Fair offer?

[kmspac611]

I have received a job offer in a PCP office in a big corporate healthcare organization. I'm not sure how much more I can ask for or if it is even worth it. I feel like it is a pretty fair offer. Thoughts?

 

Base salary: 90k with bonus based on RVU over 3214 ($15 per extra RVU; paid at end of year) - the median for my state is 93,000 to 97,000

Health insurance: partial responsibility with multiple tiers; HSA and health equity line included (about $70/month I would have to pay)

CME/travel/member dues expenses paid for up to $2000

Accrued PTO, with max cap and rollover (not sure calculation, but recruiter said almost 5 weeks per year of potential total off time)

No contract, no non-compete

Included malpractice is occurrence based, so no tail 

401K with 6% match, 3 yr vested

 

It was lots of information and I get more details in paper later this week, but wanted to know if this was a decent offer or should I try and counter for more salary. Everything else is pretty much set by the corporate organization so not a lot of wiggle room there. 

 

Thanks!

 

[Reality Check 2]

Sounds a lot like a Catholic institution where I am.

 

I would fight the ACCRUED PTO - that sucks. You earn about 0.5 days every 2 weeks and they often won't let you take it off in advance. 

 

So,I would battle for front end loading of PTO. You are a revenue producing provider - you don't clock out for lunch................

 

No tail - NO DEAL. There is a 2 year statute of limitations on filing a claim - so, you leave the organization and someone files the next day for something that happened 2 years ago. You are hosed. 

 

I was always taught that malpractice MATCHES but never exceeds the supervising doc and ALWAYS HAS TAIL COVERAGE. amen

 

Ask about chain of command. Who authorizes your time off and CME? Who processes your reimbursement for CME expenses? Turnaround time? Who is your CLINICAL supervisor? The doc or the nurse manager? Who does your reviews? Are there cost of living raises? When? 

 

Do they bill under the doc or you? How are RVUs figured? Is it transparent? I mean really transparent and readible by the common NON CPA type of person.

 

No contract makes you a disposable employee - just know that. Docs with contracts can negotiate - you cannot for the most part.

 

Try to be treated like a provider not an hourly employee................. 

 

Who was in the position before you? How long were they there? Why did they leave? What is the turnover rate? 

 

Do you have your own MA/RN? How many exam rooms? Expected daily census? Are you subject to low census sent home without pay?

 

Call responsibilities? Paid call?

 

You have a lot more questions to ask, in my mind...........................

 

My very old 2 cents.

[MT2PA]

Always try to negotiate salary.  The worst they can do is say no.  Always try.

[coloradopa]

Sounds a lot like a Catholic institution where I am.

 

I would fight the ACCRUED PTO - that sucks. You earn about 0.5 days every 2 weeks and they often won't let you take it off in advance. 

 

So,I would battle for front end loading of PTO. You are a revenue producing provider - you don't clock out for lunch................

 

No tail - NO DEAL. There is a 2 year statute of limitations on filing a claim - so, you leave the organization and someone files the next day for something that happened 2 years ago. You are hosed. 

 

I was always taught that malpractice MATCHES but never exceeds the supervising doc and ALWAYS HAS TAIL COVERAGE. amen

 

Some comments

1. Its common for large institutions to have a policy like this. It protects them. If they advance you vacation and then you quit before you earn it, then they are out money. The PTO is pretty decent. If I count it right, its around 7.9 hours per pay period (assuming 26 pay periods per year). For comparison my large monolithic institution gives 8 hours per pay period until 5 years, then goes to 10 per pay period. If you don't get sick or have sick kids its all vacation. We are capped at 300 hours (twice per year we have to sell down to 300 hours). Basically this allows for around 3 months of vacation if you save it up. 

