oncology pay raise

[Scuba8783]

I have worked as a PA for 6 years.  4 years in family medicine and the last 2 in oncology office setting.  I do rounds at hospital only about 3-4 weekends per year.  I am rarely on call to take patient's calls, but even when I am on call I rarely get any calls.  Office hours are 9-5, but we often start seeing patents at 8:30 or 8:45.  When we are busy, we are frequently double booked and have patients booked at lunch time.  I am responsible for preparing all notes the day before and hunting down test results and getting pathology etc.  We have nurses at office, but not a nurse that is just for my or my physician.  I often have to call patients with test results and put orders in and fill out all the paperwork.  Compared to family medicine, we have much more paperwork and test results to go over.  Rarely are tests ever "normal."  I feel like I do a lot of work that a nurse would typically do on top of seeing a full day of patients.  I live in Florida, so in season we are very busy.  I often work until 7:30 or 8 at night catching up on charts, etc.  I started at 85k.  I have benefits, but I pay for a portion of health insurance.  I have 22 days off for PTO and only get 3 days off for CME with $500 towards CME costs.  Last year i was given only a 1k raise.  I was mad about it, but let it go because I was too stressed about other issues going on with my family.  This year she was going to give me $1,500 raise.  I believe I was started at a low pay, especially for the hours I work and the fact that I work occasional weekends.  She started me low because "I have no oncology experience."  Now that I have worked there for 2 years I feel I should be paid a fair salary.  The statistics I have seen show that oncology PAs make an average 98k.  

 

She hired another PA 1 year ago.  This did not really help my work load.  The physician's work load has gone down, but now we have much more to do.  I found out the other PA gets paid 90k.  The other PA negotiated to work 8:30-4:30 and to not do any work from home.  She also does not work weekends or take call.  She graduated a year after me.  I do much more work than her.  Not only do I work a lot more hours, I am much quicker to see patients and usually see many more than her.  

 

Obviously, I cannot tell the physician that I know what other PA gets paid.  She tells me a 3% raise is only for outstanding work PLUS increased duties.  A 3% raise is like $2,583.  She finally agreed to give me $2,500, which would bring me to 89k.  This is still less than other PA!!  The other PA will be due for a raise at end of month.  She said to continue to get such a "good raise" of $2,500 I would need to start seeing more patients.  She does not believe the statistics showing 98k as average salary.  She said that HR disagrees with that statistic.  She said that the nurse practitioners do get paid a little better "because they have more experience."  I am so angered by this.  I am a very good and reliable employee.  I'm not sure what to do.

[Soulfari]

This sounds miserable. I've heard of private derm practices in South Florida, specializing in Mohs surgery (6-10 cases/day), who pickup "fresh grads" for ~60k/yr and the private FL PA program grads jump on the opportunities because "they just want to work in derm so bad".  :\

 

Your description of your workload and duties in a specialized area such as oncology deserves more than 90k, in my opinion. 

[Derbingle]

Now that you have onc experience, job hunt. 11 hours a day five days, you might as well do surgery and get paid more. Unless you love onc.

[Scuba8783]

I only work 11 hours a day during season only.  Right now I am usually done by 5 or 5:30.  On Fridays the doctor is not here and I am always done by 5.  So the 11 hours a day is for 4 days a week for about 6 months out of the year. 

 

On a side note, on Fridays we do not see many patients.  We mostly catch up on all the paperwork and preparing for the following week. Even though I could do a lot of this work from home I am expected to sit here until 5, even if last patient is at 2.

 

I do like working in oncology.  It would be hard for me to find another oncology job in this area.  I work at a very large oncology practice and they are really the only ones around here.  I could possibly switch to radiation oncology, but that would be my only option as far as staying in oncology. 

 

I may just consider moving, although I do not want to.

[db_pavnp]

I am not a PA/NP, but in my experience you generally cannot negotiate with an employer you are working for without an offer in your back pocket once you have been denied a request.  You must get an offer for another job and, if you want, give your current employer your demands.  They can take it or leave it.  Providing statistics does not work.

[EMEDPA]

several problems here obviously. she thinks you are not as good as an NP and she is not paying you what you are worth.if there are no patients after 2 and you are done with your charts you should be able to leave because you are salary and stay late on occasion without extra pay.  find a new potential job, get an offer, allow her to beat it and if she can't, leave.

