pgy-2 job offer?

[ewokka]

Pgy-2 here at a three year West Coast ED program.

Family friend who recently was appointed director of a rural ED is in charge of recruiting young docs who are ED trained. Offered $200/hr. Malpractice paid by hospital. Health insurance for family covered by hospital. Basic life and disability insurance paid for as well. $40k/year loan repayment. County hospital so cannot be named in lawsuit (only hospital if I am explaining correctly?) They also have offered a $1000/month stipend until I am out of residency. No contractual obligation I would just have to pay back the stipend in the event that I choose not to work there. Will ultimately be a 4-5 person democratic group. 12 hr shifts. PA coverage 19 hrs/day. Urgent care attached to ED primarily run by Pas/NPs. I think that hits all the high points.

Is this something I should seriously consider? It seems like a good deal from the research that i've done but I would really like some input. Thanks in advance

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[deleted547339]

Pgy-2 here at a three year West Coast ED program.

Family friend who recently was appointed director of a rural ED is in charge of recruiting young docs who are ED trained. Offered $200/hr. Malpractice paid by hospital. Health insurance for family covered by hospital. Basic life and disability insurance paid for as well. $40k/year loan repayment. County hospital so cannot be named in lawsuit (only hospital if I am explaining correctly?) They also have offered a $1000/month stipend until I am out of residency. No contractual obligation I would just have to pay back the stipend in the event that I choose not to work there. Will ultimately be a 4-5 person democratic group. 12 hr shifts. PA coverage 19 hrs/day. Urgent care attached to ED primarily run by Pas/NPs. I think that hits all the high points.

Is this something I should seriously consider? It seems like a good deal from the research that i've done but I would really like some input. Thanks in advance

Depends if you want to live there or not and what type of practice you want. Job offers as a PGY-2 are not uncommon. Find out what the payback would be if you sign then later change your mind.

You need to know the exact number of shifts you'd be require and the actual pph (not the pph they tell you, but the total volume and the total number of MD hours/day).

 

[deleted245139]

It's tough to find the time or have the knowledge base to adequately vet a job. Discuss with a faculty mentor and really dig into the details. I see a lot of residents courted by groups with promises of stipends and those are frankly hard to ignore. They're not always bad offers, but also not always the best. Good luck

 

[emergentmd]

Pgy-2 here at a three year West Coast ED program.

Family friend who recently was appointed director of a rural ED is in charge of recruiting young docs who are ED trained. Offered $200/hr. Malpractice paid by hospital. Health insurance for family covered by hospital. Basic life and disability insurance paid for as well. $40k/year loan repayment. County hospital so cannot be named in lawsuit (only hospital if I am explaining correctly?) They also have offered a $1000/month stipend until I am out of residency. No contractual obligation I would just have to pay back the stipend in the event that I choose not to work there. Will ultimately be a 4-5 person democratic group. 12 hr shifts. PA coverage 19 hrs/day. Urgent care attached to ED primarily run by Pas/NPs. I think that hits all the high points.

Is this something I should seriously consider? It seems like a good deal from the research that i've done but I would really like some input. Thanks in advance

If they are offering this to a PGY2, you better assume that there are better opportunities out there or they are offering new grads a better contract.

 

[The White Coat Investor]

Wow! Sounds like a great option IF YOU WOULD WORK THERE ANYWAY. It's like the military scholarship. If you want to be a military doc, might as well get the HPSP or FAP dollars.

But whether you should abandon your plans to work in Denver just for a few thousand bucks, not so sure about that.

A few comments about the package-It's pretty good. I love the no commitment aspect. Worst case scenario you send them $18K. You can do that your second month if you take another job.

But $200k an hour plus benefits plus $40K in loan payback is not a bad income at all, especially getting some of it now. If you work 12 twelves, that's $350K + another what....$60K in benefits and debt payback? Lots of EM partners out there not making $400K. We don't pay our pre-partners anywhere near that package.

Two things that worry me though. # 1- If it is democratic, when do you become a partner and what do you have to do to become one? This doesn't sound like a prepartner package unless they are very desperate to have you. But if it is, and you make even more as a partner, awesome for you!
# 2- 4-5 people to cover 12 hour shifts? Do the math man. With 4 people, that's 15 twelves a month, or 180 hours a month. That's burnout right there. Even with 5 people, it's 12 shifts a month (144 hours, more than I want to work), and that assumes everyone is willing to work at least 12. When someone retires, quits, gets sick, dies etc, you're back to 180 hours a month until you can sucker someone else to come join you. A small group like that is pretty tough.

Personally, I'd make the decision by going there and meeting everyone of these partners and decide whether I wanted to work with them for the next couple of decades. The people matter more than anyone else. You're going to have to trust these people a lot, because when you're working 15 twelves, you're going to be giving and taking a lot of signouts.

 

[The White Coat Investor]

One other red flag- You and I aren't using the term democratic the same way. If you've got some kind of liability coverage from the county, that means you'll be an employee of the county. You won't own the business. So you don't get more than whatever the county decides to pay you, no matter what you generate.

 

[DeadCactus]

I always assumed most democratic groups had a steady flow of non-partners coming and going, i.e. 4-5 partners but another 2-3 physicians on an hourly basis for one reason or another. Is that not accurate? Do most groups consist entirely of partners?

 

[The White Coat Investor]

Our goal when we hire is to make you a partner and have you never leave the group. We traditionally have hired about once every 3 years-basically when people retire. Maybe 1 out of 4 or 5 doesn't make partner. They find out very quickly that their partnership is in trouble. Usual causes are lack of clinical skills or lack of ability to interact appropriately with others. We look at it as our failure for hiring poorly if someone doesn't become partner.

