Are You Ready For Private Practice?

[VolatileAgent]

What world do you live in? Practice management companies.....by definition will ALWAYS for HIGHER overhead....they have to pay managers who don't do clinical work......They replace groups by providing a better service...They always cost the hospital more money.

dude, calm down. you're getting emotional. it is clear by your statements that you don't fully understand the threats of the real world, but i can forgive you that because you're probably one of those high school -> college/military -> med school -> residency -> work type dudes who's only ever had professional experience in the field in which he works, and certainly no formal business training except what you've gotten on the job.

no problems. keep doing what your doing. good luck to you. i hope, for your sake (and the sake of our profession), that you're right. we'll see if that's true by no later than about 2015 in my estimation. i know i'm always looking five years down the road. that's the chess player in me. i know how i'm going to manage my practice (yes, my practice) someday, and i also said i have a five-year plan. i hope you do too.

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[militarymd]

dude, calm down. you're getting emotional. it is clear by your statements that you don't fully understand the threats of the real world, but i can forgive you that because you're probably one of those high school -> college/military -> med school -> residency -> work type dudes who's only ever had professional experience in the field in which he works, and certainly no formal business training except what you've gotten on the job.

no problems. keep doing what your doing. good luck to you. i hope, for your sake (and the sake of our profession), that you're right. we'll see if that's true by no later than about 2015 in my estimation. i know i'm always looking five years down the road. that's the chess player in me. i know how i'm going to manage my practice (yes, my practice) someday, and i also said i have a five-year plan. i hope you do too.

I know what I'm talking about because I'm living it...with education from my mentor who was the owner of a practice management company...and also established over 10 practices over the last 30 years.

You also seem to know a lot....

Tell us about your management experience and how it applies to the anesthesia business.

 

[jetproppilot]

but, many of you just seem only to want to lecture me on "the way it should be done."

If you perceive my posts as a "lecture" then, yep, you've got serious issues, Slim.

I've been very politically correct up until now but I feel a few expletives brewing in my mind in response to your chihuaha comebacks.

Your posts are full of clandestine insults.

I don't post in a fashion inferring that I think I know it all, yet you, a resident, does.

How are we supposed to interpret that?

 

[VolatileAgent]

my last post on this thread. take it for what it's worth. i'm not going to continue in "pissing contests" with attendings, many of whom i'm older than, have more professional experience, with whom i'm also going to be side-by-side colleagues, and to whom i ultimately don't have to answer.

here it is:

the field of anesthesia in the mid-90's went through a real slump. only roughly 40% of the residency spots were filled in 1995 and 1996. programs were begging for bodies, and a "weaker" cohort of residents was accepted into many programs. we are now seeing the aftermath of a poorly predicted and horrendously underemployed job market, which has benefitted the current practices in bargaining for services and securing large reimbursements for providing care.

over the past several years, in no small part because of this perception that anesthesiology has become a lucrative field, many more very bright and "top of the class" medical school graduates have entered training in the field for a variety of reasons, not the least of which is the perceived lifestyle and monetary benefits. residency spots have increased, and there will be a far greater number of anesthesiologists practicing in the coming decade. these up-and-comers, based in large part on expectation, will want to receive certain things upon entering the private practice world.

there are also more and more nurse anesthesia programs opening around the country, and a very active political group who is - in no small way - pushing for more autonomy and greater practice rights. they also want a bigger and bigger share of the pie. this is clearly the attitude of the "young" anesthetist, and may not be reflective of the "old school" crna who came into his/her profession at a different time. but, it is real and in some places they simply will not have to answer to the anesthesiology profession, especially if cost-contaiment (as it has been) becomes the primary driving force in the healthcare delivery model.

to ignore these factors - or to assume that things will chug along as they now are and the "game" will continue to be played the same way it always has been - is to adopt the ostrich syndrome. you can continue to think that things will "continue the way they have been", and seek to instruct the up-and-comers how to succeed in this paradigm, or you can make contingency plans and adapt. things will dramatically change in our field in the next 10 years, and if you can't see this coming and plan for it you will have no one to blame but yourself when it does.

see you on another thread...

 

[militarymd]

for those of you lurking in this thread...

