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Hello PAs! I need some advice. I'm a new grad, my last clinical rotation in family practice was wonderful- 100% supervision, very functional office- everyone communicates and patients are seen on time. I recieved a job offer from this site- I worked with the doc already for a month in clinicals I know we communicate well and he liked me enough to hire me! Three interviews including contract negotiation, we had decided on the contract revisions, benefits, salary etc.. and then I get a call from his office manager stating "they looked at the books and decided not to hire anyone right now, they don't have the patient volume they thought they did and financially it just isn't working out." Hold on, the entire time I was there during clinicals they had just lost their third provider and were short handed, he was interviewing to fill the position for months! So I told the office manager I felt mislead, that I had accepted the position pending revisions and she said she'd call me back right away. 45min later the doc calls me and says "I offended him in negotiations by asking for tail coverage" "It feels like I don't trust him (background- I added a section to the contract stating he would furnish me with supplies necessary to perform my job)" "And we just aren't going to have a good working relationship because I don't trust him and I was so egregiously offensive." His tone was almost hostile, It took me completely by suprise. When we had negotiated the contract just a few days prior he was smiling, very agreeable, he was happy to make the changes and we left with a side-arm hug saying "I'm happy to have you work for me." Well long story short I told him I was willing to renegotiate and he offered me the contract again- with a few of the revisions I had suggested and he "never wants to talk about our misunderstanding again." and I should "write the AAPA and tell them their advice almost lost me my contract." So now what? do I accept the job? Before those two disturbing phone calls this was my dream job!

 

The job:

$82,000/yr with growth potential

max 15 patients/day [and their patient pop is on the younger side]

M-F 8-5

One Sat OR Sun per month at the group's urgent care

NO CALL EVER!

Employer pays 75% of Health/Vision/Dental premium (AETNA!)

401k graded matching (2%/year and 20% if I leave after 1 yr, 100% if I stay for 5yrs)

$1500 CME allowance

He will reimburse me for all licensing fees including PANCE, TMB app, JP Exam, etc.. another $1k

The clinic is new, equipment is in great shape, I get to perform small procedures- skin cancers, testopel; fun stuff

Location is great, 20min from my house

I don't have any other offers, I have no doubt that with some time I could find another job in my area.. but maybe not with all these perks? Advice??

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I will bring up the same question that I bring up every time this type of discussion occurs.  Why does a new grad, assuming first position, need tail coverage?  What are you needing "tail coverage" protection for?  You were/had to be covered by your program's student malpractice coverage, which by the way, I've never heard a tale of a student being named in a malpractice case though I'm sure that it's happened to someone.

 

If you're asking for a tail coverage policy to be purchased at the time that you leave the practice at some point in the future then I think that is on you as the employee, or a generous future employer.

 

Addendum:  My initial statement is not said in anger or frustration, but is only asked as a true question.  It's hard to tell with posts/texts sometimes.

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I've never negotiated a contract, it's sounds like a good job, and I don't know your situation. For me though, and it is a personal opinion, I wouldn't work for somebody who was that thinned skinned, a group that would lie to me, and someone who would be hostile at any point in negotiations. I find speaking in any such tone unprofessional and would only conclude that such behavior would continue. That's just me. You worked with him and know better than I.

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Just to give you a heads up..... the word police will be by soon to address your use of the word "mid levels".  Some people on this forum are very sensitive to the term.

 

If you can still edit your post and remove that word it might prevent this thread from turning into an argument over the use of words to describe the profession.

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Why would it be generous for an employer to cover the cost of covering malpractice for work you did for them? I am sure OP was asking for tail at the end of their employment. I sure as hell made sure that was covered at the gig I recently accepted. If it wasn't I would have wanted an increased pay to be able to pay for it on my own.

 

As for OP, I would tread carefully and be twice as sure stuff is in writing. That kind of behavior is a big red flag to me, personally.

 

 

 

Sent from my PC36100 using Tapatalk 2

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^^^  Why would I as a future employer want to pay to cover malpractice for a different employer/time period?  Seems to me it would be so much easier for folks to get their own occurrence policy, have the employer pay for it, and then you don't have to worry about a tail.  I still don't think folks understand the difference between the two types.

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Like I was saying, I think OP was asking for his hiring doc to pay for tail for the time he works there, when he does leaves the practice.

 

Sent from my PC36100 using Tapatalk 2

 

 

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Just to give you a heads up..... the word police will be by soon to address your use of the word "mid levels".  Some people on this forum are very sensitive to the term.

