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Enticing New Grad Contract


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I am a new grad and came across the following proposal after interviewing for an ENT position in North Carolina:

 

PROPOSAL OF TERMS FOR EMPLOYMENT

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WORK SCHEDULE:  5 DAY WORKWEEK 8 AM – 5 PM, LUNCH 12-1 PM. 

 

PA WILL BE ASSIGNED PATIENTS BY THE PRACTICE WITH GOAL OF MAXIMIZING PHYSICIAN AND PA PRODUCTIVITY AT THEIR LEVEL OF EXPERTISE/KNOWLEDGE.   THE PHYSICIAN WILL MENTOR THE PHYSICIAN ASSISTANT UNTIL HE/SHE GAINS APPROPRIATE SKILLS/COMPETENCY TO WORK INDEPENDENTLY

 

SALARY: $90,000 PER YEAR PAID IN MONTHLY INCREMENTS

 

BONUS: PRODUCTIVITY BONUS BASED ON 40% OF PHYSICIAN ASSISTANT-GENERATED INCOME OVER $200,000. 

 

BENEFITS:  THREE WEEKS PAID VACATION PER YEAR (INCLUDES 5 PAID HOLIDAYS), PAID SICK AND/OR CONTINUING MEDICAL EDUCATION LEAVE (5 DAYS); AND CME/ANNUAL DUES/LICENSURE  $3000 ANNUAL ALLOWANCE

 

RETIREMENT PLAN (SIMPLE IRA) AFTER ONE YEAR OF EMPLOYMENT (3% MATCH)

 

MALPRACTICE INSURANCE PAID BY THE PRACTICE

 

ON-CALL (FIRST CALL):  5 WEEK NIGHTS PER MONTH, 1 WEEKEND PER MONTH

 

NON-COMPETE  RESTRICTION: AFTER ENDING EMPLOYMENT WITH THE PRACTICE, PA WILL NOT SEEK EMPLOYMENT  WITH AN ENT OFFICE LOCATING IN NEIGHBORING COUNTIES FOR A PERIOD OF ONE YEAR.

 

IN ADDITION TO SEEING PATIENTS IN CLINIC AND BEING ABLE TO PERFORM CLINIC PROCEDURES, THE PA WILL  BE ASSIGNED PRE-OPERATIVE VISITS, POST-OP VISITS AND SUTURE REMOVALS WHERE MINIMAL INPUT FROM PHYSICIAN IS NEEDED, AND MAY BE RESPONSIBLE FOR HOSPITAL DISCHARGES.  WHERE REIMBURSABLE, THE PHYSICIAN ASSISTANT WILL BE GIVEN THE OPPORTUNITY TO ASSIST IN THE OPERATING ROOM ON CASES.

 

*The offer does not include medical benefits

 

I have a few offers on the table and I have yet to come across this type of offer. I am very intrigued but also a bit nervous about the possibility it may not work out as I am the first mid-level that this provider has hired.

 

The productivity bonus: I keep 40% of all revenue over 200K that I bring into the clinic.

 

Can someone please give me some guidance?

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"NON-COMPETE  RESTRICTION: AFTER ENDING EMPLOYMENT WITH THE PRACTICE, PA WILL NOT SEEK EMPLOYMENT  WITH AN ENT OFFICE LOCATING IN NEIGHBORING COUNTIES FOR A PERIOD OF ONE YEAR."

 

what qualifies as neighboring counties? what's the mile-radius to not work in? if broken how much is the penalty?

 

more importantly, can anyone please tell me HOW you working at a different ENT office w/in the mile-radius (that is already present in that neighborhood at time of employment)  is going to be able to be a competition!?

 

enticing? not quite.

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Out of curiosity, I looked at the NC marketplace for healthcare (we have healthcare through her employer while I'm in PA school). Over $1,000 a month for a health, nonsmoking family of three.

 

No promise that will go down. Food for thought.

 

I actually got some quotes for BCBS (the only carrier in NC) as well. It was roughly $1200 for my family of three as well. 

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"PA WILL BE ASSIGNED PATIENTS BY THE PRACTICE WITH GOAL OF MAXIMIZING PHYSICIAN AND PA PRODUCTIVITY AT THEIR LEVEL OF EXPERTISE/KNOWLEDGE. "

 

This likely means pre/post op visits will dominate your time. These are global charges. This means it is revenue generated by the surgeon, not you, but you are freeing them up to "maximize their production." This may dramatically reduce your revenue production and make I difficult to reach bonus threshold. I would get clarification.

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looks good, but it is not.... (maybe)

 

pay could be great - but they have to give you FULL access to books, AND bill everything under you - this appears to be a small doc practice and they love to take advantage of you

 

No medical - no way - every job I have had pays most of family, or 100% of individual

 

Non-compete - will not go into details (all over this site) but the non-compete can not overly restrict your ability to make a living.  all neighboring counties... yeah no way - something like 5 miles for one year would be reasonable

 

 

 

 

So counter with 

same offer PLUS

 

Full Medical for family

Non-compete of 5 miles for one year

Mandatory access to all billings, and that anything you do it billed and tracked under you

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I am definitely concerned by the lack of medical coverage and the schedule. That's a lot of call to go on top of having to work Monday through Friday for 45 hours. The bonus part definitely sounds sketchy. Why would they give up 40% of their revenue over 200,000? They probably make that much on you within a few weeks...? The wording is actually odd. It says bonus BASED ON 40 percent of revenue not bonus OF 40 percent.

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looks good, but it is not.... (maybe)

 

pay could be great - but they have to give you FULL access to books, AND bill everything under you - this appears to be a small doc practice and they love to take advantage of you

 

No medical - no way - every job I have had pays most of family, or 100% of individual

 

Non-compete - will not go into details (all over this site) but the non-compete can not overly restrict your ability to make a living.  all neighboring counties... yeah no way - something like 5 miles for one year would be reasonable

 

 

 

 

So counter with 

same offer PLUS

 

Full Medical for family

Non-compete of 5 miles for one year

Mandatory access to all billings, and that anything you do it billed and tracked under you

In North Carolina that non-compete is likely enforceable simply due to the fact that he can work in another specialty and therefore isn't restricted.  The time and geographic constraints are probably enforceable as well.  It's moot until such a time that he attempts to test the non-compete though.  A small practice isn't likely to sue unless he fished clients before leaving the practice... even then, if those patients left they are probably gone so you aren't looking at getting much more than vengeance in the matter

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w/o medical, and having to take call, you should be making $110K out the gate, minimum, imho ($10K extra d/t lack of medical; $10K min for call shifts). I'm a new grad at $94K with medical, no call, no weekends, no holidays. And major red flags to me are the very first sentence under the work schedule, and the statement about how most of the preops, POs and suture removals go to you - you are gonna get hosed cuz those will be under global billing periods. Good luck getting the bonus pay on revenue generated!

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