Which is job would you pick ?

[Modoc]

Hello all,

Having a hard time picking between jobs. Cardiac trained, looking for academic job due to PSLF, both options are academic:

option 1: 525k, no hearts, supervise 4 rooms, short staffed with many locums. m-f general shift with 4 weekday and 1-2 weekend 24hr call shifts. Benefits standard, nothing special. 8 weeks PTO. culture kinda weird, CRNA run sedation practice (scopes, tee, etc)

option 2: 480k, has hearts, with extra compensation if staying past 4pm and holding charge phone. No 24hr calls. maybe 1 weekend day shift every 6-8 weeks. Has a night float system 7 days, 12hr shifts followed by a week off (currently about 6 night floats a year).8 weeks PTO. Heart heavy institute, likely doing hearts 4 days a week. generalist making 465k with less hours than heart people (kind of sour about this).

I'm not crazy about doing hearts everyday, I would like more of a balance...

Whats your take? Whats negotiable in a academic practice?

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[aneftp]

is academic place true state employed? Lots of issues with loan forgiveness non true state employed (or federal employed)

 

[Modoc]

is academic place true state employed? Lots of issues with loan forgiveness non true state employed (or federal employed)

true state employed. it is a state university

 

[agammaglobulin]

Tough choice. i think it comes down to if you want to do cardiac everyday or no cardiac at all. If you’re straight out of fellowship, I’d think cardiac everyday is better to keep your skills at least for a little bit.

 

[kidthor]

#2 all day.

After fellowship I think you should really practice heavily in that area unless you hate it for some reason (e.g. I had a friend do a critical care fellowship and then eject hard into community practice without CCM due to hating it). Otherwise you'll lose out on developing and retaining your skills. Plus cardiac is in such high demand that even if you do job #2 for a bit and don't like it, you'll be highly, highly marketable upon transitioning out. If doing too much cardiac starts to burn you out in #2 you can probably also negotiate for a mixed practice there since they wouldn't want to lose you.

#1 has a bunch of red flags. If they need to sustain themselves on locums it's a bad sign. As it's academic they have an in house pool of graduating residents who'd stay if it were any good. CRNAs running anything is a huge red flag. 1:4 is also an absolute hard no, there's almost no amount I'd take to do that regularly - it's truly awful. Also "weird culture" is yet another red flag... if they can't hide weird culture issues on an interview, be sure there is much more weirdness below the surface.

 

[Southpaw]

If you want more of a balance then keep looking. Job 1 has red flags all over the place and I wouldn’t step foot in the place. An academic place dependent on locums, running 4:1, and CRNA run services is a dumpster fire.

 

[Hoya11]

Hello all,

Having a hard time picking between jobs. Cardiac trained, looking for academic job due to PSLF, both options are academic:

option 1: 525k, no hearts, supervise 4 rooms, short staffed with many locums. m-f general shift with 4 weekday and 1-2 weekend 24hr call shifts. Benefits standard, nothing special. 8 weeks PTO. culture kinda weird, CRNA run sedation practice (scopes, tee, etc)

option 2: 480k, has hearts, with extra compensation if staying past 4pm and holding charge phone. No 24hr calls. maybe 1 weekend day shift every 6-8 weeks. Has a night float system 7 days, 12hr shifts followed by a week off (currently about 6 night floats a year).8 weeks PTO. Heart heavy institute, likely doing hearts 4 days a week. generalist making 465k with less hours than heart people (kind of sour about this).

I'm not crazy about doing hearts everyday, I would like more of a balance...

Whats your take? Whats negotiable in a academic practice?

I dont do cardiac but I would wonder how often I am hassled after hours by the call beeper with job #2. Might not be worth the extra pay. Might be a huge PIA IMO. I mean the nature of cardiac surgery and take backs is unpredictable.

I think you will find a lot of hospitals in the situation as #1. Easy to judge but its going on everywhere. At least the call there is defined and you are doing a variety of cases. I personally HATE the beeper at home.

 

[vector2]

Hello all,

Having a hard time picking between jobs. Cardiac trained, looking for academic job due to PSLF, both options are academic:

option 1: 525k, no hearts, supervise 4 rooms, short staffed with many locums. m-f general shift with 4 weekday and 1-2 weekend 24hr call shifts. Benefits standard, nothing special. 8 weeks PTO. culture kinda weird, CRNA run sedation practice (scopes, tee, etc)

option 2: 480k, has hearts, with extra compensation if staying past 4pm and holding charge phone. No 24hr calls. maybe 1 weekend day shift every 6-8 weeks. Has a night float system 7 days, 12hr shifts followed by a week off (currently about 6 night floats a year).8 weeks PTO. Heart heavy institute, likely doing hearts 4 days a week. generalist making 465k with less hours than heart people (kind of sour about this).

