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New Grad- multiple offers- need some advice...

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Hi all,


I need some advice on a couple of job offers since I'm new at this and have no clue what is a "good" offer and what's not.


I have been invited back by my OB/GYN clerkship on a salaried basis at $80,000/yr- they cover malpractice, 3 weeks PTO, 1 week and $1500 CME allowance.  It was a great learning environment, I liked the work, and I get along great with the SP.


I've also been offered an inpatient position at a local hospital on an hourly basis at $40/hr, 36 hrs/week (3 12's), but will be working nights with a $6/hr shift differential- they also offer occurance malpractice coverage and lots of opportunity for overtime.  This seems low to me, but unlike the other offer, I will have more opportunities to learn and advance, get advanced procedural credentialing, and I think that it leaves more options open for me down the road since it's not so narrowly specialized.


Last but not least, my family medicine clerkship has also invited me back, but I don't have the details of the offer yet.  I'm meeting with them later this week to discuss specifics.  The upside to this one is a cushy schedule (9-5, Mon-Fri) with no call, plus a good variety of patients/complaints.  It's also a large practice with lots of providers, so there will be people around to ask for help when I need it.


Money aspect aside, I think I would like to start out inpatient, because I feel like it's much easier to move from inpatient to outpatient than vice versa if I want to switch in the future.


So...  what should I do????  Are these offers reasonable compensation wise for a new graduate with relatively little pre-PA medical experience?  Should I ask for more money?  And if so, how do I go about doing that without torpedoing my offer?


Thanks guys- I really appreciate your input.



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One thing I'll never do again, at least not willingly, is commute in the greater DC metro area.  Have you commuted in this area before?  I have a rough idea, geographically, where you are and commuting is miserable for the distances I think you're talking about.  It will get old and it'll get old fast.  That's something else to consider in evaluating your options.


Part of the consideration here, too, includes your professional goals.  What do you want to do?  Where do you see yourself in a year?  Five years?  Ten years?  Do you want to work in women's health?  Do you want to do medicine?  Do you want to do something completely different?  Which of these offers will best help you to get there?

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You mention salary, learning environment, benefits... Your three potential positions are varied. You seem to imply learning opportunity and "opening doors" later in your career is important in your post and willingness to make a trade off for long term gain.


What do you want? What kind of field/position do you envision yourself in 10 years?


Do you want to see the same patients and their families (family practice)? Or do you get bored of treating the same hypertension or managing diabetes?


Do you want to work with "sicker" patients, generally taking orders and consults but putting out "fires" at night (inpatient)? You'll miss rounds which is a great learning opportunity, but develop more confidence quicker.


Do you want to work in a specialty in a focused field/subspecialty? Or are you the type always wants to be challenged and learning everyday? Your learning is likely to plateau quicker in a subspecialty than for example hospitalist...


Do you want a 9-5 job and not want to read up too much on medicine, focusing on your quality of life?


Do you want to work with the most autonomy? Willing to study outside of work/CME because you love it.


Does all of the above not matter as much as $$$ (ie best paying fields: derm, ER, surgery specialties first assists, critical care...)


For myself, I am willing to sacrifice some $$$ for good learning environment, location and awesome schedule at the same time working in the field I love... though when the learning plateaus and if my scope becomes more limited I'll be off to find more autonomy and $$$.

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These are all really great questions- the money is not as important to me as a supportive learning environment and a good working relationship with my SP.  I do want a challenging environment, and I don't shy away from putting in some extra time with the books after I finish school to continue bettering myself as a provider.  As far as what I want to do for the next 10 years- in all honesty it's difficult for me to pin one thing down.  I deliberately reserved judgement when going through my clerkships because I wanted to keep an open mind and get the everything possible out of each experience.  I thought I would have some sort of ah-ha moment somewhere along the way, but in truth, I've loved every clerkship except Psych and the ER.  What I learned along the way is that I can be happy doing pretty much anything as long as I like the people I'm working with.  I love the pace and variety of the inpatient setting, but I also like the continuity aspect of outpatient care.  


To be completely honest-


I think I would learn more and have more opportunity for advancement in the hospital job, but they have a reputation there for hiring new grads, paying poorly and running them into the ground.  I've heard this from multiple different people, without prompting, and this worries me a bit.


I'm very good at family practice, it comes easier to me than some of the other fields, but yes- treating diabetes and hypertension all day every day is boring.  Really, really, boring.


I loved the OB/GYN rotation, but I'm worried about pigeon-holing myself by going into a sub-specialty straight out of school.  On the up-side, my SP for this one is awesome.


I'm kind of leaning toward the OB/GYN offer, but I don't want to be kicking myself 5 years from now if I want to do something else and can't get out of women's health.  Am I right to be concerned- or is there enough demand out there that I can overcome it?

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I can't comment on the market for OB/GYN PAs or the regional preferences of PAs vs NPs in this field. You need to weigh that also if you plan to pursue this specialty long-term.


I can make some general comments...


The OB/GYN position is in a inpatient setting I assume and not a clinic or doctor's office? If inpatient and you can surgical first assist or scrub in... This will broaden your skillset and make you more desirable if you decide to move into other surgical fields and obviously cover some occasional basic inpatient medicine. If you can take consults in the ER for emergent cases... even better as this will really open up doors and show that you can quickly prioritize and be decisive.