Volatile is not saying anything that the attendings don't already know.....we manage practices, we negotiate with hospitals, we talk amongst ourselves...comparing notes....we try to win contracts away from each other and anesthesia management companies...we compete...

Volatile seems to think that private practice groups are stagnant.

Volatie, you're not addressing my questions directly at you......how come?

1) your experience
2) how are nurse anesthetists different from ICU nurses ....using your definitions.
3) why do you need your nurses to have fudiciary responsibility...when in fact they are nurses.
4) how are practice management companies lower their overhead when they have non-clinical managers to pay?
5) why are you focused on independent CRNA practice when all their lobbying efforts don't change medical bylaws?

 

[johankriek]

. And you and I know your goal is to become a partner........[/B]

umm, not really!... .. Anesthesiologists dont build practices.. the surgeons bring the patients and we service them .. I see no need to work for somebody else and watch them exploit me.. As a resident i did not have a choice.. but as an attending i will never ever work for a group or accept a partnership track.. since residency i have been totally independent.. I am a partner.. My own.. there are other anesthesiologists who work with me, we help each other all the time, we hang out, we play poker etc etc.. But im not in his/her pocket and he or she is not in mine.. I dont tell them what to do in the OR. If they like central lines after induction for a cabg hey go for it. Im not around to dictate anybodies practice. the whole group thing arose out of hmos trying to dictate your salary and hospitals as well trying to dictate you and your salary. My advice.. stay independent.... take vacations.. yes its not as secure as being in a group and collecting a salary but really much much more rewarding.. can you imagine having a guylike military telling you what to do? lord have mercy..

 

[Noyac]

umm, not really!... .. Anesthesiologists dont build practices.. the surgeons bring the patients and we service them .. I see no need to work for somebody else and watch them exploit me.. As a resident i did not have a choice.. but as an attending i will never ever work for a group or accept a partnership track.. since residency i have been totally independent.. I am a partner.. My own.. there are other anesthesiologists who work with me, we help each other all the time, we hang out, we play poker etc etc.. But im not in his/her pocket and he or she is not in mine.. I dont tell them what to do in the OR. If they like central lines after induction for a cabg hey go for it. Im not around to dictate anybodies practice. the whole group thing arose out of hmos trying to dictate your salary and hospitals as well trying to dictate you and your salary. My advice.. stay independent.... take vacations.. yes its not as secure as being in a group and collecting a salary but really much much more rewarding.. can you imagine having a guylike military telling you what to do? lord have mercy..

Even when I was an associate no single person told me what to do or how to practice. Thats not the point of a group. There are many advantages to groups and many advantages to being independent. As an independent practice guy you can make your own schedule, bill your own, pay your own malpractice, etc, etc. But everything is on your own. As a member of a group you can make more money, get a rate on insurance or even self insure. You can take more vacation while making the same money you would independently. So there are many advantages both ways but the idea of a group is not to tell anyone how to practice anesthesia. You did a residency, you know how to practice anesthesia. Nobody needs to tell you how to practice. They could care less as long as you are safe and efficient.

 

[militarymd]

You did a residency, you know how to practice anesthesia. Nobody needs to tell you how to practice. They could care less as long as you are safe and efficient.

Noy,

There is a problem with that statement....no ONE person knows everything about anesthesia....

If you think you know it all...and never need any help....you'll become a dinosaur in the blink of an eye.

One person can't read all the journals....

One case at a time will never give you the breath of experience that comes from a collection of cases that you and your partners do.

The only advantage I see for the independent lifestyle is if you don't play well in a sand box.....but that's ok.....

However, it's the independents out there who are being taken over by groups and management companies....

watchout...they and we are coming for your jobs.

 

[militarymd]

can you imagine having a guylike military telling you what to do? lord have mercy..

Wave of the future....might want to get used to it.

 

[Noyac]

Noy,

There is a problem with that statement....no ONE person knows everything about anesthesia....

If you think you know it all...and never need any help....you'll become a dinosaur in the blink of an eye.

One person can't read all the journals....

One case at a time will never give you the breath of experience that comes from a collection of cases that you and your partners do.