[gbrothers98]

I only work 11 hours a day during season only.  Right now I am usually done by 5 or 5:30.  On Fridays the doctor is not here and I am always done by 5.  So the 11 hours a day is for 4 days a week for about 6 months out of the year. 

 

On a side note, on Fridays we do not see many patients.  We mostly catch up on all the paperwork and preparing for the following week. Even though I could do a lot of this work from home I am expected to sit here until 5, even if last patient is at 2.

 

I do like working in oncology.  It would be hard for me to find another oncology job in this area.  I work at a very large oncology practice and they are really the only ones around here.  I could possibly switch to radiation oncology, but that would be my only option as far as staying in oncology. 

 

I may just consider moving, although I do not want to.

From both the original post and this one, several points to make:

1. AAPA salary survey for IM:Oncology, <4 yrs experience without bonus, 85k for 50th%, 90k for 75th%

2. Same survey, Florida PA with 5-9 yrs experience, 90k for 50th%, 100k for 75th %

3. If your oncology gig is the only oncology practice in the area, they can for a period of time set salary levels until providers leave and the incoming providers wont accept their salary levels and negotiate higher.

4. Many employers, not only in healthcare, will pigeonhole an employee, both in job position and in salary. At times the only way to change this is to seek employment elsewhere. Pay will increase, responsibilities can improve, job conditions can improve. 

5. This kind of treatment and what you are paid does not reflect an understanding nor appreciation of what you do. It is likely this will not change.

6. The responses you are getting re not believing salary survey, NPs have more experience, etc, are all techniques managers use to deflect the real issue. You become tongue tied because statements such as these are so subjective and without insight nor depth that they shock one into silence. Or you have successfully held back your response of Bullsh&t!!

 

You can try to negotiate a better deal but it seems they have offered you their deal and that is that. You can accept and try again next year. This will be it for them/her.

 

The only way you will get what you want is when you walk into the office and give your notice.

 

I would seriously consider this. Line up other employment. You sound like you are a good catch. If you have geographic flexibility, start looking, there is a lot of opportunity out there. The PA world is littered with people whom have the same story as you. Worked hard, not appreciated, couldnt get appreciated when they asked. Stayed and are miserable. Left and found something new, different, better.

 

In your original post, you outlined your benefits, what you listed for time off and CME fund and time really suck, period. You can get better. Cost sharing on health insurance is hard to avoid but your cost sharing at this practice can be a benchmark for other offers. 

 

Good luck.

G Brothers PA-C

 

PS the best feeling in the world is when the employer you are leaving says they want to keep you, what do you want? Dont fall for this. Smile and tell them you have enjoyed your time there, learned a lot but you need a change and wish them well. If you do not have a contract in place or agreement about notice to leave, I would give them the shortest amount of time YOU need. Dont forget to take a week or 2 off between jobs. You wont wish you worked more on the day you die.

[EMEDPA]

agree with above. I have left several jobs where I was treated poorly or paid less than fair market value.

money isn't everything however- I have also stayed at (or transitioned to) great jobs that paid less- but poor pay and a poor work environment is a no go.

[Scuba8783]

The statistics I showed her were from Advance. Those showed both PA and NP salaries. Actually PA salaries were slightly higher. I think we should be paid the same since we do the exact same work at my office. I didn't have access to the AAPA salary report, but thanks for the information. I told her I would be happy at 95k. That was less than the 98k that was listed. She said I was being unrealistic. I think since I work at least 8 hours per week more than other PA (during season) and do weekends occasionally, I should be paid at least 5k more than other PA. Under no circumstance should I be paid less. The other PA happens to be married to a general surgeon. I suspect that is why she is paid more. Sometimes he refers us patients.

 

I am currently 24 weeks pregnant. She even made a quick comment about how I would not even be here for a lot of the upcoming season due to maternity leave. As if that would be a reason I would not get a better raise?? I think I will take the whole 12 weeks off for maternity leave and see what options I have in area. I am in no position to leave at this time though.

 

Thanks for all the advice.

[winterallsummer]

Look what's out there and do some interviews. It will put things in perspective for you and make your decision much easier to make, whether you choose to stay or go.

