1st performance review in the ED. Do I ask for a raise?

[bjmcell]

Hello all, 

I was hired as a new grad in the ED. I have been there almost 6 months now. I have been working mostly in fast track/provider in triage position up to this point. I have my first performance review coming up and I was wondering do I ask for anything additional or do I wait till my 1 year? My current salary is 94,000 per year. Four 10 hour shifts per week. Anything after 40 hours in a week is paid at 47 dollars per hour. I get 22 days PTO per year with 5 days CME with 1,500 for CME. I get all licensing paid for. We get pretty low differentials on the weekends ($2 an hour) and they are expanding the times that PAs work in the ED to also cover nights at $3 an hour. I have been seeing between 20-30 patients each shift. One thing that I do not like is that we do not get any cut of RVU's which is not ideal. I was told that administration is looking to change this so that we do. With this being my first job, I am not sure if 6 months is to early to ask for a raise. I wanted to work in the ED coming out of school so I basically took the first ED job I was offered in order to get my foot in the door. According to the AAPA salary report I am fairly close to the middle 50% of pay for new grads in the ED. I am part of one of the largest medical groups in my state and the weird thing is that they never had me sign a contract when I started. I have asked the other PA's I work with and none of them have had a contract to sign either. 

 

Any suggestions on things I should say/ask for during this performance/chart review?

[cop to pa]

6 months is a bit soon, IMO. Really, the first year is you and the employer learning and gauging each other. I'd wait till at least the 12 month mark. For a first job where pay and benefits are at the 50% target, maybe 18 months to 2 years.

[ventana]

Honestly they have likely lost money on you at this point

 

If you signed on with a low ball salary (i.e. Under 75k) then ask

At 94k - I would just sit down and say thank you for the mentoring, teaching and understanding and ask how you can do you job better

Maybe ask for some additional CME for things like difficult airway course or some other relevant thing - maybe a day or two doing intubations?

 

94k for 6 m of experience.... Took me from 2002 to 2007 to get over that....

[mgriffiths]

I'm not graduated yet, so take my input with a grain of salt, but I agree with the above.  The only way I would consider asking for any pay increase after 6 months would be if I was already generating high numbers of billing/RVUs in comparison to other PAs/NPs in the ED.  But even then, I would probably still wait until the 1 year mark to have more data to back up my request.

[tunafish]

why not ask? worse case scenario they say no. if you do your job no one would fire you because it is PITA to find another one of you and you do not know if he is even better. Do you know what a fair janitor's salary is? is it 10/hr or 12/hr??? if janitor asks you for a 13.50/hour and he does his job, are you going to think that he is a thankless egomaniac? Same is PAs to your med director and office manager...

 

Where the heck this "loosing money" coming from? He or she is doing the job, it maybe 100% intellectual or 30% intellectual de[ending on what came through the for of that ED, but it is job in the ED that needs to be done and it can be done by either a doc for $150/hr or you for $42/hr... for experienced provider time to make the decision is the same be it acute MI or ankle sprain. If PAs would cost money to the practice or health system they would never be hired to begin with.

 

All that being said, it is very difficult to convince people to pay you more money for the same job you already do. Hence notable increase in compensation usually means a new job search.

[mgriffiths]

That is true tunafish.  I tend to like having data to back up any time I ask for a raise (I've done it before) because it seems to be more successful.  That is the only reason I would wait a full year.  But your comments are not wrong, just a different viewpoint.

[ventana]

94,000 salary means likely need to generate about $190,000 to cover employment expenses (or maybe about $150,000 at bare min)

 

You need to figure out how many patients you are seeing and what they are getting for collections

 

You will likely find that your productivity stinks (and it should as a new grad!, if it does not you are doing something wrong)

 

 

So you cost a bare minimum of $12,500 per month to have as and employee

If you only brought in 10,000 per month - they lost about $2500 per month on your employment

 

 

As for comparing a new grad PA in the ER to a Doc - that is just simply the not a valid comparison. A doc should and does run circles around a new grad PA in just about any setting, They have had years to refine their trade, and the schooling to back it up.

 

Let's compare the experienced PA generating $400,000 for the ER getting $150,000 in salary, who is a smooth oiled machine - to the new grad as detailed above......

 

 

 

I am not putting down your viewpoint, but sometimes setting expectations to high can really hurt both the employer and the employee..... In this case a new grad making almost a 100k in the ER should likely just be a sponge for knowledge... Hence the idea of asking for CME or courses like Airway..... Or time off to do intubations with anesthesia or something that will help the skill set......

[Walkoffshot]

94,000 salary means likely need to generate about $190,000 to cover employment expenses (or maybe about $150,000 at bare min)

 

 

Im only curious... how do you gather these numbers? That's almost 100k for expenses on top of salary assuming your high number. (obviously benefits, insurance, maybe staffing etc but 100 K?)

