Critical Care offer, soon to be new grad

[Dynamo24]

This offer is from a large teaching institution in the Midwest.

 

Hours: 3 12 hour shifts/week, 6pm-6am

 

Salary: 96K base, extra shifts include base pay + $400 bonus per shift

 

Duties: Covering various services including transplant, trauma (plus responding to traumas), pulmonary, and surgical inpatients. I rotate each service per shift, not covering all services on one shift. ER Consults and admissions.

 

Benefits: 2 weeks vacation (this increases as tenure increases, 3.5 weeks after 3 years, etc), 40 hours sick/personal time, 7 holidays plus one floating holiday, $2500 CME, licensure and DEA covered. I have no concerns about health insurance at this moment because my wife has unbelievable benefits through her job. Tail coverage included.

 

Other perks: Fellows who are willing to teach procedures regularly. Get to work with and train residents. Will always have an attending, fellow, resident, and 1 to 2 other PAs/NPs each shift.

 

Any thoughts on this offer?

[RuralER/Ortho]

Looks pretty good really. Could ask for a little more base since its all nights, but this isn't unreasonable by any stretch.

 

Vacation is a little weak, but sounds like it is standardized.

 

Any time off for CME?

 

Any retirement accounts/funding? Otherwise, congrats, sounds like a good gig!

[Dynamo24]

Looks pretty good really. Could ask for a little more base since its all nights, but this isn't unreasonable by any stretch.

 

Vacation is a little weak, but sounds like it is standardized.

 

Any time off for CME?

 

Any retirement accounts/funding? Otherwise, congrats, sounds like a good gig!

 

Just to answer a few of the questions: 5 days off for CME, 75% match up to 3% for retirement that increases by 2% every 5 years and tops out at 13%. 

[polarbebe]

Salary is dependent also on the number of years of experience you have and region (urban areas generally pay less)... 96k is good for a relatively new PA or only a couple of years experience (outside of critical care).

 

You mentioned working the overnights from 6PM to 6AM... if they included at least at 10% differential then the day shift pay is roughly 86k... not so good for day or night pay. Keeping in mind that critical care is generally one of the top 5 paying specialties and 1% of PAs work in critical care.

 

On the other hand, willing to mentor you is a huge plus and you will become very proficient at procedures, develop a lot of confidence with handling emergent life threatening situations (codes, acute respiratory failures...i.e. when the $:@/ hits the roof) and also not have a lot of competition with house staff for procedures since you work at night. The down side, you will miss morning and teaching rounds...which honestly is where you learn the most. The intensivist Monday morning quarterbacks the admission and the entire group discusses management throwing out different ideas... learning from different perspectives.

 

In a month anyone can become capable at procedures but it's the management of critical ill patients that takes years and participating in rounds in the morning is undoubtedly the best way to understand the pathophysiology and build your knowledge base.

 

I have been working at a large academic hospital in the MICU for the past 5 years... in the past year started a per diem at a mixed ICU with no house staff where my scope of practice is much larger and have the respect of the ICU attendings and critical care nursing (most of the credit goes to me working with over 10 different intensivists, 50+ fellows and hundreds of residents who each taught me something).

 

Overall sounds like a good learning opportunity especially if you can work some days to attend rounds... it is hard to break into critical care (you can always move down in patient acuity but moving up is much harder).

[Gaijyn]

Generally looks like a pretty solid offer. I agree with the the increase in base. Or maybe a reevaluation at 3-6months? Overall this seems like a pretty solid set up for a new grad and if the learning process plays out the way you describe you will have a solid foundation in a very intense area of medicine. Just make sure you abuse the system when it comes to learning. Anything and everything is fair game when it comes to learning. Good luck!

[coloradopa]

Salary is dependent also on the number of years of experience you have and region (urban areas generally pay less)... 96k is good for a relatively new PA or only a couple of years experience (outside of critical care).

 

You mentioned working the overnights from 6PM to 6AM... if they included at least at 10% differential then the day shift pay is roughly 86k... not so good for day or night pay. Keeping in mind that critical care is generally one of the top 5 paying specialties and 1% of PAs work in critical care.

 

On the other hand, willing to mentor you is a huge plus and you will become very proficient at procedures, develop a lot of confidence with handling emergent life threatening situations (codes, acute respiratory failures...i.e. when the $:@/ hits the roof) and also not have a lot of competition with house staff for procedures since you work at night. The down side, you will miss morning and teaching rounds...which honestly is where you learn the most. The intensivist Monday morning quarterbacks the admission and the entire group discusses management throwing out different ideas... learning from different perspectives.

 

In a month anyone can become capable at procedures but it's the management of critical ill patients that takes years and participating in rounds in the morning is undoubtedly the best way to understand the pathophysiology and build your knowledge base.

 

I have been working at a large academic hospital in the MICU for the past 5 years... in the past year started a per diem at a mixed ICU with no house staff where my scope of practice is much larger and have the respect of the ICU attendings and critical care nursing (most of the credit goes to me working with over 10 different intensivists, 50+ fellows and hundreds of residents who each taught me something).

 

Overall sounds like a good learning opportunity especially if you can work some days to attend rounds... it is hard to break into critical care (you can always move down in patient acuity but moving up is much harder).

