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RVUs, independent contractor and benefits oh my! Help!


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Ok guys...I have a dilemma and am in desperate need of advice from the wise/more experienced folks on here.

 

Briefly, I am a PA with over 3 years EM experience in a very busy teaching ED. Now looking to move. I interviewed with five ED groups and have had three offers. The trick is..I am currently salaried and an employee of the hospital system so being employed by these "groups" or as an independent contractor is a bit different. That's where you experts come in! Help!!

 

OPTION ONE:

Pros: $67/hr plus RVU, shift differential, group covers all benefits including $3000 CME, DEA, license and $5000 for relocation.

Cons: bit of a commute (45 min), have to present all Pts, rotating between two hospitals and sort of nasty shifts.

 

OPTION TWO:

Pros: no nights, $70/hr plus RVU, holiday differential, block scheduling, group covers benefits ($2000 CME)

Cons: seeing only fast track patients, heavy PEDI shift, rotating through three sites.

 

OPTION THREE:

Pros: location, shift differential, group covers malpractice, no nights, have most autonomy

Cons: independent contractor (con??), no CME, no benefits, $35/hr plus RVU and a bonus pay (they say you average between $90-$100) and they give you a stipend to ?cover extra costs...fishy?

 

I need help understanding this RVU business. Who pays that out...insurance? Group? Hospital? Should I be cautious of independent contractor stuff? Pros and cons to these things? Advice??

 

Thank you all!!

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First of all independent contractors is crazy business especially at 35/hr. You have to ask them who pays the taxes. If it is you then it is even less. I wouldnt do it for 35/hr.

Where are you located? 70/hr is awesome. I havent seen such figure even for the ED unless crazy hours or location.

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Option 3 is a bare hook awaiting the bait that you supply. It means there is direct incentive to see as many as possible, likely provide substandard care and a tendency to over document to overbill. It is a shop to move the meat.

 

Other 2 options seem reasonable and you will have to take a look at your own situation. Cant do an apple to apples compare because you left some stuff out in each.

 

As for RVU, google this:

The Nuts and Bolts of RVUs and Reimbursement

First thing that should pop up is an ACEP video that does a good job outlining RVUs.

 

Something to consider that you may not have. You will be moving from one system of practicing EM to another. They can be very different, moving from a large employer and academic medicine to a smaller employer whose focus is the business of medicine. It can be a tough world you are entering with entirely different expectations and standards.

 

Good luck

G Brothers PA-C

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I like #1.  Once they get to know you, the presentations will decrease to so brief that you could barely notice, and you can always work on a shift schedule over time.   It seems like relocation closer would also be possible.    Everything is negotiable over time once they like you, and the benefits and salary certainly seems okay.  

 

Independent contractor is a  buried bomb waiting to go off.    It may never but you will sleep less well at night.   Potential problems with Medicare,  fraud you cannot control,  IRS, social security,  and more.  Situations can arise years after the fact.    Can be done but........

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I can't thank you all enough! I agree, transitioning from the big teaching hospital system to a smaller "business driven" group will be eye opening.

 

As a new grad I didn't have many options or room to negotiate so I am in new territory, I really appreciate all of the advice. Keep it coming!!!

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