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  1. Hey all, I have been a PA for 9 years now (1yr cardiac sx, 4yrs EM, 4yrs ortho hand) and just took a new position about one year ago in a new specialty. I went from Hand surgery/upper extremity ortho to ENT. I have a good salary and when I started, the bonus structure was TBD as I am their first APP. My position is unique as they wanted a PA to help offload consults and hospital rounds in the afternoon so the on call physician doesn't get stuck doing everything after their day. I typically see patients in the morning and occasionally in the afternoon (only until about 230pm to allow for time to go to the various hospitals depending on what has come in for the day). Sometimes I am super busy in the afternoon and cannot get to everything (but I leave around 5pm, although, some weeks my days are longer, regardless) and other times there isn't much to do and I will help out one of the docs with their PM clinic or catch up on patient phone calls, notes, etc. LSome weeks I am bored in the afternoon but they want me to be 'available.' I help out in surgery, but rarely, despite 5yrs of OR experience. I was completely new to ENT, so, to some extent, I had to be taught a lot this past year, however, on the other hand, I have lots of experience with abscess drainage, hospital familiarity, etc, so, a lot of things did not have to be taught. I just had my annual review and I have received pretty much all positive remarks. They are thrilled to have a PA and wonder why they didn't hire one sooner. They are a pretty old school private practice, so, a lot of the physicians don't prefer me to first assist them in the OR (they help each other out), which would be another way for me to make $$ for the practice. For this past year, they have given me a 5k bonus (I'm ok with that given my learning curve). I currently make 105k for 4.5d a week, plus $1800 cellphone reimbursement, laptop, and 4 weeks vacation. We discussed a bonus structure moving forward and I was asked what I thought was an appropriate bonus. I said 5-10% annually. I have my numbers, also, and in just 3 quarters, I have almost earned my salary and I am projected to pay for myself in charges with a full year of work, despite some afternoons not having much to do and having to train office staff that I am a provider and how to schedule me patients, etc. The issue is, they want to provide a bonus quarterly based on 'how they think I'm doing." There will be a low tier, middle tier, and high tier. They said most of the time, the expectation is that I will probably get middle tier $$ and usually only reach the highest tier if I seem to have an exceptional quarter. They also said putting in more face time with the physician partners in the office to 'help them out' in the afternoon when I'm not busy in a hospital can be a real boost. Some of our docs love it when I help and other docs don't seem to really want a PA in their office flow...they are used to doing everything themselves and it is awkward. The issue is, I am not entirely comfortable with the idea of my bonus being based solely on subjective opinions of the partners. Some seasons are busier than others with the number of consults that come in and while I try to see everything that we get, sometimes I physically cannot make it to 4 different hospital facilities in an afternoon (for consults ranging from epistaxis management to abscess drainage to trach care). When I asked about a bonus based on productivity, however, they said they don't want to incentivize my office productivity because they care more about me being available to help out in the hospital to offset having to see consults after their main office day. I just have no control over the subjective opinions of the physicians and I also don't have control over what comes in from the hospitals. They are open to ideas, but, I don't have any. Can anyone provide any sort of alternative bonus structure? THANKS!
  2. Hello, I am still rather new to the derm world and I am coming up on my first annual review. I could really use some help with negotiation, in terms of salar and bounus strucutre. I have been working as a PA for almost 2 years and working in dermatology for about 14 months. I had a three month training period where I was paid 5,200 per month (working well over 50 hours/wk.) Then I began seeing my own patients making 83,000/year with a 5% monthly productivity bonus after 10,000 collections for the practice. I usually work 4 1/2 days per week and 6 days once a month when we are open on a Saturday. I work on average 40 hous work weeks, get 2 weeks paid vacation, one week CME, holiday time, and $1500 for CME yearly. I am coming up for my annual review and expect my supervising physician to start by making me an offer. I see about 20-25 patient per day plus new patients with my supervising physican. The new patient visits are all billed under his name. I usually stay for the whole visit, write prescriptions, perform the surgery, etc. Just to calrify things, new patients are never put on my schedule. I am not sure why he has structured things in this matter, but obviously this effects my productivity. Initally he had told me that I am not allowed to see new patients, however I knew this not to be true. When I confronted him he said our billing company had advised him to do things this way. Billing has explained to me that there is a lot more verification needed before a new paitent can be scheduled with me as some insurances are not reimbursing for new patient visits with a PA. We see a lot of medicaid patients so this may be why I am running into this problem. Any how, I would appreciate some advice on how to structure my salary and bonus structure given my years of experience and the limitation with aquiring new patients. I am wondering if I should be compensated more in my base salary for this reason? Also, the current bonus structre may have been fine for my first year, but now I feel it is a little too low. Please let me know any advise you may have. I would really appreciate your help.
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