I'm not saying that any one person knows everything and that you don't continue to learn from your partners as they also learn from you. I'm just saying that the PP field is not there to tell you how to practice your day to day anesthesia. That's not how my two PP jobs have been at least. What it did teach me was how to run a daily schedule, how to manage a business, how to manage employees, and how to make a lot of c-notes. I also changed my practice a bit but I came out of residency knowing how to pass gas. Thats all I'm saying. Does that make it more clear?

 

[militarymd]

Noy,

There is a problem with that statement....no ONE person knows everything about anesthesia....

If you think you know it all...and never need any help....you'll become a dinosaur in the blink of an eye.

When i said "you"...it was a generic "you".

 

[Noyac]

When i said "you"...it was a generic "you".

Yeah, I understood that. I think it was my original statement that was misunderstood. I didn't find that anyone in my group tried to tell me how to pass gas. I didn't mean to give the impression that I or anyone else coming out of residency knows everything.

 

[timtye78]

fascinating discussion. I appreciate Jetprop,Mil, and others giving us information we probably won't get in residency.

 

[EV-Stentor]

Thank you very much Jet. I am a CA3 and will try to remember all of this. Hey Mil if you and Volatile want to "take it outside" give me a call ...miss UFC

 

[militarymd]

Thank you very much Jet. I am a CA3 and will try to remember all of this. Hey Mil if you and Volatile want to "take it outside" give me a call ...miss UFC

He says he's old....so I guess I wouldn't want to go at it with an old guy

 

[chesterfield]

What world do you live in? Practice management companies.....by definition will ALWAYS for HIGHER overhead....they have to pay managers who don't do clinical work......They replace groups by providing a better service...They always cost the hospital more money.

Practice management companies, Anesthesia Management Companies (AMT) or whatever you want to call them, they are able to make more money than private practice groups and make money in situations that would not allow a private group to succeed.


1> Their personnel costs are lower; they use every game in the book to keep you for earning a fair wage for the work you do. They get Visa workers to work for next to noting, lie to new graduates about an imaginary bonus that they will never get. Sucker you in with a salary that seems good but kill you with endless hours and very heavy call. Bottom line is you will work more hours for less money if you work for an AMT and you never will have any equity in the practice.


2> They reward the key administrators for getting the contract. The AMT owners do not practice medicine they spend 24-7 dreaming of ways to get more money. The convince the administration to fund the AMT with a big management fee and in return for the management fee the AMT rewards the key administrators with promises of better service , gifts and money. I have seen several situations where a local anesthesia group asked the hospital for a small stipend for covering money loosing services like OB. The hospital refused and instead terminated the exclusive anesthesia contract and hired an out of town AMT and cheerfully paid them several times what the anesthesia group requested.

 

[militarymd]

As I said, management companies will always cost the hospital more money IF the docs get paid the same.

So...where do these companies find docs to abuse and misuse....

right now, they hire the UNemployable....non BC, FMG, personality disorders, etc.

In about 5 years, they will be hiring new grads, who came into anesthesia for the "lifestyle" and "money".....

Why would new grads take these management company jobs? The market will saturate, and it is already....at least the good jobs...

The new grads won't find groups wanting to hire them...or places where they can go independent.....but they need jobs...guess who will be offerring?

The evil, corporate management companies will hire them for 90,000 a year.

The next step....the management companies will win contracts from current groups by providing the same or better services for a lower cost...

Current groups will only keep their current gigs....if they lower their costs.

That's the future of the anesthesia business in the next 5 to 10 years....

For all you "lifestyle" folks....better start thinking fellowships....something like CCM.

I'm not kidding about the future.....

 

[The_Sensei]

As I said, management companies will always cost the hospital more money IF the docs get paid the same.

So...where do these companies find docs to abuse and misuse....

right now, they hire the UNemployable....non BC, FMG, personality disorders, etc.

In about 5 years, they will be hiring new grads, who came into anesthesia for the "lifestyle" and "money".....

Why would new grads take these management company jobs? The market will saturate, and it is already....at least the good jobs...

The new grads won't find groups wanting to hire them...or places where they can go independent.....but they need jobs...guess who will be offerring?

The evil, corporate management companies will hire them for 90,000 a year.

The next step....the management companies will win contracts from current groups by providing the same or better services for a lower cost...

Current groups will only keep their current gigs....if they lower their costs.

That's the future of the anesthesia business in the next 5 to 10 years....

