I live in a fairly decent size metropolitan area but work across state lines for a medical group with a small neurosurgery department. I am a salaried full time employee with the med group. There are now two surgeons who collaborate with me. But, the newer surgeon is actually paid by a local academic center and not the med group. The academic center has a business arrangement with the med group to provide 1 neurosurgeon 3 weeks a month. He is filling that role but also has agreements in place with the other surgeon in order to cover patients if an issue comes up.
The medical group has furloughed most of the advanced providers across many specialties. Recently it sounds as if the med group does not want to keep my position. However the surgeon (who is paid by the academic center) is interested in continuing to have me work with him and hire me as a private assist to him. He is not in a position to provide benefits which is okay with me to negotiate around. It seems that being an independent contractor 1099 is not the correct way to be employed by him technically since I won't really determine my own hours or provide any materials etc.
Im looking for options on how to work with him. Does anyone have what appears to look like a standard supervisory arrangement with their surgeon but goes about it in an unconventional way? I really like the surgeon and he is loyal to me. He does his fair share of work and gives me the freedom to do a lot more than the other surgeon in the OR.
This month's ACEP Now has an article called "Optimizing our collaboration with Advanced Practice Providers". It includes a statement: "Despite the publicized experiences of a few, the vast majority of APP's are, in fact, directly supervised for patients with Emergency Severity Index levels 1-3".
While it's certainly not my experience in my current full-time job where I do solo coverage in a critical access hospital, it also wasn't my experience in my last full-time job in a level III trauma center staffed by one of the large national EM staffing companies. I routinely saw mostly level 2-4, and only on some of the level 2's and 3's did I have "direct supervision". Many of these patients I managed autonomously. Sometimes the doc read the chart, other times it was a "do I need to see this patient?, No, OK". This even included patients I admitted.
What are other folks experiences, especially those who aren't doing solo coverage? Are folks running their patients by docs that much? Are docs documenting face-to-face encounters that often? A caveat, I have worked with docs who in an RVU based compensation environment pop in even on simple lacs.
My concern is that ACEP isn't recognizing the difference between a new PA in their first few years of practice who's still learning EM vs a PA with 5+ years of experience who can and should practice largely autonomously using the EM doc as a consultant as needed, similar to how they should use other consultants like gen surg, cardiology, hospitalists, etc.
By Jim Anderson
I just wrote this on the Huffington Post blog, based in part on my mostly productive and positive conversations here with PAs recently about what AAPA needs to do. I am running for the AAPA Board Secretary-Treasurer position in the April 1 election, and I hope you will take a look.
Jim Anderson, PA-C, MPAS, ATC, DFAAPA
(AAPA election page: http://www.aapa.org/about_aapa/leaders/resources/item.aspx?id=7390)