If in an office setting, you will obviously see the more common problems and non-urgent ones... and have less opportunity to see or see management of other medical complications of women's health that you would see in a hospital (ie. PE during pregnancy, eclampsia, ARDS, etc).


I work with a ER PA, she had her first job for several years in OB/GYN. You can definitely change specialties later... It's just a little harder (and helps if you get more autonomy and get to see the emergent cases or can scrub in) because you will forget a lot of basic medicine.


My first job was a specialty within a specialty but now I work in two fairly broad specialties EM and critical care (within 2 years of graduating). After my rotations I only knew I didn't want to do psych, peds or OB/GYN and leaned towards family medicine (building a relationship with patients, etc.)... But wanted more teaching so I took a hospital based specialty... Then I learned I like dealing with stressful situations when seconds to minutes count... so keeping an open mind is great.


You can always change... As other ppl. have mentioned on other posts, get a per diem medicine or urgent care position if you go into a specialty to keep your knowledge fresh and doors open.

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Met with the FP people this morning and now have the details of all 3 offers- would really appreciate some input if anyone cares to weigh in...


Hospital PA

  • $40/hr + 5.85 night shift differential and 1.25 weekend differential- works out to about $85,800/year before OT
  • 45 minute commute
  • Patient provider ratio on nights is 24:1 (Yikes!)
  • 3 12-hour night shifts/week (7p - 7a)
  • 2 weeks PTO/year
  • $200 and 3 days for CME
  • Initial license fee and PANCE are my responsibility, they will reimburse for renewals
  • Claims-made malpractice insurance - no tail
  • Opportunities for advanced training: excellent
  • Marketability of experience if I want to change jobs later: excellent
  • SP/Staff support: meh...

Family Practice

  • $85,320/year
  • 15 minute commute
  • Initial patient load of 8/day, working up to 16 within 3 mon and 24-28 by 1 year
  • 40 hours/week, one late day (10a - 7p) and 1 Saturday/mon
  • 4 weeks PTO
  • $500 and 5 days CME
  • PANCE, license, delegation agreement, and DEA fees paid
  • Claims-made malpractice with tail
  • Opportunities for advanced training - none
  • Marketability of experience if I want to change jobs later: good
  • SP/Staff support: good
  • *** also offers short/long term disability coverage, and annual bonus of 2-3% base salary based on productivity


  • $83,200/year
  • Would have to move closer to avoid horrible commute
  • Initial patient load vague- ultimate expectation is 24-30/day
  • 40 hours/week, 32 in office and one day/week in hospital (OR, vaginal deliveries), plus shared hospital rounds
  • 2 weeks PTO first year, 3 weeks thereafter
  • $500 CME, no additional paid days
  • License, delegation agreement and DEA fees pain
  • Occurrence malpractice coverage- no tail needed
  • Marketability of experience if I want to change jobs later: meh
  • SP/Staff support: excellent
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I chose FP starting for year plus then switch to hospitalist or start hospitalist and switch to FP  . As new grad it will be great to have few years of experience in internal med and Family med  before deciding for specialty . don;t worry about money too much for first year,  any thing 40/ hour is acceptable for first year provided you get benefits and learning experience .



it seems FP is the better option here .

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I chose FP starting for year plus then switch to hospitalist or start hospitalist and switch to FP  . As new grad it will be great to have few years of experience in internal med and Family med  before deciding for specialty . don;t worry about money too much for first year,  any thing 40/ hour is acceptable for first year provided you get benefits and learning experience .



it seems FP is the better option here .


Thanks for the input- I agree and the FP offer is what I'm leaning toward at the moment.  I turned down the hospital job because of the night shift schedule and patient load- and I'm hesitant to take the OB/GYN job because I don't want to specialize too early.  My ideal job would be inpatient hospitalist days- which is what I'm doing my 1st elective clerkship in right now.  Maybe I'll get really lucky and get an offer out of this clerkship and then my decision will be easy!  But if not, I'll probably take the FP job.

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Re obgyn: I would ask whether you will be able to do vaginal deliveries unassisted.. Would be interesting if the state and hospital would credential a newbie for that.. Just thinking.


take the fp job, slow growth and gentle learning curve. Hone skills and get firm medicine base, THEN spread out as desired.

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Guest Paula

I agree with taking the FP job.  I am in FP and honestly it is not boring.  Currently I am working up a patient with microcytosis and believe me it is interesting and challenging.  I work in rural area so have almost complete autonomy and carry my own patient load.  FP in a metropolitan area may not be as interesting if they give you the simple patients.


FP will give you a good base as a new grad and will help you if you decide after 2-3 years to go into hospital care. 


All CME offers are dismally poor, however.  Can you negotiate a higher CME allowance to at least $1500?

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  • 3 weeks later...

Hi all,


Just wanted to say thank you for all the advice and guidance- I was really struggling with the decision and the outside perspectives were very helpful.


An update on the situation in case anyone is still following- I did end up getting a hospitalist offer last week and I decided to officially accept it this morning.  It's 3 12's/week, so I'm going to see if I can also set up some PRN shifts with the OB/GYN practice- that way I get the best of both worlds!


Thanks again everyone, and wish me luck- I'm sure I'll need it!



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