HammockHoodlum Posted April 28, 2013 Share Posted April 28, 2013 Hello all. I have a job offer as a new-grad in the ED in a critical access hospital and would really appreciate some input. The practice setting seemed ideal during my time checking out the site. It's a rural ED, primarily staffed by PAs (there is an MD onsite 1-2 days/week). The rest of the PAs working here are well seasoned however. They are willing to train a new grad toward becoming an autonomous provider (there will be a 6mo-1yr orientation period). The shifts are 12 hours with the choice to work either 3 or 4 days per week (84 or 96 hours per 2 week pay period). The administration staff and providers were all very nice. So at this point sounds great, right? Sign-on: $2500 Wage: $39/hr with bump up to $41/hr at end or orientation (6-9mo). Wage reassessment at end of 1st year. Time and a half for anything over 40 hrs/week.I have told them the rate is low, but they rebut with the fact that I will be making $105k/yr if I work four 12 hour shifts/week [*]$1500 CME, 7days. [*]PTO: 2-3 weeks determinate upon hours worked [*]Benefits: Health, Dental, Vision included [*]401k: 4% match after 2 years [*]All licensure expenses paid [*]$350/mo additional for loan repayment [*]Contract length is 2 years The job is in an area that I would enjoy living (lots of outdoor possibilities). Everything looks good to me except the hourly wage. When you look at the annual salary including overtime, it's not bad ($105k), but that's working four 12s/week. Is that a lot of hours in the ED? Working three 12s/week would drop it down to 87,204/yr. I have talked to a couple class-mates taking ED jobs starting at $55/hr, but with a less autonomous position. I know there are a lot of contracts posted right now with it being that time of year but I would really appreciate your input. What are your guys/gals thoughts? Link to comment Share on other sites More sharing options...
gatormaz Posted April 28, 2013 Share Posted April 28, 2013 This does not sound like an ideal job for a new grad. 4 12's a week is a ton of hours particularly in the environment you're describing. Benefits look good. Even with an orientation the amount of stress will be substantial. Autonomy looks great on the surface but will crush you quickly. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 28, 2013 Moderator Share Posted April 28, 2013 a few things...what is your prior background? really the only folks who should consider jobs like this as new grads are folks with lots of prior high level experience like medics, etc. solo coverage is serious business. are you ready for a 2 yr old with facial trauma and an unstable airway who is a difficult intubation? how about a septic 90 yr old with no iv access? 4 twelves is a lot if they are busy. if they see 1-2 pts/hr like many rural sites this is not a lot of hrs. one of my rural jobs sees 10-12 pts/24 hrs. the shifts there are either 12s or 24's. this is a lot less painful than working 8's at my other job at a busy urban trauma ctr. Link to comment Share on other sites More sharing options...
HammockHoodlum Posted April 28, 2013 Author Share Posted April 28, 2013 First-off, I appreciate the replies. I have 2 years experience as an EMT basic, but no medic and minimal ACLS experience outside of PA school. The ED sees roughly 20-30 pts/24 hrs. They stated there would be no solo-coverage until both parties were comfortable with that (they were hoping for 6-12 months). There are always two providers on site in the ED except for a 3 hour window in the morning and evening. I had initially planned to apply for an EM residency but the allure of a full time salary was hard to brush off. However, I am starting to lean more towards applying for an EM residency for the very reason EMEDPA stated above. I would not be very comfortable with acute pediatric airway intubation at this point. What do you guys think about the salary? Thanks for the input. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 28, 2013 Moderator Share Posted April 28, 2013 the salary is fine and loan repayment is nice.. a residency would be a great idea but if you opt to take this position let me suggest you take the following courses ASAP: ACLS, ATLS, PALS, THE DIFFICULT AIRWAY COURSE. these are really the bare minimum coursework you need to master to work solo. if they are really willing to precept you to a level where you are comfortable working solo before letting you off the leash this would be an excellent job. I would have taken this job right out of school if I didn't have the option of a residency. what part of the country is this in if you don't mind me asking? Link to comment Share on other sites More sharing options...
HammockHoodlum Posted April 28, 2013 Author Share Posted April 28, 2013 I have completed ACLS. They will pay for PALS and ATLS. I will look into the Airway course. They did agree that I will be precepted for that orientation period as they want to make sure I am ready for solo, hence the 2 year contract. They have reassured me that they will not let me work solo until I am ready, but obviously they would prefer that to be sooner than later, as would I. For me it comes down to this: Do I 1) want to work my arse off in this job while getting paid an 'ok' amount and gaining great experience 2) work a low stress fast-track position for less hours while making more money or 3) bite the bullet and do a residency. I have cycled through these options about a thousand times and always end up back at square one. I'm thinking about flipping a coin at this point. The job is in coastal Michigan area. Ideally, five or six years from now I would like to work for remote medical or another expedition medicine company. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 28, 2013 Moderator Share Posted April 28, 2013 Ideally, five or six years from now I would like to work for remote medical or another expedition medicine company. given this I would do first choice: residency(look at uiowa, has a rural/solo focus) 2nd choice: this job don't even consider the fast track type jobs. the money is great but you are basically treading water in your career learning wise. Link to comment Share on other sites More sharing options...
