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Help! Primary Care Job Negotiation (New Grad)


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Hey everyone,

 

I just returned from an interview with a multi-site primary care provider. I am a new grad in NYC area looking for some pointers about negotiations I am having with them. Please let me know what you think of this "package", and how I should counter as I have never negotiated a contract before. Thank you very much for your help and for your time. 

 

 

 

The package that was discussed includes the following:

 

- 2 yrs Contract. with 60 days advance notice if I want to bail.

- $85K starting with possibility for raise, bonuses and incentives

- M-F roughly 8hrs/day,and a few Saturdays.

- On the job Training ------------------------------------------------> I just asked if it's paid training, forgot to ask during meet up, smh

- Pt load: average 20/day once I pick up the pace

- Paid Malpractice

- Medical benefit (no dental and vision)

- 16 days  (10 Vacation, and 6 days PTO/sick/CME) ----------> I'm not happy with that.

- No CME fundings ----------------------------------------------------> Definitely not happy with that!!

- Loan Repayment option

- 401k after 2 yrs unmatched ----------> I don't know too well how that works, but it doesn't sound good to me.

 

No DEA license needed, plus I already have my State Licence so they won't be paying for them.

 

 

 

Cheers,

PAC-hristian

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Starting salary looks ok, especially for New York,  but the rest of the package is a little bit weak... 6 days PTO and no CME funds, awful.  401k setup is also very poor.  Your employer should have a 401k or other retirement package (403b) that you can contribute to immediately upon employment.  Ideally you want some sort of match as well to be available at 6 mo. to a yr after start of employment.   Also, 20 patients a day once you "pick up the pace" is a little bit vague...and yes, find out more info about the on the job training and when they expect you to ramp up to 20 patients per day. 

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What does the loan repayment look like at a dollar level? i.e. How much per year will you recoup to put towards your loans, and how much overall loan debt do you have?

 

If they are willing to give you, say, $20,000 per year towards your loans, I think you should seriously consider the offer--unless you can find another clinic willing to do loan repayment (NHSC, perhaps?) AND provide some of the other benefits this place is lacking in their offer (CME, increased PTO, etc.).

 

An "extra" $20,000, or $10,000 per year towards loans is a nice deal to have. Once that loan burden is gone, think about the freedom you will have professionally and personally. 

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starting salary fair

what does 2 year contract mean?  you can still leave within that 2 years as long as you give 60 days? 

How many Saturdays specifically?

malpractice --> I would try and get tail coverage in writing

no dental and vision = not ideal

 

I think the biggest potential weak spot is the vacation/PTO/CME/sick days.  First off, what about the days where the clinic is closed (federal holidays, etc)?  I'm assuming those don't count from your PTO days?  Because they do at my job, and I am forced to take a PTO day for those.  But I have more PTO days to draw from (I think like 28) in those cases.  And on top of that, I have 5 CME days.

 

Clarifying that loan repayment could show a lot of extra money earned so that could be really good

 

401k = weak

 

professional orgs, licensure, recert fees, etc ?

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What does the loan repayment look like at a dollar level? i.e. How much per year will you recoup to put towards your loans, and how much overall loan debt do you have?

 

If they are willing to give you, say, $20,000 per year towards your loans, I think you should seriously consider the offer--unless you can find another clinic willing to do loan repayment (NHSC, perhaps?) AND provide some of the other benefits this place is lacking in their offer (CME, increased PTO, etc.).

 

An "extra" $20,000, or $10,000 per year towards loans is a nice deal to have. Once that loan burden is gone, think about the freedom you will have professionally and personally. 

 

didymus -

 

the loan repayment is the NHSC loan repayment program. I am not sure how it works, but I believe I get 20K toward loans each year for 2 yrs (total 40K ?) as long as I am working at an under served area. (I have less then 50k loans so it would be a major help).

 

 

 

starting salary fair

what does 2 year contract mean?  you can still leave within that 2 years as long as you give 60 days? 

How many Saturdays specifically?

malpractice --> I would try and get tail coverage in writing

no dental and vision = not ideal

 

I think the biggest potential weak spot is the vacation/PTO/CME/sick days.  First off, what about the days where the clinic is closed (federal holidays, etc)?  I'm assuming those don't count from your PTO days?  Because they do at my job, and I am forced to take a PTO day for those.  But I have more PTO days to draw from (I think like 28) in those cases.  And on top of that, I have 5 CME days.

