Family Med Offer - Need Advice

[bears610]

New grad offer in Georgia

 

Salary  - 85 base with monthly production bonus . Production bonus = " product of 15% multiplied by excess of PAs allocable collections over 40k during the applicable determination period (calendar month)

 

Expected Patient Load - 20 pts max for a typical 8 -5 when im establised. (Edit)

 

     - Ill be honest, i have no idea how that bonus works.  HR Manager said "most new grads make at least 100k in their first year" for whatever that's worth lol.   Also said that they're not flexible in negiotiating 85k, because of the friendly bonus structure. 

 

 

Retirement plan - Offers 401k, but doesn't currently match.  The company is looking into possibly matching in the future.

 

Health Insurance - Company covers 50%

 

Non - compete clause: 2 years post, 15 mile radius for each location (7 possible locations) that i work with

 

CME: 1 week PTO + 1K

 

PTO: 2 week PTO + 5 paid sick leave

 

Licensing, DEA, professional fees fully covered.

 

Malpractice: "During the term of this agreement, the practice shall pay on behalf of the PA the premiums for PA's professional liability insurance.  The level of coverage of such insurance shall be commensurate with that of the other physician assistants employed by the practice.  If the cost of PA's professinal liability insurance is above the average market rate, considering speciality, tenure, and other factors specific to PA, the practice in its sole discretion ay require PA to pay the difference in the cost. "

                  "After the termination of PA's emplyment with the practice for any reason whatsoever, PA shall be responisble for his/her own professional libaliity and PA shall also be required to maintain and pay all insurance premiums for PA with teh same liability amounts as practice was providing for PA while employed ( wheter in the form of tail coverage or otherwisee) covering claims made with respect to PA's practice of medicine while an employee of the practice"

 

      Not sure what kind of malpractice I would have based on this wording of the contract.  Can somebody help me out here?

 

 

No SOB or Relocation in contract, but did say during interview that will consider 5k Relocation.  I Will have to add that in my counteroffer.

 

Hours - "Physician assistant will make him/herself available to work where assigned by the practice during the hours as set forth on a scheduel to be provided to physician assistant by the practice.  The practice may amend physician assistant's hours without advanced notice to PA. PA shall have responsibility for certain night call, holiday and weekend coverage."

             Not sure if i like this wording in contract.  No mention of expected hrs per week or holidays I would get off. Though, I was told that initially the schedule would be 8-5 m - f, but will eventually transition to 3 week rotation of me doing weekends once every 3 weeks. Hours avg out to 41/week. They did tell me which location I would be working at long term, but that's not in contract.  They did bring up that they may move me to a different location in future.

 

Week 1

M 8 - 7 (9.5 hrs)

T 10 - 7 (7.5)

W 8 - 5  (7.5)

R 10 - 7 (7.5)

F 8 - 5 (7.5)

S x

Sx

 

Week 2

M 8 - 7 (9.5)

T 10 - 7 (7.5)

W 8 - 5 (7.5)

R x

F 8 - 5 (7.5)

S 9 - 6 (8)

S 12 - 5 (5)

 

Week 3

M 8 - 5 (7.5)

T 8 - 5 (7.5)

W x

R 8 - 7 (7.5)

F 8 - 5 (7.5)

S x

S x

 

Please critique it. I haven't asked yet, but im assuming i get 1.5 and 0.5 hr lunch breaks based on those hours.

 

 

At the end of the day, I really am interested in the this practice (location + my preferrd speciality), but not sure if this is a good contract.  Any help as far as critiquing and how i should proceed in negotiating would be greatly appreciated.

 

 

My concerns and questions.

 

1. Lack of 401k match.  Should this be a deal breaker.

2. Non competitive clause ina major city = how to negiotiate this? Is this a deal breaker if they say no?

3. Is that 3 week rotation typical? I'm okay with it, but then again, what do i know. 

4. Company covering 50% of insurance coverage.  Should my expectations be full coverage?

4. There's a lot of mumbo, jumbo in the contract that im jjust not sure is standard or not.  

[mgriffiths]

I'll answer your specific questions first, but please understand I am almost a new grad myself - I have secured a position in orthopedics and this is my second career, so I have a bit of a background I guess.

