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Ortho Job Offer


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Some of you have probably seen my previous threads, but I finally have a new ortho job offer that I am excited about!  I have one more interview later this week as well!

 

New Job: Southern IN (pretty large practice, something like 14 docs and around 10 NP/PAs) - cost of living is slightly below average

  • Schedule most days 50% surgery and 50% clinic - supposedly around 30 patients per half day in clinic
  • Salary: $90K with NO bonus, but call is paid separately. I have calculated this out to approximately $10k per year.
  • 15 days PTO with additional 2 personal days
  • 5 days sick time
  • $2500 CME + 5 days PTO (I actually need to confirm this as it sounded like she said on the phone, "$2500 OR 5 days PTO) - big difference!
  • Health insurance is reasonable cost
  • essentially an 8% match in 401k (I put in 5% and end up with a total of 13% due to match and profit sharing)
  • Paid licensing, credentialing fees, and any other fees I would need to practice
  • Malpractice (under the practice's umbrella policy and includes tail)
  • Disability insurance, life insurance (I don't know specifics on any of these)
  • $10k sign on bonus to be used as I please (moving/loans/etc.)
  • There is NO separate/ongoing loan repayment
  • I am never scheduled to work weekends (other than call), but can offer to work Saturday clinic or take additional call for extra pay (I stressed pretty heavily that loans are a major priority!)

My questions:

  • They have stated that I will generally be paid $200 per call shift, and this does not change whether I do nothing, take phone calls, or have to go in for surgery.  Is $200 reasonable?
  • "On regular night call every 3rd Monday night, rotates call on Wednesday night, Friday night , Saturday and Sunday-with the number of doctors taking call, her rotation is about every 6-8 weeks on these days. It’s not a definite time frame due to changes, vacation, swaps, etc." - this is the exact quote regarding my supervising physician's schedule for call.  Assuming $200 per day/night call (therefore $400 per weekend), can someone who is more familiar with call schedules double check my math?  As I said above, I calculated it to be around $10k.
  • I was thinking about countering the base salary at $98k, with the hopes of getting somewhere around $95k.  My plan is to make them aware that my annual loan repayment will be ~$16,500 for 10 years.  An $8k increase would be approximately half.

 

Thanks, and any input is appreciated!

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I just got some questions answered:

  • I am actually not on the call schedule, so that $10k doesn't exist.  BUT, I can let the physicians know that I am willing to take call and cover for them as they would like.  There is also Saturday clinic that I am never scheduled for, but can cover as well.
  • The CME is $2500 AND 5 days PTO. 

 

Nice to have the "freedom" to not have call or weekend work, but with my loans that $10k would definitely be missed!

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I just re-read your post.

 

The flat salary with NO bonus is hokey to me.

 

My experience in ortho is shared revenue. We had a base salary and quarterly reconciliation. We, the PAs, got a percentage of revenue we produced or helped to produce. 

 

You should be billing for clinic patients seen unless you get 100% of no-pay post ops dumped on you. You should be billing for injections, casting, etc.

 

I made well over $130K with these reconciliations and a base salary of $80K with 15 years experience at the time and that was nearly 10 years ago.

 

We had a motto of "eat what you kill". My quarterly reimbursements after taxes were often $7000-$10000 at a time. We paid overhead just like the docs.

 

If we were on call and went to the OR - we got 90% of the PA billing reimbursement - 10% to the billers and collectors. 

 

Our call weekends were worth $500 PERIOD and we rounded at 3 hospitals (sometimes 2 depending on who was on call) and then we got paid for going in to the ER or OR  We shared call one night a week and went in if called. We didn't get paid for the one night a week because we just worked with the late doc, not overnight. 

 

So, I am not too keen on the flat salary with no advancement or reimbursement based on billing.

 

There is so much more potential and your surgeon could be walking away with your assist fees to your detriment.

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This is similar to my new grad package. 90k year 1 with increase to 92.5k once I was in the black. 3 weeks PTO + 1 week and $1500 for CME. Call schedule is similar and I get and extra $50/patient if I have to actually go in for a consult or surgery but otherwise call is included in my salary. Graduated bonus structure.

