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Hope this post finds everyone well. I am currently negotiating compensation for a part-time derm position. I have 5 years experience as a pediatric PA and had to take a short leave of absence, and am finally able to try to get into derm which has always been my goal. This potential employer would train me for 4-6 weeks unpaid and then start to book me patients. The SP does not want to pay an hourly wage and only want to pay me 25% of collections for what i bring into the practice. They will not cover malpractice the first year and it will be revisited in one year. We are in the early stages of negotiations and I need your help.


Does anyone here only get paid a percentage of collections and if so what is the norm? I am unsettled with this because I am not sure how busy this practice is (only one physician) and its not clear how much work she has available. I am really unsure of the earning potential. I would start with follow up patients, general derm until I was more comfortable. The physician is very nice, willing to train (unpaid), and the physician wants to cut her own hours. It is a way for me to get in the derm door. What are your thoughts??? Thanks, Tee

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Thanks for your reply. We are still in the very early stages of negotiations. I will have to pay my own malpractice the first year. I won't need medical insurance. CME, Vacation etc has not been fully discussed yet. I am wondering if anybody else have this type of arrangement in derm and is this percentage too low?


I have not worked in derm and don't know how much income I can generate per hour. Of course, I won't be doing lots of procedures right off the bat and want to know what is a reasonable amount that I can expect to make per hour doing regular derm (follow ups, acne, cryotherapy, eczema, psoriasis etc,) if I take the 25% offer. I don't know of any PA that has not had a set salary and worked solely on income percentage. I know bonuses are calculated in similar ways but your regular pay? Is this reasonable?

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no salary and no malpractice? unacceptable. 6 weeks unpaid? unacceptable.

you can do better. run away. seriously.

if you really want to do derm consider doing a derm residency then no one needs to train you after and folks will be knocking down your door with GOOD offers.

a 1 min search of indeed.com shows 122 derm pa jobs paying > 100k/yr. many do not require experience.

you can do better. don't take this ridiculous lowball offer. this is the kind of thing which makes docs think they can treat pa's like crap. as a profession we need to make it known that we will not take crap jobs at bad wages with no benefits. this would be like offering a doc 30k/yr with no bennies to work full time. none of them would take it and none of us should either.

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this sounds like a mistake. if a derm PA gets no benefits the salary should be over 100K, even as someone with little experience. If you are a new grad I could see a bit lower of a salary, especially if it seemed like you would be unproductive to start (no derm rotation or previous experience). 25% of billing hmmm...what is an average derm visit billing? maybe 100 with most insurances for a follow up / non procedure visit (i have no idea, im guessing). You would need to see 4 patients an hour at least. Do yourself a BIG favor and tell her the benefits/salary is not going to work for you and thank her for time spent meeting with you.

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Run away from that job offer. Unpaid training? No way! No health insurance? Even if you're healthy as a horse - no way! 25% on your collections? No way! You have no control over the efficiency of the billing office, so you'd be leaving yourself wide open to get hosed - what if the billing office only submits charges on or is aggressive about collecting 75% of your visits - then you'll only actually see MAYBE a 60% collection rate... So you're $100 dollar office visit just turned into $15 MINUS your overhead. That doc is not doing you ANY favors. Hope you can make this work out more in your favor.



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run run run far far away


any doc that makes such an insulting offer is NEVER going to respect you for what you are worth and doing for the practice - just the thought of someone saying they will not pay for 6 weeks is merely insane - ask him if he will provide services for free for 6 weeks and see his reply



tell him he is full o poop (so that he can hear that PA's are not to be taken advantage of) and decline

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If you aren't already a member of the Society of Dermatology PAs, I would suggest you join asap. There is a derm PA forum that has lots of info on this topic. Several people I can think of off the top of my head who were in a similar situation and lots of good feedback from experienced derm PAs.


I have 10+ years derm experience. I would be wary of a position that has unpaid training time. She is making an investment in you and while it may slow her down temporarily (probably a negligible amount of time, especially with someone with your experience), the payback would make up for it. Twenty-five percent of collections is respectable *but* do you know if there is enough business to generate a decent salary? Twenty-five percent of $200k, for instance, wouldn't be producing a very good paycheck. Also, insist on complete transparency on your "numbers". You need to know what you billed, collected, written off, etc. Otherwise you are flying blind.


It is tough to get your foot into derm and having a opportunity like you have been given is tempting. You could always take the training and if it doesn't work out, go to work for the derm down the street. Once you have that experience, you are very valuable to any derm.

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OMG I agree, decline this offer. Training does not equal free labor. Sorry, it just doesn't. I've never paid for my own malpractice insurance. Either the derm doesn't have faith in their training skills or they are trying to con you into thinking that you are lucky to have this job. I have found that dermatologists treat PAs as either grunt workers and/or cosmetic cash cows. PAs get the stuff the docs don't want to do and then are under pressure to push cosmetic stuff so the practice makes more $$$$.

Don't sell yourself short, don't take this offer.

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