For all you "lifestyle" folks....better start thinking fellowships....something like CCM.

I'm not kidding about the future.....

Quite a grim prognosis.......I hope you're wrong, but I have had similar thoughts. Unfortunately, I think we will be proven right.

 

[chesterfield]

The new grads won't find groups wanting to hire them...or places where they can go independent.....but they need jobs...guess who will be offerring?

The evil, corporate management companies will hire them for 90,000 a year.

The next step....the management companies will win contracts from current groups by providing the same or better services for a lower cost...

Current groups will only keep their current gigs....if they lower their costs.

That's the future of the anesthesia business in the next 5 to 10 years....

For all you "lifestyle" folks....better start thinking fellowships....something like CCM.

I'm not kidding about the future.....

Mil is right on in his assessment of the long term dismal job outlook for Anesthesia.

 

[militarymd]

So that's my prediction of what's going to happen in the future.....now, what's everyone going to do about it.

Sit around and wait for it?

I think that's probably not a good idea.

I say...control the situation....become an employer...be the management company....and hire the new grads...

What should we pay the new grads? Well.........what do you all say?

I don't plan on getting screwed...I plan on being in the driver's seat....and if it means screwing some new guy who chose this specialty because of "lifestyle"............

 

[DrDre']

You know I appreciate your medical input vastly MMD but you are doing OR anesthesia for the money and the lifestyle, too. Remember your CCM that dies on the vine?

It is nice to know that you are willing to screw others (your peers) who have chosen the lifestyle and money, like you. Remember your CCM?

So that's my prediction of what's going to happen in the future.....now, what's everyone going to do about it.

Sit around and wait for it?

I think that's probably not a good idea.

I say...control the situation....become an employer...be the management company....and hire the new grads...

What should we pay the new grads? Well.........what do you all say?

I don't plan on getting screwed...I plan on being in the driver's seat....and if it means screwing some new guy who chose this specialty because of "lifestyle"............

 

[militarymd]

You know I appreciate your medical input vastly MMD but you are doing OR anesthesia for the money and the lifestyle, too. Remember your CCM that dies on the vine?

It is nice to know that you are willing to screw others (your peers) who have chosen the lifestyle and money, like you. Remember your CCM?

I chose anesthesia in an era when no one wanted to do anesthesia ...to do CCM.

And currently...it is LITERALLY not possible to make a living...beyond what a resident would make, as a private practice anesthesiologist doing CCM.

I actually still provide this service...FREE of charge...to the surgeons who would request the service.

As for what happens in the next few years......my choices are:

1) find employees to work for me (probably pay them more than a managment company would)

2) let the new guys work for anesthesia management companies (making less than what I would pay)...and then let the anesthesia management companies SCREW me.

3) let the new grads become partners with me when I don't need new partners...and dilute the income in a "fair" and "equatable" manner.

Look at the choices...which would you choose?

 

[DrDre']

Tough choices, I appreciate that. I love CCM myself. I feel as if I must do it just to guarantee my future even if it is at a lower wage!

Q 3 right now in the unit makes you think twice though.

How much can you make locums in CCM, teleCCM?

I chose anesthesia in an era when no one wanted to do anesthesia ...to do CCM.

And currently...it is LITERALLY not possible to make a living...beyond what a resident would make, as a private practice anesthesiologist doing CCM.

I actually still provide this service...FREE of charge...to the surgeons who would request the service.

As for what happens in the next few years......my choices are:

1) find employees to work for me (probably pay them more than a managment company would)

2) let the new guys work for anesthesia management companies (making less than what I would pay)...and then let the anesthesia management companies SCREW me.

3) let the new grads become partners with me when I don't need new partners...and dilute the income in a "fair" and "equatable" manner.

Look at the choices...which would you choose?

 

[militarymd]

Tough choices, I appreciate that. I love CCM myself. I feel as if I must do it just to guarantee my future even if it is at a lower wage!

Q 3 right now in the unit makes you think twice though.

How much can you make locums in CCM, teleCCM?

Breslow's E-ICU....1000 per shift.....

 

[jetproppilot]

How much can you make locums in CCM, teleCCM?

Not enough.

 

[chesterfield]

Breslow's E-ICU....1000 per shift.....

