Employment Woes...

[Avalon]

Any advice is appreciated as this unfolds.

 

I worked for three years in a solo practitioner's OB/GYN office, having been recruited by him from family practice.  I loved my job, my patients, my staff, and my role (did not love my CP, but that's another story).  One year into this gig, the practice owner sold out "for a ridiculous amount of money" to a completely unscrupulous and sociopathic entrepreneur, also a physician, with over 40 pending lawsuits in my state alone.  Due to increasing concerns with potential billing fraud after the departure of my office manager, and due to over six months of waiting for my requested CME funds (which still have not been paid), I resigned 11/25, with an end date of 12/25.  I immediately began the job search process, with some added anxiety, as I now faced increased expenses with my daughter's planned transition to college the first week in January.

 

After two phone interviews and two in person interviews (one of which included a written test in the specialty area), I was offered a GYN position, again for a solo practitioner.  She had employed two NPs, each for several years; one had departed in September because the CP in her second job (plastics) had apparently demanded that he have full control of her and her schedule.  The second NP is older and had health concerns which resulted in neurosurgery last summer.  There are still some mild deficits I am told, but she remains there part time.

 

The CP and I emailed back and forth to settle the contract and the compensation details and reached an agreement on 12/26.  On 12/28, I visited her office manager (the CP was in Florida for the holidays) and took her all the relevant paperwork she might need to begin the process of credentialing, liability coverage, etc.  A start date of 01/04/16 was decided.  I then declined two other pending positions, one in family medicine and one in residential addictions, managing the medical and not the psychiatric needs of the inpatients.

 

The night before my start date, at 10:41 p.m., I received a text message from the CP asking me to text back at my earliest convenience, before I went to the office the next day.  I texted back immediately, and she then called me.  She asked me to "delay" my start date until Wednesday, as she had just that day been contacted by her former NP, who is apparently leaving the plastics gig and is requesting to return to her GYN job.  I start to see the big picture here and ask, "If she does return to your practice, would this mean you would not need me to join you?"  Of course she reluctantly admits this is the case.  I am now asked to wait until Thursday, with the promise that she will let me know "just as soon as (she) knows something."

 

Really???  What would you do in my shoes?  If she does subsequently extend the offer again, how can I trust her?  Not to be paranoid here, but am I disadvantaged because I am a PA?  She has never worked with one before and seemed a bit concerned about billing issues, such as "incident to" restrictions.  I do understand that she and her patients have a prior relationship with this NP, but I feel rather uncomfortable with how this has unfolded.  I was definitely disadvantaged by thinking I had secured this position when I declined two others.  On a positive note, I already have another GYN position interview scheduled for Wednesday.

 

So sorry for the length of this post.  Just wanted to touch on the relevant details.  I'm a bit shocked and overwhelmed.

[RuralER/Ortho]

Sorry to hear about that situation. It sounds like you're in a decent market though. If it was me, I would move on to a position that I felt more comfortable and secure in. The short term financial pain of being out of a job a little longer will likely be worth it long term.

[jmj11]

You know, you are probably right that she favors NPs . . . because she has never worked with a PA. I would not blame you for continuing your search, but her bias towards NPs is not an absolute deal breaker.  If you do like everything about the job, and if the offer is returned to you, I think I would take it and see it as a challenge to change this CP's mind by proving what a PA can do.  There is a lot of ignorance about there about PAs (due to our own fault for keeping our profession a low profile).  I cannot count how many jobs I've worked where there was not some great challenge where I would have to prove myself.

[TWR]

I would wait to hear back from her and politely decline the second place offer.  Once she offered the job to you and you gave all the info requested and she accepted, she is "morally" obligated to continue with you.  She may not know about PAs but she was comfortable enough to hire you.  If she was not on holiday and hired you in December would she fire you and take back the NP?  I would not trust her.  Karma is a B...h!  IMHO.  Good luck with your next position.

[Guest Paula]

The problem is that the NP resigned and left and has been gone for a few months, and the CP should have politely told the NP that she was sorry, she had already hired a replacement who was ready to start on 1/4/16.  

 

Instead the CP does not use good leadership skills to navigate within her own clinic, so I am not sure I would trust her at all.  She should have offered the NP part time work to fill in for the NP who is older and when that one retires, she could have a FT position again.

 

Did you sign the contract with the CP yet?  If so, she should be obligated to fill the requirements of the contract. 

 

PAs are not Kleenex to be disposed of in favor of facial tissue.  

 

Continue with the interview you have set up and see what comes about with it.  You have a foot in each door, but that CP put you at a great disadvantage and was certainly unprofessional.  I would have been offended, personally. 

[Reality Check 2]

This is the good and bad of solo practice. Corporate settings can offer an HR department but be too big and impersonal. Solo practitioners are not necessarily nice people or good at business - they are physicians. 

 

I would have been offended. She offered you a job and you accepted. That is a huge commitment and you have bills to pay and a career. This isn't a part time gig or a hobby.

 

I hope you find something meaningful and good. Assert yourself and be active on the commitment.

 

If you signed a contract with this provider - enforce it - or get a 90 day severance for breaking the contract. You are a professional.

 

My very old 2 cents.

[rpackelly]

verbal contracts are enforceable for a year and email generally can constitute the equivalent of one or more.......even a written contract in many states.   Plus, you have evidence.  You were supposed to show up the next day. 

