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Frequently Asked Questions

When should I start applying for private practice jobs?
If searching locally, start around September to November in your CA3 year because that is usually when vacation schedules for the upcoming year are made for the local private practice groups, and thus, the hiring needs can be determined. If searching in a different region of the country, start much earlier, especially if you are cold-calling the private practice groups. Sometimes, it may be advantageous to apply off cycle because there may be job openings with fewer applicants.

How do I find private practice groups in a region, especially elsewhere in the country?
-alumni network
-gaswork.com
-glassdoor.com
-online search engines

What should I consider when looking for private practice jobs?
-locally held versus public companies
-size: small (5-10), medium (20-100), large (>100)
-physician ownership of company versus employee
-practice own cases versus supervise CRNAs (West Coast has lots of self-practicing anesthesiologists versus Midwest and East Coast, which is more CRNA-heavy and has a more supervisory role)
-supervision ratio (e.g. 3-4 CRNA:1 anesthesiologist); a CRNA-heavy practice also decreases partnership option, may require managing of CRNA hiring, firing, and morale
-payer mix
-distribution of reimbursement (see below)
-group stability (personnel, ownership turnover)


How much does a fellowship improve my job candidate status?
Fellowship helps in the sense that you obtain more experience, but you could also get experience from either attending after graduation or working locum. Thus, do a fellowship only if it really interests you, because it may be expected that you do more cases pertaining to that subspecialty in private practice. Several private practice recruiters did not see an increased value in an obstetric fellowship.

How do I get paid?
In a hospital, you make money for your anesthesia group either from taking call or working in the operating room.
Your pay is determined by the reimbursement structure of your private practice group. The two extremes of reimbursements are the "socialist" and the "eat-what-you-kill" model. In the "socialist" model, the total reimbursement for the group is divided evenly amongst the providers without regards to the type of cases you do. In the "eat-what-you-kill" model, your pay is directly tied to the case types, the patient’s insurance, and the amount you work, and thus, case assignment becomes especially important as it determines your pay. Most practices are in between the two extremes, and use a blended unit, for cases done in a particular time period. An alternative is the salary model often seen in academic settings, where your pay is not tied to your individual production.
Beware of private practices with a pyramid scheme, where a small number of top people (partners) get extravagant pay at the expense of others, and it is almost impossible to make partner.

What is useful information for a new associate?
-Is there equal treatment of junior and senior members?
-Does a junior member have access to good cases and insurance?
-What is the governance structure, and who determines hiring and firing?
-How are quality improvement problems (i.e. CQI) addressed?
-How are problems with surgeons and nurses addressed?
-Is anesthesia integrated into the administration of the hospital?
-What has the group turnover been in the last 10 years, and why did people leave?
-What are the criteria for partnership, and how is it determined?
-How much is partnership making (range)?

What are useful things to do during my interview?
-Seek out the newest partner to gain perspective on being a junior member
-Speak with anesthesia technicians to gain insider perspective of work environment
-Get a sense of collegiality in the lounge area

Does time to partnership matter?
Usually, the difference between 1 to 3 years will not matter if you plan to work at the place for 10+ years. Thus, it is recommended that you do not negotiate the time to partnership.

How do I market myself?
-Be on time for interview
-Align your strengths with the needs of the group
-Separate yourself from a CRNA
-Offer additional services such as working in preoperative clinic or in administration
-Show your personality, as you will likely be spending 10+ years with the group; the informal dinner is usually more important for the group members to get to know you than the formal interview

As a graduating resident or fellow, what can I negotiate with the private practice groups?
-relocation and signing bonus
-timing of job start
-part time versus full time (if it is very important for you)

Do I need a lawyer to review my contract?
-In the Northwest, a contract lawyer is usually not needed. However, other places may have pyramid schemes, therefore, a lawyer may be warranted. More importantly, ask the group whether other members have the same contract, which can help you assess the need for a contract lawyer.

What should I pay attention to in my contract?
-Is there a buy-in, and if so, is it the same for everyone
-Is there any flexibility in hiring time
-Is there a non-compete clause, and if so, is it mileage-based and/or time-based
-Who does the billing
-How is malpractice covered
-Are there any special needs (e.g. traveling with the surgery group to multiple locations)

When does my audition for a private practice job start?
Your CA1 year, because your reputation in residency counts. Private practice groups who do their due diligence can usually find someone, who knows someone else, who knows you; therefore, it is not difficult to find out how well you play with others.