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First PA job – derm or neurosurgery?


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I’m a recent graduate, and I have two paths to consider. I’ve found a dermatologist who may be willing to train me for a year at a greatly reduced salary (probably about $40,000). There is no firm agreement. I’ve always wanted to do dermatology, and I know how hard it can be to find someone willing to train you. Currently, I’m spending time in the office to see if it’s a good fit.

 

Second option came up recently with a neurosurgeon who is looking for clinic coverage. He is also willing to train a new graduate, and I am in early negotiations regarding salary.

 

In terms of future earning potential and work/life balance, which path seems the best? 

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I know it's low, much lower than I made before PA school. That's why I'm asking if those with derm experience think it's worth it in the long run. Will this pay off? Several experienced derm PAs have told me they basically worked as "glorified MAs" during training, and the pay reflected that. I appreciate there's a lot to learn in a specialty, and I'm willing to sacrifice. But is this the norm for getting in? 

 

And any thoughts on neurosurgery, primarily clinic, would be appreciated. Does it get repetitive? Earning potential compared to derm?

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i have a different opinion here .... if a derm group offers you a salary w benefits at 50k for 1 year but promises education opportunities which seem very useful I would consider it. maybe work in they send you to 1 or 2 conferences on their dime as well during that time. 

 

In the contract it should identify the salary after 1year being close to 100k for dermatology. 

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If you had to choose between the two I would pick derm. Here's why:

 

You need to look at this in terms of career capital. I can virtually guarantee you will not enjoy neurosurgery. They are surgical slavery jobs with high PA turnover. Do you know how difficult it is to get a derm job with no experience??! Almost impossible. Supply and demand 101. Derm jobs often offer superior lifestyles and pay, which are both rare and valuable. Something rare and valuable always comes with a commensurate price, in this case its your time and money. I know it's insultingly low pay, but look at the long-term gain: if you stick it out for 1 or even 2 years, you now have derm experience which is very valuable career capital, indeed a relatively rare and valuable skill in the PA world. You can use this to your advantage to acquire jobs most of us only dream of---sane hours, big pay, and low stress yet interesting work--- all at a young stage in your career.

 

I would try to negotiate that to at least $50k, using PA residents as an example.

 

If you don't go that route then get into family med or primary care. You will at least have a broad experience base (making you more employable) and not be hamstrung by choosing a specialty you may not like.

 

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agree. the techs who work with me in the ER make more than 40 k/yr with less than 1 year of post high school education.

don't take less than 50 with a guarantee of 100 in a year. also specify that this is a training year, they pay a bunch of cme, send you to a bunch of conferences, have set aside time every week to discuss cases, maybe do an informal journal club, etc. also you should get a rock star benefits package if they are going to go cheap on the salary.

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Even a medical residency these days pays 60K+, at the very least 50K+, and many PA residencies are paying 50-60K+.  And you are getting a very diverse training (in theory) during a residency, not just by one doc in one office.  Personally there is no way in hell I'd work for 40K no matter how great the job, in part because my loans and debt don't allow such a luxury, and also because any job as demanding as being a PA, with the liability of being a PA, deserves a hell lot more money.  

 

Between the two I'd personally keep job hunting.  Neurosurg but just in the clinic?  Doesn't sound that great to me, personally, when there are considerable neurosurg jobs that allow OR and hospital time.

 

To me the bottom line is neither place values you.  On one hand you are only seeing clinic patients in a surgical practice, which most surgeons don't like to see, so he/she is just dumping the part of the job they don't like on you, and not training you to see in-pts and work in the OR.  On the other hand yes you could argue derm jobs are so hard to come by, and perhaps if it's really worth it go for it, but IMHO, you are going to make that office a hell of a lot more than 40K in the first year, no matter how much they train you, and they should pay you appropriately.  I'd keep job hunting for sure.  Yes as a new grad PA we do need a job that fosters learning, but at the same time we can't settle for this crap because a) it sets the bar low for future PAs and b) we have enough training to generate enough money for a practice, even as a new grad in a specialty, to deserve a salary that allows us to feed ourselves and our families while paying back our loans.

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Thank you all for your honest feedback. This forum has really helped me navigate some potential pitfalls. What a difference a day makes. The neurosurgery job came up with a solid offer. I won't go into details, but it was in line with AAPA salary survey. This pushed the derm offer to solidify or melt away, and it pretty much crumbled. No real funding available at this time, no job promise at the end, no benefits. 

 

Two things are very important to me: that my SP is willing to train me as a new grad and values my role, and that I can have a decent work/life balance. This job seems to offer both. And after about four months of searching, this offer is the first real one I've had. Already turned down three (one was 60K for three 12s in an urgent care!!).

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I hope it works out for you. I made a similar decision before I graduated; I took a spine surgery job because it was a solid offer on paper and they SEEMED willing to work with a new grad. Long story short it did not work out, nor did I like it, and I had a hell of a time finding work after that.

 

If the derm gig couldn't even agree to benefits and a nominal salary I think you made the right choice there. Offers like that are insulting and keep our profession down.

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I am also concerend with all the negative talk about Neurosurgery PAs.....I am really interested in being a surgical PA (that is always what I wanted) and I am really interested in neuro...do you really think all neuro PAs are that unhappy? Or is it just that they didn't know what they were getting themselves into?

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I'm sure someone will chime in here saying they are the exception that makes a rule, but I have yet to talk to a happy neuro PA in real life. It is a demanding area of medicine. Attending are very opinionated and all have different preferences, the cases are LONG, pts are often a wreck, and PAs are used for a lot of scut work. Not to mention long hours and call.

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Job ads like this sound pretty good to me. This isn't the job I applied for, but it's not very different. I've done my homework -- talked to PAs there and asked around in general about the practice. If it is a giant bait and switch, so be it. At some point, you have to commit and give it a go. I'll keep you posted.

 

http://www.physicianjobboard.com/jobdetails.cfm?jid=146426&utm_source=Indeed&utm_medium=cpc&utm_campaign=Indeed&rx_medium=cpc&rx_campaign=indeed25&rx_source=indeed

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stellahead: you'll never really know if you made the right decision. I started out in Spine surgery and later went into Derm. It's not impossible to do, it's just difficult. Keep in mind the long term goal- get as much experience as you can, pay off any loans, make some money, and then perhaps start looking into Derm. Sometimes it takes a while before you get the job that works for you. Just ask EMEDPA!

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I sat next to a neuro surg PA who loved his job and we were at our State meeting.   He had a collaborating MD that was a good one.  He's been at the job for almost 10 years.  The only downside is it wreaks havoc on your own spine and he was recovering from neck surgery for cervical compression and radiculopathy bilaterally that affected his ability to be the first assist.  His collaborating MD did the surgery and he has a 6 week or  more recovery period.

 

maybe not stay in it that long?

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I would never take a job making that low. Derm is a high pay specialty. I would seriously think about NS before you did that. I just left a job 2 months ago with a very nice boss, loved all the people. Wearing a lead apron bending forward caused me to have a low grade spondylolisthesis. This was due to a pars defect that I was unaware I had. If I continued In That job I would be crippled or need a fusion myself. It may still lead to that. I worked in Neurosurgery for her for 1 year. It is not worth it, no amount of money is. I didn't feel like I had a life. Never home. Because I ended up unable to wear the lead I have over 6 months of a great deal of radiation exposure. I took a pay cut for my present job but I am happy and slowly regaining my life. My spine unfortunately will never be the same not to mention the worries from radiation exposure.

 

 

Sent from my iPhone using Tapatalk

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