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Ortho job talk

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Hey all -

 

I am looking at possibly taking an ortho job with a well established practice. The catch is that the particular surgeon I would be working for has never used a PA before.

 

What I'm looking for are things that I can ask for in a rural, moderate volume orthopedic surgery practice. Not only am I concerned with compensation (though I am curious what I could pull in), but primarily I want to know how much responsibility and autonomy (if that's the right word) I can ask for. I fully understand that I am not an autonomous provider and that I am linked to my SP, but I know I am capable of solid medical decision making and I want to utilize my abilities to the fullest extent possible.

 

For example, I would like to be able to perform morning or evening rounds on our patients by myself (at some point). Is this asking too much? I expect to train with the surgeon up to the point where I am capable of handling the hospital management of a post-op patient. This doesn't sound outlandish in my mind.

 

Thanks in advance for your perspectives.

 

Andrew

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So, I'm meeting with the office manager to go over numbers and, most likely, an offer... Any help in negotiations would be most appreciated. Anything at all?

 

Andrew

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Hey Andrew, if you go to the contracts, negot section, there are a few threads on this. On the second page towards the bottom, there's a thread "new grad rural ortho offer" that sounds good....there are also other ortho threads, good luck.

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So, here's what I have come up with. I am submitting this to the office manager to begin negotiations this week. How does this look?

The responsibilities:

 

1. Typical rural Ortho clinic: Intakes, Follow-ups, Pre/Post-ops, casting, injections, etc.

2. Hospital: Post-op checks and rounds, co-management of post-op issues with hospitalists and my preceptor.

3. Surgical first assist: this is only 25% of the job.

4. Call: 1 day each week and 1-2 weekends per month.

 

The surgical practice sees 30 patients per day (3 days/wk) in clinic and the surgeon performs an average of 6 surgeries per week.

 

With that in mind, how does my proposal look?

 

 

 

Salary: $92,000 (based on 2009 salary reports)

Annual performance review and cost of living raise.

Pay for call: $50/day

Signing Bonus: $10,000

CME: $3000/year

Professional fees/licensing/DEA: covered in full

Professional memberships: covered in full

Health Insurance: Full coverage for myself and partial coverage for family (25/75)

Malpractice Insurance: covered in full

Retirement: 401(k) with 3% matching after 1 year

Loan assistance: $10,000 per year after the first year (pre-tax deduction)

Pager/Cell phone

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one big thing you are missing is call schedule and responsiblities.

 

More here in NC and some in SC the ortho PAs are primary ortho on call for ED and floor. In ED they are coming in for fracture reductions and disclocations we ED guys do not or tecnically cannot do, post reduction casting, plus any preop admissions.

 

Autonomy in the ED, however, if expected by your group, will need to be slowly and gently developed as your ortho skills expand.

 

I think that you are asking for a top tier package for a new grad.

 

I suspect they will counter offer with about 10 k / yr less, increase call comp to $100/ day, bag the sign on bonus, offer relocation assistance, and will not offer student loan repayment.

 

But it certainly will not hurt to ask.

 

More imprtantly.. do you WANT to do ortho? Will they teach you? If both are truw, are you willing to forgo some compensation while you are learning your trade?

 

And then ask for more when you present a modicum of experience to the table.

 

jusgt thinking.

 

davis

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Negotiating 101: Get them to make the offer first, their numbers may be higher but you will never know if you show your cards too soon.

 

This sometimes can be difficult and can go aound several times, ie "what do you want?" "What are you willing to offer?"

 

Once you have their offer, THEN you can counter, but only after you have thought it over for a few days.

 

Unless you have some solid ortho skills, you're not going to be much help to him in the beginning, so you're not coming from a very strong position. It's a very cool specailty though and is worth paying your dues.

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Also find out not just about ED call but about practice call. How often will you be expected to round on post-ops on the weekends? Also, if you're on ED call on Thursday night, your 85 y/o with a hip fracture may not be medically cleared for surgery until Saturday, in which case there you are on Saturday morning in the OR even though you're not "technically" on call. I speak from experience here.

 

At least $100 a day for call, more on the weekends...ortho call can suck, especially when you're in the OR at 11 PM on a Sunday night looking at coming back for rounds by 7:30.

 

I would also ask for more $$ if you end up coming in to work when you're on call. Hourly pay, flat fee for a surgery/reduction, etc.

