ANNOUNCER:

This is Residents in a Room, an official podcast of the American Society of Anesthesiologists, where we go behind the scenes to explore the world from the point of view of anesthesiology residents. This episode is sponsored by ASMG, a physician-only, privately owned practice group serving the San Diego area. The ASA thanks ASMG for their support.

SHARA, HOST:

Hi. I’m Shara Azad and I hosted the first few episodes of ASA’s resident podcasts, Residents in a Room. Today we’re going to do something a little different. We’d like to welcome Dr. Maxwell, who is a practicing anesthesiologist and the chair of the hiring committee with our sponsoring group, ASMG. Dr. Maxwell is going to shed some light on the topics my fellow residents and I have been discussing. And he’s coming from a very different point of view.

Welcome to the show, Dr. Maxwell.

DR. MAXWELL:

Thank you, Dr. Azad. I’m happy to be here.

SHARA:

So just so that our listeners are in the loop, ASMG is a California based, physician only, private practice group. It’s great to get your perspective today, Dr. Maxwell. My fellow residents and I have been talking about our futures in anesthesiology and what the future holds for us.

So to kick things off, my resident friends and I are wondering if you have any advice for us as we look at our next steps.

DR. MAXWELL:

I certainly do. I think these will be helpful, or at least I hope they will be. Uh, Dr. Azad, you know you, you all find yourself in a very interesting marketplace right now. And, I think this is always true but maybe more so now, you’re in a position that, I think you can come straight forward and talk to groups who are really interested in finding good people, and they’re hungry to find, uh, people such are yourself that are well trained. Um, when you come to then for interviews or early in the application process, I think you cannot, you don’t need to hold back with your questions. That you can, um, ask maybe some of the more difficult questions that you’ve probably have already been thinking about. Um, you know a lot of residents who need it, look at, think about things like well, gosh, it’s really scary when I first, you know, going out to do my first cases, um, how does this group that I’m looking at, how do they help me transition into the practice. Um, can I ask questions like what, where’s my back up? Or, what if something goes badly? How do I, how do I address that? And hopefully, you, the answer you get will hopefully be, um, something that helps destigmatize those questions in your mind and frees you up to ask them and get good, truthful answers. Um, hopefully the groups that you look at will have some sort of system for that. Um, hopefully they do very thorough orientations. Hopefully they have information maybe both in print as well of the things they speak about to you, um, that allow you to, um, reach back and look at those sources and find the information that you want. Um, also, uh, some of the groups will have mentors and things like that. Or liaisons at the least for the different sites. And hopefully you know that you’ll, or at least you’ll be encouraged to reach out to them and ask them those questions. Uh, it’s important for all of us that you guys succeed when you go out there. And, uh, information like this can only help.

Also, you know, sometimes when you’re looking at jobs you might have something particular you want to know. Hopefully, you’ll be able to feel free to ask if you can speak to someone who’s a little bit different, maybe they’re in a niche practice, maybe you have a fellowship. Maybe you could ask the question like “hey, do you have any young cardiovascular fellows that we can speak with?” Uh, that would be especially helpful. Or do you have just in general any new partners, someone who’s gone through your process, cause I’d love to pick their brain.

And those are the things that I think you should be, uh, especially in this marketplace, more free to ask, uh, and almost expect from the groups that you apply to.

SHARA:

I think our residents will find all of that really interesting. So here’s something else that they might want to know: when you’re hiring residents, is there something specific you’re looking for?

DR. MAXWELL:

Uh, well it goes without saying probably that we’re looking for well trained, uh, young people, uh, with good clinical experience. Uh, but I think most of the applicants that I’m getting now are really, really well trained. And I’ve been very happy with that with my group as a whole.

Um, you know if you’re someone who’s listening who’s already out of practice, I mean out in practice, and they’re applying for a job, you know we do hope that often they have been doing some percentage of their own cases as well.

