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New grad ortho offer - please help!


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Hello!

New grad PA here. I did a rotation in orthopaedics where I did first-assist the majority of the time. Just received an orthopaedic surgery offer- This is in Massachusetts. I updated the offer after some negotiation.

Salary: $100,000 + 5K relocation for 1 year

15% over 300,000 collections.

Average of 7 weekend calls per year. 1-2 clinic calls per month. No additional call pay. They offered "5k more to compensate for call". 

3 weeks vacation, 1 week CME

$2,000 CME

Malpractice covered.

75% health insurance covered

Professional fees included.

3 days clinic minimum, otherwise surgery. 

May terminate with 60 day notice.

 

Let me know what you think!

 

 

 

 

 

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Honestly its not a bad offer. Definitely ask for extra for call pay especially if you can be called into the hospital to consult. You can ask for 2k for CME if you want, but it wouldnt be a dealbreaker if they say no. My guess is you will far exceed 300k, in primary care PAs in my practice bring in 400-500k per year and ortho probably bills higher with more procedures etc. In leiu of a bonus structure you could just counter with an increase to 105k 2nd year or something like that. Or a base increase too 100k plus the bonus. (Its hard to know until you see the billing - make sure they say in the contract that you can see your billing and collections at any time upon request - what your bonus would be). 

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11 minutes ago, marktheshark89 said:

Honestly its not a bad offer. Definitely ask for extra for call pay especially if you can be called into the hospital to consult. You can ask for 2k for CME if you want, but it wouldnt be a dealbreaker if they say no. My guess is you will far exceed 300k, in primary care PAs in my practice bring in 400-500k per year and ortho probably bills higher with more procedures etc. In leiu of a bonus structure you could just counter with an increase to 105k 2nd year or something like that. Or a base increase too 100k plus the bonus. (Its hard to know until you see the billing - make sure they say in the contract that you can see your billing and collections at any time upon request - what your bonus would be). 

Thanks for answering! What do I ask for to be compensated for call? And they want to do the bonus for year 2, is it crazy to ask for that bonus structure year 1? 

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Is it crazy, no. But its not unusual for an employer to want to work with you for a year before offering a profit sharing option. You are feeling them out and vice versa. Neither of you really knows what your value to the practice will be until the first year is up. As far as call, i would say 50$ for every night you are on call and then maybe $300 for every time you have to actually go in to consult. (I have no personal experience with this, just friends with similar deals). 

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8 hours ago, marktheshark89 said:

Is it crazy, no. But its not unusual for an employer to want to work with you for a year before offering a profit sharing option. You are feeling them out and vice versa. Neither of you really knows what your value to the practice will be until the first year is up. As far as call, i would say 50$ for every night you are on call and then maybe $300 for every time you have to actually go in to consult. (I have no personal experience with this, just friends with similar deals). 

I understand that. I just think the offer of 95k for ortho surgery seems a little low so I'm trying to decide how much more to ask for or whether to ask for that profit sharing the first year instead. And okay thanks for the idea on call, I haven't had experience negotiating call pay. Thank you!

Anyone else with ortho or surgery experience have an opinion on what's fair?

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16 minutes ago, Monte said:

I understand that. I just think the offer of 95k for ortho surgery seems a little low so I'm trying to decide how much more to ask for or whether to ask for that profit sharing the first year instead. And okay thanks for the idea on call, I haven't had experience negotiating call pay. Thank you!

Anyone else with ortho or surgery experience have an opinion on what's fair?

The deal seems fair but there are questions:

1. Call schedule? Phone, ER, or practice call? Docs are likely receiving call pay so you should too. Pay setup can vary: per day, per call in/work, or per weekend.

2. Expected hours? If above 40 like most ortho positions end up being, pay on the low side for COL

3. Expected clinic schedule? Own schedule or share?

4. Working with 1 surgeon or multiple?

5. Reason for open position? (For example, new doc, prior PA left, growing/busier practice...)

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Just now, Sed said:

The deal seems fair but there are questions:

1. Call schedule? Phone, ER, or practice call? Docs are likely receiving call pay so you should too. Pay setup can vary: per day, per call in/work, or per weekend.

2. Expected hours? If above 40 like most ortho positions end up being, pay on the low side for COL

3. Expected clinic schedule? Own schedule or share?

4. Working with 1 surgeon or multiple?

5. Reason for open position? (For example, new doc, prior PA left, growing/busier practice...)

They are getting back to me today on call schedule. It's ER call covering 3 ERs. What do you think a fair asking pay to start for Mass ortho would be? 3 days minimum clinic per week at 8-5. Working with 2 surgeons, one sports medicine, one hand. Open position as PA of 12 years is leaving to spend more time with family and is staying to train me for a few weeks.

Also, how do you think I should work around them wanting 2 years at 95k both years? Can I ask 102k for one year and to have a reevaluation at the end of the year to discuss the next year instead?

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7 minutes ago, Monte said:

They are getting back to me today on call schedule. It's ER call covering 3 ERs. What do you think a fair asking pay to start for Mass ortho would be? 3 days minimum clinic per week at 8-5. Working with 2 surgeons, one sports medicine, one hand. Open position as PA of 12 years is leaving to spend more time with family and is staying to train me for a few weeks.

