Joelseff Posted February 23, 2011 Share Posted February 23, 2011 Ok guys i am in a little bit of a pickle. I have two very good prospects. 1) Int Med: 10-15 pts per day, 2 weeks vacay, 1 week CME, DEA CME paid, 9-5 no call or weekends pay is comparable to area and specialty, full bennies plus 401K, but will only see overflow pts (not own case load). Commute: 45mins-1hr each way in traffic 2) Physiatry/Spine Med: 15-20 pts per day (Own Case Load), 2 weeks vacay 3days CME, DEA, CME paid, NO BENNIES, 401K will match contribution, Profit sharing and bonuses on performance. 9-5 no weekends, but everyday home call unless on vacay. Commute: counter traffic 20-30 mins each way. Base Salary at least 5K higher than #1 but with incentives, can be 30K higher. I like IM and I am more comfortable in IM but this Physiatry job is intriguing-though I have to do my homework for sure, at least more than the IM job. Plus it allows me to do procedures etc.... What do you guys think? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted February 23, 2011 Moderator Share Posted February 23, 2011 how about full time at 1 and part time at the other? Link to comment Share on other sites More sharing options...
marilynpac Posted February 23, 2011 Share Posted February 23, 2011 Boy this is tough. I would say IM b/c of the bennies and you're more comfortable with IM, but the fact you get procedures makes you more competitive as a PA. So I'm going to go with 2. Less commute and you get your own case load. What does your gut feeling tell you???? Link to comment Share on other sites More sharing options...
bradtPA Posted February 23, 2011 Share Posted February 23, 2011 It's my own personal bias but I think doing a few years primary care before specialization makes you a better clinician in the long run..... Link to comment Share on other sites More sharing options...
SocialMedicine Posted February 23, 2011 Share Posted February 23, 2011 No bennies? Does that include malpractice and health insurance? Individual health plan cost, for a mix of reasons, have sky rocketed the last year. You could EASILY pay close to 30,000 for health insurance, dental/vision, and malpractice plans. Do you have a family? Im terrified to think what an individual plan for a family of 4 would cost .... over 1,500 a month easily. Malpractice for me in NY state is 6,000 a year, and I purchase my own dental plan which costs close to 1,000 a year. Also, I would imagine handling the business of all these different plans is a headache, that has to cost something as well. Figure as a PA every hour you spend on the phone with an insurance company is worth 60$ of your money at minumum. The IM job sounds quite "easy" with 10-15 patients a day ... mostly urgent care overflow issues like sore throat and BP check. If you really want your own case load I bet in a year or so you could pose the idea to the group. Sadly, medicine is a business and if patients want to see you they will unlikely stand in the way. I dislike the idea of not providing benefits. I prefer IM. So my vote is number 1 Link to comment Share on other sites More sharing options...
MCHAD Posted February 23, 2011 Share Posted February 23, 2011 This is a student perspective so take it for what its worth...In my opinion Physiatry would be very difficult just because of the nature of the patients. I did fam med at an office that had physiatry on the other side and there is no way I would be able to work in that field. Yes there are patients in genuine need of pain management but there are also a lot of people that don't need it but know how to get what they want, and are very manipulative...I just couldn't do it. Link to comment Share on other sites More sharing options...
Joelseff Posted February 23, 2011 Author Share Posted February 23, 2011 Emed: Cant work both since they are both M-F 9-5 Marilyn: My gut tells me to go for #2 My wife has great Med/Dental/Vision plan. BradtPA: I agree, too that is why it is a difficult decision The own case load and money is very attractive with #2 esp since we lost everything for me to go back to school, it would really help get us back on our feet. Social: No I get Malpractice covered by SP. WHen I was self employed a couple years ago medical alone for family of four was 890/month! yikes, but my wife has full coverage thru her job that's why i am not really worried about the bennies. Mchad: This concerns me too I worked FP/IM for 7 years in a community that thrived on vicodin it seemed like. The Doc reassures me he has strict guidelines and does not tolerate misuse of narcs (whatever that means). Link to comment Share on other sites More sharing options...
marilynpac Posted February 23, 2011 Share Posted February 23, 2011 What you didn't explain is who/what you will be working for. Are they both solo/private practice. Is one hospital owned??? If you have bennies with your wife....I stand by option 2 for the reasons stated above. Link to comment Share on other sites More sharing options...
Joelseff Posted February 24, 2011 Author Share Posted February 24, 2011 Job #1 has 13 docs and 3 PA's it is a multispecialty practice (IM, Endo, ID, heck accupuncture and they do BD scans) but I would work for 3 different IM docs (2 days with one 2 with another and 1 day with the third) Job #2 is solo practitioner. Link to comment Share on other sites More sharing options...
marilynpac Posted February 24, 2011 Share Posted February 24, 2011 I would go with 2....again. With 13 docs and 3 PAs there already I don't see you getting your own case load anytime soon. IMHO. Link to comment Share on other sites More sharing options...
debtooker Posted February 24, 2011 Share Posted February 24, 2011 Go with your gut. We can all vote here, but you are the one that is going to have to show up to the job. Good luck! Link to comment Share on other sites More sharing options...