 

1.  I wouldn't say lack of a match is a deal breaker as long as the rest of the compensation makes up for it.  In other words if you had a job that pays $100k with no match vs. a job that pays $90k with a 3% match, then you actually come out ahead with the $100k job (ignoring taxes).  You just have to look at it holistically.

 

2. A lot of non-competes are 100% unenforceable because they are too broad.  The bottom line is that in most states a company cannot keep you from being able to work.  I would try to get this stricken from the job altogether, but if you can't I would definitely research Georgia's stance on non-competes and maybe even contact a lawyer to review your contract.  This is probably a good idea anyway since it is such a complex contract.  I didn't do this, but I've been told this costs just a few hundred dollars.  For me, as opportunities began to open up for me I stopped looking at any jobs that included non-compete clauses.  With my position, the only limitation to me leaving is I have to return my sign on bonus if I leave before 24 months of full-time employment.  It's just less of a headache.

 

3. I've never worked in FM, but the rotation doesn't look too bad.  Personally, I like having my weekends so that was something I looked for, but it may not be as important for you.  But, you should be paid a bit more for working those weekend days.  I do know there are A LOT of FM jobs out there that are just normal business hours with maybe one half-day Saturday worked every 3-4 weeks.

 

4. The question here is if you are single.  A lot of the jobs I interviewed for covered almost all of the monthly premium for a single employee.  Actually had quite a few that covered 100%.  I don't know the exact percentages, but I think as you start adding a spouse and/or children is where you see the 50% coverage more often.

 

5. As mentioned earlier, I would likely have a contract/employment lawyer take a look.  It will be a couple to a few hundred dollars, but better to understand now than to have something bite you in the rear later.

 

Now just my general thoughts: I would want the bonus model explained in a very clear manner to me.  I just don't understand why they make it so complicated unless their goal is to screw over the employee.  I would also fight for more PTO.  I really don't like less than 3 weeks.

 

I don't like the wording of the malpractice at all.  They should not be stipulating what you must have after you leave them.  I would definitely fight for tail coverage.

 

I don't like their wording when it comes to scheduling and holidays.  It is unacceptable for them to change your schedule without prior notice.  You are a professional and they should treat you as such.  It's fine for them to ask you to change your schedule, but to demand it without notice...I'll be clear, that alone would be a deal breaker for me.  You are essentially always on call.  They could call you the night before and tell you that you aren't working, or tell you that you are.  As a professional you should have more control over your schedule.  Secondly, I really don't like, "The practice may amend physician assistant's hours without advanced notice to PA."  Does this mean they could make you part-time whenever they want?  To unsteady a position for family medicine in my opinion.

 

Lastly, 3-4 patients per hour is too much, unless all you are seeing is people with runny noses.  In an 8 hour day that is 24-32 patients.  That is overwhelming from what I have been told.  That is 15-20 minutes maximum per patient to take history, examine, discuss treatment plan, chart, review labs, review images, etc. and that is assuming you work straight through lunch.

 

Overall, from what I have seen the compensation sounds pretty good at $100k, but that assumes that is a true estimate.  The rest is highly questionable.

[marktheshark89]

My quick read of the bonus structure makes it seem like your monthly bonus is 15% of whatever you collect over 40k. Its actually a pretty crappy bonus imo. 40k is probably an good month of collections once you are fully up to speed and scheduled. On a great month 50k, in which case you''d get an extra 1.5k. If you did that montly youd be over 100k as they suggested. The typical bonuses i have seen are 20-30% of collections after 2.5x you salary. In your case 2.5x your salary is around 225k. If you brought in roughly 40k per month that would amount to 20% of 255k or an extra 50k bonus: also realize it will likely take you a few years to establish a strong patient base and chances are you will likely be bringing in closer to 30k per month over the first 1-2 years, which would mean no bonus, if I'm interpreting their language correctly. For perspective, I work in outpatient IM and was told they would be happy with 250k collections for my first year. Or approximately 20-25k per month.