I'm not crazy about doing hearts everyday, I would like more of a balance...

Whats your take? Whats negotiable in a academic practice?

I say option 2. But if you're deadset against 100% cardiac then maybe take option 2 but ask for the generalist position? You can take generalist call and simply ask if they will let you do enough daytime hearts over the year to keep your cert.

 

[anaesthetic]

We would probably not take a "cardiac-trained" person who didn't do any cardiac straight out of fellowship, and the further away from fellowship you are, the farther you'll fall behind in terms of skills. It's a waste of a year, IMO, since the learning doesn't stop after June 30th. There are nuances to cardiac cases that just can't be taught in a year of fellowship with someone looking over your shoulder the whole time. I've made some tough calls on tough cases, and I've made some wrong calls as well. It's important to experience this when you get out, IMO, and there's nothing else that can replicate doing your own cardiac cases for several years.

Let's say you choose #1 and do zero hearts for three years while you get your PSLF stuff squared away. Now you're looking to move and are looking at cardiac positions as well. Would you feel comfortable doing elective CABGs? Probably. What about aortic dissections, tamponades, advanced heart failure therapies/mechanical support devices, complex valve repairs, minimally invasive/robotic cases, in addition to making the calls on TEE (e.g., RWMAs coming off of CPB, wire placement on dissections, cannula positioning, specific valve defects, volume assessments, etc.) and managing complex cardiac patients needing non-cardiac surgery? I'd say you'd need a lot of time, motivation, and proctoring to re-learn, develop, and refine those skills that were lost in those three years.

 

[BLADEMDA]

Hello all,

Having a hard time picking between jobs. Cardiac trained, looking for academic job due to PSLF, both options are academic:

option 1: 525k, no hearts, supervise 4 rooms, short staffed with many locums. m-f general shift with 4 weekday and 1-2 weekend 24hr call shifts. Benefits standard, nothing special. 8 weeks PTO. culture kinda weird, CRNA run sedation practice (scopes, tee, etc)

option 2: 480k, has hearts, with extra compensation if staying past 4pm and holding charge phone. No 24hr calls. maybe 1 weekend day shift every 6-8 weeks. Has a night float system 7 days, 12hr shifts followed by a week off (currently about 6 night floats a year).8 weeks PTO. Heart heavy institute, likely doing hearts 4 days a week. generalist making 465k with less hours than heart people (kind of sour about this).

I'm not crazy about doing hearts everyday, I would like more of a balance...

Whats your take? Whats negotiable in a academic practice?

Job number 2 for you or that fellowship has been wasted. This won't be your last job so take number 2 and keep looking for something better down the road.

 

[aneftp]

If you want more of a balance then keep looking. Job 1 has red flags all over the place and I wouldn’t step foot in the place. An academic place dependent on locums, running 4:1, and CRNA run services is a dumpster fire.

That’s common at probably 30% of true academic places these days. Locums docs and locums crna’s. Every place is Short staff trying to make money for the hospital. Including academic places

 

[ToKingdomCome]

Academics pay this much? Is this after call points, etc. or is this salary?

 

[IMGASMD]

#2.
Also do yourself a favor, if you haven’t done it, calculate out how much you’ll actually be forgiven. Since you’ll be back on income based repayment, after fellowship (?). If you’re doing it straight through, you still need five more years, right?


If you can find a job with better conditions in private practice for 600K, how would that compare?

I am allergic to CRNAs at this time in my career. So 1:4 all day, everyday. On top of that without a steady work force?! That’s a he!! No from me.

 

[PpfSuxTube]

Cardiac 100% of the time over general supervising 4 rooms. Jesus. F that...

 

[chessknt]

Do you have over 1M in loans? 5 years at what income loss to qualify for a program that might not exist? I wouldn't restrict your options to pslf...

 

[Modoc]

Thank you all for your input! Very valuable in my current position.

Heres a update.

#1 increased salary to 572k, no non compete, allowing me to moonlight at other hospitals to retain my cardiac skills. with loan forgiveness, package ~ 620k/ year

#2 holding fast to offer, not being flexible.

Sucks being poor and coming out of fellowship.

It will be a tough decision.

 

[vector2]

Thank you all for your input! Very valuable in my current position.

Heres a update.

#1 increased salary to 572k, no non compete, allowing me to moonlight at other hospitals to retain my cardiac skills. with loan forgiveness, package ~ 620k/ year

#2 holding fast to offer, not being flexible.

