Family Medicine Offer - almost a new grad

[mgriffiths]

I am approaching graduation and have my first offer.  It is in Northern MI and family medicine, which is my first choice.  I also have a few friends who work at the clinic and having spent some time shadowing there I believe it would be an ideal situation for a new grad.  My family is also in the area, which in my case is a plus!

 

So, if people could review the offer and give some feedback I would greatly appreciate it.

 

First, it was mentioned in the interview that the clinic may be moving away from doing contracts.  Is this a problem, or is there another option I can ask for?  I read on another thread about having a signed letter that spelled out the offer to avoid potential confusion if a contract was not available.

 

Offer:

• 36 hours worked per week with 1 Saturday morning per month, no call (Saturdays may become less often)
• Base Salary = $80,000
• Bonus = $2,000/year based on supervising physician evaluation (every PA and NP has gotten it every year since the clinic started offering the bonus)
• Productivity Bonus = they expect 333 RVUs per month and then I get a percentage of any billing above that (talking to my friends, without working overtime they get between $500 and $2,000 per month)
• PTO = 3 weeks vacation, 5 days sick/personal (sick/personal days paid if unused) - no time is rolled over to next year
• CME = $2,500 and 5 days
• Retirement = 401K, 3% automatic contribution (whether I contribute or not)
• Health Insurance = single approx. $30/mo with $100 deductible, family between $400-500/mo and $500 deductible (supposedly it's good insurance)
• Licensing = everything required is covered 100%
• 2 Professional memberships covered 100%
• Malpractice + Tail = $1,000,000/$4,000,000

 

They do not have a specified program to start off a new grad and ramp up their productivity gradually, but during the interview they clearly expressed understanding and my friends had no issues starting as new grads.

 

My biggest question is tuition reimbursement.  I know for a fact they are doing it for one other PA and one of the recently graduated physicians.  The partners meet in two weeks to discuss, but it did sound like they were open to it during the interview.

 

So, does the offer sound solid?  If they do not offer tuition reimbursement what are your thoughts?

[mgriffiths]

Meant to include that my friends get the monthly productivity bonus seeing average 16 patients per day, and both have been getting bonuses every month since starting - even as new grads.

 

Also, all benefits begin day 1, including health insurance.

 

I also don't know about a non-compete clause.  I plan to ask when I find out the results of their meeting in a few weeks regarding my potential hire and tuition reimbursement.

[marktheshark89]

Looks pretty solid to me. See if they offer dental. Definitely push for tuition reimbursement if it is offered to others.

[rev ronin]

Yep, solid.  Oh, also see if they cover vision, but yeah, they've got things pretty well covered.

[delco714]

16pt per day is solid. What's the yearly or whatever raise plan? Otherwise pretty rock solid. I would ask for another week off (maybe even if you have to offer to not be paid if you don't use sick time). How real is the 36hr? What's Saturday morning...Will it together be a fair average? Overall I like it. I really like that you are excited and that it seems the pa are happy and treated well. That's more important then a few extra bucks

[cinntsp]

It's a nice offer for family medicine, especially since that's what you want to do and it's in your ideal location.  Good luck!  

[JtheWorker]

Seems like a very solid offer, congratulations and I hope this turns out well for you.

[mgriffiths]

I believe there is the option for vision and dental to be covered, but costs a little extra per month.  Probably won't do that now, but will as we start having children (hopefully!)

 

As for the yearly raise, I totally missed the ball.  The CEO mentioned that they normally do provide a raise yearly, and said that one possible option is to forgo my yearly raises to provide me tuition reimbursement.  I should have asked what the yearly raise is right then but didn't, but I plan to ask when we talk again in two weeks.  This is likely a better option than no tuition reimbursement, but depends on how quickly they pay off my loans - because they also mentioned refinancing to a much lower interest rate at a local bank, which would prolong the loan from 10 to 15 years.  I don't like the idea of no raises for 10 years, let alone 15.  Might be better to start a new thread, but does anyone know if I get taxed on tuition reimbursement as income if the clinic pays the loan for me?  If I am taxed, maybe I could just ask for the tuition reimbursement directly as "salary" and not get raises for however long since that would increase my initial "base salary." 

 

As for Saturday mornings, that is included in the 36 hour work week, so my understanding is that I would actually get an entire day off the week I work a Saturday.  I plan to confirm with my friends how this works. I would obviously prefer no weekends, but understand that the practice wants to be available for patients.

 

The 36 hours is time open for patient visits.  They specifically told me that the 4 hours of "time off" is so I can catch up on paperwork, but both of my PA friends already working there almost always get their paperwork and everything done in the 36 hours.  I wouldn't expect this of myself immediately, but I tend to be pretty efficient in what I do.

 

Anyone have any thoughts on the possibility of not having a contract?  This isn't definite, but should I ask for a signed "letter of intent" or is there a better option?

 

Thanks for the input everyone, I greatly appreciate it.