 

You made decisions on this to your detriment.....gave up two other jobs. 

 

Talk to a lawyer.  You don't want to work for her but I think someone decent could negotiate a settlement of several months salary for you to take the sting out of it.......try for a year's worth with downward departure from there.  There is ample precedent.   I don't think this would ever see a courtroom. 

 

It's business, a physician would sue regardless.     She needs a warning shot over the bow right about now. 

[afarmboy]

What ended up happening?  

[Avalon]

Good Morning,

 

I do now have an update.  The reader's digest version is that I started last Friday with the original offer and now have two day's experience on which to base my impressions.  The CP did hire back the prior NP, but only for very early morning hours (really, who gets a pap smear at 6:30 a.m.?) and late afternoon hours; neither of these blocks would interfere with my scheduled hours.  I'm not sure how the NP managed this after the contentious history with the plastics doc and I haven't asked. 

 

The CP called me last Wednesday to share this news, apologetically, and to ask if I was still interested in the original offer.  I let her know that I was very concerned with the way this unfolded and that I had scheduled another interview that afternoon.  She was understanding and supportive of my decision to look elsewhere and wished me luck on the interview, adding that she hoped it went well, but "not too well!"  We agreed to speak by phone on Thursday.

 

The other interview was......interesting.  I had always admired this gynecologist (from a completely impersonal distance) for her advancement of robotic surgery, political activism regarding women's rights, and global outreach to underserved women.  However, I was disappointed in our meeting.  She shares office space and resources with another gynecologist, but the practices are actually separate.  She made a point of telling me that this office partner, who does provide back up while she is away, had a "bad experience" with a PA and refuses to work with one ever again.  She also made a few derogatory comments about PAs in general, often in comparison to NPs, and told a story about the incompetence of one PA she worked with that I frankly found hard to believe.  She talked a good bit about needing a PA for routine things she was too busy (and too disinterested in) to handle.  Finally, she shared that she was leaving the office in mid-February for an extended "sabbatical" of eight weeks; patients and staff were not yet aware of this.  Taken together, I did not feel comfortable with this practice, and as of today I haven't received an offer from her anyway.

 

The prior CP called me immediately upon completing her surgeries Thursday and asked if I had any updates.  At that time I accepted the pending offer and we agreed to a start date of the next day.  She seemed delighted and said while she welcomed competition, she was glad I chose her group.

 

There are indeed numerous challenges in the practice I chose and I will see over time if they are manageable.  The CP is, I believe, a warm and caring person who, if anything, has become overly invested in her employees and has difficulty separating personal from professional, which is in part why I think she panicked when the prior NP requested to return.  The impaired NP is utilizing a lot of resources, as an MA has to accompany her at all times to scribe and to make sure nothing is missed.  The second MA leaves us any moment for maternity leave.  I'm not sure how we are going to staff an office with (now) four providers and one MA, and it has been made clear (and I have accepted) that I will need to "be flexible" and assume some of these responsibilities.  I am not at all opposed to that and believe in being a team player.  I am actually not scheduled to see patients at all until I spend time training on the EMR and shadowing the CP so that she can become comfortable with me.  This will take some time, actually, because she is out of the office Mondays and Fridays and in surgery a good part of Tuesdays and Thursdays. So essentially, this will be paid training for some weeks, which allows me to recover from my last job debacle and to master the idiosyncrasies of this new office.  Initially I am concerned about patient volume (10 minute slots for all annual exams and problem visits; not sure yet about time allocation for procedures).  I do plan to address this with her and I know I cannot keep my record of being a thorough and likeable provider if I do not have sufficient time to do my job.

 

My last concern, which I may post later in a separate thread, is how to maintain my general medical skills in this specialty.  The annual exam does not even include a cardiopulmonary assessment on the EMR template, which is totally unacceptable to me.  I've thought of doing a once or twice monthly fast track or urgent care shift, but I have not been able to find an offer with such limited hours.

 

Thanks to all for your thoughts and your support.

[Guest Paula]

An annual exam must mean you are only doing a pap smear. That is not an "annual exam".  Interesting.

[winterallsummer]

Glad it worked out. Hope things go well at this job. A bump in the road like that certainly doesn't mean this won't be a worthy position.

 

As far as maintaining general skills, that is a common question on this forum, and the options include 1) do your CME in IM instead of your specialty, 2) PRN somewhere (urgent care or FM), 3) if time allows you can actually pick up some good medicine in specialty fields. When I did my OB/GYN rotation in school, the attending I was with shared an office with a rheumatologist and a couple other specialists. They often shared patients and we actually had some pretty interesting rheum cases that came to us for unrelated issues but Istill was able to take a history and see interesting exam findings when time allowed. Of course if you have settled on GYN then your general medicine skills will naturally decline and if you do switch specialties later in life you will just have to deal with that learning curve (which is possible and many have done).

[ventana]

thoughts

 

make sure you have REGULAR meetings with her and a roll out plan for being independent in the office

be the professional

hold her feet to the fire on timing, schedule, patients

 

sounds like she is a good person, and good doc and in the long run might appreciate a super duper employee that really gets the big picture.  

 

Actions speak a lot louder then words and she seems to have honor on her side....