Attending jobs where you are the frontline provider vs. supervising?

[FunnyDocMan1234]

As I'm looking at jobs it seems like a lot of the private practice opportunities you work as the frontline provider managing 15-20 patients. This is in comparison to academic jobs where you always have an NP/PA or resident taking first call about patient questions and you are in a supervisory role. Obviously pay is better in private practice but it seems like always having to do all orders, consult calls, procedures, nurse questions, family calls on 20 patients by yourself would suck and be a quick road to burnout.

Since obviously there are people working in these models, I wanted to see if anyone here who has done this could share their experiences and workflow, perhaps it's not as bad as I envision.

---

Members don't see this ad.

 

[psychbender]

That's not quite an accurate assessment of the private/academic divide. While I do rarely see academic positions where attendings directly manage everything without residents or midlevels (I even remember the "non-teaching" MICU service in fellowship that was one attending and 1-2 midlevels for 6-8 generally lower acuity patients), the private market is far more varied. My current shop has us directly managing one geographic unit each, with an average daily census of 8-12 per unit. Midlevels are only used here for help with admissions and overnight cross-cover (paired with an attending). I also interviewed at other places where a standard service was 12-20 patients per day, managed by one intensivist and one midlevel. There was some variation at other practices, and I did locums with one, where I covered two units by myself, with an average of 18-24 patients per day. One of my colleagues recently left an HCA hospital where he routinely was responsible for 30+ patients, with maybe one disinterested Medicine resident to assist.

Bottom line, if you want to manage patients entirely on your own, it may be best to leave academia. However, be prepared to look around a lot, as there will be a lot of practice variability between solo and supervision, and you may have unrealistic/unsafe work expectations.

 

[CCM-MD]

There are so many different types of coverage models out there in a the non-academic world. Intensivist plus residents of a community based program? Yes. Intensivist solo? Yes. Intensivist with midlevels? Yes. Days only, no nights? Yes. Only nights? Yes. Less than 8 patient census per day? Yes. Census of 18-20 patient per day? Yes. 7on/off? Yes. Scattered shifts? Yes. Mon-Fri with rotating weekends? Rare, but yes.

Pay, location or ideal work set up - you can easily get 2 of 3. Can you get all 3? Yes. Keep in mind that great opportunities often aren’t advertised. I would strongly recommend avoiding the sweatshops that are wanting you to see close to 20 patients a day. Not all gigs are like that outside of academia. My personal experience also is that nurses in the community do a lot more of the scut work that falls on the shoulders of interns in training institutions. Keep looking there are good opportunities out there.

 

[Katheudontas parateroumen]

Generally I saw in private either solo attending or attending plus APP for 15-20 patients. Nurses out in the community put in orders and call consults too if you ask them too. Everything varies of course. I’ll be starting a job where it’s private practice but has contracts with the medical school so I have supervision of residents.

 

[Steege305]

As I'm looking at jobs it seems like a lot of the private practice opportunities you work as the frontline provider managing 15-20 patients. This is in comparison to academic jobs where you always have an NP/PA or resident taking first call about patient questions and you are in a supervisory role. Obviously pay is better in private practice but it seems like always having to do all orders, consult calls, procedures, nurse questions, family calls on 20 patients by yourself would suck and be a quick road to burnout.

Since obviously there are people working in these models, I wanted to see if anyone here who has done this could share their experiences and workflow, perhaps it's not as bad as I envision.

I have what feels like an academic private practice split. I cover two units - one with a fellow and residents, and the other with APPs. I did a brief stint with the whole busy solo unit thing, and I’m going to say that replacing K, doing your own admissions, procedures, and family calls is… meh. It just sucked the life out of me. I’m sure there are people out there that dig it, but it ain’t me.

 

[forchinet121]

I have what feels like an academic private practice split. I cover two units - one with a fellow and residents, and the other with APPs. I did a brief stint with the whole busy solo unit thing, and I’m going to say that replacing K, doing your own admissions, procedures, and family calls is… meh. It just sucked the life out of me. I’m sure there are people out there that dig it, but it ain’t me.

Who’s easier to work with residents or APPs?