[bears610]

My quick read of the bonus structure makes it seem like your monthly bonus is 15% of whatever you collect over 40k. Its actually a pretty crappy bonus imo. 40k is probably an good month of collections once you are fully up to speed and scheduled. On a great month 50k, in which case you''d get an extra 1.5k. If you did that montly youd be over 100k as they suggested. The typical bonuses i have seen are 20-30% of collections after 2.5x you salary. In your case 2.5x your salary is around 225k. If you brought in roughly 40k per month that would amount to 20% of 255k or an extra 50k bonus: also realize it will likely take you a few years to establish a strong patient base and chances are you will likely be bringing in closer to 30k per month over the first 1-2 years, which would mean no bonus, if I'm interpreting their language correctly. For perspective, I work in outpatient IM and was told they would be happy with 250k collections for my first year. Or approximately 20-25k per month.

 

 

I'll answer your specific questions first, but please understand I am almost a new grad myself - I have secured a position in orthopedics and this is my second career, so I have a bit of a background I guess.

 

1.  I wouldn't say lack of a match is a deal breaker as long as the rest of the compensation makes up for it.  In other words if you had a job that pays $100k with no match vs. a job that pays $90k with a 3% match, then you actually come out ahead with the $100k job (ignoring taxes).  You just have to look at it holistically.

 

2. A lot of non-competes are 100% unenforceable because they are too broad.  The bottom line is that in most states a company cannot keep you from being able to work.  I would try to get this stricken from the job altogether, but if you can't I would definitely research Georgia's stance on non-competes and maybe even contact a lawyer to review your contract.  This is probably a good idea anyway since it is such a complex contract.  I didn't do this, but I've been told this costs just a few hundred dollars.  For me, as opportunities began to open up for me I stopped looking at any jobs that included non-compete clauses.  With my position, the only limitation to me leaving is I have to return my sign on bonus if I leave before 24 months of full-time employment.  It's just less of a headache.

 

3. I've never worked in FM, but the rotation doesn't look too bad.  Personally, I like having my weekends so that was something I looked for, but it may not be as important for you.  But, you should be paid a bit more for working those weekend days.  I do know there are A LOT of FM jobs out there that are just normal business hours with maybe one half-day Saturday worked every 3-4 weeks.

 

4. The question here is if you are single.  A lot of the jobs I interviewed for covered almost all of the monthly premium for a single employee.  Actually had quite a few that covered 100%.  I don't know the exact percentages, but I think as you start adding a spouse and/or children is where you see the 50% coverage more often.

 

5. As mentioned earlier, I would likely have a contract/employment lawyer take a look.  It will be a couple to a few hundred dollars, but better to understand now than to have something bite you in the rear later.

 

Now just my general thoughts: I would want the bonus model explained in a very clear manner to me.  I just don't understand why they make it so complicated unless their goal is to screw over the employee.  I would also fight for more PTO.  I really don't like less than 3 weeks.

 

I don't like the wording of the malpractice at all.  They should not be stipulating what you must have after you leave them.  I would definitely fight for tail coverage.

 

I don't like their wording when it comes to scheduling and holidays.  It is unacceptable for them to change your schedule without prior notice.  You are a professional and they should treat you as such.  It's fine for them to ask you to change your schedule, but to demand it without notice...I'll be clear, that alone would be a deal breaker for me.  You are essentially always on call.  They could call you the night before and tell you that you aren't working, or tell you that you are.  As a professional you should have more control over your schedule.  Secondly, I really don't like, "The practice may amend physician assistant's hours without advanced notice to PA."  Does this mean they could make you part-time whenever they want?  To unsteady a position for family medicine in my opinion.

 

Lastly, 3-4 patients per hour is too much, unless all you are seeing is people with runny noses.  In an 8 hour day that is 24-32 patients.  That is overwhelming from what I have been told.  That is 15-20 minutes maximum per patient to take history, examine, discuss treatment plan, chart, review labs, review images, etc. and that is assuming you work straight through lunch.

 

Overall, from what I have seen the compensation sounds pretty good at $100k, but that assumes that is a true estimate.  The rest is highly questionable.

Thanks for taking the time to answer my questions. I really do appreciate it.  