2. If you don't understand malpractice insurance then try not to comment on it. I highly doubt there is a state with a two year statue of limitations. Peds for example usually has an limit that allows them (or their parents) to sue until 18 no matter the length of time. Furthermore there are two types of malpractice insurance. Claims made is what you are referring to covers you while the policy is in effect. If you drop the policy then you have to buy a tail which covers future claims for the time the policy is in effect. Occurrence policies which the OP refers to cover you for the time period covered forever. There is no need to buy a tail. Occurrence policies usually cost more than claims made but tend not to go up since you are paying for exposure for each year. Claims made tend to go up every year since you are paying for the exposure for that year and the years the policy is in effect. 

3. CME is OK. Make sure you have CME time separate from PTO. I would try for 40 hours.

4. Salary is hard to gauge. They have an interesting proposal. According to MGMA average IM RVUs is around 4700. So if you can make the same RVUs that's an extra $20k per year and puts you well above average. The devil is in the details. Do the docs skim the high RVU patients etc. Also as reality check points out if you don't have your own MA etc its hard to get RVUs. No contract is not that unusual for large health care organizations. 

[Reality Check 2]

Some comments

1. Its common for large institutions to have a policy like this. It protects them. If they advance you vacation and then you quit before you earn it, then they are out money. The PTO is pretty decent. If I count it right, its around 7.9 hours per pay period (assuming 26 pay periods per year). For comparison my large monolithic institution gives 8 hours per pay period until 5 years, then goes to 10 per pay period. If you don't get sick or have sick kids its all vacation. We are capped at 300 hours (twice per year we have to sell down to 300 hours). Basically this allows for around 3 months of vacation if you save it up. 

2. If you don't understand malpractice insurance then try not to comment on it. I highly doubt there is a state with a two year statue of limitations. Peds for example usually has an limit that allows them (or their parents) to sue until 18 no matter the length of time. Furthermore there are two types of malpractice insurance. Claims made is what you are referring to covers you while the policy is in effect. If you drop the policy then you have to buy a tail which covers future claims for the time the policy is in effect. Occurrence policies which the OP refers to cover you for the time period covered forever. There is no need to buy a tail. Occurrence policies usually cost more than claims made but tend not to go up since you are paying for exposure for each year. Claims made tend to go up every year since you are paying for the exposure for that year and the years the policy is in effect. 

3. CME is OK. Make sure you have CME time separate from PTO. I would try for 40 hours.

4. Salary is hard to gauge. They have an interesting proposal. According to MGMA average IM RVUs is around 4700. So if you can make the same RVUs that's an extra $20k per year and puts you well above average. The devil is in the details. Do the docs skim the high RVU patients etc. Also as reality check points out if you don't have your own MA etc its hard to get RVUs. No contract is not that unusual for large health care organizations. 

 Don't be rude.

 

I KNOW why the institutions do the PTO the way they do. I am saying it is not acceptable to professionals and we shouldn't promote it at our level of function. I am an adult and know how to use my PTO. I don't want new grads taking clock punching jobs.

 

I DO KNOW statute of limitations (and IT IS 2 YEARS TO FILE FOR AN ADULT CASE) and have experienced it first hand. Are you an attorney? I commented on my 25 years of experience in 2 states and being around a lot of JDs who discuss this type of thing freely. I also ask a lot of questions. 

 

Malpractice insurance should never stop once you are no longer employed there. I don't ever want to buy my own tail coverage and shouldn't have to. The insurance should be appropriate to the level of practice and care and not leave anyone hanging in the breeze. So, OP needs to make sure they are getting the coverage they need and not ever feel compelled to have to buy their own. I see a lot of really crummy insurance pushed on new grads that will leave them vulnerable and hanging. 

 

I don't think PAs should be employees without contracts. 

 

As our profession is trying to fight for more independence we need to stop punching clocks and being employees. We need to be participating partners in our practices and professions. 

 

I don't like corporate medicine and make no effort to hide that fact. Corporate medicine is going to ruin the ART of medicine and turn it into a for profit situation at the expense of the patient and the providers. We aren't gods but we sure aren't making widgets in a factory either.

