electric130

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  1. I think just the fact that you will only work 5 hours per day on the days you do research, and then doing home health on other days will break up the monotony. I also felt like you did, the in and out of the office all day for 15 years in a high volume practice was leading to total burn out. I recently started working as an IC with no benefits. It was worth it for me to do something different, but if you look at it from a purely monetary standpoint being a W2 employee is almost always better unless you are at a really high rate of pay as an IC. It really makes contract and negotiations quite easy, I would just clarify if they will pay any vacation. Honestly this is somewhat of a luxury to be able to do, fortunately we have spouses/partner that have good medical benefits, my husband is career military so health insurance and most of our retirement funding once he retires from the military will be taken care of. The older I get the more I realize I really do not enjoy doing anything 40 hours per week in an office, and really like having a combination of different types of work or just more time off. I have an interesting mix of a little bit of clinical work with insurance work from home and I love it. I am also looking at possibly starting a side gig with my sister doing something completely out of the medical field. I would go for it, just do your research on being a 1099 employee, (I am assuming that is what you mean by IC) and timing of paying your own taxes and self employment tax amounts.
  2. No harm done in asking, and I can see how you would find UNCC a good option possibly. My husband is a UNCC graduate from their engineering program which he said was excellent. And of course he is a brilliant engineer. However I agree that NC is very saturated, there are 11 PA programs when I last looked this up, Pfeiffer university is planning to offer a program as well. Elon and Wingate are both very close to Charlotte. I have lived in the Charlotte area for close to 15 years, the last two times I interviewed they told me how many applicants they had and I was very surprised. One was 10 years ago for a IR group in Charlotte, 200 resumes submitted, a GI practice I interviewed with a couple years ago said they also had over 100 resumes submitted. I was actually offered both of those positions, the GI position was because I have a tremendous amount of experience, the IR one I think was because my doc was retiring and they liked that I wasn't "jumping ship" and I think I interview well. This is just to give an example of the amount of competition for one position in this area. I really don't think pumping out more grads is wise, yes this is a very popular, growing, area but at some point salaries will start to go down, I am honestly already seeing that in the Charlotte area.
  3. A couple of thoughts from someone that wants to do something similar once we are close to retirement, I am only 40 though and have at least 10 more years so we have decided to hold off on buying any properties for now as our needs may change and keeping it as a rental for that long was not a desirable situation for us. I also spent 3 years living in Hawaii, various places on Oahu. Upsides of Island living is nobody really cares what type of car you have and you will spend very minimal on gas, although it is expensive. I found it to be much less materialistic there, no need to feel dressed up, have nice puses, etc...I still don't care about these type of things, but you can really get by very cheaply with clothes and material possessions there, I loved it! Food is more expensive, at least when I was there, but for two people should not be that big of a deal. For families the schools are not great, having a single family home, not a condo is extremely expensive. You seem happy with the thought of a condo so no worries there, I could never get my husband to be happy in a condo, sigh.... I think as far as finances go you have it pretty much figured out either way. The only downside I can see is having to pay a mortgage on something for 2-3 years that you are not living in. You may save a bit if property values go up, but it just depends if that is going to be a financial burden or not. I would consider renting it out to family/friends/ people referred to you that you would trust. This would offset your costs and it is easy to get a cleaning service after each rental. My parents recently bought a condo by the beach and are doing this, when they are not there they try to rent it out and they have a property manager doing this for them. It offsets alot of their costs. A couple other things we thought about when looking at properties: Have you taken into account property taxes and insurance? I know you plan on paying it all off, but definately look at what you tax bill and insurance will be. How often do you plan to travel back to the mainland and have you budgeted for that? Have you taken an extended vacation or leave and actually sort of lived on the islands? Have you taken into account that any trip you make you will need to fly? That kind of bothered me in my 20s, I don't forsee that being an issue now as I have come to hate driving, the Island we are looking at on the east coast is connected by bridge and only 4 hours from family. Those were big deals for us, and we will probably still keep our home in North Carolina and go back and forth once we are completely retired. That is not really an option with Hawaii, you kind of have to go all in. I think if everything falls into place I would just go for it, hard to say if home prices will be even higher in 2-3 years, I loved living there, it is an amazing place!
  4. You are completely being taken advantage of. Why in the world as a medical professional are you doing marketing calls? Ridiculous. Asking you to drive those extreme distances is a problem too. The problem is partly the nature of our employment. Most docs are reasonable and know what reasonable expectations are, but I have seen many circumstances such as yours where we are seen as an employee that can be asked to do anything and for any amount of hours, not as a professional. I have even experienced it myself. I agree you need to start saying these are the hours I can work, such as 8-6, something where you are working 40-50 hours a week. We should not be expected to work as much as they do, as a previous poster said they make probably six times what you do. Presentations and etc should be paid extra for your preparation time, unless you are doing everything during your working hours during the day. I would go back and say I would be happy to do that for you at 100 dollars per hour since I will be taking my personal time to prepare this. Also you have no contract but the office lawyer is trying to intimidate you? Not sure with what if there is not contract. As a new grad it is really tough, you need to work and you want them to be happy with you, I get it. This is unfortunately a downside of our profession and can happen too easily because we are dependent providers and honestly right out of school there is a huge learning curve and we cannnot hit the ground running. There are better situations and you will find one, I would start putting my resume out there, you may be at the one year mark by the time the right position opens up. Best of luck to you.
