Being paid a reduced "training salary" when you first get hired

[Chrisw8739]

Apologize for the length. Was wondering if any other PAs have had this problem, or could provide feedback on how to deal with this situation.

I just graduated from PA school this past May. I am working my first job, in a small, mom-and-pop outpatient psychiatrist's office. This doctor has never worked with a PA before and knew next to nothing about the profession. I was told when I got hired that I would be paid a reduced salary for the duration of my training period, which was never clearly specified but was roughly estimated at 6-8 weeks. I'm now at the 6 week mark, being paid a pittance, 50% of an already-modest salary that is lower than average for first-year PAs in NJ. (I love the job though, psychiatry is what I want, the commute is short, hours are good.) The doctor's wife basically runs the office, handles all the billing. I asked her today when I might be able to receive a full salary. She said when I've been approved as a provider by the numerous insurance companies - Aetna, Horizon, Qualcare, etc. - which could take months. The reasoning for this is that they can't make money off me (i.e. bill the insurance companies) until I'm approved as a provider. Till then, I'm a financial drain, which I've been told in so many words. (I realize I'm making these people sound horrible - they aren't. It's just this money thing.) I am at a point in my training where I am handling the full patient encounter, including prescribing, with the stable patients, and doing everything except prescribing with the unstable patients. 

So my question is, has anyone been through anything like this, and how did you handle it - or how should I handle it? I am not making enough money to support my family right now, but I love the job. Other than the pay, it's everything I want. I've already built a good rapport with several of the patients; many of them have asked to see me instead of him. 

Thanks for any feedback.

-Chris

[mgriffiths]

Having a training salary is not uncommon, but is ridiculous.  If you are a certified PA then you should be paid as a certified PA.

Reality: you either have to be willing to walk, or you are at their mercy.  It sounds like you did not get the 6-8 week comment in writing (lesson to be learned).  Secondarily, most insurance companies will allow you to bill back a certain amount. In other words, if you see a patient in August, but aren't eligible to bill until September you can still bill the insurance company.

Bottom line: are you going to be paid based on RVUs or some other system linked to how much you make them in billing?  Doesn't sound like it, therefore they shouldn't base your salary on when you can start making them money.  And stating that it is going to take several months to get you enrolled is ridiculous.  If you have your certification, license, etc. it should only take a matter of weeks.

[LKPAC]

P.S. Never work in an office in which the manager is the doctor's wife!

[303909]

Do they employ PMHNPs? I'm curious if there would be this many roadblocks for the so-called "ready made" provider in psychiatry versus a PA.

[CAAdmission]

Sounds like they lacked a clear plan and are not too bright. I would demand some solid dates and develop an exit plan just in case. 

[south]

4 hours ago, CJAdmission said:

Sounds like they lacked a clear plan and are not too bright. I would demand some solid dates and develop an exit plan just in case. 

Concur, just testing you, the money and time saved is tempting but needs to stop now.  Also not buying the "months" to get insurance company billing set up.  Not even Medicare is that slow.  I'll bet you dollars to donuts they have been getting the full rate for you for a while, by 8 weeks in.  

Performance review / conversation at 8 weeks with bump to full rate or they can look for someone else, my vote.  Offer your help to find out why the insurance companies are dragging their feet.  "Just give me the numbers and I will follow up". If they respond with something reasonably coherent, point out that it's not your problem anyway - your salary rate is a function of your training and nothing else.  

I'll forgive them the test of you for now - that's quite a benefit they are getting there, but it has a limited life and needs to get shut down.

[DizzyJ]

Run run run from any office with a spouse as the office manager/director.  I worked in outpatient psych practice with an executive director wife and it was horrible! 

Second, I started at full salary and seeing patients week 1.  I'm certain they didn't apply for insurance credentialing until my first week.  We had no problem getting me through quickly and billing retroactively. 

If you are seeing patients individually and prescribing meds then you should be at full salary.  If you are sitting side-by-side the doc ,observing his practice, and not practicing yourself, then okay that is training. 

[Guest ral]

Interviewed once, a few years ago, with a physician in private practice.  Great guy.  After a prolonged discussion, ranging from evidence based medicine to what brand of dirt bikes we rode as kids, he passed me off to the office manager to discuss pay, benefits, etc.  Turns out, it's his wife.  I smiled and nodded a lot, while she did her best to present a poor overall package.  She wasn't aware that she could have offered me a gazillion dollars a year, and I would have passed.  The number of horror stories surely cannot be folklore, and I am not willing to find out.  Have had many colleagues make the mistake, and don't recall any of them even hitting the one year mark.

