Pulm/CC offer NEW GRAD

[Ikaruga102]

Edit: Sorry for the late response, my notifications were not turned on. Changes in red. I am thinking about negotiating for 95k

I would love some input on a verbal offer I received from a 1 doctor pulm/critical care practice in the Southwest region.

Their mission is to expand the business. The environment seems positive, new grad friendly and I could see myself working with this doctor. I have heard many good things about the doctor from the hospital staff.

• States that I will mostly be doing followups independently but initial consultations with him.
• 100k 90k salary (office manager gave me the wrong salary, I believe it was an honest mistake), bonuses will be considered in 2nd year depending on performance and revenue generation. No update on bonuses. How should these be calculated if my time is split between the hospital and the clinic?
• Trying to negotiate some sort of sign on bonus so I can get situated closer to the clinic to cut down commute. They seemed okay with the idea and are currently calculating how much to give.
• They will pay for licensing, credentialing, DEA and malpractice (unsure if full tail is provided).
• 2 weeks of PTO.
• 1 week CME with $1500, but would be willing to give a bit more if needed (verbatim language "however much you need, just don't go crazy")
• 401k offered. They will contribute 7-20% of my salary to my 401k depending on profits. Vested 20% per year. 
• No health plan provided
• No tail coverage

Schedule

• M-F Mornings starts with hospital rounds (start time may depend on patient load). Clinic time from Noon until 4:30. NO clinic on Fridays .
• 1-2 weekends per month of morning rounds.
• NO CALL

Anything else that I need to ask for?

 

 

[GatorRRT]

Not a bad offer, but I'd never accept a position without health ins. I'd counter with an additional 5k so you can buy your own coverage.

[PACJD]

Yea only downside is the lack of health insurance. Otherwise pretty solid offer. Don't know if you have a significant other who can cover your health insurance, then you wouldn't have to worry about that. 

Also how early is "mornings"? Wouldn't want to be there at 4am if the patient load is consistently heavy.

 

[spa-c]

With no health insurance, it's a no. If health insurance were provided it would be an OK offer, but without health insurance--it's a no. You deserve health insurance and full benefits.

I would say to look elsewhere.

[spa-c]

Honestly I think the money is too low.
Starting out as a new grad hospitalist PA I was making close to 115K and my second year in the same job close to 135K. (105 salary, 30K productivity bonus). This is with full benefits, CME, 4 weeks PTO,  401K and match. I don't know what state you're in though. I am in MD.

As a critical care/pulm PA you deserve more money.

And they need to cover tail as well for you. Without health insurance and tail, and just a measly 2 weeks off work they are very much underpaying you. Add up all the benefits you could get at another job (tail, health insurance, more PTO, matching 401k etc) and you will easily see they are jipping you of 20 to 30 thousand dollars. Benefits add up. Don't skimp on that.

With those skeleton benefits they should be offering you 130K straight up.

[PACJD]

4 hours ago, spa-c said:

Honestly I think the money is too low.
Starting out as a new grad hospitalist PA I was making close to 115K and my second year in the same job close to 135K. (105 salary, 30K productivity bonus). This is with full benefits, CME, 4 weeks PTO,  401K and match. I don't know what state you're in though. I am in MD

wow I didn't know Maryland has offers as good as yours, haha. I know certain areas in the northeast pay well, but didn't know Maryland was one of them. Was this a large teaching hospital or a smaller community? Near baltimore at all?

[EMEDPA]

I think 100k for any new grad is fairly generous with an appropriate benefits package. keep in mind you will be pretty worthless to the practice for quite some time. not too many new grad pas can run an ICU by themselves or do many of the procedures required. I am not a fan of the teaching salary anywhere outside of a residency, but I think 100k is a very reasonable amt of money for reasonable hrs. as you are basically a trainee. now if this is 80 hrs/week with q3 call, then yes, more $ is in order. keep in mind avg new grad salary is around 90k. when I graduated 20 years ago a lot of offers were 1/2 that. we all thought 40k was fair for primary care, more for specialties. we were all coming from jobs making 32-35k as paramedics, RNs , RTs, etc so 50k was huge money back then. I actually made 70k my first year out of school with a bit of OT.

