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Ortho - New Grad Offer

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I just got a job offer for Orthopedic Spine


Salary: 81963

Schedule: 40 hours/week, no call, no weekends

6 holidays, 20 days PTO

CME: 4000/yr

Benefits: Dental, medical, life and disability.

403b/Roth 403b, contributions to 401a, at % salary match based on years of service.


Licensing, DEA, covered

Malpractice: Modified claims-made, 1M/3M limit, with coverage after retirement, resignation, or move to another practice.

(I assume this means tail coverage, but they didn't say if I'd have to pay for it, if I ever leave).


This is a clinic-only Ortho Spine job, with an Ivy League academic hospital. They were upfront about no OR because of residents, but they seem invested in training me as a new graduate. 

Aside from working with the surgeons, I also get dedicated time with a Radiologist for MRIs, and time with PM&R and Pain Management. Eventually, they want me to run clinic independently with my own patient panel, being able to read my own imaging, see new patients, and offer treatment, without needing much physician oversight, instead of just doing followups for the surgeons. They weren't very clear if I was going to have a chance to expand my role, or move within the department over time. 


The pay is on the lower side, and I'm not sure if they're willing to negotiate like private practices do. The fixed 40-hour schedule could allow me to work 1 day a week at a per-diem to keep my generalist skills sharp, and they didn't put a non-compete clause on the employment offer. 


I'm still looking to hear back from a private multispecialty group, also Ortho Spine, but with OR, trauma, ER, and clinic. Call will be % collection of RVUs. Medical management will be left to the Hospitalists, Ortho-style. This is more likely going to be 50+ hours, and around 85-90k salary + bonuses. No word about the rest of the compensation package. The increased hours makes their pay actually less than the academic job, and I can't imagine getting a per-diem with their schedule, but they do offer trauma and fracture management, which I won't get with the dedicated Spine job.


I have until next week to decide, but I don't want to keep them hanging that long. I'm tempted to let the private practice job know I have an offer, but I'm not sure how that comes across. I was considering getting an offer from the private practice job, to negotiate my current job offer, but this risks taking too long and I don't want to appear greedy. That aside, I think that I will learn more with the teaching hospital, work less hours for comparable pay, but give up OR experience, in exchange.


I think I can be a much more autonomous, and productive Spine PA, if I learn from a teaching hospital first, then move on to private practice, than balance learning with the practice's productivity if I go straight to it as new graduate. However, while the teaching is valuable and the Ivy League hospital's name looks good in my resume, I am concerned how the lack of OR experience could affect transition into private practice in the future, where I likely have a better chance of getting procedures, autonomy, and better pay.  




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Having been house staff PA in a Level I Trauma Center 1000 bed teaching hospital - I was the ortho for the ER to triage, treat, set, reduce, prep for surgery AND help with pre-ops for the residents.


It was tough. I trained at this hospital and then went back as House Staff. You can't always go home.


I had 14 attendings, 25 residents - 5 in each year and then medical and PA students and the ER staff and residents to deal with. 


Absolutely EVERYONE had their own idea what my job was and no one told me. Yours sounds better with some organization.


However, be prepared. Residents sometimes aren't that smart and looking for surgery notches to put in their magic case book. Doesn't matter if the patient is safe for surg or not - just do it.


A chance to cut is a chance to cure - Hmmmm, no - a chance to cut is a chance to kill.


The attendings came in all flavors - raging A-holes to teaching wizards and the residents often thought PA meant Personal Assistant. Be careful of case poaching and treatment plans and options. Residents rotated every 30 days and everything had to be re-explained and retaught and redone. Kind of like the movie Groundhog Day without the laughter.


Make sure you have the self confidence to stand your ground, present well, know the treatment options and bend to multiple different personalities and styles.


The pay seems painfully low, by the way.


After being out 25 years, I would advise new grads to go into primary care, urgent or er care or something where general skills will be reinforced daily - THEN pick your specialty and take your generalist knowledge with you.


Pigeon hole yourself too soon and your skill set shrinks and you have no one to teach you.


My very old 2 cents…...

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Thank you for the replies.


RealityCheck, your job sounds a lot like the private practice one. While the SP is Spine fellowship trained, he still does a lot of trauma, and expects that of his PA. In the interview, the plan seems to be to get one PA first, hire a 2nd MD for the Trauma service, then get a 2nd PA for that physician. It sounds like I'll get chances to operate and work with fractures, along with our routine Spine cases. But with the way they're planning ahead, it sounds like they need the new hire to do a lot very soon, and I'm concerned if they'll even train that well, when I still need to get up to speed. The SP has also never had a PA before.


In contrast, the academic gig even planned on making sure I'd get off-service time with Neurosurgery, Radiology, Physiatry, and Pain Management to really know the specialty. They seem intent on me doing more than just the surgical patients. There was even talks on doing 4 10hr shifts since it's pure clinic, which could allow me to get 1-2 days on part-time FM/UC to keep my generalist PA skills sharp (extra cash doesn't hurt too).


The job offer looks good to use for learning the specialty, then move on to something better. I'll have the skills and confidence to do more, and get a better paycheck. I know how lucrative Spine can be, but it's tricky balancing how much you can be productive when you're still trying to learn.  


Granted, all jobs hire PAs to improve their bottom-line, but I still want to get as much learning as possible, since it's unlikely I'd stay at my first job long-term.

Salary-wise, they actually emailed me back with a $2400 increase, just after I sent a thank you letter saying I was going to think about it. It's better, but the pay only goes up 3000-4000/year, with how their payscale for the department's PAs are set up.

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