ERCat

ER Pay - Fair?

27 posts in this topic

New grad in the ER. I've been in it for 4 months. I work in an amazing residency like atmosphere. Docs love to teach. I get to staff all of my patients with them and they give me as much or as little guidance as I need. They trust me and respect me.

 

Now the cons - the schedule blows (lots of weekends, midday to night shifts, and they work me a ton - amywhere between 180-220 hours a month so far). This is supposedly temporary as they just started hiring PAs and they are waiting to get more and credentialing takes forever. I love every day at work and I love the money (plus I get OVERTIME PAY!) but I do hate having only random week days off as I feel like I never get to see my family and friends as much as I want to. Working weekends AND working noon to 10 or 11pm... Yeah, basically I see no one. They've been good about giving me weekends and days off when I request them, though. Another con is the schedule and policies are constantly changing as we were just bought out by a bigger ER group. My schedule has been 9am-6pm, 11am to 9 pm, 2pm to midnight! 1pm-9pm! Random days! No consistency and I've come through for them with all the last second changes.

 

The other con - I make 53/hr flat, no bonuses. Yes, I do get overtime pay so those hours over 40/week are paid about 79/hr.

 

I am starting to question the pay especially in light of how crazy the schedule has been. Most of my new grad friends in AZ are making in the 60s PLUS RVUs (don't know if they get overtime like I do though) and seem to have more predictable schedules rather than all the randomness. However those friends have been thrown in and don't get to staff all their patients with an experienced physician and excellent teacher.

 

Thoughts?

 

PS. Bennies (if this makes a difference) - 2500 CME, 100% covered medical and dental and life and disability, 80 hour PTO a year (yes I know... I know... LOL), and a 401K without any match, basically a glorified savings account. Plus free food and drinks all day long!

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Pay stinks, benies are blah. But you are 4 months out working in a "residency like" atmosphere....that sounds terrific! You would not be wrong staying there for a while as you gain competence.

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Pay stinks, benies are blah. But you are 4 months out working in a "residency like" atmosphere....that sounds terrific! You would not be wrong staying there for a while as you gain competence.

I agree the benis leave something to be desired (and malpractice coverage, DEA / licensing, professional memberships aren't even mentioned), but why do you say the pay stinks?  

 

Using a base of 2080 hours in a work-year, less 80 hours for 10 days of holiday pay (a presumption I'm making that may or may not be accurate!), less 80 hours PTO (and is this also CME time? which would be another strike against the benis), leaves 1920 hours.  1920 * $53/hr = $101,760 annual.  Isn't that a decent base salary for a new grad?

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I agree the benis leave something to be desired (and malpractice coverage, DEA / licensing, professional memberships aren't even mentioned), but why do you say the pay stinks?  

 

Using a base of 2080 hours in a work-year, less 80 hours for 10 days of holiday pay (a presumption I'm making that may or may not be accurate!), less 80 hours PTO (and is this also CME time? which would be another strike against the benis), leaves 1920 hours.  1920 * $53/hr = $101,760 annual.  Isn't that a decent base salary for a new grad?

 

 

I agree. Since the time off is paid at the same rate, it's actually a base of $110K. This is fine for a new grad, in fact it is very good, although you need way more PTO. 

Your friends in AZ that are making "60 plus RVUs" are probably not getting any benefits.... or this is a misunderstanding and they are getting $60K/year base plus RVUs, not hourly. 

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ERCat:  You are in a sweet situation since you are getting good mentoring.  It will prepare you for future jobs, treat this one as a residency and a well paid one at that.  The sacrifice is your personal time, but for a year, it may be worth it.  Do you have family, kids, spouse, elderly parents you are caring for?  IF not, and you are single, then go with the flow and learn as much as possible.

 

Then take your ER CAQ, keep track of all procedures you do, too and keep in a file.

 

Keep in mind the new ER group may or may not be agreeable to any further changes to your compensation or benefits and could downsize them as well.

 

In the end you will ultimately benefit....albeit you will be very tired by the end of your first year.  

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Having just left AZ, I'm pretty sure your friends are getting no benefits. A (very) large majority of the jobs are 1099/independent contractor positions. And in these positions, there is NO overtime. You get paid the same flat rate no matter what.

Your best first job is where you are going to learn the most. And it sounds like you have a great opportunity there.

