Academic Institutions where attendings do their own cases?

[propadex]

Anyone know of any academic institutions where attendings do solo cases? My selfish dream is to continue to do a wide range of interesting and complex cases with a group of experienced partners that I can learn from, all while still being able to sit the stool and do my own cases. I am concerned that in a private practice setting I would potentially get bored of doing the same repetitive ASA 1-3 cases.

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[2010houston]

These definitely exist. I do this, though pedi so I guess that’s a bit specialized. But some of the less metro areas, academic off-the-main-campus, etc this can be found. Not sure how rare it is without fellowship.

 

[ambiturner]

Every academic hospital I’ve ever worked at had attendings do solo cases, some up to 30% of the time. In the adult places I’m familiar with, Stanford is where you’d be solo the most.

 

[Arch Guillotti]

I am concerned that in a private practice setting I would potentially get bored of doing the same repetitive ASA 1-3 cases.

Private practice in my experience is anything but boring. Busier and much more stimulating than my time in academics.

 

[2010houston]

Private practice in my experience is anything but boring. Busier and much more stimulating than my time in academics.

Agree - it’s a fallacy to think that all PP is ASA 1-3. There’s a lot of disasters out there, and they don’t all come to the academic centers.

 

[nimbus]

Do a cardiac fellowship. Plenty of complex cases in PP cardiac. We have MCS at 2 of our sites. Also have a healthy liver transplant program at another of our sites. All MD only. No residents or CRNAs.

 

[Realgassy]

I’m in a PP covering a level 1 trauma and a couple other hospitals. Md only 95% of the time. Average Asa 3-4. My group helps each other out starting big cases (if we have free hands) and everyone is helpful with bouncing ideas off each other for problems. Definitely not boring.

 

[staple]

Anyone know of any academic institutions where attendings do solo cases? My selfish dream is to continue to do a wide range of interesting and complex cases with a group of experienced partners that I can learn from, all while still being able to sit the stool and do my own cases. I am concerned that in a private practice setting I would potentially get bored of doing the same repetitive ASA 1-3 cases.

Not trying to sound snotty, but i work PP in a community hospital and we take care of the sickest of the sick. We do the same major vascular cases, pheos, lungs, crani, vads, etc as the comparable academic hospital near us. We also do double their open heart cases annually.

The only difference? We do it more efficiently. We see anything from the asa 1 in the surgery center to the ASA 5E disaster cases. I may start the day doing an elective lap chole in an asa 2 and finish the day doing a ruptured AAA.

Don't think that PP is boring and easy.... Think if it as more efficient. 90% sit cases, 10% medical direction at our gig. Plus we are hiring!

 

[aneftp]

If you are in the south or Midwest you are looking at primary act models. Up north and out west more solo md practices.

so residents get this misconception of act models everywhere if they are trained in the south or Midwest.

 

[coffeebythelake]

I’m in a PP covering a level 1 trauma and a couple other hospitals. Md only 95% of the time. Average Asa 3-4. My group helps each other out starting big cases (if we have free hands) and everyone is helpful with bouncing ideas off each other for problems. Definitely not boring.

You are telling me your average patient has "severe systemic disease that is a constant threat to life?"

 

[chocomorsel]

You are telling me your average patient has "severe systemic disease that is a constant threat to life?"

Yes. We are in America. It’s called OBESITY and all its comorbidities!!! As much as the general population tries to downplay that ****, we know better.
Lol

 

[GassYous]

You are telling me your average patient has "severe systemic disease that is a constant threat to life?"

Easily. Just this week had a few bmi 50s getting limbs chopped, crappy vasculopaths getting carotids and revascs, sick as **** septic ex laps, aicd/pacemaker people in endo, gi bleeder that crashed in pacu and went straight to ir for embo. Placed a bunch of lines.

Week before did a whipple where tumor was surrounding the hepatic vein. Emergent crani for a cerebellar bleed. Yeah I did some cataracts and choles too.

The average patient in our surgery center is bmi 30s asa2-3. Wouldn't mind a few more asa1 tbh.

Our cases take half the time they did in residency. But we did have plenty of attendings do solo cases.

 

[zizzer]

You are telling me your average patient has "severe systemic disease that is a constant threat to life?"

Absolutely. I'll chip in as another attending doing close to 100% physician only cases in a private practice job at an academic center in a big city. Level 1 trauma, high risk OB, transplants, regional, big vascular, neuro. You name it.

 

[2Fast2Des]

Trust me the excitement of doing big cases will go away when you're on your own. They're fun in residency, but you want to sleep at night when in the real world. PP is a mix of all the above. Healthy ASC cases, then the disasters in a ****ty community hospital where you have to use whatever you have to keep the pt alive. Unless you literally only work in an ASC then yes you will have varying levels of excitement.

 

[Mman]

You are telling me your average patient has "severe systemic disease that is a constant threat to life?"

I feel like my median inpatient case is 50+ years old, BMI > 40, diabetes, hypertension, vascular disease, +/- smoking, at least stage 2-3 CKD, etc. I start to notice BMI when it gets above 60.

 

[Hork Bajir]

I feel like my median inpatient case is 50+ years old, BMI > 40, diabetes, hypertension, vascular disease, +/- smoking, at least stage 2-3 CKD, etc. I start to notice BMI when it gets above 60.

I believe every word you are saying, but… Man that is sad. Super morbid obesity is such a widespread and insane problem.

 

[pgg]

You are telling me your average patient has "severe systemic disease that is a constant threat to life?"

Not everyone's a 4, but he said "average ASA 3-4" and that's totally consistent with the case load at most non-academic places I've worked. For every pleasant ASA 2 elective case, there's a train wreck from the ICU or a 400 pound woman in labor breathlessly declaring she's ready for her apadermal.

 

[Mman]

I believe every word you are saying, but… Man that is sad. Super morbid obesity is such a widespread and insane problem.

yes it is quite sad.

Anything under 100 kg is a small healthy patient.

 

[jwk]

yes it is quite sad.

Anything under 100 kg is a small healthy patient.

100kg isn't even close to raising an eyebrow.

 

[abolt18]

100kg isn't even close to raising an eyebrow.

Unless your patient is 12 years old and under. But I agree.

 

[IlDestriero]

Either way, PP or academics, just ask in your pre interview phone call. Find out if they offer the kinds of cases and staffing you want, and at the frequency you’re looking for. I do my own cases ~1/3 of the time at an academic children’s hospital. The job you want is out there.