1099 sucks or "anyone want to start a union?"

[problem child]

I went locums this past year bc I was tired of being hired for a 40 hour week and then working 50 or 60 (without being compensated for the extra hours), or even a 20 hour week and working 30 (again, without extra compensation...and being told, "hey, if you don't like it, there's the door"....)....so I am contacted regularly by recruiters (as I'm sure many of you are), and I would estimate that ~60% of them are offering locums employment to PAs as independent contractors (1099).

 

in my state (MA) the labor law under the attorney general's office seems to have wording very specific which precludes PAs from working as 1099s:

http://www.mass.gov/ago/docs/workplace/independent-contractor-advisory.pdf

 

my problem with working as a 1099 is there is NO payroll tax withholdings, the PA pays all their own taxes, there is NO unemployment insurance available when your contract ends, no workmen's comp protection...but really, by definition, how can a PA (who requires an SP) be defined as an INDEPENDENT contractor? we do not carry out our duties "without control or direction", whether it be by our SP, an attending, the surgeon on-call, or a chief resident.

 

anyone else have experience with this? it adds more fuel to my fire of wanting to start a union.

 

1099 work is basically being paid scab wages and screwing ourselves of ALL benefits, not just employee benefits like healthcare and retirement. it undermines PAs who want to work and have some of the things we deserve, like benefits, bc 1099s undercut the bidding price for our services. it robs the state of tax revenue which we then have to pay ourselves. the agencies pay NO TAXES, we also have to pay all 15% of our SS tax, not the 7.5% usually split with the employer.

 

I will not work for an agency that hires PAs as 1099s and I urge you not to either. insist on a W-2 where they at least cover the payroll taxes.

 

I'd like to hear the experience of others (please no wild speculation, raving, whining, or complaining - EXPERIENCE) and if anyone out there wants to start talking union, message me. I've had it with being screwed.

[winterallsummer]

What's unfortunate are the jobs that hire as W2s but do not provide any benefits (albeit they have good hourly/salary wages).  

[problem child]

What's unfortunate are the jobs that hire as W2s but do not provide any benefits (albeit they have good hourly/salary wages).  

 

some do offer benefits (like health care coverage after a certain amount of time, etc, or right out of the box) - but what you lose working as a 1099 is criminal. I would work as a W2 locums with no benefits (although health care would be nice) and just ask for a higher rate to cover my health care costs, etc. I have done this successfully - it's called "negotiating". trouble is, companies like these are being undermined by these 1099 hyena-pack companies who hire and pay no taxes, nor do the hospitals to whom they send the "independent contractors". the PA pays all the tax burden.

 

it's sickening.

[burnpac]

you have pointed out well the significant pitfalls to working as a "independent contractor." there is a reason why employers want to treat you this way, and it has nothing to do with benefiting the PA! they do a because it's in their best interest to avoid wage and hour rules as well as to avoid employer side taxes.

 

There is no interpretation of IRS rules on independent contractors that would view PAs as eligible.

 

It is not all bad however. The risk is all on the employer side. If they get caught classifying PAs or any other workers as independent contractors when they are not, the penalty is double taxes, back OT, penalties for missed breaks, etc.

 

The goal for someone contemplating being treated as a 1099 employee is to make enough per hour so that these issues don't matter to the PA. Then you pay your quarterly taxes as directed by your accountant, and it could be beneficial. There is a different way in which to do it which gives all the control to the PA.

 

I have had my own physician assistant corporation in California for almost 10 years now. I contract with all of the physicians and medical groups as a "leased employee," and they pay me by the hour, or by the month, or any number of other schemes. I work for my corporation, and the corporation pays me a salary, and all employer taxes from the gross proceeds from my various contracts and direct billing for clinic and first assist. I have my own 401k (which I also contribute to on the employer side to the max each year), and get to write off a lot of business expenses through the corporation. I would never go back to being someone's employee ever again.

 

Unionizing is not the answer, because there is no one to collective bargain with in a small group practice / organization. They will tell you to go F. yourself and hire someone else. It would work in large HMO / ER group / Etc. organizations where there are many PAs working for the same employer. However, groups like this don't often treat PAs as 1099s because they have good labor attorneys and they don't want to take the chance of getting screwed by the wage and hour folks when they treat employees unfairly or illegally.

[gbrothers98]

1099 is not a good deal individually unless you have gotten some good tax advice prior to entering the relationship and have a plan to itemize and deduct much of your expenses. As OP pointed out interpretation of state law can make working as 1099 a difficult premise but the recruiters offering this likely justify the status based upon temporary nature of staffing. Plus the reality is that they just serve as a conduit between you and place you work at, which is whom will basically be held responsible in the end since you technically worked for them and not for the agency.