 

If you can still edit your post and remove that word it might prevent this thread from turning into an argument over the use of words to describe the profession.

I'm one of those people. Avoid using the term mid-level. You don't practice mid-level medicine!

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To the OP:

 

This is a bad way to start a position with this practice. Hard to have an open communicating relationship with a doc if they put rules on what you can and can't talk about, no?

And the fact that  the group tried to dismiss you with a story about staffing needs, and then you only find the real scoop after a callback?

 

Also you didn't include CME funds in the job description, hope they are offering that.

 

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It's an open wound. I know many people who see work as a job and can follow directions and more important leave conflict there. Others live their job and carry conflict with them. For me. I don't do well with sensitive people who are reactionary. I'd probably walk.

 

Oh and I think the offer is just so-so for a new graduate.

 

 

Sent from my iPhone using Tapatalk

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To the OP:

 

This is a bad way to start a position with this practice. Hard to have an open communicating relationship with a doc if they put rules on what you can and can't talk about, no?

And the fact that  the group tried to dismiss you with a story about staffing needs, and then you only find the real scoop after a callback?

 

Also you didn't include CME funds in the job description, hope they are offering that.

 

This sums up my reaction after reading the OP; just one red flag after another.

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I will bring up the same question that I bring up every time this type of discussion occurs.  Why does a new grad, assuming first position, need tail coverage?  What are you needing "tail coverage" protection for?  You were/had to be covered by your program's student malpractice coverage, which by the way, I've never heard a tale of a student being named in a malpractice case though I'm sure that it's happened to someone.

 

If you're asking for a tail coverage policy to be purchased at the time that you leave the practice at some point in the future then I think that is on you as the employee, or a generous future employer.

 

Addendum:  My initial statement is not said in anger or frustration, but is only asked as a true question.  It's hard to tell with posts/texts sometimes.

If you are asking for a tail coverage, Essentially you are asking that the company provide coverage for the terms of employment at the company. This is a very reasonable request. The option is to insist on occurrence coverage which is usually much more expensive. As far as being your responsibility, I guarantee the physician owners are taking it as a practice expense, not out of their pocket. I also guarantee that physician employees are getting this covered. 

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"Tail coverage" in a contract doesn't mean tail from the previous job, it means tail coverage in the future, for claims made after employment had terminated for events occurring during the employment.  I have no idea why anyone who knows anything about insurance would think otherwise.

 

But yeah, that's simply not going to work out, so stop hoping it might.  They like you fine for free, they don't like you for $82k/year plus bennies, and that's all there is to it.

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 They like you fine for free, they don't like you for $82k/year plus bennies, and that's all there is to it.

 

Exactly!

The switch from free student labor to paid employee tends to bring an entirely different perspective to the table…welcome to the world of being a PAC!

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I join in to say OP walk & don't look back. It wasn't meant to be. Better pulling the plug now than say 1,2,3+ years in...look at it that way at least.

 

The initial phone call from the practice mgr was the Yellow Card and the actual phone call from the doc was the Red Card (red flag)..

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"Tail coverage" in a contract doesn't mean tail from the previous job, it means tail coverage in the future, for claims made after employment had terminated for events occurring during the employment.  I have no idea why anyone who knows anything about insurance would think otherwise.

 

But yeah, that's simply not going to work out, so stop hoping it might.  They like you fine for free, they don't like you for $82k/year plus bennies, and that's all there is to it.

I understand the concept Rev, and yes, some folks do ask for tail coverage when interviewing for a new job to cover their current job if going directly from A to B if it hasn't been provided already (first jobs especially when they didn't understand the concept of claims-made and occurrence based).  What I would not do as an employer is agree to such a situation as a contractural obligation before knowing the circumstances surrounding the cause for leaving my employment.  That's just me.

 

I stand by my original statement to just get your own occurrence policy and either have them pay for it or reimburse you for it.  Now you don't have to mess with this.  If negotiations are going through the office manager/administrator I wouldn't be surprised if THEY didn't understand the concept either.

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I will bring up the same question that I bring up every time this type of discussion occurs.  Why does a new grad, assuming first position, need tail coverage?  What are you needing "tail coverage" protection for?  You were/had to be covered by your program's student malpractice coverage, which by the way, I've never heard a tale of a student being named in a malpractice case though I'm sure that it's happened to someone.

