Mistakes I Made After My Residency

Good morning, party people. What’s going on? Hey, thanks for watching this video.

In this video, I’m gonna tell you all the dumbass mistakes I made after residency and give you, hopefully, an insight into how jobs and careers and practices and groups and all that stuff, medical groups, work. Mostly, it’s gonna be based on my experience, obviously. But I’ll tell you a little bit more too.

First, let me tell you that when I was in residency, I wanted to just go to my hometown and practice for the rest of my life. I wanted to be a general surgeon, not doing anything terribly exciting and just maybe do hernias, gallbladders, appendix. Maybe a little colon cancer here and there. Some scopes. And take it easy and ski my brains out and enjoy life in the outdoors and all that. So I talked to the hospital in my hometown, and there was a CEO there. She had been there for a really long time, and she knew my family. She knew me, and she was like, “This is great. We’d love to have you.” She said, “I can’t give you a contract, but you can come and be a private practice general surgeon. And the hospital will support you.”

I said, “Great.”

There was a couple of other general surgeons there, and they (bleep)ing hated this idea of course because it’s a small town.

In that town, the cost of living was high. And they wanted to make sure that they get paid for all their fancy toys and their expensive house and their country club access, right?

I met with one of them. He said, “Yeah, I will support you. And I will-” We weren’t partners, but he was renting an office to me. So I felt like he was an older guy. I thought this was a good idea to partner up. I wasn’t business partners with him, but at least I could ask him questions. And I could learn from him and stuff like that. It turned out to be not even close to that. Basically, none of those guys wanted me there because I was taking their cases and revenue. And me being stupid, I just thought – or me being young, really. I just thought, “Hey, I’ll just go here, do a great job, be nice to everybody, and it’ll be easy.” And, yeah. It turned out that those guys really did not want me there, and even my own partner really, I don’t think, wanted me there. I couldn’t learn from him. He just wasn’t that kind of person, and I don’t know if he was necessarily trying to do that. But there was just no communication. There was no me helping him with cases or him helping me. I mean, he helped me with a few cases. The only time I helped him was when his assistant was out of town or there was a problem. Then, all of a sudden, I became valuable.

I tried to do that for about three years, and I made no money. And it just sucked more and more. Actually, I put one of the guys out of business. He was just a total jerk, and nobody really liked him. So that was kind of easy.

I decided that I needed to do something else. I started doing locum surgery, which is just travel gigs here and there, like, a week, two weeks a month. I got a couple steady jobs, which were out of town. I would have to drive. I’d be gone from my place for two weeks at a time, and that was a tough deal for my little doggy and my girlfriend at the time. She didn’t like that either, so I started looking for a new job.

I found this company called Mcare, and they staff surgeons, mostly trauma surgeons. Mostly acute care surgery, so emergency general surgery and some trauma. Mostly level two places, a few level one hospitals. And I didn’t wanna move to Florida, but they had an opening in Florida. And the reason I liked it is because it was seven days on, 7/12s on, and then seven off. Seven on, seven off.

I was working two weeks a month, right? 26 weeks a year and getting a full-time salary, so that sounded pretty good. I moved to Orlando, and it was pretty good. Honestly, it was kind of a new program. It wasn’t too busy at first, and then it picked up. And it’s very busy now. That was really good. There were some other older surgeons there that I could learn from. That was very important; that’s what I learned. Super important if you’re gonna go into practice right out of residency. You need people stacked in ages and experience.

If the oldest guy with the most experience is not there, there’s somebody else that you can talk to and say, “Hey, I just wanna run this case by you. What do you think?” Blah blah blah. You may be right, you may be wrong. He may say, “Oh, you need to operate.” Or, “No, you don’t need to operate” when you thought the other. Or whatever. It’s still a learning process outside of residency. I think that was one of the biggest, maybe, mistakes that I made. I though, “Oh, well, I’m done with residency. I can just go practice,” and stuff.

Actually, one orthopedic surgeon told me one time when I was in med school. He goes, “Do you know what I remember from residency?” I was like, “No, what?”

He goes, “Absolutely nothing.”

His point was is that it’s a continuous learning process, and that’s a big deal outside of residency. And never think that, “Oh, because I’m a 50-year resident. I’m taking care of all these crazy patients in the hospital.” If you’re in a big program or something that you can just take care of anybody outside when you’re done. You’re always running into new cases and things that you’ve never seen before, so it’s always important to have somebody be there to back you up and just to call.

That was the biggest thing is I just felt like I couldn’t call anybody there. I did call those guys there, but it was met with opposition, basically.

When I got to Florida, it was really nice to have somebody and start learning from people again. And I understood that that was super important, so that’s super important for you guys to always remember. When you’re getting out of residency and you’re looking at a job, who are your mentors? Because, those people, you will become those people, right? If they’re angry all the time and they’re throwing instruments and stuff, then you will become that.

That’s really important. Don’t forget that the five people that you hang out with the most, that’s who you are. That’s who you are in income, that’s who you are in personality. We’re very influenced, as humans, from other people. That’s a big deal.

I got there, and it was a good job. But it’s also a tough job. It’s 12-hour shifts. 12-hour shifts then another 12-hour shift ends up to be 13, 14. And then you drive home. I was driving home 45 minutes a day, so basically, I left my house at 6:00 a.m. I get up at 5:00, 5:30. I leave at 6:00 a.m. I get there at 7:00. I do a 12-hour shift, I work my balls off. I’m up on my feet the entire time, and then I sign out for an hour, get two hours. And then I go home. By the time I get home, it’s 10:00 p.m. Time to do it again, right? So I go to bed. You eat something real quick, you go to bed, do it again.

