Guest ERCat Posted July 9, 2016 Share Posted July 9, 2016 New grad here at my current ER job for seven months. In the seven months I have been here, four out of the five original nurse practitioners have left and one has considered leaving. Additionally we hired two PAs, one experienced one that left after two weeks and now I find out the other one is choosing to leave after three months because she "realized ER isn't right for her." That makes me the second in seniority for all the advanced practice providers and I've been here just seven months. The turnover is insane and they can't seem to get people to want to work here or stay working here. I KNOW what the issues are - and there are many. Lack of true respect to "midlevels" as a whole (not being a part of provider meetings, being subjected to last minute schedule changes without any apology, being given the crappy shifts that just make things easier for the docs) although they are all fairly nice and pleasurable to work with on a day to day basis. Crazy schedule (I would say we work 75% of more of our shifts nights such as 3pm-1am, a lot of weekend shifts too, and zero regularity to the schedule...). Low pay for ER (start around 53/hour without any RVUs and only the ones with years of experience make more than that... Most ERs in my state pay at least 60-65 even for new grads). Crap benefits (pretty much only medical and a retirement plan without any match and that's literally it for benefits, but that extends to the doctors too). And the most important downside of all is the over promising and under delivering. We've been told multiple times about "raises," getting RVUs (I have yet to see a check) and being invited to meetings now (that was 2 months ago and we haven't been invited to a meeting). When I was hired I was told I would get a raise at six months and when I asked about it later they acted like they had no idea. There's just a lot of disorganization and it's clear we are not the priority. Here's the deal - I LOVE my job. Despite the above issues I love the fact that I work for a group who likes me a lot, who teaches me literally anything I need to know, and seems to respect me a lot as an individual. These doctors have been kind to me, have never pushed me or berated me... If anything they want me to be easier on myself. They are constantly providing wisdom and are willing to sit down and talk me through each patient if I need. In that sense it's amazing and it makes me love my job and feel good about challenging myself with tough patients as I know I always have the support. That said - I think they're not "getting it." You'd think that after having such insane turnover they would be working on changing things (better pay, better hours, etc) but they haven't. I've brought these things up in a subtle way before when they've mentioned "So and so is leaving - and we are worried now you're going to leave." But it doesn't seem to make a difference... They say they will change things but really haven't. As someone who has been there only eight months part of me tells me to shut up and keep on going with my job because I like it a lot for now anyway. And maybe it's a little too early in the game to be making demands. But the other part of me knows a lot of these things are gonna get old, especially as I gain experience. And that we are going to keep hiring people that will just leave. The constant turnover is frustrating. I have a feeling I am their "golden child" (LOL) because I have worked my butt off and they know I love working and that I am always wanting to improve - I feel like I have been the "dream employee" for them in that sense. I've also been very flexible with all the changes. So part of me thinks I should say something. Anyone have any thoughts? Link to comment Share on other sites More sharing options...
Maverick87 Posted July 9, 2016 Share Posted July 9, 2016 Damn, I make almost that much in an outpatient IM clinic that is WAY more laid back than your environment. And, if memory serves me, we live in the same state. You can do better than that, imo. Link to comment Share on other sites More sharing options...
Will352ns Posted July 9, 2016 Share Posted July 9, 2016 If you are really getting what you need as far as experience and can tolerate the pay (it's pretty low) and schedule for a while, you might want to hang in there for a year or so. It sounds like you are getting the training/mentoring that you need. To me, new grad as well, that carries a lot of weight. In the end, you will have good experience and better references for your next job if you don't jump ship too soon. It's a balancing act. Link to comment Share on other sites More sharing options...
Michigander Posted July 9, 2016 Share Posted July 9, 2016 At my first job out of school I was the fifth provider to leave in less then 18 months in a very small clinic (we only had 3-5 at a time). I had some of the same problems, not being included in major decisions/meetings, lack of respect, pay was relatively low. I tried the subtle approach. Then I tried the "here's my resignation and why" approach. My administrators told me that "every clinic has a different way of communicating" and, my favorite, "you need to be more efficient" (without any MA support). The work itself was great and I had the opportunity to grow as a provider. I used my experience there to look for a better job. I knew what to ask and what to look for this time around. I found a much better job that is actually supportive that I like 95% of the time. I agree with Will352, having training/mentoring is extremely valuable. My goal was to stick out the old job for a year and I did. I think it's hard to look for a new job if you've been there less. Link to comment Share on other sites More sharing options...
