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Tough to turn down offers as a new grad, but harder to accept a terrible one

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#1 canada202



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Posted 14 February 2017 - 01:38 AM

Hi All,

Looking for some input from those experienced with the FL job market. I am a new grad freshly moved and licensed in FL. Just turned down my first offer.



2 days OR, 3 days clinic (expected to be seeing ~70pts/day after 6 months)

  • Salary: 85,000 no bonus, potential for bonus after 1 year
  • "at will employment w/ 90 day probation" 
  • NO PTO = burnout
  • Wants me to get my own malpractice and be reimbursed > I have spoken with a med malpractice attorney friend who thinks this is beyond being a terrible idea
  • No bennies for 3 months
  • Health insurance "% to be paid by employer and % by employee TBD"
  • "Keeping up with Dr. X's medical records deficiencies"...????
  • $1500 CME
  • Be clean shaven at all times..


After countering on nearly every point, I received a reply that consisted of telling me

  • "unhelpful for 1+ years"
  • "a liability in the OR for a long time"
  • "will slow the Dr. down for ~ 1 year"
  • "will be a money suck for ~6 months and MIGHT break even by 1 year"
  • "will never see 100k as a new grad since NASA makes 80k and avg for new PA is 72k"


Please feel free to correct me if I am being an overly pushy new grad, but I rejected this offer and took the opportunity to educate this particular physician on the value of a modern PA. I have studied the 2016 AAPA Salary report and understand my value to a practice. My argument involved simple RVU calculations that indicate with even lowest tier patient visits and seeing only 20pts a day, I will be generating >$60,000 in the first 6 months, not including OR assist fees, procedures, etc. Also no PTO in ortho sounds like death...


Why isn't RVU understanding and valuing ourselves included in the PA school curriculum?!?! 


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#2 cg02186



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Posted 14 February 2017 - 02:08 AM

I'm a soon to be new grad who is beginning the job search.  Completely agree with you that this is a ridiculous offer.  No PTO in ortho is pretty crazy.  Also, was that a typo or do they seriously think you'll see 70 patients in one day?!   Good on you for rejecting the offer and sticking up for yourself and the profession.  Hopefully no other PA accepts that position until it's valued correctly by the practice. 


#3 MT2PA


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Posted 14 February 2017 - 02:09 AM



The $85k is actually fairly on par for new grad in FL.  And bennies kicking in at 3 months is....not the best but not unheard of. Same with the 90 day 'probation'/at will.  Fairly common hospital red tape (for general healthcare at least).  But that's about it.  The rest is the biggest red flag you will ever see.


70 pts a day?!  7 minutes per patient?  No PTO ever?  Do these folks even know what a PA is?


Do NOT feel bad about walking away from that.  

#4 qmoney22



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Posted 14 February 2017 - 02:56 AM

What a ridiculous offer. I hope you were very blunt in telling them the value of a PA. That is just insane that they think that it would be ok to send someone an offer like that. Also, agreed with other response in hoping that no other PA takes it. Wish more PA's and PA Students used this site so we could get the word out about not accepting bad offers like this!

#5 canada202



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Posted 14 February 2017 - 03:09 AM

Thanks for the support. I really wish that others would advocate for themselves and the profession a little more strongly although I know as well as any how tempting it is to take something just to get that initial 1-2years experience...Any yep, no typo. He schedules patients q5minutes. All about that bottom line.


For what it's worth, my response:

Thank you for your thoughtful reply, I respect where you’re coming from, however I will not be accepting your offer


I want to make it clear that I didn't pull my compensation request figures out of thin air, I have done significant research and am aware of the value a PA adds to a practice such as yours. I have turned down 2 offers already in the area for >$100,000, neither in derm. That amount is very much within the norm at this point in time, even for a new graduate. Attached you will find the charts detailing the exact breakdown by specialty and state. In Florida, 50% of new graduates in orthopedics make at least $89,000; 25% make >$100,000. I am very confident in my abilities and consistently yield impressed patients that bring ever increasing value to the practices in which I work. I value these skills well within the top 25% of my peers and as such I believe I made a very reasonable offer. 


So you’re aware how I came to my valuation: the lowest level office visit for an established patient is .56 RVU, which is equivalent to ~$20. A new patient lowest level visit is 1.22 RVU which is equivalent to ~43. (https://www.cms.gov/apps/physician-fee-schedule/overview.aspx)

You told me I would initially be in the office 4/5 days. Let's say on the low end starting out I see only 20pts/day; 10 established, 10 new, at their lowest respective RVU values. This would yield $63,000 in the first 6 months. If I was seeing the 70-80pts that you indicated I would reach, that number jumps to ~$250,000 in 6 months. That is not including any procedures I perform nor is it including the revenue from having me as a first assist on your surgical cases. Rather than losing money on me (or another PA), it would be a fair and low-end assessment to say a PA would produce more than triple their salary for your practice in the first year.


One final thing of note. One of the offers I rejected was from ____ and it clearly included malpractice provided for me, on their policy. I've never heard of a PA being asked to get their own and it really send the message that the practice isn't there for the employee if a bad situation were to occur. 



I thank you again for your time, good luck in finding the candidate you're looking for. 

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Posted 14 February 2017 - 05:36 AM

"be clean shaven at all times"-deal  breaker alone

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#7 mgriffiths


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Posted 14 February 2017 - 06:46 PM

"be clean shaven at all times"-deal  breaker alone

I don't even understand that.  I completely understand that as a professional I shouldn't look homeless, but who cares how I groom myself as long as I am clean.  We are so beyond the days of no piercings, tattoos, etc.  These used to be things providers would comment on in their notes hinting at potential risky lifestyle behaviors, but today it's no longer any indication - and this is coming from someone who has never had a beard, tattoo, or piercing ever in his life!

#8 ventana


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Posted 14 February 2017 - 10:01 PM

Best response is simply to say it is an unacceptable offer, state why, provide the data from AAPA and let them shoes do the walking/talking.....

Be professional, be firm, but say no and walk away

The Fine Print - you didn't pay for my advice so please consider this when reading it. I don't care about typos so don't tell me I can't type.:eek:

I vote for a  Full Practice Authority and staged independent practice.




#9 AbeTheBabe



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Posted 16 February 2017 - 03:06 AM

Wow, that is a horrible offer. The pay is okay, but the benefits and expectations are TERRIBLE. If you saw 70 patients per day you definitely bringing in more than $500,000 to the practice. Unless you're working patients from 6AM to 10PM, that is not enough time for 70 patients, ESPECIALLY when you factor in charting. Clean shaven at all times? Give me a break, it's 2017. I've had a beard for years. Didn't shave it for PA school interviews and I didn't shave it for job interviews, no way in hell I'm shaving my beard for a shitty offer like that!

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#10 MyNameWasUsed


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Posted 17 February 2017 - 02:40 AM

looks like a terrible offer. 

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