[spa-c]

On 9/16/2017 at 10:46 PM, NJPL1213 said:

wow I didn't know Maryland has offers as good as yours, haha. I know certain areas in the northeast pay well, but didn't know Maryland was one of them. Was this a large teaching hospital or a smaller community? Near baltimore at all?

Sorry for the late reply.
It's a small hospital, not teaching. (let me add though, I am not employed by the hospital I am employed by a group)

I am credentialed in 3 hospitals in Maryland though.
Baltimore has a LOT of jobs for PAs and they pay VERY well!
The job I am speaking of is closer to DC, but Baltimore is a GREAT place for PAs to work! So many opportunities and the pay is excellent.
 

[camoman1234]

On 9/18/2017 at 4:04 PM, spa-c said:

Sorry for the late reply.
It's a small hospital, not teaching. (let me add though, I am not employed by the hospital I am employed by a group)

I am credentialed in 3 hospitals in Maryland though.
Baltimore has a LOT of jobs for PAs and they pay VERY well!
The job I am speaking of is closer to DC, but Baltimore is a GREAT place for PAs to work! So many opportunities and the pay is excellent.
 

Seems good, but that area has a high COL. Good luck!

[camoman1234]

On 9/17/2017 at 1:05 AM, EMEDPA said:

I think 100k for any new grad is fairly generous with an appropriate benefits package. keep in mind you will be pretty worthless to the practice for quite some time. not too many new grad pas can run an ICU by themselves or do many of the procedures required. I am not a fan of the teaching salary anywhere outside of a residency, but I think 100k is a very reasonable amt of money for reasonable hrs. as you are basically a trainee. now if this is 80 hrs/week with q3 call, then yes, more $ is in order. keep in mind avg new grad salary is around 90k. when I graduated 20 years ago a lot of offers were 1/2 that. we all thought 40k was fair for primary care, more for specialties. we were all coming from jobs making 32-35k as paramedics, RNs , RTs, etc so 50k was huge money back then. I actually made 70k my first year out of school with a bit of OT.

I appreciate your experience, but I have had this discussion on here before and your words are not that accurate. The average for a new grad in some areas is 90K, but in the mid-west (where I live) it not the case. I typed in on bankrate.com, the COL calculator and to move from Baltimore to a major lower mid-west city there is a pay decrease of 21.37% assuming your making $90,000. See below: 

• Equivalent income in the city you are moving to: $70771.28.
• You may take a 21.37% decrease and still maintain your standard of living.

Like I said before my first job paid me $66K a few years ago, now I got some experience and make more, but look at the difference in the COL. NOT all new grads have to make $90,000 cause most PAs/NPs around where I live barely make that with 15+ years of experience. 

[WeBuyAndSellJunk]

1 hour ago, camoman1234 said:

I appreciate your experience, but I have had this discussion on here before and your words are not that accurate. The average for a new grad in some areas is 90K, but in the mid-west (where I live) it not the case. I typed in on bankrate.com, the COL calculator and to move from Baltimore to a major lower mid-west city there is a pay decrease of 21.37% assuming your making $90,000. See below: 

• Equivalent income in the city you are moving to: $70771.28.
• You may take a 21.37% decrease and still maintain your standard of living.

Like I said before my first job paid me $66K a few years ago, now I got some experience and make more, but look at the difference in the COL. NOT all new grads have to make $90,000 cause most PAs/NPs around where I live barely make that with 15+ years of experience. 

I have always viewed this a bit differently than a standard job. You work in the middle of nowhere mid-west? You get paid for it. It might only get you back to the standard 90k average, but your COL is lower. Wanna work in a hip area? Supply > demand, but COL requires a higher pay rate. You are probably going to bill out a relatively similar rate wherever you wind up. Why should you simply let someone else take that money because you think it is okay to make less in a different region? If you have 15 years of experience and you aren't making 90k, you are doing it wrong wherever you live. 