  5. I have been part time for the last 13 years, 24 hours a week. I have had CME, around 1000 per year, all licenses paid, malpractice and PTO covered. PTO is based on hours worked, so I do not have as much as I would for 40 hours, but have always had plenty to take four full weeks off a year, I am off four days a week anyway. I am part time but I have my own patient panel and usually see 75 patients a week so it is not like a typical per diem type position where I am just working as needed. I am actually transitioning to that and am asking for a higher per hour rate and no benefits at all. I think most positions will pay for health insurance at 32 hours, I believe our employer covers health insurance/disability at 24 hours. All of our part time employees have PTO except for PRN positions. If you are being paid a typical hourly wage that is more consistent with average salary with benefits I would ask for them. To me that would be any less than 75 an hour, I would expect benefits, even if they are reduced for being part time.
  6. Katera, I am helping a local physician do chart reviews. I was just working for him very part time, he offered four days per week. I work from home and have great flexibility. Hourly rate is the same as I was offered by a local GI group recently. No benefits, but I do not need them. It is working well for me at this stage of my life. I need to be home more with my kids and have some mental capacity left at the end of the day. Currently my clinical practice is completely running me ragged. I really wish we had more non clinical options. I have found that you likely will not be able to do this directly for an insurance company because the medical director has to be an MD. I just lucked out to be in the right place at the right time. My employment is completely tethered to this one person, which is a bit of a risk. Our finances are fortunately such that we will be ok if I wasn't working, so it was worth the risk for me. Another option I looked into was being a medical liaison for genetic testing or something of that nature. We have a couple MSNs, and I know of a couple PAs that do this, it was not a good option for me because it would require travel. Military husband precludes any travel on my part. Sorry this is off topic, hope this helps you a bit.
  7. I agree with many of you above, I think PANCE has a place, the PANRE that is another thing altogether. The longer I practice in a specialty, the more I feel like the relevance of the PANRE just is not there. I think those that practice in family medicine or EM, IM, or even hospital medicine most likely would not have a problem with it. If you have been in a specialty for more than 10 years, it is stressful and time consuming. Each time I take the test (have taken it 3 times, always passed on first try) my score gets lower, but yet truthfully I am an excellent provider and have a huge depth of knowledge in my field. I am only 40 but do not plan on taking the PANRE at 50 which is when I have to re test, as I am transitioning out of clinical medicine in the next year. I may still practice again, but very doubtful I will be in 10 years. I do think that for everyone else that is in a specialty there needs to be some sort of fix for this.
  8. Good points above, I agree with Bruce and ventana. We are definately a profit center, at least an experienced PA that is practicing to their full ability is. I am probably an outlier, I actually make about half of what my collections are. However, I see mostly medicaid and medicare (pretty much so the doc does not have to), and we have a terrible collection rate. Both of those things are out of my control, so really for how hard I work my compensation is probably more like a third of what my collections should be. I do wish that in general we were treated more like providers instead of employees.
  9. I was not as young as you were, 26 when I started as a PA and had the same concerns. My first advice would be to show humility and always be willing to learn. Do not let others take advantage of you, but understand that you are just starting out. Think before you speak, especially if you are feeling angry or put on the spot. Every PA needs to do that right out of the gate, at 21 or 41, IMO. I did have patients frequently ask me my age, if I was old enough to be doing this, etc.....I always smiled and said old enough and that I was well trained and would give them very good care. I also had no problem stating that if I was not sure about something I was very comfortable consulting with my supervising physician. Do not be overbearing or arrogant and do not take the questions about age personally. If you handle this with grace people will admire you for your hard work and for how young but yet competent you are. PAs can get taken advantage of regardless of age, with time you will find your way and hopefully your first position will be a good experience. Best of luck to you.
  10. You sound like an excellent clinician. I would not rush to thinking you need a new career. Becoming a PA is a huge investment, you sound like you are very good, you are just in a bad environment. I think the combination of trying to manage too many complaints in each patient and not enough support is a problem. Your volume seems reasonable, but not if each patient has 5 problems at each visit. Believe me, I get it. Even with being in a specialty I have struggled with burn out. We have a number of non compliant, difficult patients, some with chronic GI diseases, others with psychiatric issues that manifest in "stomach pain" with no organic origin. Ah....fun. I have also found that my happiness with practicing taps out at about 15 patients in a 6 hour clinic time period. I work 7 hours, one hour for lunch. Unfortunately 15 patients is very rare, I usually see around 25 in that time, so about 4 per hour for a full 6 hours which is just exhausting. I am at the point that I am done trying to buck the system and am actually taking a non clinical position for now. I have practiced 15 years and have the flexibility to do this. At your point in the game I would just try to find a better fit for you, I do think you could find something that is not causing you to cry every night for 2 weeks straight, that is just not healthy. I do not think you are the problem, it is your environment, you deserve better. With a specialty you would feel like you may be able to get more in depth, and you would be able to focus on one area of medicine. You seem very detail oriented, which of course is awesome for primary care, but it sounds like you just feel very overwhelmed by the amount of care each patient requires. I can completely understand that. Primary care was never something I wanted to do, exactly for that reason. There is a huge benefit in getting a couple years under your belt though. I would look into derm, ENT, psych, something outpatient and concentrated. Or you could even just see if there is another better fit for FM, although truthfully you will probably be expected to see more patients at another practice, not less. Best of luck to you, if you continue to be unhappy I would start looking.
