New Grad Urgent Care

[ltran15]

Hi Everyone! I wanted to receive input on a job offer in the Southeast US. I am a new graduate (August 2018) from out-of-state and moved back home. I have been job searching daily for about 1 month now in a large city. I applied for an NP job posting for an urgent care position, was interviewed, and was offered a job but the compensation and benefits are terrible relative to the numbers I have seen/heard from others. My case is a little unique though; hence the reason I am posting and seeking opinions. So here goes: 

The urgent care is brand-new and has been open for only 5 months. It's privately-owned and surrounded by large hospital-owned urgent cares in a relatively nice suburb of a large city. Since it's still new, the practice only sees an average of 4-5 patients daily, which is an increase from when the physician first opened it where there were days with no patients at all. He projects that it will continue to increase in patient load with time. At the interview, he pimped me on the several most common urgent care conditions (types of STDs, management of STDs, pneumonia, UTI, strep throat, pink eye differentials etc). I was able to answer all of them, and he was impressed. He mentioned that many of the applicants he interviewed couldn't even get those answers correctly. I am the first PA that he interviewed because the job posting was for NPs. He told me he previously had an NP when he first opened the practice and she couldn't do suturing or I&Ds. He would have to come to the practice just to do it for her. So he liked that I knew my stuff and that I had all the procedural skills. Here comes the best part - He initially offered me:

 Base salary: $80K with annual increments of $1,200 per year. 

Bonus based on # of patients I've seen annually. 2% of base salary if I see average 25 patients daily, up to 4% for 31 patients daily and up to 6% if I see 40 patients daily average annually.  Average excludes patients co-seen by supervising physician. 

Financial Assistance (CME, licensure, & certificate reimbursement): up to $1500 annually. No carry overs. 

Tax filing reimbursement: up to $750 annually, no carry overs

Travel, relocation, and temporary lodging: up to $10K

Child dependent care: up to $1K annually

PTO: up to 30 days (includes sick, CME, 6 holidays, vacation)

Malpractice

Worker's comp

Optional benefits (eligible after 180 days): health, life, disability and retirement with employer matching. 

Term: 4 years

 

After discussing that I was expecting a higher pay and CME and showed him the AAPA salary report, he told me that the practice is very new and his "financial partners" (I'm assuming investors) are very rigid in terms of money but he thinks my request for higher salary is fair. He wants to do what he can to have me cause he likes me. He sent me a counter offer the following day with these new changes:

$86K with $1500 increase annually

$1800 financial assistance.

Sign-on bonus: $2500 (paid with first pay check. only forgiven after 3 years)

 

The pros I see from this job: 

1. He enjoys teaching and wants to train me. 

2. 4-5 patients a day is a nice, slow pace for me as a new grad.

3. Specialty. my ultimate goal is work in the ED.

4. Location

The cons:

1. Low Pay 

2. Salary and not hourly

3. Lacking Benefits (CME, licensing, health insurance). I don't have a child so childcare is irrelevant. I also don't need relocation assistance. I dont care for tax filing either. the bonus, I know I won't meet the bonus seeing 5 patients daily

4. For the most part, I'll be taking my own vitals and taking my own XRs until the practice becomes more established. According to him, he will eventually bring on a rad tech. He's currently training "MAs" right now to take vitals. So it depends on which MA is working. One of 2 can do vitals. 

5. 4 year contract! Can I break this without penalty?

 

A potential ethical concern also is he is a pediatrician. He is a foreign medical graduate and did a residency in the US. After thorough research, I do not think he isn't board certified for family practice. However, he opened up this practice to see patients from ages 0-50. Is he legally allowed to see patients over 21 years old?

Any input would be greatly appreciated! 

 

 

 

[MT2PA]

Run.

[GetMeOuttaThisMess]

I don’t think this clinic is long for this world. I almost went to work for a similar setup years ago with a similar ownership setting and my gut said don’t do it. I didn’t, and it was closed within six months. Your mileage may vary.

[jeepgirl]

Don't do it. Keep looking. 

[mgriffiths]

pediatricians can do training to get certified to treat adults - one of the pediatricians that works in our FM clinic has training for ED and covers a few times a month to make extra money.

But, to expect you to take your own vitals and be a radiology tech!!!!  I worked in ortho and feel very comfortable reading a variety of XR, I have no idea how to set up patients to actually take the XR so ALL of my radiographs would be useless.  That is bad medicine and could be grounds for malpractice if patients are harmed.  It is also just bad to allow that expectation to be set.  That alone would make this a non-starter for me, but as others have mentioned there are other major concerns.

[GetMeOuttaThisMess]

Better check to see if your state allows you to take radiographs w/o being trained in such formally. Tx. used to, but not any longer as I understand (early 90’s at that time).

