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Ortho Hand/upper extremity offer

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Hello, I am new graduate that has been presented with an offer with an orthopedic surgeon that specializes in upper extremity with hand being her primary focus.


Monday-Friday 8-530 (I think 2 days of which are OR)

3 weeks PTO

Vision, dental and health insurance

401k with match

CME 2500 + 5 days

Call: one weekend a month and I think 2-3 days/month of secondary call. I was told that this doctor doesn't get called in often


Stating salary: 77k + Bonus (I was told that on average this would boost my salary by 20k annually on average but more could be made. The bonus is production based and would begin following my first 6 months at the end of the next bonus period)


I have seen on this site, plus seen from other sources, that the base salary is on the lower end. (Also, this office is out of the Atlanta Georgia metro area.) My question is, with bonus taken into account, is this a good offer for going into this particular field? Does anyone know of anyone that works in upper extremity and given that field and expected workload, is this a decent offer? The doc seems willing to bring a new graduate along and seems willing to teach and does not expect me to know the hand in great detail.


Thanks in advance


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Traditionally the CPT surgery codes for hand surgeries DO NOT allow for an assist or an assist fee. ie. carpal tunnel, trigger finger, even little fractures.


I can name 2 PAs I have ever known who work for hand surgeons.


Not sure where your bonus would come from..... You can't bill post ops - global. 


Would you be seeing new patients in the clinic? How many? Average billing?


Has this surgeon ever had a PA before? How did it work? Do assist fees get paid? What are the main surgeries the surgeon performs - Carpal Tunnel Release, Ulnar nerve transposition, hand trauma and replant?


The base salary is Meh for a new grad but I am not sure what they anticipate in bonus - production, billing, performance, portion of surgeon revenue?


Would you have to take call with other surgeons who do more than hand or just hand call? Hand call is usually separate from ortho call and handled by both ortho and plastics.


I think you need more info.

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Those are all good questions that I will ask before going forward. The surgeon has never used a PA before as she is relatively new and has been  in practice for only three years. That much I do know. As far as surgeries, She does do a lot of the smaller surgeries such as carpal tunnel release, trigger fingers, mallet fingers, etc.But she also does some joint replacement in the hand and elbow.


No I would not take call with other surgeons. Just her.

On average, I was told the quarterly bonus would be 5k equaling a total of 20k in bonus for the year.


The two PAs that you knew that did hand ortho, did they seem to like it? As far as a work/life balance?

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My first job as a PA was for a private practice hand/plastics surgeon.  I was a certified hand therapist (OT) before PA school and knew the physician because I had treated a lot of his patients.  On paper it sounded like a good fit.  The truth was that he didn't know how to use a PA and I was a new grad PA and not assertive enough.  It didn't work and we parted ways after a few months.  He was a really difficult guy to work for.


What did I learn? 


1) don't work for anyone who hasn't had a PA before, especially if you're the PA and a new grad

2) stand up for yourself and what you can do

3) prior relationship is no guarantee of success


Good luck

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Yeah, I want to echo the sentiment that "never had a PA before" and "hires [you] as a new grad" are just not a good pair: neither of you knows how things CAN work, let alone SHOULD work.  The bonus structure/salary sounds weird, but the rest of the package looks good, so this seems to be more cluelessness than intentional lowballing.

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I am almost a new grad and have an ortho offer for joint replacements, and am expecting another soon (or at least I hope so!!!)


I have a thread about my current offer, but I'll list the highlights for you so you can compare:


  • 48 hours/week 
  • $80k base salary with 10% of collections bonus for my billing (have been quoted this can be around $30k)
  • 2 weeks PTO, 1 week CME
  • other normal benefits


One other thing to keep in mind, Atlanta seems to be one of those areas where a lot of people want to live...or at least I've been told that.  Unfortunately, a lot of employers use their location as part of their "benefits package" and this might be why your base salary is low.  But with the bonus seems possibly above average.  The big question I'm trying to get answered from my current offer is how salaries increase and it was mentioned that in the past he has doubled the collections bonus after the first year - which is a massive raise!  It could be the same for you.

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