What do you wish you had asked before you got hired?

[Andrew0568]

I'm a second-year starting to think about where I'm going to apply after graduation. Are there any questions you wish you had asked but didn't before you signed on to a job?

[sk732]

What is/are the real reason(s) that the people I'm replacing left?

 

What is the ACTUAL current annual patient census through the dept and how do you expect to keep up with the 150% increase in patient volume with the (lack of) available staff/space?

 

Once the job is in hand...How much lead time do you REALLY need to ensure I can start work when I show up?

 

These due to the somewhat discombobulated place I'm currently working in...

 

SK

[EMEDPA]

how supportive will the physicians be when working with a new grad?

[PACdan]

how supportive will the physicians be when working with a new grad?

 

 

Definitely turning some places off with this question. But I assume those are places I don't want to begin my career at...

[ventana]

don' believe corporations when they say "that is all we can do"

 

The only thing this really applies to is 401k or 403b contributions - as this is set in stone

but everything else is negotiable..  (not so much for the new grad, but experienced...)

[TWR]

As far as what is and is not negotiable, I agree with Ventana but do not be too cocky with requests. They don't know you and you don't know them. Maybe build some time frame for constructive review in say 3 months. Some things you need to "earn it" (reminds me of an old wall street ad).

[Croooz]

The best raise you can ever give yourself is to come in with a good salary.  I've seen too many agree to below-market salaries and receive promises of productivity bonuses and such only to then get taken off the schedule or not meet the requirements for the bonus.  The tactic is to get hungry new blood into the fold, have them work like dogs, then right before the bonuses are due they are either fired or quit because they won't get the bonus...then the partners divvy up the funds.  Unethical?  Absolutely.  Illegal?  Nope because the person agreed to the subjective metrics.

All that to say I would ensure everything is in writing and it's clear.

[Katera]

Are you another soul sucking, non-clinical run corporation managed by people who have never seen a patient?   Well.....are ya?

 

 

I would of asked something like that...........

[BruceBanner]

The best raise you can ever give yourself is to come in with a good salary.  I've seen too many agree to below-market salaries and receive promises of productivity bonuses and such only to then get taken off the schedule or not meet the requirements for the bonus.  The tactic is to get hungry new blood into the fold, have them work like dogs, then right before the bonuses are due they are either fired or quit because they won't get the bonus...then the partners divvy up the funds.  Unethical?  Absolutely.  Illegal?  Nope because the person agreed to the subjective metrics.

 

All that to say I would ensure everything is in writing and it's clear.

 

+1.

 

Always good to keep in mind most private practices and corporations will only pay you only as much as they need to get you hired and the minimum to keep you from leaving. Unless you are in a union with scheduled raises, or have compensation explicitly spelled out in your contract, nothing is ever guaranteed. Talk is cheap but when it comes time to pony up nobody likes to part with their money. 

[sunshinePAC]

+1.

 

Always good to keep in mind most private practices and corporations will only pay you only as much as they need to get you hired and the minimum to keep you from leaving. Unless you are in a union with scheduled raises, or have compensation explicitly spelled out in your contract, nothing is ever guaranteed. Talk is cheap but when it comes time to pony up nobody likes to part with their money. 

 

 

Agree with BruceBanner,  most companies will say whatever to get you in the door.  Best advice I can give you is to get whatever they promise you in writing.  If it's not in writing, it doesn't exist.

 

Also I would ask will there be a SP on site or only available by phone.  And has that SP ever worked with a PA before.

 

I've had situation before where the SP is available by phone only but doesn't call you back for HOURS, not an ideal situation.  As a new grad you will likely want/need closer supervision and should make sure the place that is hiring you can provide that, for your safety and the patients.

[jwells78]

Read the bios of Attendings who will be overseeing you in the practice; read up and learn them before they learn you. It gives you an edge in the interview, and it will give you some insight into their motivation.

 

Then see if you can do a site visit/ work a shift to see how things run. I did this with a job I ultimately turned down.

 

1. It enabled me to see if I would actually fit, and

 

2. It allowed me to feel out the PAs on the service and THEIR job satisfaction.

 

 

 

My 2 cents

[swooshie1]

What is the makeup of MY support staff; e.g., do I have my own M.A., nurse, etc ?  What is their role in my support, e.g., does the MA just room my patients (and then skim through facebook on their iphone in the meantime?) ...?  Who trains the support staff, etc.  How involved is administration in clinical management, and, are there any clinicians who make up admin?

