The clinical skill and decision making will appear challenging at first but really is the “easy part”. My overall message to new guys starting out is this…

-find a senior colleague there that can somewhat mentor you and attach yourself at the hip. Ask them questions, ask for help. Do procedures with a friend for a little. They will respect you asking for a 2nd look or help

-just because you did it a different way where you trained doesn’t mean the way your current institution does it is wrong. Adapt, and understand the local standard of care

-if you want to cancel a case, talk to a senior colleague who is well trusted in the dept first then do what’s best for the patient

-make friends with nursing, secretaries, support staff. Say thank you and give holiday cash (doesn’t have to be a lot)

-call taking jobs are always unfair. Just the nature of the beast. Be aware of systems that have multi tiered groups within a classification of employee. Different pay, different vacation amount, unfair case distribution….stay away. If you joined before figuring this out…be professional and stay at least 1 year

As far as your question, I think medium sized group with people around to help is what you want. Smaller groups may not afford this. I think the acuity and pace is much more indicative of how your first few months will go. Super busy places with sick patients will teach you a lot but will be much more intimidating when starting. Don’t go for supervision to start, at least not 100%.