 

[Monte]

Really bad for the mentioned reasons.. run!

[MediMike]

Yikes. 

4 year contract is a terrible idea.

Benefits are poor.

Salary for urgent care is terrible.

Sounds like there are significantly larger, well established UCs in the surrounding area, why would this place start to grow?

You sound like you'll be solo on site.  Bad idea for a new grad.

The taking your own vitals and xrays thing, pretty much unheard of to me, as mentioned above many states require special training etc. to help prevent Bruce Banner type situations

I think you can find better.

[beattie228]

Send an email declining the offer. Yesterday isn't soon enough.

 

Reasons are listed above but the big ones that stand out to me:

• Salary in an UC setting doesn't work to your benefit. Hourly is the way to be. Any extra time you spend seeing patients/charting is on the clock and paid in full
• 4 year contract?! Not a chance. A year at best and even then I'd be very hesitant
• Solo new-grad PA in UC. Bad news bears. You need support. You need direction/teaching. Patient's don't present like Up-To-Date tells us they do. Being solo in the UC setting as a new grad is a recipe for disaster
• Hasn't ever hired a PA before. My first gig out of PA school was joining a team that had never hired a PA before. I spent that first year trying to defend what I could do with my license. Was given lip service over the teaching, but that eventually fizzled out and my schedule got packed quickly

 

Your goal is the ED, wait for a gig in the ED. Better yet, take the pay cut for a residency and don't look back. 

[ltran15]

56 minutes ago, beattie228 said:

Send an email declining the offer. Yesterday isn't soon enough.

 

Reasons are listed above but the big ones that stand out to me:

• Salary in an UC setting doesn't work to your benefit. Hourly is the way to be. Any extra time you spend seeing patients/charting is on the clock and paid in full
• 4 year contract?! Not a chance. A year at best and even then I'd be very hesitant
• Solo new-grad PA in UC. Bad news bears. You need support. You need direction/teaching. Patient's don't present like Up-To-Date tells us they do. Being solo in the UC setting as a new grad is a recipe for disaster
• Hasn't ever hired a PA before. My first gig out of PA school was joining a team that had never hired a PA before. I spent that first year trying to defend what I could do with my license. Was given lip service over the teaching, but that eventually fizzled out and my schedule got packed quickly

 

Your goal is the ED, wait for a gig in the ED. Better yet, take the pay cut for a residency and don't look back. 

Thank you all for your input!

I figured the responses were going to be along the lines of what everyone has said so far. I wanted affirmation that this is indeed a cruddy offer. 

To clarify, the physician enjoys teaching and plans on teaching me and provide guidance until he trusts me to be on my own. Whether he will keep his words or not is another topic. He also has worked with PAs in his prior practice in a different state before. I am the first PA he interviewed for this new practice. The job post was listed specifically for nurse practitioners. I applied anyway and he commented on the fact that he liked that I did that. He actually prefers PAs over NPs but his "financial partners" (who are non-clinicians) wanted NPs for whatever reason. 

The sad part is that he told me there were actually people who accepted the original offer he made! Insane. I told him I wanted to be paid for what I was worth even as a new grad. He respected my confidence. 

Also, I have applied to 2 EM residencies. I was not selected for either. The disadvantage for me is that I had no prior EM experience, and I am competing with applicants who are ER PAs who are unhappy being stuck in fast track, new grad CERTIFIED PAs (I was still in school when I interviewed), or PAs with prior backgrounds as a paramedic, EMT, etc. Through a series of events after my rejections, I realized I am one of those people who actually prefer being in fast-track and don't mind not ever working in main ED. That's why I figured I'd start in urgent care first but finding a job in urgent care as a new grad is also a struggle especially in a large city, saturated with PAs and NPs.

All-in-all: I will be turning down the job offer. I really appreciate for all the feedback! 

 

Question: What is the average/standard length of commitment for job contracts? Are there contracts without a required length of time commitment?

 

 

[ltran15]

What do you think about me renegotiating for a part-time or PRN position with the physician since benefits suck anyways? 

I would imagine there would be higher pay and no term commitment. Get the experience until I secure a better job?

He originally wanted me to be part-time but I told him I'd look elsewhere. I believe he is also open to 1099.

[mgriffiths]

16 hours ago, ltran15 said:

Question: What is the average/standard length of commitment for job contracts? Are there contracts without a required length of time commitment?

I have never signed an employment contract - only an employment agreement.  It's splitting hairs, but does matter.

Also, I have never had a length commitment attached to any job.  There have been sign-on bonuses or similar that have to be reimbursed if I leave before 1-2 years or something, but nothing else.