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  1. No health,dental,insurance. No retirement benefits for 2 years. *Unacceptable in my book for a professional job. Even a 1 year wait time for retirement benefits is not great. You could at least put your own money into an IRA during that time. They aren't compensating you well enough with your salary to make up for no insurance. Hours: 8-5 pm with a 30 minute lunch. Monday-Friday. holidays and weekends off. No call. *Standard hours. If you're the only one at that clinic, who covers for you when you are sick or on vacation? What does your support staff (RN, MA, front desk clerk etc.) look like and what happens when they are out sick or on vacation? Is there an office manager for that location or will you be expected to wear multiple hats? $90,000 salary. *You are already paid VERY low for your work experience of 5 yrs right now, counter with 6 figures. Do not accept less than that. I'd counter with $110-115. Get the AAPA report, show them, discuss it. I second considering locums, moonlighting, etc. Regarding "My problem is that if this is a bad offer and I counter with 120,000, will they just say no and hire someone else? If thats the case then when will I get a decent paying job?" *They could absolutely do that, but they are unlikely to just turn you down flat out. Most likely, they will counter with a less than ideal counter or just he same original 90k and theyll give you a bunch of excuses why they wont offer more. I can't answer your question as to when you'll get a decent paying job but I will say that if you accept a salary thats far less than you feel like you deserve (and you do deserve more than 90k) and thats less than you need to support your family....your current burnout is only going to transfer to the new job and you'll be soon looking for yet another new job in the near future. One way or another, you have to fully investigate why you are burned out and the answer is hardly ever "I just need a change of scenery from my current job" There's usually some very specific things that trigger your burnout (ie: the front desk cannot figure out the scheduling so they're always overbooking me and that stresses me out -or- my MA is incompetent but they;ll never replace her because shes been there for 15 years -or- my SP sits on his ass all day while I work mine off -or- They dont give me CME time and money so I dont feel like my employer is invested in helping me become the best provider I can be -or- I cant succeed at goals in life (save for home, save for retirement, pay off debts, investments, buy a boat, etc) because Im simply not paid enough dollars)) Its important to know what specifically contributes to your burnout so you can ask about those things and avoid them in future jobs. Just some thoughts. Best of luck!
  2. If you and your supervisor/coworkers are on good terms both professionally and interpersonally, then there can often be NORMAL bittersweet sadness when someone leaves. Those people may feel sad or a sense of loss of a team member when you are leaving but are just as likely to be happy for your next opportunities. Your employer... Yes, they trained you but they HAD to train you, just like they would have had to train anyone else for that position. Perhaps you needed more time as a new grad but the training investment is what is expected of any employer of a new employee and not unique to our profession. Not even a seasoned PA can start a new job without some training on that specific workplace. You should try to not feel guilty for leaving an employer. Ultimately, this is a professional and business transaction in which you work for them by performing skills (medicine) that brings cash to the company and then they give you a cut of that income that they make. I tend towards the more emotional/guilty feelings when I leave a job so I can understand and which is why I try to force myself to force myself to think about the aforementioned more practical/transactional approach to the relationship between you and your employer. That being said, we also work in a unique profession where we have these intimate relationships with patients which I think contributes greatly to a sense of guilt when we leave a job (except for maybe terrible toxic jobs). Check out some youtube videos and articles on the guilt that teachers face when they choose to leave a teaching position for similar personal reasons (such as low pay) and you may find some common ground in their feeling of obligation to their students. Best of luck!
  3. I'm also interested to see how much this is different between the varying graduating class years etc. but this should be interesting. If this has been done recently elsewhere on the forum let me know.