Sucks being poor and coming out of fellowship.

It will be a tough decision.

Even with the salary bump that first job is a dumpster fire. It'd have to pay 7 figures before I'd consider a job with rampant locums, 1:4 all the time, and CRNAs running academic Endo/Nora cases solo.

 

[IMGASMD]

Even with the salary bump that first job is a dumpster fire. It'd have to pay 7 figures before I'd consider a job with rampant locums, 1:4 all the time, and CRNAs running academic Endo/Nora cases solo.

I just saw an email, something about a RRNA doing his doctoral project.
GTFOH.

I just had a conversation with my SO. I would gladly take a 20% pay cut, if I NEVER have to deal with a crna again in my career.

OP, you can
1. Show them your other offer. (They may not care, nor have the money to bump up your pay…)
2. Negotiate something within the practice. Less call, more general days, more vacation. Or like someone else mentioned, be a generalist in the group and “cover” cardiac for a fee. Or maybe buy some cardiac days.
Sometimes a group may have separate pot of money or separate goals. (General vs cardiac vs pediatrics vs pain vs OB). It’s not inconceivable different division heads will have different needs. If you have the skill sets that can help out both, maybe that’s your way in.

The first job really sounds like a dumpster fire. If I wasn’t clear in my other post. When you have a locum revolving door, with very unstable workforce, it’s dangerous. No one really “knows” anything for sure, policy, politics or culture of the place. On top of that you’re supervising 1:4? Don’t kid yourself…. The crnas will come to you, (if they actually bother to come), and say I’ve been here longer than you have. I know the “leadership” and the surgeon better than you.
You are doomed from the getgo.

 

[BLADEMDA]

I hated covering 1:4 for many years. I think 1:3 or 1:2 (if you can get it) is so much better and worth a small pay cut.

 

[Twiggidy]

Do as much cardiac after fellowship as you can and negotiate some general rooms so you can maintain being a "well rounded cardiac anesthesiologists". You'd be surprised how fast you can manage to lose skill both cardiac and general skills (sic mostly regional blocks). Plus, sometimes it's a breath of fresh air to not have to line every patient up and drag them off pump and just site and do a room full of lap choles.

 

[secretasianman]

Number one sounds toxic. Makes me wonder what messed up politics led to 1:4 all the time and ceding sedation completely. That is, it’s no sedation until it hits the fan and you get paged to gi for bad aspiration or massive gib. Then it’s “I’m just a nurse.”

 

[pgg]

Does job #2 do transplants and VADs?

That's the stuff that makes cardiac call hurt.

 

[Modoc]

Does job #2 do transplants and VADs?

That's the stuff that makes cardiac call hurt.

they do , but I wouldn't consider them high volume.

Number one sounds toxic. Makes me wonder what messed up politics led to 1:4 all the time and ceding sedation completely. That is, it’s no sedation until it hits the fan and you get paged to gi for bad aspiration or massive gib. Then it’s “I’m just a nurse.”

sounds like a nightmare.

yeah I hear what you all are saying. Sounds like the consensus is pretty uniform. I'm in a undesirable region for people to move to / live in, the university hospital lost several anesthesiologist (>10) in the last three months. So the system is desperate on recruitment. SO is still a resident and also busy, im at a point were im unsure if I should just work a ton to make a lot of money before moving back home (HCOL) or just kick it and take #2 for what it is.

I appreciate all your insight. Been very helpful.

 

[kidthor]

I wouldn’t take #1 ever, ever. There are too many red flags and your soul will be crushed. It’s not worth it. There’s a reason they’re hemorrhaging.

 

[abolt18]

I wouldn’t take #1 ever, ever. There are too many red flags and your soul will be crushed. It’s not worth it. There’s a reason they’re hemorrhaging.

Like losing more than ten anesthesiologists in the last few months???? That's crazy!

 

[Modoc]

Like losing more than ten anesthesiologists in the last few months???? That's crazy!

Yeah, that's #2.

 

[nimbus]

Yeah, that's #2.

Yet they won’t negotiate pay 🤔. $480k is not competitive for 4days/week of hearts.
They’re not desperate enough yet. They will likely lose more people in the coming months. Wait a few months and maybe there will be a better offer. They will still have many vacancies.

 

[Modoc]

I was able to negotiate 20% cardiac, 80% general with generalist call for cardiac pay for #2. Retention bonus is pretty weak, 2k /mo until starting for a 2 year commitment.

 

[vector2]

I was able to negotiate 20% cardiac, 80% general with generalist call for cardiac pay for #2. Retention bonus is pretty weak, 2k /mo until starting for a 2 year commitment.

I think you made the best choice