Residents in a Room
Episode Number: 80
Episode Title: Private Practice in Practice
Recorded: September 2025
(SOUNDBITE OF MUSIC)
VOICE OVER:
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 anesthesia
residents.
Our goal, number one, is to provide excellent, safe anesthetic care.
Allow yourself to be uncomfortable because you’re going to grow and
you’re going to learn and you’re going to expand.
You’ve got to be good. You’ve got to be willing to work. And you’ve got
to be a Swiss Army knife capable in any room that you walk into.
In private practice setting, it’s just very important to understand how
to do that.
DR. ALEXIS RICE:
Welcome to Residents in a Room, the podcast for residents by residents.
I'm your host for this special episode, Alexis Rice, HCA Sunrise Health CA3
chief resident. I'm joined today by my program director, Dr. Ryan Hafen, who's
also a partner and clinical governance board member of USAP Nevada, along with
Dr. Kelly LeBlanc, partner and Clinical Governance board member of USAP Texas
Gulf Coast. This episode is sponsored by US Anesthesia Partners and we're
recording this at USAP’s Future Leaders in Anesthesia conference in Austin,
Texas. Drs. Hafen and LeBlanc are going to take us behind the curtain and share
their expertise on life inside private practice. Fortunately, I'm not alone.
I'm joined by a fellow resident. Can you introduce yourself?
DR. ALEXA MSAYS:
My name is Dr. Alexa Msays. I'm a CA3 at
Houston Methodist Hospital and very excited to be here today.
DR. RICE:
And now let's meet our guests. Drs. Hafen and LeBlanc. Can you give us a
little intro to you? Tell our listeners a little about your pathway and your
current role.
DR. RYAN HAFEN:
Well, thank you, Alexis. Um, appreciate. I'm Dr. Ryan Heffern from Las
Vegas, Nevada. Born and raised. I'm the current program director of, uh, our
anesthesia residency in Las Vegas. The only residency in Nevada. I did my
training at UNR med school, then UCSD in anesthesia, and I did my fellowship at
Stanford. Been back in Vegas about nine years. And, uh, initially came out,
worked at a trauma center. Then I did ICU for three years, and that's when I
first started working with residents at Mountain View Hospital in Las Vegas
that has the anesthesia residency program. I was working at the time per diem
with USAP Nevada platform. And by platforms, that's just our practice in
Nevada. We have different platforms all over the country and in different
cities and states. I then decided about three four years ago to join full time
with USAP Nevada, and at that time there was a vacancy in the residency program
director. I applied and I was very blessed to get the opportunity to train our
residents, and I've been the residency director ever since.
DR. KELLY LEBLANC:
Hey, thank you for having me. I'm Kelly LeBlanc. I'm a physician partner
in Houston. Undergrad at Howard University. Medical School UTMB in Galveston,
Texas. I did my residency at Baylor College of Medicine, where I was chief
resident. Uh, got a chance to rotate at Houston Methodist Hospital during my
residency. Loved it. Joined the group, which at that time was GHA. And I've
been with them ever since. We're now USAP. It's been a great experience. I sit
on our clinical governance board, I sit on our clinical operations committee,
which is our national committee that helps govern our clinical care throughout
the country. Um, I'm currently the site chief at Houston Methodist Cypress
Hospital, um, formerly the site chief at Houston Methodist Baytown Hospital,
where I was chief of staff as well. So lots of
opportunities and it's been a great ride.
DR. RICE:
Can you talk about what it's like to work in private practice, especially
just out of training?
DR. LEBLANC:
We're not going to let you go your first day by yourself. The last thing
I'm going to do is have you come, this is your first day and boom, you're
there, right? So it's let's partner you with someone.
