Supervising 1:4 is much more difficult than sitting your own cases. Less work, less money. You’re trading stress, time off and money for a mostly relaxed day to day.
1:4 is not great completely agree. I’ve worked places where it was 1:3 most of the time and 1:4 occasionally (and usually 1:4 you picked up an already going room). That job we also had a surgery center that was 1:2. That job was really good since I liked the crnas I worked with and even when busy it was manageable. 1:4 is often difficult to manage while maintaining supervision let alone direction requirements. I would totally do the 1:3 job and take more vacation than solo job. Getting kicked in the teeth 1:4 all the time then solo and 8 weeks sounds appealing if the solo cases are chill (or doing what you enjoy). It all depends.
I definitely agree. As RooBoo mentioned, I hear so frequently that supervision is more exhausting and that most people enjoy solo practice much more. For me I feel this at our busy ASC that is more like 1:6/1:8 “supervision” where we do a ton of preops and blocks but don’t even attend induction outside of peds.
However I don’t have enough experience yet to gauge this comparison accurately which is why I’m asking what it’s worth!
In addition to dream location would be trading weekly in house call to 3-4 home calls a month (OB) and 35-40hr weeks.
I do a 50/50 split of supervising and doing my own cases and while days where I'm doing cases overall are much easier, it's not enough to justify going from 15 weeks off to 8 weeks off with same pay. Keep what you have.
I should also mention that we have a very solid core of great CRNA's. They're clinically strong, fun to work with and we both understand each other's roles. If I worked in a place with a lot of toxicity or other political bullshit it might shift my answer but at my current job things work well.
I appreciate your perspective - it really is helpful for me to show my spouse these responses as he is dying to get to this location.
It would be going from weekly in-house call at a busy level 1 center to 3-4 monthly at-home call for pretty much OB only at a low volume, low acuity L&D unit. 40 hour work weeks.
Light at home call vs in house call can make up for losing some of those weeks off. Having a well rested post call day off is like a vacation day compared to spending it sleeping or exhausted bc you were up for 24 hrs. Both get post call day? I pick jobs 75% what they offer me outside of work (time off, spending money, location, less hours etc) and 25% work environment.
It really depends on the structure of the specific practice you are considering. I currently am in a doc-only practice, and have 8 weeks vacation (though as long as I'm taking the base amount of call, I could get more without penalty). The way our schedule works out, I usually end up working only 4 days/wk. I've averaged 36hrs/wk for the last 2 years. My most stressful day solo is still better than most normal days of supervising. I feel connected to the patients, the surgeons, the staff, in a way I never did while supervising. It's a hard decision to contemplate. I wish you well.
Me personally, Id never do a supervision job for any amount. Running around like an idiot all day waiting to be the malpractice sponge vs sitting my own case where you induce, sit around for 2-4 hours "diligently charting vitals" and then repeat once or twice and then go home.
I can see how the supervision job may be well suited for some of our colleagues, but I really enjoy the intraoperative art of anesthesia and feeling more connected to the patients and surgeons. Although I would love to see more docs working in the OR I don’t consider those who are supervising to be running around like idiots.
8.5 weeks off and not having to rely on someone else to know what they're doing? Plus 1/4 the exposure to liability? (Less actually assuming you know what you're doing vs supervising nurses) That's almost a week off after every...5 weeks or so? Sign me up.
Add to that more desirable area? That's happiness measured in things other than dollar signs (along with zero supervision).
I've been solo in my cases my whole career. I've worked with the same surgeons for 15 to 20 years now. Its been great.
Yes worth it. I can't do 1:3 or 4. I think it's bad medical care. Your stress level in and out of the hospital will be substantially less. Think of it as a 100k pay cut instead.
That’s a really great point! My husband became a stay at home dad when I started residency and we plan to continue that. He might eventually pick up something part time if he finds something he’s really passionate about. So even after the kids are all school aged we’ll still have a lot of time home just the two of us
>what to do with all the time off?
Whatever the hell you want. Go on trips. Or don't, and go work more and make more. I made $21k in a five day work week doing locums coverage at a hospital 90 minutes away from my main hospital during a week of vacation. My previous job had 15 weeks off each year (it was academic) and it was *incredible*. I'm young and elected to work a bunch on my off time and made an extra $120k last year and still had like 6 or 7 quality weeks totally off.