[camoman1234]

20 hours ago, printer2100 said:

I have always viewed this a bit differently than a standard job. You work in the middle of nowhere mid-west? You get paid for it. It might only get you back to the standard 90k average, but your COL is lower. Wanna work in a hip area? Supply > demand, but COL requires a higher pay rate. You are probably going to bill out a relatively similar rate wherever you wind up. Why should you simply let someone else take that money because you think it is okay to make less in a different region? If you have 15 years of experience and you aren't making 90k, you are doing it wrong wherever you live. 

I make more in a rural area than the city, 94k last year and I have 3 years experience. Making less in a different area is due to the lack of competitors in the area. Your theory sounds nice but its not what HR does. Billing out is a lot different, rural health clinics bill differently.  Guess you might not even take medicaid/medicare as you would understand reimbursement.

[WeBuyAndSellJunk]

Lol, good ol' ad hominem. I work in a rural health clinic where more than 70% of patients don't even have insurance and they are starting new grads in the mid 80's (this is before the 15k a year state loan repayment award). Most uninsured patients aren't even paying. We aren't in the red and see approx 10-11 pts per half day. Lots of days less because the population is so fickle about showing up to appointments. You know our problem? We can't find people to work here because it is rural and difficult. They have to pay people more to attract them because while the COL is low, the social and cultural scenes are poo for most people who are young, well educated professionals. 

The point is, they can pay a physician 2-3x a PA for a similar position and justify cost. An APP of 15 years should be right there productivity and skill set wise. You are a poor bargainer or not productive if you aren't making at least that at that point. Hell, maybe I am wrong, but show me a PA specific salary report where PAs with > 10 years of experience are making less than 90k on average. I don't care which state/area, except maybe south Florida, they have issues :) 

A new graduate shouldn't be far behind that 90k mark even in states that re-imburse poorly and if they had a majority medicare/medicaid payer mix. Some of the worst states re-imburse docs at ~$61 per 99213 for medicare. 

($61 x 0.85%) x 20 pts x 4.5 days x 46 weeks = $215280. You can shave this down a bit and still justify a decent salary and cover overhead. This is considering you do all 99213. The rates get better with MACRA incentives. 

Rate is $41 for FQHC medicare 99213 visit in my state. Rate is about $61 dollars for a 99214 (pretty much every stinkin pt if you bill correctly). It is up to you how you feel that money should be split up, but I am a bit partial to it going in to my pocket and not someone elses. By the way, the difference is made up with federal grants for all of those uninsured patients.

[camoman1234]

On 9/22/2017 at 8:53 PM, printer2100 said:

Lol, good ol' ad hominem. I work in a rural health clinic where more than 70% of patients don't even have insurance and they are starting new grads in the mid 80's (this is before the 15k a year state loan repayment award). Most uninsured patients aren't even paying. We aren't in the red and see approx 10-11 pts per half day. Lots of days less because the population is so fickle about showing up to appointments. You know our problem? We can't find people to work here because it is rural and difficult. They have to pay people more to attract them because while the COL is low, the social and cultural scenes are poo for most people who are young, well educated professionals. 

The point is, they can pay a physician 2-3x a PA for a similar position and justify cost. An APP of 15 years should be right there productivity and skill set wise. You are a poor bargainer or not productive if you aren't making at least that at that point. Hell, maybe I am wrong, but show me a PA specific salary report where PAs with > 10 years of experience are making less than 90k on average. I don't care which state/area, except maybe south Florida, they have issues :) 

A new graduate shouldn't be far behind that 90k mark even in states that re-imburse poorly and if they had a majority medicare/medicaid payer mix. Some of the worst states re-imburse docs at ~$61 per 99213 for medicare. 

($61 x 0.85%) x 20 pts x 4.5 days x 46 weeks = $215280. You can shave this down a bit and still justify a decent salary and cover overhead. This is considering you do all 99213. The rates get better with MACRA incentives. 

Rate is $41 for FQHC medicare 99213 visit in my state. Rate is about $61 dollars for a 99214 (pretty much every stinkin pt if you bill correctly). It is up to you how you feel that money should be split up, but I am a bit partial to it going in to my pocket and not someone elses. By the way, the difference is made up with federal grants for all of those uninsured patients.