HammockHoodlum Posted April 28, 2013 Author Share Posted April 28, 2013 I appreciate the wisdom and advice, EMED. Thanks. Link to comment Share on other sites More sharing options...
Just Steve Posted April 29, 2013 Share Posted April 29, 2013 Paramedics on busy rigs work four 12's a week plus do overtime. That is system status management where there is no station to relax in. They are parked on a street corner, stuffed in the front seat. I was one of those dudes..sitting in a well lit, warm, dry, relatively safe ER where you are pretty darn high up the food chain is an easy gig. In a C.A. hospital, seeing less than a patient per hour, with full bennies, tons of vacation time, sign on bonus, all your fees paid, training, supportive agency no wants you to fail...you want to walk from that for what? Another 5-10 bucks an hour? What if you did get that 10/hr more elsewhere but you had to pay 20% of bennies, no kicker to loan repayment, no paid time off, and a administrative staff who treated you like a number who expected you to be up and running in a couple of months, seeing 4 patients an hour? Money is not everything my friend.. plus, if they are rural and a C.A. hospital, u may be eligible to apply for NHSC award and may get another 20k a year to loan repayment. My only hesitation is your lack of experience in critical emergency medicine but that is why they are willing to train...I think you would be foolish to walk away but I am just a lowly, poor student aching for a job. edit to add: 1000 hrs at 39/hr + 1000 hrs at 42/hr = 80,000. Add to that 350*12 = 84200. Plus 2500 sign on bonus = 86700/yr. 86,700/2000 hr = 43.35/hr in your first year, plus bennies and all fees AND potential for resume building autonomy and that is based on working 2000 hr/yr (50 weeks of 40 hr/wk. We haven't even discussed any tax credits for being a rural provider. Oregon gives a 5000/yr tax credit...maybe MI has similar? Link to comment Share on other sites More sharing options...
HammockHoodlum Posted April 29, 2013 Author Share Posted April 29, 2013 This is exactly why I posted the contract. The idea of making $16/hr more is tempting, but you're right, money isn't everything. I appreciate the perspective, Steve. Link to comment Share on other sites More sharing options...
HammockHoodlum Posted April 29, 2013 Author Share Posted April 29, 2013 This is exactly why I posted the contract. The idea of making $16/hr more is tempting, but you're right, money isn't everything. I appreciate the perspective, Steve. Link to comment Share on other sites More sharing options...
HammockHoodlum Posted April 29, 2013 Author Share Posted April 29, 2013 This is exactly why I posted the contract. The idea of making $16/hr more is tempting, but you're right, money isn't everything. I appreciate the perspective, Steve. Link to comment Share on other sites More sharing options...
HammockHoodlum Posted April 29, 2013 Author Share Posted April 29, 2013 This is exactly why I posted the contract. The idea of making $16/hr more is tempting, but you're right, money isn't everything. I appreciate the perspective, Steve. Link to comment Share on other sites More sharing options...
k10yake Posted April 30, 2013 Share Posted April 30, 2013 Sorry to piggyback this onto this forum, but I also received an ER offer this week (Indiana). The position is for 10 hour shifts, 4 days on, 4 off in 2 month rotations at (3) hospitals in the area (i.e. work 2 months at hospital A, then 2 months at B, and so on) for a minimum of 1800 hours/year. I'd be working with the MD's in the "regular" ER, as well as fast track, depending on the hospital. The offer at the interview is as follows: - Date of Hire- First anniversary $50hr - First - second anniversary $57hr - Second - third anniversary $62hr - Third - fourth anniversary $66hr - Fourth - fifth anniversary $69hr - Fifth- anniversary plus $70hr No sign on bonus or tuition reimbursement Full benefits paid by employer (health, vision, dental, disability, and 401K) $2,000 for CME and licensure reimbursement "Yearly bonus for production at company's discretion" I felt like this was an amazing offer for a new grad and got a good vibe from the CEO when interviewing with him (low midlevel turnover rate--only 2 midlevels have left in the past 5 years (and they staff 8 hospitals!) The problem is, I received my contract today and it states that I would be working "to a total of 1612 hours/year" with no mention of the tiered pay increases. The hours alone are a $10,000 pay cut. Am I pushing my luck to bring this up, as it was not what was originally offered? Link to comment Share on other sites More sharing options...
