Jump to content

New Grad Orthopedic Position/Interview


Recommended Posts

Hello, I have another thread regarding a family medicine offer but was recently offered an interview at two different orthopedic practices - which may have usurped FM place as my first choice.

 

To start, I have a general question regarding orthopedics.  I am curious how much autonomy is available in clinic in orthopedics?  I recently rotated with a large orthopedic group that is also a large residency program.  I overheard one of the surgeons mention to his PA that he wants her seeing all of his post-op patients, and I know that she already does the injections for three surgeons.  Basically her clinic days are going to be full of post-ops and joint injections.  Obviously these are part of the job, but is that common for orthopedic PAs to be relegated to this, or is this more because this employer has cheap labor in the form of residents?

 

As mentioned, I have two interviews, but I only know some basic information for one.

 

Job 1: Central MI (5 physician practice with 7 PAs, I would be working primarily with one physician who has one PA already but wants another)

  • 48 hours per week with NO call and NO weekends
  • 3 days OR and 2 days clinic
  • Salary: $80K with a 10% of collections productivity bonus (told a recently hired PA netted $30k from this alone, but I don't know his experience, hours, or area of orthopedics; also curious if this would normally include surgeries I assist on?)
  • 2 weeks personal time (potentially does not include sick days)
  • 1 week paid CME time, $1500
  • 90% paid for health insurance
  • 3% match in 401k
  • Paid licensing, credentialing fees, and any other fees I would need to practice
  • Malpractice, Disability insurance, life insurance (I don't know specifics on any of these)

My biggest questions (other than what is listed above) are how my salary increases and the potential for loan repayment?

 

Job 2: Tennessee - orthopedic practice with associated orthopedic residency

  • I don't know any of the job specifics, but I rotated with this practice and very much enjoyed it 
  • Worry about autonomy and the potential to be reduced to simply injections and post-ops
Link to comment
Share on other sites

Autonomy varies from practice to practice. I left a practice 1 year ago where I was basically used as a scribe and first assist. Hated it.. so much I left within 6 months. My current practice my SP and I share clinic (more like 60/40 as I am 1 year in). I see most post ops and new patients and tee em up for surgery if indicated. I would say we split established/follow ups. Both do injections as we go. My SP primarily sees work comps throughout the day, and we split the rest if he doesn't have WC. We are also 50/50 OR (first assist) and clinics days. Works well. He's always available if i need him to examine a patient or peek his head in and say hi. At the end of the day he is the surgeon, and every patient for the most part needs to be seen by him at some point, unless non-surgical. 

 

To be honest, injections and post op only would be pretty simple (likely less/easier charting and no call back for imaging etc).

 

Regarding the first offer, pretty low salary. My first job was 80 K too, with "bonus" that was not attainable being a glorified scribe/MA. If you can reach 20 K in bonus, would be a much better offer. Benefits are pretty average. 

Link to comment
Share on other sites

Your hours are set to 48? Seems a little odd.

 

10% should include when you are FIRST assist, injections, and seeing patients (not postops as you don't get paid for that). It is not unreasonable to get 30K at all, but you shouldn't expect that your first couple of years.

Link to comment
Share on other sites

As many of you have mentioned, I am worried about the pay compared to the hours as well - plus the benefits from what I know aren't astounding.  I'm holding out hope that this is a starting salary that lasts for a training period with a nice pay raise at its conclusion - even though I know many here don't like this model.

 

To give some more information that I learned: He currently has one full time PA and one part time (who I think I would be replacing).  The full time PA works 52-55 hours per week now, but he knows he needs to lower her hours to keep her.  That is why he wants to hire another full time PA, so we would both end up working the approximately 48 hours.

 

Out of curiosity, what would you expect to make working 48 hours per week in orthopedics?  Is the $110k estimated decent, or should I be expecting more than that for the hours worked?  Would you be ok with that high of a percentage of your income coming from a productivity bonus?

 

Thanks for the input, it is greatly appreciated. 

Link to comment
Share on other sites

For 48 hours, the pay rate is extremely low, especially considering the unlikelihood of producing much if any bonus you're first year on the job as someone else pointed out. Also, I can't decide if the low pay or the low 2 weeks of PTO compared to your 48-hour work week is worse.

Link to comment
Share on other sites

I definitely plan on getting some more information about the PTO and asking for more.

 

What would you expect to make for 48 hours/week?  If he states that the $30k is achievable, I was thinking about asking him to guarantee a certain amount, like $10k-$20k.  That way if I don't make much from the productivity bonus my first year my salary doesn't get smashed.  Does this seem reasonable, what amount would you ask for to be guaranteed?