It’s a tough deal when you’re doing seven on, seven off. It’s okay, but it never ends up being really seven on and seven off really because schedules are always different. And if this person wants that off. Blah blah blah. So you start jockeying stuff around, and pretty soon, you’re doing 10-7, 10-12s at a time. You’re doing 12-12s. I did 14-12s at a time. Sometimes they’re days, and sometimes they’re nights. If they’re nights, you don’t do (bleep). You just go home and go to sleep. You come back, you’re a freaking vampire. You never see anybody, you never do anything.

It’s tough, but it was a good job. I think it was good at learning little mini fellowship kind of thing again because remember, I went to a smalltown general surgery for a big level one hospital. And those guys didn’t wanna do anything. They didn’t wanna do the big cases. They wanted to get everything out of that hospital as soon as possible. They wanted to do hernias, gallbladders, and that was it. They did some colon cancer, colectomies and stuff. But everything was super simple. If anybody came in that had a broken pelvis or whatever. The first few weeks of that hospital, I kept somebody that had a broken pelvis because I’m used to that. And they were (bleep)ing their pants. The nurses tortured me, the administration tortured me until I transferred that patient out. The guy was fine. He just needed a little bit of blood, BT and all that other stuff. But they just lost their (bleep)ing (bleep), so I learned a very important lesson.

If you’re in a level one trauma center or a big, busy hospital and then you go to a smaller hospital, it’s no longer what you can take care of, it’s what the hospital and that system can take care of. Those are often two very different things. Even now, when I’m in level two hospitals, they are not comfortable and don’t understand the systems that I have experience with.

It’s a very frustrating thing to go in and say, “Okay, these things need to happen,” and they don’t happen. You know what? It’s not to the point where it involves patients’ safety. The patients are still safe, but you see things that are gonna be problems. And it’s like a trainwreck. You can’t stop a trainwreck. You see where it’s gonna happen, but you can’t stop it. That’s the kind of things that I experience now.

I’m actually driving to a new hospital where I’m gonna get privileges and get my orientation and badge today.

What I’m doing now is I was at Mcare, and I was in Orlando for a while doing that. Basically 7-12s. Now I’m in Salt Lake City, and I’m doing a level two trauma center. But we do it different because it’s just not as busy, so we’re doing 12x24s. So I’ll do a 24 seven days a week or for 10 days or even two weeks sometimes, so I’ll be on-call constantly for seven days to two weeks.

Sometimes it’s super busy, and sometimes it’s not. Most of the time I can stay at home because I’m so close to the hospital. I can get there if trauma happens within, like, 10 minutes. And other times, I stayed at the hospital for three days in a row one time. Now what I’m doing is we’re doing a different hospital with, actually, it’s my brother-in-law, which is probably a bad idea. But we’ll still find out. It’s just because it’s never good to do business with relatives. That’s what everybody says, right?

I’m working with a company that I’m helping grow their marketshare of acute care surgery, so only acute care surgery. No trauma. I think, maybe, it’s a level three trauma center, which means you don’t do a lot of trauma stuff. It’s mostly packed, stabilized pack and (bleep) kind of thing.

We’re just doing acute care surgery, and we’re just taking call. As much call as we can get per month, so right now, I just have five days a month. And other than that, I’m not sure if we’re gonna do elective surgery.

I think a new model that, say, Mcare and these other companies are looking at is having surgeons that are doing acute care surgery or emergency surgery stuff not do the elective stuff. And that’s because the elective stuff, the emergency things get in the way of the elective surgeries. So if you’re on-call and you take, you have stuff in the middle of the night and then, all of a sudden, you have- not 10 cases, but- Some people do have 10 cases maybe. Some scopes or something.

Maybe you have four hernias in the next day, and you’re up all night. Now, is that a great idea for you to be up all night and then do four cases the next day? So now you’re up, like, almost 48 hours. Maybe, like, 36 hours?

They’re looking at just having that surgeon do, like, a 24-hour shift. And then that’s it.

That’s what we’re trying to do there. I’ll do, like, five days a month. Probably more. Probably end up with a total of, like, maybe 10 calls a month. But I’m not doing anything else. We’ll do clinic on, like, one day a week but no elective surgery.

Then I just round, the days I’m not on-call, I’ll just round and see those patients and take care of anything. Of course, you sometimes still have surgeries to do when you’re not on-call. Like leftover stuff from yesterday or two days ago or whatever so that you end up doing surgery not only on your call days, but also on your non-call days.

So what happens, you’ll be on for the company or for your practice for, like, two weeks out of the month. But you’re really taking call for the hospital only five days or maybe seven days or eight days or something like that, so we’ll see if that’s better. I don’t really know. There’s a lot of different ways to do this.

I think we’re getting away from private practice models just because it’s the administrative burden is too much. There’s a lot of government oversight. It’s a lot of housekeeping things that a general surgeon by himself with one secretary is gonna be overwhelmed with the stuff to do all the time. To always keep up electronic medical records. You have to have people making sure that’s secure and all that stuff. It’s a lot of work, and I don’t think it’s a great idea to do by yourself because I actually tried to do that. It was terrible.

I wasn’t even that busy, and it was terrible. So I think, my recommendation if you’re getting out of residency, is to get a group, a particular medium to a large-size group. And make sure you have people, mentors, that are great that you trust or at least you think you trust that are able to teach you everything. And then you don’t have to worry about the administrative stuff. You don’t wanna do that.

Hey, I appreciate you guys watching this video. I’m gonna get some coffee right now, and I’ll talk to you later.

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