 

As for unionizing, that would be a difficult thing to do nationwide, there are pockets of healthcare that are union jobs. Seeking them out in your local area may be worthwhile. 

 

Overall I think there should be several things that need addressing.

 

First, at PA programs across the country, job search, employment arrangements, contract negotiations and salary levels should be points of discussion and teaching early in the training. You know that docs out of residency know their worth but if you discuss with many PAs they have not one insight into the business they have entered.

 

2nd, whether you pursue 1099 or W2, understand the role of taxes and benefits. If you succeed in obtaining a W2 position without benefits, understand that for many positions benefits are usually a third of your salary. So if you are making 100k, up to 33k above that entails employer cost of benefits. So the savvy negotiator tallies up prorated benefit cost ie health, life, disability, dental, malpractice, 401k match (you can open a self directed 401k if employer does not contribute), lic fees, cme costs and adds it to the hourly rate.

 

The reality is that most PAs should not work for less than 60-75 (and more dependent upon specialty) an hour without benefits dependent upon geographic location.

 

3rd, here is my fortunate anecdotal experience. I am an employee of an PA owned group that staffs 2 rural EDs in New England.

All the employed PAs are salaried employees, work above scheduled shift and above prorated contract hours for the month is awarded an hourly rate in excess of above rate. Salary is consistent with 75th% or higher on AAPA survey for EM PAs dependent on several factors. All prior benefits I outlined are paid in full by employer.

Employer passes all costs to staffed facilities.

 

Its a better mousetrap. Even at the level of compensation we receive, both facilities could not get a contract agency in for less nor could they hire and fire on their own when they run the numbers if they chose to staff with docs. When the PAs were employees of the facility, both could not recruit other PAs to save their lives. I was in that situation and worked over 21 12 hour shifts a month, switching from days to nights to days, working many weekends. I would never go back to that again.

 

On top of that we provide a consistent competent service to both facilities, have high pt satisfaction scores, low time to patients and short throughput (unless you are a psych pt which we have minimal control of).

 

I saw something similar happen when I lived in a small midwest city. The local CRNAs got sick of both the medical center and the local anesthesiology group. They knew they were doing the majority of the cases if not all and were being compensated poorly plus treated badly and overworked. A new surgicenter opened and all of them went there as a group that worked similar to what I described above and REFUSED to work at the medical center till they were hired back as a separate staffing group. The medical centers surgical case load plummeted and they could not entice enough locums CRNAs nor anesthesiologists to get their volume back up. Plus locums are extraordinarily expensive and their cost ate into every surgical case.

 

So my last point is that one does have to look for opportunities locally or try to make them happen locally. On the other hand, there is plenty of fuel here for national organizations to latch on to and make an agenda around. One issue that does not seem to be associated with this but actually is, is the issue of independent practice for PAs. Much of the restraints faced by experienced PAs to improve their employment situation stems in part from the need for supervision. The AAPA has to address this in the near future. PAFT already does. They have a survey that bears filling out that can provide better direction for this issue to be discussed and addressed. Go to their website and take a look.

 

G Brothers PA-C

[Corpsman2PA]

Agree with all that's been said. I was offered some per diem work, and they tried classifying me as 1099. After researching it, I said heck no. Not worth it at all.

 

 

Sent from my iPhone using Tapatalk

[ventana]

just say no to 1099 unless you are at or over $100 per hour

 

If everyone did this it would stop the silly low ball offers

 

 

 

Where are you working?

I am in mass and hiring for a part time house call PA.....  or I know of a NH that is hiring, and it is a great facility where I have worked - rare but true - great nurses, staff and doc.

 

 

 

 

 

 

BTW last time I looked most locums were offering 45-55 as a 1099  I flat out declined and told them their is now way in HECK I will EVER work for that -- no way no how - then went on to explain what we are worth - most recruits just don't care and just want a warm body to fill a slot, but I felt like maybe I was helping out the next person

 

 

 

We as a profession MUST hold our own salaries up high - if we have PA accepting low ball offers it hurts us all........  just say no

[BruceBanner]

I've just been debating and dealing with this same thing.

 

I work as a 1099 for a per diem gig, but the pay is substantial----$140-285 per pt (each visit is 15-30 mins). Some weeks I will see 20-30 pts...which is good money for a couple 6 hour days. I've been saving 35% of all my checks for taxes, and crossing my fingers it's enough. I figured I need to add 10% on top my usual 25% tax bracket.