 

For example, I am now into my 2nd family practice job (2-yr grad); at my first job MAs only roomed patients, occasionally called patients who were late to check in.  Otherwise, no support beyond that.  Nurses fielded phone calls, and that was pretty much it.  We did not have assigned staff to help us, so there was no buy-in/investment for provider support.  Now into my 2nd job, and the MAs do a ton more, they are trained well to the top of their licenses, same for nursing staff.  Support is pretty great in comparison, providers have assigned staff with consistency of having the same personnel assigned to them.

In job #1, administration had their thumbs on everything, none of them clinicians.  In job #2, our medical director oversees clinical operations as well as being a clinician, and administration stops by to hear about what we need and keep us posted on how our needs are being met by their efforts.

[Marinejiujitsu]

Yep. Learning environment. We are all stupid even out of school. Lol.

 

Nothing learning from people that have seen it a zillion times. There are places that prey on new grads make you work and make them rich in a time when oversight is needed.

 

Give yourself at least 2 yrs in a learning environment them go where the money is.

 

Sent from my SAMSUNG-SM-N920A using Tapatalk

[muchi]

In addition to the above, I would ask if they've hired a new grad before and what their experience was/how they've leaned from it 

[gcox87]

Not a pa, yet, but I remember reading several horror stories about the wife and husband office combos.. might be smart to ask if any family works in the clinic/department.

[bike mike]

No matter what you ask things may be different than described. I just left a job where I asked these questions at the interview:

1. Are we primary on these pts? Told yes and when I showed up for work my first day I was told they decided to change to a consulting service only and we were no longer primary.

2. How are team dynamics? Told great and in fact were toxic.

3. Hours? Told 3 x 12 but was in fact 4 x11

4. Train me up? Told me everyone was on board and in fact nearly no one was.

Red flags popped up from the first hour on the job and I was out the door soon after. No matter what you ask you will only find out what the job is like once you start.

[Lauren R]

I would ask to shadow the office for a day to see the day to day preceding to ensure that it is a fit.  Ask to talk with a PA who is already there about his/her experience.  I would ask more specifics about my benefits, like what must I do to utilize them.  I found out after starting my job that although I accrue PTO, I am not allowed to use it. Huge bummer, don't assume.  Ask about your malpractice insurance and CME time/allowance.  Ask why they're hiring. Growth is awesome. Everyone else left- big red flag.  Ask about expectations and details regarding the role.  Will there be hip to hip rounding? Will I see my own patients independently always or will they follow up with the doctor every few times?  Office dynamics- how many PAs, doctors, nurses, etc.  Ask about specifics regarding hours.  Places that see patients in the office and then round in the hospital often stay until the work is done, which might mean you always work 10-12 hour days when you were expecting to work 8 hour days.  Ask about their experience regarding new grads.  Some places love that the new grads are malleable and can be great teachers.  Others have not worked with a new grad before and are shocked when you aren't super productive day 1.

[PAC1720]

It's always a good idea to come up with a list of questions that focus on what is important to you in a job. But if I learned anything from my first job it's that people lie and you can't beat yourself up for not asking better questions.

 

Next time I will ask more specifics about the pain management side of the practice and ask if any of the doctors are being investigated.

[PAS2014]

Same as above... I would ask if my supervising physician is a felon who cannot write for controlled substances or see Medicare/Medicaid patients... because, I found out 3 weeks into my job that the only reason I'm working there is to fill his gap.  And, after I did some research, it's actually illegal for me to work under this guy.  When I mentioned this to my medical director, he told me I am "no good to the organization now", and said "the NP you replaced never had this problem, so I should have just hired another NP".  So, I'm secretly back on the job market after being at my first PA job for less than 2 months. I should have done my research and looked into all the physicians that work at this clinic.  

[paboard]

The best raise you can ever give yourself is to come in with a good salary.  I've seen too many agree to below-market salaries and receive promises of productivity bonuses and such only to then get taken off the schedule or not meet the requirements for the bonus.  The tactic is to get hungry new blood into the fold, have them work like dogs, then right before the bonuses are due they are either fired or quit because they won't get the bonus...then the partners divvy up the funds.  Unethical?  Absolutely.  Illegal?  Nope because the person agreed to the subjective metrics.

 

All that to say I would ensure everything is in writing and it's clear.

 

The best raise you can ever give yourself is to come in with a good salary. Well said, I couldn't agree with you more.

[PAC1720]

Same as above... I would ask if my supervising physician is a felon who cannot write for controlled substances or see Medicare/Medicaid patients... because, I found out 3 weeks into my job that the only reason I'm working there is to fill his gap. And, after I did some research, it's actually illegal for me to work under this guy. When I mentioned this to my medical director, he told me I am "no good to the organization now", and said "the NP you replaced never had this problem, so I should have just hired another NP". So, I'm secretly back on the job market after being at my first PA job for less than 2 months. I should have done my research and looked into all the physicians that work at this clinic.