 

I interview in just about a week and would like to have some numbers in mind for this to hopefully work out.  I think he is open to negotiating based on our conversations, but I guess I'll find out!

Link to comment
Share on other sites

The 40 hour equivalent for the Michigan job is ~$67k a year plus whatever bonus you get.  You are making like $33.50 an hour before bonus.... 

 

If you were being paid $110k salary for 48 hours a week that would be different, but $80k salary then depending on a bonus... the practice is making a pile off of you.  Even at $110k a year you'd be making around $46/hr.  

Link to comment
Share on other sites

Thanks anewconvert.  It's helpful to see it broken down that way.

 

If someone could give me an idea of what I should be aiming to make working 48 hours per week that would be great.  I have seen the latest AAPA salary report, but working 48 hours seems to throw the numbers off a bit.

 

Thanks!

Link to comment
Share on other sites

The AAPA salary report states that the 50th percentile ortho PA is paid hourly is $49.42.  As a new grad, I don't think making $46 per hour is too far off - assuming 40 hours per week.  Correct me if I am wrong though.  With some calculations, using $46/hr for 40 hours, and 1.5 x $46 for the extra 8 hours I come to:

 

$119,600 - obviously ignoring any kind of a productivity bonus

 

Would this be realistic?  Would you expect a productivity bonus on top of this, or would this be the full amount?

Link to comment
Share on other sites

Based on my experience in ortho and many years......

 

The salary offered for a new grad is adequate. You will not make a lot of reimbursement for the first 2-3 years. 

 

There is a definite ceiling in ortho for base salary and you are about there. Ortho counts on reimbursement to be your jelly on the bread and butter. You work with a high volume, high dollar surgeon - you make bank. You work with a scope doctor - NO assist fees allowed and you are a scut monkey. 

 

You will not make over about $150K a year in most places ever. You will make the doc a lot of money but will not get base salary raises. I have never seen that except ONE cost of living raise in 15 years and it was 2%. 

 

As a brand new grad in ortho your should not be seeing post ops alone for 3-5 months. Too dangerous and you need to learn EXACTLY what the doc wants in post op. Most docs have protocols for PT, motion, weight bearing, etc. Until you learn those verbatim - you should not fly alone. 

 

You will very very little autonomy in an ortho practice. VERY LITTLE.

 

I left ortho because my shoulder doc was SOOOO restrictive that he freaked if I varied from HIS standard NSAID (which sucked). I was subject to his schedule and his schedule alone. No leaving for school events and do not ask for an OR day off. I took ONE vacation in 3 years and he freaked out. I prescribed the same 4 drugs all day every day and gave the same preop speech and did the same consent warnings ad nauseum.

 

I was there to make the doc look like a god and a rock star.

 

PAs seeing post ops all day is a cost measure by the doc and pretty chicken &hit in my opinion. The global fee means no charges for 90 days after surgery - so the surgeon dumps the patient on you and you have to answer every single question and know what outcome the doc wanted and the patient feels slighted by not seeing the surgeon at least once in 3 months. Some patients liked me better than the doc but felt slighted that he never followed up with them.

 

You do not perform surgeries but do injections. You do not get to decide if someone needs surgery on your own for several years and you develop a rhythm with your doc, if at all. Some folks are way territorial and you are a submissive subject, not a partner or peer.

 

If you work for multiple docs - prepare to be schizophrenic and know how to word things carefully, walk on eggshells, know who yells and be a giant gumby doll pulled in multiple directions. 

 

I am really not trying to bum on ortho. I loved it. I just worked for psycho surgeon with communication issues and a gigantic ego.

 

A couple of things - 

I am a girl

I am smart and not really into political correctness (it is a form of passive/aggressive)

I speak my mind

I like to think - regularly and not into rote junk

I fit better in FP

 

It works for some folks. It bit for me in the long run because I had no control over my schedule and couldn't dare call in sick for me or my kids and was on call every 6-7 weekends and 1 night a week and often worked on holidays. The pay was good for a while but the doc was not.

 

Just my very old 2 cents.....

Link to comment
Share on other sites

I have only one question: why ppl work for docs like that???? Anywhere you spit all over the country there is an ortho opening... why???

 

 

I was there to make the doc look like a god and a rock star.

