Guest bleu818 Posted July 11, 2013 Share Posted July 11, 2013 I graduated almost a year ago and have been practicing hand surgery for 10 months. I am moving to a different state and really want to go into the field of dermatology. I interviewed last weekend and received a potential contract today. I don't think it's great, but of course I want to work in derm and know it's a hard field to break into without experience. Also, incidentally, my husband was diagnosed with melanoma today (of all days) so I'm more interested than ever. Is it something I should even consider, try to negotiate or just walk away from? Here are the main points: $40K during training $75K once I'm seeing an avg of 6 pts per day (estimated about 6 months) Biannual bonus of 20% of collections over $187,500 120 hours PTO (including CME) $1750 professional expense allowance I'm responsible for tail coverage It's a 3 year contract - I can leave with 120 days notice Also the clinic I will train at is atleast an hour drive from where I have signed a 1 year lease, although once I'm independent, I could work at a location closer to where I live. The contract makes no mention of benefits such as health insurance (or vision or dental), short or long term disability so I'll need to ask. It did seem like a great practice. I would have excellent MA coverage. I could be trained in surgery / cosmetic / peds as I prefer. Potential for working 4 days per week eventually. Very nice office. And I really liked the doctor. Thanks in advance for any input :-/ Link to comment Share on other sites More sharing options...
SocialMedicine Posted July 11, 2013 Share Posted July 11, 2013 the tail coverage can suck. ask around. call the malpractice company. that can wind up costing alot. probably thousands of bucks. find out more. if no health insurance ABSOLUTELY not. the 40K sucks ... most on this board would veto this immediately. but im not so sure its AWFUL ... what does training mean ? are they essentially making no money off of you for those months and you are shadowing someone ? I would have written into the contract at 6 months salary automatically becomes 75K regardless of 6 patients or not. you need to start somewhere ... id rather do it in a place that is dedicated to training over a clinic that may pay double put my opinion ... not a great offer ... but if it truly seems like a GREAT practice with growth potential.. they give health insurance ... and can PROMISE you 75K in a few months and have that in writing I would consider it. Worst case scenario you work there 12 months. They do not advance your salary. You quit and then wind up paying a few thousand in tail for malpractice coverage. That sounds lousy to me. Link to comment Share on other sites More sharing options...
Guest bleu818 Posted July 11, 2013 Share Posted July 11, 2013 if no health insurance ABSOLUTELY NOT I heard back from the doc. No health insurance. I think that seals the deal :( Link to comment Share on other sites More sharing options...
Just Steve Posted July 11, 2013 Share Posted July 11, 2013 I get confused a bit over productivity bonuses. How easy will it be to reach that $187,500 in collections? I am assuming derm offices typically do not take Medicare/Medicaid so billing and collections should be fairly close. At $100/visit billed (just a wild guess, please correct me if I am way off base,) it will take you 1875 visits. At six visits a day, that is 312 work days. With an average work year of 50 weeks, 5 days a week, that's 250 available work days. I realize procedures will bill out at a higher rate but will you get to do procedures? You mention training in them but you do not mention getting to perform them once up to speed. Do they have another PA in the office? What does the AAPA salary report say the average pay is in your area? I have always heard of Derm being one of the better paying fields but you are saying that after working for a year, you are still worth the a salary below the average salary for a new grad going into family practice? Plus having to pay your own tail? Plus no health insurance? Plus having to commute an hour each way? I don't know mileage, but I'll throw some numbers out to ponder...Government reimbursement for mileage is generally calculated to cover fuel and maintenance costs for your vehicle. Right now, the local school system pays $.50/mile. That's what they figure it costs someone to operate their car when you factor in oil changes, tires, brakes, fuel, all that. An hour commute could potentially be 120 miles, or $60 per day. 6 months of training rounds out to be around 125 days. 125x$60= $7500 in vehicle costs. So now you are working 125 days for $32500. 8 hour work day x 125 days = 1000 hrs. That's $32.50 hr before taxes and insurance, assuming your work day is only 8 hours. I am 40 years old and have been drawing a paycheck for over half that time. I have never ever seen a true 40 hour work week. So you really like this clinic, like the doc, and they hand you an offer that to me, as a student, doesn't look appealing at all. You come across as very eager to work in derm and that feeling is conveyed in a relative short post from you. I can imagine what an interview would be like. I am wondering if they are not capitalizing on your eagerness and lowballing you. I know business is business and that it shouldn't shade your opinion of the actual providers and work space but still...seems pretty damn cheap on their part. I guess the super variable part is how fast can you reach production goal so that you can get that bi annual bonus to supplement your base pay? I know my $100/visit is low but I don't know how low. Your three year contract, you can break with 120 day notice. How fast can they terminate you? Do you get three months pay if things don't work out and they let you go? Is there a non compete clause? How long do you need to be employed before that goes into effect? Will it only be started once you build up a patient panel? How many miles does it reach for? How long after you leaving that clinic will it last? In other words, if they decide to let you go after 6 months of training, can they effectively ban you from derm for any clinic with an hour's drive from your home? I don't like the contract offer at all. I think they are lowballing the crap out of you and have poor benefit package. i think they are taking advantage of your eagerness to work in derm. Link to comment Share on other sites More sharing options...
SocialMedicine Posted July 11, 2013 Share Posted July 11, 2013 Your 40k minus taxes is 30k. When u buy health insurance that's 9-10k a year. When you quit in a year it's 3-4k for tail coverage. You will lose money. Counter w health benefits, 45k, and guaranteed 75 at 6 months and I would consider it. Let him know his offer is insulting. Link to comment Share on other sites More sharing options...