As far as hours, the shifts you describe are what we end up working in the ER. Most docs have similar schedules as well. About the only way you can get a schedule that isn't bouncing all over is to work straight nights (this is seen as a less desirable shift, and is usually easier to be able to take all the shifts without someone complaining). But, you'll always have to cover holidays and weekends.

If you are working 180-220 hours a month, maybe the first place to take a step back is there. Give yourself one full weekend off a month (at least). Don't burn yourself out at your first job. Find a good balance between your family and your job.

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Thanks for the feedback. I was never dissatisfied with the pay, but I've had a few providers telling me I get paid way less than other ER PAs, even new grads so I wanted to get a better understanding. Most of our providers left BECAUSE of the pay.

 

Well - two of my new grad friends work for 65 an hour, plus full benefits and RVUs. Another new grad friend made 65/hour without benefits but pulled in a sick amount of RVUs and made 170K first year out of school. Finally the other new grad I am friends with makes 100/hr without benefits as an independent contractor (!!!!) at a very rural site. And lastly at another ER in my town they are independent contractors and make 95/Hr.

 

I am happy where I am at now. I am learning a lot. Just want to keep my mind open for future negotiations. Thank you guys for the different perspective; I feel much better!!! I've always been happy but I've been listening to the above people who say I am underpaid.

 

PS I do get my malpractice covered (and tail).DEA and license was covered. NO time is paid for CME OR holidays. I simply get 80 hours PTO a year.

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work it for a year

learn like a sponge

 

then move on

 

demand a reasonable schedule in your first you - no point in sacrificing yourself, or setting up the next PA's to be schlep that gets all the crappy shifts dumped on them

 

I think a VERY reasonable comparison is to compare to the doc schedules..... doesn't have to be the same, but if they work 1:4 weekends you should too...

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Pay is pretty low for EM especially if your not getting bonuses. I started at 60/hr + bennies + 15-20k bonus per yr. However pay depends on where you live so if your in a very PA-saturated area then 53/hr might be average there for EM. But It sounds like your PA friends are making more than that so it sounds like you are under paid....

 

The hours you are working are insane for EM. My fulltime job is 150 hours per month (salaried :-) )...I do 1-2 moonlighting shifts a month... so Im at 160-170 and Im exhausted! EM is draining and working 180-220 hrs a month will burn you out fast.... slow down!

 

I'm off 3-4 days a week....THATS what makes the irregular hours/working weekends worth it....and thats why the majority of us EM folk put up with working nights/weekends

 

However... If I were you I would stick around for 2yrs to get EM experience and then move on..

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Right. For now it's amazing because the docs are excited about having me, many of them say "It's gonna be a good day because you're here today!" and want to teach me things. They'll be like, "Hey, I am doing an LP... Want to help?" Or "Go look at the stroke patient in room 19; do a neuro exam and you'll learn a lot." Couldn't really ask for a better environment so for now I am willing to take a "cut" in pay for that.

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I'm in a similar situation but about a year ahead of you. You can't put a price on the training aspect. That right there is worth putting up with everything else (you would be paid half as much in any official PA EM residency and work just as much). But after a year or 2, it's up to them to respect what they've taught you and what they've made you capable of. Pretty soon you will be hugely marketable for jobs with better pay and hours--don't be afraid to take advantage of that.

 

 

Sent from my iPhone using Tapatalk

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I agree the benis leave something to be desired (and malpractice coverage, DEA / licensing, professional memberships aren't even mentioned), but why do you say the pay stinks?  

 

Using a base of 2080 hours in a work-year, less 80 hours for 10 days of holiday pay (a presumption I'm making that may or may not be accurate!), less 80 hours PTO (and is this also CME time? which would be another strike against the benis), leaves 1920 hours.  1920 * $53/hr = $101,760 annual.  Isn't that a decent base salary for a new grad?

An easier way to generally figure annual salary from hourly salary (w/40 hrs/wk) is double it and add a thousand.  $50/hour = $100K/year.  $80/hr = $160K/year.  

 

For meat-grinder ED positions (which this one sounds like it is) the pay sounds low.  I'm in a relatively saturated area and the ED pay is $70/hr, and the EM pay in this area is going up fairly quickly.  Of course, it's all relative to location.  

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west coast ED pay typically is less than this. 50-65/hr is fairly common. to get more than this you need to be in a busy urban practice or very experienced and working solo. the best position I know of pays 80/hr for solo coverage, suburban practice.