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Just a frame of reference. I have been working a large ortho group for 4 years. My attending does 600 foot and ankle cases per year. My salary is 76k plus a 15k bonus. I get 1500 for CME/licensing. 401k matched up to 5%. Malpractice covered 100%. I choose not to get health insurance through my job. We do 1-2 nights of call per month plus 4 weekends a year. Call hours are part of the salaried position. We split up rounding (though he does more than I do). We operate 2.5 days a week and see patients together 2.5 days a week.

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Just a frame of reference. I have been working a large ortho group for 4 years. My attending does 600 foot and ankle cases per year. My salary is 76k plus a 15k bonus. I get 1500 for CME/licensing. 401k matched up to 5%. Malpractice covered 100%. I choose not to get health insurance through my job. We do 1-2 nights of call per month plus 4 weekends a year. Call hours are part of the salaried position. We split up rounding (though he does more than I do). We operate 2.5 days a week and see patients together 2.5 days a week.

 

76k with 4 years of experience seems pretty low... As a reference point, the average new grad salary last year was around 82K for ALL specialties. Ortho tends to be one of the higher paying specialties, there have been threads on here in the past that show the majority of ortho PAs were making into the 6 figures. The bonus is nice, but you should be getting something for your time on call. If this were my contract after 4 years, I'd be asking for a quite the bump in salary or preparing my CV to test the waters.

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For Pennsylvania, you're actually not doing bad at all. With 4 years experience, you're near the 75th percentile. I appreciate the feedback - trying to sort this out one step at a time.

 

Regarding how productive and helpful I'll be - yeah, I get that I won't be extremely helpful right out of the gate. However, I have practiced as an Athletic Trainer (think sports medicine) for the past five years. I've seen a number of shoulders, knees, ankles... And during my Ortho rotation, things came very quickly to me. Joint injections went well, evals were fine, reading x-rays, and I was able to learn prepping and draping patients decently. I was by no means perfect, but I believe there is potential here (my rotation was in the same practice).

 

icthus13 - I'm thinking that if I get the salary I'm asking for (which I know will be a little higher than they're thinking) then I won't need so much call differential. That's part of the reason I left it low - so they'll be more likely to give me the base pay that I want. Thoughts?

 

Andrew

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icthus13 - I'm thinking that if I get the salary I'm asking for (which I know will be a little higher than they're thinking) then I won't need so much call differential. That's part of the reason I left it low - so they'll be more likely to give me the base pay that I want. Thoughts?

 

 

Then I would definitely get it in writing: No more than X days of call per month without that $50/day increasing.

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76k with 4 years of experience seems pretty low... As a reference point, the average new grad salary last year was around 82K for ALL specialties. Ortho tends to be one of the higher paying specialties, there have been threads on here in the past that show the majority of ortho PAs were making into the 6 figures. The bonus is nice, but you should be getting something for your time on call. If this were my contract after 4 years, I'd be asking for a quite the bump in salary or preparing my CV to test the waters
.

 

Depends on location, as due to higher cost of living, and/or demand for physician assistants the salary may be higher. Also, most times in orthopedics, you are compensated longer due to working more hours. Thus if you are in an area with a lower cost of living, and only working forty hours a week with periodic call, and you like your job....I wouldn't send out your CV to "test the waters" unless you are ready to change jobs...

 

Jim

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Depends on location, as due to higher cost of living, and/or demand for physician assistants the salary may be higher. Also, most times in orthopedics, you are compensated longer due to working more hours. Thus if you are in an area with a lower cost of living, and only working forty hours a week with periodic call, and you like your job....I wouldn't send out your CV to "test the waters" unless you are ready to change jobs...

 

Jim

Ya, I probably jumped the gun a little bit and didn't consider location and other factors. But the fact remains that a base salary of 76K is low for a PA. As I mentioned, the average new grad salary last year was around 82K if I remember right... and we are talking about a guy with 4 years experience in one of the better paid specialties. Factor in not getting extra for being on call, etc. and I personally wouldn't be too excited about those terms.

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Here is their counter-offer. Thoughts?

  • 3 year contract
  • Starting salary of $62,000 including call
  • Possibility of performance based bonuses at the surgeon's discretion - NO guarantees
  • $1000 CME with prior approval of the event by the surgeon

  • 15 days vacation/year - 10 must be at the same time as the surgeon
  • Health insurance for me only.

