I have no clue what to do - New Grad offer (ER vs. IM)

[JKBrow13]

In essence, I have received two offers as a new grad. One for the ER in Louisville and the other for an outpatient IM clinic in Denver. Coming into PA school I was primarily interested in getting into the ER, but at the same time I was also wanting to move out of Kentucky. Its kind of a win-win scenario, but now I feel overwhelmed with the decision to choose one. So in a way this post will be an ask for advice, as well as a way for me to work through the pros and cons of both.

Internal Med

• Small Private clinic made-up of 4 providers, seeing primarily medicare/medicaid patients, 9-5:30 M-F
• Expectation to develop my own patient panel to around 400-500, and to see 10 patients a day with one hour slots
• Salary - 105,000 with potential to go to 110,00 after 6 months; Bonus potential of 1200 per quarter if seeing over 500 patients in that quarter (7.2 a day); Goal to transition to primarily productivity pay based on RVUs after first year (unsure of exact details)
• Benefits - Dental, Vision, and Malpractice (Claims made, with tail); No 401k, no CME
• On-boarding - Shadow Doc for first month, then begin seeing patients and presenting to doc ~ one month, then begin building own panel
• Misc - On-call every other weekend (no extra pay, not inpatient), one year contract, 16 day pto, 8 holidays, 60 days notice, non-compete clause over 25 miles

ER

• Contractor group that staffs 3 ERs; DISCLAIMER, currently in the process of being bought out by the hospital and are in negotiations so none of this is concrete.
• Expectations to see patients of any acuity (But prioritize lower acuity) and to see around an avg of 2 an hour; 8 hour shifts with a practice avg of 1700 hours annually
• Salary - Between 7a-7p $75 an hour, $83 an hour if between 7p-7a
• Benefits - Dental, vision, malpractice (Occurrence based), 401k w/ match, and CME
• On-boarding: One month (15 shifts) with an APP, then on your own HOWEVER there will always be a doc assigned with you to your patient, and they are required to see them before admission/discharge
• Misc - 10k signing bonus, 2 year contract, 90 days notice before leaving, non-compete clause over 20 miles

 

On paper the ER is better in my mind, but I'm worried about the situation they are currently in for New Grads, as well as the uncertainty of the contract itself.  I have done a rotation with this group, and "locker talk" is focused around how many of the providers are looking for different jobs due to the buy-out by the hospital. I also think the on-boarding is not the best for new grads, but that money is just too good to ignore.

On the other hand I think the IM gig would be a great environment for new grads, however Denver is an expensive city to live in and the benefits are not the best. I also don't find IM quite as interesting as ER.

I know this is just a decision I'm going to have to make, but I was curious if anyone had any advice after comparing the two offers? I just feel stuck trying to decide which one to take, to the point I might just flip a coin. I am planning on negotiating with the IM gig and getting more clarification regarding the productivity pay after year 1, but they are a small clinic so I'm not expecting them to budge much on the contract. I have two weeks to make a decision. I hope you enjoyed the read

Edited May 16, 2023 by JKBrow13
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[MediMike]

Take the ED job. Get some experience, if you don’t like the gig after the hospital completes the takeover move on to another ED position now that you have some time under your belt.

Practice in the field that interests you, if you find IM boring do you really want to move multiple states away to be bored in an expensive city?

Unless someone has some insider information that everything will go to hell once the hospital takes over I would give it a shot.