cop to pa Posted July 9, 2016 Share Posted July 9, 2016 As one of the senior affected staff, if you want to make the issues of retention clear, you need to use a sledgehammer. Write a formal memo to management addressing the high turnover/ low retention rate. Offer reasons for it, what data you can to back it up, and constructive, realistic solutions to correct it. Be prepared for it to be dismissed. Then, when you resign in about six months with a new job lined up and they ask you why, remind them off the reasons you gave six months prior. Then enjoy your new position with better pay and hours. Of course, they may listen to you and things may get better. Link to comment Share on other sites More sharing options...
TWR Posted July 9, 2016 Share Posted July 9, 2016 I ASSUME THIS GROUP THAT YOU LOVE ARE NOT THE SAME PEOPLE THAT "DON'T GET IT". CORPORATE PEOPLE? ARE THEY AT LEAST MEDICAL OR JUST "SUITS"? Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted July 9, 2016 Share Posted July 9, 2016 Be prepared for it to be dismissed. Then, when you resign in about six months with a new job lined up and they ask you why, remind them off the reasons you gave six months prior.What would lead one to think that they'd even ask why one was leaving? They've already been hit in the head with a 2x4 enough times already. Most likely the OP is just another spoke in the spinning wheel about to pop out. Link to comment Share on other sites More sharing options...
Guest ERCat Posted July 9, 2016 Share Posted July 9, 2016 ^ Sadly I worry that you're right. Maybe they DO get it and they know they're underpaying and underdelivering but haven't decided that it's worth it for them to change. I think the way things are set up they're going to get a bunch of new grads who leave after six months to year and go on to opportunities with better pay and schedule once they have experience under their belt, or a bunch of experienced PAs who leave after just a few months when they realize they were misled. God... I can't even tell you how many things I've been told would happen that never happened. "You will only be working day shifts and the latest you will be off at 10." I work mostly all nights and weekends. "You will get a raise at six months." When I asked about that raise two months ago they confirmed it would happen. When it didn't happen I asked again and heard "Huh? A raise? Who told you that?" "We are going to start inviting you to the provider meetings because the last PA that left suggested it and it makes sense that we should invite you guys; we just didn't think of it." They have had five meetings since that conversation and I have still not been invited to a meeting. "You will get RVUs." Seven months later it's "Oh, we are still figuring out how to calculate those." And "You don't need to be working more than 160 hours a month." Yet I have been working close to 200 on average! I would THINK that by now that THEY are tired of the turnover and would do whatever it takes to retain people. But maybe none of us "midlevels" have wowed them enough to care to retain us. Maybe none of us have proven to be irreplaceable and THAT is why they haven't wanted to change things? However I would like to think that they really like me and think I have potential - many of the docs have told me that - so maybe I can make myself irreplaceable to them with time? On multiple occasions my direct supervisor has come into my office with a concerned look on his face to make sure I haven't been "poisoned" by the negativity, to make sure I am not thinking about leaving. Sad thing is if they offered competitive pay and benefits I probably WOULD never consider leaving because I love the job so much. And yes - I do work for a big ER corporation but we are part of a division in which there is more flexibility. We rarely get much intervention from the corporation believe it or not, so I really do think it is the CEO of our direct group is responsible for all of this. Link to comment Share on other sites More sharing options...
