia.  Dr. Lawson picked up on my early curiosity and invited me to hang out with him in his medical office observing patients.  After college, med school proved to be a great experience at University of Texas Medical Branch in Galveston and it felt like learning on steroids (as compared to college).  My clinical rotations led me to the path of choosing anesthesiology as a career.  Anesthesia is the perfect combination of anatomy, physiology, pharmacology, psychology, and sociology.  I matched into a terrific internship in Austin, TX and continued my anesthesia training at the prestigious Massachussetts General Hospital.  Following 4 grueling years of training, late nights, memorable cases, and lifelong friendships, I chose to pursue a cardiac anesthesia fellowship at University of California San Diego — a world renowned institution for the treatment of right heart failure following pulmonary thrombosis.  14 years after graduating high school, I have the job of my dreams.  Here’s a sample of my day…

My Day:
Today I’m #2 in our call lineup, which means it will be a pretty busy day. Typically, we have 15 call spots in our main operating room (OR) numbered #1 to #15. #1 position gets the first pick of cases. #2 gets the next pick and so on.

5:45a Early heart day wake up. Today, I will be providing anesthesia to a 70-something year old lady who needs a new heart valve.  On heart days, I wake up at 5:45a to be at work by 6:30. And on regular main OR days, I wake up at 6:15a to be at work by 7:00. Ahhhh… To have more beauty sleep!

6:17a Breakfast in the car – it’s either green juice, Shakeology, or banana on the go!

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Breakfast on the go!

6:31a I meet the patient and her family in the pre-operative area.  We go over a detailed plan for her anesthesia as well as answer any questions.  One of the best parts of my job is meeting all different types of people.  It’s an amazing feeling to meet people at one of their most vulnerable moments in their lives and win over their trust and respect.  It is my job to safely manage their physiologic processes.  Oftentimes, patients tell me it is the anesthesiologist who is the most important part of a surgery — they understand how easy it is to bring them close to the brink of death and then revive them back to a wakeful state.  It’s incredible the amount of trust patients place in your hands in such a short time after meeting them.

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7:15am The patient is under anesthesia and all invasive monitoring lines (arterial, central venous pressure, cordis, pulmonary artery lines) have been placed.  The transesophageal echocardiogram is performed and results are relayed to the cardiac surgeon.


7:45am Cardiac surgeon makes incision.  The patient is monitored throughout the case.  Multiple screens show all the physiologic monitoring results.

10:00a Bathroom break! Partners/colleagues break each other out so there is always an anesthesiologist monitoring the patient.  It’s also a good time to grab a snack!

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My work bag with some life saving snacks to avoid hangriness!

11:32a Drop first patient off in Cardiac Care Unit and grab some lunch. The doctor’s lounge keeps us fed with soup and salad. Today, I’m feeling the vegetable soup. Grab a quick bathroom break and then to interview the next patient.

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Lunch on the go!

11:45a Electrophysiology study for atrial fibrillation ablation. The view from this OR is such a delight!

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The view from my little nook.

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14:00 I get a call from our anesthesia czar, one of my partners who runs the schedule. He was wondering if I would make my 15:00 hip replacement. After a quick conversation, we decide that I would call him in 30 minutes for an update.

14:33 We are finishing up with the current case and I call the czar back to find out about my next case. I learned that there is an emergent heart that will be started by another colleague and that I will continue the lineup in EP (so my day went from a 16:30 finish on paper to roughly a 19:00 finish). Anytime I am in the top 5 call positions, I know not to make defined plans because you never know if there will be add-ons or changes to the schedule. This makes my social life a bit frustrating as my non-medical friends have a tough time understanding and adapting to this “you don’t get out of work at 5p?” concept.


15:20p Drop patient off in the Post Anesthesia Care Unit (PACU). Grab a quick snack and head back to EP for the next patient.

15:25p Speak to the next patient who has arrived for an a-fib ablation as well. Induce and get started with the case.

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19:22 Drop last patient off in the PACU.  As #2 on the call list, I look at my watch and realize that I am #2 at night.  This means I will be the 2nd person they call tonight if extra rooms in the OR get booked (traumas, heart call, etc.).  As much as I’d love to head home and grab a glass of wine and unwind, I meet up a friend for dinner to catch up and relax.

21:42 Head home. Shower. Brush my teeth and get into bed.  There’s always a risk of being called into work.  Tomorrow will be a shorter day.  After the hectic day, I am still thankful for my wonderful job and colleagues.  Looking back at my journey to get here, I smile because I couldn’t be happier.

The Beauty of Anesthesia

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These parents were so sweet. Sloane was their fourth baby, and they barely made it to the hospital. They left their camera at home and their cell phone just went to 0% charge. I asked if it was ok to use my cell phone and then send them pics so they could capture this special day. (In a hospital setting, permission and patient consent is everything). I love deliveries because the little babies are so precious… Innocence captured in such a happy moment.

Little notes from patients like this truly make my job incredible!

Keep calm and page anesthesia!

Anesthesia is a pretty social field in medicine.  Even though you can be stuck in a room with no windows for hours on end, one can typically have good conversation with the people in the room (nurses, scrub techs, surgeons, assists, reps, etc.).  Typically, it’s a jovial atmosphere.  Well, while checking-in with our schedule runner (the czar) a call came through that someone needed to be intubated upstairs.

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Luckily, I was in between cases and decided to run upstairs to assess the situation.  I see a rather obese gentleman appearing a bit mottled in color.  The vitals monitor said SpO2 90%.  The patient was on a bipap machine.  His belly was heaving up and down with each breath…making it appear that he was using a lot of effort for each breath.  I called for the intubation supplies.  Sadly, this gentleman had suffered from a cerebellar stroke a week ago and they had attempted an extubation a couple of hours prior to my arrival.  Needless to say, his respiratory effort was wearing me out…and I had already huffed and puffed my way up several floors of stairs (my preferred method of solo transport).  Once the supplies were ready, it was go time.  Labs checked out ok.  He seemed to be moving all extremities appropriately, despite his stroke.  All systems go.  After the drugs were pushed through his central line, I took a look and quickly suctioned his posterior oropharynx — there was mucus covering his glottic opening.  Once it was cleared, I skillfully maneuvered the endotracheal tube through the vocal cords and secured his airway.  The end tidal CO2 detector changed color appropriately and bilateral breath sounds were established.  For those crucial few minutes, everything around me seemed to halt.  I consciously let out a sigh of relief and thanked the RT and nurses who were present in the room for their help.  The beauty of my job is that it’s ever changing. One must be flexible enough to adapt to different types of cases as well as challenging anatomy and situations. Plus, I get to meet all types of people from all walks of life. Therein lies the reason why I love my job.

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