 

Clarifying that loan repayment could show a lot of extra money earned so that could be really good

 

401k = weak

 

professional orgs, licensure, recert fees, etc ?

 

 

treejay - 

 

- contract last for 2 years, I have 60 days to notice if I wanna leave/break the contract at any time without penalty of course.

 

- 1-2 Saturdays/month

 

- Tail coverage? I am told most places don't offer that. 

 

- Dental+Vision = not ideal, I agree.

 

- Vacation/PTO/CME/sick days part is what I am not happy about the most. I'd prefer separate days for CME, and not to use my PTO days for that.

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If the NHSC loan repayment is guaranteed in writing, I could almost live with this.

 

HOWEVER, since your loan repayment will be taxed at your highest nominal rate, you're better off negotiating a lower base salary and better bennies to minimize your tax burden.... if this employer is willing to play that way.

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As a counter I was thinking something like this (I am open to suggestions and comments):

 

 

Edit: Bold are the Changes I would counter with.

 

 

- 2 yrs Contract. 

- $85K starting with possibility for raise, bonuses and incentives

- M-F roughly 8hrs/day, and 1 Saturdays/month

- Paid On the job Training

- Pt load: Newbie: 10-13/day, [i was told average is 20/day post training]

- Paid Malpractice

- Medical and Dental benefits

- 20 days-off total  (10 Vacation, 6 days PTO/sick, and 4 CME days) + Federal Holidays.

- No CME fundings (I am not sure how to approach this)

- NHSC Loan Repayment option

- 401k: 3% match after 1 yr?

 

professional orgs, licensure, recert fees, etc... though important, I believe I can do without them for now...

 

No DEA license needed, plus I already have my State Licence so they won't be paying for them.

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If the NHSC loan repayment is guaranteed in writing, I could almost live with this.

 

HOWEVER, since your loan repayment will be taxed at your highest nominal rate, you're better off negotiating a lower base salary and better bennies to minimize your tax burden.... if this employer is willing to play that way.

 

rev ronin - 

 

I am going to do some research on the subject, as I have no idea about what you meant... lol.

 

If it's not too much to ask, can you please explain a tiny bit more. Thanks :)

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problem is, and I'd be interested to hear others thoughts on this, it seems like some groups, especially the larger ones like with an HR dept (like my integrated healthcare group), the bennies appear to be mostly or entirely non-negotiable.  they seem totally established and written into policies.  but i might be misled on that.  have others had good luck negotiating well on bennies at large groups/HMOs/integrated healthcare orgs?

 

Salary = very negotiable in those cases however.  as a new grad, less so I'd say.  the ole supply n demand game

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problem is, and I'd be interested to hear others thoughts on this, it seems like some groups, especially the larger ones like with an HR dept (like my integrated healthcare group), the bennies appear to be mostly or entirely non-negotiable.  they seem totally established and written into policies.  but i might be misled on that.  have others had good luck negotiating well on bennies at large groups/HMOs/integrated healthcare orgs?

 

Salary = very negotiable in those cases however.  as a new grad, less so I'd say.  the ole supply n demand game

Benefits will be largely non-negotiable for most large (and even medium to small corporation). Most of this has to do with EEOC and tax law. You can offer different benefits for different employment based classifications. For example since a PA needs CME you could offer CME money to PAs but not Nursing Assistants. At our organization everyone gets the exact same base benefits. Other benefits such as CME are determined by department and are somewhat negotiable. 

 

In the OPs case the 401K doesn't make any sense. It carries little or no cost to the practice and presumably the docs would want to be able to put away money. On the other hand if thats the way they set it up there is probably not much you can do about it (especially the match). 

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Benefits will be largely non-negotiable for most large (and even medium to small corporation). Most of this has to do with EEOC and tax law. You can offer different benefits for different employment based classifications. For example since a PA needs CME you could offer CME money to PAs but not Nursing Assistants. At our organization everyone gets the exact same base benefits. Other benefits such as CME are determined by department and are somewhat negotiable. 

 

In the OPs case the 401K doesn't make any sense. It carries little or no cost to the practice and presumably the docs would want to be able to put away money. On the other hand if thats the way they set it up there is probably not much you can do about it (especially the match). 

 

coloradopa - 

 

I have a friend who works there, and what she got when starting is totally different than mine.

 

plus she received CME money and 401K 3% match. 

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you have to get a DEA license.... just crazy to not get one....

