PAS2014 Posted September 12, 2016 Share Posted September 12, 2016 Hey all, I have been beating the street out here after graduating, as my area of the country is still very PA naive. I am less interested in what specialty I go into right now, as I am in getting the best training and experience possible, while also working in a solid PA friendly environment to start my career. There are WAY MORE unfriendly PA environments in my area, so finding one has been a challenge. Here are two. Tear em' up! HOSPITALIST Rural Kansas regional hospital (250,000 catchment) 2.5 hours from home (so I'd be living in two places at once - husband cannot currently move for work under any circumstance) Team of 4 doctors Patients per day: 12-14 7on/7off schedule, day shift 3 weeks of accrued PTO 1 week CME PTO $88,200 salary (after one round of negotiation) $3000 CME $10,800 student loan repayment ONLY if I sign 3 year contract $3000 relocation No sign on bonuses No production bonuses or RVUs (only doctors are eligible for these) Paid malpractice, DEA, license fees Health/dental/vision benefits eligible after 30 days of hire 3% 401k match available after 1 year of service No additional profit sharing I am replacing a PA who left due to not feeling her license was utilized to it's fullest extent, nor feeling compensated fairly. At least they are honest about that! They said they are making changes to how they utilize PAs... FORENSIC PSYCHIATRY Suburban Missouri inpatient facility Government job 1 hour away, begrudgingly commutable :) Team of 4 psychiatrists, one part-time IM doc (2 days/week) 200 patients total M-F 8AM-4:30PM 3 weeks accrued PTO 1 week CME $110,000 salary (before any negotiation) $3000 CME No sign on bonus No production incentive No call to start, HOWEVER when I'm eligible for call, it's PAID! Paid malpractice, DEA, licensing Requires Psychiatry CAQ after 1 year Deferred compensation plan, 403b, ROTH options all eligible after 30 days Pension plan, vested after 10 years of service Government health/dental/vision eligible after 30 days. BONUS: None of the psychs want anything to do with general medicine anymore, and there is one IM doc that rounds 2x/week for half a day. SO, they are excited to let me manage all the comorbidities or urgent care cases on site when IM doc isn't there. Pharmacy on site, and pharmacists would help with medication questions or titrations, etc. I would have IM doc on call for questions if necessary, as well as the 4 on-site psychiatrists for back up. I am having this responsibility WRITTEN out in my contract when the time comes. I am replacing the happiest PMHNP on the planet. He started as a new grad in this position as well, and is moving into an administrative role. I would be the utility worker (ie help cover patients on all units of the hospital, not just the step downs or less-severe patients). He agreed to stay on part-time for 3-4 months to assist me in the transition. Current NP made the following as starting compensation: $115,000/yr + $25,000 loan repayment/yr for 2 year contract (state paid, not NHSC). My student loan repayment is pending. I called the state and they said that PAs are not eligible for loan repayment... only doctors, dentists, NPs and RNs. Yes folks, THIS is the state in which I live. The medical director is trying to fight for something for me. I'm prepared to ask for higher salary ESPECIALLY since it's likely I won't get SLR and I'm going to be the general medical provider 3 days/week (NP did not have this role)! I feel like the choice is an obvious one, but I'm interested in your thoughts. Any good ideas for countering? Glaring red flags? Thank you! Link to comment Share on other sites More sharing options...
NYCPAC Posted September 12, 2016 Share Posted September 12, 2016 Sounds like you want the psych job. Sounds like a solid gig, but I feel hesitant about that mandatory caq portion. Unless you plan on working in psych your entire career I wouldn't take it. And if you do, ask for a raise when you pass it. If they are unwilling to allow you to be eligible for loan repayment ask for the $25k to be included in your salary (although now it becomes taxable). Or a quarterly bonus! Good luck with your decision! Sent from my iPhone using Tapatalk Link to comment Share on other sites More sharing options...
PAS2014 Posted September 12, 2016 Author Share Posted September 12, 2016 Thank you @NYCPAC for your response! My background is in psych (BA Psychology, Mental Health Specialist in the Army). I enjoy psych, and especially forensic patients. However, NO I did not expect to spend my career in psychiatry when I started PA school. It's a critically low provider specialty, though, so I know my job prospects may be good in the future. This particular hospital does not have credentialing for surgical services, but I know there are some psych hospitals that do offer more comprehensive med/surg services. In the future, I would like to be involved in that sort of program (provided I stay in psych) to be able to keep up my general medical knowledge. I will try to negotiate the CAQ requirement! Do you feel that would build a pigeon-hole, just by having that certification? Link to comment Share on other sites More sharing options...
mgriffiths Posted September 12, 2016 Share Posted September 12, 2016 Just FYI, loan repayment is considered taxable income. There are only a few ways to get money without it being taxed, pretty much putting it straight into retirement and education funds. Link to comment Share on other sites More sharing options...