[loliz]

How are you calculating your hours? Either you plan on a very long and uninterrupted lunch break (unlikely) or the hours required are much higher than the "estimated weekly hours." I see no way that 8 am-7 pm can be considered a 9.5 hr shift. Can you clarify?

[dchampigny]

Hard pass.

 

3-4 patients an hour for a new grad is too much.

[bears610]

How are you calculating your hours? Either you plan on a very long and uninterrupted lunch break (unlikely) or the hours required are much higher than the "estimated weekly hours." I see no way that 8 am-7 pm can be considered a 9.5 hr shift. Can you clarify?

 

That's what it shows on the sample template HR provided. 

Hard pass.

 

3-4 patients an hour for a new grad is too much.

I should clarify that line. They said 20 max for a typical 8 - 5 for when im established. So whatever the typical pt/hr rate that comes out to.  

[bears610]

Btw, is there any resources you guys can direct me to on this forum or elsewhere on how to negotiate a contract. Feeling lost on how to ask for what I want, if that makes sense. 

[loliz]

That's what it shows on the sample template HR provided. 

 

 

 

I would definitely clarify that. 

[mgriffiths]

After reading the bonus structure a bit more thoroughly, with the help of marktheshark's interpretation.  I completely agree with him.

 

It sounds like 15% on anything above $40k in collections per month.  In other words, you get a 15% bonus on collections over $480,000 per year.  Plain and simple, that is crappy.  To reach the $100k total compensation you must collect $580,000 per year.

 

If we break this down, typically an employee costs 1.5-2x their compensation (usually closer to 1.5x).  Your compensation is $85,000/year therefore your cost is $170,000 being conservative.  Assuming you reach a full $100k compensation, your employer made a total of $395,000 in collections from you (you would still need to subtract the cost of your MA, billing coordinator, etc. before calculating profit).

 

I'm all for employers making a profit, and I understand that the doctor(s) have to review charts, but that this still absurd.  I'm sure there are costs I'm not including that detract from the $395,000, but is it incorrect to think the doctor is making at minimum $200,000 from this?  Why should the doctor make twice as much as you on your own work?

 

In reality, I'm not even sure you would even actually bill for that amount each year without working yourself to death in Family Medicine.

[loliz]

I would really have an issue with that 15 mile non-compete; especially if you are going to be working at multiple sites. That pretty much guarantees that you will need to move if you want a new job. 

This link might give you a better idea of what a 15 mile radius really means. I was curious and put my work location in and found that a 15 mile radius pretty much rules out my city and much of the suburbs. 

 

https://www.mapdevelopers.com/draw-circle-tool.php

[mgriffiths]

I would really have an issue with that 15 mile non-compete; especially if you are going to be working at multiple sites. That pretty much guarantees that you will need to move if you want a new job. 

This link might give you a better idea of what a 15 mile radius really means. I was curious and put my work location in and found that a 15 mile radius pretty much rules out my city and much of the suburbs. 

 

https://www.mapdevelopers.com/draw-circle-tool.php

 

This goes back to whether the non-compete is even enforceable.  A non-compete cannot keep you from being able to work - but of course every state is different.  Jimmy John's is the classic case.  They used to include a non-compete in every employee contract stating you couldn't work at another sandwich shop/restaurant within a radius of ANY Jimmy John's location.  This basically precluded any employee from ever being able to work in a sandwich shop again.  This was recently found illegal and Jimmy John's has struck the non-compete from their employee contracts.

[bears610]

This goes back to whether the non-compete is even enforceable.  A non-compete cannot keep you from being able to work - but of course every state is different.  Jimmy John's is the classic case.  They used to include a non-compete in every employee contract stating you couldn't work at another sandwich shop/restaurant within a radius of ANY Jimmy John's location.  This basically precluded any employee from ever being able to work in a sandwich shop again.  This was recently found illegal and Jimmy John's has struck the non-compete from their employee contracts.

 

Under Georgia’s updated statute, employers may now restrict the post-termination competitive activities of four categories of employees. These employees include: (1) sales employees; (2) key employees or professionals; (3) management employees (which are described more fully in the statute); and (4) employees that customarily or regularly solicit customers for the employers. However, any non-compete provision which restricts any employees who do not fall into these categories from competing with the employer, after termination of the employment agreement, will be found to be overbroad and unenforceable by the court.

