Hospitalist position: are these red flags?

[eluch15]

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Posted 13 minutes ago

So I am a new grad, in search of a good broad medicine job. I prefer ER or UC, but it has been almost impossible to land an interview as a new grad with no ER experience so I have been widening my search to hospitalist positions. I got one ER interview, but still waiting to hear back about an offer and they said they can take up to three weeks to get back to me. So, I got a hospitalist PA job offer and these are the details: 

 

- 115k salary, with 110k during 90 day probation period with 5 k sign on bonus (half given at the signing contract and other half after 6 months of working)- I owe them the 5k back if I leave before two years

- Nocturnal shifts starting out and then moving up to day shifts. 15 shifts of 12 hours per month with a total of 183 shifts per year 

- NO PTO because they let you ask for days off and work around your schedule ahead of time 

- Two year contract. If I leave before two years, I owe malpractice tail coverage up to 10 k within first year of leaving or 5 k within 2 years of leaving---- red flag??? or is this typical?

- If I terminate the contract before Commencement day, I will owe them 2k within 5 days of termination--- Is this a red flag or typical?

- I shadowed the main PA for a few hours and she admitted that most APPs leave after 2-3 years due to burnout. But said that she isn't planning to leave after 5 years and likes working with the doctors. She said she learned a lot on the job and started out as a new grad herself. 

- Dental, medical benefits. they have a 4% match for 401k 

 

For the hospitalist PAs here, would you take this job? 

[SedRate]

Not a hospitalist PA.

I say no.

Firstly, starting out on nights is a terrible idea for a new grad, IMO. The sign-on bonus payback clause isn't a complete deal breaker but the other paybacks are (leaving before commencement and malpractice), so red flag #2. And the comment about burnout is red flag #3.

Pay and benefits are good. However, the whole "time off is built into your schedule" claim is BS to me as you're usually making up hours so you never really get that extra time off you're looking for: oftentimes a recipe for burnout. 

My recommendation: find a job with a supportive work environment fit for a new grad that will help you establish your practice skills and style. Look into trauma/acute care surgery. Similar to ER and hospitalist but with surgery.

[eluch15]

Thank you for your comments and confirming my gut feelings about this position. The PA and NP there did say they always feel supported by the physicians and feel like they’re available for questions and for learning, so I know I’d learn a ton, but I don’t like the clauses in the contract at all. 
 

I would say the OR is an absolute dealbreaker job for me (my least favorite speciality by far is OR). OR would lead me to burnout and misery for sure. But thank you for your suggestion! 

[MediMike]

Nocturnist shifts are difficult as you are only doing admits and some cross coverage for the most part, you aren't actually "managing" the patient.  Real medicine honestly gets learned during day shifts, but if its a temporary thing then not a big deal.

If you work 183 shifts x 12 hours = 2,196 hours/year.  (I'm guessing 7on/7off?) That equates to around $52/hr.  Not good unless you are in a SUPER low cost of living area.

Not pro-rating the bonus penalty is ridiculous.

I have never ever ever heard of someone owing malpractice back when they leave.

Contract termination penalties suck but they are out there for some jobs.  I feel like if you leave this job early though you're going to be paying out the...rear.

The turnover rate is definitely alarming.

I'm not sure I'd take this even if you were desperate, simply because leaving them if the work environment is untenable would financially ruin you!

[eluch15]

17 hours ago, MediMike said:

Nocturnist shifts are difficult as you are only doing admits and some cross coverage for the most part, you aren't actually "managing" the patient.  Real medicine honestly gets learned during day shifts, but if its a temporary thing then not a big deal.

If you work 183 shifts x 12 hours = 2,196 hours/year.  (I'm guessing 7on/7off?) That equates to around $52/hr.  Not good unless you are in a SUPER low cost of living area.

Not pro-rating the bonus penalty is ridiculous.

I have never ever ever heard of someone owing malpractice back when they leave.

Contract termination penalties suck but they are out there for some jobs.  I feel like if you leave this job early though you're going to be paying out the...rear.