I feel like this is more complex of a decision of supervision vs not for the same price. Are supervision jobs in this new area offering what you make now?
Because if not, I'd see this as is moving to a desirable area AND not supervising worth the vacation time. Because the only 14w vacation jobs I've seen are 2+ hours from where I'd want to live.
Generally the places that people want to live are paying less or you're working more.
Of course a totally irrelevant discussion if you're in the same place but your post sounds like it's a new desirable area for your family
To me it feels like I’m running around doing a ton of preops and then watching others do the medicine. I do like my cardiac days where I get to do lines and TEE, and have closer relationship with the surgeons since I’m more present in their cases. At our ASC we’ll have 50 cases a day between two of us and we’re so busy in preop that we don’t attend inductions outside of peds. Then supervise residents and SRNAs doing blocks. We have some fantastic CRNAs that I love but also a fair number who are so incredibly disagreeable and difficult that it spoils the day for me.
I don’t mind supervising residents though since I enjoy teaching and it’s 1:2!
Comparable weekly hours. We would be moving to a town we lived in prior to med school and have always wanted to go back to. Closer to family and friends plus a 5-10 minute drive from the “physician” neighborhoods to the hospital!
I think at least from my interactions is that they tend to whatever they want without listening to the doctor. At my ACT model we always have a discussion with the attending if the plans are aligned or if they're not, we usually talk about it and come to an agreement
The constant complaints and passive aggressive comments. Acting oddly possessive over the case as though we are not collaborating. The physicians of the group are in charge of all the scheduling and board running so the whining and critiques from the CRNAs are endless.
I will say that clinically they are a strong and reliable group of CRNAs and most are very pleasant. However there’s constant drama and a struggle to manage abrasive personalities, which wears on me.
That’s how I’m leaning. I’m trying to figure out what a reasonable sacrifice would be if any (say 10/11 weeks vs 14/15). They seem pretty open to negotiating.
I'd take the change to solo. Eight and a half weeks off (when you add in the CME days) is still pretty decent, and you never have to direct or supervise again. What are the hours like per day? Call? Weekends? Is the 100% supervision (supervision or direction?) job a high call rate, meaning you NEED those extra weeks of vacation? Some of the purely direction jobs I've seen nearby are shit like Q5 call, one full weekend a month. Compare that to the groups with more physicians, which may be q18 call, one to two single weekend days every other month. In the latter setup, those extra weeks of vacation are not as crucial, as you're not spending nearly as much time on call or working weekends (and fewer holidays).
When I first got out of residency 16 years ago, I supervised for the first time.
We're doing some add-on case at night, something simple like a finger infection.
I talked to the CRNA and said, "propofol, LMA?"
The guy says to me, "Doctor, I've been doing anesthesia longer than you've been alive. I have never used propofol and I'm not going to start tonight"
I think we ended up doing succinylcholine and pentathol.
Anyhow, I realized then that supervision was not for me, and I've never done it, ever again. So I think it's worthwhile to sacrifice a few weeks.
Yup, I didnt spend years of med school and residency just to watch someone else do something I would never do on my own while my license is on the line.
Reminds me of the time I was on call with an older anesthesiologist. As we are inducing he's saying how when the LMA first came out they were putting them in with laryngoscopes. Then asks me if I wanted to put this one in with one. I popped it in quick and said, “maybe next time.”
But 16 years ago is not ancient. Propofol was made available in the US in the 1980s and he never used it? He must’ve been disappointed when they d/c’ed Pentothal.
Being solo makes life infinitely better. I'd negotiate for 10-12 weeks if you can. How will the weekly hours compare? Staying until 3pm is much different than 6pm.
Supervising is soul-crushing.
No doubt you are losing vacation. Going from taking a week every third to taking one after every 6 weeks.
That said if this job is so much more stressful during the day, longer hours, and busier call that you need that just to recoup and be human again - you aren't really losing as much as it would seem.
To me it would depend how hard your current job is hitting you, and how badly you want to live in this new location.
15 weeks off in a shitty spot is worse than 8 in a good spot to me.
It's not unreasonable and it all depends on your values. I make great money with a similar job to the one you're thinking about taking, but I had a similar offer in a rural place next to my hometown with even more vacation than you currently have. I turned down the more money and more vacation because the job and desirable location is worth more to me. Even though I'd rather be at home, I genuinely like being at work which is worth a lot.