The new statute also provides that the activities, products, or services found to be competitive to the employer may be construed to include any such activities, products, or services “of the type conducted, authorized, offered, or provided within two years prior to termination,” or any similar language utilizing a time period of the same or a shorter duration. See Ga. Code Ann., § 13-8-53©(1).

As to the geographic area in which the employer can restrict the employee from competing with the employer’s business, Ga. Code Ann., § 13-8-53 provides that employer’s may now “estimate” the employee’s future territory when defining the area to which the non-competition provision applies. According to the statute, the phrase, “the territory where the employee is working at the time of termination,” or language similar to that, is considered sufficient to describe the geographic area where the employee will be restricted from competing with the employer, so long as the employee “can reasonably determine the maximum reasonable scope of the restraint at the time of termination.” See Ga. Code Ann. § 13-8-53©(2).Overall, Ga. Code Ann., § 13-8-53 provides greater latitude for employers to determine the territory in which they can restrict an employee’s competitive activities.  

 

     

Based on what i've read, looks like what is in my contract is enforceable. Apparently, GA is more "pro-employer" when it comes to non competes. 

[bears610]

How are you calculating your hours? Either you plan on a very long and uninterrupted lunch break (unlikely) or the hours required are much higher than the "estimated weekly hours." I see no way that 8 am-7 pm can be considered a 9.5 hr shift. Can you clarify?

 

So i got that part clarified.  It is 1.5 hour lunch break.   To be honest, the schedule is the biggest thing holding me back right now.  Not sure if it is a fair schedule or not.

 

True hours spent at office NOT including extra time spent at office finishing up charts

Week 1 = 47

Week 2 = 52

Week 3 = 36

 

Avg - 45 hrs / week

 

Hours Getting paid

 

Week 1 = 39. 5

Week 2 = 45

Week 3 = 32

 

Avg - 38.33

 

Is this ideal, considering weekends are involved?

[loliz]

So i got that part clarified.  It is 1.5 hour lunch break.   To be honest, the schedule is the biggest thing holding me back right now.  Not sure if it is a fair schedule or not.

 

True hours spent at office NOT including extra time spent at office finishing up charts

Week 1 = 47

Week 2 = 52

Week 3 = 36

 

Avg - 45 hrs / week

 

Hours Getting paid

 

Week 1 = 39. 5

Week 2 = 45

Week 3 = 32

 

Avg - 38.33

 

Is this ideal, considering weekends are involved?

 

I would say not ideal to work more hours than being paid. The schedule is just weird. Seems more complicated than it should be. 

[camoman1234]

I work in FM in a very under paid mid-west state. My base salary is comparable and my hours are less and "normal" (8-4:30 M-Th and 8:12:00 Friday), but I am usually done by 3:30 on M-Th and 11:00 Friday.

 

The hours you have are terrible.

 

The traveling of up to 7 different places is crazy.

 

Malpractice is terrible in the wording, doesn't matter if it is occurrence based or claims made, terrible.

 

Non-compete is horrible, would not sign.

 

Patient load is way too HIGH if you are using EMR. At my old job I used EPIC EMR, I am very tech savvy, type ~100 wpm, had templates completed for ~30-40 diagnosis and procedures, and I would still leave around 5:45 - 6:00 every night (spending 45 mins finishing charting) when I would see 19-22 patients per day. 

 

I see ~24 patients per day now, but I paper chart. 

 

The collection bonus is horrible.

 

I would ask for ~92-94 K per year, change non-compete (maybe from 1 location only, such as main clinic you work at, but not ALL 7 clinics), decrease patient load (especially for a new grad), I do NOT like hours, but that is just me, and the malpractice wording is scary as it states you could potentially pay for the amount above the "normal" or "national" average, which is crazy. I am ok with the tail insurance, but the other is crazy.

 

Again, I would NOT take the job as it stands at this time.  

 

[FSUnoles]

yea everything about this job seems predatory. pass.

[knitpurl]

This job sounds terrible.  I agree with everything camoman1234 says.  I hope you said no.