Telemedicine scares me since there is no way to tell who is actually doing the work.

I envision a US residency trained FMG with dozens of state licences living in his home country, running a Telemedicine practice employing several local non- US trained, non- US licensed physicians or non- US licensed nurses taking call for hundreds of hospitals at the same time.

The US residency trained FMG signs off on all of the reports but the local non-US trained, non- US licensed physicians or nurses do all the work.

__________________________________________
"When my colleagues get a letter from a constituent who has been displaced by temporary foreign guest workers, they should write back to them and say, 'It is the policy of this government to displace you, to move you into a lower economic income category, because we believe in cheap labor and we believe the politics of open borders helps our party." -- Rep. Tom Tancredo (R-CO), U.S. Congressman

 

[militarymd]

Telemedicine scares me since there is no way to tell who is actually doing the work.

I envision a US residency trained FMG with dozens of state licences living in his home country, running a Telemedicine practice employing several local non- US trained, non- US licensed physicians or non- US licensed nurses taking call for hundreds of hospitals at the same time.

The US residency trained FMG signs off on all of the reports but the local non-US trained, non- US licensed physicians or nurses do all the work.

__________________________________________
"When my colleagues get a letter from a constituent who has been displaced by temporary foreign guest workers, they should write back to them and say, 'It is the policy of this government to displace you, to move you into a lower economic income category, because we believe in cheap labor and we believe the politics of open borders helps our party." -- Rep. Tom Tancredo (R-CO), U.S. Congressman

That's not how it works.

Although, the office is off-site, it is in the same locale as all the ICUs...and there is also an on-site, physician who is available for procedures.

95% of CCM is MEDICAL decision making...with a NURSE carrying out your ORDERS...a paradigm that anesthesiologlists are not used to......just like 95% of a case is sitting there charting vital signs....

 

[Noyac]

And there are quality control issues that are monitored as with the radiology nighthawk services.

 

[dpatelmd]

Jet great initial post.

Lots of helpfull info.

On a side note, what are the best ways to look for the good groups out there.

I happened to do a residency and I am doing a fellowship in an area totally different from where I want to practice, so I do not have access to people that know about the tendencies of all of the groups.

Thanks.

DP

 

[jetproppilot]

Jet great initial post.

Lots of helpfull info.

On a side note, what are the best ways to look for the good groups out there.

DP

Word of mouth. Buddies that are already in the group you are looking at. Networking.

Same way to identify the bad groups out there....word of mouth, buddies, etc.

Short of this, if you're looking at a place completely strange to you, speak to as many people as possible...several anesthesiologists, several CRNAs, several surgeons....speak to the CEO of the hospital......

then take everything you heard with a grain of salt and go with your gut feeling.

 

[Noyac]

Word of mouth. Buddies that are already in the group you are looking at. Networking.

Same way to identify the bad groups out there....word of mouth, buddies, etc.

Short of this, if you're looking at a place completely strange to you, speak to as many people as possible...several anesthesiologists, several CRNAs, several surgeons....speak to the CEO of the hospital......

then take everything you heard with a grain of salt and go with your gut feeling.

i agree with almost everything here, Jet. But I gotta say that crna's have a totally different outlook on jobs and I have found their information totally useless. THey seem to always think that the Dr's have a sweeeeet deal and this is not always the case. I would still talk to them but I would take everything they say with a grain of salt.

 

[jetproppilot]

i agree with almost everything here, Jet. But I gotta say that crna's have a totally different outlook on jobs and I have found their information totally useless. THey seem to always think that the Dr's have a sweeeeet deal and this is not always the case. I would still talk to them but I would take everything they say with a grain of salt.

I see your point.

 

[jetproppilot]

bumped for my CA-3 emerging-colleagues.

 

[rmh149]

bumped for my CA-3 emerging-colleagues.

What is CA-3? I have seen it frequently on the forum.

 

[jetproppilot]

What is CA-3? I have seen it frequently on the forum.

I read your reply to my thread The White Coat which stated you chose not to wear a white coat most of the time while rounding on patients. From your reply, I assumed you were an anesthesiologist, especially after your comment about what the surgeons would think.

Since this forum is laden with terrorists with sinister motives, may I ask what you do for a living?