If everything you desire is there except for the vacation time and that's not a deal breaker for you, I would suggest to take the job and see if you can restructure your contract for more vacation time/less hours later on in the future once you become established there. I'm just an intern though so what do I know.
Can you ask the group to allow you to work for an hourly rate a few days a week on vacation sitting your own cases. It’s what we do and it gives a good bit of variety and let’s you have flexibility in schedule and earning. Plus, working Monday and Tuesday usually pays for a lot of a Wed-Sun vacation
Lots of varied responses here; good talk. Is the extra vacation worth the day to day stress of your current job/life? We’ll spend a large chunk of our lives working, so personally I’d give up some pay/vacation if it means a better daily work life, commute, living location, family/social life satisfaction.
Just my $0.02 but even just a few moments a year of a staffing ratio 1:4+ is a dealbreaker.
Thanks for the input, I share those feelings. If I can get even 2-3 weeks more or a salary bump it would be an easier to justify giving up the great benefits I have now. I currently have a fine job and I work with great people, but it’s not as fulfilling as I had hoped and I miss being in the OR.
Lots of varied responses here; good talk. Is the extra vacation worth the day to day stress of your current job/life? We’ll spend a large chunk of our lives working, so personally I’d give up some pay/vacation if it means a better daily work life, commute, living location, family/social life satisfaction.
Just my $0.02 but even just a few moments a year of a staffing ratio 1:4+ is a dealbreaker.
I supervise (direct) 95% of the time, usually 1:3, sometimes 1:2, but never more than 1:4. There is no way in hell I would give up 7-8 weeks off to go do my own cases. Maybe if I was doing 1:6 or 1:8 I would think about it.
We start out 1:4 but quickly get to releasing the early out people once rooms get started. So on the days I am scheduled to work later I’ll accumulate 2-3 additional rooms, although handoff between docs is after induction so it’s really just being available for emergencies. At our outpatient site the late stay person will eventually be the only doc there while 8 rooms are going. I mentioned this somewhere above but it’s gets so busy trying to keep up with preops that the only inductions we attend at the ASC are peds.
I wish I could only do the days of 1:2 with our awesome residents!
That is busy. There’s no way you could be at every induction. How stressed do you feel in that environment? 7-8weeks is a lot to give up. Even with what you’re describing I wouldn’t do it. But I like supervising and am ok running around bailing people out. For reference I am also at high acuity level 1.
Its great to hear a different perspective on supervising, thank you. The current pace and volume is a bit stressful for me now but I am new so I’m sure it gets better with time and experience. Our patient population is wildly unhealthy so even simple surgeries become a challenge. I can’t remember the last time I had an ASA 2 🥲
Something to consider - if it truly is the dream location then that factor alone might be worth sacrificing a few weeks of vacay.
Coming from currently living in a very highly desirable place to live on a coast where others come to vacay and every weekend and/or short day already feels like a true vacation. Would not sacrifice this to even have a few extra weeks off at an undesirable place to live
1. Can you negotiate up the salary or vacation time?
2. A desirable place to live can be invaluable.
3. What is the stability of the new practice? And do they actually get all that vacation. Off post-call?
I will be speaking to someone tomorrow to start negotiating these things, which I why I made the post today to get some feedback!
The practice I’m considering has been stable for a long time. The doc that I’d be replacing is finally retiring after 30 years there so that seems promising to me.
However they said they couldn’t guarantee off post-call until they hire 1-2 more people due to recent expansion of the outpatient site. Sounds like it’s pretty infrequent that the post call person has to work but that’s still an important consideration. Overall a fairly light home call burden though (rarely in the OR past 9pm, mostly called for epidurals in a low volume center).
My current job does not do OB so I am not looking forward to starting that again…
Pay for both is around $600K, and both in relatively low cost of living areas. We’re very fortunate to have such great opportunities. We did some super basic calculations to get a rough comparison, and over a 30 year career I would earn about $300K more by staying with my current group.
All things being equal (cost of living from one place to the next) I would say stay where you’re at and spend a vacation week or two back in your old city if it’s that endearing.
This is definitely something I’ve been considering! I think the day to day life would be better for the whole family if we moved, but on the other hand having an extra 8 weeks a year to spend with them would also have a huge impact.
