Two offers, EM and Primary care

[siskiyoufire]

Hey guys, Im graduating in 2 weeks, taking the PANCE 9/6.

I have two offers on the table. Im married with 3 kids. 

 

Family practice in a tiny rural community pacific northwest (pop 400) near the Canadian border. 

I would be the sole provider 3 days a week with supervising Doc on site one day a week. average 16 cases a day. 

1 hour from nearest ER and pharmacy. 2 hours from decent city and specialty care. 

 

4 10 hour days. 8-6

95k increasing to 100k after 6 months. 

10k sign on

full medical coverage for me and all dependents at no cost to me (<This is really good right?!)

3 weeks PTO increasing to 4 weeks after 3 years

high chance of loan repayment (HPSA score 20)

retirement matches 2% (seems shitty)

 

Pro's

Gorgeous area,

cheap property, I could afford a badass riverfront house

schools are highly rated

high chance of loan repayment

Everyone Ive met has been very like-able and easy to get along with. 

The CEO has been very nice, took me out to lunch. 

regular schedule

having everyone know me in a small town

 

Con's 

Isolated

Wife would have to delay her nursing school ambitions for a few years. 

schools only have 4 kids per school... kids would be lonley

no activities for kids

having everyone know me in a small town know me. 

Primary care isnt what I want to make my career doing, I like it Ok

 

 

 

EM in northwest coastal city pop 30,000

lvl 3 ED of 30 k a year volume wants to incorporate PA's. in the fast track and main dept.

 Is doing an "internship" period at half pay that lasts 1-3 months depending on how well you do, BUT Said you could pick up fast track shifts at full pay during that period. 

 

13 ten hour shifts a month (you can work more if you want)

62$ an hour

10 k sign on

profit sharing

yearly bonus

health care has different premiums and deductibles at 90% coverage, (seems kind of shitty from the pricing I looked at )

4 weeks PTO

120% match to 6% retirement (seems badass right?)

 

Pro's 

I wanna Do EM

Salary works out to a little bit more I think, not sure if it'll even out other ways though

sign on

Doc seems super cool, wants to fly the PA's to different workshops for training

wants PA's to do alot of cool progressive stuff in the ED.

retirement seems awesome

more to do in town

wife could continue to pursue her career goals. (she says she wants to but is fine waiting awhile if needed)

 

 

Cons

half pay "internship"

cost of moving

I couldnt afford as nice a house there, expensive housing.

I may have to give up by beloved pet chickens! as its hard to find acceptable places for poultry. I love my chickens. the thought sickens me. 

 high income and property tax

 

Also I verbally agreed to the primary care job before the EM was offered to me. They are pressuring me to sign. Ive been sitting on the contract a few days.

Would I be a total dick if I backed out? I would feel bad... thats just business right?

I had planned to work this primary care in hopes of getting loan repayment, I have significant debt (155K) knocking down my loan and then doing EM in a few years because its what I want to do. I like primary care and have fun doing it as well, but I find it tedious sometimes. 

 

ANyways I'd appreciate any input from you guys here. 

Regards

 

 

 

 

 

 

 

 

 

 

[Reality Check 2]

Trying to remain anonymous ---- if the CEO of the rural gig has long red hair and it is a community health center - RUN.

RUN AND DO NOT LOOK BACK.

 

Just a weird feeling that I know who it is and cannot say anything else without risk.

 

And the other offer sounds much better. Hope the chickens can stay.

[NYCPAC]

Verbal agreements and offers mean nothing until it's on paper. You'll feel guilty no matter what happens so might as well go with your gut. Go with what you'd be happiest in.

 

That being said, maybe see if ER is negotiable on that half pay bullshit. Never heard of anyone willing to pay half. I have a boatload of debt too and just left an icu job I loved for an ER job that was willing to pay me more. Hoping to tackle some of these loans faster and eventually get back to the icu.

 

Best of luck to you and your chickens

 

 

Sent from my iPhone using Tapatalk

[LT_Oneal_PAC]

I'm a man of my word and would feel incredibly guilty about not following through on verbal agreement. Having said that, do not feel obligated to stay with the primary care gig based on a verbal agreement. There is no reason to be unhappy for years because you were nervous about not getting a job and jumping on something early. Just let it be a lesson to be more reserved with promises in the future.

 

The half pay thing is BS. Would definitely see if they would renegotiate that and the insurance plan. If not, it does sound like a good new grad job.

