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WanderlustPA

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About WanderlustPA

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  1. Bringing back an old thread. It seems still in this day & age there are many employers offering sh&t for PTO! If all PA's across all specialties stop accepting minimal PTO, then this won't happen, but obviously many are accepting very little PTO. I had one offer that was only 10 days PTO. I didn't even bother negotiating that. Even worse a while back, had an offer of only 7 days (though it was 12 hrs/day), and another that wasn't an offer, but out-of-state so I wanted to clarify what a hypothetical offer would be before flying out to interview, and it was 7 days (in this case 8 hour days). The office manager said she'd ask the doctor if they could do more, but I never heard back. I have a current offer that is 14 days PTO + 5 days CME. No mention of holidays. I need to clarify all of that, and I'd like to get the PTO up to 20 days. IMO, working in medicine can be physically and mentally exhausting, and the time off is needed, or burnout can & will happen. I also hate when there is no additional sick time, so if you get the flu one year, there goes a week of your vacation! We should be given 10+ sick days per year, as we should NOT be working while sick AT ALL in the medical field!
  2. I just got an offer for a general surgery position. I have no prior surgery experience other than rotations. Location: DFW, TX Salary $121,000 Retention bonus of $8k after 12 months (to be paid over the subsequent 12 mos), and then $5k after another 12 months 14 days PTO 5 days CME $750 (must be approved) Health insurance (no details given at this time) 401k after a year I think (not that concerned right now, as I'm paying off loans first, and more interested in investing in real estate) Liability coverage paid for (not including tail coverage) Licenses, etc. paid for I need to verify days/week. Schedule seems fairly unknown at this point. Sounds like they don't see a lot of office patients, so it'll primarily be first assisting and rounding. They also want me to network with other PA's in primary care/urgent care offices in order to boost referrals, and have said that as business grows, I will be rewarded for that in higher compensation. Personally I'd like more PTO. Everything else I'm good with. Depends on days/week I'll be working, but I'd prefer to have 4 weeks of PTO. But I could sacrifice some PTO for the first year if it can be bumped up in year 2. What do you guys think?
  3. Okay guys, I'm trying to break into derm with no previous derm experience. Well, other than a clinical rotation, but that was nearly 4 years ago, and only 4 weeks, so I don't think that counts for much. Here's my plan: I've joined SDPA and am going to try to complete the Diplomate program. That depends on them accepting me into it, since I do not currently work for a dermatologist. I figure this will somewhat make up for my lack of experience. I can at least come in with more extensive book knowledge. It also shows my level of commitment to derm vs just applying without any experience or any other sort of additional effort related to derm. After that, I'm not going to wait for open positions, I'm just going to mail resume's out to every dermatology practice in my area, with a cover letter explaining the steps I'm taking to get past my lack of experience, as well as my reasons for wanting to be in derm. Does this sound like something that could work? Any additional tips of things I could do to better my odds? It seems that every single derm job I see posted wants 2+ years of derm experience, but at some point something has to give, and somebody's gonna have to hire someone without experience. There can't possibly always be more experienced candidates than available jobs.
  4. This is how I feel. I'm actively looking for another job, and have a few interviews this week. I honestly hadn't planned on being there as long as I have, but just got comfortable, and stopped putting a lot of effort into searching for a new job. I think the time is about up for these types of clinics. One of the other employee providers, not an owner, was saying that BCBS is now only allowing an office visit code to be used once a month for hypogonadism. I'm not surprised, and I bet that the others aren't too far behind. I see this business tanking in the next 3-5 years, perhaps even sooner. At any rate, they finally listened to my concerns and have hired a 3rd party billing company to review our notes.
  5. I've been working at a testosterone clinic for a while, and I'm questioning their billing practices. I'm trying to find another job anyway, but I'm wondering what you guys think of this. They're billing all visits at least a 99213. 90% of the visits are just the patient coming in for their weekly injection. Before I started, I assumed this would be a 99212. Even with me seeing the patient, it's a simple, quick visit. They are now wanting to add a FULL HPI to the notes, with all the elements. I've objected to this, saying that I refuse to put something in the note that isn't being done. Which is probably what everyone else is doing. So instead we're going to actually cover all of this stuff on EVERY visit. I don't think the patients will like this, as they are just there to get their shot and get out. I also feel that it borders on being unethical, as there isn't even a medical necessity for us to see the patient every single week. Let's be honest, they can get a testosterone Rx from their PCP (which I prescribed a lot in family practice), and do the shots at home without any weekly oversight. Just come in for labs every 3-4 months to monitor T levels, Hct, PSA, estradiol, etc. A friend of mine is an office manager in Internal Medicine, and he says if they are just there for an injection, there should be no E&M at all, just the injection code. I feel that instead of doing what is appropriate and then billing for that, they are targeting a 99213 code, and then doing what they have to do to meet that code. Overall I just think this is kind of a shady business, and I think there's probably a day coming where insurance companies are going to refuse to pay for a 99213 for a simple injection visit, even if the coding requirements are met, it just isn't medically necessary. It's costing the patient way more than it needs to, and it's costing the insurance company way more than it needs to. I don't feel good about it, and besides I want to get back to REAL medicine anyway. This was just the first job I could get after being laid-off from my previous job (yes, believe it or not, I was laid-off as a PA!).