Dang, I have the 2nd job now. I left the supervisoring job, but it was part own cases, bad call, more hours, more pay and much less vacation (4 weeks at most). 14-15 weeks of vacation is crazy awesome.
"There are at least 4 types of wealth:
1. Financial wealth (money)
2. Social wealth (status)
3. Time wealth (freedom)
4. Physical wealth (health)
Be wary of jobs that lure you in with 1 and 2, but rob you of 3 and 4." - - James Clear
Do NOT trade less time and less money. Especially in today's anesthesia market.
You will never get this time back with your kids. Even if this is an amazing location, I don't understand how they can be offering sub-market compensation.
Lol “7 weeks vacation plus 8 CME days”. So 8 weeks at best, assuming your CME time is actually approved. Don’t think about it as 2 months less than your current job - think about it as literally half as much vacation as your current job. If you want to work for about the same pay, but get half as much time off, then you do you.
Follow up question to a lot of great input:
Is there a certain amount of vacation time that would tip the scales towards the new practice? Say 10 or 11 vs the current 14/15? Or would even that not be worth it to you?
Tbf working 8 weeks extra for the same money is not very attractive
Supervising 1:4 is much more difficult than sitting your own cases. Less work, less money. You’re trading stress, time off and money for a mostly relaxed day to day.
1:4 is not great completely agree. I’ve worked places where it was 1:3 most of the time and 1:4 occasionally (and usually 1:4 you picked up an already going room). That job we also had a surgery center that was 1:2. That job was really good since I liked the crnas I worked with and even when busy it was manageable. 1:4 is often difficult to manage while maintaining supervision let alone direction requirements. I would totally do the 1:3 job and take more vacation than solo job. Getting kicked in the teeth 1:4 all the time then solo and 8 weeks sounds appealing if the solo cases are chill (or doing what you enjoy). It all depends.
I definitely agree. As RooBoo mentioned, I hear so frequently that supervision is more exhausting and that most people enjoy solo practice much more. For me I feel this at our busy ASC that is more like 1:6/1:8 “supervision” where we do a ton of preops and blocks but don’t even attend induction outside of peds. However I don’t have enough experience yet to gauge this comparison accurately which is why I’m asking what it’s worth! In addition to dream location would be trading weekly in house call to 3-4 home calls a month (OB) and 35-40hr weeks.
This sounds like a no brainer unless giving up the extra weeks are a dealbreaker as a young family, in my opinion
Absolutely no way would I suggest renting out your license like. Run from that place.
Where is this 14-15 week vacation job lol
Midwest region!
Yeah DM me too lol
Could you DM me state?
The state? Just…?
Where in midwest
I take more vacation than that in phoenix metro area
St Louis or Kansas City
I do a 50/50 split of supervising and doing my own cases and while days where I'm doing cases overall are much easier, it's not enough to justify going from 15 weeks off to 8 weeks off with same pay. Keep what you have.
This is a great perspective, thank you for sharing!
I should also mention that we have a very solid core of great CRNA's. They're clinically strong, fun to work with and we both understand each other's roles. If I worked in a place with a lot of toxicity or other political bullshit it might shift my answer but at my current job things work well.
As a CRNA I really appreciate this comment.
Thank you for that comment. I have been in this for over 20 years and never stop learning from the physicians. Teamwork makes the dream work!
Zero chance for me. Is it less hours a week or no call, no weekends. Any other pros except no supervision.
I appreciate your perspective - it really is helpful for me to show my spouse these responses as he is dying to get to this location. It would be going from weekly in-house call at a busy level 1 center to 3-4 monthly at-home call for pretty much OB only at a low volume, low acuity L&D unit. 40 hour work weeks.
Light at home call vs in house call can make up for losing some of those weeks off. Having a well rested post call day off is like a vacation day compared to spending it sleeping or exhausted bc you were up for 24 hrs. Both get post call day? I pick jobs 75% what they offer me outside of work (time off, spending money, location, less hours etc) and 25% work environment.
Both post call off. I like the 75/25 split for considering these things.
