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Hi! I'm new to the forum and wanted to ask some career advice from all the pros out there. 

I will graduate in 6 weeks and have been lucky enough to receive two job offers in a pretty rural area.  However, I'm really struggling between the two.  I've made a pros/cons list and still haven't come to any conclusion.  One is my ideal speciality (peds ortho) while the other is in a speciality I've never wanted to work in but seems to offer a fantastic work environment, SP, and more money. I was approached by the physician for this job and considered it as jobs are somewhat scarce in my area. I would love some insight on what has provided you with the most happiness in your career. Was it work environment, a speciality you're passionate about, salary or lifestyle?  I am married with a 9 year old too so lifestyle kinda automatically factors in for me. 

I will list a summary of the two and appreciate any advice on the offers!

1) Ob/Gyn private practice with first assist duties at his private surgery center and hospital for deliveries/sections

  • 94K base salary with bonus of 10% on anything I bill over $52250 per quarter
  • Contracted-60 days notice required for both parties; can break contract for any reason
  • Noncompete for 1 year in that county only (not the county I live in) and that speciality only 
  • Mon-Thurs (4 10 hr shifts = just 40 hrs a week)
  • Typical week for him includes 65 patients a day, 8 deliveries a week, and 6-8 surgeries a week
    • I will have to build my own patient schedule as he has never had a PA only PA students (little concerned he has never had a PA and in his mid 60's)
  • 3 weeks PTO, 1 week CME
  • 2500 CME (includes fees, dues, licensure)
  • Malpractice with tail coverage included 
  • Pays for my health insurance (family coverage is available but extra)
  • No 401K offered
  • Gave no reference to evals/raises/increase structure but when asked stated we could discuss them anytime I desired
  • No call
  • SP says he has no expectations for me and will fully train me; I can begin seeing patients when I feel ready as early or late as I am comfortable with
  • Moonlighting ok, doesn't need approval

2) Peds Ortho with travel for large multispeciality practice; typically 5 clinic days/2-3 OR mornings with first assist duties

  • 90K base salary with  statement of "bonus may be given by SP physician and will vary"  (got a flat "no" when I countered with 94 to try to make it equal to my prev offer)
    • Starting pay of $15 an hour until I have licensure (they stated temp licensure would suffice) 
  • NO contract-letter of intent only and states "may be terminated at will" at bottom (I used to work for this company and never had any issues before but this bothers me)
  • NO noncompete
  • Mon-Fri with no definitive schedule;  M, W, TR are OR mornings and clinic the other times
    • Multiple locations each day with lunch used to travel to a different office
    • His current PA said she was "happy" with her hours and only offered that they varied with two "long days" a week 
    • I'm estimating at least 55 hrs a week with drive time 
  • 2 weeks PTO, 1 week sick, 1 week CME
  • $2500 CME (includes fees, dues, licensure); must be paid back if I leave within 1 year of them paying for it
  • Malpractice with tail coverage included
  • Stated his patient load and surgery schedule varied by season (busier when kids are in school and playing sports and when deductibles are met)
  • Health insurance begins after 90 days; I am responsible for the cost and that was not provided
  • 401K with 4% matching
  • Ignored my question about raises/eval when I asked in email
    • I have since found out the company states they are on a salary freeze which began 4 years ago when I worked there!
  • Call (two types: phone post ops and level 1 trauma hospital call 1-2 times a month); gave no clear layout for this or how this factored in to pay; there is nothing about this in the "letter of intent"
  • Option to work UC once I am trained (stated this would be an extra hourly rate but did not state how much and said this could be discussed later if I was interested)
  • He covers 8 locations and I would be responsible for half of them once fully trained...so lots of travel
  • Mileage reimbursed at .52 to any location outside of my home facility
  • Monthly cellphone stipend of $100
  • PA friendly company-facility has multiple (55+) PAs and frequently hires new grads so I'm assuming he understands the training process
  • States he is willing to train me and also has a PA to train with that has been with him for a 1 year (last one was there 6 years before moving out of state)

I've always wanted to do peds ortho so that excites me, but I was a little disheartened by the immediate "no" to my counter offer and the lack of structure in their letter of intent. I had to press for the benefits to be sent as it simply stated eligible for benefits and PTO. It's kind of like pulling teeth to get information that seems like it should be included without question.  Also, the bolded statement saying they could "fire me at will" requiring my signature makes me uneasy as a new grad. The lack of job schedule and description is somewhat worrisome too.  I would love to have a little bit of heads up on my schedule as I have a family and a 9 year old. Maybe this is common for ortho though?? Sounds like they plan to work me to as much as possible for little as possible.  Should I just accept this if this is my dream speciality, do my time as a new grad, and bolt once I've gained experience? Also, is this offer even fair? Does this offer seem sketchy or am I being paranoid? 