[rev ronin]

I am currently 24 weeks pregnant. She even made a quick comment about how I would not even be here for a lot of the upcoming season due to maternity leave. As if that would be a reason I would not get a better raise?? I think I will take the whole 12 weeks off for maternity leave and see what options I have in area. I am in no position to leave at this time though.

Talk to an employment law lawyer.

[Scuba8783]

Well, she spoke with me for the third time.  She said she thought about it more and wants me to be happy.  She likes the 3 of us working together because we are all close in age and will have children close in age.  She says she wants to pay me what is fair and "a little above" what average pay is.  HR tells her the average PA at our company gets paid 90k and has 5 years of experience.  HR says 88k is a fair pay for me.  I know that the hospital PAs make 92-97k and they only work 5 days a week.  In my opinion they have a lighter workload than the office PAs.  The NP that I know that worked in the office was getting 97k.  

 

When we talked she agreed to pay me 91k.  So, I was able to get a 4.5k raise out of her.  Better than the initial 1.5 she wanted to give me.  I am not thrilled about it, but I guess it's better than that 89 she was going to give me a couple days ago.  I would probably be fine with it if I didn't know that the other PA we work with already gets 90k and that she will be due for a raise in a couple weeks.  So, she will still be making more than me and working a lot less hours.  

[FSUnoles]

ive been trying to get my employer to move my pay up as well. Florida is notoriously horrible for PA salaries. (its pretty rough for all sectors, SO is a Nurse and her pay is lower on avg as well)

 

Everyone i know out of the state of Florida is making 20k more

 

The best thing you can do if you live in Florida is get out

 

to give you some perspective im not even a year out making 82k. no call. no weekends. 8-5 and this is academics which pay is lower

 

but my job responsibilities are similar to you in the ca setting. I handle all my docs labs and imaging and path

[Scuba8783]

I know Florida is not the best state to work in as a PA.  Florida is not a good state for nearly all professions.  I used to work in Illinois.  Started at 65 and was up to 85 after 2 years.  I hated living in southern Illinois.  I am originally from Chicago suburbs.  I love where I live now.  It's beautiful here and I love the weather.  We built a house and got a great deal.  It would take a lot for me to move back to Illinois or any other part of the country.  I know I would never want to live in a small town again.  I really don't think I would really want to have to deal with winters again.  I am not tied down to living here and have no problem moving again, but I'm not going to move somewhere and hate it just so I can make an extra 10k.  I'm sure other parts of the country are just as nice as where I am at, but I'd have to really start exploring my options.  If my husband were to find some amazing job somewhere else I would be willing to move.  It's easier for me to find work than him.  He is an attorney and has an okay job that pays very bad.  However, as an attorney he would need to take another states bar exam in order to move out of state.  

[Guest Paula]

If you take the last offer do NOT work at home for free.  The other PA negotiated to not work after 4:30.  Why would you?  It sounds to me you are doing a lot of paper work and are very conscientious, maybe to a fault in that the physician now expects you to work late at home, etc. 

 

How much of your services are billable?  Are you seeing patients on a regular basis and do you and the other PA see the same number of patients?  Ask the physician to see your production and reimbursement statistics. 

[JohnnyM2]

If you really like where you live and if you want to stay in that job, you may not be able to get more this round. It sounds like your employer came up quite a bit from the original increase. One possibility is to take her offer, graciously of course, and shoot for another big bump next year.

 

Heck, we would all like to get paid more but lifestyle matters, as you have indicated. One thing puzzles me. You say that you "obviously" can't let your employer know that you are aware of what a colleague makes but she has told you she really likes that you are all friends. What? She thinks you don't talk and compare notes?

 

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[Scuba8783]

Well, the other PA did not tell me her salary and I doubt she would if I asked her.  I work at the physician's desk on Fridays and she left out paperwork from HR on the other PA.  I saw her salary there.  So, I don't have a good reason to explain why I know her salary.  I don't want people think I'm "snooping" around.  I wouldn't say we are all friends.  We get along well at work.  I am more friendly with the PA. We don't hang out after work.