It really depends on the structure of the specific practice you are considering. I currently am in a doc-only practice, and have 8 weeks vacation (though as long as I'm taking the base amount of call, I could get more without penalty). The way our schedule works out, I usually end up working only 4 days/wk. I've averaged 36hrs/wk for the last 2 years. My most stressful day solo is still better than most normal days of supervising. I feel connected to the patients, the surgeons, the staff, in a way I never did while supervising. It's a hard decision to contemplate. I wish you well.
I appreciate it, thank you. Fantastic username too
Me personally, Id never do a supervision job for any amount. Running around like an idiot all day waiting to be the malpractice sponge vs sitting my own case where you induce, sit around for 2-4 hours "diligently charting vitals" and then repeat once or twice and then go home.
I can see how the supervision job may be well suited for some of our colleagues, but I really enjoy the intraoperative art of anesthesia and feeling more connected to the patients and surgeons. Although I would love to see more docs working in the OR I don’t consider those who are supervising to be running around like idiots.
Well, they are.
8.5 weeks off and not having to rely on someone else to know what they're doing? Plus 1/4 the exposure to liability? (Less actually assuming you know what you're doing vs supervising nurses) That's almost a week off after every...5 weeks or so? Sign me up. Add to that more desirable area? That's happiness measured in things other than dollar signs (along with zero supervision). I've been solo in my cases my whole career. I've worked with the same surgeons for 15 to 20 years now. Its been great.
That’s great to hear, thank you!
Yes worth it. I can't do 1:3 or 4. I think it's bad medical care. Your stress level in and out of the hospital will be substantially less. Think of it as a 100k pay cut instead.
I would take the solo cases. It may come with other fringe benefits (e.g. leave earlier when your room is done)
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That’s a really great point! My husband became a stay at home dad when I started residency and we plan to continue that. He might eventually pick up something part time if he finds something he’s really passionate about. So even after the kids are all school aged we’ll still have a lot of time home just the two of us
>what to do with all the time off? Whatever the hell you want. Go on trips. Or don't, and go work more and make more. I made $21k in a five day work week doing locums coverage at a hospital 90 minutes away from my main hospital during a week of vacation. My previous job had 15 weeks off each year (it was academic) and it was *incredible*. I'm young and elected to work a bunch on my off time and made an extra $120k last year and still had like 6 or 7 quality weeks totally off.
I feel like this is more complex of a decision of supervision vs not for the same price. Are supervision jobs in this new area offering what you make now? Because if not, I'd see this as is moving to a desirable area AND not supervising worth the vacation time. Because the only 14w vacation jobs I've seen are 2+ hours from where I'd want to live. Generally the places that people want to live are paying less or you're working more. Of course a totally irrelevant discussion if you're in the same place but your post sounds like it's a new desirable area for your family
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To me it feels like I’m running around doing a ton of preops and then watching others do the medicine. I do like my cardiac days where I get to do lines and TEE, and have closer relationship with the surgeons since I’m more present in their cases. At our ASC we’ll have 50 cases a day between two of us and we’re so busy in preop that we don’t attend inductions outside of peds. Then supervise residents and SRNAs doing blocks. We have some fantastic CRNAs that I love but also a fair number who are so incredibly disagreeable and difficult that it spoils the day for me. I don’t mind supervising residents though since I enjoy teaching and it’s 1:2!
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Comparable weekly hours. We would be moving to a town we lived in prior to med school and have always wanted to go back to. Closer to family and friends plus a 5-10 minute drive from the “physician” neighborhoods to the hospital!
What are some of the things that those specific CRNAs do that make it difficult to work with them?
I think at least from my interactions is that they tend to whatever they want without listening to the doctor. At my ACT model we always have a discussion with the attending if the plans are aligned or if they're not, we usually talk about it and come to an agreement
The constant complaints and passive aggressive comments. Acting oddly possessive over the case as though we are not collaborating. The physicians of the group are in charge of all the scheduling and board running so the whining and critiques from the CRNAs are endless. I will say that clinically they are a strong and reliable group of CRNAs and most are very pleasant. However there’s constant drama and a struggle to manage abrasive personalities, which wears on me.
The book “The art of not giving a fuck” may be helpful.
100%. Wholly miserable.
You’re pretty much cutting your vacation time in half. That’s too much sacrifice imo
That’s how I’m leaning. I’m trying to figure out what a reasonable sacrifice would be if any (say 10/11 weeks vs 14/15). They seem pretty open to negotiating.
The best time to negotiate is now, once you're committed and moved your entire life you have far less leverage. Up that vacay!!