Let's make sure you have your access, your epic access, your badge access. Let's
make sure you know everyone. You know all the players. Let's introduce you to
the OR staff, the teams, maybe some of the surgeons, um, to give you that
opportunity to get a little more acclimated. And then after that, it's how do
we then get you in the operating rooms? We're going to start you on the easier
cases. Bread and butter. This is what you're used to. So
it's being intentional in that making sure you have the support. We do have a
peer support team where we partner you with someone. So
if you have a question or need, you have a phone, a friend. How do I do this? I
still do that. I still call my partner physicians and say, hey, what would you
do? That's important, right? And so setting up our new
physicians as they come in, um, and transition to start a career with us is
really important. And also getting feedback and checking in with you after a
few months to say, hey, how it's going. Get your feedback and then give you
feedback as well on what we see and how we also think we can partner with you
to kind of further your experience and improve it.
DR. HAFEN:
When somebody starts with us, we actually assign them a physician mentor,
and that person checks in with them regularly. If they go on to a partner track
with us, we actually do regular checki ns with HR.
And so we try to engage that person early and give
them a support system early, because when you first come out in private
practice, it is a whole new ball game: new people, new places, fast pace and
you're by yourself. And it can very quickly feel like you're on an island. And so we try to make sure that isn't what people feel. We
always want them to have 2 or 3 numbers in their phone that they can quickly
call and say, hey, I haven't ever ran into this
situation. Can I just bounce this off you? Or, hey, I'm having a problem with
this surgeon. How do you deal with that person? Or, hey, I got something going
on at home. Can I talk to you about that? So we
formally approach it, and then hopefully that's enough to start and then take
an active role and look for those mentors. You're going to find people that you
have commonality with, share interests with, um, engage those people, take them
out to dinner, get to know them.
Our chair of our group always tells the young residents, the new partners,
be an owner. And that doesn't mean buy stock and become an owner. It means have
an owner mentality of your group. Get involved. If you don't like something,
well, then change it.
We are the traditional physician led private practice group on a local
level, and getting those partners to be engaged really helps them start a
career path towards leadership and allows them to meet more people, which then
allows them to expose more mentorship. And I think career satisfaction goes
through the roof once you start engaging those individuals to start being a
part of the solution and not just the problem. Yeah, so very formal type of
stuff, but also informal.
You know, we're a little unique because we do have a residency program.
We actually have residency families where we assign one faculty member a person
from every PGY level. And that's the little family. And they take them out to dinner and they take them bowling or to the movies. And so you have this little tiny, close
knit mentorship family. And then, as they go through residency, we try to
mentor them through it. And Alexis is joining our group and we're super proud
of that.
DR. LEBLANC:
Congratulations.
DR. HAFEN:
You know, for four years, we've been bringing her along and raising her
up like one of our own children. And, um, and she's going to be awesome. And so we try to engage them, even at that level, to bring them
into the group and show them what their future could look like. And, you know,
she's chief resident. So mentoring her in that
leadership role, these are all things that they started very early in your
career.
DR. RICE:
Really enjoyed having a mentorship family.
DR. LEBLANC:
Um, that's a great idea. I like that.
DR. RICE:
Especially because there's one in each class. Yeah. So not only do we
have that attending mentor, but we have each other every step of the way too,
which is awesome.
DR. LEBLANC:
And you all are exposed to such great mentors and and
let me just say this, you don't have to have just one mentor. Right? You know
this is my mentor for work life balance right. They're able to maintain their
family and balance and and and
that's great. And maybe that's the person I go to when I feel like I'm being
challenged with my work life and trying to hold on to that. And then this is
the person I aspire to be if I want to be. ASA, Pat Giam
is right there. I can go talk to Pat because he's a physician partner, and I
can talk to him and say anything and everything, right? So
it doesn't have to be one person. Yeah.
DR. ALEXIS MSAYS:
It sounds like mentorship is also an active process. Can't be passive.
And just you're going to get all those mentors. You have to actually seek.
DR. LEBLANC:
Absolutely. Yeah.
DR. MSAYS:
You know that's one thing that I've learned. Um, you gotta
you gotta ask that mentorship. Everyone's always
super willing to lend a helping hand, but sometimes they don't know you need a
helping hand.
DR. LEBLANC:
Correct.
DR. MSAYS:
It's up to you to find the person that, like you said, maybe they see a
bit of you in them.
DR. LEBLANC: Absolutely.
