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ArmyVetPA

Primary care offer- way too low

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I need some advice to make sure I don't sell myself and our abilities too cheaply.

 

I'm about to graduate in a couple months and have interviewed at 2 family practices, both of which offered me a position. 

 

One is just not in an area I want to live, but offered 85k. I thought it was reasonable, along with the benefits, but felt I would overall be happier closer to the city (Portland, Or). 

 

The other is in the metro in an area with a cost of living at 125% the national average. 4 days/week including 2 Saturdays/month.

 

Today they offered 65k base salary with 10% productivity bonus from all my billing after what sounds like just my salary deduction.  (full details via email to follow next week)

 

To me, this seems extremely low. The 50th for new grads in my state according to the salary report is about 84k (only 28 responses though) and I'm not seeing any states lower than the 70s even in the 25th. I told myself I wouldn't take a job for less than 80k, and I honestly think I should be able to get more in general after seeing classmates with straight salaries in or closer to the 90s. The clinic manager claims I will make about 40k in productivity, but I'm really not excited about this level of uncertainty and honestly have a hard time believing that I will make that much starting out in productivity.

 

My planned counter: 80k guaranteed, then the rest can be productivity.

 

Is this the right counter or is that too low? Am I missing something about how productivity bonuses work that means this offer isn't as bad as it sounds? I have time to keep looking if this doesn't work out, but I did really like the practice, and the PAs I met have been there for several years so they must have some reason to stay. 

 

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Portland, OR is an oversaturated area, with both OHSU and Pacific churning out 40-odd new grads each year.  Someone with less self-respect than you will take that job at that salary, most likely, just to get experience.  You can walk, you can counteroffer, or you can cave, but when a job has a great supply in an oversaturated PA labor market, they don't really have to play ball like rural clinics might.

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I will definitely counter, but asking for 15-20k more in salary is a pretty significant jump. I still refuse to take less than 80k guaranteed at this point, but countering with my bottom number is not what I had ever expected to do. The insistence that I will be close to 100k by the clinic manager started on the first interview, but I just was expecting more guaranteed. To me this just looks like they are saying they will pay me way below typical starting and once they have pretty much recovered their costs for hiring me, I can potentially make a decent amount- but they won't take the risk and expect me to. 

 

Do you know what a family practice PA (new or otherwise) typically brings into a practice financially (actual paid amount, not billed amount, majority being from private insurance), to at least know if the insistence that I could get 30-40k on top of that is even reasonable? If they are lying to me I don't want to waste my time. 

 

Of course I could still take the other offer, but it's an hour drive from where I want to live, I hate workday commutes, and I would work every Saturday. I like college football, so this is a pretty major downside for me. 

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Three years ago, I started at $85k in the Olympia area, but with no bonuses or productivity calculations.

Heck, if you want to come north to Olympia, my current practice is hiring, and you'd likely get $80k as a new grad for an attractive--for some--practice environment. (Single MD, 3 PA clinic looking to hire a 4th, family med/occ med/walk in with a pretty low peds or women's health census, ~10% medicare, 0% medicaid, and NO EMR)

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I would not accept the 65K offer at all. It's way too low. Productivity should be a "bonus", not an excuse to underpay you and then make you chase a carrot. Primary care is notoriously low margin with notoriously high "admin" work that will be uncompensated such as lab sign offs, insurance forms (prior auths/pre-auths, explanations about why you rxed this or that), pharmacy phone calls, patient phone calls, review of consults. I would guess it will be nearly impossible for you to make up the difference in salary with a productivity percentage in a non-surgical or procedure-based specialty. You will feel overworked and stressed from trying to squeeze in more and more patients to make productivity, then work after hours to finish charts leading to burnout.

 

Don't settle. You still have some time until graduating and passing boards, I'd keep looking around. Also consider larger hospital systems or academic centers (more structure) or government (no productivity/profit pressure). 

 

I work in primary care in a government facility. Slightly underpaid for my metro area (83k), but I work my 8 hours and leave. No one cares if I see 2 patients or 15 patients. Average 10 patients a day and it's plenty because they can be extremely time consuming. No insurance/billing. Limited formulary pharmacy is 5 steps from my office in case either of us has a question we just shout down the hall. No phone calls from anyone. Feel free to PM me for details.

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The standard Primary Care new grad offer my class has been getting in Nevada has been:

 

$95k annual salary

$15k annual bonus

$50k tuition reimbursement after 2 years

 

CME + licensing + malpractice insurance + 401k + health coverage + a few other mixed benefits.

 

Just wanted to let you have something to compare it to regionally. 

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The standard Primary Care new grad offer my class has been getting in Nevada has been:

 

$95k annual salary

$15k annual bonus

$50k tuition reimbursement after 2 years

 

CME + licensing + malpractice insurance + 401k + health coverage + a few other mixed benefits.