 

PAs seeing post ops all day is a cost measure by the doc and pretty chicken &hit in my opinion. The global fee means no charges for 90 days after surgery - so the surgeon dumps the patient on you and you have to answer every single question and know what outcome the doc wanted and the patient feels slighted by not seeing the surgeon at least once in 3 months. Some patients liked me better than the doc but felt slighted that he never followed up with them.

 

You do not perform surgeries but do injections. You do not get to decide if someone needs surgery on your own for several years and you develop a rhythm with your doc, if at all. Some folks are way territorial and you are a submissive subject, not a partner or peer.

 

If you work for multiple docs - prepare to be schizophrenic and know how to word things carefully, walk on eggshells, know who yells and be a giant gumby doll pulled in multiple directions. 

 

I am really not trying to bum on ortho. I loved it. I just worked for psycho surgeon with communication issues and a gigantic ego.

 

A couple of things - 

I am a girl

I am smart and not really into political correctness (it is a form of passive/aggressive)

I speak my mind

I like to think - regularly and not into rote junk

I fit better in FP

 

It works for some folks. It bit for me in the long run because I had no control over my schedule and couldn't dare call in sick for me or my kids and was on call every 6-7 weekends and 1 night a week and often worked on holidays. The pay was good for a while but the doc was not.

 

Just my very old 2 cents.....

Link to comment
Share on other sites

  • 1 month later...

The AAPA salary report states that the 50th percentile ortho PA is paid hourly is $49.42.  As a new grad, I don't think making $46 per hour is too far off - assuming 40 hours per week.  Correct me if I am wrong though.  With some calculations, using $46/hr for 40 hours, and 1.5 x $46 for the extra 8 hours I come to:

 

$119,600 - obviously ignoring any kind of a productivity bonus

 

Would this be realistic?  Would you expect a productivity bonus on top of this, or would this be the full amount?

How did it work out? Reading through these posts I see my offer for an ortho clinic job (joint replacement practice) was low as well. I took the job being promised bonus structure of about $5k to $10k per quarter depending on volume, but when the office changed locations/hospitals, that did not pan out. Their response? Raise our base about $7k/yr and offer us call weekends that were previously not offered. Kinda crappy if you ask me. When I do the math with my take-home pay I'm netting about $30/hr working between 45-50hr/week, so grossly about $38/hr. Dismal. I have a rounding meeting with my office manager tomorrow.... might have to bring these numbers up. 

 

Anyway - I hope it worked out well for you. Would love an update!

Link to comment
Share on other sites

I am still looking.  I did an in person interview at the MI job and really liked what I saw and what I discussed with the doctor.  He offered me the job while I was there, and told me to think about it and if I had any other questions to let him know.  I asked a few more questions in an email, which based on his response definitely irked him.  My initial compensation is set, he is not willing to negotiate in any way.  While not in writing, he made multiple comments about how my salary had potential to greatly increase if my work ethic and learning were positive after the first year.  One example he made was doubling the bonus percentage. In the end I accepted the job.  While I wouldn't say it is the perfect job, there are some other positives that are difficult to discuss.  The only problem is that he started interviewing people for the job again after my email with questions. We have since had another phone interview and I'm waiting until this coming weekend to find out if the job is mine.

 

I am still waiting to hear back because there are other positives as I mentioned, but I'm getting impatient - which might be enough as I write this.  I have heard from multiple other job opportunities, including a spine clinic.  I did a phone interview with their current PA who I would be potentially replacing (he's moving to be closer to his wife's family).  Everything sounded wonderful and the clinic has offered me an in-person interview.  Since I still have 6 months until I graduate, I'm thinking about scrapping the Central MI job and pursuing the spine opportunity.  It would suck to walk away from a potential offer in the MI job, but I think I'm too frustrated to be excited about the job at this point...and there are WAY too many opportunities for me to be frustrated.

Link to comment
Share on other sites

I am still looking.  I did an in person interview at the MI job and really liked what I saw and what I discussed with the doctor.  He offered me the job while I was there, and told me to think about it and if I had any other questions to let him know.  I asked a few more questions in an email, which based on his response definitely irked him.  My initial compensation is set, he is not willing to negotiate in any way.  While not in writing, he made multiple comments about how my salary had potential to greatly increase if my work ethic and learning were positive after the first year.  One example he made was doubling the bonus percentage. In the end I accepted the job.  While I wouldn't say it is the perfect job, there are some other positives that are difficult to discuss.  The only problem is that he started interviewing people for the job again after my email with questions. We have since had another phone interview and I'm waiting until this coming weekend to find out if the job is mine.

