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Negotiation strategy in the pacific NW

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#1 ran2much



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Posted 11 November 2016 - 09:40 PM

Any business/ negotiation savvy folks, pls weigh in!  So - The Portland, OR and Vancouver, WA market is hotter than anywhere else right now. In our community based oncology practice, they have not kept up with the market.  Our HR leader for our 6 sites knows it as do the APPs.  We are about 20-25k under the average market price in our region right now (based on actual payroll data in our region)... or, if you wanted to go to Kaiser we are 50k under.  They obscure our RVUs so we can't see what we bring in (and they say it is unintentional and not sure how to fix).  They tell us if we want to get paid the market average, then where will the money come from?  You need to see more patients (oh, but you have a diff MA every day and some visits have to be 45-60 min long ones) or where else should we get the money? Um, docs whose bottom lines we pad!  Half the docs like APPs, the other half are indifferent or opposed.  But, in PA school, you're taught don't get between the doc and his/ her money.  I feel like they want to create a Lord of the Flies scenario.


He has told us look, the parent company doesn't get it no matter what he tells them.  The physicians can choose not listen to the parent company, but they never have.  I just don't think you are going to get the market average, but I may be able to get you halfway there. But, think of the advantages of working with us.  We are flexible, if your kid is sick and you need to go, you make arrangements and go.  There is some flexibility that way and its why I stay.  Our health insurance is too expensive for families (and doesn't cover enough) so we are covered under my husband's.  Our 401k has a roughly 3% profit sharing distributed in April each year.  You don't get it if you leave before then.  Ive been here six years and get 4 weeks PTO and a week for CME with $2500 to spend on it.  Pretty typical, I think. He says we hire people because they want to work in oncology, they want to take care of patients and thirdly is compensation. $200 end of year bonus.


As a group of APPs, we are trying to figure out how to negotiate. Honestly, I wanna get paid the average market rate and go home to my kid and the hiking trails after 40-42 hours a week.  I excel and see the 2nd highest # of patients in the clinic.  THAT is clearly has never been rewarded and especially now if we can't even get to average. I'd much rather do average volumes and get average pay and some (like those without kids or spouses who stay home are willing to crank patients out like a puppy mill), but what they are saying to everyone is do more with no support and we'll pay you what an average PA gets.  Anyone who is business savvy pls, weigh in. Is there no strategy and I should just take one of the many urgent care jobs popping up all over that do value APPs and do pay the market average and incent with sign on bonuses if I'm gonna have to crank out patients like no tomorrow regardless? Thanks!

#2 mgriffiths


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Posted 11 November 2016 - 10:51 PM

Can't really weigh in on the Pacific NW, but the reality is that any employer is going to pay the least amount to keep you.  If it were me, I would find another position that is willing to pay closer to market value and give your current position the opportunity to match - OR WALK.


The other question is the obscured RVUs.  If they are required to provide this information per your contract, then I would possibly get a lawyer involved to force this information.  My understanding is that they have to know this information for billing/collections - so there is no reason not to provide this data other than to minimize your compensation.


Lastly, only you can decide whether the job is worth it.  You didn't go into a lot of specifics, but working 40-42 hours and having the opportunity to actually spend time with patients is great - but how does that compare to your compensation?  Only you can decide whether the compensation meets the job requirements.

#3 ran2much



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Posted 11 November 2016 - 11:44 PM

thank you. I did this once before and they matched and brought everyone up to market value with me.  I just didn't want to pull that card again unless I had to.  but, youre right.  I may have to and I may have to accept that I will have to be ready to walk.

#4 JPMiller


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Posted 12 November 2016 - 06:04 AM

PNW is crazy. Just go get 4 more offers in the next 2 wks. Use them to negotiate or take one of the other offers. They will get the point.
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#5 ventana


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Posted 12 November 2016 - 01:20 PM

Talk amoung yourself and find some other PAs to stand together and ask for change

I a very difficult time as they can always say "leave if you don't like it" and if you are bluffing you get called on it

I think standing together, and having detailed solutions to the problems, and verifiable data on what you are asking for it very helpful

As well the emotional comparison to. "If you replaced me with a doc it would cost you an extra $200,000 per year, so giving me and extra $50,000 is a great deal". Hard to get across, but well worth it.

A few finer points

NEVER make it negative
Stress you like for the job and desire to stay
Show how you excel at your job

No one wants to bend rules, and force change in an an agency they have to feel like they are your champion and gong to bat for you. Very rarely does playing hard ball get you anywhere......

The Fine Print - you didn't pay for my advice so please consider this when reading it. I don't care about typos so don't tell me I can't type.:eek:

I vote for a  Full Practice Authority and staged independent practice.




#6 Scuba8783



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Posted 29 December 2016 - 05:47 PM

If you are willing to move, apply with Mayo (or some other tertiary center).  They paid for my flight out there to interview and will pay moving expenses. 30 min patient appointments, max 10 per day, no call or weekends.

#7 Reality Check 2

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Posted 29 December 2016 - 06:34 PM

I did not move to Oregon 20 years ago because the salaries offered were laughable and insulting.

The laws in Oregon and Idaho are way behind the times as well.


We are in Washington and doing much better - good laws. Salaries are meh sometimes depending on West Side/East Side of state and whether or not corporate (YUCK) is involved.


The cost of living in Portland and the west side of Washington is high and salaries don't go as far. 


So, no pearls of advice except what others above have offered. 


If you just HAVE to live there then you have to dig deep and search high and low for the good stuff. If you don't HAVE to live there - don't - you could end up tilting at windmills for the duration of your career and that will definitely burn you out fast - speaking from experience.

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Posted 29 December 2016 - 11:58 PM

OR is getting better. it isn't WA yet, but much better than when I started working there 18 years ago.

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#9 primadonna22274


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Posted 30 December 2016 - 12:04 AM

RealityChick: I'm accepting a physician position in Chewelah/Colville WA for next summer. A nice mix of inpt/outpt/geriatrics and ED coverage. All my favorite things. I hope to run into you out that way!

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