 

also, PTO is horrible!

and there is no such thing as unpaid training....  you are fully licensed PA (new grad) and they are saving on salary by hiring a new grad, no need to cheapen yourself more with free anything

 

loan forgiveness is a tricky beast so I am told - has to do with scores and all, you need to figure out before hand rather this is realistic that you might get the forgiveness

 

 

Most my jobs have been 1-2 yr contracts with a 60 day notice but NONE have had a penalty with it - no way, no how would I ever sign a contact where I had to pay the employer to leave.... that is cray crazy!  That would be a deal breaker for me

 

The PTO is a close second on a deal breaker - followed closely by the 20 patients a day - you will be doing good to be at 50% of that initially

 

 

 

 

 

BUT biggest issue is mentoring..... is their any?

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you have to get a DEA license.... just crazy to not get one....

 

also, PTO is horrible!

and there is no such thing as unpaid training....  you are fully licensed PA (new grad) and they are saving on salary by hiring a new grad, no need to cheapen yourself more with free anything

 

loan forgiveness is a tricky beast so I am told - has to do with scores and all, you need to figure out before hand rather this is realistic that you might get the forgiveness

 

 

Most my jobs have been 1-2 yr contracts with a 60 day notice but NONE have had a penalty with it - no way, no how would I ever sign a contact where I had to pay the employer to leave.... that is cray crazy!  That would be a deal breaker for me

 

The PTO is a close second on a deal breaker - followed closely by the 20 patients a day - you will be doing good to be at 50% of that initially

 

 

 

 

 

BUT biggest issue is mentoring..... is their any?

 

ventana - 

 

There will be plenty of mentoring as the place is one of my school's rotation site.

I agree, the PTO doesn't sound good. I will try to fix it before signing.

As for loan forgiveness, all their locations are in under served communities and have a good score

Training is paid. I checked with them yesterday.

 

Today is my first day, so I'll get more clarification on the contract and see if I can get them to revisit the 401K, PTO, CME funds etc...

 

Thanks for your input :)

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Here is the A "close example of the" Contract: Advice please 

 

 

 

MEMORANDUM OF UNDERSTANDING

By and Between

BlueMoon Owl, MD PC

And

MidNite Bark, PA-C

 

WHEREAS, MidNite Bark (“P.A.”) is a Physician Assistant who desires to be employed as a full-time P.A. in Employer’s New York based practice.

 

WHEREAS, BlueMoon Owl, MD PC (“Employer”) is an established New York based practice and is willing to employ P.A. Upon the terms and conditions set forth herein.

 

NOW, THEREFORE, the parties agree to the following terms and conditions:

 

  1. Employer hereby employs P.A. on a full-time basis in Employer’s medical practice for a two year term commencing September___, 2014 and ending September___ , 2016 with an option for renewal annually.  Employer or P.A. may terminate this Agreement with due cause upon ninety (90) days prior written notice to Physician or Employer, as the case may be.

 

  1. P.A. shall, at P.A.’s own expense, maintain a valid registered Physician Assistant license in the State of New York and shall comply with all the rules and regulations pertaining to the maintenance of such license.

 

  1. It is agreed that P.A. shall devote his full-time, interests, abilities and energies during his office hours (8am-5pm, five days per week, plus two weekend days per month per scheduled office site hours).

 

  1. Employer shall pay P.A. an annual salary of $85,000.00 per annum, payable in arrears in accordance with Employer’s regular bi-weekly salary payment. Base salary is agreed upon meeting all duties/responsibilities, as outlined in Appendix A.

 

  1. P.A. shall also be entitled, during the term of his employment to the following:

(a)     Sixteen (16) days leave annually with full pay and benefits, commencing with date of employment. This includes any sick days and national holidays and are non-cumulative (During 1st year one week (5 working days) vacation can be used after six months from start date and another one week (5 working days) can be used after nine months from start date.

(b)    Medical malpractice insurance coverage in the minimum amount of $1Million/$3Million per occurrence/yearly aggregate.

©     Participate in any 401K pension plan and defined benefit plan once eligible of Employer now existing and hereafter maintained in effect or hereafter adopted for the benefit of Employees.

(d)    Participate in any medical insurance plan (Individual coverage) of Employer now existing and hereafter maintained in effect or hereafter adopted for the benefit of Employees.

