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ER Pay - Fair?


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#1 ERCat

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Posted 26 March 2016 - 08:26 AM

New grad in the ER. I've been in it for 4 months. I work in an amazing residency like atmosphere. Docs love to teach. I get to staff all of my patients with them and they give me as much or as little guidance as I need. They trust me and respect me.

Now the cons - the schedule blows (lots of weekends, midday to night shifts, and they work me a ton - amywhere between 180-220 hours a month so far). This is supposedly temporary as they just started hiring PAs and they are waiting to get more and credentialing takes forever. I love every day at work and I love the money (plus I get OVERTIME PAY!) but I do hate having only random week days off as I feel like I never get to see my family and friends as much as I want to. Working weekends AND working noon to 10 or 11pm... Yeah, basically I see no one. They've been good about giving me weekends and days off when I request them, though. Another con is the schedule and policies are constantly changing as we were just bought out by a bigger ER group. My schedule has been 9am-6pm, 11am to 9 pm, 2pm to midnight! 1pm-9pm! Random days! No consistency and I've come through for them with all the last second changes.

The other con - I make 53/hr flat, no bonuses. Yes, I do get overtime pay so those hours over 40/week are paid about 79/hr.

I am starting to question the pay especially in light of how crazy the schedule has been. Most of my new grad friends in AZ are making in the 60s PLUS RVUs (don't know if they get overtime like I do though) and seem to have more predictable schedules rather than all the randomness. However those friends have been thrown in and don't get to staff all their patients with an experienced physician and excellent teacher.

Thoughts?

PS. Bennies (if this makes a difference) - 2500 CME, 100% covered medical and dental and life and disability, 80 hour PTO a year (yes I know... I know... LOL), and a 401K without any match, basically a glorified savings account. Plus free food and drinks all day long!

#2 Boatswain2PA

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Posted 26 March 2016 - 01:03 PM

Pay stinks, benies are blah. But you are 4 months out working in a "residency like" atmosphere....that sounds terrific! You would not be wrong staying there for a while as you gain competence.

#3 AliB

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Posted 26 March 2016 - 01:32 PM

Pay stinks, benies are blah. But you are 4 months out working in a "residency like" atmosphere....that sounds terrific! You would not be wrong staying there for a while as you gain competence.

I agree the benis leave something to be desired (and malpractice coverage, DEA / licensing, professional memberships aren't even mentioned), but why do you say the pay stinks?  

 

Using a base of 2080 hours in a work-year, less 80 hours for 10 days of holiday pay (a presumption I'm making that may or may not be accurate!), less 80 hours PTO (and is this also CME time? which would be another strike against the benis), leaves 1920 hours.  1920 * $53/hr = $101,760 annual.  Isn't that a decent base salary for a new grad?


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#4 loliz

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Posted 26 March 2016 - 02:41 PM

I agree the benis leave something to be desired (and malpractice coverage, DEA / licensing, professional memberships aren't even mentioned), but why do you say the pay stinks?  

 

Using a base of 2080 hours in a work-year, less 80 hours for 10 days of holiday pay (a presumption I'm making that may or may not be accurate!), less 80 hours PTO (and is this also CME time? which would be another strike against the benis), leaves 1920 hours.  1920 * $53/hr = $101,760 annual.  Isn't that a decent base salary for a new grad?

 

 

I agree. Since the time off is paid at the same rate, it's actually a base of $110K. This is fine for a new grad, in fact it is very good, although you need way more PTO. 

Your friends in AZ that are making "60 plus RVUs" are probably not getting any benefits.... or this is a misunderstanding and they are getting $60K/year base plus RVUs, not hourly. 



#5 Paula

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Posted 26 March 2016 - 03:10 PM

ERCat:  You are in a sweet situation since you are getting good mentoring.  It will prepare you for future jobs, treat this one as a residency and a well paid one at that.  The sacrifice is your personal time, but for a year, it may be worth it.  Do you have family, kids, spouse, elderly parents you are caring for?  IF not, and you are single, then go with the flow and learn as much as possible.

 

Then take your ER CAQ, keep track of all procedures you do, too and keep in a file.

 

Keep in mind the new ER group may or may not be agreeable to any further changes to your compensation or benefits and could downsize them as well.

 

In the end you will ultimately benefit....albeit you will be very tired by the end of your first year.  


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#6 ajnelson

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Posted 26 March 2016 - 04:27 PM

Having just left AZ, I'm pretty sure your friends are getting no benefits. A (very) large majority of the jobs are 1099/independent contractor positions. And in these positions, there is NO overtime. You get paid the same flat rate no matter what.
Your best first job is where you are going to learn the most. And it sounds like you have a great opportunity there.
As far as hours, the shifts you describe are what we end up working in the ER. Most docs have similar schedules as well. About the only way you can get a schedule that isn't bouncing all over is to work straight nights (this is seen as a less desirable shift, and is usually easier to be able to take all the shifts without someone complaining). But, you'll always have to cover holidays and weekends.
If you are working 180-220 hours a month, maybe the first place to take a step back is there. Give yourself one full weekend off a month (at least). Don't burn yourself out at your first job. Find a good balance between your family and your job.


