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please help a new grad know his place in orthopedics

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I am a PA student 1 month from graduation. I was invited for a face to face interview for a full time job in orthopedics very soon. The job is as a 1st assist in the clinic and the OR, seeing 30 patients per day in clinic.

It is in a large non for profit organization with more than a dozen hospitals in the middle part of the country.

The recruiter for the organization informed me how much they want to pay during a phone interview, and I proceeded to tap-dance around the question and avoided giving the recruiter a firm answer on how much I wanted. Overall the interview went well and now I am getting ready for the face to face interview. 

They want their employees to sign a no complete clause of 20 miles for one year after employee initiated employment termination.

They are offering:

Staring Salary: $86,000/year. no bonus pay. 

CME: 5 days per years, $2000

Schedule: 8-5pm Mon-Fri with weekend call of no more than 1 weekend per every 4 or 5  (unsure if compensated or part of salary).

PTO: 28 total days

Company retirement contribution without employee contribution: 3% of salary 

Company retirement contribution with employee contribution: company will match 75% of up to 6% of employee salary if employee contributes 6%.

Health and Dental is not 100% covered, but health benefits are excellent and would cost me approx. $200 per month


As a new grad with a mountain of student loan debt, I am trying to get the most money I can without annoying the interviewers. I suspect that they do not want to negotiate. 

I have 10 years of experience working for 2 fortune 500 companies. My resume shows professional and academic success in everything I have done since becoming an adult. However I do not have health care experience other than the CNA work I did to get into PA school, and what I have done as a PA student in rotations.

Is this a straight offer that I should take and run with? Is my previous experience worth anything in the healthcare world when it comes to negating salary? what do you think? thanks for reading...

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Non profits don't negotiate a lot so may be little wiggle room on salary. Plus 30 patients per day between 2 of you or by yourself, because 30 by yourself is insane. Ask what kind of call and do they pay extra if you have to come in? The rest of benefits are pretty standard.

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Guest Paula

I have found the clinics/hospitals that are part of large systems have no-competes in them for PAs.  I have one and there was no negotiation allowed to get out of it.  Mine was a 20 mile radius as well, 18 months.   


The OP could ask to have the no-compete struck from the contract because it is unlikely a PA in orthopedics will have any type or recurring patient loyalty once the ortho problem is solved.  Plus a PA is highly unlikely to start their own ortho clinic and hire an orthopedic surgeon.  It would be reasonable to get that clause out of the contract.  A contract is only offered to protect the employer not the employee. You could also have a lawyer look at the contract, but get one who understands medical practice. 

In my case, I am in primary care and potentially if I ever leave the practice I could take patients with me who want to stay on with me as their provider.  My employer doesn't want to lose any patients to any of the competing clinics in the area. It's all business. 

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in many states non-competes are illegal


You need to have an attorney review and advise


(BTW a 20 mile 1.5 year non-compete is likely illegal)

The courts look at the 'reasonableness' of the non-compete - typically something like 5 - 10 miles and no longer then one year is reasonable.  A non-compete is invalid if the courts say it is unreasonable (all this is at a state level as state law prevails)

A non-compete also can be deemed unreasonable if it reasonably takes away the individuals right to get employed with out having to move


I am luck, in MASS physicians are specifically EXCLUDED from non-competes - the state decided the health and well being of the community trumps any one companies business interests


Also to correct the above poster, it does not just stop you from starting your own clinic, but instead from working ANYWHERE with in the time frame or radius listed in the contract.  




dislike to reference this but check out the wikipedia entry on non-competes - is a good basic primer

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Just have to echo what everyone else said.  Make sure no competes are legal in your state.  In some areas, they aren't worth the paper they're written on.  I think practices sometimes put them in there to frighten people into honoring them when they really don't have to. I also agree with the "reasonableness" of the clause as being an PA in ortho, its not likely you will leave and take patients with you to start your own practice like in a family practice.  That said, I work in a town with two Ortho practices and they might be able to make the clause stick in that situation, but again, not sure of the legality.


A few things I would add:

Find out what "call" entails.  Is it just phone calls?  Only go in if doc gets called for surgery? etc.  This makes a big difference and should be compensated to the level of what you do.  At 86K, I would ask that call  be added to that and not rolled into your base pay.  My call is in addition to my base pay.


Another, ask if when you take your CME days, if it pulls out of your 28 day PTO pool.  Thats one that tricked me up.  But the monetary allotment is a good amount.


30 patients/day with you and doc is not bad.  If its on your own, that is a bit much, for a new grad.

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Take it from me, it's always better to restructure or eliminate a non-compete before hire.  As Paula said, they are more common now and where we live in Michigan, there's no way around it.  Every health systmem has them and they are all similiar.  I just spent $1200 on attorneys fees to get out of one a few months ago and it was decided by their corporate attorney that the verbiage was extremely broad (every specialty and 30 mile radius of the entire county i worked in - this left me with over an hour commute if I ever wanted to work again). Since it was so broad it was deemed not contractually binding because it interfered with my livelihood and abilty to provide for my family.   So they re-wrote the non-compete to apply only to my last specialty .  Some of you out there on this board always tell people not to work for companies that require non-compete clauses, but I'm here to tell those of you who haven't changed jobs in a while....this is the way of things now in a lot of geographic regions...not just mine.  If you refuse to work for these companies, than you will be hard pressed to find employment without moving a great distance to one of the few regional networks that don't yet have non-competes. 


What I would do, instead of trying to have it eliminated, is just have it written to pertain to that specialty.  What a lot of systems do, is lump our contract process in with physicians'.  So, ours aren't much different with the exception of salary.  This is why these non-competes are so broad and loosely worded.  Physician's have specialties they can't readily change and a client base. So these types of non-competes make sense from that standpoint.  But for us, who can switch specialties or areas of medicine, it's tough.  As if we could really steal patients from doctors anyway.


So, deal with it up front and have it worded the way you want, or that makes sense for both parties.  If you do that off the bat, you won't have to pay an attorney like I did.  Additionally, once I hired the attorney and had it changed, my practice though I was leaving and this created tension between us.  Ultimately, I had to leave because of this.  So, get it out of the way up front. 

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You can make a lot of money going into primary care with loan repayment options if you're so concerned about your student loan debt.


The $86k/yr offered I can guarantee you it won't go up that much. You're a new grad w/ zero experience. Did you say it's a non profit organization?


Primary care pays $75-85 range for new grad even more depending on region. You can negotiate to work 3 /12hrs shift per wk or 4 days per wk. You gets $40-50k loan repayment for every 2 yrs commitment through NHSC. You can pick up extra shift on weekends in the ED fast track or in the urgent care. If you work smart, going into primary care, you'll have higher earnings potential and you can quickly pay off your loan.


Good luck.

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If this job is in an area that you plan on being a resident of for some time, then the noncompete will work against you. Dont sign the contract with that in it or at least do what was outlined above and limit it to orthopedics.

If you are planning on this job to be a short term, get the feet wet and get a good experience and then move at least 20 miles away, who cares? Get your pound of flesh out of them and move on.

And ask for $100k. 

I think that should be mantra for every graduating PA student this year....ask for 100k.

The worst they can say is no. The more employers hear that, the more likely they will accept it.

And paying $200 a month for your health bennies is steep. Likely it is going right back into your employers pocket if they are large enough and self insure.

Good luck.

G Brothers PA-C

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