Hospitalist Offer, 1 year experience as a PA-C

[PAS2014]

Hi all,

 

I've been working as a general medical provider for a state psychiatric hospital for about one year.  I'm leaving my current position at the end of June, but will be staying on PRN.  It's just not a good fit for me professionally to remain here full-time.

 

I was offered a hospitalist job today at a 590-bed Level I Trauma and Stroke center.  They are building a 42-bed observational unit which will open January 2018, and this unit will be the main focus of my position once it opens.  Until then, I will work at the regional sister hospital (which is 20 miles away) rounding on all units.  Here are the particulars:

 

Things I'm OK with...

 

- $100,000 base salary.

- 1 year contract renewed annually.

- Quarterly performance bonus, not to exceed $25,000/year.  

- Bonus based upon the following metrics: # of patient encounters, quality of work, timely completion of notes (w/in 24 hours), and peer reviews.

- Malpractice dues paid by employer.

- 180 10-hour shifts per year, divided into 7on/7off schedule (7:30AM-5:30PM).

- 30-day termination of employment required by both parties (unless something illegal/unethical occurs, etc).

 

Things I'm not OK with...

 

- REQUIRED to see minimum of 15 patients per shift.

- 401k/profit sharing, medical/dental benefits available, but no mention of what the match is, the cost, or anything else for that matter.

- They will pay my state and organizational licensing dues only.  All other CME expenses are to be paid by me.

- Tail coverage required, and paid for by me.

- Required days of call and carrying pager, but no mention of how often or whether it's paid or not (verbally she told me it would be paid, but it's not written in this contract).

- Apparently if I have to file an employment lawsuit or if they have to file a lawsuit against me, I have to pay THEIR legal fees as well as my own.

- Not really OK with a maximum yearly bonus amount either, but it's better than no bonus...

- The vague parameters of this entire contract...

 

I am so disappointed with this.  I used to work for an employment lawyer years ago, so I'm going to see if she will review this for me and help with a counter.  But, how do you all think I should counter based on your experiences?

 

I'm going to put this in the Hospitalist Specialty folder as well, in hopes of catching a few more people who can assist.

 

Thanks! 

[sas5814]

- REQUIRED to see minimum of 15 patients per shift.

 

What are the consequences of not seeing 15 a shift? What is there just aren't 15 to see? (Unlikely but ask anyway)

 

 

- 401k/profit sharing, medical/dental benefits available, but no mention of what the match is, the cost, or anything else for that matter.

 

Easy.... ask for clarification. This effects your bottom line possibly significantly.

 

 

- They will pay my state and organizational licensing dues only.  All other CME expenses are to be paid by me.

 

Just nope....ask for a reasonable amount of CME money and paid time to attend CME. IMHO if you are an employee anything that is required for you to continue working should be covered by the employer.

 

- Tail coverage required, and paid for by me.

 

 

If they require it they pay for it.

 

 

- Required days of call and carrying pager, but no mention of how often or whether it's paid or not (verbally she told me it would be paid, but it's not written in this contract).

 

Also easy. Ask for clarification and make sure it is in writing and in the contract. 

 

 

- Apparently if I have to file an employment lawsuit or if they have to file a lawsuit against me, I have to pay THEIR legal fees as well as my own.

 

Oh hell to the no. Pay for them to sue you? That is absurd in the extreme. You are on your own for your expenses as are they. Not negotiable.

 

 

- Not really OK with a maximum yearly bonus amount either, but it's better than no bonus...

 

If the bonus is based on RVUs or productivity there should be no limit. That is the wonderful thing about it. More work=more money for everyone.

 

 

- The vague parameters of this entire contract...

 

Never never never sign a contract that has unanswered questions in it and do not start work until all questions are answered and in writing in the contract. I had a good friend and really smart PA ask me for contract advice and I told him the same thing. He didn't listen and created a cardiology practice with a cardiologist and, 18 months later after the practice was rolling, he was put on the curb and another cardiologist was brought in to take his place. His "buddy" screwed him and he could do it because they never finished the promised contract. The doc kept kicking the can down the road until the big event. My friend helped him build a practice from scratch and got screwed for his efforts.

 

Good luck!

