Another job offer

[BruceBanner]

So the offer is for a full time primary care position. Major provider/organization (Kaiser).

 

-Float PA position, spending ~2 months per clinic in a major metro/suburban area. 1 year contract with the float pool.

-About $51 an hour, with mileage and various differentials should I work anywhere outside of the 8-5, M-F norm.

-Union (yes union) position.

-Unparalleled benefits: Health/dental PAID in full by employer, life/extended income protection/STD paid by employer, 1 personal day, 11 sick days, 10 days PTO (but I cant use the PTO for 6 months), pension after a year, $1500 CME, etc. A bunch of other odd union benefits.

-No weekends, no call.

 

They quoted "14-16 PPD with occasional double bookings". I am skeptical of this.

 

No room for negotiation (I tried, it's all based on years of experience).

 

 

Pros: It's a $6/hour raise from my current job and an exponential increase in benefits; most of which wont be realized for a year or more. It's a union job, good or bad depending on who you ask, but the job is pretty protected. Regulated hours for the most part.  

 

Cons: Major HCO with all the associated bureaucracy. No one really gives a crap what an individual provider thinks. Everything is electronic and monitored. Kaiser is a nursing-ran organization. My immediate manager will be a nurse (not an NP, a nurse). Predominantly female work environment (I am a male). Weak PTO, in my opinion.

 

Any thoughts, words of wisdom? I am undergoing credentialing. I currently have 2 jobs and don't need to take it, but I'm leaning towards yes.

[Reality Check 2]

You are a PA. Your supervisor is a physician - NEVER A NURSE. PERIOD.

Like apples and bananas - work in the same fruit bowl but different species.

 

Kaiser was in Texas years ago in my hospital. They had vans out in the garage that said Kaiser Permanente - Good Medicine, Good People.

I always wanted to spray paint underneath - GOOD LUCK.

 

Your capacity to practice good medicine aside - Kaiser is an HMO and rewards people for NOT DOING THINGS and not spending money. They are cheap beyond belief. The formulary and restrictions will cause you pain and suffering. 

 

So, my very old cranky cynical 2 cents - You need to work - You like being a PA - Kaiser is an employer - not a good one from my past experience.

 

You need the proper supervisory heirarchy and representation. Your contract is with the employer - your medical responsibility is to the physician and not a nurse.

 

I wouldn't take it in my current situation but understand the need to work and what is available.

 

Hoping the best for you.

[BruceBanner]

Thanks for the input RC. Just to clarify, the nursing supervision is administrative---e.g. scheduling, clinic placement, etc. It would be neither legal nor ethical to have nursing clinical supervision. 

[Reality Check 2]

I have been under "nursing supervision" at a large public hospital before. It was still very inappropriate as the nurse had no administrative training such as a business degree or an MBA. He was a nurse who didn't want clinical contact with patients anymore, so they made him a clinic supervisor.

 

Just like physicians aren't always qualified to be business owners.

 

I found judgment and lack of professional acumen with this guy in that position. I would rather have a stuffed shirt MBA than an inappropriately placed RN without the proper education. 

 

So, I guess my warning there would be that having an RN doesn't guarantee that this person has a clue about office management or practice management just as an electrician is not a plumber. Just beware. Very similar to the physician's spouse being an office manager. 

 

Take pride in your profession and represent it well. Call out stupidity and inane issues to prevent our profession from being downgraded any further.

 

Again, I am old and cranky and more than cynical.......

[Reality Check 2]

AND besides being cranky - I have a business degree to boot... makes me dangerous and seldom admired by administrators.

[Simplify]

So the offer is for a full time primary care position. Major provider/organization (Kaiser).

 

-Float PA position, spending ~2 months per clinic in a major metro/suburban area. 1 year contract with the float pool.

-About $51 an hour, with mileage and various differentials should I work anywhere outside of the 8-5, M-F norm.

-Union (yes union) position.

-Unparalleled benefits: Health/dental PAID in full by employer, life/extended income protection/STD paid by employer, 1 personal day, 11 sick days, 10 days PTO (but I cant use the PTO for 6 months), pension after a year, $1500 CME, etc. A bunch of other odd union benefits.