MT2PA Posted July 9, 2016 Share Posted July 9, 2016 ^ Sadly I worry that you're right. Maybe they DO get it and they know they're underpaying and underdelivering but haven't decided that it's worth it for them to change. I think the way things are set up they're going to get a bunch of new grads who leave after six months to year and go on to opportunities with better pay and schedule once they have experience under their belt, or a bunch of experienced PAs who leave after just a few months when they realize they were misled. God... I can't even tell you how many things I've been told would happen that never happened. "You will only be working day shifts and the latest you will be off at 10." I work mostly all nights and weekends. "You will get a raise at six months." When I asked about that raise two months ago they confirmed it would happen. When it didn't happen I asked again and heard "Huh? A raise? Who told you that?" "We are going to start inviting you to the provider meetings because the last PA that left suggested it and it makes sense that we should invite you guys; we just didn't think of it." They have had five meetings since that conversation and I have still not been invited to a meeting. "You will get RVUs." Seven months later it's "Oh, we are still figuring out how to calculate those." And "You don't need to be working more than 160 hours a month." Yet I have been working close to 200 on average! I would THINK that by now that THEY are tired of the turnover and would do whatever it takes to retain people. But maybe none of us "midlevels" have wowed them enough to care to retain us. Maybe none of us have proven to be irreplaceable and THAT is why they haven't wanted to change things? However I would like to think that they really like me and think I have potential - many of the docs have told me that - so maybe I can make myself irreplaceable to them with time? On multiple occasions my direct supervisor has come into my office with a concerned look on his face to make sure I haven't been "poisoned" by the negativity, to make sure I am not thinking about leaving. Sad thing is if they offered competitive pay and benefits I probably WOULD never consider leaving because I love the job so much. And yes - I do work for a big ER corporation but we are part of a division in which there is more flexibility. We rarely get much intervention from the corporation believe it or not, so I really do think it is the CEO of our direct group is responsible for all of this. Or they are trying to placate you and keep you emotionally happy so you won't use your better judgement and leave for the same reasons everyone else has. Solely based on what you've said in this thread it sounds like the KNOW you love the job and the mentoring and are banking on that being enough to keep you as long as they keep checking in and showing concern. It's a win-win for them - keep a hardworking employee without paying them what they deserve and keep playing dumb about improvement of the job. They'll milk you for all you're worth. Even if you DO leave in 6 months, that's 6 more months of taking advantage of you that they have compared to you leaving now. Link to comment Share on other sites More sharing options...
HJK Posted July 9, 2016 Share Posted July 9, 2016 Experience. That's what you are getting with first job. If safe environment and if you love what you do, stick around for at least 1 year, better with 2 years. Then yoy can reassess. I got paid a way less starting. Now i am pretty good place professionally and financially. Link to comment Share on other sites More sharing options...
Guest Paula Posted July 10, 2016 Share Posted July 10, 2016 Find out when the next meeting is and just show up for it and say "thanks for inviting me to the meeting". When you are asked who invited you, just say, "what are you talking about? " you invited me", remember? Link to comment Share on other sites More sharing options...
Lauren R Posted July 10, 2016 Share Posted July 10, 2016 I'm sure they recognize something is causing a high turn over. Most people aren't that clueless. The place I work has a similarly high turn over, but they're struggling to get the funding to make the changes that would make more people stay. If they ask your opinion, definitely give it. Otherwise, if you're happy with your job, keep at it. When you start to be unhappy with your job I would express your concerns as well as continue to look for other positions. Link to comment Share on other sites More sharing options...
cbrsmurf Posted July 10, 2016 Share Posted July 10, 2016 ^ Sadly I worry that you're right. Maybe they DO get it and they know they're underpaying and underdelivering but haven't decided that it's worth it for them to change. I think the way things are set up they're going to get a bunch of new grads who leave after six months to year and go on to opportunities with better pay and schedule once they have experience under their belt, or a bunch of experienced PAs who leave after just a few months when they realize they were misled. God... I can't even tell you how many things I've been told would happen that never happened. "You will only be working day shifts and the latest you will be off at 10." I work mostly all nights and weekends. "You will get a raise at six months." When I asked about that raise two months ago they confirmed it would happen. When it didn't happen I asked again and heard "Huh? A raise? Who told you that?" "We are going to start inviting you to the provider meetings because the last PA that left suggested it and it makes sense that we should invite you guys; we just didn't think of it." They have had five meetings since that conversation and I have still not been invited to a meeting. "You will get RVUs." Seven months later it's "Oh, we are still figuring out how to calculate those." And "You don't need to be working more than 160 hours a month." Yet I have been working close to 200 on average! I would THINK that by now that THEY are tired of the turnover and would do whatever it takes to retain people. But maybe none of us "midlevels" have wowed them enough to care to retain us. Maybe none of us have proven to be irreplaceable and THAT is why they haven't wanted to change things? However I would like to think that they really like me and think I have potential - many of the docs have told me that - so maybe I can make myself irreplaceable to them with time? On multiple occasions my direct supervisor has come into my office with a concerned look on his face to make sure I haven't been "poisoned" by the negativity, to make sure I am not thinking about leaving. Sad thing is if they offered competitive pay and benefits I probably WOULD never consider leaving because I love the job so much. And yes - I do work for a big ER corporation but we are part of a division in which there is more flexibility. We rarely get much intervention from the corporation believe it or not, so I really do think it is the CEO of our direct group is responsible for all of this. When you reach 1 year: *Find out when and where the meeting is and just go *Have a presentation or powerpoint ready with all the issues you stated along with your evidence (schedule, pay in other ER's, etc) *In the same presentation, provide your proposed fixes AND timeline of those fixes, with the specifics (i.e. exactly how much to pay per RVU) If they truly value you and the other pa/np's, you'll find out. I wouldn't expect them to fire you and give you too much flak if they truly do like you based on what you wrote, but you should be prepared to leave anyways, since it doesn't seem like an ideal long-term job. Link to comment Share on other sites More sharing options...
