BruceBanner Posted November 10, 2014 Share Posted November 10, 2014 So I'm in the midst of contract negotiation with a new business. It is an established concierge model focusing entirely on men's sexual health---all ED modalities and all androgen optimization modalities. It is a M-F, 9-5 clinic, with one primary provider (me) and a token MD on the books for a few hours a week. There are several established clinics in the southeast; I live in the mountain west. The proprietor is a businessman leaving the pharm industry to start this clinic. He plans to open several in the city within a few years. It is not a franchise, it's an owner-operator kind of thing. Basically it's like any other concierge model---patients pay for an initial consult then based on their needs select a (costly) long-term plan, which includes all meds, follow ups, etc. The eastern clinics have reportedly done very well. A bit on my background: Been a PA since 2012, 2.5 years clinical experience. I live in a desirable area that is fairly saturated with PAs, so the job market is competitive. Compensation is typically lower than east coast gigs. I've been through a couple rounds of revisions and here are my highlights and concerns: -Lowish (but not unfair) salary, $85k -Modest benefits: 10 days PTO, $250 HC allowance, $1500 CME, licensing paid, Med Mal paid, standard paid holidays. No 401k. -Vague language in the contract regarding call and hours. I've asked him to be more specific than "5 days a week", but he says it would be too prescriptive for a new business. Also there are ambiguous statements about taking "call" if necessary, which I told him needs to be outlined in more detail, i.e. what type of call, rotation, shared with doc, etc. The above may sound bad, but overall he has been a really nice, straightforward guy. Taken me out to lunch a few times, calls me every few weeks, etc. The MD on board is also a legitimate local provider on staff at a major hospital. The pros are it has the potential for incentive pay and future practice management/ownership since I would be coming on board from the ground up. I spoke with the PA at one of the eastern clinics and he said it was a low stress job with good medical autonomy and no "sales" pressure. The cons are it is obviously a start-up practice, so it could flop, but I think it is unlikely. It has almost zero career capital potential for other areas of medicine. I do feel I am being slightly low-balled on compensation. Additionally I have concerns that this could turn into a "I need you to come in Saturday", or "I need you to be available for telephone call" type situation. Also, he currently has no other providers on staff who could cover for me if I needed time off, so if I'm not there, nobody works and no money is made. Other clinics have agreements with locums agencies to fill this need and he assures me he is working on it. Talk is cheap, I know, so just looking for any thoughts, opinions, red flags, etc. Thanks! Link to comment Share on other sites More sharing options...
Guest Paula Posted November 10, 2014 Share Posted November 10, 2014 I imagine if you can deliver the goods to the patients you should make some large bonuses. Link to comment Share on other sites More sharing options...
gbrothers98 Posted November 10, 2014 Share Posted November 10, 2014 So this is a manopause or low T clinic right? A mix of on and off label use of meds? Treatment plans and subscriptions on a monthly basis as a result of simple blood tests done in the office? Low salary but bonus structure with no sales pressure? When the f^ck did sales pressure become part of medicine? Rapidly expanding presence but no 401k? Vague contract language without important stipulations about your employment? Narrow career possibilities? You think? A nice guy who bought you lunch a few times? Worked in pharmaceuticals prior? Only gives you holidays off? Did you get a coffee cup and a pen after? Where is this potential for ownership, for incentive pay, for management discussed? During lunch or in black and white on paper vetted by his business manager and your lawyer? Likely will succeed until one of 2 things. The FDA shuts down off label prescribing of testosterone. Or someone is harmed which usually will lead to the preceding sentence. http://abcnews.go.com/Health/story?id=118016 Oh boy. G Brothers PA-C Link to comment Share on other sites More sharing options...
BruceBanner Posted November 11, 2014 Author Share Posted November 11, 2014 Ha! Well when you put it that way it does sound pretty bad. Thanks for the input. I'm leaning towards no. Link to comment Share on other sites More sharing options...
Febrifuge Posted November 11, 2014 Share Posted November 11, 2014 The negatives are all fairly significant. The lowish (even if not unfair) salary needs to at least have a clause about year 2 going up from 85 to 90, then year 3 going to 95, then year 4 doing something else... and/or something about the salary being guaranteed regardless, but then adding a specific and sensible production bonus. If they want you to be a motivated go-getter, there needs to be something you personally can go and get, for yourself and not just for the owners. I absolutely agree this sounds like a quagmire in terms of "you have to be on call every Saturday" since you're the only one actually there so much of the time. Call might sound benign when it's all abstract, but it can mean no beer at the BBQ, or missing out on an event because the phone might possibly ring at some point. That's worth more than nothing, and it needs to be very clearly spelled out now, or else it never will be. Just my own personal bias, but the narrow focus especially for someone not yet 5 years out of school is a red flag too. If things don't work out, consider how the conversation might go at the interview for the next job. It's a little bit of a pessimistic approach to take, but it's also pragmatic so let's call it that. Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 11, 2014 Moderator Share Posted November 11, 2014 run far and fast this is a money making machine, and if was a great gig he would have docs banging down his door. The fact that he will not answer CALL requirements and not provide a health bonus plan just shows all he really wants is someone with a DEA and a license.... don't be that person At 2.5 years into your career this could be a very bad move... But the biggest reason is this http://www.fda.gov/Drugs/DrugSafety/ucm383904.htm Oh yeah and the single biggest red flag is that it is a pharma guy wanting to do it - they are really not your friend and are nothing more then somewhat educated salespeople who really should hardly ever be trusted and you should never go into business with one that you have just meet when you are just barely over being a new grad....... Link to comment Share on other sites More sharing options...