  4. Congrats on finding a better offer than what you've been getting and after your last experience. Seems pretty solid
  5. I live in an area with an unusually high number of NDs etc. and see a TON of this. I'm not saying that all NDs are terrible. I think that naturopathic practice and allopathic medicine can coexist and be quite beneficial to the patient, but only in the right situation. There's a few main groups of patients that I see who come from these practitioners near me: 1. Thyroid: Dessicated hormone therapy, specialty compounded blends of thyroid supplements, often with lab values far outside the normal. ("Ma'am, your TSH has never been abnormal until your ND started you on high T3 compounded/ dessicated replacement therapy and since then your T4/T3 have been through the roof and your TSH nearly undetectable" Pt: "But its natural. Oh, and my ND has a list of labs they want you to order and draw for them (hands me sheet of paper...because these "practitioners" cant even order their own labs) *face palm*" 2. Chronic Lyme Disease: These are often pts tx'ed by one-off GP and Internal Med MDs gone awry. AKA "Lyme-competent physicians" per patient lingo. They are cash only and like to place patients on unfounded treatment regimens like daily double ABX therapy (ie: Cipro and Azithromycin at max doses per day every day, planning for years if not lifetime of treatment) and often use independent labs for testing, because as one pt recently stated "Your lab, Quest or Labcorp or any of the hospitals really, will show false negative testing" *face palm* 3. BHRT: Weird dosing on compounded BHRT. Unopposed estrogen therapy, etc. There's a lot of gray area in the science and even the guidelines leave room for discussion, but overall are pretty clear on how to manage the above patient populations. I explain to patients that I follow current evidence based guidelines and do not practice medicine that I have legitimate fears would introduce more risk than benefit for them. I explain the R/B/SES and current reasoning to them as much as they will listen. Encourage them to use other natural, evidence supported, treatments for things (think zinc oxide sunscreens, fish oil, ginger tea for nausea, exercise and diet to reduce their cholesterol and blood pressure if their #s are safe enough to go that route, etc)
  6. Probably unlikely that a lawsuit would come of those few days but you have put yourself at significant risk by participating in patient care in that manner. I have not encountered this before but you might think about speaking with a malpractice insurance company about retroactive coverage of some sort. Best of luck. I have done a shadowing day during an interview process, but I don't do anything with the patients other than introduce myself as the person who is job shadowing the PA and that I am just there to observe and I specifically tell them that I will be playing no role in their care for their visit. Then I shut up and watch. I dont even so much as touch the patient, tie their loose gown strap, listen to an interesting murmur that the PA heard etc.
  7. I would recommend choosing something that hits one of these points: -A specialty that you may be interested in, but were not exposed to in your core clinical rotations. (ie: Nephrology, Dermatology, etc. I chose Cardiac ICU which I LOVED and helped me feel more confident handling sick, complicated patients) -Build more upon a field that you are definitely interested in. (ie: If you loved the ER and know its for you, then consider a Peds ER rotation, an Ultrasound ER rotation, repeat ER rotation at a different ER (think Rural v. inner city v. volume v. patient population differences), repeat ER at the same as your core (I did gen surgery and Ortho/trauma surgery at the same hospital and since they already knew me, I had the opportunity to have a lot more trust of my teachers and was able to do a lot more procedures because of it), or even trauma service because you may have more opportunities to do advanced procedures. There is benefit to working on different but similiar services at the same site. If you did trauma service at the same ER that you did your core ER rotation, you will already know how the operation works, whose who in the game, what the general roles of everyone are, not to mention you'll know your way around the hospital, and often its easier for PA Program clinical directors to set up rotations with elective specialties at sites they already have another student agreement with.) -Rotate in an area that you feel weak in or have not had much exposure in (For me, it was ortho. So I chose Ortho/Trauma Surgery as an elective)
  8. I have one for sale up on ebay right now. Welch Allyn 71050-C Rechargeable w/ insufflator bulb and spare light bulb. Item # 233211787719 Comes in carrying case. I replaced the battery with a new one in 2017. Starting BID $135 plus addtl shipping. Buy it now for $225. Take a look. It was perfect for PA school and is a high quality scope that would serve you well as a clinician too.
  9. It's not for a lead PA position. The Lead PA that I mention was the person I had my initial phone interview with. Although that may be a position I would be interested in eventually, it certainly is not what I am looking for right now. I appreciate the input though.
  10. Thanks all! The salary offer was quite a bit more than I had honestly hoped for and would be double my current salary. I also found out there is 1 week CME allowance, a dedicated scribe for the PA while working the trauma side. I am very excited to be in the midst of this interview process and hope to hear something one way or another within the next couple weeks!
  11. Thank you to both of you who took the time to read this and reply! I am definately taking this interview process seriously and am likely to take the offer. It is so very difficult to break into Emed locally in my region and this would definately be my best opportunity right now. A follow-up question: How do you deal with the feelings of guilt in leaving your current job? (My job isn't toxic, but it pays terribly and the commute is horrendous. Not to mention I don't think I can ever live in the same tiny rural town where most of the residents are my patients. I feel supported by my SP and clinic manager (theyre new additions over past 6mo) and the place has turned a new leaf in part thanks to my contributions and theirs ) I'm sure its normal to have feelings of guilt about leaving. But, I've also been told to never quit on a bad day, only on a good day. (ie: if things still are not what you ideally want even on a good day, then its a better informed decision than leaving when things are at their worse and you're in a rut)
  12. Good luck. I work in FP right now and searching for Emed jobs. I have multiple friends (physician and PA) that are in Emed whom Ive had lengthy discussions about alot of this with. My comments are food for thought and in no way should determine your choice. Figure out YOUR priorities and find a job to match them. It doesnt have to be a job that matches them from now to retirement, but at least fitting of your current goals and priorities for the next few years.