[PAS2014]

@sas5814 - thank you for your notes!  

 

Just after posting this, I asked the company to clarify paid call/telemedicine/etc and PTO/sick leave/conference leave time.  I will never pay their legal fees or any sort of malpractice tail coverage so I'll be having my attorney draft a response regarding that for sure.  

 

I also asked for the penalty of the <15/patients per shift.  The way I see it - if there are 40 patients to go around that day, and it's me and two doctors (who are also required to see a certain amount of patients) - guess who gets screwed and only is allowed to see 5 patients or whatever?  The PA.  If our bonuses are structured by it, then the doctors will win every time.  I don't like the minimum patient idea.   Should I counter with a % of collections?  Or a tiered bonus structure? ("10/pt avg then XX, 12/pt avg then XXX, 15/pt avg then XXXX" so on and so forth)?  I know she wants the physician rounding on all of my patients at least initially which means they will bill for everything I do so a % may not be a good idea either.  Any advice on that front?  

 

I also responded with a CME "industry standard" of $2,500-$5,000 for licensing, conference, medical databases, books, etc, etc.  I'm required to do ACLS and get a DEA, so I don't feel so hot about paying out of pocket for either of those specifically for this job.

 

I also want to mention that there is no PTO or sick leave.  There is a notation that any unapproved time off that is more than 3 days nor for appropriate medical reasons is grounds for termination.  

 

And, I'm interested to hear thoughts on the 100,000 SALARY for a minimum of 180 shifts.  Should I try to counter with an equivalent hourly rate, as I assume I'll be covering people with extra shifts here and there, thus being able to get overtime?  I see a lot of conversation on this site regarding shift work pay (hourly vs salary). 

 

Thanks again everyone!

[fishbum]

 

 

- Apparently if I have to file an employment lawsuit or if they have to file a lawsuit against me, I have to pay THEIR legal fees as well as my own.

 

 

 

Are you sure you're understanding that part of the contract completely? It sounds like it might be a "prevailing party" clause, which isn't all that uncommon in contracts. Basically if you sue them and they win, you pay their fees, but if you sue and win, you do not. The stated purpose is to discourage frivolous lawsuits. Still might not be a good idea in your contract, but might not be quite as crazy as it sounds. Also, I'm not a lawyer and don't pretend to be one, and I'm not offering legal advice, and you should probably ask a lawyer before you take the word of any random person on the internet, particularly me. 

[PAS2014]

Exact language:

"In the event Company is required to incur legal expenses or take legal action to enforce terms of this Agreement, Employee shall reimburse Company immediately for all costs and expenses relating thereto including legal fees. Company further retains the right to offset any amounts owed to Company against any amounts Company owes Employee including, but not limited to, compensation."

[fishbum]

Exact language:

"In the event Company is required to incur legal expenses or take legal action to enforce terms of this Agreement, Employee shall reimburse Company immediately for all costs and expenses relating thereto including legal fees. Company further retains the right to offset any amounts owed to Company against any amounts Company owes Employee including, but not limited to, compensation."

 

Yeah, that doesn't sound like it has anything to do with you initiating an action against them. I don't think it's terribly uncommon for a successful litigant to be awarded legal fees in addition to a judgment with or without a clause like this. I'd be interested to see what your lawyer has to say about it...please let us know if you will.

 

ETA: still not a lawyer, still not legal advice 

[DizzyJ]

I think $100k with bonus up to $25k is pretty good, but need specifics about how the bonus structure works.  As stated above, what if you are unable to see 15 pts because of competition with the docs or lack of patients. 

 

CME is a must.  They need to provide you with adequate funds to maintain certification/licensure. 

 

PTO is a must.  They are likely thinking "well you have every other week off.  Take your vacation then". 

 

So, the pay $100k for 180 days is $55.56/hr.  I think that is pretty good to be in the $100-125k range just a year out of school. 

 

What does on-call look like.  Like will you be on call on your week off or if you finish rounding and leave early are you just on call till the end of your shift.  Needs specifics on that.  If any of the call is during your week off that must be compensated in addition to your salary. 

[roger777]

@sas5814 - thank you for your notes!  

