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New Grad ER Offer - Any red flags?

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Long-time lurker, I was just offered a job (my first) in emergency medicine and I'm very excited to get my feet into this field. I researched salaries in the AAPA salary report and would like to solicit some additional thoughts on this.


  • Base salary $55/hour - translates to $92,400 base salary with 1680 hours expected annually (aka 140/hours a month)
  • $1.50 per RVU bonus, paid out bi-yearly
  • $3,000 CME
  • Malpractice with tail coverage in perpetuity 
  • Health / Dental / Vision provided at a very low cost
  • Long-term disability insurance provided
  • 401K
  • Low-volume, small ER, semi-rural area. Low cost-of-living. I've been told I'll see about 10 patients per shift. Twelve hour shifts by default.


  • It's the field I've desired since staring PA school
  • Only day shifts, there is no overnight PA coverage
  • Access to every level of acuity. There is no fast track. So I'll really get to practice to the fullest extent.
  • Low patient volume means I can spend more time with patients and not feel super rushed while I'm learning or getting used to EMED
  • Supervision: I'll always be working with at least one physician who is willing to help and bounce questions off of me. I spoke with this person and they have a great attitude and outlook about emergency medicine. The group also states that they've trained up many new grads.
  • I'll have the ability to travel to different locations and/or pick up extra shifts 
  • They will work with me to make sure all of my credentials get processed quickly 


  • There is no PTO throughout the group. I've seen this before for EMED, but I also know that some people receive several weeks of vacation. I personally love my vacation time, so I was torn about it. I was told that people would take 2-4 vacations a year, but this involves moving shifts around or working less in a particular month. 
  • The 401k is available, but there's no information on an employer match (because I don't think there is one)
  • Not sure how many RVUs I would generate with such a low volume of patients
  • I do not believe DEA fees will be covered. I also already paid for my state licensure fees out-of-pocket. 

The offer seems very fair, especially for my location. But I'm obviously inexperienced and the doctor alluded that he expects me to negotiate and come up with a counter-offer. So I don't think I'm jeopardizing the job by coming back with something. I have all of my certifications and prior EMS experience if that means anything. 

I also wanted to say that I see the RVU bonus as just that... a bonus. I don't really expect it to sway my decision by much. Does the value of $1.50 seem fair? 

Thank you for your time.

Edited by frenchcrazy
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I am a new grad as well and I’d take this. Obviously it isn’t perfect but from my experience aggressively trying to obtain an ER job over the past six months, this sounds like a great gig! I may have missed this in the post, but are you expected to fly solo with access to the physician or will they be there onsite with you? 


As far as negotiating, I’d personally try to bump it up a couple bucks and ask for 60 or something like that because why not. I’d also ask for DEA reimbursement. That thing is expensive. 


Edit: is it possible they provide DEA reimbursement out of the CME? 3k is on the higher side of what I’ve seen and I did speak with one ER group who lumped all of their licensing reimbursements under “CME”.



Edited by Hopeful2015
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3 hours ago, frenchcrazy said:

Yes, one physician would always be on site! I was also thinking about asking for $60 and expecting some sort of counter, but as you alluded to - it's hard to find a new grad EM job and I'm pretty risk averse. I don't want to let this opportunity pass me by. 

Thank you for the response 🙂

No problem. Obviously my experience is limited, but I’d absolutely submit a counter. They’ve already invested a lot of time and energy into interviewing and selecting you and I promise they don’t want to go through that again, even if they do have lots of apps to choose from. Also, your EMS experience is a big deal and is becoming rarer and rarer among new grads. 


Either way, nice job nailing this one! 

Edited by Hopeful2015
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Offer sounds pretty good.  A couple of questions  you should ask: 401K match - one large national company advertises that they have it but don't clearly state that it's at the company's discretion and have been underfunding it; what kinds of patients will you be seeing.  10 pt's in 12 hours is very low volume.  If there's not a good mix of complexity/acuity you won't learn as much as you might.

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@ohiovolffemtp I visited the ER yesterday and it didn't seem hectic, but they did have a variety of cases present and the PA told me that they wind up seeing almost everything come through that door. Patients I'm seeing include everything from vague abdominal pain, lacerations, strokes, heart attacks, to even a few deliveries/year. But I agree, it's definitely low volume compared to the expectations that I had even during my rotations. 

I wound up considering everybody's suggestions here in addition to a few friends and I accepted the job after some back-and-forth. Thank you everybody for your time. 

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  • 2 months later...

The advantage to low volume is that the docs actually have time to teach. If you're constantly just trying to keep your heads above water seeing everyone coming through the door, you'll inevitably end up seeing what you're comfortable seeing, i.e. the low acuity patients, and the docs won't have time to help you learn procedures, talk through cases, etc.

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Hello everybody, the job was exactly as described. I spent a few days already and the census has been anywhere from 25-50 patients in a 24-hour period (average looks to be around 40). 

The pay is more so around $107,000 (this is before RVUs/taxes; and adjusted for 2 weeks "vacation"). The number quoted earlier was if I worked the absolute minimum. However I'm on the schedule a bit more as the PA shift for the entire month is split between me and one other PA.

I received my healthcare benefits and already put some of my CME money to use. 

I have to present every case to the Physician for the first 6 weeks and will be under a close eye for the first few months. The doctors I have met were very nice and willing to talk about anything. The nurses / techs / RTs do a considerable amount of work and really just leave us with procedures and decision-making. 

I realize I'm very fortunate to find an ER job right out of school as many of my ER-hopeful friends had to settle with urgent care for the time being.

Once again, thank you to all who have commented.

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