Joelseff Posted February 24, 2011 Author Share Posted February 24, 2011 I have pretty much made up my mind and once my Ca Lic comes in (hopefully tomorrow) I'm gonna take Job #2. I wonder if there are any Physiatry PA's here who can chime in on nature of job...I'll post it on the specialties board but if any of you guys know, I would appreciate any further input. Thanks so much for all your help guys! Link to comment Share on other sites More sharing options...
Hemegroup Posted February 24, 2011 Share Posted February 24, 2011 Congrats Joelseff, mine comes in tomorrow as well! I'm in a similar boat on the job front also, and have been offered an amazing salary as well as a great amount of independence ... but no bennies. Compared with another offer with a 12K lower salary difference, but full medical/dental. Still, if a yearly dental plan is 1000K then that would be no problem at all. And they did offer to give me a stipend to help cover medical. Make the right choice, which is what I'm trying my best to do ... wherever we choose is going to be our home for a while ... Link to comment Share on other sites More sharing options...
Joelseff Posted February 24, 2011 Author Share Posted February 24, 2011 Congrats Joelseff, mine comes in tomorrow as well! I'm in a similar boat on the job front also, and have been offered an amazing salary as well as a great amount of independence ... but no bennies. Compared with another offer with a 12K lower salary difference, but full medical/dental. Still, if a yearly dental plan is 1000K then that would be no problem at all. And they did offer to give me a stipend to help cover medical. Make the right choice, which is what I'm trying my best to do ... wherever we choose is going to be our home for a while ... Congrats to you too Heme! Yah I plan on staying at my first job for at least 2 years. That is why I am weighing out everything but all things being equal I think Job #2 is more appealing! Good luck to you man. I just hope these PA board guys get the lead out :D Link to comment Share on other sites More sharing options...
rcdavis Posted February 24, 2011 Share Posted February 24, 2011 Re: Any Physiatry PA's out there? I would appreciate your input.... Before they had a residency program, I moon-lit as the weekend in house for the Carolinas (Charlotte) institute of Rehabilitation. I would round on the 60-70 patients that they had as inpatients each day... divided into traumatic brain, stroke brain, and spinal cord sections(also infarct vs trauma). The physiatrists that I worked for , when I told them that I did not have a lot of brain or cns experience, told me what they principlally wanted me to do was manage those things that got the pt there: DM, HTN, ETOH/ drug abuse, liver dz, esrd, etc.. that they would handle the day to day rehab things. Hour for hour, except for a year and a half in CV and surgical ICU training, was the best learning experience I have had. learning curve was steep. But doable. Most of the stroke patients are vasculopaths... bruits galore, renal, hepatic, subclavain, carotid, (one occular!) and all have varying degrees of difficult to manage diseases. Of course, varying degrees of mobility leads to higher than usual incidences of pneumonia, stasis problems (clots, decubitii, atrophy, embolii), urosepsis from catheters, de-conditioning, etc. But excepting the trauma cords (which are usually spinal GSWs and MVAs) the vast majority are patients with the same problems that u would see in an IM clinic... only more so. Learn some of the types of cord injuries (frankel, brown sequard, anterior and central cord , etc) and sensory/motor deficits, the major deficits with areas of the brain injury (eg, what are the sensory changes in a pure thalmic cva), KNOW THE STAGES OF decubiti and wound ulcers. The rest: management of the lipidemias, the diabetes, the hypertensiion, the renal and liver, etc.. you should have enough of the basics. In 18 months, you will be studly, will be able to correlate a physical exam finding with the nerous system deficit (peripheral or central... and where), and will have a much better handle on what is a "serious" defect, or level of hypertension. You will also have a pretty good idea about physicial rehab and occupational rehab. And will have significantly better insight into peoples' inate character... and ability to handle devastation and seemingly insurmountable odds. (18 y/o with a t4...sex??). You will learn more PRACTICAL medicine and see more END STAGE disease in a year than you will see in your multispecialty clinic in 10 years. If you do get out of that business, you will never never ever regret it... there will be a capacity gleam in your eye that only trauma, and ICU or heart surgery PAs have... your inate level of insecurity and fears of bad things will be lowered immensely. This is a good decision. Now that you have made it, make the most of it. Start studying with any book of clinical correlatibve neurology.. oh.. what a minute, there just happens to be a text of that name... good luck, future stud.. davis Link to comment Share on other sites More sharing options...
Joelseff Posted February 25, 2011 Author Share Posted February 25, 2011 I took Job#2 the doc just called me tonight to find out my decision and I took it! I sign contracts next week! THANKS PA forum for all you guys' (and Gals') Help!!!! Link to comment Share on other sites More sharing options...
marilynpac Posted February 25, 2011 Share Posted February 25, 2011 Okay, I'm doing the happy dance for you/with you... Link to comment Share on other sites More sharing options...
Joelseff Posted February 25, 2011 Author Share Posted February 25, 2011 Thanks Marilyn you were a HUGE help!!! Link to comment Share on other sites More sharing options...
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