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Internal medicine in a suburb of a major metro area

 

*Has 8 MDs, 7 PAs, 2 clinics

*3 year contract

*Hours: 40 hours: M-F 9AM- 5PM. Every other Saturday from 7AM- 2PM, compensated with a 3 day weekend every other week. 

*Salary: $96,000 first year, $102,000 second year, $106,000 third year

*Cannot officially start before licensure/credentialing are approved. Option to make $25/hr shadowing for 3 months while waiting

*Training: 1 patient q30min for 4-6 weeks, then 1 patient q15min thereafter. These can be BP checks, med refills, and for complex patients one of the PAs told me she will discuss 15 minutes worth and then schedule the patient for another appointment to discuss the rest if needed. They also allot 30 minutes for physicals, pap smears, hospital follow-ups, and new patients. There are also six 15-minute blocks on the schedule to allow time for charting. One of the new PAs said she's never seen more than 24 patients in an 8 hour shift so far. The maximum possible is 28 patients. Is this reasonable?

*10% of profit collected on behalf of my services above $300,000 and 25% above $370,000

-Claims made policy; no tail coverage. Premium costs are covered up to $1800 per year

-Up to $500 per year for professional dues, memberships, staff privileges

-Health/dental/vision

-10 days PTO yearly (40 hours after 6 months, 40 hours after 12 months). Does not accrue.

-3 days sick leave after 6 months of employment

-Employee may take leave without pay if it does not interfere with the normal function of the office

-5 days CME, $1500

-Non-compete clause covering a 5 mile radius for 1 year following termination of employment; $10,000 fee if violated 

*No mention of 401k

*$2500 moving allowance 

 

Curious what anyone's thoughts are on this offer. Any thoughts appreciated!

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I am also a student currently looking for jobs, but am focused on orthopedics - so take my thoughts with a grain of salt.

 

- Other than being in a "suburb of a major metro area" we know nothing about the location, and cost of living can wildly differ.  San Francisco or New York City is incredibly different cost of living than Atlanta.  Otherwise, I think the pay is pretty good, and the fact that they are willing to pay $25/hr for shadowing ain't to shabby - as long as you ARE NOT WORKING.  If they actually start having you do work seeing patients then you should be paid your regular salary.  Of course, this could also be an awesome time for further education.

 

- I would be very curious what the expected bonus will be from the profits. They have 7 other PAs, and therefore should be able to give you a number.  This could be pretty lucrative, but is weird that it's based on profits. I've only seen it based on RVUs or collections.  The math on $400k of collections is $14,500 bonus to you.  That puts you at $110,500 your first year.  But is that achievable without killing yourself?  Also, a piece of advice I've been told, "Don't even think about bonus for the first year, focus on learning your craft."  The other comment is that you should potentially getting a bigger cut if you are truly bringing in $400k of PROFIT.  As I understand it, if you bring in $400k profit, then that is $14,500 bonus to you and $385,500 to your employer(s).  Profit is after overhead costs, including your own salary and benefits.

 

- I'm not an insurance expert, but I think you need to fight for tail.  From what I understand, tail coverage can be extremely expensive if you were to ever leave this office. Maybe look into the cost.

 

- The PTO sucks...even if it were to increase each year.  Anything less than 3 weeks is ridiculous in my book.  I am interviewing soon for a job that starts with 5 weeks + 1 week for CME - not including 7 other holidays.  That's more than normal, but gives some comparison.

 

- Hard to comment on the non-compete.  A lot of them are not even enforceable by law, but that depends on your state.  It kind of sucks, but at least the "buy-out" isn't ridiculous like "1 year's salary" (which I have seen multiple times).  It's also hard to say how restrictive the distance is.

 

- You need to find out about the 401k or any other retirement benefits.  A lot of people overlook this, but it can make a HUGE difference in the long term.  The difference between 3% and 5% match is $200k over 30 years, assuming a $100k salary and 7% annual return.  Obvious these numbers are made up, but it proves a point.  The difference between nothing and a 5% match is over $500k in 30 years.

 

- Moving allowance is nice, but would probably be the first thing I would offer to remove to get something better - like maybe more PTO.

 

Obviously you have to be the one to make the decision.  The salary sounds like it could be WAY above average, and assuming you can get more PTO it might be worth it to potentially have some other costs down the line (like tail coverage).

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The worst part about the offer in my opinion is the PTO. 

Followed by the non-compete clause.

Finally, would want to get retirement benefits as this is standard for a working professional. (401k or 403b or similar)

Otherwise, seems reasonable.

I personally do not support or agree with production/incentive pay.  Employers should not incentivize upcoding/procedures/etc. 

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