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Who has used their licensed independently to work in an Urgent Care Setting


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I had an interview today with a Doctor that is affiliated with an Urgent Care with multiple locations within Ohio. This Urgent Care has multiple locations in Ohio, and I am looking for employment right now, but I don't know if this is the right for me. This is what I was told today: work four 12 hour shifts per week (total of 16 shifts per month), 80 hours paid time off, $ 1000 for CME, Malpractice is covered at 100%, paid health insurance, no on-call, two days of training and after then I am by my self but I can call and ask questions, written contract will be by email and contain less sentences, to complete my first 500 hours I have to work in the ED where there is a Doctors supervision, all billing and prescription will be written under my license when at the urgent care, wait time for patient cannot be more than 30 minutes, and they want to start me $45/hour?

 

Any suggestion please?

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4 hours ago, airslant said:

What if it's more than 30 minutes?

Sent from my SM-G955U using Tapatalk
 

I won't get pay increase and of course, he made sure that I was aware that they will not be happy with me if it is more than 30 minutes of wait time. As of right now, if I want to make more money, I will have to work more hours. 

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38 minutes ago, ArmyMan said:

I won't get pay increase and of course, he made sure that I was aware that they will not be happy with me if it is more than 30 minutes of wait time. As of right now, if I want to make more money, I will have to work more hours. 

Just so you know, if you have 2 DOT physicals, 1 lac repair, and 1-2 sick visits (1 with vaginal discharge who will require a pelvic exam done) walk in at the same time, your wait time is going to be 1.5hrs+.

 

I work in urgent care as a MA and let me tell you...our wait time can go up to 2 hrs.

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17 hours ago, ArmyMan said:

I had an interview today with a Doctor that is affiliated with an Urgent Care with multiple locations within Ohio. This Urgent Care has multiple locations in Ohio, and I am looking for employment right now, but I don't know if this is the right for me. This is what I was told today: work four 12 hour shifts per week (total of 16 shifts per month), 80 hours paid time off, $ 1000 for CME, Malpractice is covered at 100%, paid health insurance, no on-call, two days of training and after then I am by my self but I can call and ask questions, written contract will be by email and contain less sentences, to complete my first 500 hours I have to work in the ED where there is a Doctors supervision, all billing and prescription will be written under my license when at the urgent care, wait time for patient cannot be more than 30 minutes, and they want to start me $45/hour?

 

Any suggestion please?

I have worked a few jobs like this. It can be challenging because you never know what will walk in the door. Among the colds and lumps and bumps people will wander in having and MI or a stroke or bleeding because their INR is 12. You need to clear understanding of what is expected in these circumstances and the places I worked at varied from basically trying to act like an ER to "ship them ASAP".  Also your support call needs to be spelled out clearly. I have had a doc available to be in the building in 20 minutes and I have had one I could call who was on vacation out of state.

$45 seems very very low to me but these things vary so much by location and demand that I can't be accurate for your area and circumstances. I don't get out of bed for less than $60 and I have made quite a bit more. Your mileage may vary.

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$45 is too low. What is the average census? Are you getting over time then each week for working behind 40hrs a week? Will you be solo provider on and what support staff will you have? 

This doc is probably sitting back making bank while employing slaves at $45 hr. 

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22 hours ago, ArmyMan said:

I had an interview today with a Doctor that is affiliated with an Urgent Care with multiple locations within Ohio. This Urgent Care has multiple locations in Ohio, and I am looking for employment right now, but I don't know if this is the right for me. This is what I was told today: work four 12 hour shifts per week (total of 16 shifts per month), 80 hours paid time off, $ 1000 for CME, Malpractice is covered at 100%, paid health insurance, no on-call, two days of training and after then I am by my self but I can call and ask questions, written contract will be by email and contain less sentences, to complete my first 500 hours I have to work in the ED where there is a Doctors supervision, all billing and prescription will be written under my license when at the urgent care, wait time for patient cannot be more than 30 minutes, and they want to start me $45/hour?

 

Any suggestion please?

