PA union

[kittryn]

given the overall state of our economy, and the particular hiring practices "enjoyed" by most PAs (exempt, salary = no OT, no limits on hours, no protection), has anyone out there started to warm up to the notion of starting a PA union?

I have brought this topic up from time to time over the years on this forum, and it has always been politely shut down.

 

I find it so unacceptable that we do not have the luxury of, say, signing out our "shift" (hours actually hired to work) to another PA, the way nurses do. the upshot is we end up OWNED, with no power to say, "uh, sorry, but my shift's over and I need to go home now", much less actually do it. I watch scrub nurses sign out to each other MID-OPERATION without anyone even batting an eye. they are told, "have a great night!" as they break scrub and LEAVE.

 

even suggesting that one expects to go home at the end of their work hours is automatically put in the crosshairs for being fired.

 

nurses (as in NPs) have a union, and they enjoy a great deal of protection and salary standards that we do not.

 

why don't we? 

[rev ronin]

I negotiated a lower base salary, but 20% of my time for charting, all charting done on the clock, and time and a half for more than 80 hours in a two-week pay period. I'm still making less money, but working a lot less hours and enjoying life quite a bit better than I was at my previous practice.

 

ETA: Not to mention, I get to give my patients better service and actually do better patient care in a "fee or service" practice than I did in a managed health/capacitated practice, which really drives job satisfaction.

[Acebecker]

The thing that strikes me about the desire to be like the nurses is that they are nurses.  We have totally different jobs and we actually own responsibility for the patient.  Our nurses bear perhaps a small amount of responsibility, but for the most part they are not calling the shots, they are not the one holding the buck for the patient should something happen.  That is why we can't leave mid-case (or even before our cases for the day are done if they should go long).  We have signed on to be part of the surgical team bringing our expertise to the case so that the patient will have a better outcome from their operation.  The nurses do not get to do that.  They are not awarded with that privilege as they are nurses. 

 

Now, I think having a sign-out option would be fantastic.  I now work primarily urgent care and at the end of an 11 hour day it's not unusual that I've had to say, "Nope, sorry... Can't see you today because we're too busy," to one or a handful of people.  Now, these patients have somewhere to go, so I try not to feel too bad about it especially when I've seen 44 patients and triaged 6 others already.  I would love to be open for longer hours to be able to take care of more people, but I can only do so much.  It would be great to sign out my overflow to someone else...  Is a union the answer?  I don't know. 

[EMEDPA]

I was part of a union once as a PA and I've got to say, it was sweet. 2 guaranteed raises/yr, get paid for the whole shift if you see a single pt and later leave, etc.

punch line: it was a nursing union that the pas were a part of at a major hmo. the union doubled our salary overnight and came with lots of nice benefits( 12 weeks vacation at 10 years, 6 mo sabbatical at 1/2 pay every 6 years, etc). I would not be opposed to having this again.

As a senior pa there at 13 years I was making more than the new fp docs....of course, the job sucked so I left for a better scope of practice and more autonomy elsewhere...

[PACdan]

...12 weeks vacation at 10 years, 6 mo sabbatical at 1/2 pay every 6 years, etc...

 

Sign. Me. Up. :)

 

Unless it was KP, I have mixed emotions about KP.  Did it suck as in boring-suck or as in 35th-patient-of-the-day suck?

[cinntsp]

We aren't nurses, so we shouldn't use them as an example. 

[EMEDPA]

Sign. Me. Up. :)

 

Unless it was KP, I have mixed emotions about KP.  Did it suck as in boring-suck or as in 35th-patient-of-the-day suck?

it was KP.

boring/low acuity/35-55 pts/12 hrs every day. calls by the scheduler EVERY SINGLE DAY I was off at 0600 (seriously, even if I just got off at 0200) asking me to come in for over time because they were chronically understaffed. It was good as a first job, but after I qualified for the pension at year 5 I started cutting way back and working elsewhere. 1/2 time at year 5, per diem years 6-13 then quit altogether > 5 yrs ago.

[PACdan]

it was KP.

boring/low acuity/35-55 pts/12 hrs every day. calls by the scheduler EVERY SINGLE DAY I was off at 0600 (seriously, even if I just got off at 0200) asking me to come in for over time because they were chronically understaffed. It was good as a first job, but after I qualified for the pension at year 5 I started cutting way back and working elsewhere. 1/2 time at year 5, per diem years 6-13 then quit altogether > 5 yrs ago.

 

The benefits sound good as long as you stay in for the long haul, or at least as long as you did. There is a little pocket of KP on my coast/region, so I've seen jobs pop-up every now and then that strike my curiosity.

