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Two Job Offers and LOTS of indecision

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I'm a new grad in New England (over-saturated area) originally planning on starting out in primary care. After a couple months of coming up empty, I expanded my hunt to include ER jobs.

As these things tend to happen, I had one week of interviews all over the place followed by 2 offers.


1) Primary care -- urban setting. The practice was originally privately run until the physician retired and the practice was acquired by a bigger community health center.

They're really just getting things back up and running. It would just be a solo physician who seems great and me with occasional part-time PAs coming and going. There would be a lot of hiccups starting out with this, I think.

The offer is less than I'd like with the cost of living in this area at $76,000.

4 weeks PTO, 3 "personal days", 1 week/$3000 CME, full benefits, no call/weekends.


Here are my concerns -- It's not challenging enough. The health center has a well-established protocol for their PAs where they are not considered "PCPs" they merely take on the overflow from the physicians. Not my jam. My appointments would also be a minimum of 30 minutes even after I'm up and running and comfortable.

They've also said upfront that 20% of my time will be spent addressing prescription refill requests and phone triage. So 20% of the time I'd be an overpaid nurse.

Like I said, the supervising doc seems cool and open to making some changes here and there, but I'm concerned about the serious lack of autonomy.


2) ER -- fulltime @ $50/hr ~40hrs per week with option for more. All the PAs there have started out as new grads; they have a well-established ramp-up/training protocol for new grads starting them out alongside an physician in the fast track and moving to the main ED once they're comfortable.

The benefits are equal to the first offer except for no paid time off -- just a week off every 6 months. And 1 week for CME.



I don't want to pigeon-hole myself right out of the gate -- ER is NOT what I want to do for the rest of my life. I've been advised to start out in primary care and give myself that foundation.. is this as important as it's made out to be? How hard is it to transfer from ER to something else (family practice, oncology, etc?)


They both made the offers last week so I'm kind of just bouncing around in my head trying to make this decision and no revelations are coming to me.


I need help!

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ER hands down! Because it is shift work, it would provide you plenty of time to work else where....primary care p/t.


Initially, I would've recommended primary care as new grad, sharpen your skills set then move on to EM work. But because of your ill feeling about your #1 offered that I gave the above advise.


I will discourage new grad from starting out in the ED. Things would makes lots of sense if you were to start out in IM/FM and your life would be easier.

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ER all the way! Your first offer would "pigeon" hole you more then the second by far. The FP offer you would probably be seeing bullcrap pts and doing low level menial work it seems like. Basically a scut monkey making no money. The ER offer you will make an acceptable amount of compensation and learn a lot. You will see higher acuity pts that will challenge you and make you a better PA. There will be a steep learning curve so be ready. I also like the fact that the ER offer has a 'new grad protocol' type picture that slowly works you in.

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Thanks guys. I was still leaning toward the FP but today their HR refused to even agree to an earlier performance review, so I'll be underpaid and unable to change that for whole year -- well after I've already hit my benchmark of productivity. Also she was a huge snot about it so whatever. I'm bummed cause now I have to move but oh well. It'll be worth it.

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