 

I had another job recently offer to take me on as a full-time 1099, to which I said no. 

 

Most jobs that offer 1099 do so to avoid taxes and basically any other costs associated with you. It really does not benefit you at all unless you are making close to double what you would as a W2. I've been offered as low as $40-45 per hour as a 1099. Pardon my french but ****** please. It's insulting, and when PAs take offers like this, it drives down our market value. Many, if not most employers see PAs as 'cheap' medical labor. Give us a borderline "competitive" salary, some modest benefits, and then expect us to be real go-getters, have amazing customer service skills, and praise them for their generosity.

 

Employers will low ball PAs (especially those with <5 yrs exp) as much as they can get away with. Part of it is I think they really don't know our scope and the extent of our training, and part of it just plain old economics. I'd be all for starting a national union. We need it.

[Boatswain2PA]

Some folks are saying you shouldn't take $50/hr for 1099 work....but that depends on what the work is, and what the cost of living is in the area.  I occasionally work for that little, but it is for a place that gets an average of 2-3 patients a DAY in the ED.  They pay me $1200 per day to just stay in town, and they put me up in a nice house a few blocks from the hospital.  My wife usually joins me as well and we get a nice, relaxing weekend....and a $3600 bonus check (half of which goes to taxes).

Oh, and I live in an area with a median household income of less than $45K a year, and you can buy a McMansion on 80 acres of prime deer hunting land for about $400,000.

[burnpac]

Some folks are saying you shouldn't take $50/hr for 1099 work....but that depends on what the work is, and what the cost of living is in the area.  I occasionally work for that little, but it is for a place that gets an average of 2-3 patients a DAY in the ED.  They pay me $1200 per day to just stay in town, and they put me up in a nice house a few blocks from the hospital.  My wife usually joins me as well and we get a nice, relaxing weekend....and a $3600 bonus check (half of which goes to taxes).

 

Oh, and I live in an area with a median household income of less than $45K a year, and you can buy a McMansion on 80 acres of prime deer hunting land for about $400,000.

 

As he said, it is all in the context. If the working conditions and pay are right, then do it. If not, don't. The economics of the situation, and the lack of ability of employers to recruit qualified PAs will do more to shape the working environment than anything else. It is a PA market right now. Don't work in sh*tty jobs.

[Boatswain2PA]

As he said, it is all in the context. If the working conditions and pay are right, then do it. If not, don't. The economics of the situation, and the lack of ability of employers to recruit qualified PAs will do more to shape the working environment than anything else. It is a PA market right now. Don't work in sh*tty jobs.

I find it interesting how the PA driven market is so incredibly local.  In the city where I live (and there is a PA and NP program) the PAs make $80-95K/year, but they get worked to death.  Most jobs are hospital based specialty jobs where they frequently take first call.  While they get great benefits from the hospital systems, their time off is usually limited.

 

Meanwhile you can drive an hour (or more) away from the city and get paid much more for locums work because the rural hospitals are so short staffed.

[problem child]

Some folks are saying you shouldn't take $50/hr for 1099 work....but that depends on what the work is, and what the cost of living is in the area.  I occasionally work for that little, but it is for a place that gets an average of 2-3 patients a DAY in the ED.  They pay me $1200 per day to just stay in town, and they put me up in a nice house a few blocks from the hospital.  My wife usually joins me as well and we get a nice, relaxing weekend....and a $3600 bonus check (half of which goes to taxes).

 

Oh, and I live in an area with a median household income of less than $45K a year, and you can buy a McMansion on 80 acres of prime deer hunting land for about $400,000.

 

how do you get $1200/day out of of $50/hr? even for a 12 hr day that's $600/day.

 

if I do locums and it's 1099 (which I have discovered recently is illegal in my state, bc a PA by definition cannot be an "independent contractor" on a number of levels, the SP being one of them), I take nothing less than $75/hr bc I have to cover my own tax liability (est 30%). as for a 1099 being a misclassification, it's true - we do not practice completely free of direction or control; we take input and direction all the time from nurses, residents, SPs, attendings; we are provided with equipment by the hospital, and we do not provide a service which is outside the scope of business provided by the institution....so 1099 is a misclassification of a PA and is cheating not only the PA out of sharing the payroll tax load but also cheating the state of tax revenue. PAs who are 1099s are basically being hired as scabs for companies which don't want to pay any taxes to the state or provide any benefits (including workmen's comp, think about it) to the provider.

[ventana]

how do you get $1200/day out of of $50/hr? even for a 12 hr day that's $600/day.