  • Retirement eligible after 3 years

  • Malpractice, licensing, DEA and recertification fees paid for term of employment (if I leave early I have to pay them back)

  • No professional memberships or loan assistance.
  • Pager provided

  • This would be for a standard work week; I could make extra by picking up extra call but this is not guaranteed.

My initial reaction is that this is just awful. Insulting, to be honest. I need some help with how to go about talking to these people to let them know, respectfully, that their offer is no good.

 

Thanks!

 

Andrew

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Here is their counter-offer. Thoughts?

 

 

  • 3 year contract
  • Starting salary of $62,000 including call
  • Possibility of performance based bonuses at the surgeon's discretion - NO guarantees
  • $1000 CME with prior approval of the event by the surgeon
     
  • 15 days vacation/year - 10 must be at the same time as the surgeon
  • Health insurance for me only.
     
  • Retirement eligible after 3 years
     
  • Malpractice, licensing, DEA and recertification fees paid for term of employment (if I leave early I have to pay them back)
     
  • No professional memberships or loan assistance.
  • Pager provided
     
  • This would be for a standard work week; I could make extra by picking up extra call but this is not guaranteed.

My initial reaction is that this is just awful. Insulting, to be honest. I need some help with how to go about talking to these people to let them know, respectfully, that their offer is no good.

 

Thanks!

 

Andrew

 

Ouch that is a pretty rough offer... might want to consider walking away and heading for greener pastures unless this is an ideal location/job for you. 62K is insulting, especially when call is included in this. If this group wants to find a good ortho PA that is interested in staying beyond 1-2 years simply to gain experience, they will need to bump up the starting salary 15-20K minimum. It was lofty to expect a sign on bonus and tuition reimbursement, but a new grad should be able to make 75-80K starting, especially in a field like ortho.

 

Sounds like they are looking for cheap labor for 3 years and then moving on to the next PA.

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Here is their counter-offer. Thoughts?

  • 3 year contract
  • Starting salary of $62,000 including call
  • Possibility of performance based bonuses at the surgeon's discretion - NO guarantees
  • $1000 CME with prior approval of the event by the surgeon

  • 15 days vacation/year - 10 must be at the same time as the surgeon
  • Health insurance for me only.

  • Retirement eligible after 3 years

  • Malpractice, licensing, DEA and recertification fees paid for term of employment (if I leave early I have to pay them back)

  • No professional memberships or loan assistance.
  • Pager provided

  • This would be for a standard work week; I could make extra by picking up extra call but this is not guaranteed.

My initial reaction is that this is just awful. Insulting, to be honest. I need some help with how to go about talking to these people to let them know, respectfully, that their offer is no good.

 

Thanks!

 

Andrew

 

holly crud

 

that sucks

 

tell them no thanks - they can hire and MA for almost that and not get reimbursed a single thing.... with you then get to earn money instead of loose it....

 

 

don't take a substandard offer - it hurts all of us

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Highly unlikely that you will be able to negotiate this to within a range you would find acceptable. Even if they came up by 10k, it wouldn't be near what you want/deserve and it will likely create animosity that you should not have to deal with. Negotiating will not bring this offer close enough to 90k to make it worth your effort (they are not going to offer you half again as much as the initial offer).

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After reading this section I would have to agree and say unfortunately you should turn down this offer. They are being unrealistic and cheap with the proposed package. Having said that you don't want to burn any bridges because the medical community is very small. I would simply state thank you for the offer. The job description looks nice but financially this job does not make sense for you to take.

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So, you can only take vacation when the surgeon takes off?! With a 3-year contract they're probably just hoping to get lucky with a PA who doesn't know his worth and happy to take ANY job and "lock 'em in" for the time being. 62k with uncompensated call, I think you know the answer to this...

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Everybody:

 

I do know this is nearly the worst offer of the century - I needed input on ways that I might be able to work it a bit and change the situation to something mutually beneficial. That several of you feel this may be impossible is very helpful. My gut reaction was to say, "You may try again at a later time if you want to think of something more reasonable," but I have to be careful that I don't burn bridges in my small community. I will counter later this week but I don't hold

much hope for this position anymore. And that's ok. Thanks for all the input.

 

Andrew

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Oh sorry saw the offer.

 

Again, that blows.

 

62K

Forget that, in ortho you get spanked. 62K is what RNs make or RRTs with OT. No friggin way!

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