[Boatswain2PA]

given the overall state of our economy, and the particular hiring practices "enjoyed" by most PAs (exempt, salary = no OT, no limits on hours, no protection), has anyone out there started to warm up to the notion of starting a PA union?

 

I have brought this topic up from time to time over the years on this forum, and it has always been politely shut down.

 

I find it so unacceptable that we do not have the luxury of, say, signing out our "shift" (hours actually hired to work) to another PA, the way nurses do. the upshot is we end up OWNED, with no power to say, "uh, sorry, but my shift's over and I need to go home now", much less actually do it. I watch scrub nurses sign out to each other MID-OPERATION without anyone even batting an eye. they are told, "have a great night!" as they break scrub and LEAVE.

 

even suggesting that one expects to go home at the end of their work hours is automatically put in the crosshairs for being fired.

 

nurses (as in NPs) have a union, and they enjoy a great deal of protection and salary standards that we do not.

 

why don't we? 

I don't need a union bureaucrat to take my money in exchange for supposedly representing my interests (which are seldomly the same interests as said union thug....errrr....bureaucrat) to my employeer. 

 

I am an educated professional who can make my own decisions, and wrangle out my own contract with my multiple employers.  

 

And I hand off my patients.  Not in the middle of a procedure of course, but while waiting for test results, waiting for treatment efficacy, or waiting for the tincture of time I will hand off patients to my relief.  

[BruceBanner]

given the overall state of our economy, and the particular hiring practices "enjoyed" by most PAs (exempt, salary = no OT, no limits on hours, no protection), has anyone out there started to warm up to the notion of starting a PA union?

 

I have brought this topic up from time to time over the years on this forum, and it has always been politely shut down.

 

I find it so unacceptable that we do not have the luxury of, say, signing out our "shift" (hours actually hired to work) to another PA, the way nurses do. the upshot is we end up OWNED, with no power to say, "uh, sorry, but my shift's over and I need to go home now", much less actually do it. I watch scrub nurses sign out to each other MID-OPERATION without anyone even batting an eye. they are told, "have a great night!" as they break scrub and LEAVE.

 

even suggesting that one expects to go home at the end of their work hours is automatically put in the crosshairs for being fired.

 

nurses (as in NPs) have a union, and they enjoy a great deal of protection and salary standards that we do not.

 

why don't we? 

 

 

I understand the frustration, but we aren't nurses. There are higher expectations of providers, even if unfair.

 

When I was in surgery it used to make me so mad that the anesthesiologists or CRNAs would clock out mid-case and transfer to their colleague so they could go take their mandatory breaks, or go home. Meanwhile I'm rotting away in an 8 hour fusion case and still have to go round, do orders, and other busywork before I could go home.

 

I agree with you in principle: we should be able to go home at the end of our shift and get OT for anything over 40, etc. I just think the implementation is not as tidy as it seems on paper. PA Unions would probably only make sense in hospitals.

 

I share Boatswain's libertarian view---we are professionals who can make our own decisions and negotiate our own contracts.  I think you'll find office-based jobs to be much better in terms of your independence and how you are treated. You can manipulate your own schedule, have time blocked out for lunch, and you leave when you are done with your patients and/or charting for the day.

[PACdan]

As a counter-point, I think unions for medical providers probably make more sense now than anytime previously. Especially now that the independent practices are drying up and entire swaths of providers are being hired into expansive health regional systems. When "BigCorp Health" owns 80% of the hospitals and clinics in a geographical berth, wouldn't unionizing make sense to maximize the collective bargaining power of that system's providers? Individuals, disorganized in their requests, can be cherry-picked off. But the collective bargaining power of an organized union can not only improve working conditions, but also compensation and benefits for members.

 

Rarely do we see benevolence in the form of large organizations. Just look at the long history it took (and still takes) to establish safer working conditions and regulations for basic safety of many laborers in the United States. While not immune from poor practices themselves, labor unions certainly improved the working safety and conditions for millions in this country beyond what companies or government would do themselves.

 

I don't see unions for providers jeopardizing patient safety anymore than the hospital systems themselves. If anything, there may be improved conditions through unions which benefit provider and patient alike. I'm not saying you can't negotiate for what you feel is amicable, yourself. I'm just questioning how feasible and realistic that is in the face of modern, large system medicine, or how feasible it will continue to be...

[Boatswain2PA]

Unions are no more benevolent than the hospitals. As to unions jeopardizing patient care....just look at how they have treated our schools.