[delco714]

I believe there is the option for vision and dental to be covered, but costs a little extra per month. Probably won't do that now, but will as we start having children (hopefully!)

 

As for the yearly raise, I totally missed the ball. The CEO mentioned that they normally do provide a raise yearly, and said that one possible option is to forgo my yearly raises to provide me tuition reimbursement. I should have asked what the yearly raise is right then but didn't, but I plan to ask when we talk again in two weeks. This is likely a better option than no tuition reimbursement, but depends on how quickly they pay off my loans - because they also mentioned refinancing to a much lower interest rate at a local bank, which would prolong the loan from 10 to 15 years. I don't like the idea of no raises for 10 years, let alone 15. Might be better to start a new thread, but does anyone know if I get taxed on tuition reimbursement as income if the clinic pays the loan for me? If I am taxed, maybe I could just ask for the tuition reimbursement directly as "salary" and not get raises for however long since that would increase my initial "base salary."

 

As for Saturday mornings, that is included in the 36 hour work week, so my understanding is that I would actually get an entire day off the week I work a Saturday. I plan to confirm with my friends how this works. I would obviously prefer no weekends, but understand that the practice wants to be available for patients.

 

The 36 hours is time open for patient visits. They specifically told me that the 4 hours of "time off" is so I can catch up on paperwork, but both of my PA friends already working there almost always get their paperwork and everything done in the 36 hours. I wouldn't expect this of myself immediately, but I tend to be pretty efficient in what I do.

 

Anyone have any thoughts on the possibility of not having a contract? This isn't definite, but should I ask for a signed "letter of intent" or is there a better option?

 

Thanks for the input everyone, I greatly appreciate it.

The government doesn't care what the money is for on YOUR end. Taxable income yes.

[anewconvert]

I believe there is the option for vision and dental to be covered, but costs a little extra per month.  Probably won't do that now, but will as we start having children (hopefully!)

 

As for the yearly raise, I totally missed the ball.  The CEO mentioned that they normally do provide a raise yearly, and said that one possible option is to forgo my yearly raises to provide me tuition reimbursement.  I should have asked what the yearly raise is right then but didn't, but I plan to ask when we talk again in two weeks.  This is likely a better option than no tuition reimbursement, but depends on how quickly they pay off my loans - because they also mentioned refinancing to a much lower interest rate at a local bank, which would prolong the loan from 10 to 15 years.  I don't like the idea of no raises for 10 years, let alone 15.  Might be better to start a new thread, but does anyone know if I get taxed on tuition reimbursement as income if the clinic pays the loan for me?  If I am taxed, maybe I could just ask for the tuition reimbursement directly as "salary" and not get raises for however long since that would increase my initial "base salary." 

 

As for Saturday mornings, that is included in the 36 hour work week, so my understanding is that I would actually get an entire day off the week I work a Saturday.  I plan to confirm with my friends how this works. I would obviously prefer no weekends, but understand that the practice wants to be available for patients.

 

The 36 hours is time open for patient visits.  They specifically told me that the 4 hours of "time off" is so I can catch up on paperwork, but both of my PA friends already working there almost always get their paperwork and everything done in the 36 hours.  I wouldn't expect this of myself immediately, but I tend to be pretty efficient in what I do.

 

Anyone have any thoughts on the possibility of not having a contract?  This isn't definite, but should I ask for a signed "letter of intent" or is there a better option?

 

Thanks for the input everyone, I greatly appreciate it.

 

 

10 years of raises at 3% results in a salary of $107,513 a year by your 10th year.

 

In the interim you would lose out a combined $144,619 in lost earnings (the difference between $80k and a yearly 3% increase, summed over the 10 years).  Nevermind the increased value of a 3% 401k contribution each year that you get a raise.

 

Here is the salary growth table for your salary compounded over 10 years:  http://www.easysurf.cc/samt8n3.htm?ansal=80000&ipcsal=3&time=10

 

So... if it is forego raises for student loan repayment or get a raise and be responsible for your own payments... take the raises. 

 

(While you are at it check out the value difference between negotiating a 3% yearly raise and a 4%.. by year 10 you are giving up $11k a year)

[mgriffiths]

Thanks for that info "anewconvert."  I hadn't run the numbers, but I figured it would be something like that.  Even ignoring the numbers, I wouldn't support no raises for 10 years on principle.  It's not really tuition reimbursement at that point, I'm paying for it myself, they're just hiding it from me.

 

Also, thank you "delco714" for the clarification.

[rev ronin]

The thing about banking on raises is that those are all well and good models, but PA saturation may put a significant dent in future increases in compensation.

[mgriffiths]

Any suggestions if they decide not to do a contract?  Is a signed letter that states the expectations, requirements, benefits, etc. of the job enough?

[rev ronin]

Any suggestions if they decide not to do a contract?  Is a signed letter that states the expectations, requirements, benefits, etc. of the job enough?

