There's a really good article in this month's ASA Monitor that describes the choices one has to make to find a job in anesthesia that is both satisfying and rewarding. Some of the suggestions are obvious but others may make you think about what aspects of a job are acceptable to you personally.
Their first suggestions is to decide where you want to live. Most people wind up working where they did their training. It's pretty obvious since that's the job market you know and the professional network you've developed. Since the location of your residency match frequently is based on where you want to live, this just makes sense. But don't forget that many people have to take their spouse's concerns into consideration too. Maybe the spouse wants to move back closer to their family and not where they've been stuck in training all these years.
Next you have to consider if you want to be involved in research, educational training, or neither. When I finished residency, I knew I didn't want to do any research or teach residents. I went straight to the private practice model. But now that I've had years of experience, I have started getting move involved in working with residents and even done some simple research projects. Luckily I am able to do that without changing job locations. So keep an open mind as your preferences may evolve over time.
Do you want to do your own cases or supervise others? I absolutely wanted to do my own cases when I first started out. As a new residency graduate, I didn't feel comfortable supervising CRNA's. I didn't have enough self confidence to tell other people how to give anesthesia. And some of them probably wouldn't pay any attention to me anyway as they can claim many more years of experience compared to me. But now that I've been working for nearly two decades, I'm more open to supervising others. I know many anesthesiologist who love to supervise CRNA's. They feel perfectly comfortable lounging in the break rooms while the nurses work in the OR.
What kinds of cases do you want to do? Do you want to do a bunch of knee scopes and hernia operations all day or do you want to go hardcore and work at a Level 1 trauma center and deal with whatever medical catastrophe rolls in through the ER?
Here's literally the big money question--how do you want to be paid? Do you want to receive a salary or do you want a fee for service model? A set salary is preferred by many as it usually involves a more predictable work environment, either at an academic or government institution. You also get the benefits and perks associated with these locations. However if you're looking to make a lot of money, fee for service is where it's at. Your daily schedule is more unpredictable, as it's impossible to know ahead of time how many cases the surgeons are going to book, but this is where the you can make far more income.
Then finally, make sure you have a good feeling for how the other anesthesiologists feel about working there. Though it may be difficult to get an objective opinion of the job during your interview, it never hurts to ask them what their opinion is. Do the partners steal cases from each other after they've performed a wallet biopsy? Do the new guys take all the holiday and weekend calls? How long have they been working there? Is there a revolving door of anesthesiologists? These are important factors to think about when interviewing to see if a new job will fit your personality and lifestyle.
So there is a lot to think about when deciding what is your perfect anesthesia job. Answering these questions will narrow your choices considerably and make it easier to decide. And remember, sometimes things don't work out and you realize your choice was not the correct one. That's okay. You're still a physician anesthesiologist and you can take your skills anywhere you want. Nobody is forcing you to work at a place that doesn't fit your needs. Good luck.
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