#7 ERCat

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Posted 26 March 2016 - 05:20 PM

Thanks for the feedback. I was never dissatisfied with the pay, but I've had a few providers telling me I get paid way less than other ER PAs, even new grads so I wanted to get a better understanding. Most of our providers left BECAUSE of the pay.

Well - two of my new grad friends work for 65 an hour, plus full benefits and RVUs. Another new grad friend made 65/hour without benefits but pulled in a sick amount of RVUs and made 170K first year out of school. Finally the other new grad I am friends with makes 100/hr without benefits as an independent contractor (!!!!) at a very rural site. And lastly at another ER in my town they are independent contractors and make 95/Hr.

I am happy where I am at now. I am learning a lot. Just want to keep my mind open for future negotiations. Thank you guys for the different perspective; I feel much better!!! I've always been happy but I've been listening to the above people who say I am underpaid.

PS I do get my malpractice covered (and tail).DEA and license was covered. NO time is paid for CME OR holidays. I simply get 80 hours PTO a year.

#8 ventana

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Posted 26 March 2016 - 07:07 PM

work it for a year

learn like a sponge

 

then move on

 

demand a reasonable schedule in your first you - no point in sacrificing yourself, or setting up the next PA's to be schlep that gets all the crappy shifts dumped on them

 

I think a VERY reasonable comparison is to compare to the doc schedules..... doesn't have to be the same, but if they work 1:4 weekends you should too...


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#9 jen0508

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Posted 27 March 2016 - 05:26 AM

Pay is pretty low for EM especially if your not getting bonuses. I started at 60/hr + bennies + 15-20k bonus per yr. However pay depends on where you live so if your in a very PA-saturated area then 53/hr might be average there for EM. But It sounds like your PA friends are making more than that so it sounds like you are under paid....

The hours you are working are insane for EM. My fulltime job is 150 hours per month (salaried :-) )...I do 1-2 moonlighting shifts a month... so Im at 160-170 and Im exhausted! EM is draining and working 180-220 hrs a month will burn you out fast.... slow down!

I'm off 3-4 days a week....THATS what makes the irregular hours/working weekends worth it....and thats why the majority of us EM folk put up with working nights/weekends

However... If I were you I would stick around for 2yrs to get EM experience and then move on..
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#10 ERCat

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Posted 27 March 2016 - 06:20 AM

Right. For now it's amazing because the docs are excited about having me, many of them say "It's gonna be a good day because you're here today!" and want to teach me things. They'll be like, "Hey, I am doing an LP... Want to help?" Or "Go look at the stroke patient in room 19; do a neuro exam and you'll learn a lot." Couldn't really ask for a better environment so for now I am willing to take a "cut" in pay for that.
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#11 Eastcoast PA-C

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Posted 27 March 2016 - 12:03 PM

I'm in a similar situation but about a year ahead of you. You can't put a price on the training aspect. That right there is worth putting up with everything else (you would be paid half as much in any official PA EM residency and work just as much). But after a year or 2, it's up to them to respect what they've taught you and what they've made you capable of. Pretty soon you will be hugely marketable for jobs with better pay and hours--don't be afraid to take advantage of that.


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#12 Boatswain2PA

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Posted 27 March 2016 - 02:18 PM

I agree the benis leave something to be desired (and malpractice coverage, DEA / licensing, professional memberships aren't even mentioned), but why do you say the pay stinks?  

 

Using a base of 2080 hours in a work-year, less 80 hours for 10 days of holiday pay (a presumption I'm making that may or may not be accurate!), less 80 hours PTO (and is this also CME time? which would be another strike against the benis), leaves 1920 hours.  1920 * $53/hr = $101,760 annual.  Isn't that a decent base salary for a new grad?

An easier way to generally figure annual salary from hourly salary (w/40 hrs/wk) is double it and add a thousand.  $50/hour = $100K/year.  $80/hr = $160K/year.  

For meat-grinder ED positions (which this one sounds like it is) the pay sounds low.  I'm in a relatively saturated area and the ED pay is $70/hr, and the EM pay in this area is going up fairly quickly.  Of course, it's all relative to location.  



#13 EMEDPA

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Posted 27 March 2016 - 06:43 PM

west coast ED pay typically is less than this. 50-65/hr is fairly common. to get more than this you need to be in a busy urban practice or very experienced and working solo. the best position I know of pays 80/hr for solo coverage, suburban practice.


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#14 Michaelcohn

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Posted 27 March 2016 - 09:33 PM

west coast ED pay typically is less than this. 50-65/hr is fairly common. to get more than this you need to be in a busy urban practice or very experienced and working solo. the best position I know of pays 80/hr for solo coverage, suburban practice.

 

Interesting that even with all your years of experience the highest you have seen is 80, while ERcat has new grad friends making 95 and 100/hr...do salaries really vary that widely?