 

if I do locums and it's 1099 (which I have discovered recently is illegal in my state, bc a PA by definition cannot be an "independent contractor" on a number of levels, the SP being one of them), I take nothing less than $75/hr bc I have to cover my own tax liability (est 30%). as for a 1099 being a misclassification, it's true - we do not practice completely free of direction or control; we take input and direction all the time from nurses, residents, SPs, attendings; we are provided with equipment by the hospital, and we do not provide a service which is outside the scope of business provided by the institution....so 1099 is a misclassification of a PA and is cheating not only the PA out of sharing the payroll tax load but also cheating the state of tax revenue. PAs who are 1099s are basically being hired as scabs for companies which don't want to pay any taxes to the state or provide any benefits (including workmen's comp, think about it) to the provider.

 

 

$50 x 24 = $1200

[BruceBanner]

Oh, and I live in an area with a median household income of less than $45K a year, and you can buy a McMansion on 80 acres of prime deer hunting land for about $400,000.

 I wanna live there. 

 

Actually I love it here, but $400,000 gets you an upper middle class house on a half-acre in the burbs.

[Boatswain2PA]

how do you get $1200/day out of of $50/hr? even for a 12 hr day that's $600/day.

 

if I do locums and it's 1099 (which I have discovered recently is illegal in my state, bc a PA by definition cannot be an "independent contractor" on a number of levels, the SP being one of them), I take nothing less than $75/hr bc I have to cover my own tax liability (est 30%). as for a 1099 being a misclassification, it's true - we do not practice completely free of direction or control; we take input and direction all the time from nurses, residents, SPs, attendings; we are provided with equipment by the hospital, and we do not provide a service which is outside the scope of business provided by the institution....so 1099 is a misclassification of a PA and is cheating not only the PA out of sharing the payroll tax load but also cheating the state of tax revenue. PAs who are 1099s are basically being hired as scabs for companies which don't want to pay any taxes to the state or provide any benefits (including workmen's comp, think about it) to the provider.

72 hour shift X $50/hr = $3600.  Easy to do if you're only seeing 3-4 patients a day.

 

You cover most of your tax liability when you are a W-2 employee.  Your employer just withholds it from you and sends it to Uncle Sam for you.  There is an additional self-employment tax that you have to pay, but it is slight.  It certainly is not an additional 30%.

 

I understand you have strong feelings about this...but I would argue that I am not a "scab".  I make much more than the average PA salary in this area.  It's not our fault that you live in the socialist commonwealth of Massachusetts.  I worked in Boston for a couple of years, you couldn't possibly pay me enough to live/work there again. 

 

Western Mass is beautiful, but unfortunately the politics is controlled the Boston mafia, err, ahem, I mean politicians.

[cbrsmurf]

Last time I calculated it, 1099 was additional +7.5% on my gross income vs W2

[davidlewispa]

I work as an independent contractor and wouldn't do it any other way. I have an S-Corp and accountant and I pay 20-22% in taxes. I get $15 more per hour than the W-2 mid-levels because I have no benefits. I went back to W-2 for 3 months and the additional tax burden was ridiculous. I went right back to IC.

[Boatswain2PA]

Last time I calculated it, 1099 was additional +7.5% on my gross income vs W2

As an IC you get to deduct expenses that you don't get to deduct as a W2 employee which reduces your overall tax burden as well.

[cbrsmurf]

As an IC you get to deduct expenses that you don't get to deduct as a W2 employee which reduces your overall tax burden as well.

 

That is indeed true, although I didn't too many expenses that I could remember besides gas and food

[problem child]

$50 x 24 = $1200

 

 

oh. you said per/day. I wondered if it was a weekend gig

[Boatswain2PA]

Yeah, I'm not going to drive 1-2 hours without doing a 24 hour shift, or 3-5 hours without doung a 48-72 hour shift.

[problem child]

As he said, it is all in the context. If the working conditions and pay are right, then do it. If not, don't. The economics of the situation, and the lack of ability of employers to recruit qualified PAs will do more to shape the working environment than anything else. It is a PA market right now. Don't work in sh*tty jobs.

 

if you accept $50/hr (or $45, as I've been offered [i laughed and hung up]) for a 1099 - you will only be earning about $35/hr pay bc you have to put aside appx 30% to cover your income taxes. as a 1099 you pay ALL of your SS (15%), and that's on top of whatever your other tax liability is (usually around 20-22%).

