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New Grad - Two "offers" - which one?


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Full disclosure, I'm an FNP student, so feel free to ignore. :)  I'm about to graduate. No written offer yet, but I'm 99% sure I'm about to get two offers.  Here she be:

 

Option 1:  Newly created NP/PA position at a "walk-in" (urgent care?) clinic 15 minutes away.  They didn't want to hire a new grad, but after getting my resume, and calling my clinical references, I am their only candidate (so says the office manager). It is a walk-in clinic, but I'm not sure I would call it urgent care.  They do no labs on-site, only x-ray.  They need someone to get up to speed ASAP, as they are down 1 of 2 providers.  Ultimately want two docs, two NPP's. Will get an offer after background check clears,.

 

Option 2: Doc that was ready to hire me my first semester.  Has spent two years trying to get a new position approved to hire me, and just did. Literally wants (or did 2 years ago) to build a wing on the clinic to give me rooms.  Interview scheduled with him and management. Love this guy, we really click. 30 minutes away in a small town FP clinic.

 

Me:  RN with 1,000 hours in ED, 2,500 hours in ICU.  Very high GPA in grad and undergrad.  Did a walk-in clinic over the summer as a rotation, was able to handle only 75% cases that came through the door, but I don't graduate until Dec. However, to handle the other 25%, I think I have a ways to go.

 

Pros/Cons with #1 -- Pros:  Urgent care, which I really love.  More procedures. 3 12's.  Very flexible schedule. Higher pay (probably). Well-respected physician group in my area. No boring chronic follow-ups.  Cons:  Expected to fly solo (with a doc on call and 10 minutes away) relatively soon, but no exact time frame has been given.  No on-site labs.

 

Pros/Cons with #2 -- Pros:  The doc is basically a buddy of mine.  Will get to get my feet wet, adjust and learn at my own pace.  Small town (love that too).  I know and like everyone at the clinic. Remote possibility of ultimately getting privileges at a nearby, small, rural hospital, which would be stinkin' sweet.  Cons:  I really don't think they have the patient volume to justify me, at least they didn't 2 years ago when I rotated there. Lower pay (probably).  The doc thinks I walk on water for some reason (too high expectations?). 30-35 minutes away.

 

Soooo.....Unlike PA's, I didn't get an EM rotation.  I do have 1,000 hours in the ED as an RN, but, not the same, I know, but with 2,500 hours in the ICU too.  Concerned about needing to get up to speed (too) quickly at the walk-in clinic, but I really dig walk-in/urgent care.  Second option would allow for easier transition post-grad, but I am concerned I'll spend the first year staring at the wall and seeing no patients until the practice gets built up, with the remote possibility of getting let go for that reason, and gaining no real experience.

 

What would you do as a new grad PA, esp. given you've had an EM rotation, vs. me?

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I would take the walk-in clinic job.  Better to jump in and get your feet wet and be stretched to learn the medicine of the 25% of cases you think will be a challenge.  

 

It is better to work with patients than to sit idly in a clinic will low patient volume and let your brain turn to mush.  You will be bored.  Also, working for someone who is a "buddy" of you can quickly turn sour when he becomes your supervisor.  

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I would talk to the doc at place #2 and find out what kind of volume they have TODAY. rural jobs are awesome, especially if you could get hospital privileges and potentially some loan repayment. It is nice feeling like you are a parrt of a community. I feel more connected to the rural community where I work 4 days/mo that the large, urban community where I work 10-12 days/mo.

if they can get you 10-12 pts/day with the potential to see more I would seriously consider it.

best of luck whatever you decide.

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Thanks for the feedback.  At the moment, I think I would lean towards the FP clinic, assuming I can be assured the patient volume is there, though Paula raises an interesting issue about being friends with the doc.  Walk-in/urgent care is very appealing, as long as I can be assured that I will get the necessary transition/training time. I just don't know how long that is, and I don't think anyone (myself included) can answer that.  I'm almost certain the clinic would not agree to anything open ended.  I should know more next week.

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  • 2 weeks later...

Update to the above.  I have received a contract/offer from the FM clinic.  Here are the highlights:

 

-2 year agreement

-30% of collections above expenses

-3 weeks PTO (sick, vacation, whatever)

-6 holidays

-1 week CME/$2000

-90 day notice both ways

-401K 50% match up to 4%

-Charting complete w/in 48 hours

-Malpractice paid

-No mention of licensing or cert fees

-No continuation clause

-No non-compete clause

-About 42 hours per week (I think) which includes 1 sat/mo at a walk-in clinic

-My health and dental paid (not sure of family cost)

-Hire my own MA or LPN

-Nice dedicated office and dedicated patient rooms

 

During the dinner with the CEO and the doc, they told me to "fill in the blank" on the contract for salary, within reason.  What's above is in their standard NPP contract, and I'm sure some can be negotiated.  

 

Problems is, I have no idea what to ask for in base salary.  I think they said that with 12-15 patients/day I would break even(does that sound right?), above that I'd get the 30% of collections. I know they use MGMA as a reference for their salaries, but they seem to be lower than everybody else (bls.gov for my area, Advance, AANP) best I can tell. And, those numbers are for total compensation, not a base salary. Being a new grad makes it even tougher. Doc mentioned I could make $100K in urgent care, that they can't pay that, but that the bonuses would help close the gap?

 

Thoughts, suggestions, comments?

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you have to hire your own MA/LPN? WTF! There goes 15-20/hr for a good MA or 18-27/hr for a good LPN

 

The way I understand it is I am given a budget that includes my base salary, the MA/LPN salary, office expenses, rent, admin fees, etc.  This is a physician-owned practice group, and this is the way it is done with all providers, the NP's, PA's and MD/DO's.  If I heard them correctly, about 15 patients per day covers these expenses.  Any collections from patients in excess of "break even," I get 30% of on top of my base salary.

 

Assuming I am understanding this correctly, let say I am allotted $130,000 per year in my budget to cover my base salary, my MA/LPN salary, rent, office expenses, and admin fees.  If I collected $45-50 per visit, 15 patients per day, 240 days per year, at an 80% collection rate, I would cover that.  Anything over that, I would get 30% (the practice gets 70%).

 

And, MA's/LPN's do not make that much in my area.  About $11-12 hr for MA, $14-15 for LPN.

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  • 2 weeks later...

Who pays the unemployment insurance and worker's compensation for the MA/LPN? Depending on your state, that can work out to be a significant amount more than what the base hourly rate works out to be.

 

In illinois for example your $14-15/hr LPN would actually cost $20-25/hr.

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