DR. MSAYS:
It's going to be a great mentor for a younger. And so I do feel like, um,
you know, being in this program, there's a lot of fantastic mentors who had a
lot of opportunities in their career and just a lot of experiences that I've
been hearing about since I was eight, you know, fresh CA1 and goes to the way
that, you know, our attendings teach us. Of course, we get taught like the
clinical pearls and all of the academics. But, you know, it was one of my
attendings always says anesthesia is the easiest part when you get out that is
the easiest part. And the hard part is everything else that they do.
DR. LEBLANC: Absolutely.
DR. MSAYS:
We're in that unique position where we are learning that kind of, you
know, healthcare is in business. Medicine is a Science. Healthcare is a
business. Healing is an art. But every day my attendings are telling me, you
need to start thinking about this. And now that I'm CA3 and I will be, you
know, I also signed so I'll be joining USAP. And, um, I get a lot of that.
You're going to be with us next year. You're going to be an attending. You can
start thinking like this. You start thinking like this.
DR. LEBLANC:
Yeah. That’s correct.
DR. MSAYS:
And it's all things that I have nothing to do with academics. It's other
things, higher level things to be successful as an attending in a private
practice setting. It's a big academic hospital, and there's of course a lot of
teaching going on. But at its core, this is it's run like a private practice.
DR. LEBLANC:
Well, yeah. You're both part of our residency programs. And so you have the unique opportunity to get the best of both
worlds. You're able to see the academic, but you're also able to see what
private practice really is. And you're able to see it in a very good way,
because you're seeing a very strong, physician led, physician owned
organization, and you're watching physicians do more than just delivering
anesthetics and support care team, but you're also watching us run the
organization, make the clinical decisions, making the business decisions. You
don't get a chance to see that often, but you get to see what really goes into
running a successful anesthesia company. So I wish I
had your opportunities, I really do.
DR. HAFEN:
I trained at a large academic center at UCSD. Awesome place, great
people, wonderful training. Um, but the difference transitioning from that to
private practice was just the the pace. The speed of
private practice surgeons was for the first probably 3 to 4 months was quite
shocking. I came out and I, I remember my first day, I looked at my schedule
the night before and I had four robot hernias scheduled, plus three lap
collies, and the timings looked like they were out of some imaginary book, and
it said I was going to be done by 5 p.m. And I hit the ground and learned to
turn the room fast, learned to wake my patients up fast, be efficient, be safe,
use all the principles I learned in residency. Um, but do the work of a private
practice anesthesiologist. And at the end of the day, our goal number one is to
provide excellent safe anesthetic care. But also there
is the efficiency component in private practice.
DR. RICE:
Well, you had a basically perfect segue to the next question. What would
a typical daily routine look like and how much autonomy might we have over our
practice and routine?
DR. HAFEN:
Um, so typically the night before I get my lineup, um, I get up early,
just like you would in residency, and some days I'm working with residents.
Sometimes I'm by myself. Sometimes I'm with the care team or the CRNA or CAA,
but the day to day doesn't change clinically that much. Take good care of my
patients. Usually, if I'm not on call, it's a 7 to 5 or 7 to 7 shift.
The interesting part of it that I never knew about is not only am I going
to be taking care of these patients, but, you know, at 4 p.m. I'm going to jump
on a call with Human Resource Committee or Finance Committee or our governing
board. And now I'm doing the business of medicine during the day and being
involved in that part of it. So there's more than just
the clinical aspect and private practice. If you join leadership, you will be
involved in all the day to day types of things with
scheduling and HR and finance and all the things that you need to run a very
successful practice.
And then, you know, just the rest of the day is go
home and be a good dad. Change caps from a doctor and and
a leader, and be a dad and a husband and and do all the things that you're supposed to do. And
learning how to flip that switch is important too. And that's pretty much my
day to day. I love our group in terms of call. You know, we don't get crushed
with a call. We take 4 to 6 calls a month. I work probably 50 to 60 hours. I
make great money. I have autonomy and I think I have a great work life balance,
so we can take as much vacation as we want. I can work 80, 100 hours if I want,
and I can take less vacation and make more money. And so
we have a lot of flexibility in our practice. And so
your life can look as varied as as you want it.