  13. Go for that Addiction Med repayment. If you are also in primary care doing MAT/Suboxone, you CAN double dip into the primary care loan repayment program too. This is the only time they allow you to be in both at once. Thats a lot of money. Not alot of people are probably applying for the MAT program so maybe youll have a higher chance. Just make sure your DATA 2000 is good to go and that your employer qualifies and has filed the correct paperwork. I believe there is an extra form they have to submit on top of the regular forms for the primary care site qualification registration. If I'm wrong about the double dipping please correct me, thats just what I interpreted from the website. Great incentives.
  14. So…. After months of searching for a job (currently in FP w/ 1 yr total experience), I had an initial phone interview today with the Lead APP at a Level 1 Trauma Center ER. I know my description is a bit lengthy but I hope it provides some details and leads to some feedback from all of you on this position and things I should ask at the next stage of the interview (by phone with HR and shadowing on-site in 1 week). Red Flags? Good, bad, ugly? Potential Offer: Metropolitan Area Level 1 Trauma Center, 70k annual volume, 38 bed ED (also addtl psych ED, peds ED, and 9-bed OBS unit), Attending, Resident and PA/NP coverage all day/night w/ residency program. Base Pay: Unsure. I do know that it’s SALARIED at “40hrs” per week, 36hrs actually schedule. If you work an extra shift, you get your salary rate turned to an hourly rate and paid that per hour. I should have more on this soon…. Note: A friend of mine has worked the Psych ER side for 1 year and is at $107K. So I’m guessing 100k-110K. Bonus is unknown. Shifts: 12 hr shifts, Required 12 shift per month, combination of 7a-7p, 11a-11p, and 7p-7a. (NP I spoke to there said they are typically in the department 36-39hrs, rarely more unless you picked up more shifts) Scheduling done by the Lead APP approx. 6 weeks in advance according to provider preference for days that everyone submits on a shared spreadsheet by the deadline. Typically able to accommodate requests for front loading/back loading weeks or specific days off without dipping into PTO) There are 2 FT night PAs that cover 6 nights per week (3/3), the remaining 1 night per week is split amongst the rest of the team. Typically I’d work 2-3 night shifts per month. No night differential that I’ve heard of thus far (I’ll ask) Acuity: Typically high (safety net hospital in state capitol). 50% of time in OBS unit/ 50% of time in main ED seeing Level 1-3’s. All the Level 4 & 5s go to the Adult Walk In Clinic which is a separate job title and department entirely (note: I also applied for an open position with that dept but haven’t heard back yet from that team). No peds ER coverage. No psych ER coverage. No Fast Track. Pts per shift: Average 15. Range 15-20. APP Lead states it’s not higher because of high acuity pts and not working fast track. The Day to Day: 50% Obs Unit inside the ED (7a-7p and 7p-7a shifts): Solo w/ RNs and Techs, attending SP and Senior Resident backup from the main ED. Sick/tricky complex pts, intoxicated pts, and actual obs of pts just being monitored until able to be discharged. 50% Main ED incl. trauma (11a-11p shifts): Attending coverage, working side by side with residents, PAs take Level 1-3 pts, Not involved in resuscitations or most “advanced” procedures (chest tubes, intubations) due to the residency program. Will suture, LP, paracentesis, the like. CME: “Money and time allowances” per job listing, however my friend in the psych ER states NO CME time off but CME $2,000 annually. Required to attend 1 M&M per month. Allowed and encouraged to attend all resident lectures etc. Training/transition: Limited. 6-12 shifts double coverage with another PA/NP, then you’re on your own. It sounded like this isn’t really flexible. (Will be asking LOTS more questions about this) PTO: 160 hours/year, accrued per pay period. (Essentially 4 wks PTO) Medical/Dental/Vision: 3 plans ranging from $66/mo in-house plan up to $177/mo for Highpoint HMO w/ Cofinity network for individual only. $0-$500 deductible. Max out of pocket 5k per individual/10k per family. Dental is Delta PPO (3 different plans. The option I’d chose to keep my same dentist is $2/mo individual and $4/mo for me+1. Sweet.) Vision available, I don’t need it. FSA available. Retirement: 401(a) Defined Contribution Plan (all employees contribute 6.2% of each paycheck (up to IRS limits) to an individual 401(a) plan instead of paying into Social Security. In addition, employer contributes a total of 3% (up to Social Security limits) of each paycheck on the employee’s behalf. In addition to the 3% contribution for the Social Security Replacement Plan, Denver Health contributes an additional 3% (up to IRS limits) on behalf of all benefit-eligible employees) 100% vested after 3 years. Also, an alternative 457b Deferred Compensation Plan w/ 3.5% match but higher dollar amount limits. (I’m not very familiar with either of these plan types…thoughts?) Malpractice: Uncertain. Possible FTCA coverage. (More questions to ask) Non-compete: None. Loan Repayment: None offered by the hospital. ER does not qualify for loan repayment. Per the NHSC and state program websites, the Adult Walk In Urgent Care there DOES qualify (I also have an application in with them, but haven’t heard back yet) Pros: -It’s a foot into the door of Emergency Medicine, and at a Level 1 Center