 

This practice is very odd.  The 3 of us share one schedule.  For the most part me and the other PA see every other patient.  The physician usually "stops in" and see the patient after us.  She does't do this with all patients, but probably 75% of them.  For the most part she is quickly in and out unless a major change in treatment or symptoms.  Me and the PA write all the notes, put orders in, make calls, etc.  The physician makes all the chemo change decisions and is the one that calls all the physicians that are also treating the patient (radiation, surgery, etc).  On Fridays she is not there, so we obviously see those patients alone.  I known most PAs would probably not like this set up at all.  Oncology is much different than most other specialties.  In family medicine I saw my own patients and never interacted with the physician.  Anyways, it is very difficult to track how much money I bring in or how many patients I see.  Everything is billed under the physician. 

 

They problem with not doing work at home or not working late is that the work has to get done eventually.  I don't have the luxury of a contract that says I only work set hours.  I'm really surprised that she let this other girl have a contract like that.  I think she wanted me to be the main PA and the other girl to be there to just help.  That would be fine, but its not fine to pay her more!!  She knew this PA outside of work because her husband is a general surgeon.  I really think thats why she gets such a good deal and better pay.  I guess life isn't always fair, but I can't help but be mad about it.

[JohnnyM2]

She knew this PA outside of work because her husband is a general surgeon. I really think thats why she gets such a good deal and better pay.

That figures, and welcome to the world of political favoritism. Anyway, you did negotiate a decent increase. Look, it's not fair and it may never be fair. Your choices are to get out or stay there and make the best of it. I never recommend to people that they just quit because I don't know the ENTIRE situation. There seem to be things about this job that work for you and you can work to improve the pay some more next year. But, if you just can't live with it, maybe you need to start looking.

 

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[Guest Paula]

Your practice is likely billing incident-to since the physician sticks her head in the door of the patient so the practice can bill 100% of the fee.  Just make sure on Fridays your services are not billed incident-to.  The physician needs to be there and see the patient (I think I have that correct in the interpretation of incident-to billing).

 

You need to know if billing is done correctly for medicare purposes and to follow the law.  Fraud can be unintended but we still are liable if audited.  

[JohnnyM2]

Services provided in offices and clinics may be billed under Medicare’s “incident-to” provision, as long as Medicare’s more restrictive billing guidelines are met. This provision allows payment at 100 percent of the fee schedule if:

 

1. The physician is physically onsite when the PA provides care;

 

2. The physician personally treats and establishes the diagnosis for Medicare patients on their first visit for a particular medical problem (PAs may provide the subsequent care); and

 

3. Established Medicare patients with new medical problems are personally treated and diagnosed by the physician (PAs may provide the subsequent care).

 

- See more at: http://www.physicianspractice.com/blog/understanding-physician-assistant-reimbursement#sthash.O8k6Gbdg.dpuf

 

So, on Fridays, billing should be under your NPI instead of the physician's and the practice would then be reimbursed at 85%. It seems to me, though, that if you are a W-2 employee and are not involved in the practice's Medicare billing AND are unaware of how your services are being billed,, you would not be liable for any inappropriate billings. Not sure about that, however.

 

It is interesting, never-the-less that by structuring the practice so that your billings are incident-to, at least four days per week, the practice could be reimbursed at 100% of the md reimbursement schedule. Our medical reimbursement rules are full of such perverse incentives, and then we wonder why people look to find ways around the rules.

 

Sorry if this digression has given you something new to be concerned about because it doesn't really help you with your original concern about fair pay.

 

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[Guest Paula]

^^^^  I actually believe we are liable even if we are unaware of the billing practices.  There was a case in Michigan where the PAs services were being charged wrong and she ended up being liable, with sanctions, even tho she was unaware.  There was an article in our newsletter about it and she was a speaker at a conference (I was not able to go so don't know the details.).  I might be able to find it and make sure I remember right.  

 

Sorry for the digression, too.   I hope this all works out for the OP. 

[JohnnyM2]

^^^^ I actually believe we are liable even if we are unaware of the billing practices. There was a case in Michigan where the PAs services were being charged wrong and she ended up being liable, with sanctions, even tho she was unaware. There was an article in our newsletter about it and she was a speaker at a conference (I was not able to go so don't know the details.). I might be able to find it and make sure I remember right.

 

Sorry for the digression, too. I hope this all works out for the OP.

Man, that really sucks! Not fair at all, but it wouldn't surprise me if Paula is right.

 

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