DR. MSAYS:
Can you talk about the kinds of clinical cases we might expect to see in
private practice? I know some people, new grads, get worried whether they're
going to be pigeonholed into certain types of cases or if they see a broad
range of work.
DR. LEBLANC:
Um, wherever you go and you're just coming out of residency, what I would
really want to make sure everyone knows is do not go somewhere where you're
only going to do one type of anesthetic. Unless you did a fellowship and that's
all you want to do. And I just want to do peds. I just want to do hearts. Make
sure you get exposure in everything. You do not want to pigeonhole yourself
that early in your career. Give yourself as much variety as you can.
And one of the things that I thought was very helpful for me is when I
started my career is not only had to go to Methodist, but we had to cover all
the Methodist hospitals. And just by having that exposure of cases, not only
case variety, but surgeon variety, administration variety, operating room
variety, I learned so much. So it could be a little
daunting at first. It's like, oh my gosh, I'm going to new hospital. I'm
comfortable here. Allow yourself to be uncomfortable because you're going to
grow and you're going to learn and you're going to expand. So
you don't want to do it all right away, but you want to make sure you have the
opportunity to do that.
DR. HAFEN:
Yeah, I totally agree and would echo that. I think this is a hard
question to answer, because the type of cases you're going to see is dependent
on the opportunity that you seek out and that you accept as a job. And when I
first came out, I went to the second largest hospital in the state of Nevada
and the only level one trauma center, and I did everything, everything. And
that set the basis for my career.
I think I'll add a layer to that. It's not just you need to be looking at
case types and variety and maybe even sites going to different sites going to
an ambulatory. The first time I went to an ambulatory standalone surgery center
was like four years into my career, and that's a whole nother
adventure. You want to talk about feeling like on an island? That can be very
isolating.
The other thing I'll layer on to that is what is the ratio of doing cases
on your own versus doing them with residents versus doing them with a care
team. There are jobs out there where you can immediately come out and, you'll
see it on gasworks, it says 100% supervision job. And that is true. And I would
caution that in in a graduating resident, you really do want to be the one
doing your own cases. Um, so find that job that maybe has a 50/50 mix or a 25/75, but be cautious of just going into that gig where
it's like, all right, cool. This is a huge paycheck and it's all outpatient GI
and I'm just supervising care team. You will be pigeonholing yourself in your
career that you just aren't comfortable doing everything. Um, so I would, I
would say, seek out the jobs in which you can further your education. And I
always say, look, there's some retirement jobs out there. They’re best for when
you're closer to retirement. If your goal is to become the best
anesthesiologist that you can, which it should be.
DR. LEBLANC:
Agreed. The more you're out of the operating room, the less comfortable
you're going to be. You want to make sure you continue to do some of your own
cases. It may not be 100%. I think being able to learn how to function in a
care team setting, you've got to know how to do that, because we're never going
to go back to the days where it's, you know, physician, you do your own cases
all the time. We'll never do that. So being able to master those skills is also
very important. So the variation is is is necessary right.
DR. RICE:
And for us listeners who are scrolling through gasworks and trying to
look for jobs, what should we be thinking about when we go on interviews? How
do we identify opportunities to grow? How do we gauge how well organization
will meet personal needs? Any tips on how to tease out opportunities for growth
through interviews?
DR. HAFEN:
Um, I'm going to just go right back to the statement I made earlier with
one of my mentors who has taught me to, um, be an owner. And so
the first thing I want to know when I'm sitting in an interview with a group
is, are there opportunities to get involved? Um, if there are not, I would be
very worried. Okay. So if if
it is just a job where you have zero input on anything hiring, firing,
scheduling, vacation, contracting, anything, and there's plenty of jobs out
there, probably 60% of the jobs right now are looking more and more like that,
where you just show up, you get a paycheck and that's it. For me personally, I
worked in that situation for four years. For me personally, if I were to go out
and interview, I know what I want in a job that's given me fulfillment, which
is being involved to be able to shape my career, the career of my partners and
colleagues, and grow anesthesia in a physician-led way. That is very important
to me when I'm in an interview. What opportunities are there for me to be
involved and grow? Do you have committees? Who does the contracting? Is a
physician involved in that? Who does scheduling? Is a
physician involved in that? Um, I think that's super important for me. That
might not be important for other people. So you have
to think about what are your principles, what do you want in a job? But for me
that's a big, big, big one. Seek out somebody in that interview process that
has similar beliefs and life goals and maybe family goals and talk to them
about does this job allow them to function the way that I would want to
function? You know, maybe I need more time off for my kids. Maybe I need more
time off for my wellness. Maybe I like to do other things outside of work that
take some time. I'm a triathlete or something, so don't be afraid to find those
people when you're interviewing and ask them very personal questions.