 

Just after posting this, I asked the company to clarify paid call/telemedicine/etc and PTO/sick leave/conference leave time.  I will never pay their legal fees or any sort of malpractice tail coverage so I'll be having my attorney draft a response regarding that for sure.  

 

I also asked for the penalty of the <15/patients per shift.  The way I see it - if there are 40 patients to go around that day, and it's me and two doctors (who are also required to see a certain amount of patients) - guess who gets screwed and only is allowed to see 5 patients or whatever?  The PA.  If our bonuses are structured by it, then the doctors will win every time.  I don't like the minimum patient idea.   Should I counter with a % of collections?  Or a tiered bonus structure? ("10/pt avg then XX, 12/pt avg then XXX, 15/pt avg then XXXX" so on and so forth)?  I know she wants the physician rounding on all of my patients at least initially which means they will bill for everything I do so a % may not be a good idea either.  Any advice on that front?  

 

I also responded with a CME "industry standard" of $2,500-$5,000 for licensing, conference, medical databases, books, etc, etc.  I'm required to do ACLS and get a DEA, so I don't feel so hot about paying out of pocket for either of those specifically for this job.

 

I also want to mention that there is no PTO or sick leave.  There is a notation that any unapproved time off that is more than 3 days nor for appropriate medical reasons is grounds for termination.  

 

And, I'm interested to hear thoughts on the 100,000 SALARY for a minimum of 180 shifts.  Should I try to counter with an equivalent hourly rate, as I assume I'll be covering people with extra shifts here and there, thus being able to get overtime?  I see a lot of conversation on this site regarding shift work pay (hourly vs salary). 

 

Thanks again everyone!

Hourly is the same as my new grad contract ($55). I would ask for 60. If their SOP is to not pay OT then unlikely they will change that for you. But at least better to just get the guaranteed part increased. I was able to get small amt of PTO doubled to slightly less small. See if you can get 5 days at least. Agree with above CME should be minimum $2000.

[PAS2014]

Yes, I currently make $117,000 as a new graduate in my current role (which includes $10,000/year in student loan repayment rolled into my regular paycheck).  I was thinking of countering with $110,000 especially if the call is not paid, the benefits are costly, or if there is no wiggle room on CME.  I still haven't heard back from her yet on my questions from yesterday. 

[PAS2014]

@dizzyjon:  There was no structure written about on-call scheduling, etc.  I know there are tele-medicine opportunities at the 9 rural satellite hospitals this medical center owns.  And there is a residency program, so I know that some of the residents will be handling on-call responsibilities as well.  But I am not a resident, so I do expect to be paid separately for my time.  As it's written, it simply states on-call is "at Company discretion."  I, too, am worried that I'll be on-call during my weeks off, which would basically give me no time off at all.  There are a lot of things in this contract that need to be fine-tuned, so I'm hopeful my attorney can help pinpoint exact verbiage that should be changed.

[PAS2014]

@roger777:  My significant other presents his research at an international conference every other summer, thus we usually go somewhere for 2-3 weeks to wrap that work into a vacation.  I'd like to not have to work 4 straight weeks in a row in order to get 3 weeks of time off so I can attend the conferences with him!  Thus, I was considering even asking for just 7 days PTO at least in order to be able to use a week at my discretion for our yearly vacation.

[PAS2014]

And lastly, @dizzyjon:  Here is the language regarding the production bonus.  It does not appear to be linked specifically to RVUs.  

 

"Employee shall be eligible for a quarterly performance bonus up to a yearly maximum of $25,000.  The amount shall be determined by Company in it's sole discretion based upon Employee's professional performance during the prior calendar quarter.  The metrics which Company may consider include but are not limited to:  number of patient encounters, quality of work, timely completion (within 24 hours) of medical charts, and peer reviews."  

 

I'm having my attorney review the bolded language - I believe this to mean the previous 3 months employment of same calendar year, but I want to ensure that this cannot be read and interpreted as the previous calendar year quarter (ie:  bonus for work completed Jan-Mar 2018 not paid out until 2019).

[PAS2014]

I got clarification on a few issues:

 

1. 401k won't be matched until year 3 of employment and at 3%.  Followed by 4% @ 4 years, 5% at 5 years, and MAX 6% at 6 years and beyond.

