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Neurosurgery offer

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#1 stellahead



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Posted 11 December 2016 - 11:24 PM

New job offer to chew on.

Job I have: Two years in neurosurgery, mainly spine, started as new grad. Earning 90K with annual bonus at SP’s discretion. Last year was 5K. 3 weeks PTO, 2 days CME, pays for my own malpractice policy with tail, no CME or licensing money. I’m not unhappy here, and I feel I’ve had good training in clinic and OR. Call every third weekend, but this is 95% patient phone calls. Mostly healthy patients and largely outpatient. One other PA. Really a princess gig as far as neurosurgery goes.
New job offer: 85K for first six months then 90K if review OK. 5% annual bonus of collectibles in excess of 1.5x my salary. Increases 5% per year until maxes at 40%. 3 weeks PTO. 3 CME days. $1000 CME costs. Will include me on their malpractice policy with no tail. This will include brain cases and sicker patient population with a lot of inpatient coverage. One in six weekends call, but this is real call. I really like the neurosurgeons and the other PAs. This is a much larger team, and they all seem to work well together.
My main points to ponder:
  1. This new job will be harder, but I feel I need to get more comfortable with the complicated stuff.
  2. Is it normal for PA to round and then round again with surgeon? This seems redundant to me.
  3. Is six weeks enough notice? I have no contractual notice obligations. 
  4. Reasonable counter offer: 85K to start and 110K after six months with 3 weeks PTO + 1 week unpaid
  5. I feel strongly about having my own malpractice with tail and not being on same policy as surgeon. I worry PA would be thrown under the bus pretty fast.
  6. Is it unreasonable to ask for access to billing?

Any feedback welcome. Thanks!



#2 mgriffiths


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Posted 12 December 2016 - 03:57 AM

1. That is completely up to you.


2. Does seem redundant, but I know multiple practices that do this - most of the time the second round is quite quick (or at least should be)


3. I think 6 weeks is plenty.  Not bad to give more, but enough that shouldn't be an issue.


4. I doubt you'll get the $110k, but not unreasonable for 2 years of experience.  The real question is how much the bonus will end up being.  Also, why go for 1 week unpaid?  I would personally ask for another week.


5. I doubt they will give that to you.  In all of my interviews all of the practices had an umbrella policy that covered all providers.  I would definitely counter to get tail paid for though.  That can be quite expensive, and you don't want that going forward.


6. If any of your compensation is tied to your billing you should have 100% access.  You should have access either way, but it is not even a question if your compensation relies on it.


I would ask what the average annual collections will be before countering.  You also have to decide what's most important, comparing income vs. PTO vs. tail vs. etc.


The other question is how many average hours worked per week compared to what you work now.

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#3 anewconvert


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Posted 12 December 2016 - 05:34 PM

Perhaps you are in a saturated area, but $90k for an experienced neurosurg PA seems like the doc either doesn't have an idea of your value or believes you don't understand your value.  The bonus structure is pretty great if you hang out there though.  I'd try to get either the initial bonus bumped to 15% (as if you were a 2 year employee of theirs) or work on getting that base salary up.  I would think the bonus would be less likely to irk the employer and would be a big chunk of change if you are efficient. 

#4 tunafish



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Posted 14 December 2016 - 02:07 PM

Perhaps you are in a saturated area, but $90k for an experienced neurosurg PA seems like the doc either doesn't have an idea of your value or believes you don't understand your value. 


My point exactly - this is the MOST compensated area of medicine. Why some PAs agree to this crap of a salary??? It is like asking your doc to work for 200K a year. RNs make over 100K a year


If you agree and start at 85K, no one will get you 110 in six months. the only way to get a desired salary is to negotiate it before you start. It is psychology101. If you do your job for 85 why do we have to pay you 110 for the same job?

#5 stellahead



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Posted 14 December 2016 - 11:45 PM

Update: the bonus is unachievable, basically. Countered 90 to start, then 110 after trial, 4 weeks PTO, and tail.

Rejected flat out. Not even an extra 5. And at least one surgeon expressed disdain that I dare counter.

I am in a terrible area for PAs: South Florida. And they're considering me as a new grad because I only know spine, not brain.

Luckily, I'm not unhappy where I am.

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