  6. I know this thread is old, but I'm bringing it back. I'm jealous of a lot of your schedules. My practice is 10 minute acute visits and follow-ups, 20 minutes for procedures or complex problems like chest pain or abdominal pain (supposed to be, sometimes these still get scheduled as 10 min appts depending what the patient tells the scheduler), and 30 minutes for physical exams. I honestly hate the 10 minute appointments, and as others have pointed out, I really don't feel like I can give quality care to a patient in 10 minutes. My schedule tends to be a log-jam first thing in the morning, as well as at the end of the day, and the middle of the day will vary. There's no built-in time for charting. My busiest day I saw 31 patients, and that was only like 2 months into seeing patients as a new grad. I've had several mornings where I've seen 16-18 (8am until the last appt 11:30am). I do like the office, but the fast pace is burning me out already, in just over a year of practice.
  7. I graduated in August 2015, and I started the process in April. I had a phone interview in April, a face-to-face interview for a different job in June, and finally had 2 interviews and 2 job offers just a couple days after taking the PANCE. There's no harm in starting to browse and apply for some jobs in the next couple months. From my experience, it seems most places are wanting to hire ASAP, so they may not be willing to wait for you to graduate, and you'll have much better luck as you get closer to graduation. By the way, I was in a similar situation, applying where I had no contacts. However, it was in one of the top markets for PA's in the country. Not so sure about Maine.
  8. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf There's a lot of reading there, but those are the guidelines. There are basically 3 key components, the history, exam, and medical decision making. There are specific requirements for each of these to reach the level 4, but you only need to reach level 4 in 2 of those 3 key areas. It's too complex for me to explain in a post, but that guide should help.
  9. I'm not in the hospital setting, though it sounds to me like their expectations for a new PA may be unrealistic. I did a hospital rotation and my preceptor said that all he expected of a new PA was for them to give him enough info about the patient that HE can formulate a diagnosis and plan. I would express your concern over your training with your boss. Do so tactfully, but emphasize that you did not go through a hospital rotation while in school, and may have very limited experience in some of these procedures. Nobody is an expert after doing something once. The main thing I have taken away from my first year in practice is that PA school really only scratches the surface. It's going to take us years to becoming highly proficient providers.
  10. Salary.com seemed to be more in line with the types of pay rates I found when looking for a job. The AAPA report was way too low. Most job postings don't post a salary, but some do. Do some searches and see if you can find what other employers are offering, heck even apply. You'd certainly have negotiating power with another offer on the table!
  11. I'm attending a billing & coding workshop on Tuesday. I hope to get a clear understanding of this for the first time in my life! I'll let you know what I find out!
  12. You should only be paying an additional 7.65% vs. being an employee. This is half of FICA & Medicare tax, which is covered by the employer if you're an employee. Did you do your own taxes, or hire someone? Definitely a mistake on your tax calculations. Also agree you should be making more than $108k. What is the value of the benefits you're not getting? I saw an ad for a 1099 job offering $90/hr (granted that's just an ad, take it with a grain of salt).
  13. I'm not sure of the specifics, but they've been doing it this way for years. I'm sure they're within the laws. I rarely see Medicare patients, it's almost all private insurance because we only started accepting Medicare (and only for our established patients aging into it) this year. Anyway, that's another topic.
  14. I'm not sure what my average patients per day would be, but I've seen as much as 31 in a day, and as little as 6 (on a half-day). Probably average around 15. Reimbursement is higher than average because an SP signs off on every note, and apparently that allows them to bill at the same rate as a physician, as far as I understand. Total collections for year one $550k.
  15. I work in family practice, with a salary plus bonus, which equals roughly 19% of my collections total. This seems low to me, although my total pay is above the median for my area. I've now been seeing patients for a full year, and I'm thinking if I want any kind of raise, I'm going to have to initiate that. What would be a fair pay rate? Should I push to a level that would be 25 or 30% of my collections? Does anyone know of any resources that show an average pay rate in terms of percentage of collections for family practice?
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