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I'm a relatively recent PA grad who is almost a year into my first position as a CC PA at a large tertiary care facility. In a perfect world, I would like to stay for at least two years to further refine my skills, expand my knowledge base, and show some maturity/stability to future employers. In my current position, I make more than the national average for new grads, have full benefits including 401k with match, malpractice with tail, ample CME/licensing, and find that my SPs are fantastic people and educators - this is what sold me on the position and makes it so attractive. Since being here, I have worked hard to build strong relationships with my core team, including the notoriously surly surgical team, and have rather rapidly ascinded to the ranks of "one of the reliable ones" in the group. Despite these positives, I am starting to feel like this position is non-sustainable for the below reasons: Census: I currently have 10-14 beds to cover per shift, provided the units are not over capacity or we turn over beds. Some days I am seeing upwards of 20 critically ill patients on my own. There is no plan to add additional providers, despite numerous complaints from APPs and physicians. Quaity of care: Blows. See above. Administration: Is becoming progressively shadier by the day. Recently handed out contract amendments to all of the APPs to remove key bonus language without negotiation. Will not negotiate pay increases during the annual contract renewal period, despite stating otherwise during the initial contract negotiation. Mishandled privileging so that many APPs cannot perform procedures. The Director of CC, when confronted with this fact, said that it's all crap and we should go ahead and do the procedures because any liability ultimately falls on the SP. Obviously, this is not acceptable and would not hold up in court. Will not complete the paperwork for PAs to be able to prescribe. Schedule: Random - you will flip-flop days to nights back to back. Even if you have blocked shifts, you'll be moved unit to unit. There is no continuity to your schedule or the care you provide. You may be assigned to an outside facility to cover a one-off night shift. You will not have an attending in-house. You are expected to stabilize critically ill patients, even if you are not credentialed to do so (See above.) Morale: Probably the worst I've ever seen, and I worked in some truly toxic environments prior to PA school. My question to you all: Is this normal? Is that just what comes with the territory for CC and working for a large hospital group? If I have solid relationships and feel, in some ways, valuable, should I just suck it up and make the best out of it? Or is this, as I suspect, absolute lunacy and I should run as fast and far as I can to save my sanity and license?

So I have graduation coming up soon, and have recently been offered a job in general surgery. I'm in a state that does not have the best median salary for PA's. The offer is 80k for first 6 months, then 85k for next 6 months, then 90k after 1 year. After 6 months I can begin to collect a bonus of 1% of my supervising physician's net collections which is paid out quarterly. I should also add that they've agreed to pay me a monthly stipend of $1,000/month until graduation, which would total $5,000. They are offering full benefits, $1500 + 1 week off for CMEs, & 10 vacation days (will go up to 15 days after 1 year). It's a very busy job with long hours but I love the physician and love surgery. I learn so much every day. I guess I am just looking for reassurance that this is a respectable offer. I was honestly expecting to start out higher than 80k, but since there is a guaranteed salary raise plus the bonus it seems like a good compromise. Any thoughts?

Hey all! I am getting ready to interview for a dermatology "residency" position at a very large and expanding dermatology clinic with offices that serve almost the entire state I live in. After requesting the interview with me, the company sent me a very simplistic form of the terms of the contract for residency prior to interviewing. Holy crap, it is a DOOZY. So, without further ado... 4 Year MINIMUM contract. 1st yr: "fellowship pay" = $30,000/yr 2nd-4th yrs: $90,000 + 25% production bonus above $400,000 in collections $2000 CME Licensing fees/textbooks/equipment paid Full benefits (paid? not paid? not sure.) Covered malpractice w/ tail. No mention of PTO or vacation days. 3 Year RESTRICTIVE COVENANT for 30 mile radius of all clinics this practice owns (not just the one you worked in). Thus, you are basically barred from employment unless you leave this area for good. Or, it's a $100,000 buyout. I'm PRETTY CERTAIN RCs are not enforceable, especially without a partnership agreement. There you have it, folks. I haven't canceled the interview yet, because my curiosity is piqued to hear their logic behind this befuddling term sheet. But I'm certainly not signing up for anything remotely close to that.