k10yake Posted April 30, 2013 Share Posted April 30, 2013 Sorry to piggyback this onto this forum, but I also received an ER offer this week (Indiana). The position is for 10 hour shifts, 4 days on, 4 off in 2 month rotations at (3) hospitals in the area (i.e. work 2 months at hospital A, then 2 months at B, and so on) for a minimum of 1800 hours/year. I'd be working with the MD's in the "regular" ER, as well as fast track, depending on the hospital. The offer at the interview is as follows: - Date of Hire- First anniversary $50hr - First - second anniversary $57hr - Second - third anniversary $62hr - Third - fourth anniversary $66hr - Fourth - fifth anniversary $69hr - Fifth- anniversary plus $70hr No sign on bonus or tuition reimbursement Full benefits paid by employer (health, vision, dental, disability, and 401K) $2,000 for CME and licensure reimbursement "Yearly bonus for production at company's discretion" I felt like this was an amazing offer for a new grad and got a good vibe from the CEO when interviewing with him (low midlevel turnover rate--only 2 midlevels have left in the past 5 years (and they staff 8 hospitals!) The problem is, I received my contract today and it states that I would be working "to a total of 1612 hours/year" with no mention of the tiered pay increases. The hours alone are a $10,000 pay cut. Am I pushing my luck to bring this up, as it was not what was originally offered? Link to comment Share on other sites More sharing options...
k10yake Posted April 30, 2013 Share Posted April 30, 2013 Sorry to piggyback this onto this forum, but I also received an ER offer this week (Indiana). The position is for 10 hour shifts, 4 days on, 4 off in 2 month rotations at (3) hospitals in the area (i.e. work 2 months at hospital A, then 2 months at B, and so on) for a minimum of 1800 hours/year. I'd be working with the MD's in the "regular" ER, as well as fast track, depending on the hospital. The offer at the interview is as follows: - Date of Hire- First anniversary $50hr - First - second anniversary $57hr - Second - third anniversary $62hr - Third - fourth anniversary $66hr - Fourth - fifth anniversary $69hr - Fifth- anniversary plus $70hr No sign on bonus or tuition reimbursement Full benefits paid by employer (health, vision, dental, disability, and 401K) $2,000 for CME and licensure reimbursement "Yearly bonus for production at company's discretion" I felt like this was an amazing offer for a new grad and got a good vibe from the CEO when interviewing with him (low midlevel turnover rate--only 2 midlevels have left in the past 5 years (and they staff 8 hospitals!) The problem is, I received my contract today and it states that I would be working "to a total of 1612 hours/year" with no mention of the tiered pay increases. The hours alone are a $10,000 pay cut. Am I pushing my luck to bring this up, as it was not what was originally offered? Link to comment Share on other sites More sharing options...
k10yake Posted April 30, 2013 Share Posted April 30, 2013 Sorry to piggyback this onto this forum, but I also received an ER offer this week (Indiana). The position is for 10 hour shifts, 4 days on, 4 off in 2 month rotations at (3) hospitals in the area (i.e. work 2 months at hospital A, then 2 months at B, and so on) for a minimum of 1800 hours/year. I'd be working with the MD's in the "regular" ER, as well as fast track, depending on the hospital. The offer at the interview is as follows: - Date of Hire- First anniversary $50hr - First - second anniversary $57hr - Second - third anniversary $62hr - Third - fourth anniversary $66hr - Fourth - fifth anniversary $69hr - Fifth- anniversary plus $70hr No sign on bonus or tuition reimbursement Full benefits paid by employer (health, vision, dental, disability, and 401K) $2,000 for CME and licensure reimbursement "Yearly bonus for production at company's discretion" I felt like this was an amazing offer for a new grad and got a good vibe from the CEO when interviewing with him (low midlevel turnover rate--only 2 midlevels have left in the past 5 years (and they staff 8 hospitals!) The problem is, I received my contract today and it states that I would be working "to a total of 1612 hours/year" with no mention of the tiered pay increases. The hours alone are a $10,000 pay cut. Am I pushing my luck to bring this up, as it was not what was originally offered? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 30, 2013 Moderator Share Posted April 30, 2013 get the original offer and hrs in writing then sign asap. I didn't make 70/hr until I had been an em pa for >10 yrs and then only if you included bonuses in the total financial picture. I know make about 72.50/hr. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 30, 2013 Moderator Share Posted April 30, 2013 get the original offer and hrs in writing then sign asap. I didn't make 70/hr until I had been an em pa for >10 yrs and then only if you included bonuses in the total financial picture. I know make about 72.50/hr. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 30, 2013 Moderator Share Posted April 30, 2013 get the original offer and hrs in writing then sign asap. I didn't make 70/hr until I had been an em pa for >10 yrs and then only if you included bonuses in the total financial picture. I know make about 72.50/hr. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 30, 2013 Moderator Share Posted April 30, 2013 get the original offer and hrs in writing then sign asap. I didn't make 70/hr until I had been an em pa for >10 yrs and then only if you included bonuses in the total financial picture. I know make about 72.50/hr. Link to comment Share on other sites More sharing options...
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