I think that people missed the differential. Its $96,000 + $400/shift. If you work 48 weeks that works out to $57,000. We pay $30k night differential and we have the highest dif in the area. If this is correct pay looks to be around $160k per year which is pretty good for a new grad. If you get good orientation nights offers a lot of autonomy. 

[Dynamo24]

I think that people missed the differential. Its $96,000 + $400/shift. If you work 48 weeks that works out to $57,000. We pay $30k night differential and we have the highest dif in the area. If this is correct pay looks to be around $160k per year which is pretty good for a new grad. If you get good orientation nights offers a lot of autonomy. 

 

Just to clarify, its base pay + $400 bonus for each additional shift over 3 shifts a week. Shakes out to about an extra 1k per additional shift. So, even working two additional shifts a month cranks pay up to around $120k. 

[coloradopa]

Just to clarify, its base pay + $400 bonus for each additional shift over 3 shifts a week. Shakes out to about an extra 1k per additional shift. So, even working two additional shifts a month cranks pay up to around $120k. 

I take that back. Horrible offer. We start new grads at $90k with a $30k night differential. We get $900 per shift over 3. It works out to $75/hour which is above base pay for everyone but the very senior people. You are getting $46/hour base pay. The extra shifts are being offered at $33/hour. You don't get less pay for working extra you get more. 

 

Critical care gets 4.5 rvus per hour. At medicare rates thats $139/hour. If you figure 50% productivity then that's $70/hour. We actually get $41/RVU so break even is around 6 hours billing in a 12 hour shift. 

[Dynamo24]

I take that back. Horrible offer. We start new grads at $90k with a $30k night differential. We get $900 per shift over 3. It works out to $75/hour which is above base pay for everyone but the very senior people. You are getting $46/hour base pay. The extra shifts are being offered at $33/hour. You don't get less pay for working extra you get more. 

 

Critical care gets 4.5 rvus per hour. At medicare rates thats $139/hour. If you figure 50% productivity then that's $70/hour. We actually get $41/RVU so break even is around 6 hours billing in a 12 hour shift. 

 

A few updates and clarifications. I countered asking for 5K extra, which would bump me to 101K. Secondly, I think I am not explaining the extra shift correctly. It would be my normal daily pay, which would be around $54 an hour with an additional $400 dollar bonus for that extra shift. Adding those together, its more like $87 an hour for an extra 12 hour shift, $6 more than time and a half. I hope that clarifies the extra shifts, unless I am not understanding your explanation. 

[Poetsiren]

Just to clarify, its base pay + $400 bonus for each additional shift over 3 shifts a week. Shakes out to about an extra 1k per additional shift. So, even working two additional shifts a month cranks pay up to around $120k. 

 

I think that people missed the differential. Its $96,000 + $400/shift. If you work 48 weeks that works out to $57,000. We pay $30k night differential and we have the highest dif in the area. If this is correct pay looks to be around $160k per year which is pretty good for a new grad. If you get good orientation nights offers a lot of autonomy. 

 

umm.... I feel super stupid here and it could be because it's so late, but I am not seeing the math.... can someone dumb this down a bit more and lay it out for me....?

 

I'm seeing this, so correct me:

We are assuming approximately 4 weeks of time off, so 48 weeks instead of 52.....

You work 3 shifts/wk regularly x 48 wks. If you work 6 shifts per wk (That's seems ALOT to me) for 48 wks then that makes at $400/shift for those other 3 shifts.

So that's the 96K base plus (3x48x$400) = 96K plus 57.6K = $153.6K annual (and I am reading this as a "potential" because I wouldn't want to work 6 shifts per week for a year!)

 

BUT, recent comment states additional base pay for extra shifts also, so that means that by doubling amount of weekly shifts he is effectively doubling his base pay AND adding 400 per shift which would make out as 153.6K plus the additional 96K.....???

That is $249.6K annual potential....... I am so lost here, LOL!

 

Why am I reading 120K and 160K as potential earnings in the comments?

[Dynamo24]

Okay so I'll try again. Assuming they accept my counter for 101K. Here is the math:

 

Each individual shift is worth $648. Every shift over 3 shifts in a week is equal to $648 + a $400 bonus = $1048. I mentioned working two extra shifts a month = $2096 extra a month. 101k + (2096x12 months) = 126k potential.

 

I could earn more but I'm not interested in burning myself out for money that I wouldn't even have time or energy to spend.

[coloradopa]

A few updates and clarifications. I countered asking for 5K extra, which would bump me to 101K. Secondly, I think I am not explaining the extra shift correctly. It would be my normal daily pay, which would be around $54 an hour with an additional $400 dollar bonus for that extra shift. Adding those together, its more like $87 an hour for an extra 12 hour shift, $6 more than time and a half. I hope that clarifies the extra shifts, unless I am not understanding your explanation. 

In that case not so bad. Pretty close to what we do. Base is better but differential is less. The extra shift money is also reasonable. I will point out the traditional way to calculate hourly rate is salary/2080 which equals $48.56 for you. So for your calculations its around $980/shift not $1048. Its still good but it will add up to around $1000-2000 per year in calculations. I think that a smaller differential is preferable from a systems view. Our differential is higher than our competitors but our base pay is lower. This leads to new grads taking a night position with us due to money and then leaving in 2-3 days when they want to go to days and can't afford the pay cut.