 

If you're asking for a tail coverage policy to be purchased at the time that you leave the practice at some point in the future then I think that is on you as the employee, or a generous future employer.

 

Addendum:  My initial statement is not said in anger or frustration, but is only asked as a true question.  It's hard to tell with posts/texts sometimes.

 

 

 

It always amazes me when people do not really understand insurance coverage, in what is being presented. I'm sure some of this is due to an abbreviated presentation on the Internet.

Tail coverage is utilized after you leave the position.  Most companies have malpractice which covers the Corporation as long as it is in place, if they have an occurrence you are fine, but if they do not you will be looking over your shoulder hoping you don't get sued. The employer gained the revenues and profit from your efforts while paying a lower malpractice rate by going with a claims made, it is exceptionally reasonable and should be standard practice that they offer to purchase a tail coverage policy upon your leaving. You are correct in negotiating this up front as you will never get them to pay it unless it is in the contract

 

 

 

 

 

 

 

 

 

 

 

 

Why would it be generous for an employer to cover the cost of covering malpractice for work you did for them? I am sure OP was asking for tail at the end of their employment. I sure as hell made sure that was covered at the gig I recently accepted. If it wasn't I would have wanted an increased pay to be able to pay for it on my own.

 

As for OP, I would tread carefully and be twice as sure stuff is in writing. That kind of behavior is a big red flag to me, personally.

 

 

 

Sent from my PC36100 using Tapatalk 2

 

 

Bigger issue than the insurance is how the dock seems to flip flop so much.  He is playing with your life, and seems to be a bit bipolar. These do not make good supervising physicians nor good bosses

 

 

 

 

 

^^^  Why would I as a future employer want to pay to cover malpractice for a different employer/time period?  Seems to me it would be so much easier for folks to get their own occurrence policy, have the employer pay for it, and then you don't have to worry about a tail.  I still don't think folks understand the difference between the two types.

 

 

 

In a perfect world we would all have an occurrence policy, but that is expensive, I pay close to $6000 for mine and that is without touching an ER or OR without any procedures.  As a new grad there is discounted policies out there, but realistically it is the responsibility of your employer to provide your malpractice insurance.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I think you did fine in the negotiation, remember it is just business. It does provide a glimpse into their reaction and "honor" so to speak. If it looks like a good job, make sure you get everything in writing, take it, learn as much as you can, and if he is a total failure as a supervising physician get a different job after a couple years. It is interesting that they just had their third provider leave, does not sound like a good environment.

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The occurrence cost is dependent, as you all know, on risk stratification based upon practice setting, as it is with a claims-made policy.  Mine is under $1K annually and I keep it regardless of employer coverage because I wish to have someone look out for MY best interest (legal coverage) as opposed to that of the deeper pockets of the practice setting.  V, I understand the comments about asking for the tail and how the tail works.  If you can get them to pay for it, have at it and I think that you have negotiated well in that regard.  It would be interesting to know what the cost comparison is across the spectrum of risk stratifications (I-IV) and whether or not there is a break even point on having occurrence based versus claims-made, factoring in the tail-coverage.  I've never had a tail-coverage need so I have no idea what the cost is though I would assume it would be greater than the equivalent of one years premium.  My misunderstanding was the assumption that it was a common occurrence to have an employer pick up the cost of a tail coverage when you are leaving their employment.

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under 1K for occurrence?

What are your limits?

 

That is crazy cheap - who it writing it so I can have them quote my policy!

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$100/$300K, Cat. I (office based primary care), Marsh (Seabury & Smith), occurrence based.  Annual premium $984.  Texas has had tort reform so I'm "only" out $250K max/occurrence due to exclusion of "pain/suffering".  Minimal coverage to keep target off back (no assets that can be claimed in an award, i.e.-house, one of two vehicles are protected, as are all retirement accounts as I recall).  This policy was used with past position which was also said to be covered by umbrella for department (local gov't).  Moving to VA, malpractice coverage won't be needed.  May keep it since it's good through Jan. in case I have a mental meltdown and decide to moonlight (can't imagine doing that).  Since I'm no longer hospital/free-standing clinic based there are no institutional mandated minimum coverage amounts.

 

If not mistaken, I think AAPA endorses this bunch at present, though I hooked up with them before AAPA did.  Wife has hers through them (dental hygiene).  You don't want to even begin to guess what her premium is for $1/3 million (less than $100/yr.).

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