No disrespect intended, but I will not fuel the terrorists.

Maybe you are an anesthesiologist in another country, since every USA anesthesiologist knows what a CA-3 is.

Or maybe you are a physician of another specialty who has been drawn to the greatness of SDN anesthesia (grin).

 

[burntcrispy]

What is CA-3? I have seen it frequently on the forum.

CA-3 is a where an anesthesilogist is in his training after 4 years college, 4 years medschool, 1 year internship and 2 years of residency. It is the end of the line of a long, grueling journey. Unless, of course, if one chooses to do a fellowship whcih means even more time.

 

[jetproppilot]

It is very hard to tell the tone of someone's posts on the internet.....or what your personality is like...or whatever....

Having said that....you sound like you're going to have problems....seems like you have a chip on your shoulder already....and you haven't even finished residency yet.

Just my 2 cents....job markets aren't what they seem.....especially as viewed from the eyes of a new grad with no years of practice experience....

But this is just an internet forum....can't really tell what you're like....but, like I said....the way you string those keystrokes together....gives me the impression of someone who will become the bitter, I'm getting screwed by everyone....kind of anesthesiologist.

Concur.

 

[Camel]

rmh149 is a nurse anesthetist, and based upon the posts so far, does not seem to indicate a sinister motive (at the very least, has been respectful)

 

[VolatileAgent]

Concur.

well, jet, despite that i said i would no longer post on this thread... but because you felt the need to bump it almost 9 months after it was originally posted... i'd have to ask what exactly do you concur with in mil's statements?

i ask you this because - and with all due respect - shortly after you originally started this thread, you lost your job to a private practice management company in almost precisely the manner i describe. however, you were also able to find another job fairly quickly and in the same area... again in almost precisely the manner i describe on this thread.

i like you, jet. you're a hoot. but, i also have to know exactly with what do you "concur" here?

 

[jetproppilot]

well, jet, despite that i said i would no longer post on this thread... but because you felt the need to bump it almost 9 months after it was originally posted... i'd have to ask what exactly do you concur with in mil's statements?

i ask you this because - and with all due respect - shortly after you originally started this thread, you lost your job to a private practice management company in almost precisely the manner i describe. however, you were also able to find another job fairly quickly and in the same area... again in almost precisely the manner i describe on this thread.

i like you, jet. you're a hoot. but, i also have to know exactly with what do you "concur" here?

I bumped this thread for the initial post that I wrote, not for yours and Mil's posts.

I've thought the same thing,,,,,hey, this is an internet forum so you cant really tell, but geez Volatile, seems like most of your posts are either disagreeing with someone or being mildly-mannered-confrontational.

Not trying to be personal, just an observation.

Can you take what may be constructive criticism from someone and learn from it, without lashing out? Or do you always respond with "I don't think so," or "Your observation is wrong," or "theres a better way to do this," etc

I had a partner that was like that....no matter what the subject, if I, or "we" as a group, would say A, he would say B.

And argue his point.

It was exhausting at times.

It was like he was disagreeing just to disagree.

So I was concurring that if in fact thats the way you handle interactions with colleagues in person, then that may present a problem.

 

[VolatileAgent]

So I was concurring that if in fact thats the way you handle interactions with colleagues in person, then that may present a problem.

well, jet, all i can say is that i don't blanketly agree with people for the sake of agreeing, especially if i disagree (haha). throughout my four years of residency, my evaluations have reflected someone who is occassionally adept at "telling others what they already know" to great teacher to leader. i've never been called "dangerous" or "attitude/arrogant" or "perceived ability exceeds actual ability" or anything of the like. and, i've always been the guy who's not afraid to tell the emperor that he's not wearing any clothes. some people don't like that, i'll admit. but, i'll soon be 43-years-old and it's not likely that i'm going to change now.

all i know is that i'm frequently singled-out as the "go to" guy by fellow residents and even attendings. as a result, i have a very long leash. i've never, in my four years, written anyone up. i deal with conflict face-to-face, and mostly i'm respected for that (although clearly sometimes people can't handle their faults and mistakes pointed out to them... at least i hope they can respect the fact that it's not done in a chicken-s**t way by being handed to them on a piece of paper that goes into their permanent file).