 

The RVUs and all that don't matter when the providers are supporting a heavy umbrella of mid level managers and admins who do nothing to actually bring income to the organization. Medicine is not McDonalds and medicine should not be for profit by CEOs and admins.

 

So, eat what you kill. Be paid a fair wage for fair work. Practice medicine wisely and appropriately. DO not be a peon or drone. Make sure you have appropriate malpractice coverage to avoid future disaster and accept nothing at face value. If you can't understand it in writing - then you don't sign it. And, if you have nothing to sign - you can't accept anything - thus, a contract.

 

Done

[treejay]

Occurrence based insurance does not require a tail policy.  It is valid for life.  This is in contrast to claims made insurance which does require a tail until until the statute of limitations applies.

 

I personally think this job offer is fair for the most part.

I didn't see # of patients/day.  That is crucial.  Is it 15?  or 30 ? couldn't be more different

 

 

 Don't be rude.

 

I KNOW why the institutions do the PTO the way they do. I am saying it is not acceptable to professionals and we shouldn't promote it at our level of function. I am an adult and know how to use my PTO. I don't want new grads taking clock punching jobs.

 

I DO KNOW statute of limitations (and IT IS 2 YEARS TO FILE FOR AN ADULT CASE) and have experienced it first hand. Are you an attorney? I commented on my 25 years of experience in 2 states and being around a lot of JDs who discuss this type of thing freely. I also ask a lot of questions. 

 

Malpractice insurance should never stop once you are no longer employed there. I don't ever want to buy my own tail coverage and shouldn't have to. The insurance should be appropriate to the level of practice and care and not leave anyone hanging in the breeze. So, OP needs to make sure they are getting the coverage they need and not ever feel compelled to have to buy their own. I see a lot of really crummy insurance pushed on new grads that will leave them vulnerable and hanging. 

 

I don't think PAs should be employees without contracts. 

 

As our profession is trying to fight for more independence we need to stop punching clocks and being employees. We need to be participating partners in our practices and professions. 

 

I don't like corporate medicine and make no effort to hide that fact. Corporate medicine is going to ruin the ART of medicine and turn it into a for profit situation at the expense of the patient and the providers. We aren't gods but we sure aren't making widgets in a factory either.

 

The RVUs and all that don't matter when the providers are supporting a heavy umbrella of mid level managers and admins who do nothing to actually bring income to the organization. Medicine is not McDonalds and medicine should not be for profit by CEOs and admins.

 

So, eat what you kill. Be paid a fair wage for fair work. Practice medicine wisely and appropriately. DO not be a peon or drone. Make sure you have appropriate malpractice coverage to avoid future disaster and accept nothing at face value. If you can't understand it in writing - then you don't sign it. And, if you have nothing to sign - you can't accept anything - thus, a contract.

 

Done

[mgriffiths]

Others have brought up good points, but the one question I would have is similar to treejay: what is required to start making a bonus?  Will you reach that seeing on average 15 or 30 patients per day?  How many other PA/NP providers received a bonus last year and what was the average amount? 

[kmspac611]

Thank you all for the input. To answer some questions you all had, all ACPs are "non-contract", so this is a norm for the institution. This is a new position being created in the practice, so I am not replacing anyone. They need another provider because both docs are near max capacity for patients. Max capacity is 15-20 patients, which I feel is a very fair and realistic patient schedule. I have been to places where I have seen over 40 in a day, which was doable, but stressful. To my understanding, because it is occurence based malpractice, there is no need to for tail coverage, which is why I did not push for it. They also see all their ACPs (MD, DO, PA, NP) in primary care positions as independent providers, so all my own billing, my own MA, etc.

 

The recruiter (I felt) was very transparent about the RVUs. He calculated it based on seeing 20 patients a day with each patient billing an average of 1 RVU. It came to about a 10K bonus, which I wasn't mad at. Of course, I know this will not be the case starting out, I probably will get little if no bonus this year just because I will be beginning to build my patient base. 

