Derm PA - Help with renegotiation

[lameuse]

I have been working at the same practice for 3 years. I currently make 100k base salary with productivity bonus. This is the first year I've been paid the productivity bonus based on revenue I made the previous year. I receive 20% of the revenue I made for the practice in the previous year, minus my base salary. The % increases 1% each year. Bonus is paid out quarterly. I am pretty happy with how much I made this year (pretax salary+bonus is approximately $176,000/yr).

 

However, starting in July, my practice hired a 5th PA. Under NY State law, a supervising physician can only have 4 PAs. They basically gave me an ultimatum to go under another physician's malpractice insurance or to restart double providing with the supervising physician (Absolute HELL!!!). I'm already used to my autonomy so I opted to go under the other physician's malpractice insurance plan. The problem is that, due to this change, I have lost a lot of patient volume in the past 3-4 months (~600 patients as compared to last year). This patient volume loss is due to:

 

1) The physician I am now under had credentialing issues and I was unable to see a lot of insurance plans I used to see. I have gained a few of the major players back, but still have quite a few that I am unable to see.

2) They changed my normal scheduled locations in attempt to maximize the number of patients I could see because I was unable to see some insurance plans. But that lead to losing my normal patient following. The switch in locations clearly did not help with volume.

2) I am no longer under the physician who owns the practice, thus, I lose a lot of volume through Zocdoc bookings. If a patient is going to book on Zocdoc, most will choose the main physician that owns the practice.

 

I can't simply ask for a raise in base salary, because that figure is subtracted from the total revenue I make for the practice and thus would not increase my pay.

 

I don't know if I should wait until January to see the figures (revenue I made the practice). Technically, my incentive will be 21% v 20% this upcoming year and supposedly we are getting better reimbursed by insurance because they are fixing credentialing issues.

 

Do I ask for an hourly rate? $90/hr would about match what I made this year but this entirely eliminates incentive bonus or increase in wage year to year. However, as I see it, if I stay at this practice long term (another year or two), I don't see my volume increasing to what it once was as I would still be under another physician's malpractice insurance (i.e. less bookings on Zocdoc).

 

Should I ask for increase in percentage for my incentive bonus? What would be appropriate?

 

Also, the supervising physician can be really sensitive about "money talk".

 

This is giving me anxiety. What should I do? Help!!! I need a career coach!!!

[rookiejay]

I know this is late, I am just getting into Derm, I would love to hear how things turned out? 

Thanks 

J