but, i feel strongly that this is what medicine desperately needs now. people who are willing to stand-up and put the patient first. likewise, i recognize good work point out when people do a great job, from the guy who buffs the floor to the cashier in the cafeteria to the nursing student who just put in her first i.v. on a forum, there's not as much time or opportunity to always do that. and, controversial posts are the ones that get the most attention (i can't change human nature either).

so, if you don't always like my candor, i can't help that. consider it a reality check. but, don't miss the point either. on this forum, i respect many of my attending colleagues accomplishments and what they've already given to the field. but, just because you've achieved, don't get lulled into the belief that what you say is "the right way" or that your ideas and comments can't be challenged. maybe i'm like that guy in your former practice, and perhaps i do enjoy at times being adversarial. but, it is done mostly in order to be thought-provoking. and, maybe that guy in your practice was the same way and you just focused on the apparently confrontational parts of his personality.

just know that, in the end, if you say something good or right, or do something good or right, it is only my opinion that is speaking back to you. if i agree with you, it doesn't make you (or me) right. it is only one person's opinion that is talking. likewise, if i disagree, it doesn't necessarily mean that you are wrong.

just know that none of us opens our mouths and has "the gospel" spill out. it seems lately that there have been more than a few members of this forum who erroneously believe the opposite to be true. expect to be challenged, just as i expect it, if you come here to play.

that is all.

 

[VentdependenT]

Thanks for the BUMP jet.

Its a good reminder of the real world of Private Practice. Speed, flexibility, and humble knowledge sound like the big things to nail down before heading out.

On it.

I didn't read any of the posts on the thread. I can't handle the personal battles.

 

[The_Sensei]

that is all.

For heaven's sake let's hope so.

 

[militarymd]

I didn't read any of the posts on the thread. I can't handle the personal battles.

You should. ....it is actually quite educational.

 

[VentdependenT]

Ok Mil, just read all the other stuff.

It just reinforced my current position which is to apply for fellowship. So I'm taking a fellowship.....in something. Part of me says Pain, part says CV, and part says Regional.

I just printed out 10 applications.....ohhhh man this ain't gonna be fun.

Any input would be GREATLY appreciated.

I DID NOT choose the field for lifestyle. I would NOT want some jack off taking care of me in a perfunctory manner while he/she is mobile text paging their buddy about a new Soduku (however you spell it..I don't do em) they found.

 

[Planktonmd]

Ok Mil, just read all the other stuff.

It just reinforced my current position which is to apply for fellowship. So I'm taking a fellowship.....in something. Part of me says Pain, part says CV, and part says Regional.

I just printed out 10 applications.....ohhhh man this ain't gonna be fun.

Any input would be GREATLY appreciated.

I DID NOT choose the field for lifestyle. I would NOT want some jack off taking care of me in a perfunctory manner while he/she is mobile text paging their buddy about a new Soduku (however you spell it..I don't do em) they found.

I would say definitely CV fellowship, you will always have a job and no mid-level will compete with you because no cardiac surgeon I know of would have a mid-level take care of his/her patients without at least close supervision from an anesthesiologist.
Pain fellowship might look tempting now but the future is very uncertain.
A regional fellowship is a waste of time, why would you need a fellowship to do regional?

 

[epidural man]

I don't really have anything much to say about this topic, but I thought the original post was so great, I wanted to write something so it would be listed as a recent post again.

Plus, how come The_Sensei was banned? What does one have to do in this anesthesiology forum of heated words and mean spirited comments to get banned?

 

[The_Sensei]

Plus, how come The_Sensei was banned? What does one have to do in this anesthesiology forum of heated words and mean spirited comments to get banned?

I'm back......was on a temporary hiatus for being a bad boy and speaking my opinion in a vehement fashion. Got to watch out in this PC world of ours, you know........

Just like on TV - horrible, deplorable violence is OKAY, but say "Shi t" and your career is over.

 

[VentdependenT]

filthy potty mouth

 

[cfdavid]

Hey gents, just for some positive reinforcement, many of us greatly appreciate the activity of the attendings and residents on this forum. Not everyone likes to chime in, but I know that there are a lot of lurkers out there that benefit from such involvement. This is by far the best forum on SDN, in my opinion. So, thanks.