Hey all, I'm in dire need of help. I have been practicing as a Neurology PA in the Denver metro area for over three years now. Same practice - private practice that is currently growing. I see about 10 - 12 clinic patients a day along with hospital call. I take one weekend of call a month. (stroke call, etc..) When I moved to CO, I had very few peers to counsel me on the region and what to expect compensation-wise. I was initially hired at 65k a year with the hope of a drastic increase as we figured out my role (I was the first mid-level in this small private practice). I now make 80k a year. My patients and other health care providers love me, and my providers constantly tell me how invaluable I am to them. My providers rely on me to do the majority of the hospital work. I feel very undercompensated and taken-advantage of. I have spoken at length with my providers (guys that treat me VERY well, otherwise, and are like my older brothers) who ensure me this is competitive for the area. I, however, still feel this is very untrue. I need some reassurance that going to them with the idea of looking for other work unless I am better compensated is the next step. Please help, as I am not wanting to let go of an otherwise great job. But when I am the only PA in the practice, it is not too unusual to get taken advantage of. Please let me know your thoughts. Thanks J

Hi, I'm about to be a new grad (no prior medical experience but with great academic record); am curious about the following (see questions below) all feedback/insight/comments/curse words are welcomed! 1. what I can really expect as starting salary in internal medicine? (nyc hospital based, three 12's, no call, some weekends) i haven't seen or heard of anything higher than 85k and i'm starting to wonder if i would be low-balling myself 2. how much can a new grad (again, with no prior medical experience) successfully negotiate with hospitals who advertise a new hire flat rate? 3. what's the typical yearly bonus most nyc hospitals (city and private) are offering? thanks in advance!

Hey everyone, need some advice. I am a second year PA student with an Athletic Training background set to graduate on Oct 1st of this year and have two orthopedic job offers waiting. I was hoping you guys who take a look and give me any/all advice you have. Job A Exciting position in practice that does not have a PA but Dr. I would be working with has experience training PAs. Base $95,000 Bonus 10% of base 22 days PTO (if holiday falls on week day, counts against PTO) Call 1 weekend a month 5 days CME with 2k allowance Malpractice with tail coverage Health insurance on day 1 and short/long term disability after 90 days Job B Better location for my wife and I. Really nice sports medicine doctor who I get along well with. Replacing previous PA who left to follow passion for ortho trauma Base $87,500 Bonus "30% of all revenues exceeding PA overhead. PA overhead is salary plus 25% benefit load" Not exactly sure what that verbiage means if anyone can help. 15 days vacation. 8.5 days of paid holidays. 7 days of sick leave. NO call. 5 days CME with $2,500 allowance Malpractice (not sure if tail coverage) Health Insurance but no short/long term disability included My questions. What offer looks better overall? What should I expect to bring in as a first year ortho PA (the PAOS salary survey says 280k is the 50th percentile)? I have not began negotiating, what should I try to include in each package? Thank you so much for all of your advice! Kevin

Hello PAs! I need some advice. I'm a new grad, my last clinical rotation in family practice was wonderful- 100% supervision, very functional office- everyone communicates and patients are seen on time. I recieved a job offer from this site- I worked with the doc already for a month in clinicals I know we communicate well and he liked me enough to hire me! Three interviews including contract negotiation, we had decided on the contract revisions, benefits, salary etc.. and then I get a call from his office manager stating "they looked at the books and decided not to hire anyone right now, they don't have the patient volume they thought they did and financially it just isn't working out." Hold on, the entire time I was there during clinicals they had just lost their third provider and were short handed, he was interviewing to fill the position for months! So I told the office manager I felt mislead, that I had accepted the position pending revisions and she said she'd call me back right away. 45min later the doc calls me and says "I offended him in negotiations by asking for tail coverage" "It feels like I don't trust him (background- I added a section to the contract stating he would furnish me with supplies necessary to perform my job)" "And we just aren't going to have a good working relationship because I don't trust him and I was so egregiously offensive." His tone was almost hostile, It took me completely by suprise. When we had negotiated the contract just a few days prior he was smiling, very agreeable, he was happy to make the changes and we left with a side-arm hug saying "I'm happy to have you work for me." Well long story short I told him I was willing to renegotiate and he offered me the contract again- with a few of the revisions I had suggested and he "never wants to talk about our misunderstanding again." and I should "write the AAPA and tell them their advice almost lost me my contract." So now what? do I accept the job? Before those two disturbing phone calls this was my dream job! The job: $82,000/yr with growth potential max 15 patients/day [and their patient pop is on the younger side] M-F 8-5 One Sat OR Sun per month at the group's urgent care NO CALL EVER! Employer pays 75% of Health/Vision/Dental premium (AETNA!) 401k graded matching (2%/year and 20% if I leave after 1 yr, 100% if I stay for 5yrs) $1500 CME allowance He will reimburse me for all licensing fees including PANCE, TMB app, JP Exam, etc.. another $1k The clinic is new, equipment is in great shape, I get to perform small procedures- skin cancers, testopel; fun stuff Location is great, 20min from my house I don't have any other offers, I have no doubt that with some time I could find another job in my area.. but maybe not with all these perks? Advice??