2. CME is now $2,500.

3. To carry pager for overnight call (5:30pm-7:30am) on days off is $100.00/night.  For working days, there is no extra compensation.  Telemedicine fees will be paid separately as well, but have not been determined yet.

4.  No set days for PTO.  They will review my previous quarter shifts, and provided I have worked 15 shifts/month or similar equivalent, then I can request extra time off without penalty.

5. If I don't hit the 15 patient minimum every shift, it will not affect my compensation or my employment because she said the physicians will likely round on my most of my patients during my first year anyway.  She stated to me that she puts that in there (and I quote) "because too many NPs I have worked with expect to collect a paycheck without trying very hard.  This is a way for me to make sure the APPs who work for me are agreeable to put forth some real effort."  - I'll still have a lawyer review and possibly soften the language in the contract to be safe.

[LKPAC]

Sounds like things are getting better, and more clear!  Please keep us posted.

[PAS2014]

I finally heard back from them.  I hired an attorney (which was NOT cheap) and we forwarded our recommendations to make this an equitable contract and they still refuse to change anything.  

 

They are requiring I pay tail coverage if I leave the company, which I find absurd.  

It's an evergreen contract without any COL increases built in, maximum bonuses based on productivity (metrics of which I'm not allowed to see) and no PTO.  

I'm required to do a minimum of 180 10-hour shifts with no extra duty pay built in if I do more. I can always refuse other shifts, I suppose.  

401k matching does not start until year 3 (and at that time it will be 3% of salary).  

I requested a sign-on bonus (since I'm not getting 401k, overtime or PTO - and they refused.

They demand that I will pay attorney fees for both parties no matter if I bring a case against them or vice versa, and no matter who wins the outcome.

 

I feel I need to walk, but the jobs in this area are just plain awful.  Horrible pay and equally horrible treatment pretty much everywhere you go.  No respect of our profession at all.  My only other option is an NP/PA "fellowship" that is starting at a huge well-respected hospital system in the area - but it's a hospital that does not currently have very many PAs - maybe 20 at most.  And at least 750-1000 NPs.  Obviously a huge paycut, and I don't feel the curriculum is up to par with a PA education - it is geared mostly toward NPs who go to school online.

 

I'm certainly at an empasse.  Any suggestions are helpful.

[sas5814]

It begs the question is a crappy job better than no job and the only one that can answer that is you. There are a lot of red flags in this deal. May turn out to be nothing...may be critical. There are a few big flags. 1)Tail Coverage can be expensive. That creates an incentive for you to stay even if you don't like the job. 2) Bonuses based on a metric they won't share with you and you have no way of verifying. This is also known as the "take my word for it" bonus. 3) Minimum shifts required but no extra pay for more shifts? That gives them the ability to work you to death if they want to and just rake in the money from your work.

Roll the dice? My sage advice is when faced with nothing but choices that suck pick the one that sucks the least and get happy with it. Good luck!

[BruceBanner]

Wow. Well, sounds like money well-spent to me.

 

Unless you're between a rock and a hard place financially, I would not accept this job. They are already demonstrating their unwillingness to negotiate which is a sign of things to come. Plus, the contract itself isnt really that fair. No PTO, flat salary, and no 401k matching until year 3?? I mean that's not necessarily a deal-breaker but if you want to stay in that area it might be. 1 year is the standard for matching. As sas mentioned tail coverage is expensive---you are basically paying them to leave your job.

 

I suspect you will be used as a workhorse here...might want to consider relocation or even locums.

[Guest ral]

FAIL

[PAS2014]

Thank you folks.  My partner is currently a tenuring college professor, thus we cannot leave the area right now until he makes tenure (+/- 2 years from now).  And yes, I have no interest in paying to quit a job, which would make this entire situation horrible IF I want to quit.  I don't know why these people expect a PA to be able to afford thousands of $$ in tail coverage, but it certainly appears to be a way to keep people working for them even in poor conditions.

 

I agree with all of you that they plan to utilize me as a work horse.  I have asked to get the malpractice carrier's contact information so I can find out what the tail coverage will cost, and I have not heard back yet.  That is my deal breaker.  If they refuse to pay tail, then I may never be able to afford to quit if/when things get bad, which they may. 