[treejay]

We aren't nurses, so we shouldn't use them as an example. 

come on, this is dumb.  One can and should look to any profession for ideas, especially relevant professions. 

[treejay]

Unions are no more benevolent than the hospitals. As to unions jeopardizing patient care....just look at how they have treated our schools.

nope.  a union would have the interest of its members much more than a hospital would.

[PACdan]

Unions are no more benevolent than the hospitals. As to unions jeopardizing patient care....just look at how they have treated our schools.

 

I don't believe there are any studies that demonstrate unionized teachers result in poorer student outcomes. It is; however, a fluffy political talking point. On a societal level we seem to undervalue public school educators, while shifting more and more parental responsibilities onto the school systems, taxing them even more.

 

A new generation of highly indebted providers, without proper organization, in large health care bureaucracies may be much worse.

[Boatswain2PA]

nope.  a union would have the interest of its members much more than a hospital would.

 

In theory, yes.  However it doesn't take long before the union loses focus on the interests of its embers, and instead focuses on the interests of the union.

I don't believe there are any studies that demonstrate unionized teachers result in poorer student outcomes. It is; however, a fluffy political talking point. On a societal level we seem to undervalue public school educators, while shifting more and more parental responsibilities onto the school systems, taxing them even more.

 

A new generation of highly indebted providers, without proper organization, in large health care bureaucracies may be much worse.

"Fluffy political talking point"?  Yeah, sure.  

 

It is the liberal democrats who are  doing the "shifting more and more parental responsibilities onto the school systems".  The same liberal democrats who the teachers unions ALWAYS support in elections. 

 

What's a greater parental responsibility than feeding your kids?   http://www.nationalreview.com/article/423784/uncle-sam-and-school-lunches

[cinntsp]

come on, this is dumb.  One can and should look to any profession for ideas, especially relevant professions. 

 

A nurse is as relevant to us as a respiratory therapist.  They are shift workers. They will leave when their counterpart arrives.  I'm not endorsing having to work extended hours without adequate compensation, but we need to be careful about who we compare ourselves to.

[PACdan]

In theory, yes.  However it doesn't take long before the union loses focus on the interests of its embers, and instead focuses on the interests of the union.

"Fluffy political talking point"?  Yeah, sure.  

 

It is the liberal democrats who are  doing the "shifting more and more parental responsibilities onto the school systems".  The same liberal democrats who the teachers unions ALWAYS support in elections. 

 

What's a greater parental responsibility than feeding your kids?   http://www.nationalreview.com/article/423784/uncle-sam-and-school-lunches

 

Republican, Democrat, I don't care about the label, just what the person does. There is good and bad in every political camp, but the divisive "us VS. them" narratives are way too common these days, getting everyone stirred up, mostly for the sake of generating ad revenue.

 

It makes no sense why a school system is supplying free or reduced meals not based on financial need, but simply to anyone who wants it. Parents' driving a nice Lexus or BMW should be paying for their kid's food, we can fit that under common sense. But having volunteered at a summer food program, I can say that there are some kids that would be going hungry if it weren't for these programs. They are very real, and very poor. And no matter how the parents' ended up in poverty, we can never punish the children for that.

 

 

A nurse is as relevant to us as a respiratory therapist.  They are shift workers. They will leave when their counterpart arrives.  I'm not endorsing having to work extended hours without adequate compensation, but we need to be careful about who we compare ourselves to.

 

Aren't EM docs/PAs shift workers? Don't they do just that, leave when their counterpart arrives?

[True Anomaly]

 

Aren't EM docs/PAs shift workers? Don't they do just that, leave when their counterpart arrives?

 

Yes we are- I am out the door when my shift is over.  My charts are done, my patients are signed out, and I walk out.  Except when there are things left dangling that are inappropriate to sign out, like waiting for a callback from a specialist, or doing a pelvic exam or I&D an abscess, etc- those things are completed before I leave even after my shift is scheduled to be over since it's just considered professional to neatly wrap things up.  

[EMEDPA]

Agree with TA above. It's ok to sign out a patient awaiting a CT scan or something, but you always need a defined plan in place like this:

" Dr. smith of surgery already knows about this patient. If it is appendicitis call him back. If it is mesenteric lymphadenitis, I have already written up his scripts for pain and nausea control and he can follow up with his pcp tomorrow or return here if worse".

that being said, most of the places I work now ( 3 out of 4) are fairly small depts with single or double coverage only, so if the dept is super-busy or something weird is going on (expecting 4 pts from a big mva, etc) I will typically stay around until things are at a more reasonable level. all my partners do the same. it sucks to come on shift to find many more pts waiting to be seen than normal or something bad coming down the pike. that just makes you feel hopeless at the beginning of a long shift and it sucks. when I work at the urban trauma ctr job I leave on time. there are many other folks there to take up the slack and I'm typically tired and ready to go...