-No weekends, no call.

 

They quoted "14-16 PPD with occasional double bookings". I am skeptical of this.

 

No room for negotiation (I tried, it's all based on years of experience).

 

 

Pros: It's a $6/hour raise from my current job and an exponential increase in benefits; most of which wont be realized for a year or more. It's a union job, good or bad depending on who you ask, but the job is pretty protected. Regulated hours for the most part.  

 

Cons: Major HCO with all the associated bureaucracy. No one really gives a crap what an individual provider thinks. Everything is electronic and monitored. Kaiser is a nursing-ran organization. My immediate manager will be a nurse (not an NP, a nurse). Predominantly female work environment (I am a male). Weak PTO, in my opinion.

 

Any thoughts, words of wisdom? I am undergoing credentialing. I currently have 2 jobs and don't need to take it, but I'm leaning towards yes.

 

Thoughts, yes.  Your current job pays $46 an hour?  I make $30 more an hour than this and I am a new grad.  Why take a job with this kind of awful pay?  Even $51 is pretty bad.  How many years experience do you have?   Are you restricted to a certain region?  

[Sunnyn]

Thoughts, yes.  Your current job pays $46 an hour?  I make $30 more an hour than this and I am a new grad.  Why take a job with this kind of awful pay?  Even $51 is pretty bad.  How many years experience do you have?   Are you restricted to a certain region?  

IF you don't mind...could you please tell what type of PA, and which region this is in pls for a new grad?  Thanks.

[Febrifuge]

One thing I didn't realize I would love about being in a union position is the thing with Weingarten rights.

 

https://en.m.wikipedia.org/wiki/Weingarten_Rights

 

If at any time your administrative supervisor, or anyone in management, wants to talk to you -- and if the results of that discussion could conceivably result in any kind of disciplinary action -- you have the right to have a union rep there with you. Kind of like having a lawyer present when talking to the cops (except without having to be charged with anything first).

 

If nothing else, it's handy to be able to know beforehand if this really is a "hey, I just wanted to ask a few questions and see if you can shed some light on something that happened last week" like they say it is, or if it's something that could potentially cause you trouble in the future.

 

Last year at my place, there was some confusion at the front desk area, a patient left before being seen, and there was a whole hairball about it which eventually led to some rule changes and clarifications. I don't believe anyone got in serious trouble, but there was some investigating. Since I didn't even see the patient I knew nothing about it and there was no need to talk to me, and they figured that out soon enough, but not until they had emailed me to ask if I could meet.

 

My blood pressure went up when I read the required language about my rights to have union representation, but if in fact I had needed to go through with it, I would have appreciated very much being able to lean over and consult with someone who has sat in on a bunch of similar meetings. Especially in a big, bureaucratic organization.

[medic25]

One thing I didn't realize I would love about being in a union position is the thing with Weingarten rights.

 

https://en.m.wikipedia.org/wiki/Weingarten_Rights

 

If at any time your administrative supervisor, or anyone in management, wants to talk to you -- and if the results of that discussion could conceivably result in any kind of disciplinary action -- you have the right to have a union rep there with you. Kind of like having a lawyer present when talking to the cops (except without having to be charged with anything first).

 

If nothing else, it's handy to be able to know beforehand if this really is a "hey, I just wanted to ask a few questions and see if you can shed some light on something that happened last week" like they say it is, or if it's something that could potentially cause you trouble in the future.

 

 

To take the other perspective, I've seen this became a real impedance to quality improvement in the past.  I'm responsible for EMS CQI, and at times I have just wanted to chat with a paramedic about their care for a specific patient.  Rather than a collegial conversation with some advice on how to do things differently next time, it becomes escalated to a major incident because they will not even discuss a case without their union rep and fire chief present.

[BruceBanner]

Thoughts, yes.  Your current job pays $46 an hour?  I make $30 more an hour than this and I am a new grad.  Why take a job with this kind of awful pay?  Even $51 is pretty bad.  How many years experience do you have?   Are you restricted to a certain region?  