[cbrsmurf]

Im only curious... how do you gather these numbers? That's almost 100k for expenses on top of salary assuming your high number. (obviously benefits, insurance, maybe staffing etc but 100 K?)

 

Employer has to pay taxes as well as benefits (malpractice, med insurance, etc)

[tunafish]

1. Standard fringe benefits calculation is 35-40% over the compensation to the person. Standard budgeting

2. Using your logic janitor, office manager of that ED and a security guard should work for free because they do not produce any income. Ideally we should make them pay since they go to the bathroom and use the paper and soap.

3.My wife just got a bill for her 3 stitches fixing a simple lac on her hand. Job related, done by a PA. Billed at $985 for a visit... just saying

94,000 salary means likely need to generate about $190,000 to cover employment expenses (or maybe about $150,000 at bare min)

You need to figure out how many patients you are seeing and what they are getting for collections

You will likely find that your productivity stinks (and it should as a new grad!, if it does not you are doing something wrong)


So you cost a bare minimum of $12,500 per month to have as and employee
If you only brought in 10,000 per month - they lost about $2500 per month on your employment


As for comparing a new grad PA in the ER to a Doc - that is just simply the not a valid comparison. A doc should and does run circles around a new grad PA in just about any setting, They have had years to refine their trade, and the schooling to back it up.

Let's compare the experienced PA generating $400,000 for the ER getting $150,000 in salary, who is a smooth oiled machine - to the new grad as detailed above......



I am not putting down your viewpoint, but sometimes setting expectations to high can really hurt both the employer and the employee..... In this case a new grad making almost a 100k in the ER should likely just be a sponge for knowledge... Hence the idea of asking for CME or courses like Airway..... Or time off to do intubations with anesthesia or something that will help the skill set......

[Z PA-C]

20-30 patients per 10/hr shift is a decent speed for ED isn't it? on my ER rotation, it seems as though most providers tend to have 2-3pts/hr on average so it sounds to me like you're pulling your weight.

[ventana]

1. Standard fringe benefits calculation is 35-40% over the compensation to the person. Standard budgeting

2. Using your logic janitor, office manager of that ED and a security guard should work for free because they do not produce any income. Ideally we should make them pay since they go to the bathroom and use the paper and soap.

3.My wife just got a bill for her 3 stitches fixing a simple lac on her hand. Job related, done by a PA. Billed at $985 for a visit... just saying

 

1)most medical practices run at about 100% of salary for provider - you make $100k, you are expected to bring in $200k - there is support staff that you have to pay, and taxes, insurance, electricity, telephone, business owners insurance, med mal, liability insurance, phone book listing, cable TV for waiting room, and the list goes on and on.....

2) totally irrelevant logic to apply them to this category - we are talking PA salary here....  you strike at the single biggest issue with small practices that try to treat a PA like an office manager - we are revenue generators, they are not...

3) I went to ER for an acute back spasm (horrid exam, 3 hour wait, just needed some meds but have to have an active script as I can be drug tested)  $600 bill for something that was a worthless visit minus the 2 scripts I got.  Our system is broken!

 

20-30 patients per 10/hr shift is a decent speed for ED isn't it? on my ER rotation, it seems as though most providers tend to have 2-3pts/hr on average so it sounds to me like you're pulling your weight.

 

If you are seeing 20-30 patients a day as a new grad in the first 3 months you are seriously over doing it. I would litterally pull you aside and review cases with you as I find it next to impossible that you are getting through this many and really understanding what you are doing..... jsut saying

 

 

Im only curious... how do you gather these numbers? That's almost 100k for expenses on top of salary assuming your high number. (obviously benefits, insurance, maybe staffing etc but 100 K?)

 

If the billing company does not want to release them (with the employers permission) you have no ability to get them.  As well they might be billing under the pin......  yet another reason we should be independent so that we are not "just put in the mix" for revenue

 

Medicare does release the info....

 

 

 

 

This is a common theme I see in PA's - they think they are producing FAR more then they are.  You really have no clue at what you are bringing into the practice unless you have actual numbers.  And typically these numbers are FAR under what you think   The whole "I do things to free up my doc so he/she can bill more" just does not support a $100,000+ salary and bennies package....

 

 

Not to hijack the thread, but we MUST know what we generate for the practice, and then use this for evidence we need to be paid more, or realize you are not a good revenue generator and see if you can improve on it.  Our fee for service system STINKS........

[bjmcell]

Ventana, 

I am able to see 20-30 patients per day in the first 6 months due to a high amount of visits that require little intervention by me. I see probably 5-7 patients per day that are there for penile/vag discharge that require a gonorrhea/chlamydia send off/ a wet mount and then treatment. Male penile d/c's without any testicular pain take very little time to see and dispo. Those 5-7 patients per day inflate my numbers along with simple things like suture or staple removals that return to the ED rather then going to their PCP for removal.