Um, the other thing that we look for obviously are on your CV. But we really do look for people who have other interests. Um, leadership is one. You know they’ve worked either on committees or on special projects and they’re able to express that to us during the interview and tell us a little bit about that. And then people who have other life experiences outside of just the clinical arena. I mean people who go on missions, and, or do other things, and volunteerism of other types. All of those things I think show that you’re able to take leadership, you’re able to, um, learn other information, and dive into other parts of life. It all make you more, I think, sellable to groups ‘cuz we know that you’re a real person who has interests in medicine and in people.

Uh, I think additionally, you know, we do look for people with good communication skills. And, uh, that usually is reflected in the, the interviews, but it could be reflected on your CV’s as well through these extracurricular activities, and through the letters of reference that we receive on your behalf.

SHARA:

All of that is really interesting. I think something that residents really wonder about though, is letters of recommendation coming from residency applying to practice.

DR. MAXWELL:

Yeah we, we ask for three letters. You’ll get requests, probably, you know, for different amounts from different groups that you apply to. Um, but as far as the particulars of those letters, you know, certainly things like a letter from a program director, a PD, or maybe an assistant PD, or somebody really well known at your particular training program, um, those are all very nice to have. But at, at the end of the day we also like to see something that’s a little bit more personal. Maybe a letter from someone who knows you, has maybe worked with you on research projects or travelled with you on a mission, or, um, just that knows particulars about you, more than just what is already on your CV. We’ll know things like what rotations you did, and, you know, the committees that you joined. But those give us more of a little personal take on your background. And it’s really nice to see that ability to have a relationship with your, your, the people that you trained with. Um, so hopefully everybody can include something like that and think about that along the way as they go through residency.

SHARA:

Maybe you can tell our listeners a little bit more about ASMG and what’s unique about your group.

DR. MAXWELL:

Well, first of all we’re a large group for a small, for, for a private practice group. I think we used to be considered large, is something I should probably state. Now we’re, by national terms, more of a mid-sized group with about 260 people. Uh, we are, uh, privately held, meaning we each are the shareholders of the group. Uh, there are no CRNAs in our group. It’s an MD only group. Um, and as far as the things that we like to represent ourselves about are values like transparency and fairness. With, um, regard to fairness, um, some of the ways we demonstrate that, or embody that is, um right from the same, from day one, all of our new hires get exactly the same slice of the schedule basically that we do. So we assign, assign schedules each day, you’re put right into the, the rotation with everybody else. Um, with um, regards to income, you know, the pay structure is such that you get the same pay from day one that the, even the most senior doctors in the group get paid. Um, we don’t take a percentage of uh, money for example for the shareholders.

Um, with regards to transparency, uh, we like to kind of rep, represent ourselves honestly, right from the get-go. Um, our partnership track is, about two years, and the, I think the percentage of people who make it to the two years in partners is in the high nineties. Uh, you could, at that point you’ll end up having to buy a share, and basically that’s just a share of our assets, which, you know, we audit our ownership, a build, our building and things like that each year and you pay a, just a slice of that. It’s the same share that everybody else buys. Uh, the benefits of being a shareholder are, are actually quite few. Um, you do get an equal voting right. Um, everybody gets one share, no more – everybody gets one vote. And theoretically, um, I guess it would cause, create some degree of job security if something were to ever happen to our group. Of course we never intend that to be the case. Um, and then the shares double at the time of your retirement or departure.

Um, the schedules, you know I already talked about that a little bit, but as far as, um, how we keep the, keep track of it, you know there are schedulers at each of the hospitals, and they make sure to track of the high-call, low-call days, mid-call days, OB shifts, or whatever other call is at that, that facility, and make sure that on an, on an ongoing rolling basis that those are distributed equally to all the, the employees and shareholders. Everyone has equal access to the schedules, um, right from day one. The, the high days, the low days and the call days are all shared equally. Um, those schedules are posted on our computer website and you can access those at any time. Um, of course, there’s also issues of flexibility.

SHARA:

Um, so it’s interesting that you make that point about call burden and how to integrate call sharing with work life balance issues. Do you think flexibility has become a bigger issue in recent years?