But a group of 4 or 5 having 2-3 pre-partners at one time? That would suggest a ridiculously high turnover. I wouldn't want to be a partner in that group.

 

[Tenk]

If you want to work there: do it. If you don't want to work there: don't do it. Job satisfaction is more important than good benefits and loan repayment. The job is gonna take up almost half your month. Who the hell wants to be unhappy every other day? I go to work every day smiling and leave smiling. It's awesome.

But for a decision now: just sign and don't touch the money until you know for sure. Then you'll have a nice graduation present for yourself July 1st., 2017. Hope it works out for you!

 

[emergentmd]

Pgy-2 here at a three year West Coast ED program.

Family friend who recently was appointed director of a rural ED is in charge of recruiting young docs who are ED trained. Offered $200/hr. Malpractice paid by hospital. Health insurance for family covered by hospital. Basic life and disability insurance paid for as well. $40k/year loan repayment. County hospital so cannot be named in lawsuit (only hospital if I am explaining correctly?) They also have offered a $1000/month stipend until I am out of residency. No contractual obligation I would just have to pay back the stipend in the event that I choose not to work there. Will ultimately be a 4-5 person democratic group. 12 hr shifts. PA coverage 19 hrs/day. Urgent care attached to ED primarily run by Pas/NPs. I think that hits all the high points.

Is this something I should seriously consider? It seems like a good deal from the research that i've done but I would really like some input. Thanks in advance

Seriously. It may sound like a good deal. And Maybe it is. I have had friends go for "its too good of a deal" to come back once they figure out why it was such a good Deal.

IMO, there is rarely a Really good deal. If it is a really good deal, you bet an insider would have the job or a friend of an insider would get a job. There is no reason for a group to track down residents to fill a job.

If the job was really good, there would be attending applying for the job. You are getting this as a resident b/c they could not fill with an attending. Trust me.

I was part of a group that was sought after, in a highly desirable area, pay above market, democratic, good hours, good hospitals. Everyone knew this. Well, try getting into our group required intimate knowledge of our partners. We never advertised a position. We would never even think of interviewing a PGY-2 and on top of that paying them money.

I remember as a med student the Army came to my campus offering the world. Stipend, loan pay back, and on top of that essentially any field I wanted to go into. It sounded great, I passed. Then the ones who did it, was shipped to places they hate doing residencies they did not intend to pick.

Also, how does working a County Hospital precludes you from being sued?

 

[Daiphon]

Also, how does working a County Hospital precludes you from being sued?

Some (at least, if not all) county shops have sovereign immunity as a result of state laws... so if you're sued, short of criminal stuff I believe, "you" as an individual aren't the defendant; but rather the county.

Similar to the VA system.

-d

 

[Old_Mil]

What is the patient volume? Is it a Medicaid expansion state? What is the malpractice climate? Even with sovereign immunity you can get sued it is just less likely...and most instances of sovereign immunity I know of are for state or federal - not county institutions.

If it is a rural ED, I am assuming it is single doc coverage. So a total of 43 hours of coverage. Assuming that is 19 hours of coverage in the ED and not the urgent care. Multiply 43 x 365 to get annual hours of coverage. Divide the annual visit volume by that to get pph which should be no more than 2.0. Yes acep says 2.5 but that is because they have dual loyalties to EPs and CMGs.

Where is the nearest tertiary care hospital? The nearest cath lab? The nearest medivac helicopter? How long are ground transport times to tertiary care? What is the nursing / ancillary staff like? Sometimes bad staff ends up in rural hospitals because they can't find work elsewhere. Check city-data.com for crime and demographics. Things like nearby Indian reservations or meat packing plants will absolutely affect your quality of life at work.

There is a department a few hours from me where 1000 migrants have settled. About 20% of the ED patients are non English speaking and need a translator phone. They can't keep a doc there to save their life.

On paper it sounds like a strong offer. $200 an hour + hospital paid benefits + loan repayment + stipend + sovereign immunity isn't the sort of thing you see in the northwest very often.

If you want to be in that area and find no red flags, I would grab it.

 

[ewokka]

What is the patient volume? Is it a Medicaid expansion state? What is the malpractice climate? Even with sovereign immunity you can get sued it is just less likely...and most instances of sovereign immunity I know of are for state or federal - not county institutions.

If it is a rural ED, I am assuming it is single doc coverage. So a total of 43 hours of coverage. Assuming that is 19 hours of coverage in the ED and not the urgent care. Multiply 43 x 365 to get annual hours of coverage. Divide the annual visit volume by that to get pph which should be no more than 2.0. Yes acep says 2.5 but that is because they have dual loyalties to EPs and CMGs.

Where is the nearest tertiary care hospital? The nearest cath lab? The nearest medivac helicopter? How long are ground transport times to tertiary care? What is the nursing / ancillary staff like? Sometimes bad staff ends up in rural hospitals because they can't find work elsewhere. Check city-data.com for crime and demographics. Things like nearby Indian reservations or meat packing plants will absolutely affect your quality of life at work.

There is a department a few hours from me where 1000 migrants have settled. About 20% of the ED patients are non English speaking and need a translator phone. They can't keep a doc there to save their life.

On paper it sounds like a strong offer. $200 an hour + hospital paid benefits + loan repayment + stipend + sovereign immunity isn't the sort of thing you see in the northwest very often.

If you want to be in that area and find no red flags, I would grab it.

Thanks everyone for the responses thus far. Patient census ~20-30k. Avg 2pph. They aren't strictly recruiting residents because no one wants to work there, the family friend I mentioned agreed to work there only if he could fill the group with physicians of his choice.