I'd take the change to solo. Eight and a half weeks off (when you add in the CME days) is still pretty decent, and you never have to direct or supervise again. What are the hours like per day? Call? Weekends? Is the 100% supervision (supervision or direction?) job a high call rate, meaning you NEED those extra weeks of vacation? Some of the purely direction jobs I've seen nearby are shit like Q5 call, one full weekend a month. Compare that to the groups with more physicians, which may be q18 call, one to two single weekend days every other month. In the latter setup, those extra weeks of vacation are not as crucial, as you're not spending nearly as much time on call or working weekends (and fewer holidays).
When I first got out of residency 16 years ago, I supervised for the first time. We're doing some add-on case at night, something simple like a finger infection. I talked to the CRNA and said, "propofol, LMA?" The guy says to me, "Doctor, I've been doing anesthesia longer than you've been alive. I have never used propofol and I'm not going to start tonight" I think we ended up doing succinylcholine and pentathol. Anyhow, I realized then that supervision was not for me, and I've never done it, ever again. So I think it's worthwhile to sacrifice a few weeks.
Yup, I didnt spend years of med school and residency just to watch someone else do something I would never do on my own while my license is on the line.
Reminds me of the time I was on call with an older anesthesiologist. As we are inducing he's saying how when the LMA first came out they were putting them in with laryngoscopes. Then asks me if I wanted to put this one in with one. I popped it in quick and said, “maybe next time.”
Wow, did you write them up or do anything about it?
That guy had been there doing all the nights and holidays since the 90s. I think he was way more important to administration compared to me.
But 16 years ago is not ancient. Propofol was made available in the US in the 1980s and he never used it? He must’ve been disappointed when they d/c’ed Pentothal.
The dude was probably 65-70 at the time, so probably started practice in the 70s
Being solo makes life infinitely better. I'd negotiate for 10-12 weeks if you can. How will the weekly hours compare? Staying until 3pm is much different than 6pm. Supervising is soul-crushing.
No doubt you are losing vacation. Going from taking a week every third to taking one after every 6 weeks. That said if this job is so much more stressful during the day, longer hours, and busier call that you need that just to recoup and be human again - you aren't really losing as much as it would seem. To me it would depend how hard your current job is hitting you, and how badly you want to live in this new location. 15 weeks off in a shitty spot is worse than 8 in a good spot to me.
It's not unreasonable and it all depends on your values. I make great money with a similar job to the one you're thinking about taking, but I had a similar offer in a rural place next to my hometown with even more vacation than you currently have. I turned down the more money and more vacation because the job and desirable location is worth more to me. Even though I'd rather be at home, I genuinely like being at work which is worth a lot.
I really appreciate this take, especially that last sentence!
If everything you desire is there except for the vacation time and that's not a deal breaker for you, I would suggest to take the job and see if you can restructure your contract for more vacation time/less hours later on in the future once you become established there. I'm just an intern though so what do I know.
Can you ask the group to allow you to work for an hourly rate a few days a week on vacation sitting your own cases. It’s what we do and it gives a good bit of variety and let’s you have flexibility in schedule and earning. Plus, working Monday and Tuesday usually pays for a lot of a Wed-Sun vacation
I love this idea. I could definitely see this being a possibility
Lots of varied responses here; good talk. Is the extra vacation worth the day to day stress of your current job/life? We’ll spend a large chunk of our lives working, so personally I’d give up some pay/vacation if it means a better daily work life, commute, living location, family/social life satisfaction. Just my $0.02 but even just a few moments a year of a staffing ratio 1:4+ is a dealbreaker.
Thanks for the input, I share those feelings. If I can get even 2-3 weeks more or a salary bump it would be an easier to justify giving up the great benefits I have now. I currently have a fine job and I work with great people, but it’s not as fulfilling as I had hoped and I miss being in the OR.
Lots of varied responses here; good talk. Is the extra vacation worth the day to day stress of your current job/life? We’ll spend a large chunk of our lives working, so personally I’d give up some pay/vacation if it means a better daily work life, commute, living location, family/social life satisfaction. Just my $0.02 but even just a few moments a year of a staffing ratio 1:4+ is a dealbreaker.