The turnover rate is definitely alarming.

I'm not sure I'd take this even if you were desperate, simply because leaving them if the work environment is untenable would financially ruin you!

Thank you! This is actually is in Philadelphia, a high cost area of living! Unfortunately this was my highest offer too… You are right, I calculated this offer with another outpatient offer and I’d end up working about 300 hours less with the outpatient job for 4 dollars less an hour.. 

[SedRate]

On 5/7/2023 at 5:46 PM, MediMike said:

If you work 183 shifts x 12 hours = 2,196 hours/year.  (I'm guessing 7on/7off?) That equates to around $52/hr.  Not good unless you are in a SUPER low cost of living area.

I guess I'm outta the loop with the going rate for new grads nowadays. What's a good going rate? 

[eluch15]

7 minutes ago, SedRate said:

I guess I'm outta the loop with the going rate for new grads nowadays. What's a good going rate? 

I second this! Maybe it depends on the area, but my fellow new grads in East PA near Allentown area, are being offered 95k (that’s low cost of living areas though). I have been applying to surrounding counties outside Philadelphia and in Philadelphia. So far have been offered this hospitalist job which I thought was the most decent offer, and two other outpatient jobs one for 87k and the other 90k. I interviewed for an ER job and they start out at 85k with bonuses. This shocked me because Philly and surrounding counties is expensive. Philly has a hefty income tax. It’s ridiculous and I’m not sure if this is the normal unless I go into critical care or surgery? 

[trazodone]

It sounds like it is time to broaden your horizons. I agree with above is that I have never heard of someone having to pay back malpractice. You should always listen to the provider who is there and try to track the history. "Everyone else got burned out and I didn't" may actually mean "Wow, I really need someone to take this job so I'm not always being asked to do more shifts". Read between the lines. Run. 

[SedRate]

2 hours ago, eluch15 said:

I second this! Maybe it depends on the area, but my fellow new grads in East PA near Allentown area, are being offered 95k (that’s low cost of living areas though). I have been applying to surrounding counties outside Philadelphia and in Philadelphia. So far have been offered this hospitalist job which I thought was the most decent offer, and two other outpatient jobs one for 87k and the other 90k. I interviewed for an ER job and they start out at 85k with bonuses. This shocked me because Philly and surrounding counties is expensive. Philly has a hefty income tax. It’s ridiculous and I’m not sure if this is the normal unless I go into critical care or surgery? 

It also has to do with how saturated the market is for PAs. Saturated markets can have low market pay despite high COL.

Pay rate also has to do with how it's broken down, e.g., salary vs hourly: $115k salary at 40h per week is roughly $55/h vs 183, twelve hours shifts is $52/h. This helps compare salary to hourly offers. 

[MediMike]

On 5/9/2023 at 8:16 AM, SedRate said:

I guess I'm outta the loop with the going rate for new grads nowadays. What's a good going rate? 

I'm up in the PacNW which probably pays a part in this, but in 2015 I started at $62.50/hr at an academic center known for low pay.  In general offers less than $100k/yr in my neck of the woods don't even get looked at.  Our COL is a bit higher and I was probably being a bit hyperbolic with my "SUPER low COL" statement.  Little Bulleit has a tendency to add unnecessary capitalization.

[SedRate]

1 hour ago, MediMike said:

I'm up in the PacNW which probably pays a part in this, but in 2015 I started at $62.50/hr at an academic center known for low pay.  In general offers less than $100k/yr in my neck of the woods don't even get looked at.  Our COL is a bit higher and I was probably being a bit hyperbolic with my "SUPER low COL" statement.  Little Bulleit has a tendency to add unnecessary capitalization.

Nice!

Gotcha, I see where you're coming from. I will add that seeing the location of the job OP posted about changed my opinion from "pay and benefits are good" to "not so great." If the job didn't already sound terrible from all the red flags and cause someone to run away, low pay for high COL area is icing on the poop cake.