BruceBanner Posted July 11, 2016 Share Posted July 11, 2016 No one is irreplaceable in healthcare. Personally I dont think it's worth your time trying to "stick it" to administration. They dont give 2 sh!ts about you. They care about moving volume, patient satisfaction, and the bottom line. Just leave when you are ready. Get another job first, then go. No notice unless you are going to really screw over your colleagues. You could plan and fight a crusade but in my experience it wont change a thing. I worked for a toxic company a while back. In fact, I became part of the problem because I hated my job so much. Just go when you are ready, and breathe the free air. Link to comment Share on other sites More sharing options...
Reality Check 2 Posted July 11, 2016 Share Posted July 11, 2016 You have identified a problem that no one has bothered to attend to before now. You are smart and concerned. The admins don't see it or don't want to see it - in their world - the numbers must be ok or their world is safe - so they will not do anything to cause upheaval or bring attention to themselves in a negative light. You are, in their eyes, a drone and highly dispensable. If you don't work out - they will just go find another. That is why networking is so important. Where I live - we ALL know who NOT to work with. Word spreads. One truly not smart doc is dangerous and we all warn off new grads and out of towners whenever possible. Bad admin set ups - the word spreads like wildfire. So, your dedication and love for the profession are outstanding. You will have to use it elsewhere to keep making a difference and not go completely bat poop nuts and become a burned out dispassionate. Move forward. Karma is still watching. Link to comment Share on other sites More sharing options...
Febrifuge Posted July 11, 2016 Share Posted July 11, 2016 I'm sure they recognize something is causing a high turn over. Most people aren't that clueless. The place I work has a similarly high turn over, but they're struggling to get the funding to make the changes that would make more people stay. If they ask your opinion, definitely give it. Otherwise, if you're happy with your job, keep at it. When you start to be unhappy with your job I would express your concerns as well as continue to look for other positions. Personally, I've always had far better results if I didn't wait until I was miserable to start looking for a new job. I figure it helps keep away that stink of desperation, and allows for better evaluation of any new job offers. Link to comment Share on other sites More sharing options...