 

I dont know where you are working and in what specialty, but this is pretty standard pay for primary care in my region. I live in THE fastest growing city in the country. Quality of life is good and provider saturation is pretty high. The average salary for an ER doc here is about $150k.

 

That said, even on the east coast I don't think PCP salaries are dramatically higher. I've never seen anyone on this board post wages of  more than ~$60 an hour, give or take, for FM/IM/PC. 

[Boatswain2PA]

Where is that Bruce?

[BruceBanner]

Denver

[cbrsmurf]

So the offer is for a full time primary care position. Major provider/organization (Kaiser).

 

-Float PA position, spending ~2 months per clinic in a major metro/suburban area. 1 year contract with the float pool.

-About $51 an hour, with mileage and various differentials should I work anywhere outside of the 8-5, M-F norm.

-Union (yes union) position.

-Unparalleled benefits: Health/dental PAID in full by employer, life/extended income protection/STD paid by employer, 1 personal day, 11 sick days, 10 days PTO (but I cant use the PTO for 6 months), pension after a year, $1500 CME, etc. A bunch of other odd union benefits.

-No weekends, no call.

 

They quoted "14-16 PPD with occasional double bookings". I am skeptical of this.

 

No room for negotiation (I tried, it's all based on years of experience).

 

 

Pros: It's a $6/hour raise from my current job and an exponential increase in benefits; most of which wont be realized for a year or more. It's a union job, good or bad depending on who you ask, but the job is pretty protected. Regulated hours for the most part.  

 

Cons: Major HCO with all the associated bureaucracy. No one really gives a crap what an individual provider thinks. Everything is electronic and monitored. Kaiser is a nursing-ran organization. My immediate manager will be a nurse (not an NP, a nurse). Predominantly female work environment (I am a male). Weak PTO, in my opinion.

 

Any thoughts, words of wisdom? I am undergoing credentialing. I currently have 2 jobs and don't need to take it, but I'm leaning towards yes.

 

So I have 3 family members who work in Kaiser (so cal): 1 is a 30-something MD (GI), 1 pharmacist (retired with kaiser after 20+ years), and 1 PT (retired after 30 years).  MD loves it there.  Retired pharm and PT liked working there, but I think they love their retirement package even more (had pension, which I don't think Kaiser offers anymore).  From what I hear, KP works their FP/generalists hard; specialists are happier.  I didn't know that KP is nursing-run, but they use a lot of PA's.  I am guessing you are on the west coast and in a big city... you aren't going to get more than $50/hr as a new grad in FP.  Everyone here on the board who says otherwise, works out in the boonies.  Southern California is a different market than most of the US, as you probably know now.

[BruceBanner]

I am guessing you are on the west coast and in a big city... you aren't going to get more than $50/hr as a new grad in FP.  Everyone here on the board who says otherwise, works out in the boonies. 

 

Thanks for the input, smurf.

 

I agree with your quote. I'm actually not a new grad but working in a big western city a PA isn't going make these mythical 70,80 an hour wages in FP. It's fantasy. 

[Febrifuge]

To take the other perspective, I've seen this became a real impedance to quality improvement in the past.  I'm responsible for EMS CQI, and at times I have just wanted to chat with a paramedic about their care for a specific patient.  Rather than a collegial conversation with some advice on how to do things differently next time, it becomes escalated to a major incident because they will not even discuss a case without their union rep and fire chief present.

If that's the case, then the union is mis-applying the rule. If you truly just want to have a collegial chat, and there is no chance that anyone would face discipline as a result of that conversation, then the rule does not apply. If disciplinary action is possible, then it's not a collegial chat (from the employee's point of view).

[medic25]

If that's the case, then the union is mis-applying the rule. If you truly just want to have a collegial chat, and there is no chance that anyone would face discipline as a result of that conversation, then the rule does not apply. If disciplinary action is possible, then it's not a collegial chat (from the employee's point of view).

Can't say I disagree, but some guys have the mindset that any feedback or criticism has the potential for turning into punishment from their employer (rather than an opportunity for professional improvement). We will generally let the union rep attend if requested as a courtesy, but since we aren't actually the employer (we are the medical control agency) there is no obligation to let them stay. If the rep obstructs the process, we can always ask them to leave.