MedicalRN Posted July 11, 2013 Share Posted July 11, 2013 Just want to chime in here as an RN and hopeful future PA. I'm interested in ED but derm has always been a very close second. I think that offer is very, very low. Fresh out of school as an RN, I made more than that. You're not a new grad - you've practiced for almost a year in hand surgery, and assuming you received a good recommendation, you've proven you can learn and function as a PA. You shouldn't have to start over and accept peanuts every time you switch a specialty. Derm is a very high paying specialty. My main derm provider is an NP, and I can tell you she is making quite a bit, especially with procedures. Need a mole biopsied? That's about an hour of her time and I believe my insurance paid something like $600 for it. I had a cyst removed (total procedure time, including stitches, about 1.5 hours) and it was nearly $2,000. She did this all on her own, btw. I've never even seen the actual MD there. That practice would be making far too much money off of you. I would shoot for: -45K to start, but training is limited to 4 months. At the end of 4 months, have a meeting and discuss your progress and whether or not you're a good fit. At this point, either party can decide to terminate the contract with no repercussions. If you both decide to move forward, you get a raise to 75K. - Health insurance should be provided, and if not, then a "bonus" to help you cover the cost of it on your own. - Lower the productivity bonus threshold. If he wants it stay at 20%, lower it to about 150,000. If he wants to keep it in the 180,000 range, then the percent should rise to 30% or so. Just my two cents. Everything is negotiable, and taking a low salary will set you up for a low salary for the rest of your career. (Why do you think they ask your last salary when you apply for jobs? They want to see how you value yourself and what you're willing to take). Link to comment Share on other sites More sharing options...
SocialMedicine Posted July 11, 2013 Share Posted July 11, 2013 you have to realize she does not have a year of experience ... she was in hand surgery .... its almost like moving from firefighting to police work in this shift. so there will be a period where she is, if anything, slowing the practice down a bit. Link to comment Share on other sites More sharing options...
Just Steve Posted July 11, 2013 Share Posted July 11, 2013 edited as I was just flapping my lips, nothing constructive to add. Link to comment Share on other sites More sharing options...
Guest bleu818 Posted July 11, 2013 Share Posted July 11, 2013 They do see Medicare, but not Medicaid patients. According to the 2010 AAPA salary guide, derm in this state is $80K in the 10th percentile $100K in the 25th $124,500 median My “training” would be almost completely shadowing, or seeing the patient first and presenting to my SP. I would not be profitable at all. Once trained I could do procedures I am trained in. Even surgery once I’m comfortable. It seems like the 2 docs that work there are both very focused and experienced in education and training of PAs. I saw this doc interact with his current PA he’s training and it seemed like a good interaction. There is also another PA who’s been working there a few years. The office is set up extremely efficiently. Once I’m fully up and running, I would be basically doing only high-level stuff that no-one but a PA/doc would be qualified to do. In other words, “working to the level of my education.” I think this would maximize my opportunities for the bonus and personal growth in the field. Also, after I’m completely trained and have a full patient base, I can work out of another office that’s only 30 minutes away. Or I could move closer to the office after my 1 year lease is up. They can terminate me with 60 day notice. No pay if let go. 7.5 mile non-compete clause, which I think is fine since I won’t live near there. I do have excellent recommendations from my current SP and also a dermatologist I rotated with during PA school. I can definitely see him taking advantage of my eagerness... So I'm thinking of countering with $45K during training to split the coverage of insurance. Asking for the above mentioned lower bonus threshold versus higher percentage. Meet at 6 months to see if I'm ready for patients and $75K or we split ways? Link to comment Share on other sites More sharing options...
d2305 Posted July 14, 2013 Share Posted July 14, 2013 Bx are easy, and are the most common procedure Derm does. LN2 Tx doesn't take long to master. Lasers and Botox require a little more training, but not more than a month. I've never worked in Derm but have done all the above in FP. You should be up and running in a month. Keep looking for a Derm job, and buy a Habif. Link to comment Share on other sites More sharing options...
Moderator ventana Posted July 14, 2013 Moderator Share Posted July 14, 2013 if you really think a PA – see is really worth $40,000 a year then I suggest you read over other posts. You are not only yourself every other PA out there when you undercut the market. This badly. Sorry to be blunt, however if you've read other posts you would realize that this is an unacceptable proposition. Link to comment Share on other sites More sharing options...
Guest bleu818 Posted July 16, 2013 Share Posted July 16, 2013 I really appreciate everyone's feedback. After thinking about it and talking it over with my husband more, I ended up turning down the job. No negotiations. I was sad that an opportunity I was so excited about turned out so poorly. However I ended up accepting a non-derm offer where the company made an offer that makes me feel valuable and appreciated as a PA. Bittersweet, I guess... Link to comment Share on other sites More sharing options...
FSUnoles Posted August 13, 2013 Share Posted August 13, 2013 yea this offer was a joke. a classmate of mine just took a new grad derm job for 105k. Link to comment Share on other sites More sharing options...
Moderator ventana Posted August 13, 2013 Moderator Share Posted August 13, 2013 I really appreciate everyone's feedback. After thinking about it and talking it over with my husband more, I ended up turning down the job. No negotiations. I was sad that an opportunity I was so excited about turned out so poorly. However I ended up accepting a non-derm offer where the company made an offer that makes me feel valuable and appreciated as a PA. Bittersweet, I guess... good for you - that was an insulting offer and one that should have been turned down this is what I am talking about:: yea this offer was a joke. a classmate of mine just took a new grad derm job for 105k. Link to comment Share on other sites More sharing options...
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