Guest Paula Posted November 11, 2014 Share Posted November 11, 2014 I imagine if you can deliver the goods to the patients you should make some large bonuses. You all understand this was said tongue in cheek. Link to comment Share on other sites More sharing options...
SocialMedicine Posted November 11, 2014 Share Posted November 11, 2014 You know much more about the job, your career aspirations, and all things considered. But this job sounds like a definite NO. In my opinion the low T clinic is for the PA who just wants a pay check and not that interested in practicing medicine. Unless of course you are talking about an academic, evidence based medicine environment. For this kind of work... your risk in terms of future job opportunities .... the profit they make .... you should be earning 120+. I bet they sell the testosterone themselves. is that the case? Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 11, 2014 Moderator Share Posted November 11, 2014 I would say honestly for this type of model I would not consider it for any less then $250k/year with a HUGE bennies package (that is what a doc would want if not A LOT more) These clinics can rake in the $$ and it basically is a nonmedical person profiting off a medical person - ahh no thanks Link to comment Share on other sites More sharing options...
BruceBanner Posted November 11, 2014 Author Share Posted November 11, 2014 You know much more about the job, your career aspirations, and all things considered. But this job sounds like a definite NO. In my opinion the low T clinic is for the PA who just wants a pay check and not that interested in practicing medicine. Unless of course you are talking about an academic, evidence based medicine environment. For this kind of work... your risk in terms of future job opportunities .... the profit they make .... you should be earning 120+. I bet they sell the testosterone themselves. is that the case? Yeah you guessed it...they dispense all medication through the clinic. In fairness it isn't purely a low-T clinic, they deal with all the pde-5 drugs, testosterone, hcg, clomid, and their cash cow appears to be Trimix, a compounded injectable. Not that it makes it any different; still a retail business 110% about making profit. In light of all your input, plus my gut feelings, I backed out of the contract today. I think the day-to-day would actually be alright--all male staff, ESPN in every room, low stress--I just wasn't comfortable with this much risk for comparatively low compensation, PLUS the overarching issue of having zero transferable skills should it not work out. It would take me nowhere as a PA. The thing that got me was he was acting like he was doing me a favor as a newer PA. Kept calling it "generous". He ended up offering me part-time contract work which I will probably take if I don't get a real gig soon....it's money and virtually no risk for me in that capacity. To be honest I've been struggling with finding respectable work since my "not enjoying medicine" thread, and while I have a good per diem job that is keeping me afloat, no one in family med or IM wants to touch me. Tough crowd. At this point all I want is a good family med gig with an understanding SP so I can put down roots for a couple years and become more than an occ med/retail PA. Link to comment Share on other sites More sharing options...
cbrsmurf Posted November 11, 2014 Share Posted November 11, 2014 You all understand this was said tongue in cheek. Really? Come on, now. Link to comment Share on other sites More sharing options...
cbrsmurf Posted November 11, 2014 Share Posted November 11, 2014 Seriously, though, there is a place for legitimate male reproductive medicine. ED and male infertility are prevalent health issues are undertreated, underdiagnosed, and stigmatized. One has to consider neuromuscular disease, tumors, vascular disease, etc in some cases and not just be handing out scripts for pde5's. The science/testing for male hypogonadism isn't exactly clear cut and you might be feeding an undiagnosed prostate cancer by recklessly prescribing testosterone (although that's not exactly clear either). Anyways, think with your head and not your.... heart? Link to comment Share on other sites More sharing options...
Guest Paula Posted November 11, 2014 Share Posted November 11, 2014 Really? Come on, now. Ha ha. Link to comment Share on other sites More sharing options...
SocialMedicine Posted November 11, 2014 Share Posted November 11, 2014 If it seems like an environment which would be fun ... why not offer them 1 day a week ... lets say 75-80 an hour w/o benefits. given you have a per diem gig does that mean you have your own malpractice ? you can find out about some decent plans for indiv purchase through AAPA. Link to comment Share on other sites More sharing options...
Moderator ventana Posted November 11, 2014 Moderator Share Posted November 11, 2014 Per diem might be okay, but I would say no less then $100/hour for clinic time and NO call Realize only a PA,NP,Doc can fill this role, and a doc would never do it for less then $150/200 per hour, so you should be approaching this.... You are the only thing allowing his entire business to be in business - do not give yourself away on the cheap, it just hurts everyone. I have also seen more times then not, the power set up is determined early on. If you take a crappy offer it shows he has power over you, if you demand a fair rate and he has to meet your demands it says you are the decision maker. Just don't take it to have a job........ Link to comment Share on other sites More sharing options...
BruceBanner Posted November 11, 2014 Author Share Posted November 11, 2014 Per diem might be okay, but I would say no less then $100/hour for clinic time and NO call Realize only a PA,NP,Doc can fill this role, and a doc would never do it for less then $150/200 per hour, so you should be approaching this.... You are the only thing allowing his entire business to be in business - do not give yourself away on the cheap, it just hurts everyone. I have also seen more times then not, the power set up is determined early on. If you take a crappy offer it shows he has power over you, if you demand a fair rate and he has to meet your demands it says you are the decision maker. Just don't take it to have a job........ Good points, thanks for the input. The problem is supply and demand. When there are more PAs than jobs, you just need a lot of experience or some really valuable skills to demand a high salary. When PAs are taking jobs for $75k because they need them, it drives the whole market down. I'm going to come back with a 2 days a week per diem offer for $75-80 an hour. $100 may be a tough sell for me at this point in my career and in this area. Like I said I have nothing to lose with per diem; it wont hurt my CV and it's easy to explain in a real job interview. Link to comment Share on other sites More sharing options...
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