1st Job Offer: What to look for...

Trauma Columnist · Nov 17, 2007

Try to find out ballpark figure as to what new grads make in your area. Perks I like:

1. Reimbursement for mileage depending on price of gas we get $0.41-$0.43 /mile.

2. Help to offset cell phone cost - we get $600/year.

3. Free pager.

4. CME allowance - we get $1500/year.

5. Rolling PTO bank. This is new - it used to be we got 160 hours of PTO and 40 hours of sick time but you lost your PTO if you didn't use it. Now we can roll it over from year to year.

6. Get the times/amount of call in a contract - whether you can do it by phone, have to go in, what you are responsible for EXACTLY.

core0 · Nov 17, 2007

okay guys,
i need help. the cardiology group is putting together an offer for me and will be presented to me in the next couple days. i wanted to know what your thoughts were on what i should:
a) expect them to offer (e.g. cme credit, other benefits) - not talking about salary
b) ask them to provide (e.g. loan payoff/assistance, x amount of time off)
c) be willing to accept (what are some absolute no-no's or perks?)
anything that you would have liked to negotiate up front with your first job offer? any pointers? anything to look out for? just any tips would be greatly appreciated! :)

first if you are used to hospital benefits get ready for a shock. most private practice doesn't compare - especially in the insurance category. our insurance was free for the employee but pretty expensive for a family, and had some pretty high co-pays/deductibles.

1. make sure they pay for cell phone and pager. i would rather have them get you a separate cell phone. if not then $50 per month seems average.

2. mileage for driving between hospitals. you can't be paid for going to work but they can pay you between the various offices and hospitals.

3/ cme - make sure you get days and $. 5 days/$1500 seems to be the norm. 6 days and $3500 would be better. conferences have gotten more expensive. this would allow you to go to one 4 day conference such as acc for $2500 and one three day for $1000.

4. loan payoff - pretty rare to non-existent for private practice. there is no real tax payoff for them and it is taxable income for you.

5. car allowance - gotta dream;)

6. time off. some use pto but most still use sick days and vacation days separately. 2 weeks is the usual starting off. make sure the progression is in writing ie. 3 weeks after one year. 4 weeks after 5 years. ask what the physicians get. sick time is per policy.

7. make sure that call obligation and expectation are in writing.

8. make sure that orientation is realistic and in writing.

9. make sure that you have a contract. make sure that there is not a non-compete clause. if they insist make sure it is the least restrictive it can be (ie. can't compete within 10 miles with cardiology but could do any other specialty).

10. make sure they pay for malpractice insurance. make sure they will pay for a tail. get this in writing.

11. pay about $250 and have a lawyer versed in medical contract law look it over. note the bold. no you shouldn't use your cousin who just graduated from law school. this will be the best money you ever spent.

on the salary part get what you can but don't get greedy. you are a drag on the practice for the first six months. if they are smart your salary will reflect that. i do not know what np salaries are like for cardiology but for pas the new grad mean is $73k and the established mean is $83. for a pa i would expect texas to be a little higher. ymmv. if you can get a productivity bonus that would be nice. make sure it is realistic and verifiable. get it in writing.

finally while it is not np specific take a look at this from the aapa. there are many similar issues with np contracts and they should be substantially similar. especially the pre-employment checklist and anatomy of a contract on the right.

http://www.aapa.org/joblink/candidates.html

remember what they told you in nursing school - if it is not written it didn't happen? that applies doubly here. a written contract not only protects you but also protects the practice. failure to produce one should be a definite warning sign that the practice is not professional (as is the physicians wife as office manager).

good luck

david carpenter, pa-c

Trauma Columnist · Nov 17, 2007

I echo David's concerns as very valid Daisy. I almost took a job with a non-compete clause. The contract also required 3 months notice if I wanted to leave. In my area both of these things are not good for the employee.

I currently do have a contract - there is no non-compete clause.

I can't stress enough knowing what is the norm in your area. I had 12 years RN experience when I became an APN. The first offer (at the hospital where I was employed), was for LESS than what I was making as a staff nurse! The next place only offered the SAME amount that I was making. Where I finally ended up, they paid me $15k more than what I was making.

As to the health insurance, my husband works full-time too and it is cheaper for him to get his own single coverage at his workplace. My health ins is FREE. It is very expensive for my spouse and/or fmaily members.

core0 · Nov 17, 2007

I echo David's concerns as very valid Daisy. I almost took a job with a non-compete clause. The contract also required 3 months notice if I wanted to leave. In my area both of these things are not good for the employee.
I currently do have a contract - there is no non-compete clause.
I can't stress enough knowing what is the norm in your area. I had 12 years RN experience when I became an APN. The first offer (at the hospital where I was employed), was for LESS than what I was making as a staff nurse! The next place only offered the SAME amount that I was making. Where I finally ended up, they paid me $15k more than what I was making.
As to the health insurance, my husband works full-time too and it is cheaper for him to get his own single coverage at his workplace. My health ins is FREE. It is very expensive for my spouse and/or fmaily members.