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west coast ED pay typically is less than this. 50-65/hr is fairly common. to get more than this you need to be in a busy urban practice or very experienced and working solo. the best position I know of pays 80/hr for solo coverage, suburban practice.

 

Interesting that even with all your years of experience the highest you have seen is 80, while ERcat has new grad friends making 95 and 100/hr...do salaries really vary that widely?

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Interesting that even with all your years of experience the highest you have seen is 80, while ERcat has new grad friends making 95 and 100/hr...do salaries really vary that widely?

There is a lot that goes into pay/salary, especially in the ED. Location is huge. As is responsibility at your work location (solo vs fast track). The other thing is many ED jobs (in my experience) are 1099/independent contractor positions, and comparing that salary to an employer based position with full benefits, you are going to see a huge difference in pay. I'm salaried at this point, with full benefits. My hourly works out to $65ish an hour I believe. I've had other fully benefited positions at about the same pay. I've also had IC positions paying anywhere from $60/hr +RVU to $100/hr.

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1099 positions are essentially unheard of out here. all my per diem positions are employee status hourly + malpractice and they take out social security, taxes, etc. some do minimal stuff for me like state license, etc

my primary job has a full benefits package.

I currently am privileged at 6 facilities. pay as follows:

55/hr + production of approx. 10/hr

60/hr + production of approx. 10-20/hr

65/hr

70/hr

73/hr

80/hr

 

top 2 jobs are the full time job and also have a full benefits package. those rates include night differentials. days(which I rarely do) are 10/hr less

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1099 positions are essentially unheard of out here. all my per diem positions are employee status hourly + malpractice and they take out social security, taxes, etc. some do minimal stuff for me like state license, etc

my primary job has a full benefits package.

I currently am privileged at 6 facilities. pay as follows:

55/hr + production of approx. 10/hr

60/hr + production of approx. 10-20/hr

65/hr

70/hr

73/hr

80/hr

 

top 2 jobs are the full time job and also have a full benefits package. those rates include night differentials. days(which I rarely do) are 10/hr less

What's your benefit package like?

Mine.

$2k cme including fees

4 weeks off vaca and sick

Health paid for family but high deductible

Dental additional around $80s for family

Malpractice with tails.

 

If theses are generally same for PAs and NPs, is there room for negotiations? 2 year mark coming soon. Don't think I have much room for hourly increase.

 

Thanks.

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What's your benefit package like?

Mine.

$2k cme including fees

4 weeks off vaca and sick

Health paid for family but high deductible

Dental additional around $80s for family

Malpractice with tails.

 

If theses are generally same for PAs and NPs, is there room for negotiations? 2 year mark coming soon. Don't think I have much room for hourly increase.

 

Thanks.

2 K CME

2 WEEKS VACATION. NO SICK.

ALL MEDICAL/DENTAL/VISION FOR ME AND FAMILY, HIGH DEDUCTIBLE, BUT HSA TO COVER

LIFE INSURANCE

LONG AND SHORT TERM DISABILITY

RETIREMENT = 25% OF GROSS YEARLY EARNINGS

MALPRACTICE

STATE LICENSE AND DEA

AAPA DUES

ACLS/PALS/FCCS/CPR FREE AT PRIMARY FACILITY

ALL OF THE ABOVE FOR MIN 80 HRS/MO AFTER 10 YEARS. FIRST 10 YEARS REQUIRED TO DO MIN 112 HRS/MO

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Matt82 - I think that's super low!

 

I should have updated this thread. Less than a year after posting this, same job but got a raise and am glad I stuck it out. Still love the job! I am now making a lot more... about 145K a year base, 15K admin time and around 20K bonus SO up to 180K now!

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Southwest Ohio:

FT job: $65/hour, no night/weekend/holiday differential.  1.5x for hours > 40 in a week (rare), hourly rate varies by PA/NP, range is about $60-72

- malpractice w. tail

- no PTO

- $2500/yr for expenses: DEA, licenses, all CME, unused paid out as compensation

- medical, dental, vision, etc available as payroll deductions, 1 person coverage affordable, family expensive

- 50% 401K match, up to 6% of salary, i.e. max company contribution of 3%

- LT disability, we pay for ST

- W2 employee

 

PT job: $65/hour, $1,000 quarterly bonus if 150 or more hours worked.  1.5x for > 40 hours/week or holidays, no night diff.  FT experienced get $70/hr, FT new grad $65/hr

- malpractice w. tail.