 

Maybe a little more advice on how to better negotiate the PTO? I aksed about taking PTO before having it since I have a family vacation coming up in December. They told me I could take up to 40 hours in the red and not be penalized. Of course I would have to work that back to zero before accruing again, but that made me feel better about not saying no to a trip my family has had planned for over a year. :)

 

Also this is my first salary job, ever. I know I'm not gonna get a perfect salary package and don't expect to. I am just making sure I am not getting completely run over and burnt. Thanks!

[coloradopa]

Thank you all for the input. To answer some questions you all had, all ACPs are "non-contract", so this is a norm for the institution. This is a new position being created in the practice, so I am not replacing anyone. They need another provider because both docs are near max capacity for patients. Max capacity is 15-20 patients, which I feel is a very fair and realistic patient schedule. I have been to places where I have seen over 40 in a day, which was doable, but stressful. To my understanding, because it is occurence based malpractice, there is no need to for tail coverage, which is why I did not push for it. They also see all their ACPs (MD, DO, PA, NP) in primary care positions as independent providers, so all my own billing, my own MA, etc.

 

The recruiter (I felt) was very transparent about the RVUs. He calculated it based on seeing 20 patients a day with each patient billing an average of 1 RVU. It came to about a 10K bonus, which I wasn't mad at. Of course, I know this will not be the case starting out, I probably will get little if no bonus this year just because I will be beginning to build my patient base. 

 

Maybe a little more advice on how to better negotiate the PTO? I aksed about taking PTO before having it since I have a family vacation coming up in December. They told me I could take up to 40 hours in the red and not be penalized. Of course I would have to work that back to zero before accruing again, but that made me feel better about not saying no to a trip my family has had planned for over a year. :)

 

Also this is my first salary job, ever. I know I'm not gonna get a perfect salary package and don't expect to. I am just making sure I am not getting completely run over and burnt. Thanks!

I think that no contract is very common with institutions. In our institution even the physicians are not on contract until they reach tenure track. It works both ways. No contract no non compete. Leave whenever you want. 

 

We have occurrence because we self insure. Its fine and in my opinion better than claims made since you don't have to worry about getting a tail (in deference to Reality check 1/2 of states have statues of limitations for adults that are 2 years or less, the rest are longer). Its one thing to have it in the contract another thing to enforce the contract if you part on bad terms. I had one practice that promised a tail but then found they couldn't get one through their insurance company since they only did tails for physicians (things you learn the hard way). Fortunately when I pointed out they would be liable if something happened they ended up paying for something called a nose for my next job (we were also parting under good circumstances). Here is AAPAs take on this:

https://www.aapa.org/threecolumnlanding.aspx?id=353

 

While we don't get bonuses based on RVUs, we track RVUs and so I know what I bring in. One thing you need to clarify is are they talking workRVUs (wRVUs) or RVUs. If its RVUs then you will definitely should get more than 1 per patient. If its wRVU then 1 is on the bottom end (medium complexity follow up appointment (99213). Now patient moderately complex (99204) for example is 2.4 wRVUs. 20 patients per day for 5 days per week x 48 weeks (4 off for vacation) 4800 RVUs if all 99213. Which should be around $24k extra. So it should be pretty easy to get 10k. Definitely clarify if its reimbursed wRVUs or billed wRVUs. I prefer billed since it gives them incentive to make sure they get reimbursed. 

 

As far as PTO, it doesn't hurt to ask, but large organizations don't really have the latitude to be flexible on benefits. If they offer you something, they potentially have to offer that benefit to everyone in that class. The fact that they are offering let you go into the hole is probably the limit of their flexibility. If you don't take sick time it builds up pretty fast. You should build up 40 hours by December if you start soon. I will be honest that it really benefits 12 hour shift employees more. We have to work 6 shifts per two week pay period. So if I work the first six shifts of one pay period and the last six of the next then I get the 16 days off in between. One of the big advantages of shift work. When I worked outpatient it wasn't quite as good. I wouldn't hurt to ask about 4 10s it makes things better.