 

I am still waiting to hear back because there are other positives as I mentioned, but I'm getting impatient - which might be enough as I write this.  I have heard from multiple other job opportunities, including a spine clinic.  I did a phone interview with their current PA who I would be potentially replacing (he's moving to be closer to his wife's family).  Everything sounded wonderful and the clinic has offered me an in-person interview.  Since I still have 6 months until I graduate, I'm thinking about scrapping the Central MI job and pursuing the spine opportunity.  It would suck to walk away from a potential offer in the MI job, but I think I'm too frustrated to be excited about the job at this point...and there are WAY too many opportunities for me to be frustrated.

 

Sounds like an odd situation. Based on what you wrote, it seems like the doc was either trying to get back at you for asking questions or was so frustrated that he decided to see what else is out there. Red flag, for sure. What happens if you annoy him two years into the job? Will he just fire you on the spot?

 

If I were you, I would focus on those other options and forget this one. You will thank yourself later.

Link to comment
Share on other sites

Just a thought

 

The qualities that make some ortho surgeons really good at surgery make them complete A-holes to work for.

 

Yes, I said work FOR.

 

The ego and control issues will never let you be a peer or colleague.

 

No autonomy or control in ortho. Completely leashed to the surgeon.

 

Keep looking

 

Good point.

 

Interestingly, my experience with ortho docs has been the opposite. From what I've seen, they tend to be closer to frat boys than control freaks. Their answer to just about everything during a surgery is "just hit it harder" lol. Now, if we were talking about neurosurgeons or CT surgeons, I would readily agree with your statement, based on my experiences.

 

Of course, you've been doing this for way longer than I have and have likely dealt with more ortho surgeons. It's possible that the ones that I dealt with were the minority.

Link to comment
Share on other sites

Wow, I feel really lucky reading all these ortho horror stories. I work for an ortho surgeon (it's only been 4 months) but he is very easy going and it has been a great learning experience. I picked up most of the protocols and the flow of things and the surgeries very quickly, and he noticed and has been trusting me with seeing all patients and making decisions such as injection vs surgery vs MRI vs PT, etc. Of course he is always willing to help if I'm stuck. He no longer signs off on postops (I only send it to him if it's a weird case or something is wrong), only for follow ups and new patients.

Link to comment
Share on other sites

I worked for one of 22 surgeons in a group that refused to be bought by the 2 major corporate monsters in town.

A long history of success and stability.

 

My surgeon had a Napoleon issue and was terrified of litigation.

He went through 4 PAs in 10 years with one barely lasting one year.

None of the other surgeons in the group had any for less than 10 years at a time except one who fired his PA on Christmas Eve and has a reputation to match. The group won't let him have a PA ever again.

 

He dictated EVERYTHING I did and every drug I prescribed and set a very narrow path of limited options to follow with no exceptions and no individual thought. 

My schedule was his schedule - period. No exceptions.

 

I made a crap load of money for a few years but cried about 3 days a week after the first year. He treated his work crew horribly and callously but smiled nice to the patients and was so fake I wanted to puke.

 

I truly worked FOR HIM - no possibility he would ever see a PA as a partner, colleague, peer or anything other than peon.

 

So, at this point in my career, I do not want to go back to ortho ever unless some sort of outpatient clinic without weekend rounds or 6:30 am surgery set ups and a doc who doesn't need a lobotomy and a stick upside the head.....

 

I will stick with FP and my doc who treats me like a peer and a valuable partner in his solo practice.

Link to comment
Share on other sites

  • 1 month later...

Mgriffiths, fwiw, I am starting in ortho surg as a new grad in Michigan. Clinic only for first year, mostly post-op. some pre-op and chronic non-surg tx. 40 hours per week, 93K, 5 PTO weeks. I know at least 3 classmates in ortho starting at 90K or higher.

Link to comment
Share on other sites

Thank you very much for the information.  I'm actually about to start a new thread describing what happened with this job.  I initially decided to take it for a variety of reasons, and verbally accepted the job almost 2 months ago.  Then last week the doc sent me the contract for me to sign and it was completely different, including things like night call, weekend hospital rounds, and the mysterious lack of $40k in loan reimbursement we had discussed.  When I asked what changed, the reply was basically, "This is the job, take it or leave it."

 

Result: I walked away and he had the gall to email me back and tell me he was "disappointed" in my "change of heart" and was "saddened" that I couldn't see what a great job he was offering.  I didn't even reply

Link to comment
Share on other sites

Archived

This topic is now archived and is closed to further replies.

×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More