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Choosing Your Future: 5 Things to Consider Before You Job Search


Toward the beginning of CA3 year – or midway through fellowship – is typically when residents start looking for jobs. Look any earlier than that, and you risk wasting a first impression on prospective employers who don’t yet know what their future staffing needs will be. It’s never too early to start thinking about the future, however. Here are some key factors to consider before you get started with your job search. By Lisa Weiss, MD

#1. Location, Location, Location

There are many factors to consider when looking for a job, but location is one of the most important. You may be limited to a specific geographical location due to a spouse’s job or may want to be near family. Or you may want to be in a city that has a fun night life or terrain that interests you. Either way – location is a good place to start the job search.

#2. Salary & Benefits

How do you want to get paid? What about a benefits package? Do you want a job with a group that considers you a salaried employee (W2)? Or, are you okay with being an independent contractor and establishing your own business (1099)? Both pay structures have their pros and cons.

In general, salaried employees tend to have benefits built into the pay and you can take them or leave them. Independent contractors tend to have to provide their own benefits. For someone who is young and healthy, getting a private health insurance plan is probably easy and affordable. This may or may not be the case for someone has preexisting conditions or a family member who does. Independent contractors can also decide which (and only pay for) benefits they really need.

Finally, the tax structures for a W2 employee versus a 1099 employee are very different and again, there plus and minuses for both. In addition to the pay structure, how does the salary compare to other groups in the region (for number of hours worked)? Is the pay based on the number of cases performed or revenue recouped?

#3. Flexibility and Work/Life Balance

Job flexibility, call structure and number of job sites all have an impact on your work/life balance. Certain jobs may be more flexible than others. For instance, some employers offer set schedules where generally you leave at the same time every day (with overtime being paid thereafter). Other jobs have departure lists that vary each day. A set schedule provides predictability; however, departure lists times can vary widely day to day. If someone needs to be home for other commitments, a set schedule may be the way to go. Conversely, when you have a set schedule, it may be difficult to make other appointments, etc. if you never get out early. Departure lists allow you to have early days in which you can take care of other commitments.

Do you want/need to take call? Taking call typically is financially beneficial and may be necessary to get out front of your student loans. Do you care if the call is in house or home call? Do you live close enough to the site to take home call? Are the calls 12- or 24-hour shifts (or somewhere in between)? In house, 24-hour calls 3-4 days can wear on a person over time.

Finally, do you mind traveling? Often a job will require you go to at least 2 locations, sometimes even more. Are you okay with working at multiple sites? Does practice offer partner track? If so, is the partnership guaranteed after a certain amount of time? What is the buy-in for the group? If it is not guaranteed, on average, how many people that start out on partnership track actually obtain it? How many females are partners?

#4. Practice Settings

The two main practice types that need to be evaluated are academics versus private practice. In academics you will probably have several hats: clinician, teacher and possibly a leadership position as well. Academics typically involve working at one or more large tertiary hospitals along with county hospitals. There may or may not be opportunities to work at outpatient surgery centers as well.  

Private practice can encompass just about everything: large tertiary hospitals, small community hospitals and outpatient surgery centers. And make no mistake: In private practice you may still have to teach even though that wasn’t initially what you had planned. I have worked at one location in the past that had srna students. There are many opinions on teaching srnas and that is the subject for another discussion. However, they may be working with your crnas and ultimately you are responsible for them if they are working in your cases. If you are a partner in a private practice you also may have administrative responsibilities and/or some type of leadership position.

Different hospital settings have pros and cons as well. Large tertiary centers tend to have all types of cases including trauma, cv and transplants. If you want to specialize in adult cv or pedi cv, then you may have to stay at larger hospitals.

However, lots of community hospitals do cv now. Community hospitals tend to do the basics of most subspecialties, but may not do the extremely complicated cases (i.e., neuro-basic tumor resections and spines, however they most likely won’t do open neurovascular procedures). That’s not to say community hospitals don’t get complicated cases or sick patients-they absolutely do. If you work in a community hospital, you will need to know how to do everything-from blocks to OB to pedi. There isn’t enough of one case type to specialize.

Outpatient surgery centers have pros and cons as well. The cases tend to be more basic, however there are going to be a lot of them. And higher caseloads mean lots of preops. Efficiency is the name of the game in outpatient surgery centers. Most surgery centers end earlier in the day than big ORs (ad ons are rare) and hours are typically better. Most outpatient surgery centers don’t require call. Patients’ “should” be healthier. However, obesity and associated comorbities continue to be a problem and have to be dealt with in surgery centers as well. In some private practices you may work at a variety of settings-hospitals and surgery centers.

#5. Staffing Models

Some practices are MD only, however this model is increasingly difficult to find. Pros of MD only are getting to do your own cases. However, at times being solo has it downsides. For instance, if you are solo at a surgery center, there is no one available to give you a lunch or bathroom break.

Other practices are a mix of solo and care team model. During day hours one may supervise cRNAs or AAs, however on-call one may do their own cases. Most practices nowadays are only care team model and the MD is only in the room for induction, breaks or if the team is short staffed that day.

It is beneficial when starting your first job to be able to be in a room solo for some time to get used to being on your own and then transition to supervising. Supervising is its own skill set to learn. Most of us are “type A” personalities and want to be able to control situations. When you are running 4 rooms while doing blocks or other tasks, you will not be able to know what is going on in all 4 rooms at all times. We have to learn to relinquish some of that control and triage which cases will need the extra attention.

And Finally…

After mulling over the big-ticket items above, there are several other items to be considered. Will there be opportunities for leadership and growth at the practice? Does the group think it is important to be involved in ASA and state societies? Does the group support time off and or financial support for CME? Does the group provide mentors and or support for early physicians? What is the maternity policy as far as leave and making up calls?

In conclusion, there are many aspects to consider when researching jobs. Some of these factors are obvious, but some are not. If the opportunity arises, doing some locums at a potential job can give you a feel for the place. Keep in mind that credentialing can take as little as month or two and as long as four to five months depending on the site. You may not start when you had planned and either having some extra money saved for that or some locums to fall back on in the interim can provide a huge sense of relief. Take this last piece of advice from someone who knows and good luck with your job search!


Beers, Richard A. “Transitioning from Residency to Practice: Choosing Between an Academic or Community/Private Group Setting.” ASA Monitor. June 2020. Vol 84. Issue 6. 10-12.

Dutton, Richard P. “Professional Choices: How to Pick a Practice.” ASA Monitor. November 2020. Vol. 84. Issue 11. 40-41.

Nguyen-Buckley, Christine. et al. “Transitioning to Practice for Young Physicians.” ASA Monitor. June 2018. Vol. 82. Issue 6. 48-50.


Lisa Weiss, MD practices anesthesiology in Houston, TX. She graduated from the McGovern Medical School at The University of Texas, Houston, in 2013. 


ASA Community Blog is published as a benefit for ASA members. The views expressed on this blog are those of the individual contributing writers only and do not necessarily represent the opinions of ASA.