Guest JMPA Posted July 12, 2016 Share Posted July 12, 2016 New grad here at my current ER job for seven months. In the seven months I have been here, four out of the five original nurse practitioners have left and one has considered leaving. Additionally we hired two PAs, one experienced one that left after two weeks and now I find out the other one is choosing to leave after three months because she "realized ER isn't right for her." That makes me the second in seniority for all the advanced practice providers and I've been here just seven months. The turnover is insane and they can't seem to get people to want to work here or stay working here. I KNOW what the issues are - and there are many. Lack of true respect to "midlevels" as a whole (not being a part of provider meetings, being subjected to last minute schedule changes without any apology, being given the crappy shifts that just make things easier for the docs) although they are all fairly nice and pleasurable to work with on a day to day basis. Crazy schedule (I would say we work 75% of more of our shifts nights such as 3pm-1am, a lot of weekend shifts too, and zero regularity to the schedule...). Low pay for ER (start around 53/hour without any RVUs and only the ones with years of experience make more than that... Most ERs in my state pay at least 60-65 even for new grads). Crap benefits (pretty much only medical and a retirement plan without any match and that's literally it for benefits, but that extends to the doctors too). And the most important downside of all is the over promising and under delivering. We've been told multiple times about "raises," getting RVUs (I have yet to see a check) and being invited to meetings now (that was 2 months ago and we haven't been invited to a meeting). When I was hired I was told I would get a raise at six months and when I asked about it later they acted like they had no idea. There's just a lot of disorganization and it's clear we are not the priority. Here's the deal - I LOVE my job. Despite the above issues I love the fact that I work for a group who likes me a lot, who teaches me literally anything I need to know, and seems to respect me a lot as an individual. These doctors have been kind to me, have never pushed me or berated me... If anything they want me to be easier on myself. They are constantly providing wisdom and are willing to sit down and talk me through each patient if I need. In that sense it's amazing and it makes me love my job and feel good about challenging myself with tough patients as I know I always have the support. That said - I think they're not "getting it." You'd think that after having such insane turnover they would be working on changing things (better pay, better hours, etc) but they haven't. I've brought these things up in a subtle way before when they've mentioned "So and so is leaving - and we are worried now you're going to leave." But it doesn't seem to make a difference... They say they will change things but really haven't. As someone who has been there only eight months part of me tells me to shut up and keep on going with my job because I like it a lot for now anyway. And maybe it's a little too early in the game to be making demands. But the other part of me knows a lot of these things are gonna get old, especially as I gain experience. And that we are going to keep hiring people that will just leave. The constant turnover is frustrating. I have a feeling I am their "golden child" (LOL) because I have worked my butt off and they know I love working and that I am always wanting to improve - I feel like I have been the "dream employee" for them in that sense. I've also been very flexible with all the changes. So part of me thinks I should say something. Anyone have any thoughts? any place, hospital or private practice, loses money with turnover. to train a new employee costs more money than to give a raise to keep a productive employee. Link to comment Share on other sites More sharing options...
Guest ERCat Posted July 12, 2016 Share Posted July 12, 2016 Thank you, everyone, for your insightful responses. Since ER is a hard field to break into you as a new grad, I think maybe I am better off soaking up all of the knowledge I can like a little sponge. After all, although the pay and benefits and respect towards "mid levels" may not be very high, the learning experience is equivalent to a residency, in my opinion. I think my best bet is to cut down on my shifts to avoid burnout, and do everything I can between now and my one year mark To show them what I am capable of. When I hit one year, I really like the idea of having a meeting with them and coming up with a formal presentation of all of the issues I've described above. Unfortunately, the nurse practitioners and physician assistant they've hired seem to have no problem being "sheep" - just putting up with things as long as they can and then leaving. No one has ever ever ever said anything to them. Once I had my one year I think I will be in a position where I can do that. Because I am definitely not a sheep! Of note. I have become somewhat of a feminist since I started working. What is remarkable is that there is a pattern in their hiring preferences. They like to hire new grad, and they like to hire women. Yes, I get that the vast majority of of PA and NP are female… What is it, 75%? But literally they have not hired one full-time male PA. The one that they did recently hire backed out of the deal A month before he was supposed to start ( of note, in general we have had a lot of those… People that were supposed to join the team and then end up backing out for whatever reason). Link to comment Share on other sites More sharing options...
KMD16 Posted July 12, 2016 Share Posted July 12, 2016 ^^ poor decision. And a dangerous one. Yes. You're a sheep. You ain't different from others who've left. They maybe smarter than you. I smells danger. Toxic environment. Good luck! Link to comment Share on other sites More sharing options...
Reality Check 2 Posted July 12, 2016 Share Posted July 12, 2016 Not sure I would stick it out either. They show no concern for the situation. I love your enthusiasm but don't want you to get burned. Be prepared for disappointment and keep your eyes open - there may be something out there for you that would be better all the way around and get you out of this environment. Don't be complacent and don't ever put yourself at risk - Link to comment Share on other sites More sharing options...
cinntsp Posted July 13, 2016 Share Posted July 13, 2016 After all, although the pay and benefits and respect towards "mid levels" may not be very high, the learning experience is equivalent to a residency, in my opinion Whatever you have to tell yourself to deal with a crappy situation... Link to comment Share on other sites More sharing options...
moestown1016 Posted January 5, 2017 Share Posted January 5, 2017 Any update? Sent from my iPhone using Tapatalk Link to comment Share on other sites More sharing options...
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