DR. MAXWELL:

Yes, uh, absolutely. You know, it’s funny because if you look at the, kind of the job market out there in general, not even the medical jobs per say, but young people tend to, at the three year mark, move on to another job with a fairly high frequency. And we’re seeing that a little bit, too. Not to the same degree that people see it out in corporate America, uh, but certainly people like to look for job satisfaction. They like to look for, um, significance, they often like to look for some change. Um, we’re doing some things to try to help people stay happy at our job, uh, content with their work life balance. One of the things that we’re doing is, uh, job shares. And there are certain studies that we’ve done internally that show that already 25% of ASMG members are doing some sort of job share. Whether that’s a day a week off, um, so it’d be like 5 people sharing 4 full time equivalents, essentially everybody guaranteeing one day off. Uh, we have situations where 5 people are sharing 4 jobs but taking a week at a time off. You know, different phases of life provide different reasons for people to have certain needs, to balance family, work, life, other interests.

Um, so we’re working on an all the time those little options for them and we openly encourage these things to be discussed, and, uh, worked on. Each of the hospitals and their schedule writers, they all, uh, work on these with their fellow partners, to um, try to establish the system that works best for them. Um, we also have an on-line marketplace, so aside from the job shares, the other way to get flexibility is really to be able to trade and give away, give up, um, certain work shifts, but also to pick them up. You know, each time somebody gives up a work shift, somebody’s taking it on. Our group is big enough that we have people that want to work more at certain times, and people that want to work less at certain times. Once the schedules are written, you know, certainly lots of trading goes on internally at our hospitals and sites, um, but as far as, we’re at eleven different hospitals, and so people have privileges at multiple different sites, and they can pick up spots, um, shifts at different spots, um, as they become posted on our matrix, and our matrix is a daily, ah, job board that’s sent to you by email, and you can see what’s available to pick up if you’re looking for work, and if you are looking to give up a shift, you can post it on that. It actually works quite well, and is one of the ways, I think we help to really, you know, keep that work life balance working for people.

The um, I guess the one other thing I would say is, you know, groups like ours, um and many others try to work on coverage for life events. For example, say you would need maternity leave, or paternity leave. Um, maybe you have a death in the family. Um, unfortunate things like that, that need coverage for. Hopefully your group has a plan for that. You know, I don’t want to sound like a current candidate out there on the political scene, but we do have a plan for that, and so, internally we cover each other all the time, but we, uh, we have our new hires which we always try to stay just a little bit padded of the group so that we have this flexibility that we’ve been talking about and it allows us to move either partners, or our, uh, new hires around to cover people for unexpected things like this. Um, you know, everybody likes it when you can call and say “Hey, in about three months, I’m going to need a maternity leave”, but you know, not all things in life work that way. So, what we’ve done, is we’ve tried to prepare ourselves to be able to cover those things, um, in a fairly quick, short term modus.

Another example is, a partner recently came to me and said he wanted to start his own side business, also in a medical profession but not in anesthesia typical practice. “How can I do that” is what he asked me. So, we, we came up with a couple of ideas and one of them was a job share where he could get two days off a week to hold the clinic, and the other three days he would still do the more general adult practice of anesthesia. And, you know, it took a little bit of, uh, time to get there because when you come up with these type of options, these opportunities for people born over weeks, or probably more likely, months, uh, they’re not gonna start the next day. Oh, but with a little bit of advanced planning can certainly cover things like that.

SHARA:

I think we’re all interested in shedding light on what our early career stage might look like in various settings. So let’s say I came to work for you. Then what? What would the early months look like?

DR. MAXWELL:

Yeah, at ASMG, we have a slightly different system. You know, we’re trying to always figure out how we can keep our corporate cohesiveness going, which means not having to have everybody silo-ed at their different hospitals, you know, again with eleven hospitals, it would be very easy for people to feel separate, not feel like they’re with/of the same entity. Um, and in this current national marketplace, I think for it to be around for the long term we really need that. So one of the things we do is we have our rotation system. So when you get hired by ASMG, you come on board as a rotator, and you go every three weeks to a different facility. You see most of our hospitals, um, each three weeks starting a new one and that way you get to see the people, you get to, get the feel the culture of different hospitals, you get to see what their case mix is. Obviously you should learn about where they are in the county, the geography that’s involved. And the, our rotators, when they’re here and they’re taking five, maybe six months and looking at all those facilities, those are the four real elements that they’re trying to evaluate because that’s how they’re gonna pick, maybe what would be the best fit for them as far as a particular job.