 

Patient load sounds about right if 15 minute appointments.

 

Call pay is adequate.

 

Sign on bonus is good.

 

Just give them your counter offer, no need to explain they probably expect a counter offer. Worse thing to happen is they stay firm at 90k.

 

I would also go for a bonus plan too with access to your billing. If you like this office this is a good deal to get some experience and you can always move on or renegotiate for more salary.

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Here is what I make now as a new grad, although in a much higher COL area (Los Angeles).

  • Schedule M-F, usually work 40-45hrs/week
  • Salary: $95K + 10% of all billing (office visits, injections, assisting). Last quarter I made $2,500.
  • 16 days PTO.
  • $2000 CME + 5 days CME
  • Health insurance is only reasonable for employee only, but I'm on my wife's plan which is great.
  • Only 2% match in 401k.
  • No paid licensing/fees but I can use my CME for this if I want.
  • Malpractice (no tail)
  • Long term disability insurance and life insurance
  • No sign on bonus/repayment
  • Most importantly to me: No call, weekends, or holidays!
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Here is what I make now as a new grad, although in a much higher COL area (Los Angeles).

  • Schedule M-F, usually work 40-45hrs/week
  • Salary: $95K + 10% of all billing (office visits, injections, assisting). Last quarter I made $2,500.
  • 16 days PTO.
  • $2000 CME + 5 days CME
  • Health insurance is only reasonable for employee only, but I'm on my wife's plan which is great.
  • Only 2% match in 401k.
  • No paid licensing/fees but I can use my CME for this if I want.
  • Malpractice (no tail)
  • Long term disability insurance and life insurance
  • No sign on bonus/repayment
  • Most importantly to me: No call, weekends, or holidays!

 

 

So your saying that you only billed for $25,000 in one quarter? Collections typically are a fraction of that. Maybe I am missing something? Are you primarily seeing post ops? Low volume sx's? 

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Thought I would update you all...decided to neglect the offer.  I asked for some loan repayment and they denied me.  I just didn't get the feeling that my salary would increase at all.  The HR lady told me raises were based on annual performance reviews and the raise was between 2.5% and 3.5%, based on where your "score" fell into the average of everyone.  This score was not based on any quantitative data, completely neglecting billing/collections and efficiency.  It basically boiled down to how well your supervising physician thought you were doing, and that is if they even completed the performance review.  If they don't do it you get no raise that year.  I found out that an NP that has been there 8 years hasn't gotten a raise yet...NO THANK YOU.

 

Had another interview in Chicagoland Thursday/Friday that I am very excited about and waiting to hear back from, and am in the process of scheduling another interview elsewhere!

 

It's nice to have so many options, but it's frustrating to run into so many duds...

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Well, interesting update.  This clinic called me today to ask if I would entertain a "counter offer."  The only change is that they would do $5000 of loan repayment for years 2 and 3, making a total of $20k if you include the initial sign on bonus.  She also told me that they have discussed adjusting salaries to include a productivity bonus in the past, but are going to start making that transition in the future - of course I wouldn't count on this unless something was written in the contract, just something she brought up.  I think they are realizing this has become the industry standard - at least for orthopedics.

 

I was happy they liked me enough to make a new offer, even though it is paltry.  I plan to call back tomorrow and counter again with $95k salary and forget the other $10k of "loan repayment," everything else stays the same.

 

I have not heard back from the job in Chicagoland, but do expect an offer from them.  Then I plan to basically compare the two jobs and choose one.  My assumption is that both offers are going to be similar financially, and after getting some experience my salary doesn't increase as it should I can always look elsewhere to get a feel for what I should be paid.

 

One of the things I do really like about this job is that I am not on the call/weekend schedule.  This makes for a much better lifestyle, but if I want the extra money for loans or whatever I can always make it known that I am available to pick up shifts.  Of course there is no guarantee, but I know how much docs generally despise call/weekend work!

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