Also, what do you mean under your license at urgent care? In the ER will you not be seeing patients and prescribing medications as a licensed PA?  If you're a newbie PA you may not want to be in a situation working alone in an urgent care required to meet time requirements. 

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Guest Paula

$45 way too low.  The urgent care PAs in my group are paid $75 an hour and are employees, get 401k, CME of $2,000, malpractice, (but no vacation..they have to work that out amongst themselves).  They all work at least 3 12 hour shifts a week. Even our new grads are paid the same.....seems unfair, but that is how my system works. (New grads, however, likely not to be hired as readily as an experienced PA).

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On 7/28/2017 at 4:52 PM, JMPAC said:

I think the incentive for working 12 hour shifts is so you get 4 days off. "Three twelves" sounds right, to me.  That'll be a long week, especially if you end up staying late for documenting. 

I agree with you. I personally love the three 12 hour shifts work week so that I can have four days off, so that way I can use one of my days off to catch up with charting, but to work four 12 hour shifts per week is something I do not want to do especially being a new graduate - I know I will be slow at the beginning. 

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4 hours ago, dizzyjon said:

$45 is too low. What is the average census? Are you getting over time then each week for working behind 40hrs a week? Will you be solo provider on and what support staff will you have? 

This doc is probably sitting back making bank while employing slaves at $45 hr. 

The average census is about 20 patient per day, but according to him, it can be up to 40 patients or more or it could be less, it depends. There is no over time, I am being paid $45/hour whether I work above 40 hours or not, I still get paid $45/hour regardless of how much time I work. According to him, I have to work at least 48 hours per week at a rate of $45/hour and I don't get an hour and half for working over time. Yes, I will be a solo provider working under my own license and prescribing under my own prescriptive license as well so if anything goes wrong, it will affect my license only I guess. The only support staff I get are the medical assistant and registration staff, and if I have any question, I can call him with my questions, but there will be no Doctor or any other practitioner present with me the location I will be practicing at. 

 

I did 12 weeks of rotation at an urgent care center in toledo, Ohio, one day me and the nurse practitioner provider saw about 82 patients that day and after that day, the nurse practitioner quit because she wasn't getting paid completing charts at home and that is too many patients for her to see by her self with only a student PA (me). I won't be getting paid completing charts at home according to this doctor. 

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5 hours ago, dizzyjon said:

Also, what do you mean under your license at urgent care? In the ER will you not be seeing patients and prescribing medications as a licensed PA?  If you're a newbie PA you may not want to be in a situation working alone in an urgent care required to meet time requirements. 

Working under my license means that I will be practicing medicine and prescribing drugs solo under my license so that if anything goes wrong, I will be liable and this doctor will just collect the profit I make for him without his license being affect. This doctor will not be reviewing my charts at all. Whatever charts I complete is as is, so if I make any error, there is no second eye to catch it all. I will be seeing patients and prescribing in the ER/ED, but I am going to the ER/ED only to fulfill my 500 hours of supervision that we PAs (because nurse practitioners only complete 100 hours of supervision) have to complete, but those ER/ED days are extra days I have to work beyond the four 12 hour shifts (48 hours) per week I have work each week for him. 

 

Yes, I agree with you that I should not be by my self working giving that I am a newbie. That is what I was told by a nurse practitioner provider that was my preceptor during my urgent care rotation/residency. I just love working in urgent care center, but my only challenge is that I don't have experience right now because that is what a lot of the urgent cares and emergency departments are telling me right now. 

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1 hour ago, ArmyMan said:

Working under my license means that I will be practicing medicine and prescribing drugs solo under my license so that if anything goes wrong, I will be liable and this doctor will just collect the profit I make for him without his license being affect. This doctor will not be reviewing my charts at all. Whatever charts I complete is as is, so if I make any error, there is no second eye to catch it all. I will be seeing patients and prescribing in the ER/ED, but I am going to the ER/ED only to fulfill my 500 hours of supervision that we PAs (because nurse practitioners only complete 100 hours of supervision) have to complete, but those ER/ED days are extra days I have to work beyond the four 12 hour shifts (48 hours) per week I have work each week for him. 