 

Just wanted to let you have something to compare it to regionally. 

you can't compare nevada to portland, or. totally different markets.

for comparison in portland doing urgent care I got 80k 15 years ago. that job(which I left) now pays new grads well over 100k to start with outrageous union benefits.

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you can't compare nevada to portland, or. totally different markets.

for comparison in portland doing urgent care I got 80k 15 years ago. that job(which I left) now pays new grads well over 100k to start with outrageous union benefits.

 

I agree. My point being more that the cost of living is cheaper in Nevada and their new grad offer doesn't even come close in comparison. 

 

It's actually 21% cheaper to live in Las Vegas than it is in Portland. So I would expect their salary to be at least 20% better than what I mentioned.

 

http://www.bestplaces.net/cost-of-living/portland-or/las-vegas-nv/100000

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I agree. My point being more that the cost of living is cheaper in Nevada and their new grad offer doesn't even come close in comparison. 

 

It's actually 21% cheaper to live in Las Vegas than it is in Portland. So I would expect their salary to be at least 20% better than what I mentioned.

 

http://www.bestplaces.net/cost-of-living/portland-or/las-vegas-nv/100000

gotcha, the issue though is that there are 10 PAs wanting to work in portland for every 1 that wants to work in las vegas. the market here is saturated with new grads due to 3 local programs. folks are taking jobs in specialties in which they have zero interest at 10-20k below fair market value just to stay in town in hopes of transitioning to their specialty of choice down the road. most end up stuck in a specialty they hate. I have former students working in endocrinology and urology who really want to work in em, but with no em skills outside of school and 10 yrs in their specialties they are effectively stuck doing things they hate unless they ever decide to move.

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gotcha, the issue though is that there are 10 PAs wanting to work in portland for every 1 that wants to work in las vegas. the market here is saturated with new grads due to 3 local programs. folks are taking jobs in specialties in which they have zero interest at 10-20k below fair market value just to stay in town in hopes of transitioning to their specialty of choice down the road. most end up stuck in a specialty they hate. I have former students working in endocrinology and urology who really want to work in em, but with no em skills outside of school and 10 yrs in their specialties they are effectively stuck doing things they hate unless they ever decide to move.

 

Saying that, would you think taking a lower offer to get to be in the area is reasonable, especially being that 10% productivity could bring in more after I get the hang of things? It's primarily private insurance, only 4-5% medicaid, not sure the Medicare percentage. I have no intention of leaving the area. I've moved too much over the years that I would rather work for less in that area starting out. The real question for me isn't if the salary sucks- I know it does. I just need to know if it's reasonable to expect that the productivity bonuses could make it an offer that won't completely disrespect our profession. A seasoned PA did tell our class that a lot of us will turn down good offers because we would rather have higher salary than productivity, and will end up with less because we don't know any better. It's pretty difficult for us to know how much we will bring in when we've never done this job before. I have to assume I will bring in at least some profit for the practice my first year, which means a little for me too. I intend to get a lot of questions answered about billing there after I get the written offer. 

 

I would also much rather work in PC than any other specialty, and would prefer a smaller practice over a large corporation/academic center. I plan to send the offer to a lawyer, a financial advisor at my school, as well as a part-time faculty member who's income is largely productivity based. 

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take the 65 k if you get something in writing that says your bonus will be the greater of 15k guaranteed or the actual amount.

what if they give you a 3 thousand dollar bonus? 68k? we have er techs making that with overtime and paramedics making that as straight pay..

my starting salary in CA 20 years ago was 70k. when I moved to OR 16 years ago my starting salary with a bit of O.T. was 80k.

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gotcha, the issue though is that there are 10 PAs wanting to work in portland for every 1 that wants to work in las vegas. the market here is saturated with new grads due to 3 local programs. folks are taking jobs in specialties in which they have zero interest at 10-20k below fair market value just to stay in town in hopes of transitioning to their specialty of choice down the road. most end up stuck in a specialty they hate. I have former students working in endocrinology and urology who really want to work in em, but with no em skills outside of school and 10 yrs in their specialties they are effectively stuck doing things they hate unless they ever decide to move.

 

This is why I think starting off in a specialty of any kind is a bad idea (except for maybe surgery since it's so different from general medicine).

 

I have a friend right now in Boca Raton, Florida that went straight into cosmetic derm out of school. She was making bank for a little while, but now derm jobs have dried up out there. She's having trouble finding a job and she really doesn't know anything about medicine outside of her subspecialty.

 

Meanwhile, I started off in family medicine. I know a little about lot (and a lot about a little lol), but I feel very comfortable transitioning into specialties (including derm since I also have experience with minor procedures) if I wanted to. Of course, it's not like there's a shortage of family med jobs out there looking for an experienced PA.

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A salary less than 90k shouldn't be taken seriously regardless of location.

 

Sent from my Nexus 5 using Tapatalk

 

 

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