DR. LEBLANC:
I'm just going to be honest. One of the things that residents always want
to know is how much am I going to make? I was like that. I had three kids. I
want to know how much money am I going to make. But
that's not the most important thing. And so I say that
to make sure that we address it, because we know that that's important. You
want to make sure that whatever is being offered is competitive. You want to be
very weary if they're the highest paying person, because then you're like, why?
Um, why are they paying the most? And I would try to kind of read more into it
and investigate. But that being said, pay is important. But it's not the only
thing.
So one of the other things that to me--elite culture.
That's the most important thing to me because I am going to be at that site, at
that workplace every day during the week and working with these same people all
the time. Um, if I get into a bind, I'm going to need these people to back me
up. As a mom, if I need to have some more flexibility in my schedule than what
is already there, I need to switch a call or to go to a sporting event, which I
did often raising my kids. Is there someone who's going to be able to partner
with me and help me? Those kinds of things are important. Not only that, but
when you're talking about, do they value whether I'm a mom or dad? Um, it's a
job, so they're going to need you to do the job. But what you want to know is is there flexibility in the
packages that are offered? If I want them to do a nocturnus
job, if I want to work 7 to 3 and no weekends, so no call or one call a month. What
does that flexibility and range look like? Because that may be where I need to
start. Or is there an opportunity for partnership? I'm gung ho. I'm ready. I
want to get out there and start working because, hey it’s time to make some
money and pay these loans back. Can I do that? And then when I realize I can't
keep working like that because I want to stay married and be involved in my
kids, is there an opportunity to flex down a little bit? What does that look
like? And then if I decide I want to be a leader, after I've done all of these
things and I feel like I still have that bandwidth, are those opportunities
there? What does that look like and how grand is that? You know, is it just
running the schedule or can I be a leader? And what does that mean? Can I be a
site chief? Can I be a leader of a platform, or can I do the business of it? I
mean, there's so much involved in running an anesthesia practice that you don't
learn about in residency. And so you want to ask, are
those opportunities there as well?
And for me what was important is what's the opportunities if I want to
look at diversity too. And that's important to me, um, I want to make sure that
my voice will be accepted and can add value as well. Will I be able to have a
seat at the table? And so I kind of want to look and
see what does that look like too. If there is no one
at all in the company that looks like me, then I'm going to be a little
apprehensive because I'm going to say, will they value me? And I would ask
those questions.
So I think those are things. And sometimes we don't
think about that when we're coming out of residency as being important. But
those are definitely things that I would have, as well as all of the business
aspects regarding how sustainable the practice is that you're looking to join. So looking at revenue and how do they manage their revenue
and look at their partnerships with the hospital systems that they're involved
in. Are they leading in those hospital systems? Right? Or are they just
providing the anesthesia? Because if all they're doing is worried about
providing the anesthesia, then they're not really partnering with those
hospitals. And let me tell you, that's important. Those hospitals need you to
be able to run an efficient O.R., because an efficient O.R. means that their
revenue is going to go up, which is important for them, right? They want to
make sure that the patients are going to get great quality, which we'll all do.
But it's more than that, too, right? Are you going to partner with all the
areas in which you're able to take care of patients? And there's so many
different things. So you want to make sure that that
partnership with the hospital systems is there.
So all those things are important for you to ask. But
you said something important, Ryan, and that is to make sure you ask people who
work there, what their experience is like, and find out who's the newest hire.