#15 ajnelson

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Posted 27 March 2016 - 09:59 PM

Interesting that even with all your years of experience the highest you have seen is 80, while ERcat has new grad friends making 95 and 100/hr...do salaries really vary that widely?


There is a lot that goes into pay/salary, especially in the ED. Location is huge. As is responsibility at your work location (solo vs fast track). The other thing is many ED jobs (in my experience) are 1099/independent contractor positions, and comparing that salary to an employer based position with full benefits, you are going to see a huge difference in pay. I'm salaried at this point, with full benefits. My hourly works out to $65ish an hour I believe. I've had other fully benefited positions at about the same pay. I've also had IC positions paying anywhere from $60/hr +RVU to $100/hr.


#16 EMEDPA

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Posted 27 March 2016 - 11:58 PM

1099 positions are essentially unheard of out here. all my per diem positions are employee status hourly + malpractice and they take out social security, taxes, etc. some do minimal stuff for me like state license, etc

my primary job has a full benefits package.

I currently am privileged at 6 facilities. pay as follows:

55/hr + production of approx. 10/hr

60/hr + production of approx. 10-20/hr

65/hr

70/hr

73/hr

80/hr

 

top 2 jobs are the full time job and also have a full benefits package. those rates include night differentials. days(which I rarely do) are 10/hr less


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#17 HJK

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Posted 29 March 2016 - 12:31 AM

1099 positions are essentially unheard of out here. all my per diem positions are employee status hourly + malpractice and they take out social security, taxes, etc. some do minimal stuff for me like state license, etc
my primary job has a full benefits package.
I currently am privileged at 6 facilities. pay as follows:
55/hr + production of approx. 10/hr
60/hr + production of approx. 10-20/hr
65/hr
70/hr
73/hr
80/hr

top 2 jobs are the full time job and also have a full benefits package. those rates include night differentials. days(which I rarely do) are 10/hr less


What's your benefit package like?
Mine.
$2k cme including fees
4 weeks off vaca and sick
Health paid for family but high deductible
Dental additional around $80s for family
Malpractice with tails.

If theses are generally same for PAs and NPs, is there room for negotiations? 2 year mark coming soon. Don't think I have much room for hourly increase.

Thanks.
PA-C

#18 EMEDPA

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Posted 29 March 2016 - 03:13 PM

What's your benefit package like?
Mine.
$2k cme including fees
4 weeks off vaca and sick
Health paid for family but high deductible
Dental additional around $80s for family
Malpractice with tails.

If theses are generally same for PAs and NPs, is there room for negotiations? 2 year mark coming soon. Don't think I have much room for hourly increase.

Thanks.

2 K CME

2 WEEKS VACATION. NO SICK.

ALL MEDICAL/DENTAL/VISION FOR ME AND FAMILY, HIGH DEDUCTIBLE, BUT HSA TO COVER

LIFE INSURANCE

LONG AND SHORT TERM DISABILITY

RETIREMENT = 25% OF GROSS YEARLY EARNINGS

MALPRACTICE

STATE LICENSE AND DEA

AAPA DUES

ACLS/PALS/FCCS/CPR FREE AT PRIMARY FACILITY

ALL OF THE ABOVE FOR MIN 80 HRS/MO AFTER 10 YEARS. FIRST 10 YEARS REQUIRED TO DO MIN 112 HRS/MO


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#19 Matt82

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Posted 16 January 2017 - 01:47 AM

I'm coming late to this thread, but welcome input if anyone feels up to it.

I'm almost into my 5th year as a PA and am just about done with my 1st year in the ED.

Love the ED work. Love the Docs I work with. Love how much I am learning with this job.

Don't love the travel as I go between 3 different locations [get mileage paid], and don't love the late shifts without differential.

Felt like they started me out low on the salary but I was eager for this learning opportunity, so all I negotiated on the contract was a higher CME allowance so that it was on par with what I had with my old job. I did not realize this department would not compensate CME time, old job did.

There was no "easing into" the job, it was pretty much full throttle as best I could from Day 1.

Reviewed AAPA's Salary Report which had some helpful info but interested in specific feedback:

I'm salaried, and we average 144 per month hours.
No vacation/PTO/sick time. No CME paid time off.
I do have: CME money per year, health insurance, paid malpractice, malpractice insurance, DEA, State license, Short term disability, 401K match which is good.
Salaried at 91.5K. No RVUs.


Reading the prior threads makes me think this is pretty low on the salary point, but when I calculate $ per hour worked [say 145 hours/month] it's in the 50's which does not seem too bad.

Interested in approaching "higher up" about this, but want to be well rounded in my though process before asking for increased compensation and asking for PTO.

Thanks in advanced for any feedback.
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#20 ERCat

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Posted 17 January 2017 - 04:12 AM

Matt82 - I think that's super low!

I should have updated this thread. Less than a year after posting this, same job but got a raise and am glad I stuck it out. Still love the job! I am now making a lot more... about 145K a year base, 15K admin time and around 20K bonus SO up to 180K now!




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