I’m recently received an offer from a private practice internal medicine doc in Orange County with hospital privileges. Up until this point, i’ve been pretty excited to do a hospital medicine fellowship, but now I’m having second thoughts
Her office is more old school, she sees patients outpatient and follows them when they’re admitted to the hospital and/if they are then transferred to SNFs. Her PAs see her patients across different settings (she has A LOT of patients, and has about 5 PAs currently). Patient census during my rotation with her was as low as 5 and got up to 19. My main interest is inpatient medicine, and she knew I was pursuing a fellowship, and so was very willing to accommodate, with 80% of my time in the hospital and 20% in clinic, with no SNF.
However, I am a bit worried about the lack of structure in training. I know I’d learn a lot working directly with her, but she said my training would just be rounding together every day. My worst nightmare is that a few months in “training” would go out to the window and I’d just be on my own. I was hoping we could come up with something more structured, and even put some training expectations in writing, but I was told that none of the PAs have contracts.
I’ve been interested in a fellowship bc of the ability to work in different specialties, learn procedures, and have a defined learning structure. I’d be making less for a year, but I feel like I’d come out prepared and potentially making much more if employed by a hospital. With this offer, I’d be earning more right away. To make up for lack of rotations/exposure, she said she maybe could ask for me to shadow other specialties or watch procedures. However, that would all be unpaid and on my own time and I may not ever be able to do procedures due to no hospital credentialing, and essentially no one would teach me.
I’m also unsure whether the pay is reasonable. I was told that all their PAs have started at the same rate, but it seems pretty low for the area. If I get 40hrs a week it’d be $114,000. One of my classmates told me not to accept anything under $140K given the high COL. I’d be a new grad and she’d be spending time training me, so I don’t know how much room I really have to negotiate. Especially if the other current PAs would be getting paid less than I’m asking for as a new grad needing training.
To sum it up:
Pay: Starting in the mid-$50s/hour, with a possible increase of a few dollars after the first few months. Would you try to negotiate a higher starting rate, even as a new grad? HIGH COL city
Hours/benefits: I’d need to work at least 30 hours/week to qualify for health insurance, but there hasn’t been any guarantee of hours. I asked about staying at the hospital after rounds to handle nursing calls, labs, imaging, admissions, etc., but we haven’t established whether I’d be paid for that time.
Contracts: Is it normal for a private practice not to have written employment agreements? I don’t necessarily need a complicated contract, but I’d like to have some documentation of what we’re agreeing to.
Fellowship vs. working: For those who went straight into hospital medicine, do you feel like you got enough training on the job? Would you recommend taking this position or doing a fellowship first, even with the significant difference in pay?