Talk to them because their experience is going to be most meaningful for you.
And ask, what was your experience like when you first started? What was the
onboarding like? How did they treat you? Did you get the support that you need?
Is there someone that you can call if you need help? Ask all of that. That's
important. And then finally sit and observe and feel what it's like to be
there. You can learn a lot just by observing.
DR. HAFEN:
Great points. Flexibility is huge and I agree with all those things. I
think something that is very unique to both of you that I'm kind of curious
about, and I know Alexis has a different experience than maybe other residents,
is that you're trained in a private practice group. So
what do your guys's view--and that's gonna be much different than maybe someone in an academic
training--what's your view on what private practice is going to look like once
you're graduated? And how might that differ than maybe some of your colleagues
that are at academic centers?
DR. MSAYS:
So I think the the first
thing, you’ve got to be good. You’ve got to be willing to work. And you’ve got
to be a a Swiss army knife capable in any room that
you walk into.
DR. LEBLANC:
Correct.
DR. MSAYS:
And I do feel that when I see my attendings walk in the room, it doesn't
matter whether it's a crazy spine, coley, GI. They get in there, they're
confident, they're pushing the pace and they're efficient. And probably because
they've taken so many opportunities over their careers and they have seen so
many different sides. You know, at my hospital, they're credentialed at
multiple different sides within the med center. So one
day they're here, another day they're over doing OB in a totally different
institution. And everywhere you go they do cases differently. You know,
anesthesia is different.
DR. LEBLANC:
Exactly.
DR. MSAYS:
The surgeons are different. Like you can do a two hour meet here and
then, you know, you can do a
eight hour coli.
DR. HAFEN:
You get you get comfortable at being uncomfortable.
DR. MSAYS:
Yeah, exactly. So I feel that to be in private
practice, you have to be good. You have to be willing to take opportunities.
And you ‘ve got to develop those skills being comfortable and uncomfortable environments.
And that comes from constantly putting yourself in those shoes.
DR. LEBLANC:
Exposure
DR. MSAYS:
Exposure. Exactly.
DR. LEBLANC:
Make sure again, and this is, I think, why it's so important that when
you're looking for a job, you're making sure that when you start, you have the
support, because that is the expectation in private practice. So you want to make sure that you have the support, um, of
the, you know, of the team that's already there to help transition you until
you get used to that. I think that's really important.
DR. HAFEN:
You'll all be fine.
DR. RICE:
So in our residency program as a CA3, we have the
opportunity to do a rotation called practice management, which allows us to
help run the OR board and which providers will take care of which cases, take
care of the add ons, this case got cancelled, where
can we utilize this provider to to make the day more
efficient? And I think in private practice setting it's just very important to
understand how to do that. And I love that we get to do that as a CA3.
DR. LEBLANC:
That's a great opportunity.
DR. RICE:
And I'm excited to do that. I haven't been able to do it myself, but looking forward to it. And I think that's just a
very important rotation to help guide us to understand how private practice
works and why versus academic centers.
DR. LEBLANC:
I agree.
DR. RICE:
Well, thank you so much. This was a very informative conversation and a
lot of fun.
DR. MSAYS:
Very informative. It's so nice to hear everybody's experiences and just
kind of take a look inside everyone's brain.
DR. LEBLANC:
Yeah, thanks for having us and we wish you all the best of luck. We're so
excited for you and for all of you listening. Good luck with your endeavors.
Good luck with your careers, and I hope this helped you in any kind of way when
you're looking for a job.
DR. HAFEN:
Thank you guys for spending your time. And to everyone listening, no
matter what career path you choose, we need all of you. We need the good
academic people. We need the researchers, we need the
private practice docs. You all matter and wish you the best in your future
careers.
DR. RICE:
Well, thanks so much for joining us for this episode of Residents in a Room,
the podcast for residents by residents, and today sponsored by US Anesthesia
Partners. Come back again soon for more Residents in a Room.
DR. LEBLANC:
Bye, guys.
DR. MSAYS:
Bye bye. Take care
everybody!
(SOUNDBITE OF MUSIC)
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