 

at least as a W2 locums, they take out your taxes and pay half (7.5%) of the SS. so your tax burden is lessened. and there really are no significant deductibles besides food, and any locums - 1099 or W2 - will cover your lodging and mileage. so not a lot to deduct. coupla lab coats and a pair of clogs? yeah, THAT'LL bring your tax rate down!! ...NOT...

 

I ALWAYS tell any 1099 locums offer (although I won't do 1099 anymore) that I must get 30% above my normal rate ($75-80/hr) to cover my tax liability. I get it, but on my last job I was screwed out of the overtime they owe me. I'll happily do W2s at a higher rate to cover my health insurance and other costs, but never again a 1099. its the first question I ask when an agency calls, "is this a 1099 position?" and they say, "well, yes...", and I tell them thanks but no thanks.

 

I think the 1099 stinks also for reasons stated above - you are seen as cheap labor and no one - not the agency or the medical center, hospital, whatever, have ANY responsibility to you as an employee. try collecting workmen's comp if you get hurt on the job - it doesn't exist. and since no one is paying payroll taxes on you, you are ineligible for UE between gigs. anyone remember how long credentialing can take waiting for the next job?

 

I like what I've read above about some of these practice groups and may want to PM for further info. that's awesome, esp what the CRNAs did!!

 

I like locums bc I don't like being owned by these f&cking institutions that take advantage of us, don't pay us for all the extra hours we work and grind us down to nubs. with a pile of disrespect thrown in to boot. and I like working in new places, meeting new people, etc. I like my freedom. and done right, you can have jobs lined up with nice little breaks in between. but nothing works always like clockwork....

 

anyway. I'll skip the union idea, but I do like the practice groups idea!

[problem child]

I had a call from a doc today looking for a part-time 1099er....I realized almost right away that I had interviewed with him once before early this past year, and I told him I thought we had already met (the job posted is in a specialty I'm interested in switching into, addictions medicine). 

 

the first time I met him was at a starbucks last spring. we did the usual song and dance over coffee, and then the bottom line: $45/hour. for 1099 work. I told him that that wouldn't come close to meeting my financial needs and we parted cordially.

 

(I also asked where he had practiced medicine - because he looked of retirement age - and if he was getting into these suboxone addiction clinics as sort of a part-time thing. he said he had never practiced medicine; he had only kept his license active throughout his lifetime for "entrepreneurial" reasons. so he's preying on the money to be made off suboxone and the suffering addicts who seek it, without a bit of compassion for addicts or medical knowledge of addiction itself).

 

I went out and got in my car and watched as he left and got in his. it was one of these:

 

or something like that. I think his was a little sleeker so probably more expensive.

 

so when he called me today, he introduced himself, and we talked until he finally remembered the earlier interview we had had, and he said, "oh yes, we couldn't come to terms financially". and I said "that's right", and then spelled out to him why 1099 was such a poor deal for me as a PA (no benefits, no UE insurance, no workmen's comp, high personal tax rate, few deductions) and then I said, "so, yes, I think you were offering ~$45-50/hour". he said, "yes, that's right". and I said, "well, on my last locums, which was a 1099, I asked for and was paid $75/hour to cover my tax liability, and when I realized other financial matters relevant to being a 1099, I now wouldn't take less than $100/hour". we again politely said goodbye. LOL!

 

he has one NP in there already and I feel sorry for her. being a 1099, and based on the fact that NPs make a little less than we do, she's probably clearing $20/hour for this viper.

[UGoLong]

I worked from 1099s for 12 years in another line of work and loved it. The key is knowing how much you need to make to cover all of your expenses, including all taxes, a “unit k” (personal 401(k)), and so forth.

 

Unlike a regular W-2 employee, what expenses you have will come off the top, rather than just not having to pay the taxes on your expenses. So, if you need a computer, want to go to a class, pay for your licenses, buy a book, or whatever, it is as if that money never existed: it is subtracted from your gross income before computing taxes. When I did it, 100% of your health insurance premiums also were a business expense; not sure it that has changed or not.

 

Not to say that there aren’t people out there who want to get you on the cheap. You just say “Thanks but no thanks” and move on. You are actually your own company and you set your rates accordingly. Not everyone will be your client but, if you’re good at what you do, enough of them will be.

[BruceBanner]

I expect to be low-balled by any businessman. That's what they do---utilize someone else's skills and credentials to make the majority profit. I don't fault them for it; if I had a business I'd want to maximize my profits too. I'm just really wary now of any practices ran by a business or sales person and not a clinician or organization. You will ALWAYS be getting marginalized to some degree for their benefit. That's capitalism. You cant hate the game, just don't play it. Or figure out a way to be the on the winning side.