At the end of the four to five months, you’ll go through what’s called a “match”, and it’s pretty much what it sounds like. It’s with us, sub-groups in the hospitals, kind of writing out a list of maybe who we thought the, uh, new hire would be, that would be best for our site. Meanwhile, uh, the new hire, rotator, you would make a list of which hospital sites you thought were the best for you. You know, it had, one hospital had big cases, and they had no labor and delivery and that works for you. Or maybe you like a smaller hospital with a community feel that had, you know, bypasses, and didn’t have a lot of pump cases, but it had lots of joint and regional blocks. Things like that. So the, we have a huge variety of hospitals with different case mix, different cultures, different feels, and I think it’s really helped us to get people on board, um, being able to have a choice in that matter. Um, and during that process, you’re going to make tons of relationships with other people in ASMG and you’re gonna get to know the other sites. So later on, when you’re joining committees, uh, you’re crossing paths at holiday parties, you’re gonna see people that you knew, and still know, and have relationships with. And all of that really comes back to add to our, kind of our corporate, what I call “corporate cohesiveness”. But really, it’s just basically keeping people from being silo-ed and allowing us to make decisions as one big group and not multiple small ones.

So like I said, four to five months, so that the, maybe the first match happens. Um, if you don’t find the hospital that you want right then, you go ahead and you continue rotating til you find the right hospital for you.

The other thing about AMSG is that when you come on board, and you should probably try to look at this with other groups that you apply to, I think that this is something that we do well, um, but we really try to usher you in. And I think I said this early in the broadcast, which is, with a mentorship. So, we have a mentor that’s assigned to you before you even start with us, and you get a phone call, you have a conversation, each month, at least once if not more. You can access them with questions, you can meet up, or have a drink, or something like that. You might see them at a, a social event. Um, all of this, I think, gives you somebody that you can really fall back on. It’s a completely confidential relationship. Um, it never comes back to me, or anybody at the board, or anything like that. Um, and each of the hospitals in addition has a liaison, and has some paperwork, and, um, websites that you can access. All the information, including, like cheat sheets so that you can maybe like take a screenshot of that information. All those thing that, as a new person coming on board, you’re going to say “Hold it, what’s the code to the store”, “Where is this part of the facility?” All of that, really readily accessible to you. Uh, for each of the hospitals that you come to, um, so, you know, again, those are some of thing things I think we do well. Um, we’re always learning, always asking our new hires what should we do better. Um, we do a lot of surveys. Um, hopefully when you go out there and you apply for jobs, you’ll see other groups are doing some of the same things, really trying to usher you on board in a comfortable, safe fashion, so you suceed, can succeed.

SHARA:

Wow, that’s a lot of food for thought. It helps a lot to learn about different settings, and we value your point of view. Thank you so much for joining us, Dr. Maxwell. We really appreciate your time and expertise.

DR. MAXWELL:

Well, it was absolutely my pleasure, Dr. Azad. Thank you.

KENISHA MUSE:

Applications for the ASA Anesthesiology Policy Research Rotation in Public Affairs known as the Resident Scholar Program are now open through February 14th. This is a unique opportunity for 2020 through 2021 CA3 Residents and Fellows to spend 4 weeks in Washington D.C. advocating for the specialty and experiencing firsthand the political, legislative, and regulatory factors that effect the delivery of patient care. For more information and to apply please visit asahq.org/residentscholar. Take it from me, I’m Dr. Kenisha Muse, a previous ASA Resident Scholar. During this experience, which was my favorite of residency, I worked on projects such as surprise medical bills, the perioperative surgical home, and the opioid epidemic, just to name a few. But most importantly, I met with numerous legislators conveying the importance of anesthesiologists. Apply today and become an ASA Resident Scholar.

MUSIC/OUTRO:

Join us for Residents in a Room where we’ll share timely info, advice and resources designed to help residents succeed in residency and beyond. Find us wherever you get your podcasts or visit www.asahq.org/podcasts for more.

OUTRO