Women's health has NEVER been a field I've had any interest in, but the SP seems amazing! I've heard that's so important for new grads. Plus, he has been waiting on me to finish to school saying he felt like I was the perfect fit for his office and practice. Four 10 hr shifts is also nice for my family. His offer was more structured, clear and reasonable.  He originally offered 88 and then fully accepted my counter offer stating he wanted me to feel I was an equal in his practice should I decide to take the position.  I feel like if I go down the Women's Health road, it will be harder for me to transition to any other speciality. 

Ok. I've rambled long enough. Thank you in advance!


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If you are a female, take the OB job. Not because I'm sexist and that job is less hours and you can spend more time with your family, but because if you are a male finding a PA job in OB is quite difficult. I know the peds ortho is your specialty, but that's gonna be a lot of hours for less pay, plus peds ortho is way more specialized compared to OBGYN.

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These points get my attention:

"Can break contract for any reason" from OB/GYN and "may be terminated at will" from peds ortho - to me, these statements are basically saying the same thing, and I wouldn't be comfortable with either one. What is the purpose of having a contract if it can be broken for ANY reason? 

On both offers, I'd try negotiating licensure fees separately from CME. 

The cost of health insurance may or may not be an issue depending on your personal situation (you mentioned having a child, not sure if you have a spouse through whom you can obtain health insurance) just consider this carefully. 

OB/GYN: As a new graduate, I wouldn't want to work with a physician who has never hired a PA before. I'd say you should find a physician who is already familiar with the skills and value that PA's bring to the practice. If that physician is serious about hiring a PA, he should find one who has been in practice for awhile, ideally in that specialty, who will be better equipped to establish his/her role in the practice. Being in your first year of practice will come with enough of a learning curve in and of itself. 

OB/GYN: "Gave no reference to evals/raises/increase but when asked stated we could discuss them anytime I desired." A discussion does not guarantee that an evaluation and/or raise will actually happen. I would ask for more concrete details here. 

OB/GYN: No call = that's definitely a plus! 

Peds Ortho: "Ignored my question about raises/eval when I asked in email." That's sketchy. Even if they are on a salary freeze, they need to be up front about it. I wouldn't sign anything until this is addressed. 

Peds Ortho: Definitely pin them down in terms of compensation for taking call. 

Contracts aside, when all is said and done - if peds ortho is your passion, I think you should go for it. You don't know when the next opportunity will come around if you turn this one down and I'd hate for you to wonder "what if" if this is something you've always wanted. If you wait for the "right time," you'll be waiting around forever. Chase after the dream, don't chase after the money. Good luck! 

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You've received good feedback thus far.

A few other things to consider:

-Peds ortho is a lot of casting, office visits, and a lot of worried parents that sometimes won't accept that fractures will somewhat correct themselves in peds. Some will freak out on you that you would even dare to think about not making it look perfect. Also using your lunch as travel to another office? No set schedule? This is recipe for burnout. It's tiring to drive multiple facilities in one day and to do that everyday can get really old really quickly. Why is he hiring another PA? Is trauma call floor call, peds ortho call, all ortho trauma call, or ER call? Expected to round also? Pay seems low, especially with an up-in-the-air schedule, which will be hard on you and your family. 

-Ob tends to pay lower to my understanding, so beware that the bonus structure may not be attainable. Never having a PA is a red flag, but having had students will hopefully give him realistic expectations. Why is he hiring a PA? Getting busier, working on retirement, or on his way out? No 401k is crappy; negotiate an extra 3+% for this. Four 10's is awesome!!! Option to moonlight, so can do UC to keep skill set. No call is awesome!

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