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New Grad EM Job Offer

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Finally able to post something here.  Received this offer:



EM - Busy ER with Trauma Center - will be progressively working with higher acuity

~98k for 2k hrs/yr (salary) - shifts are 8-12hrs

Health/vision/dental 80/20 (elligible after 3 months)

Malpractice paid

2.5 wks PTO/yr

401k match up to 3% (match eligible after 1st yr - can invest day 1)

Short Term (after 90 days)

Long Term Disability (after 1 year)


No OT/CME/License/Professional Orgs/etc (They were not in the benefits summary.  I will be clarifying this)



Now, while I have to clarify the above, assuming it is not included (which is odd no?), what are your thoughts?  

Further, would it be feasible/acceptable to counter with higher salary to off-set the lack of CME (thus essentially getting the CME)?


It is a solid institution (academic) and willing to train me to do quite a bit.  I have an EMS background prior to being a PA, but wanted to get the consensus from those who have been around the block a few times.

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It is an occurrence based malpractice policy so my understanding is that it would not need a tail.  As for the CME it was stated as being $500.  I countered with a higher salary to offset the low CME.  Waiting to hear back.  


No productivity (which is not the best but it is what it is).  Patients per hour was not specificed.  I would probably say ~2/hr which seems to be the average is where they would want me to be after getting used to the system (realistically I was seeing that as a student with documenting/making the chart) with no problem.

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Where are you located? I'd love to hear the final contract and your success and/or ability to counter offer. Sadly, what everyone is saying about low salary in NYC is true. I interviewed with a well known Hospital ER in NYC and they offered new grads 85k for 4 10-hour shifts a week, rotating day/night benefits TBD as nothing has been finalized yet. My program told me this was a great offer for the area as some places are only offering 75k for ER. Though I would love for it to be higher, I can walk there in less than 5 mins so I'll probably take it regardless of final offer cause you can't beat that! I was commuting almost 2 hours each way for my ER rotation via public transit.

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Damn Kem that sounds a bit rough. The salary is lower and the lack of benefits would send me away. Still waiting to hear back about the counter offer. Hopefully will know by Monday.


However I got another offer yesterday from a different location (in my home town) for ER that was as follows:


$52/hr +RVUs (1 yr contract, with new grad rate, increases after the first year)

401k from day one with 5% contribution by employer (not a match - 5% of my salary put in by them)

Profit sharing after 1000 hrs (fully vested at 5yrs)

Full benefits covered for me and family day one

$3500 CME

$500 profession orgs

Paid Licensing, credentialing, ACLS, PALS

2wks PTO

OT >40hrs/wk

Paid holidays

Malpractice covered


I will not be able to get OT for the first ~6mos due to staffing though.


The difference lies in the institutions. One is a busy Trauma center ER and the other is a Busy Community ER. So my scope at one will be larger than the other. So I am waiting to hear back on my counter and to make a decision.


I'm in the southeast by the way.

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It is paid quarterly. Scale is $2-5k at what I think is about 2-4 pt/hr. I did rotate there and talked to the PAs there. Top earner is about $5k/quarter and sees roughly 3-4pt/hr. this was based on observation. Don't have set numbers but from what I saw they were feasible. Average was stated as being ~3k/qtr.

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That is kind of what I was thinking.  From what I gather the PAs there often dont use all of it annually.  I figured I could get in The Difficult Airway Course, ATLS, and at lease one conference out of that (ACLS/PALS is covered by the group separately) out of that.  Waiting to make sure the contract in in league with the above but by and large you guys pretty much replyed with what I was thinking too.  It is just my first job out of the gate so I wanted to get the feel of others to make sure what I was thinking was the same as what you guys were seeing.  


Thanks again.

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With respect,

I think you are making a rookie mistake: trading off the opportunity to get exposed to and to learn EM RESIDENCY thoughts, protocols and approaches to the myriad of EM patient illness for a lousy 5-10k in cash


In my experience, the cash takes care of itself: the better you become, the better the reimbursement.


Not to burst any bubbles, nor to flame the tender egos of the members here who seem to think that, because they rotated thru the ED as a student or because they are sucessful in outpatient medicine, EM is a breeze, but the truth of the matter is you really do not know much about the most important parts of EM: the approach to each patient as if he were truely sick, and what could that illness be?


You have a significant leg up with your EMS training... And those lessons will put you much higher in knowledge level than the typical new grad.. And yet..


I worked non academic EM for 15 years and thought I was good.


Then I went to work in an academic center where the EM residency was nationally recognized ( john Marx was department director).


Very rapidly, I discovered how woefully short my differentials were, and how I had to really expand my hx and PEs to satisfy even MINIMUM Residency trained standards.


Eventually the call of cash took me from the academic center to a place where I worked with many attendings I had previously worked with..


They ALL commented on how much better if an EM clinician I had become.. And all of a sudden NONE of my charts were reviewed.


Same guy, same brains... The difference was the exposure to the rigors and thought process of formal EM training.


THIS is what you are forgoing for 10k.


I urge you to take at least two years and take the academic job, let them teach you your craft.. Then, if you desire, enter the market as a player who brings true value to his position.


I urge you to take the long view...

Good luck..

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I appreciate your response and to be frank your thoughts mimic'd mine very closely.  I understand being a New Grad and I definitely do not feel I am finished.  Likely I will never be as I feel that life is about learning, and medicine even more so.  However while the money was part of the situation, there was a family component as well.  Further, the 10k or so is really about 20-30k if the average payscale from the current providers is anything to go by.  It is not about the money; but that is quite a bit of financial benefits that can be used towards long term goals such as paying back my loans, investing, long term retirement goals etc.  