I'm so relieved to hear that's it not just me. I'm also very sorry that you are going through it too. 8 would not wish this situation on anyone. I'm also back on the job market but it's not so secret. I tell my boss several times a week that I'm unhappy and he needs to let me out of my contract. I'm currently working with a lawyer to terminate our "agreement".

[weezianna]

To comment on a previous post that warned against working in an office with a husband/wife team....DON'T.  As a student, and years later as a practicing PA I was in that type of situation.  In one of my student rotations, the wife made false accusations towards the female students, and brought in ziplock bags of the jewelry the doc had given her to show off.  She spend long periods in the back office with him and emerged decorously reapplying her lipstick.   Very strange dynamics there.  Generally, it's not good to get into an office where business/financial interests are infiltrated by any family member.  I just started a weekend UC job, owned by an NP, and her kid is at the front desk.  Rude little thing won't do anything asked of her and texts reports of what goes on at the office to the mother/owner.  Today the kid, a non-medical person, second-guessed me on a patient I elected to send to the ER, and the mom gave me a ton of crap about how "we can't lose business".  Well, it's my clinical decision, and I guess you can find someone else to work here.

[Reality Check 2]

Even all these years in, I am still mystified by medical professionals either assuming they know how to run a business or not being willing to hire properly trained people to manage their business.

 

Then to bring in family.

 

YIKES!

 

I second, third and exponentially concur that working in a family run practice is a giant no-no and reason to run.

 

How to ask at an interview?? Tougher. I am old enough now to just say "I would like a rundown of the office staff and heirarchy. Are any of the staff related or married? How long has everyone been with the practice?"

 

Then I google everyone and look for social media posts and even read the icky Yelp etc reviews. Then I look up all the licensed folks on the state licensing website.

 

Paranoid? NO

Once bitten, twice smarter...

[overthehorizen]

How do you measure productivity and the provider contribution to profit?  You might start near the bottom in an experienced field but you are likely smarter and more motivated than most of the Physicians and NPs who work there. Will everyone see your progress and can you take documentation with you next employer on paper showing you arrived; started fresh near the bottom and through application of hard work, worked your way to the top. The Physician wants to continually deny you opportunities to advance yourself so they will tell you that your productivity doesn't warrant more money and when you leave, they will fabricate all manner of tales that your performance was questionable. Physicians are much like mobsters. Realize that they own the neighborhood but never forget they want to harm you for their personal gain. I was shocked to discover that the Physicians with 30 years experience were in fact quite lazy; many were not very bright and few have ever read anything about medicine since graduating from medical school. This business is simply a monopoly owned by the Physicians and their job is to extort, steal, lie and retaliate against any new graduate who aspires to earn what he is truly worth. Folks, this is the singular reason why PAs must seek independent practice or be left behind. We must abandon wasted time on nonsense board reviews and exams, abandon the "Physician PA partnership", abandon the Medical Board oversight. Nurse Practitioners are beating us in the market by not wasting their time on foolishness.  Everyone in the PA profession should be devoted to helping back a plan to secure independent practice rights immediately. One day, a PA should be able to graduate and be invited to become a partner in a practice comprised entirely of PAs. The Physician PA "partnership" at this time is nothing more than a Master Slave relationship. I am surprised how many PAs love being chained and whipped on a daily basis in exchange for sleeping in the field and getting scraps from the barnyard.

[jmj11]

A lesson that I learned 20 years ago. If you work on productivity, make sure there are no artificial barriers to your ability to see patients. When I received my contract for a job that was heavily production based (a family practice with a potential income, on paper, of 150K) I added the clause "there will be no barriers to the ability of the PA to schedule or see patients imposed by the practice or other providers." Their lawyers let this go through.

 

Then I started to work in this busy practice. Only then did the medical director voice his opinion that a patient should only see a "midlevel" as last resort. If all other physicians' schedules and work-ins were maxed out, then the patient could be schedule with the PA. Then he worked hard to make sure patients were not scheduled for me. I left the job after a year but because of that  wording I was able to go back and sue them (my schedule had 2-3 patients per day and the physicians were each seeing about 40). In the deposition, the scheduler testified that Dr. X (the medical director) came in and told her to only schedule a patient with the PA only with his permission. He would then try his best to squeeze the patient into some physician's schedule. 

 

So, be aware that if you work on productivity that you have freedom to succeed or fail on your terms, not by design. It turned out that the only value I brought to the practice (in their eyes) was for them to meet the qualifications as a Rural Health Clinic.

 

The other thing I learned from this experience was that I only interviewed with the hospital CEO and HR people. I only got to meet the physicians I would be working with once. So, in that one time meeting I was unable to sense their anti-midlevel thinking.