As for the "training" pay, I passed on a position way back for that reason.  The manager's argument was that a few shifts at a ridiculously low rate, would give them an opportunity to see if I was a good fit for the urgent care practice.  I was bringing numerous years of emergency medicine experience, many as a solo provider at a critical access hospital.  It would be one of those situations where I could walk in the door, be shown where the coffee and bathroom were, and start seeing patients.  (Not tooting my own horn; acute care just happens to be my forte.  Conversely, stick me in a heme-onc or neurosurgery practice, and I would need someone to hold my hand for months ;)).  Sad, because the physician director was a wonderful woman, and we hit it off great.

[Cideous]

13 hours ago, LKPAC said:

P.S. Never work in an office in which the manager is the doctor's wife!

EVER EVER EVER EVER EVER EVER EVER EVER EVER!!!!!!!

 

THIS IS THE BEST ADVICE YOU WILL EVER GET ON THIS OR ANY OTHER PA BOARD. NEVER work at any office where the doc's wife runs the office.  EVER!!!

[Lexapro]

You're being low balled in psych? That is utterly ridiculous. Leave! PMHNPs across the board can expect to start at 120/130k+ unless they're in an area that pays terribly/getting some sort of loan repayment. I see no reason why a PA in psychiatry shouldn't be paid at least 100k+ to start. Sure you might need more training up, but from my experience, so many employers are absolutely desperate for a psychiatric specialist that they'll eat the cost of training you (this is my experience aa a psych NP at least). Plus, now you have a few months of experience that you can use to your advantage while job searching. Get out of there and apply to the numerous other psych jobs that exist literally everywhere. While many positions will ask for a psych NP, I'd go ahead and apply anyway as a PA w/psych experience. Do not forget to negotiate and get everything in writing! It's a provider's market in psych.

[quietmedic]

It all depends how the market is.  If there are plentiful other jobs which guarantee you autonomy, then leave. But you are a new grad, and this may not be the worst thing in the world while you get your chops...we all had that first "training ground" job...if you are not about to face eviction from your apartment, and other jobs are not all over, might be worth the situation to use it as a stepping stone and put up with it for now.

[Chrisw8739]

Thanks for the responses - they have been very helpful. 

This practice does not employ PMHNPs. I am the only provider other than the MD. 

Good call on the not taking a job in an office where the doctor's wife runs the office. Noted. And I suspect the doctor's wife never wanted me to begin with, hiring me was his idea because he's in his 60s and in the decline phase. There are many stories I could tell about her. 

I will mention to them that they can retroactively bill the insurance companies. I will also mention that other PAs have told me that the standard is, if the PA is working full hours, doing the full patient interview and prescribing medication, that PA should get a full salary. 

I tried to look at my original post through an outsider's eyes today.  I was like, dude, just find another job. They're screwing you. You can do better than that. A huge part of me feels this way and I'm worried it may start to affect my work performance, if it hasn't already. That means it's time for me to speak up, and this time it won't be in the form of a question. 

Oh, and my impression of the market is that it is weak, at least for PAs. I don't know of any nearby psych openings for PAs, only NPs with multiple years experience. But I didn't look all that hard before taking this job. 

[bjwbell]

Thanks for the responses - they have been very helpful. 
This practice does not employ PMHNPs. I am the only provider other than the MD. 
Good call on the not taking a job in an office where the doctor's wife runs the office. Noted. And I suspect the doctor's wife never wanted me to begin with, hiring me was his idea because he's in his 60s and in the decline phase. There are many stories I could tell about her. 
I will mention to them that they can retroactively bill the insurance companies. I will also mention that other PAs have told me that the standard is, if the PA is working full hours, doing the full patient interview and prescribing medication, that PA should get a full salary. 
I tried to look at my original post through an outsider's eyes today.  I was like, dude, just find another job. They're screwing you. You can do better than that. A huge part of me feels this way and I'm worried it may start to affect my work performance, if it hasn't already. That means it's time for me to speak up, and this time it won't be in the form of a question. 
Oh, and my impression of the market is that it is weak, at least for PAs. I don't know of any nearby psych openings for PAs, only NPs with multiple years experience. But I didn't look all that hard before taking this job. 