[camoman1234]

Thank you folks.  My partner is currently a tenuring college professor, thus we cannot leave the area right now until he makes tenure (+/- 2 years from now).  And yes, I have no interest in paying to quit a job, which would make this entire situation horrible IF I want to quit.  I don't know why these people expect a PA to be able to afford thousands of $$ in tail coverage, but it certainly appears to be a way to keep people working for them even in poor conditions.

 

I agree with all of you that they plan to utilize me as a work horse.  I have asked to get the malpractice carrier's contact information so I can find out what the tail coverage will cost, and I have not heard back yet.  That is my deal breaker.  If they refuse to pay tail, then I may never be able to afford to quit if/when things get bad, which they may. 

You are correct about the tail insurance, I would NOT take this job. They will screw you and work you to death...they do not care about you or any other employee, they are there to make $$$ and we as providers are the only reason they make money... I would do locum for now and keep looking... good luck to you and keep us posted.

[PAS2014]

I spoke with the malpractice carrier, and this company does have a separate plan in place that covers tail in the event an employee leaves.  I'm not at all sure why she is so adamant that I have "paid tail" written in the contract.  The only way I'd be required to pay tail under this plan is if the company dissolves, and then it is $400.00 (which is 200% the separate tail plan yearly premium).  

 

I am also writing in that I will have a PRN job and that it will not interfere with my FT obligations.  So, in your experience, are you able to just say "No, I can't work a pop-up shift for you tomorrow, I'm already scheduled at my other job"?  Because I'm required to work 15 shifts a month, scheduled in advance.  So, to me that means those are my FT job shifts, period.  If they ask me to work extra shifts because someone is sick, etc, can I just say  "No, sorry, I'm working my PRN job."   And that legally doesn't interfere with my FT shifts...  right?  I know they can get pissy and try to tell me I have to work, but as long as I'm meeting my 15/mo shift minimum, would I have an out to take on extra unpaid shifts?

 

Or, I just work my PRN job and PRAY there are enough shifts available to get by until something else comes up...

[sas5814]

No explanation is needed beyond "I'm sorry I have another commitment." Your time is yours.

 

Now watch for the "after purchase" rules change. When I signed on to my current position we had a 13 shift a month obligation though most of us did more. Then we got a "strategic partner" and we are limited to a 40 hour week to save OT. That can be any mix of 8, 10, 12 hour days though the formula is supposed to be a 12, 2 10's, and an 8. So even if they stick to the plan ,which they don't, now people are working 16 to 18 shifts a month, making the same amount of money, and are away from home and hearth more calendar days every month. It didn't bother me that much but folks with small kids and, you know, lives are a bit put out. We lost on provider right away and at least 3 more are in the "out" lane. 

The fun part was the meeting to "get our input" on a policy that had already been decided by admin and wasn't going to get changed.

[PAS2014]

Yes, I'm concerned that this will become "but the company needs you to work extra shifts, and your contract states you have a minimum only".  I had actually tried to negotiate extra duty pay above 180 shifts and a sign-on bonus, which was declined with the mention that it's a start-up company and they do not have resources to meet my demands at this time.  

 

I'm now countering with a higher base salary with the explanation that I'm leaving a stable company with great benefits (but a job I HATE, not mentioned) to engage in a huge risk (and pay cut) with a small private organization with vague contractual obligations.  I have not heard back yet.  The good news is that I have a 30-day reciprocal clause to terminate without cause, and I'll use it if I have to and keep looking in the interim.

[cushball08]

I work as a hospitalist. I have never heard of a minimum patient requirement. Some days I have 12 pts while others days I have up 17 pts. Typical average is 15-17.Just depends on the census. They can't expect you to see 15 a day everyday. If the census is low what do they expect you to Do? Is there a penalty for seeing less than 15 pts. Are you also helping with admits? That will add more work to your load.

 

If you're a fulltime employee you shouldn't be paying for malpractice or tail coverage. Ever. Period.

 

You should be find out what happens if you work more than 15 shifts. My contact is broken down hourly despite being a salary employee. (I.e. xx an hour followed by xx plus $2 extra an hour for hours worked beyond my contracted amount of 174 hours).