[sk732]

One of the health care unions in our province decided it wanted more money and noticed that the PA's in all the Health Regions weren't unionized - they unilaterally decided that they were going to represent the folks where the vast majority are employed, since they could line their pockets with another couple hundred K/year in union dues...that pretty much made us have to form our own association/union to keep these other asshats away.  Just as well anyway - these guys would not have represented us all that well anyway, due to numbers of us vs the other professions they're representing as well.  Needless to say, the "Welcome aboard" meeting didn't go as planned by the Union.  Oddly enough, Doctors Manitoba basically said have fun and we'll support from the back benches, but turned us down when we asked to come under their umbrella. 

 

We're currently (hopefully) nearing the end of our first collective bargaining and should be voting on it within the next month or two.  As negotiations are still ongoing, I can't say much else at the moment.  The thing with us up here is all of our salaries come out of a pot from the Provincial Ministry of Health and our salaries are based on a scaled template...OT and vacation and call are all separately worked out by Region and program. 

 

More to follow when I'm allowed to make things public.

 

SK

[treejay]

A nurse is as relevant to us as a respiratory therapist.  They are shift workers. They will leave when their counterpart arrives.  I'm not endorsing having to work extended hours without adequate compensation, but we need to be careful about who we compare ourselves to.

 

There are many PAs who work in a shift work setting.  And if you go back and read the OPs post, they are referring to nurse practitioners.  That being said, for sake of discussion, there are certainly things our profession can learn from any medical profession.  Search the forum and you'll find discussions looking at optometrists, physical therapists, etc, how these professions have adopted a doctorate terminal degree.  Are you saying there is nothing to be learned from non "provider" medical professionals?  Progress will be much more an uphill climb with that narrow minded mentality

[problem child]

come on, this is dumb.  One can and should look to any profession for ideas, especially relevant professions. 

 

thank you. you saved me a long post :-)

[problem child]

I understand the frustration, but we aren't nurses. There are higher expectations of providers, even if unfair.

 

When I was in surgery it used to make me so mad that the anesthesiologists or CRNAs would clock out mid-case and transfer to their colleague so they could go take their mandatory breaks, or go home. Meanwhile I'm rotting away in an 8 hour fusion case and still have to go round, do orders, and other busywork before I could go home.

 

I agree with you in principle: we should be able to go home at the end of our shift and get OT for anything over 40, etc. I just think the implementation is not as tidy as it seems on paper. PA Unions would probably only make sense in hospitals.

 

I share Boatswain's libertarian view---we are professionals who can make our own decisions and negotiate our own contracts.  I think you'll find office-based jobs to be much better in terms of your independence and how you are treated. You can manipulate your own schedule, have time blocked out for lunch, and you leave when you are done with your patients and/or charting for the day.

 

exactly. there is no reason in the world we can't be "spelled" by a next shift PA when in the middle of a 8 hour fusion case. we are in the OR really as a technician, assisting the surgeon. we are not calling the shots in the OR and never will. 

 

I've worked in various surgical specialties for 8 years. let's take the example of the PA who's supposed to be there at 730a for OR duty. likely same PA will need to be there ~an hour earlier to round and document, review OR cases for the day, etc. so let's say that PA comes in at 6-6:30 to start their day.

 

then the 8 hour fusion case gets bumped from 730a to 1130a bc there's a couple of emergent appys or choles from the ER the night before, something like that. so that PA settles in (to rot! LOL) for the next 8 hours for that fusion, finishing in the OR at ~ 730p. even the SURGEON has left the OR, getting some of HIS (or her) "busywork" done bc s/he told you to close. then the orders, the rounding and busywork, all part and parcel of the "responsibilities" of the PA. this PA leaves at 830-9p, exhausted, stressed out, and underpaid, because after all, they're on SALARY for a 40 hour week, there's no OT to clock for the extra hours. then they have to get up at 530 to start all over again.

 

more so - how many PAs out there have actually finished the cases they were assisting on at 4p on some miraculous given day, and of course still have to write orders, round...but even if a PA is very efficient and gets this done in an hour, they feel guilty about leaving before 6 (when the attending starts their call responsibilities....and GOD FORBID an MD should be bothered before 6pm to tend to THEIR patients!!!!). 