- no bennies

- W2 employee

 

Can get paid beyond end of scheduled shift only with approval.  No pay for finishing charting after end of shift or for attending department meetings.

 

Seems to be about average across the big 3 and the local groups.

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Southwest Ohio:

FT job: $65/hour, no night/weekend/holiday differential.  1.5x for hours > 40 in a week (rare), hourly rate varies by PA/NP, range is about $60-72

- malpractice w. tail

- no PTO

- $2500/yr for expenses: DEA, licenses, all CME, unused paid out as compensation

- medical, dental, vision, etc available as payroll deductions, 1 person coverage affordable, family expensive

- 50% 401K match, up to 6% of salary, i.e. max company contribution of 3%

- LT disability, we pay for ST

- W2 employee

 

PT job: $65/hour, $1,000 quarterly bonus if 150 or more hours worked.  1.5x for > 40 hours/week or holidays, no night diff.  FT experienced get $70/hr, FT new grad $65/hr

- malpractice w. tail.

- no bennies

- W2 employee

 

Can get paid beyond end of scheduled shift only with approval.  No pay for finishing charting after end of shift or for attending department meetings.

 

Seems to be about average across the big 3 and the local groups.

The increasing trend of people reporting NO PTO in ER jobs is discouraging.  Coming from a position of working 5 PT EMS/FF jobs before PA school, and not having a paid day off for >9 yrs is leading me to reconsider my desire for ER upon graduation.  Especially when reports are now hitting in my geographical area.  Perhaps, this will be another reason to relocate post grad.  I am curious to how these positions handle time off?  In a w2 position, you do not have control over your schedule like you would with 1099 correct?  Is it common to be told you can't take unpaid time off?  I imagine the circumstances very by the groups.  However, generally speaking, I am curious to how the PA's in these no PTO environments are treated in regards to taking time off?       

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The increasing trend of people reporting NO PTO in ER jobs is discouraging.  Coming from a position of working 5 PT EMS/FF jobs before PA school, and not having a paid day off for >9 yrs is leading me to reconsider my desire for ER upon graduation.  Especially when reports are now hitting in my geographical area.  Perhaps, this will be another reason to relocate post grad.  I am curious to how these positions handle time off?  In a w2 position, you do not have control over your schedule like you would with 1099 correct?  Is it common to be told you can't take unpaid time off?  I imagine the circumstances very by the groups.  However, generally speaking, I am curious to how the PA's in these no PTO environments are treated in regards to taking time off?       

 

My job has no PTO.  If I need time off, I request certain days off on a group calendar.  If there's a need for a particular day or night off that I may be scheduled, I've mostly been able to trade with someone else in the group.  

 

I don't have many requests, and I don't go on vacation much- but I do have outside responsibilities that our scheduler understands and will make accommodations for me

 

As it is, I only work 13-14 shifts a month, which ends up being about 130-150 hours/month

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The rationale for no PTO is that it is factored in to the higher hourly rate - per the employer.  You control your income by how many shifts you work, as long as you hit the # hours you are contracted for in the year.  My FT employer does require that you work at least 122 hours in a month to be eligible for benefits in that month.  Another guy and I split a shift, so we do our own schedule.  Makes it pretty easy to schedule vacations if 1 wk or so.  If there are a few days in a month neither of us can work, the lead PA will schedule someone else.  But, she's glad we take care of 20% of the overall scheduling on our own.

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I get a week pto and a week cme pto, but realistically can get time off whenever I want by working more at the beginning or end of a month or taking a vacation spanning 2 months

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EMEDPA or anyone else, would you be willing to post a short list of new grad-friendly hospital systems/contractors who offer a highly-structured, quality training program at good pay for the first year or so? The example I am thinking of is Mayo as someone posted a few things about them before. I've heard good things about Minneapolis and will definitely apply there. I would love to do a residency but am getting a pretty late start in my career and I also have an enormously complex academic history (11 transcripts which I'd like to never have to collect again). An ER group I rotated with hires 1-2 people from our class each year, pay is good (+/- 100K to start and it's cheap here), but I am concerned the training could be a bit too short and/or perfunctory. My ideal spot would be NW or NE but not a big deal. Just finished my resume last night and the project is underway (Pance Sept 1stish).! 

 

Thanks.

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