I would recommend getting familiar with your state practice act.  I'm not from Ohio, but a quick read of their regulations states that the supervising physician needs to have a quality assurance system in place, with active review of your professional activities. 

This sounds like it has a mountain of red flags, especially for a new grad.  500 hours in the ED in addition to 48 hours/week?  Unless you are waiting years to get those 500 hours, you are looking at 60 hour weeks at a minimum.  30 minutes or less wait time with 40 patients a day and 1 MA?  Are you expected to quit suturing halfway through a complex laceration to go see a new patient?  30 minutes or less didn't work for Domino's, and it it ridiculous for medicine.  

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14 hours ago, ArmyMan said:

The average census is about 20 patient per day, but according to him, it can be up to 40 patients or more or it could be less, it depends. There is no over time, I am being paid $45/hour whether I work above 40 hours or not, I still get paid $45/hour regardless of how much time I work. According to him, I have to work at least 48 hours per week at a rate of $45/hour and I don't get an hour and half for working over time. Yes, I will be a solo provider working under my own license and prescribing under my own prescriptive license as well so if anything goes wrong, it will affect my license only I guess. The only support staff I get are the medical assistant and registration staff, and if I have any question, I can call him with my questions, but there will be no Doctor or any other practitioner present with me the location I will be practicing at. 

 

I did 12 weeks of rotation at an urgent care center in toledo, Ohio, one day me and the nurse practitioner provider saw about 82 patients that day and after that day, the nurse practitioner quit because she wasn't getting paid completing charts at home and that is too many patients for her to see by her self with only a student PA (me). I won't be getting paid completing charts at home according to this doctor. 

Lol. Everything you just stated here is a red flag. If I were you, I would send a very strongly worded email that basically says "no."

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9 minutes ago, NJPL1213 said:

Lol. Everything you just stated here is a red flag. If I were you, I would send a very strongly worded email that basically says "no."

The words I'd use are "Wake The F*ck Up" or "This is a joke right?".  If he wants you to do 500hrs in an ER, he should be plunking you into the ER for 500hrs of paid time PRIOR to letting you loose on the public independently, not as well as your other full time job - you'll be charcoal within a few weeks, and that will mess up your through put and Dr Cheapo's profit margin a bit...not to mention likely violate your Dmonino's rule as well.  I'm willing to bet not many folks applied for this job or turned it down when they saw what was on the table.

SK

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Yea the more I read the worse this sounds. Not enough money. Way too many patients to be safe. Doc/owner sounds like a jerk. I worked in an UC where the doc/owner was nuts and money driven. He did things like change the employed mid levels to contract when they had to work extra days because of short staffing (illegal). he tried to direct the ordering of unnecessary tests because there was an on-site lab and x-ray he owned. He would chastise people for not giving steroid and antibiotic shots to people with colds. He was somewhere on the autism scale so he had no social skills, talked to people in public in an insulting and demeaning way and was stunned when I'd call him on it....he really had no idea. I was flat rate contract at $80/hr which probably wasn't enough but it met my needs at the time. It wasn't fun. I finally told the manager I wouldn't work on days when he was there.

Long story longer this sounds like a nightmare and you should run...run away as fast as you can.

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I want to say thanks to everyone who gave me their heart warm advice about this urgent care job, and I have decided to move on with other employments (I have two other interview coming up soon), but I will also want to share with everyone the email I sent to this doctor concerning all the concerns that everyone voice out to me. I just want to see what this doctor response will be after he has read my email, and I will share with everyone of you. If I do not share anything with you, that means he did not response, but whatever response he sent my way I will share with everyone of you. 

Dear Dr. [removed],  

I hope you are doing fine and all is well with you and your family. I spoke to my family and I have done some research on our conversation we had when we met. 

I have some concerns that I would like to bring to your attention and please excuse me for my bluntness, but my words below are not meant to insult you or the company, but it is meant to convey the idea that I am worth something and my importance to the profession of medicine.

Concerns:

·      $ 45/hour is problematic, especially when I am not being paid a time and half when I work over time.