 

doesn't leave much time to have a "life" outside of work, much less a quality life (family? hobbies? regular R&R, a nice meal, anyone?).

 

under the union scenario, or shift scenario I'm pulling for, same PA has bargaining power for things like salary, OT and, benefits (pension anyone?). the same PA starts their day as above, but at 230p the evening shift PA comes in and goes to scrub. first PA breaks scrub when 2nd PA comes in to hold that retractor or clear the surgical field of snipped osteophytes (we're not doing brain surgery, LOL, and even if we are, there's no reason we can't break scrub for our "relief PA"!). 1st PA goes to round and tweak treatment plans, changes clothes, and is home by 4p. 2nd PA is spelled at 11 by the night shift PA, who works 11p-7a.

 

quite the difference.

 

 

***

 

I used the example of nurses and their shift schedules not to compare what we do to what nurses do (that's just dumb, LOL). of course I know we have a different set of responsibilities than nurse. we know what we do. but I have worked in hospitals where nurses cover the same things in the OR as we do - scrub nurse first assisting, anyone? how frustrating is THAT!? we stand there holding retractors, trying to tell ourselves how essential we are, when the scrub nurse is doing all the things we looong to do, bc the surgeon and the nurse have known each other for 10000 years and he just likes her; then the nurse breaks scrub at 230 when her relief scrub comes in, the doc says, "thanks!" and more importantly, "bye!" and we stand there for another 3 hours, silently calculating how much our pay rate is diminishing with each passing hour...). there's no reason the relief PA cannot write the same orders at the end of the case; the surg tells us what orders they want anyway. I do think we tend to over-glorify ourselves and the roles we play at our jobs (to compensate for the frustration and exhaustion we feel at so often being overused as technical tools/scut-monkeys in hospitals? to salve our egos bc we're not treated as well as we thought we would be, or deserve, based on our training, competence, etc?)....unless we're running a clinic with our own patient load - THEN we are def in charge of patient care, and seeing our own panel -  or covering the ER, etc in the same way.

 

I am talking about hospitals when I bring up unions, because we are treated soooo unfairly, and soooo under-compensated at the end of the day...but it wouldn't hurt for PAs covering outpatient care to benefit from union bargaining as well. I have run my own clinics, and I usually negotiate (and get) OT when I am negotiating my contract - even for a 20 hour/week job - but I can tell you: no MD likes a PA who protects themselves by negotiating for OT. the MD will resent always them bc they are "taking" those extra $$ out of the surgeon's pocket and putting it in their own (as it should be). I ran a surgical clinic, and each month when I put in my time (including maybe 3 HOURS) of OT, the surgeon would invariably come to me and argue with me over the OT. he'd say things like, "(problem child"), you are the ONLY mid-level (I don't mind that term) getting OT. are you really going to put in for 3 EXTRA HOURS?"

 

and I would say "yes, we agreed that I would get time-and-a-half when I was hired". and he would say, "but we're FAMILY here, and you're the only one who gets OT" (as if that's MY problem the other mid-levels didn't negotiate for same!), and I would think to myself, "yes I'm putting in for those 3 hours; that extra $225 is real money to me, real grocery money, and I earned it by covering clinic while you clean up in the OR"....followed by more thoughts, such as, "we'll be family when you pay off my college loans and put me in your will, dad".

 

they have such nerve, guilting us out of claiming what is rightfully ours, gypping us by not paying us for alllll the time we put in, not just time capped at 20, 30, or 40 hours. how many surgical PAs actually work 40 hours?? none, I would guess. it's always more like 50 or 60. and conservatively calculating, that extra 10 hours/week at an OT rate of $75/hour...you do the math. an extra $750/week, right? that's $3,000 extra per MONTH we could be taking home to our families, or even just for ourselves. walk into the opulence of mass general - MILLIONS of dollars circulating throught that place EVERY DAY - and tell me that you don't deserve to be paid for every hour you work. ask yourselves why you should DONATE your time to any medical practice or hospital just bc we're battered into thinking that "a good PA never says 'no'!!".

 

I have been fired from jobs for expecting to be paid what I have earned. a union would protect us from exactly that, would allow us to go home after our "shift", and have the good life we deserve.

[Guest Paula]

PAs should be paid for every single hour we work.  In the scenario that problem child describes I would vote that the surgical PAs need protection.  Whether that comes from a hospital union or every PA being taught to negotiate pay for OT is the issue.  

 

PAs are not taught how to negotiate.  PA schools don't teach those skills and it comes with experience.

 

Has anyone started a negotiation business that can be marketed to PAs.  Hmmmm.  A side business for some smart PA cookie?