Same problem here, that 215K will not even close sustain a clinic. I grossed 420K last year and the boss was still on me to get my numbers up cause we were losing money after paying me, my 4 staff members, billing/coding, rent, equipment, lights, heat/air, malpractice, lawyer, supplies and the list goes on. I am currently in the buy out phase of this clinic and I can tell you after have a business evaluation, looking at 10+ years of income statements and balance sheets, 215K will not cut it for my little whole in the wall rural health clinic that has not been updated in 25+ years. Not sure how you keep the lights on, but we struggle daily with reimbursement and staying a float. On the original topic, I do agree I do get paid more in  a rural area, but I did also work for a big corp. monster in a rural health clinic that was 35 miles away and I was making less than 70K. 

[WeBuyAndSellJunk]

Seems like it is really dependent on the clinic. I can see a solo rural health doctor + PA struggling to pay the bills with that sort of income. We are big enough to have a lot of redundancy and thus have overlapping responsibilities for support staff, legal stuff, equipment, maintenance/building, billing/coding, etc... Malpractice is covered through our FQHC look-alike status. We are also doing a lot more than 99213 visits and thus generating more income than noted above (that was a pretty bare bones minimum estimate). I guess I would just never accept to work at such a clinic with the knowledge that there are others that will pay better for the same work. I am also not stuck with respect to my location either though. 

[camoman1234]

22 hours ago, printer2100 said:

Seems like it is really dependent on the clinic. I can see a solo rural health doctor + PA struggling to pay the bills with that sort of income. We are big enough to have a lot of redundancy and thus have overlapping responsibilities for support staff, legal stuff, equipment, maintenance/building, billing/coding, etc... Malpractice is covered through our FQHC look-alike status. We are also doing a lot more than 99213 visits and thus generating more income than noted above (that was a pretty bare bones minimum estimate). I guess I would just never accept to work at such a clinic with the knowledge that there are others that will pay better for the same work. I am also not stuck with respect to my location either though. 

I agree that it is hard to keep a float as we are a stand alone clinic and he works else where. So I am running the show at this private practice. The reason I left the corp. world was I am tired of them micromanaging me such as sitting and clocking you how long you are in the room. When you have a MBA person telling me I can only spend X amount of time with my patients that does not settle well with me. If that MBA was in the room and new there was someone clocking them to hurry up they would be pissed. I also took this job cause I am from a small town and like to live/work in small towns. These people need help as well and I get blessings daily from this place and also frustrations, but that comes with medicine. Also, to add about the base salary the corp world did not pay for my medical insurance or DEA/license, but this new job does (100%) so I don't just look at the base salary cause I also get a bonus here plus he pays out for unused vacation without a penalty. I looked last week at my gross income from the year I left the corp. world to this new job (a few years ago) and the first year I made >22K with less hours.  

[camoman1234]

On 9/26/2017 at 11:17 AM, printer2100 said:

Seems like it is really dependent on the clinic. I can see a solo rural health doctor + PA struggling to pay the bills with that sort of income. We are big enough to have a lot of redundancy and thus have overlapping responsibilities for support staff, legal stuff, equipment, maintenance/building, billing/coding, etc... Malpractice is covered through our FQHC look-alike status. We are also doing a lot more than 99213 visits and thus generating more income than noted above (that was a pretty bare bones minimum estimate). I guess I would just never accept to work at such a clinic with the knowledge that there are others that will pay better for the same work. I am also not stuck with respect to my location either though. 

Also, if your logic is correct on never accepting a job that pay better for the same work, then this is true for everyone. Why is milk more expensive in different areas, same cows and way to get the milk? Why is an oil change more expensive in Houston and cheaper in a rural area, same oil? This can be said from food to your Starbucks drink to the movie theater. It is COL and the area where the "product" is being sold. 

[Ikaruga102]

On 9/16/2017 at 7:47 AM, NJPL1213 said:

Also how early is "mornings"? Wouldn't want to be there at 4am if the patient load is consistently heavy.

 

Seems like 8 am but if patient load is light I am able to come later.

[Ikaruga102]

I apologize for the late reply, I am editing the post above to share the latest meeting with their team.