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Hi guys!

I am and new grad and just wanted to get some thoughts on 2 offers that I have received. Both are located in the northeast in fairly large cities with a moderate COL. 

Offer 1:

-Neurosurgery group with 4 docs and 3 PAs (I would be the 4th). Rotate between outpatient, inpatient, and OR. Travel between main outpatient building and 2 local hospitals. 

-Talked to docs and PAs, everyone seems really nice and welcoming. Docs make it a point that they teach and PAs state that training is thorough. Good support system. 

-Monday to Friday. Hours vary from around 6 to 8 in the morning until 5 to 7 at night. Would work around 40-50 hours per week. Weekend call is 1 in 8. 

-Salary is 104k to start with a potential bonus up to 5% of salary at end of year based on patient satisfaction, meeting attendance, etc. (~5250, making total compensation ~$109,250)

-21 days PTO, 6 holidays

-5 days CME + $1500 stipend

-Medical, dental, vision covered

-401k with 3% match

-Tuition reimbursement 5k

-Licenses, certifications, and DEA are covered

 

Offer 2: 

-General surgery floor (no OR) in an a large teaching hospital. Many fellows, residents, PAs, and NPs on service. Team of 15 PAs, 4 on at a time. Will be the primary provider on floor managing pre and post op patients, residents scrub in with the surgeons. 

-Very PA friendly environment and hospital. Attendings love to teach. 4 month training with other PAs through the different surgical subspecialties. 

-After 4 month training, will work 12 12-hour shifts per month (7a-7:30p) day shifts rotating. 1-2 weekend shifts per month. 

-Salary is 104 k to start 

-Can pick up extra shifts that will be paid at 120/hr

-17 PTO days and 8 holidays

-No CME days, $2,000 allowance

-Medical, dental, and vision covered

-403b with 6% employer contribution

-Tuition reimbursement 2500

-Licenses, certifications, DEA not covered (can use CME money)

 

If I could get some feedback on both these offers I would appreciate it. I am pretty open to any specialty. The first offer pays a little more but I am kinda hesitant about the first offer because they were not giving me a straight answer on how many hours I would be working a week saying things like “30 on slow weeks to 50+ on busy weeks”. 2nd offer is nice because of the fact I will work 3 days a week, but it is a little longer commute and they are lacking certain things such as CME days and covering fees. 

At the end, both seem like good learning experiences with a good support system.

Thanks  

 

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Actually, if you do the math your second offer has the ability to make a WHOLE lot more money depending on how many extra shifts you can pick up.

Offer 1: you said you will work 40-50 hours, but just for the math lets go with 40hrs. That is 2080 hrs for the year (40hrs x 52 weeks) at 104k, maybe 109k.

Offer 2: you work 144 hrs a month (12 12hr shifts) so that is 1728 hrs a year, for argument's sake let's say you can pick up as many shifts as you want and you want to reach the 2080 hr mark. 2080-1728 = 352 hrs (an extra 2.4 shifts a month). And if you really get paid at $120/hr (which is ridiculous btw) that would be $42,240 on top of the 104k.

Unless you really want a career in the OR and need the first assist experience for further jobs, I would take the second offer hands down. Even picking up one extra shift a month is an extra $17,280.  And, double check the $120/hr bc that is unheard of.

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Yea so I clarified with them because I thought that 120/hr is rediculous as well. 

I am actually required to work 13 12-h shifts per month (not 12 as previously stated). For shifts beyond 13 in the month, I will get paid 70/h per hour for extra day shifts, 90/h per hour for weekday nights and weekend day shifts, and 120/h per hour for weekend nights. 

I can only pick up extra shifts once the 4 month training is complete, and they typically only approve me picking up day shifts usually for the first year (since one of the fellows will be in-hospital). After first year they usually approve me picking up nights. 

So it’s not 120/hour for all shifts, but it still seems pretty good if I wanted some OT. A lot of the PAs there enjoy having that option for OT and they say there are always shifts to be picked up. 

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And if you do the math...

1) Offer #1 - total of 26 days off (21 PTO + 5 CME) which = 5wks + 1day given that you are doing 5days/wk

2) Offer #2 - total of 17 days off which = 5wks +1 given that you are doing 3.25days/wk

So essentially with the academic offer you are getting more days off, especially since there appears to be no call involved.

My math may be jacked.  Transitioning from nights to days.

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I think the second offer is the better one, even though you won't get any OR time. Even though the pay is less, you'll be working a lot less. It sounds like 50+ hour weeks is the norm at the neurosurgery practice, which is common in surgery. Especially when you factor in the weekend call which it doesn't sound like you get paid extra for and is included in your salary. Unless you can get 10%+ of your collections as a bonus every quarter like I do, I would go with the second offer.

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Thanks for the he replies so far!

Unfortunately weekend call is not paid extra. The OR time would be nice experience, but I don’t know how much I would really enjoy neurosurgery specifically. Never had a rotation in it, and now that I think of it, I never really even scrubbed in to a single neuro case before. 

What really turns me off is the variable hours as it seems like I could end up working some long hours without extra pay, 5 days a week. No one I talked to, not the docs, PAs, office assistants, would give me a reassuring answer. 

As for the second offer, how common is it for an employer to not give any CME days? Also, do hospitals usually cover the costs of licensing, certifications, DEA, and credentialing for new grads or do they usually cover if you are already employed under them and need to re-certify?

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Is the academic center a state institution?  Majority of academic centers (in my experience) will cover all of those items, and the DEA fee is waived for governmental bodies. 

Also remember, all a CME day is is another paid vacation day, so if it all adds up then that's all that matters regardless of what you use them for. 

For academic centers I think 4wks PTO is fairly standard, so if you are getting the equivalent of 5wks then you essentially have CME PTO built into your vaca

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On 8/15/2018 at 7:30 PM, MediMike said:

Is the academic center a state institution?  Majority of academic centers (in my experience) will cover all of those items, and the DEA fee is waived for governmental bodies. 

Also remember, all a CME day is is another paid vacation day, so if it all adds up then that's all that matters regardless of what you use them for. 

For academic centers I think 4wks PTO is fairly standard, so if you are getting the equivalent of 5wks then you essentially have CME PTO built into your vaca

I guess you are right with the CME. I do have plenty of PTO and since I’m working only 3 days per week I will have ample time to go to a conference if I choose. 

I am still concerned as to why the licenses and DEA aren’t covered. It is a large academic center (don’t believe it is a state institution), and from what I have heard from others they are usually covered. 

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Yeah it's kind of standard for them to be covered, oftentimes these organizations will do as you said and only cover them an an ongoing thing rather than providing start up fees.

Academic centers often aren't as lucrative as private practices in terms of CME $$$ and pay although oftentimes the benefits outweigh what you miss out on.

On the other hand, sometimes they just kind of suck.

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