The non-compete clause really depends. I think that any practice if it is smart will put in a narrow non-compete clause to protect themselves. This is where a lawyer come in. Many states do not allow medical non-compete clauses. Some of them allow them only for partners. Most of them if they are present are too broad to be enforceable. The point is that they are training you and making you more valuable as an employee. You will develop a panel of patients that may want to follow you. It is in their best interests to see that you do not become a competitor. From a business standpoint this makes sense.

For example in my last job, my non-compete clause only meant that I could not work for the directly competing group (whom I wouldn't work for anyway). Even then my lawyer felt it was probably not enforceable. That was acceptable. If it had said I could not work in the specialty anywhere in the city it would not have been. In a smaller city this can get problematic.

As for salaries - it really depends on what you want to do. Nursing salaries in some areas have risen dramatically. As a new grad you do not command the salary that an experienced NP does. Depending on the situation it may not be economically feasible to pay even what an RN is making. Texas fortunately at least for PAs is a bright spot usually paying more than the national average. Remember according to the best information (admittedly pretty poor) the average pay for NPs in specialty practice is $76k.

I am not sure how much this applies to NPs but what I usually tell new grad PA students is getting a job is the most important first step. If you can get between 40-50% of the new grad salary for the specialty and area then take it. Expect a substantial raise after one year. If they do not come through, thank them for their training and find a better job. At that point the world is your oyster.

Good luck

David Carpenter, PA-C

Trauma Columnist · Nov 18, 2007

I see your points David. The non-compete clause that the hospital wanted me to sign was not to work for TWO YEARS after I left their employ within 25 MILES. Bear in mind, this is a rural area - I would have to travel 55 miles one way in order to cont to work. I felt this was not something I was willing to sign.

core0 · Nov 18, 2007

I see your points David. The non-compete clause that the hospital wanted me to sign was not to work for TWO YEARS after I left their employ within 25 MILES. Bear in mind, this is a rural area - I would have to travel 55 miles one way in order to cont to work. I felt this was not something I was willing to sign.

That is generally considered unenforceable. Generally speaking the non-compete must be as narrowly tailored as possible. It also depends on how common the service is. For example a non-compete for a neurosurgeon could be broader than family practice. Usually you cannot be prohibited from practicing at all just that particular specialty.

The issue is that while you can challenge it and probably win that will cost money and time that you may not have. Generally I would not sign a non-compete that I could not live with.

What you describe is pretty standard for hospitals. Hospitals seem to be the only business that thinks they are immune from pretty much every labor law in existence.

David Carpenter, PA-C

Trauma Columnist · Nov 18, 2007

Yes, and I guess the other APNs they employ DO sign this! I won't however. lol

DaisyRN, ACNP · Nov 21, 2007

hey guys,

thanks for all the pointers... i still haven't received an offer yet, but i have received an email saying i will be getting one and not to worry. the group is joining up with a huge collaboration of physicians and this merger means bigger money/better benefits for me (a known fact:)). the administrator at the group told me that he was reviewing benefit information for me regarding the "clinical restructuring" (a.k.a. the merger) and should have a letter in the next couple days. he wasn't going to get the benefit information from the merging company until yesterday afternoon, so we'll see...

but... in the meantime, i talked to someone that knows about the compensation package with the merging company. i think it sounds excellent, myself. i'm praying for this package... *hehe*

- $85,000 base salary + 50% of anything billed over $85k.

- 2 productivity bonuses offered every year

- $5000 for cmes

- malpractice insurance (i don't know specifics yet)

- health/vacation/all that other jazz

- i dont know about pager/cell phone/gas yet either

sounds like a great start to me though...

Trauma Columnist · Nov 22, 2007

Yes indeed! Good luck and congratulations!

DaisyRN, ACNP · Nov 29, 2007

just an update... i'm still waiting...

last week before thanksgiving, the administrator said it would probably be this week sometime... and technically, the week is not over yet. trying to decide if i should contact him today or wait til tomorrow afternoon. i have no reason to believe i won't get the offer... i am just not a very patient person. :banghead:

Trauma Columnist · Nov 30, 2007

Totally understand your impatience (I'm not a patient person either) lol. Let us know how it turns out.