[chichamorada]

Kids are totally flexible (depending on their age) and probably don't have the same expectation that their parents do about where they live.  And it seems the schools are good either way...

So, maybe think about you and your wife's well-being. Will you be happy working at a job that you only kinda like?  It sounds like both of you could enjoy your careers if you went with the ED job.  Also, if ED were my goal, I'd worry about loosing my skills while I spent 2 full years doing loan repayment in primary care.  When you do finally end up back in the ED you may have a bigger learning curve, and worst case scenario some regrets.

 

Small towns can be amazing or suffocating, and it depends on you and your wife's personalities and needs (having grown up in a super small town as a kid, it was great. When I go back to visit...boring!!!)

[siskiyoufire]

SO.....She does have red hair...Pm'd you

I'd like to hear your opinion

[MT2PA]

If you can get rid of the 'half pay internship' the second offer isn't bad.  A: it's not an internship - they are trying to pay you shit while they do on the job training so if they decide you don't fit (or you change your mind) they haven't 'wasted' money.  B: If you can pick up fast track shifts at full pay, why on earth would you need an 'internship'?

[Reality Check 2]

I have very personal knowledge of the rural job offer and have PM'ed the OP with some needed info.

 

I cannot stress enough to anyone, but especially new grads, to do research about job offers.

 

Ask about retention, turnover and be ultra specific about responsibilities.

 

Also, ask about the EHR. Ask about provider satisfaction with the EHR and how it hinders doing one's job.

 

TALK to folks who USED to work for places and get some insight.

 

The turnover rate alone on this one should be a gigantic huge flashing blinking red flag.

 

I also would never recommend a job this rural for a new grad, especially knowing that there is truly very very limited support and a very intense patient population with near zero resources in the vicinity.

 

So, I stress again - TALK TO FOLKS, ask questions, do research. If it sounds too good to be true or the hair on the back of your neck stands up - PAY ATTENTION.

[fakingpatience]

I have very personal knowledge of the rural job offer and have PM'ed the OP with some needed info.

 

I cannot stress enough to anyone, but especially new grads, to do research about job offers.

 

Ask about retention, turnover and be ultra specific about responsibilities.

 

Also, ask about the EHR. Ask about provider satisfaction with the EHR and how it hinders doing one's job.

 

TALK to folks who USED to work for places and get some insight.

 

The turnover rate alone on this one should be a gigantic huge flashing blinking red flag.

 

I also would never recommend a job this rural for a new grad, especially knowing that there is truly very very limited support and a very intense patient population with near zero resources in the vicinity.

 

So, I stress again - TALK TO FOLKS, ask questions, do research. If it sounds too good to be true or the hair on the back of your neck stands up - PAY ATTENTION.

 

 

Whether or not the OP heeds your warning, thank you for being willing to reach out and help new PAs.  I should be so lucky when I graduate and (fingers crossed) have job offers to have other PAs offer honest opinions and help.  

[Reality Check 2]

We, as a profession, should protect one another from bad employers, bad jobs and bad ideas.

Just one of us experiencing it should be enough.

 

We have to stick together and promote our profession in a positive way.

[Poetsiren]

We, as a profession, should protect one another from bad employers, bad jobs and bad ideas.

Just one of us experiencing it should be enough.

 

We have to stick together and promote our profession in a positive way.

 

I AM SUPER glad that you said something about that rural job. That sounds HORRIBLE for a new grad....

 

"Here.... let me stick you on a deserted island with 400 people where you are the ONLY med professional for miles/hours around and you have no help as a new grad except for one day per week.... "

omg, so dangerous!!

[mgriffiths]

To comment on the verbal agreement and your feeling that this should potentially be binding: read my thread titled "Always Read Your Contract"

 

Bottom line, as others have said, nothing is done until the papers are signed, which is why they are pressuring you to sign.  I had a good job offer verbally, but when it came down to the actual contract it became beyond awful.  Changing a verbal agreement goes both ways, employers do it and employees try to.  Do not feel bad. Ignoring that the rural situation may not be the best for a new grad (or according to Reality Check 2 - a bad situation in general), a good clinic would be excited for you that you have found what you truly want, because that means they can move onto the next candidate that actually wants to be in family practice. Why would a good clinic want to keep an employee they know doesn't want to be there and will leave at the first possibility?

[siskiyoufire]

Signed the EM offer! WOOT!

[SCHW9076]

Were you able to renegotiate the half pay?