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Spine and Pain Mgmt - New Grad Offer

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Hey everyone, I am graduating in December and taking the pance Dec 15. I have received an offer from a spine and pain management place in Raleigh, NC. They were unwilling to negotiate on anything in the offer except to add a signing bonus but only if I sign by Oct 7 (yes that's in two days). I'd love to know what you all think and if it's an OK deal or think it's sketchy that they wouldn't negotiate and have put such a short timeline for me. I wouldn't be starting until January.

Salary: $80,000

Hours: 40/wk M-F 8-5

PTO: 10 first year, 15 second year

2 year contract, can terminate after 90 days w 90 days notice

8 paid holidays

5 days and $1500 CME

License and DEA and memberships paid as approved by the medical director

Malpractice insurance (1 million per occurrence, 3 mill/yr max)

401k and profit sharing after 1 year

Health and other benefits after 90 days

Non-compete clause of 10miles for pain mgmt places

$3000 signing bonus

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Nope. Keep your options open. You still have some time before gfaduation, pance, and licensing. Many more jobs will open up.


Are you going to be trained on procedures or just simple clinic appointments/refills/follow ups? If you are going to get trained on procedures it may be worth it, but then you will want more money because you will be bringing in more to the practice and you will hate you signed a 2 year contract and you will give your 90 and leave.


Like I said, I would pass and keep options open unless you know that you LOVE pain management or that specific practice.

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Awful salary, especially for that specialty. I would also suggest that pain management is not a good field to start in. You don't know enough about treating pain in general to start diving into it head first. They are trying to pressure you into saying yes by giving you two days to think about it. Think about what that says about the company. A good practice will give you plenty of time to think because they want it to be a right fit for both parties. Only places that lowball new grads at 80k can afford high turnover.


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Yeah it'll have training in injections so that's why I'm tempted. Also this is the first offer (or even interview) I've gotten and they're willing to start me in January rather than wait til licensing is done on like March so it'd be nice to make money haha


What would you be doing?  Shadowing?  You won't have your license and you're no longer a student at that point so you can't practice legally.

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Just to throw a couple more numbers into the conversation, the AAPA 2015 salary survey was released.


Pain Management salaries(N=126)


10th percentile: 80k

25th percentile: 85k

50th percentile: 94k

75th percentile: 103k

90th percentile: 116k


North Carolina salaries(N=300)


10th percentile: 75k

25th percentile: 81.5k

50th percentile: 89k

75th percentile: 100k

90th percentile: 113.5k



That is some objective data showing that you're getting hosed on salary.  Add mediocre benefits to that and you have a crappy initial offer.  Join AAPA if you haven't already so you can get access to this report and present it to potential employers if it will help during a counteroffer.  

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As a current student I have one questions: have you dealt with pain management clients during your rotations? Chronic drug seeking ex-addicts multiple trauma dudes chewing 16mg "D-D-Dsomething medicine that-only-work-for-me-doc" a day like candy? Or ladies with fibromyalgia of every part of the body? Can you withstand "my dog chewed up my script" stories and find good rapport with them?

I feel like if you go to that field with an attitude "I want to cure all my patients", an attitude of a common PA student, those patient would suck the soul out of you. Seeing people in that field, they all reminded me of juvenile cops with 30 years of experience... thick skin, cynical and "I have seen it all" type. Unless of course, we are talking about different type of pain management.

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Don't do it.

Simple - as a new grad this is a pigeon-hole with low pay that will make you hate medicine quickly.

I am being painfully honest.


I am 25 years in and recently took over a doc's practice and his full panel when he retired and am currently living in Ambien, benzo, narcotic hell trying to wean all his folks off of shit they have taken for too long for all the wrong reasons without doing anything else for their condition.


AND, I AM in Family Medicine - not a pain practice. 


Pain and Spine together is notoriously suspicious for a set up of profitable coding for injections, rhizotomies and other stuff that is often short lived in relief and doesn't usually address the long term issues. OR, they ONLY do injections and then ship the patients out to their PCPs for narcotics, etc. 


PLEASE consider something else - and with better pay, to boot. Your brain, your soul, your emotions and your job satisfaction will thank you for choosing something more broad and more able to utilize all those medicine skills you learned.


NEVER work as an MA - NEVER. You are becoming a PA - license or whatever - don't set yourself up for what you do not do and are not trained to do.


Respect yourself. Go home at the end of the day knowing you helped somebody and weren't a Pez Candy dispenser for narcotics.


My very old 2 cents................................

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