Also, how do you think I should work around them wanting 2 years at 95k both years? Can I ask 102k for one year and to have a reevaluation at the end of the year to discuss the next year instead?

The PA leaving to spend more time with family points to longer hours than 8-5... Unless they're leaving for a part-time gig. 12 years is a good sign though. Big shoes to fill so that means you have the perfect opportunity to negotiate. 

Definitely ask for better salary. And you can definitely ask that way (set salary Year 1 and then sit down to review for the next year).

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1 minute ago, Sed said:

The PA leaving to spend more time with family points to longer hours than 8-5... Unless they're leaving for a part-time gig. 12 years is a good sign though. Big shoes to fill so that means you have the perfect opportunity to negotiate. 

Definitely ask for better salary. And you can definitely ask that way (set salary Year 1 and then sit down to review for the next year).

Haha perhaps, they did say he had a 50 minute commute though so hopefully that's just the case. Do you think I should mention anything about that profit sharing or let it slide for year two? Thanks for your help!

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9 minutes ago, Monte said:

Haha perhaps, they did say he had a 50 minute commute though so hopefully that's just the case. Do you think I should mention anything about that profit sharing or let it slide for year two? Thanks for your help!

Have you talked to the PA directly? I would.

This is a business decision, so yes, I would most definitely ask every and any question prior to signing any contract. Some ortho practices have non-competes, so look for that. I would cough up the 500 bucks for a contract lawyer to review yours. Typically profit sharing kicks in after Year 1. How about 401K with match?

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1 minute ago, Sed said:

Have you talked to the PA directly? I would.

This is a business decision, so yes, I would most definitely ask every and any question prior to signing any contract. Some ortho practices have non-competes, so look for that. I would cough up the 500 bucks for a contract lawyer to review yours. Typically profit sharing kicks in after Year 1. How about 401K with match?

That's definitely something to think about! No 401k the first year. So the first year is pretty barebones unfortunately!

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2 minutes ago, Monte said:

That's definitely something to think about! No 401k the first year. So the first year is pretty barebones unfortunately!

That's pretty normal, however. In addition to the money aspect, make sure it's a good fit for you as a new grad. Good luck with your negotiation. 

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57 minutes ago, Sed said:

Don't forget that it costs them money to get you up to speed and credentialed. Use objective factors when negotiating, especially as a new grad asking for more.

Update for you and others! Average of 7 weekend calls per year. 1-2 clinic calls per month. No additional call pay. They offered "5k more to compensate for call". I countered and will update when I get a response.

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As long as you're not limited to post-ops it's doable if your clinic is busy and you're doing injections. My friend is busy clinic and gets 400-500K in collections so he gets like 50K a year in bonus (12% of total). I don't see as many patients, see a lot of post-ops, plus we have a fellow so when I assist in surgery I usually don't get first assist fees. I probably barely get 200K in collections. But I work easily 5-10 hours a week less than him. All depends on your practice. It's pretty shitty that you get nothing for the first 300K though.

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2 minutes ago, AbeTheBabe said:

I would try to get that down to 200K at least, if you're hitting that they are making their money back on you and you should at the minimum get a bonus after that.

You're right, I might try that. Any other opinion on the starting salary? They want to include call in the salary. Average of 7 weekend calls per year. 1-2 clinic calls per month. 

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On average the employer really doesnt start making money off you until 2-2.5x salary because they have to pay your salary, staff salaries, for your MA/nurse that works with you, overhead, for your benefits, 7.5% taxes on your salary, among other costs. (I know this because I am privy to the finances at several clinics I work at in primary care and urgent care. Of course, ortho may be different). I think 250-300k is a reasonable cut off to be making bonus, assuming that your billing in the 400-500k range (which i suspect you would be). You could always ask the PA who you are taking over for how that worked for them. As far as call being included in the salary - i’d definitely be asking for 6 figures minimum in that case.

Here is a decent article to think about overhead and bonuses: 

http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/incentive/use-objective-measures-incentivize-midlevel-providers-incre?page=full

 

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27 minutes ago, marktheshark89 said:

On average the employer really doesnt start making money off you until 2-2.5x salary because they have to pay your salary, staff salaries, for your MA/nurse that works with you, overhead, for your benefits, 7.5% taxes on your salary, among other costs. (I know this because I am privy to the finances at several clinics I work at in primary care and urgent care. Of course, ortho may be different). I think 250-300k is a reasonable cut off to be making bonus, assuming that your billing in the 400-500k range (which i suspect you would be). You could always ask the PA who you are taking over for how that worked for them. As far as call being included in the salary - i’d definitely be asking for 6 figures minimum in that case.

Here is a decent article to think about overhead and bonuses: 

http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/incentive/use-objective-measures-incentivize-midlevel-providers-incre?page=full

 

You've had really great input, thanks a ton. That's interesting insight. Perhaps I can ask for a 250k cutoff, 15% further with 105k. 

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11 hours ago, AbeTheBabe said:

It's definitely different in my practice. The surgeon and I share the MA and practice coordinator. I see many post-ops which bring in no money to the practice but clear up surgeon schedule to do surgeries, see patients, etc.

Same here, as well as rounds and other nonbillable tasks that the surgeon would otherwise have to do. Those tasks still have value even if they're not directly billable.

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