in the main ED to boot. -I can continue to live at my current home and not have to move in order to get my feet wet in Emed -I will still be working with under served population (Important to me) -Pay will be at least a 30% increase over my current salary. It’ll take me another 5 yrs at my current position to make that. -Being in the main ED and out of fast track - 4 day weekends!? IF I can stack my days together. (I currently have 3 day weekends Fri-Sun in FP but I work 10-10-10-12 to earn it) -Daily RT commute is 1h20m. Might be able to make the bus system/bike work (free bus pass by employer) which is shorter than my current 2 hours/100 miles RT commute that’s killing my Subaru. This ER position would save me 4 hrs commute time, 220 miles driving, and 6-11 hrs of work time per week. Combined time savings: 10-15 hours a week & nearly 11k miles a year. As well as an potential $20-30k more per year in base pay) Cons: -OBS unit sounds like a potential Bermuda Triangle of the department. Will need to stay on my toes out there. -Pay not as great as other EDs may be able to offer, but then again our whole market here is below average in all specialties. -Salaried, not hourly. I swore after my current job that I’d never work salary again because although I’m scheduled 40 hrs per week, I never work less than 45-50. -No loan repayment -VERY limited training/run-in time. Due to volume and residency program, I’ll probably have to learn to swim fast. This is probably my biggest CON to this position at the moment (other than lack of participation in resuscitations and certain procedures). I have 5 yrs EMS/ER tech, my PA clinical training (included ER time at a similar Trauma center, CICU, trauma team SICU/Surgery, and the standard rotations), and 1 year FP in rural FQHC underserved population. I worry about getting stuck in FP if I don’t expand back out and start using my clinical skills on higher acuity patients and my procedural skills beyond IUDs, basic suturing/I&D, and skin bx. -I feel some guilt about leaving my current SP/patients/clinic. I finally feel supported by my current (new) SP and (new) clinic manager and I actually like some parts of FP but I’m still not super touchy feely like most of my colleagues. I kinda worry that my new colleagues and direct supervisors may not be as supportive or worse, it be a hostile work environment. Higher up in my current Admin, I feel fairly supported but they’ve specifically told us that there will be no significant pay raises for the foreseeable next few years. Limited 5k/year base salary increase and a bonus structure which will never be attainable for my position/pt volume due to rural location. (I started at 75k/yr, now at 80k/yr) OKAYYYYY....GO! Good, bad, ugly? Things I didn't think about that I should ask?
  15. At this point, we have some catching up to do with the laws that regulate NP practice. I used to naively think we should have SUPERVISORY Physicians but the reality is that we really just need COLLEAGUES. Routinely in medical practice, MD/DO/NP/PAs consult with their colleagues about tough cases etc. When I present a case to my SP on a challenging patient, it feels more akin to that, than some sort of a Mentor/Mentee hierarchical relationship. At this point, I'd have to agree that working towards obtaining at least the same amount of legal autonomy as NPs have is a priority. I recognize that there are many highly intelligent and well trained NPs out there and also that there are many stupid, lazy PAs as well. However, my recent experience with NP students at my clinic (they come mostly from a "hybrid" program where its completely online didactics and only 540 hours of clinical time, 45 hrs or so in each specialty; increasingly typical for NP programs in general) and recent experience with the two other, now former, NPs at my clinic has put a bad taste in my mouth about NP independent practice. I know we shouldn't be bashing our NP counterparts but my frustrations with the ones I personally encounter daily frustrate me to no end. -Explain to me how ONLINE coursework prepares you to be a PROVIDER. -How does 45-ish hours in each specialty prepare you to be a PROVIDER. (heck, I spent over 300 hours in one surgical rotation alone with all the extra shifts I picked up and extra time I spent in the OR) -Why were the NPs at my clinic (prior to my arrival and that of our new MD) practicing OMT, blind spinal injections, and prescribing an ungodly amount of controlled substances. (ie: S: "Tired this month after starting new job". O: Minimal documentation. A: Insomnia. P: Seroquel, Ambien, Klonopin for anxiety related to falling asleep, and MS Contin for those aches and pains of life that you notice when you lay down for bed" *pulls hair out* The honest answer, is because it was only the two of them at the clinic and no one was watching what was going on for 20 years. Thank God that I have a fantastic MD counterpart to work with now and we are working hard to undue the damage that had been inflicted on our population over the past 20+ years. It wasn't all bad, but boy when it was, it was disastrous. I don't claim to walk on water, but I know my limits and when to refer appropriately. Okay, back to the regular program. My goal this year is to be more active in pushing for more legislative support of our profession including holding our professional organisations' feet to the flames on this subject. Glad to see more people on board.
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