·      How will my support call be like (I need detail explanation of when the support call take place)? Do you have quality assurance system in place, with active review of professional activities?

·      Will I get paid for taking charts home to be completed because I was busy while at the Urgent Care? And if so, at what rate per hour? I will ensure that charts are completed before going home, but there are instances were charts might be taken home. 

·      You said malpractice insurance is covered. Is it covered 100%? You also said that my fees such as licensure and DEA will also be covered, are they covered at 100% every time each one needed to be renewed or is a one-time coverage?

·      Also, $1000 for CME is very low compare to other companies I have interview with over the phone. Every company I’ve had phone conversation with has been offering me a minimum of $2000-2500 for CME and a week off to attend CME conferences. So, I will not take $1000 for CME and I need at least a week off to attend CME conferences.

·      401 K wasn’t mentioned when I met with you, and I would like to know the status of benefits that are not mentioned anywhere here in this document.

·      Are there going to be a written contract that spells out in detail my responsibilities as well as the company’s responsibilities (an email to me will not satisfy this section)?

·      How does my 500 hours work out? Can you please explain further? (Does that mean I go into the ER on the days I am off after I’ve already worked 4 days per week at the Urgent Care in Perrysburg? Who is going to pay me while working at the ER (is it the Urgent Care or the ER hospital)? And am I getting $ 45/hour when I worked at the ER?). Please give me a detail explanation?

·      I would like to complete my 500 hours in my first 90 days or so, and not waiting months before completing those 500 hours. The 48 hours a week (four 12 hour shifts) I work at the Urgent Care should have a Medical Doctor’s license attached to it so that I am getting credit towards my 500 hours of supervision. Many PAs I know and have had conversations with complete their 500 hours first before practicing by themselves and I will like to go that route. If you want me to do my 500 hours at the ER, I should be doing the 500 hours first at the ER before letting me loose into the public independently – preferably, I will like to see this course of action take place and that will motivate me to sign a longer contract with your company.

·      Some patients’ presentation at the Urgent Care may need more attention than others; it could take more time to care for patients with a laceration compare to a patient that only need a sport physical exam completed.  

·      I do not have DOT certification for me to be doing DOT physicals. Is the company paying for me to get my DOT certificate? Or do I have to pay for it my self? I am sure patients’ will present for a DOT physical to be completed.

·      I get paid once a month, which means that my first month is going to be rough because I won’t have any income coming in except for the income coming in from the Army Reserve, which is not enough to pay for my rent in Perrysburg and take care of my self – that is the reason why I am currently living with my family to cut down on my bills and I can’t do that while living in Perrysburg, Ohio.

·      You are asking me to relocate to another city (125 miles away from where I currently reside) without relocation funds. How am I going to pay for a new rental agreement with an apartment company with limited funds at the moment? How am I going to move my belongings (such as my bed, car, and other needed items) to the Perrysburg’s location without any relocation funds? These are legitimate questions and concerns I have and would like answers to them. I will love to practice at an Urgent Care center, but I can only do it with fair compensation. My goal is to get fair compensation for my work, and I don’t need anything more and I will definitely not take anything less – except if I am not aware of it.

·      If my questions and concerns are not addressed appropriately, then I will look for another employment. I went to The University of Toledo for PA school, and at The University of Toledo the Medical Doctors that taught the MD students were the same Medical Doctors that taught the PA students and we (PA students) took the same exams as the MD students, and PA students have to receive a minimum of 80% (grade of B) on all didactic exams and residency exams in order to proceed to the next level of education (I even had a Medical Doctor told me once that it is not fair for PA students to receive a minimum of 80% on exams while MD students receive a minimum of 70% when the MD students will be the ones telling the PA students what to do in the future). So, I would like to get paid for what I am worth.

 

Thank you very much for your time, effort, consideration, and meeting me in person.

Sincerely, 

[removed], PA-C. 

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2 hours ago, sas5814 said:

I predict , if you hear from him at all, it will not be positive. He is looking for the cheapest help he can get to earn as much money as possible for him. He will not respond well to being "challenged". 

I'll be interested in hearing the follow up.

Ditto.

 

SK

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