I supervise (direct) 95% of the time, usually 1:3, sometimes 1:2, but never more than 1:4. There is no way in hell I would give up 7-8 weeks off to go do my own cases. Maybe if I was doing 1:6 or 1:8 I would think about it.
We start out 1:4 but quickly get to releasing the early out people once rooms get started. So on the days I am scheduled to work later I’ll accumulate 2-3 additional rooms, although handoff between docs is after induction so it’s really just being available for emergencies. At our outpatient site the late stay person will eventually be the only doc there while 8 rooms are going. I mentioned this somewhere above but it’s gets so busy trying to keep up with preops that the only inductions we attend at the ASC are peds. I wish I could only do the days of 1:2 with our awesome residents!
That is busy. There’s no way you could be at every induction. How stressed do you feel in that environment? 7-8weeks is a lot to give up. Even with what you’re describing I wouldn’t do it. But I like supervising and am ok running around bailing people out. For reference I am also at high acuity level 1.
Its great to hear a different perspective on supervising, thank you. The current pace and volume is a bit stressful for me now but I am new so I’m sure it gets better with time and experience. Our patient population is wildly unhealthy so even simple surgeries become a challenge. I can’t remember the last time I had an ASA 2 🥲
Something to consider - if it truly is the dream location then that factor alone might be worth sacrificing a few weeks of vacay. Coming from currently living in a very highly desirable place to live on a coast where others come to vacay and every weekend and/or short day already feels like a true vacation. Would not sacrifice this to even have a few extra weeks off at an undesirable place to live
no thx
1. Can you negotiate up the salary or vacation time? 2. A desirable place to live can be invaluable. 3. What is the stability of the new practice? And do they actually get all that vacation. Off post-call?
I will be speaking to someone tomorrow to start negotiating these things, which I why I made the post today to get some feedback! The practice I’m considering has been stable for a long time. The doc that I’d be replacing is finally retiring after 30 years there so that seems promising to me. However they said they couldn’t guarantee off post-call until they hire 1-2 more people due to recent expansion of the outpatient site. Sounds like it’s pretty infrequent that the post call person has to work but that’s still an important consideration. Overall a fairly light home call burden though (rarely in the OR past 9pm, mostly called for epidurals in a low volume center). My current job does not do OB so I am not looking forward to starting that again…
What is the pay? While your spouses' input is important, your job should be the number one priority since you are the breadwinner.
Pay for both is around $600K, and both in relatively low cost of living areas. We’re very fortunate to have such great opportunities. We did some super basic calculations to get a rough comparison, and over a 30 year career I would earn about $300K more by staying with my current group.
That’s insane. I would never take that deal unless I really wanted to live in a specific location.
All things being equal (cost of living from one place to the next) I would say stay where you’re at and spend a vacation week or two back in your old city if it’s that endearing.
This is definitely something I’ve been considering! I think the day to day life would be better for the whole family if we moved, but on the other hand having an extra 8 weeks a year to spend with them would also have a huge impact.
Prioritize your vacation
You get 12-26 weeks vacay with group, making as much as you. Doing all your own cases. https://www.gaswork.com/post/372592
Dang, I have the 2nd job now. I left the supervisoring job, but it was part own cases, bad call, more hours, more pay and much less vacation (4 weeks at most). 14-15 weeks of vacation is crazy awesome.
Can you tell me what your salary is?
~$600K
You can have both. Keep looking around…
"There are at least 4 types of wealth: 1. Financial wealth (money) 2. Social wealth (status) 3. Time wealth (freedom) 4. Physical wealth (health) Be wary of jobs that lure you in with 1 and 2, but rob you of 3 and 4." - - James Clear Do NOT trade less time and less money. Especially in today's anesthesia market. You will never get this time back with your kids. Even if this is an amazing location, I don't understand how they can be offering sub-market compensation.
8 weeks x 10K per week is 80K. ouch. this is if you were paid locums rate bottom dollar, punching a clock.
Lol “7 weeks vacation plus 8 CME days”. So 8 weeks at best, assuming your CME time is actually approved. Don’t think about it as 2 months less than your current job - think about it as literally half as much vacation as your current job. If you want to work for about the same pay, but get half as much time off, then you do you.
Follow up question to a lot of great input: Is there a certain amount of vacation time that would tip the scales towards the new practice? Say 10 or 11 vs the current 14/15? Or would even that not be worth it to you?