Depends on what state you're in, I think.  I'd still have it reviewed by an employment lawyer, but if they don't intend to make any odious conditions binding (e.g., non-compete) or don't have any in the first place, it's probably a pretty low risk situation compared to contracts that do.

[mgriffiths]

Thanks everyone for your input, I greatly appreciate it.

 

I just received an offer letter today!  It is basically everything that I mentioned previously, but wanted to ask for clarification and your opinions with some of the new information.

 

1. They have offered $10k of loan repayment per year for four years, or a total of $40k.  Each year does require a one year commitment, otherwise I have to reimburse that year's $10k (makes sense).  The clinic does make me eligible to receive up to $30k of federal government loan repayment, but my understanding is that is not guaranteed (the clinic is a 9/24 on the scale).  So, extrapolating a bit, I will have a total of around $100k in student loans, and this offer would leave me somewhere between $30k-$60k. When I talked with them briefly last week the CEO mentioned that they are working to figure out "their policy" on loan repayment and that after the 4 years it is "possible that we would continue offering loan repayment."  My concern is that this is no guarantee, so I would expect to be left high and dry.  Any input?  I do plan to counter with 100% loan repayment, as I may have two offers coming in shortly for ortho (my other area of interest).

 

2.  I have the true numbers for the RVU tier bonus system.

• 349 RVUs expected per month
• 350-399 RVUs - I get $5 per RVU
• 400-451 RVSs- I get $8 per RVU
• 451 and up - I get $10 per RVU

Can anyone give some information regarding how many patients each tier is on average?  Obviously it will differ depending on whether the majority of patients are WCC, complex CHF/DM/etc. patients, or simple URI, but any information would be helpful. Also, I am concerned as in my interview I was told 333 RVUs were expected each month before bonus, so I'm wondering if something changed to basically cover the $10k loan repayment by me working more.

 

3.  There is no information given regarding annual or regular raises, so I am concerned that while other PAs and NPs may get offered raises I might not because of my loan repayment, which again basically means I'm paying for loans anyway.

 

4. There is no mention in the offer letter of a non-compete clause.  Is this something I should specifically ask about or is there not one since it's not stipulated in my offer letter?

[FfIghter23]

So, every provider is different in how productive they are. A lot has to do with how you document (basically what boxes to check) and billing/coding.

 

The median work RVUs for family physicians in ambulatory care in the MGMA data tables were 5,468, while the median for general internists were only 5,233. I'd say this will be attainable after a year of practice or so.

 

Keep a close eye your first year on your RVU data. You will be able to figure out how to work hard enough to achieve what will make you happy in bonuses. As Mark Twain once put it, "Get your facts first, then you can distort them as you please."

[mgriffiths]

Thank you very much, those numbers are very helpful!

[mgriffiths]

I have two other interviews coming up, both in ortho - which is my other main area of interest.

 

I replied yesterday to the FM offer basically saying that I am reviewing my options and their offer.  I also asked some questions about raises, the change in RVU cutoffs, and whether I have the ability to work overtime (if I want/need to increase my income).  I also mentioned that I was somewhat disappointed with the level of loan repayment.

 

One question I have that I meant to include from the start, and possibly should start a new thread for: during my interview they mentioned that I could work some shifts in one of the multiple EDs they cover.  This would be completely as I wanted to, but would potentially be a nice way to augment my salary if/when needed.  My question is, what should I expect to make per hour working part time in an ED, and should the patients I see in the ED count toward my RVUs for the productivity bonus?

[dchampigny]

I additionally had a question regarding RVU status.

 

I saw that the average for family medicine docs was somewhere in the 5,000s.....does anyone have any data on what PAs average?

[mgriffiths]

I found out the average RVU's per month for a PA or NP at this family practice clinic was around 375, but that includes some pretty rural clinics where they barely see 16 per day, if that.  If you take just the average of their three busiest clinics, then it is closer to 400 per month, or 4800 per year - but again, that's only 36 hours of patient time per day

[mgriffiths]

So I received an email back answering my questions:

 

- The typical yearly raise is 3%, but this is not guaranteed.  They review it every year, but in the last 16 years they have always given a raise to the PAs and NPs.

 

- It is likely that I can work in the ED outside of clinic hours, but this has not been 100% confirmed.

 

- I received some typical RVU numbers and I think something has changed recently or March 2016 was a very low month.  Only the top 3 PA/NPs out of 15 received a productivity bonus in March, with #1 making $400, #2 and #3 about $175.  Everyone else barely reached the 349 RVU threshold.  Unless March was abnormally low, it seems that the $500-$2000 bonus per month from RVUs is a thing of the past.  I am still trying to gather some more information to learn more.

 

Questions:

- How much should I expect to make per hour in the ED working part time?

- Does knowing the productivity bonus is much less change people's thoughts on this offer?

          Basically, if the numbers I received are typical I think I could expect to make about $2000 per YEAR in productivity bonuses.