However you are absolutely correct in the scope of practice, and the learning experience and the level of training.  While I chose the second offer for mainly person/family reasons, it was a hard thing to give up.  I feel that I did take the long view but perhaps the long view I saw entailed several factors that I do not make public on the board obviously.  My thoughts at the moment are to take the time to learn much of the basics.  I feel that I have a good idea of sick vs non-sick.  I have EMS experience yes, I also worked in a very busy ER prior to school in a capacity that let me observe the medical decision making and evaluation from start to finish.  I have a military background and served as a medic during a combat deployment.  I also rotated in ICU medicine with a Critical Care rotation and had multiple patients in the ICU in my Internal Medicine rotation.  I have seen sick, and while I do not by any means of the imagination feel that I am the equivalent of yourself, EMEDPA, or the host of others that I look to as a form of mentor by way of the forums, I do feel confident in my ability to work in an ER setting.  This is my first job as a PA but I am not without quite a bit of directly attributable experience. That is why the first job even considered me to be honest.  Where I will go from here remains to be seen.


Truth be told, if my graduation date were not what it was I would have applied to an ER residency.  I looked at all of them.  But the timing did not work out considering the financial implication.  


I understand what I gave up by choosing the second offer.  I also know that it was the better decision for me currently.  Again I appreciate your input and understand your point.  To play a bit of Devil's Advocate, did you do yourself a disservice by taking the route you did?  Realistically did working in a non-academic setting seeing the normal things a PA sees become detrimental to you in your practice as an ER PA?  While you say your DDx were significantly shorter, and the level of training was significantly higher, would you say that you did not benefit from the "bread-and-butter" as I like to call it ER experience prior to the Academic setting?  I am not trying to be cross or sarcastic, I am truly asking for your thoughts on the matter.  PM me if you wish to respond that way.


At the end of the day I feel that I made the correct decision given the circumstances I currently find myself in.  While it is, and was, hard to turn down the offer, I also think that if I would have taken it I would be saying the same thing about the offer I decided to accept.  I did not choose the second offer solely based on money, though the argument could be made that it was a justifiable reason to.  I chose it after a long and exhaustive process of evaluation that involved not only the forums here, but also family and friends.  


My apologies for the long response, at no time was the above meant to come across disrespectful or rude.  I know that tone often can be lost or misconstrued in electronic communications.  I truly am curious regarding your experience and how you felt it benefited/hurt you by going to the Academic institution later in your career.  Yes I know get it done early, but at the same time, the basics are the basics no?

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Davis makes good points- the first job or two should be about learning your trade.

on the east coast it seems that happens best in a major medical center as they are willing to let PAs see varying levels of acuity. many major medical ctrs on the west coast stick PAs in fast track and they never see the main dept.

my best learning has been at busy community hospitals sitting side by side with a doc and talking to them about my cases and theirs. later this continued at a busy rural facility where I alternated charts with a doc but they were always available for conuslts.

learning is where you find it. don't chase the money. as Davis mentioned it will eventually find you as you get more skilled. every job I have ever left has been over scope of practice. I wanted more and the new places offered it. some places paid less(one place significantly less)but it has worked out well over time. my most recent new job I knew I wanted and didn't care what the pay was.they have a 10 yr waiting list for an interview. I didn't even ask about salary at the interview and didn't find out until I got my first check. it was DOUBLE what I expected so I was pleasantly surprised.

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I agree with his points as I said above.  It may appear as though I chased the money but I did not decide on the offer I accepted due to money.  That being said, the debt of a New Grad now is rather substantial as often the undergrad education is, at least in part, financed by loans and interest is a tough task master.  At least I am very conscious of my debt load which may or may not be the case for other new grads.


I am on the East coast.  I rotated with the group as a student and got to see a lot of what the PAs got to do.  They were able to work in the main and FT.  The scope of practice is decent.  Not to the level the other one was no.  But it is not limited to FT/triage.  Obviously they scope increases with comfort typical in all jobs.  

I agree with both of you the offer was great in terms of a learning environment.  If things were not as they are I would have taken it.  That being said, I also feel that there is much benefit (not all financial) from the offer I took beyond the initial reasons that decided for me.  I also feel that I can learn from anywhere and the group as a whole has been together for quite some time.  You are correct in that learning is where you can get it.  But would not getting a solid basic foundation in the more common PA practice be beneficial also?  The ERs I will be credentialed at see a volume of about 75k, 40k, and 30k /yr respectively with the 30k projected to grow rapidly given it is a new facility and the population area that it is in is growing.  I am of the mindset that you use what you can for everything you can.  With that mindset I plan to put the training money to use in training myself in whatever I feel will make me a better PA, more specifically an ER PA.  I understand what I gave up in my decision, and while that is something I accepted, it does not mean that I cannot use the job I have for everything it is.  If, after several years the scope is not what I wish, or I feel I would be better served by going to a residency or the like, I will evaluate my circumstances at that time.  I was given to think the first offer understood my explanations for why I had to turn it down and that there were no hard feelings on their part.


Again, I appreciate all of your input and I have been on this forum, whether lurking or after creating an account for near 8 years.  I have learned a lot from reading posts and seeing the answers to the same questions I had.  I know I am a newbie to the ER PA world and appreciate the help.

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