Z PA-C Posted September 12, 2016 Share Posted September 12, 2016 Just FYI, loan repayment is considered taxable income. There are only a few ways to get money without it being taxed, pretty much putting it straight into retirement and education funds. Actually if you have loan repayment through the state or federally through some of their programs such as NHSC it is tax-free. Link to comment Share on other sites More sharing options...
mgriffiths Posted September 13, 2016 Share Posted September 13, 2016 That is true, forgot about that one, but I don't think that applies to this potential $25,000 since the OP stated the state doesn't pay PAs. Oh, and by the way, you need to report that information immediately to AAPA and the Kansas PA association (https://www.kansaspa.com/). I find it highly unlikely that this is true, and if it is the PA powers that be need to correct that immediately!!!!! Link to comment Share on other sites More sharing options...
PAS2014 Posted September 13, 2016 Author Share Posted September 13, 2016 That particular job is in Missouri. I received a call from the medical director today, and he said he is meeting with the "powers that be" tomorrow and he feels he will be able to help fix that problem. He said that they distribute student loan repayments on a case-by-case basis, and thus far the state has never hired a PA in that department or this position (which may be why the customer service rep from the State told me I wasn't eligible). I should find out tomorrow! I will be over the moon if it goes through. Link to comment Share on other sites More sharing options...
NYCPAC Posted September 13, 2016 Share Posted September 13, 2016 Forensic pysch seems like a really interesting field, I envy you a little. :) I'm not sure the caq would pigeon hole you per se but the role of a pa is that we are dynamic and I think for some people the caq doesn't do us justice. The best aspect of being a pa is the flexibility and I think the caq kind of takes away from that. I can only speak from my perspective though, I personally haven't taken the caq and don't know many pa's who have. Would be interesting to hear from others how it benefitted them. Additionally, what does taking the caq prove to your employer? That your clinical skills match your test taking abilities? Does it truly benefit the employer? Sent from my iPhone using Tapatalk Link to comment Share on other sites More sharing options...
PAS2014 Posted September 13, 2016 Author Share Posted September 13, 2016 I think you are totally right! I don't particularly care to take the CAQ. But, I live in a city that has 15 NP programs in a 2 hour radius - 3 of which house PMHNP programs. I think PAs get raked over by mental-health specialist NPs, especially in my area, without the "specialized training". I have been contacted by several employers who are looking for PMHNPs, and when I tell them I'm a PA, they thank me for my time and hang up. Maybe that proves it's benefit? But, I'd say that's only really necessary if you want to spend your life in psych and nothing else. I like to have my hands in a lot of pots, so I'd like to continue pursuing other specialties as I go through my career. Forensic Psychiatry is very cool. I worked on a forensic team years ago for a short while in a low-level role. I remember very clearly being assigned to a gentleman who was completely lucid at the time of my assignment with him. He was a gentle giant! He was also heavily medicated... Anyway, he was living on a forensic unit because he had a brief psychotic episode a few years earlier and ran through a bank with a machete and killed 3 people. As part of our therapy, I played pool with him on the grounds every morning. It's the only way he would talk to me. But, I never felt frightened of him. It's just fascinating to me. Link to comment Share on other sites More sharing options...
tunafish Posted September 13, 2016 Share Posted September 13, 2016 Who would back you up on your IM part of psych job. Who would be your SP in this case since your psych docs do not practice in IM field, so it is out of the scope of their practice? Link to comment Share on other sites More sharing options...
PAS2014 Posted September 13, 2016 Author Share Posted September 13, 2016 No, they have all been pitching in and handling situations as they arise (medicine-wise). They just would rather only handle the psych stuff. I brought it up to them on my interviews that I would like to continue dabbling in general medicine, so they were excited that they could give up some of that role to me. Usually, they do initial evaluations, then transport the patients to primary care doctors, urgent cares or ERs depending on the severity. The thought is that I could alleviate pushing people out the door SOME of the time, especially with general day-to-day medical complaints. The IM doc works part-time, but would be available for consult the other 3 days. Do you think that would be problematic? Link to comment Share on other sites More sharing options...
treejay Posted September 14, 2016 Share Posted September 14, 2016 I don't think the CAQ would pigeon hole you at all. It would just make you more marketable to psych jobs in the future. For other jobs you may want to apply to , you don't even have to mention it. Choosing psych as a first job would be the thing that would pigeon hole you way more than the CAQ. But even then, I still predict lateral mobility as a possibility. Link to comment Share on other sites More sharing options...
PAS2014 Posted September 14, 2016 Author Share Posted September 14, 2016 Getting stuck has always been my fear. My hope is that I can handle enough general medicine, urgent care complaints and chronic conditions on site that I can keep up skills enough to move into a general medical specialty later if I get sick of psych. Most PAs I have met tell me it's not super difficult to switch specialties after a few years but I'm still skeptical. Link to comment Share on other sites More sharing options...
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