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Spine and Sports Medicine/Ortho offer - New grad!

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Hi everyone,

I am graduating from PA school next week and am job hunting. I have been on multiple interviews in different specialties and I have finally received my first offer today. I don't want to be that naive new grad jumping at the first offer so please let me know your thoughts!


(Some of this is pulled directly from the contract they sent me)

-Base salary: 80K

-Health insurance after 60 days of employment, mostly paid- I will pay out of pocket $60 (no dental or vision)

-"401K. Employee will be vested after one year of full time employment. Company will match 100% up to 3% of employee’s salary and 1/2% up to 5% of employee’s contribution."

-PTO: 10 days after 90 days employment

-CME: 3 days and $1000 per benefit year (what does per benefit year mean??)

-Malpractice covered with one year tail coverage

-Non-compete: 2 mile radius of any of their clinics (they have 3 clinics) --I would make them take this out

-Position is essentially 8-5pm Mon-Fri.

-No inpatient consultations but still on call (explained below)

-Licenses covered (DEA, DPS)


From the contract:

-"Productivity Bonus. The CEO may award a productivity at the sole discretion of the CEO based on how the company and employee performance is. This can be increased each subsequent year but again at the sole discretion of the CEO based on how the company and employee performance"

-"Termination clause. Employee’s employment with the Company will terminate immediately upon the death of Employee. Either the Company or Employee may, without cause, terminate Employee’s employment upon thirty days prior written notice. The Company may also terminate Employee’s employment immediately, by notice to Employee, for cause, including, but not limited to, actions by Employee deemed by the Company to be contrary to its best interests."


Here is more info about the position:

It's a Spine and Sports medicine/Ortho clinic in the Houston, Texas area. It's essentially a two physician office but I have only one main supervising physician. The doc is actually a "physiatrist" and is not a pain management doc. They have never had a full-time PA, they had a part-time PA at one point but then she couldn't fulfill their needs of a full time position so she was let go.

-I went on three interviews there. The first was a formal interview, the second was to see patients with him, and the third was to observe procedures in the OR and practice presenting pts to him.
-The supervising physician is great, he is very academia-minded and was adjunct faculty for a major medical school for a bit before he decided to open his own practice. He's taught fellows and residents and in that sense I think he would be a great mentor, especially for a new grad like me. 

-They originally mentioned 85K during my first interview but the contract offer says 80K. Over the phone when they verbally said they were going to extend an offer they said they were actually going to offer 75K but thought I had "potential" and increased it to 80K (insert eye rolling here haha)
-He does not need me in the OR because his procedures do not need a first assist (he does mainly spine injections guided by XR);  so pretty much I'm just in clinic for him
-Thus...he justifies I shouldn't think of this position as a surgical specialty because I can't bill for first assist and therefore can't bring in more revenue and that a more comparable salary should be similar to a family medicine position
-The position requires traveling in parts of Houston. He has three different clinics and they require me to be at each one on different days. There is potential, although unlikely, that I will need to be at multiple clinics on the same day, they have not confirmed my schedule yet. (Each clinic is about 20 miles apart from each other).
-As far as being on call, after hour calls are sent to answering service. True emergencies calls are sent to staff: MA, office manager and myself (so every third week). If provider needs to be involved call goes to on call provider which will alternate between me and supervising physician (so every other week). The week I am on staff rotation I will be also be the on-call provider.

I would appreciate the feedback! Thanks in advance!
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I would not accept this offer. Salary is too low. Benefits aren't great. Don't let them tell you they aren't going to make any money from your services. If nothing else you'll be teeing up procedures.


For the family med comparison.... This isn't a great family med offer. If the position is something you're interested in, gather your evidence and present your case on what would be a more reasonable offer. Good luck!

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With demand the way it is these days I would be hesitant to accept an offer <90k for an entry level FP position with no call.


I would return with:



-PTO 15 days


-CME $1500

-Would also clarify about compensation for call


I could be entirely out of touch with the market in Houston, but this offer seems rather lackluster to me.

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My FP position starts at 100,000 for all PA/NPs regardless of the years of experience.  Salary is guaranteed for 2 years and then a base plus production bonus. 


My employer is in an area where it is hard to recruit PAs/NPs, thus salary for new grad is decent (not so much for those of us who have experience)


Your new grad offer is waaaayyyyyy to low. 


I'm concerned about the bonus being at the discretion of the CEO.  They will find a way to say you are not producing enough volume and have an out of why you might not get bonuses.


Ask them how they bill for your services and if they give you your production numbers on a monthly or quarterly basis so you can track your productivity.  If they say they will not share the data, then you are sunk.  All PAs should be allowed to have access to their productivity data no matter what field they are in. 

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I agree with Paula. What happens if you never get awarded a bonus, or end up having to travel between clinics on a regular basis. I would insist on a bonus based on productivity or some other measurable standard. Also, reimbursement for round trip travel to a second (or third) clinic during a single work day, at the federal mileage rate of $0.57/ mile. And 80k is too low in that market especially if you have no control over earning your bonus and don't know if you will ever get one. I think they low balled you anticipating a negotiation so don't disappoint them. BTW, I have had spinal injections for back pain and I know what they charge. Nice high margin business. They can afford to pay you more.


Sent from my KFAPWI using Tapatalk


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Wow. Not only is this a terrible offer, its a terrible opportunity. As a new grad you should be either seeing a wide range of patients to determine what you want to do long term or have an exceptional offer that you don't want to turn down (which will usually be too good to be true and is.) A physiatrist is not an orthopedic spine specialist. They are pain management who do some invasive procedures and the range of patients and pathology would be very narrow. If you work in spine surgery (as I do) remember that it is one of the higher paying sub-specialties but with no OR or productivity....Sounds like they're playing you.  It can be tricky to get a great offer right out of school but there are definitely opportunities which will expand your future satisfaction as well as compensation. What was the formula?





Take 2 out of 3. Simplistic, but not wholly off base.

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