New Grad Internal Med contract-Please advice

[millo10]

I am a new P.A. grad that was offered the following contract:

1.     Hours Per week: ≈40 Hours.

2.     Patient Quota: 30 Patient’s per day.

3.     Annual Salary: $150,000 

4.     Vacation: 4 weeks paid vacation per year.

a.     1 Week per quarter

b.     If longer than 1 week must make arrangements ahead of time.

5.     CME: 1 week paid time off to complete CME’s.

a.     $1000 per year is given for license & associations.

6.     Malpractice Insurance: Will be paid for,

7.     Mandatory 90-day clause: Must be given to terminate employment.

8.     Proof of paid quarterly taxes must be supplied.

9. Supplemental income Offered at 40:60, where 40% is given to employee and 60% is kept for the company when seeing patient’s at skilled nursing homes or doing hospital rounds.

 

The doctor wants to hire me as a subcontractor and wants me to start an S-corporation and bill me as a 1099. I'm not to sure about S-corporations, please advise. Additionally, I feel 30 patients is a lot for a new grad and. What is a good patient load to start, and how soon should I be expected to produce 30 patients per day, if at all? How should malpractice insurance be handled. Should I be given charting time? This is basically the contract given to me, is this wording sufficient? What else should I ask for?

 

Thank you-

 

[Reality Check 2]

Ummm, 30 patients a day in an Internal Medicine practice is INSANE - experience or none.

 

The salary is high but it sounds like you pay self taxes.

I am not keen on the self incorporating thing. 

 

The CME is too low and the malpractice needs to be clarified to exactly MATCH what the doc has AND have tail coverage. Accept nothing less.

 

Depending on the area you live in - 90 days is HUGE to quit. It is about 45 days too long and painful under any circumstances.

 

Vacation is too restrictive on when, how much, etc. If you get PTO - you get to use it whether to go to Hawaii or get your knee replaced. Not their business. Just pre-arrange and it is yours to work with. Nobody needs an extra mom to dictate PTO.

 

And - to sum all this up. There is no way you will see 30 patients a day, 5 days a week and ONLY work 40 hours. Try 55 with all the documentation - forms, pre-auth's etc.

 

Do you get an MA, LPN, RN - how many? How many exam rooms? What EHR? Policy on chart completion - same day? 48 hours?

 

The 30 patients per day is where I was done - that is insane and not responsible to the patient or the provider.

Medicine is not McDonalds..........

[Maverick87]

If they are saying 30 patients per day, that's likely the average, meaning there will be days when you see more than that. Also, it doesn't sound like they have any kind of training plan in place, which is very necessary for a new grad.

 

Some of the other things aren't so great, but the amount of patients is a deal breaker for me. Based on what you wrote, I'd look elsewhere.

[RuralER/Ortho]

Will this be out patient? First off, I don't think this will legally fly as 1099...

 

Secondly.... 30 pts per day? No chance. And no way that this will be approximately 40 hours, especially if this is 5 days per week.

[aquafresh11]

I agree with everyone, there are certain areas where 30 patients a day is do-able, internal med is absolutely not that area, new grad or seasoned. Doing that 5 days a week would make me shoot myself,

[millo10]

I was told I would have a shared M.A, and could not select my own M.A. There is about 5 exam rooms, and the EMR used is Practice Fusion. There is no training plan in place, and I'm supposed to hit the ground running. This is an outpatient setting, but the practitioner generally sees 30-70 patients per day himself, but would like me to manage 30+ patients daily. They were using dictation services, but they are thinking about terminating that service as fees are getting too expensive. They also want all charts completed same day to get better reimbursement.

 

I approached the provider and asked if I could be eased into the practice and started with 10 patients daily, and slowly increased to a manageable level. He didn't seem to happy about that idea.

 

Thank you for all the good advice.

[Maverick87]

I was told I would have a shared M.A, and could not select my own M.A. There is about 5 exam rooms, and the EMR used is Practice Fusion. There is no training plan in place, and I'm supposed to hit the ground running. This is an outpatient setting, but the practitioner generally sees 30-70 patients per day himself, but would like me to manage 30+ patients daily. They were using dictation services, but they are thinking about terminating that service as fees are getting too expensive. They also want all charts completed same day to get better reimbursement.

 

I approached the provider and asked if I could be eased into the practice and started with 10 patients daily, and slowly increased to a manageable level. He didn't seem to happy about that idea.

 

Thank you for all the good advice.

 

Too many red flags. You'd be better off with no job than this one.

 

Definitely move on and apply elsewhere.

[RuralER/Ortho]

70? That has to be a typo right. So instead it should be 40.... which is also unreasonable. Keep looking. Don't take this job.

[Reality Check 2]

Complete honesty here -

 

ANY PROVIDER SEEING 70 PATIENTS A DAY IS FULL OF CARP OR A COMPLETE HACK AND FRAUD.

 

This sounds like a Medicare mill and the expectation that a new grad hits full pace on day one is BS.

 

This sounds dangerous and just bad medicine.

 

RUN

[treejay]

definitely pass

[millo10]

Yeah, 70 patients per day is actually not a typo.

 

Thank you everyone for the all the good advice. I think I will pass.

[Reality Check 2]

Doc needs to be reported to the state board.

Cannot possibly be providing quality care.

Can you look him up on the state website for citations?

[Maverick87]

Yeah, 70 patients per day is actually not a typo.

 

Thank you everyone for the all the good advice. I think I will pass.

 

I've seen some bad docs in very sketchy situations, but I've honestly never heard of an IM doc that sees this much in a day. How is that even possible? Unless he's not actually seeing them at all...

[millo10]

He has 1 citation for lack of charting.

[Maverick87]

Doc needs to be reported to the state board.

Cannot possibly be providing quality care.

Can you look him up on the state website for citations?

 

How do you do that? I'd like to look up some docs.

[mgriffiths]

HAHAHA!!  I'm not surprised.  My wife works in an ophthalmology clinic as a scribe, and they would sometimes see 70+ patients but those were very injection heavy days...I couldn't imagine an IM doc seeing 70.  That's beyond ridiculous.

 

Glad you were able to make the right decision.

[Reality Check 2]

In Washington, it is the Medical Quality Assurance Commission.

 

You can google your state about "look up a doctor or medical provider" for your state.

[Reality Check 2]

We should all look ourselves up to make sure data is accurate and look up your supervising physicians and even those you see as a patient yourself.

 

Before I took a job, I googled every provider, read those stupid online reviews and then each state license they have held - other states included. Can be very eye opening and all public records are there including court documents.

 

Paranoid? - No

Careful and skeptical - YES

[Maverick87]

We should all look ourselves up to make sure data is accurate and look up your supervising physicians and even those you see as a patient yourself.

 

Before I took a job, I googled every provider, read those stupid online reviews and then each state license they have held - other states included. Can be very eye opening and all public records are there including court documents.

 

Paranoid? - No

Careful and skeptical - YES

 

Yeah I've been doing this too. I typically don't focus on Yelp or health grade reviews. You may get one or two patients that became angry over something stupid and then tried ruining the provider's online reputation.

 

However, it can paint an overall picture of the provider/office if you've noticed other red flags. I wouldn't rely just on those reviews though.