 

IN WITNESS WHEREOF, this Memorandum of Understanding (MOU) is executed this ___day of September 2014 by the undersigned:

 

 

By: ________________________________              By: ________________________________

 

MidNite Bark, PA-C                                             BlueMoon Owl, MD-President

BlueMoon Owl MD PC

 

 

 

 

 

 

Appendix A

 

 

 

List of Responsibilities and Duties

1.      Quality Metrics

a.       Annual/Preventive Exam

b.      Annual depression screening

c.       Smoking cessation counseling

d.      Alcohol screening/counseling

e.       BMI 30 and over—Obesity counseling

 

2.      All notes/charts closed by end of the day.

3.      All labs reviewed and reported to patient within 48 hours.

4.      Completion of all documents by end of the day.

 

 

Pay for Performance

For any month the average number increases, a bonus payment will be made for that month on pro-rated basis based on the following:

 

Avg 16 Pt/day

$85,000/yr.(Base Salary)

Avg 18 Pts/day

$90,000/yr.

Avg 19 Pts/day

$95,000/yr.

Avg 20 Pt/day

$100,000/yr.

 

 

 

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nope don't like it....

 

 

this is a contract written by a doc playing lawyer.....  

 

I have NEVER heard of ANYONE having to pay  their own state license

 

Classically and almost everyone I know gets those things needed to practice paid for by the job - IE state licence, DEA, state controlled and some CME as these are all REQUIRED to practice as a PA.  Since they are employing you as a PA in a full time capacity they should coverall all expenses to allow you to legally practice.  Is VERY much a red flag that they are trying to push these costs onto you.  

 

Hours are horrible - 8-5 is 9 hours a day, for 5 days is 45 hours per week  

Then add in 8-12 hours twice a month

 

 

Oh yeah a 12 hours shift in the ER at $50/hr is $600 - 24 shifts a year is almost $13k, so the offer is really 72k/yr for a 45 hour work week......  that stinks....

 

"Due Cause" needs to be defined

 

I have always encourged "at will" employment so that ether party can terminate with a a 30-60 day notice.  90 days is a LONG time!  And in fact TOO LONG.

 

Honestly there are some pretty big red flags, I am unimpressed that their will be a lot of GOOD mentoriing just because they are a rotation site.....   They might use this as the constant feeder for new grads that are CHEAP and they can abuse with work

 

 

 

Seriously don't like the REQUIREMENT that you finish all charts the same day, that is really really hard to do and no PA or MD I know does that.... that is setting you up to fail so they can terminate you "with cause" for simply not getting your charts done in the same day

 

 

sorry I see to many red flags to say they are any good

 

having said that - if you need a job then you take what you are offered.... but be aware this is contract that is pretty stinky.....

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Ventana -

 

Thanks for your input, I have written "comments" for all the parts you mentioned (using your inputs) + concerns I have and ways I am thinking of countering.

 

 

Bold = my concern

 

 

 

 

due cause  upon ninety (90) days

 

This term is too broad. Would you mind provide further written clarification.

60 days prior written notice is a bit long. However, I believe a 60 days prior written notice is much more generous.

 

 

 

  

 

"State Licence, DEA, State Controlled and some CMEs are all required to practice as a PA.  Since I am being employed as a PA in a full time capacity, my Employer should cover all expenses that allow me to legally practice in the State of New York. In the event that all expenses will not be fully covered, I should be reimbursed at least half (½) of the total expense that went toward these requirements."

 

 

 

 

"One weekend a month I will be able to agree to. However, I may agree to work one non-major Holiday for the year." 

 

 

 

 

 

Sixteen (16) days  leave annually with full pay and benefits, commencing with date of employment. This includes any sick days and national holiday and are non-cumulative

 

"Make sure 16 days breaks down into: 10 --> vacation days + 6 days --> sick days/time off. National Holidays shouldn't be part of the 16 days"

 
 

 

 

401K pension

 

 

401K: after 1st year 3% match is reasonable. 

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One of our other grads here is getting 6% match (EM) they say. Don't leave free money on table regardless of match!  One other suggestion.  Ask about expense rate on your 401K (I think I'd be surprised if they were able to answer your question directly without having to look it up themselves).  Anything at 2% or greater is a rip, IMO (i.e.-you have to earn 6% to really earn a 4% return due to expenses paid to plan administrator).  In this type of situation if expense rate is high, put in just enough to max the matching funds then put remainder of anticipated retirement contributions in a low-cost index fund Roth IRA (ex.- Vanguard Group, Schwab, Fidelity are typically significantly <1% cost).  Mine for example is 0.18% annually.  Sent from my iPad using Tapatalk

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