  11. I would just give it a little more time. I am in a specialty, not ENT and I would say at the 4-5 year mark I felt like there was very little that I had not seen. Yes, occasionally there was something I just wasn't sure about but I could usually tell the patient I needed to consult with my SP and would call them with a treatment plan. Now my office hours are always while my SP is doing procedures so I work pretty much completely independently. You will get there, it sounds like you have a really good base of knowledge, it just takes time.
  12. I have been out of the job market for the last 10 years, make a very high hourly rate and my SP will be retiring soon. I have been in GI, and would like to stay in a specialty, just curious what everyone is finding to be average hourly rate of pay in North Carolina, specifically charlotte area. Only looking for part time, don't really need benefits. I did receive an offer from a GI practice two years ago, it had a low base rate and a weird bonus structure that would probably get me to 60 an hour. Really bummed to think I would be going back to that pay rate from where I am now. I have no interest in EM or UC, although I know they would have a higher hourly rate. Any insight would be appreciated.
  13. Sounds like a very poor working environment. If you are sick you should be able to go home, end of story. I can totally understand your frustration on all fronts. How many providers do you have to need 3 people up front? We have two providers, at least one at all times and only one front desk receptonist, one nurse and one MA. Our office manager is also a nurse and does everything as well, nurse call backs, MA work etc... Seems like there is plenty of man power that could have covered for your MA, nobody wanted to take on any more work. I honestly feel bad for that MA.
  14. I totally agree with the advice above. I really think you are being too hard on yourself. Being able to manage the basics of family medicine is a huge skill and not to be discounted. Big admission here....I am 14 years in to practicing and have not done procedures or read an EKG for the last 10 years. (except for taking panre)... I would honestly suck big time at both of these. I did do ER and UC very part time for a few years when I first was out of school. Honestly I did not enjoy either, have happily settled into a specialty and that is that. I know my specialty very well, have physicians that call to talk to me about their patients with GI issues and enjoy my large base of knowledge in this field. This is just to say that being really good at one area of medicine is ok.... At one point I was able to read EKGs and do procedures , very basically but at this point I am not using that knowledge at all in daily practice. If you want to be able to do more procedures see if you can get a side gig at a UC or ER, just to get your foot in the door. If you want more experience in an area of medicine it can be done. I am honestly at a point that I want to finish my career in my specialty, I do not have any interest in re learning those things, but you are much earlier in your career and have plenty of time to branch out and improve your skill set.
  15. Lots to think about with this. First off I would want to know what my collections were for the last 6 months as well as a clear discussion of what percentage of this I would take home. Would it be a straight 50 percent or would you set a base amount to cover all overhead. Seems like most physicians are usually at 50-70 percent of their collections, if you are taking the risk of being an independent contractor that is what I would aim for. I probably would sit down with employer and ask what type of number range they expect my "overhead" to be. Also keep in mind your collections are not what you bill. We have a terrible collection rate, I think maybe 50% of what is billed. That may be shocking if you don't know what your actual collections are before you make this move. I can tell you from experience my collections are typically between 15-25k per month, just depending on if I take vacation and how busy I am. I work 3, seven hour days, so full time should be a higher number than that. So be prepared for a big variation, and like everyone above said less stability. I have actually considered asking for something of this nature, although I am in a large group, not sure how well it would be recieved. My salary is right at about 50 percent of what I collect though and I feel like that is fair. I am also W2 employee for my primary part time job and 1099 for another that I work at home. I agree, love the flexibility of being a 1099, but my 1099 income is just extra, not built into our budget and not money that we need. I also love that I can open up a solo 401k that I choose, I am not crazy about the funds in my employer's 401k so I plan on maxing my solo 401k this year. My W2 salary and my 1099 salary are not production based at all though, (except for a bonus, which is why I know my collections numbers)....so this puts a whole other dimension on your decision as well. I also have my cme, licenses, malpractice and vacation time through my W2 employer so I sort of have the best of both worlds right now. I can see this situation being good for you if you are very productive and/or you are towards the tail end of your career and close to financial independence and have some flexibility to make less money but want more time off. It also may work out really well if you negotiate a good percentage of your collections and you know your collections are high. Would be curious how this works out for you, I think it is great that your employer is giving you this option, will just be a matter of thinking through if it is worth it for you. Keep us posted on what you decide, would be interested to see what you work out.