There's no penalty for applying to those NP psych jobs.

Sent from my HTC One A9 using Tapatalk

[EMEDPA]

the only time a training salary is acceptable is in an approved residency program, leading to a certificate or advanced degree...

do you think new physicians in practice accept training salaries?

[south]

I think you have your head on straight.  At this point, it may be up to them to convince you to take off your boogie shoes.  Good luck.  

I'm forcing myself to be fair here; since you are here, now, and you would like to find a way to stay, another (let's say) 4 weeks of training salary isn't going to kill you in the long run and may be forgotten in a year.  It's just that there are hints of other abuses. 

Actually doing what needs to be done of course, once you make them refuse your terms, you may have to put a smile on it for a few months while you apply and interview...

these thoughts are random I know...contributing nothing, as usual...

[quietmedic]

10 hours ago, EMEDPA said:

do you think new physicians in practice accept training salaries?

Actually...yes!  They have two years of clinicals plus four years of post-school training, (residency and internship/gap year/whatever), at a salary of about $20 dollars an hour.  Compared to the average PA's measly one year of field time, six years is a lifetime of experience in training at near-minimum wage. Not to overaggrandize doctors, but honestly, we aren't anywhere near their ballpark at the time of PA school graduation.

14 hours ago, Chrisw8739 said:

Oh, and my impression of the market is that it is weak, at least for PAs. I don't know of any nearby psych openings for PAs, only NPs with multiple years experience. But I didn't look all that hard before taking this job. 

Other than applying for the NP spots, might just be worth it to stick it out for now...

[ALC0313]

I've been seeing more and more new grads posting about "training salaries" when they get their first job out of PA school. I'll admit I did the same thing when I started practicing 9 years ago. I accepted a salary of $5k less than what I was asking based on AAPA salary report, but negotiated that I get an increase of $2.5K at 3 months and then again after another 3 months, so by 6 months I was making what I asked for initially. (Part of the reason was also that I was their first PA and they were unsure how it was going to work out, and it was a very competitive job market). That's a far cry from 50% salary though. So the question is, if you have to take a training salary to get your foot in the door, which seems to be pretty common, what is a reasonable reduced amount?

[thinkertdm]

If you are getting paid a "training salary", make sure you are getting training- more than your sp expecting you to read on your own.  Otherwise you are just a sucker making more money for him.

[Cideous]

The one exception these days I would say might justify a training salary is in Derm.  You can make so much money in that field, it might be worth taking the hit for a year or so to get the experience....

[EMEDPA]

13 hours ago, quietmedic said:

Actually...yes!  They have two years of clinicals plus four years of post-school training, (residency and internship/gap year/whatever), at a salary of about $20 dollars an hour.  Compared to the average PA's measly one year of field time, six years is a lifetime of experience in training at near-minimum wage. Not to overaggrandize doctors, but honestly, we aren't anywhere near their ballpark at the time of PA school graduation.

Other than applying for the NP spots, might just be worth it to stick it out for now...

I meant after medschool and residency....I am aware of how medschool and residency work. Keep in mind many residents make 100k/yr moonlighting after internship.

[rev ronin]

If I was going to take 50% salary*, I'd expect at least 10 hours per week of face-to-face training from my doc.  Training, not shadowing, not chart review.  And if that wasn't forthcoming, then for each hour the MD/DO hadn't spent training me in a given week, I'd have the contract specify a bonus of 5% of my base salary back...  Thus, training salary becomes real salary when the training ends.

Remember, folks, always engineer the agreements so that neglect favors you, not the SP or practice.

* Never take salary.  Always be hourly with overtime.  See above.

[BruceBanner]

Not much new to add here, but reduced "training" salaries are common nowadays, in derm especially but also in miserly practices.

Their line about waiting to get credentialed with insurance companies is a chocolate-covered turd. They can retroactively bill, and they can also bill your visits under the practice owner by having him cosign all of your charts. Every job I have ever had started paying me my full salary (competitive or not) right from the get-go. Even surgery, where it takes MONTHS to get through credentialing hoops.

Bottom line is you are a certified licensed provider, and even though you are new, you are NOT an intern or resident, so you need to get paid a market wage.

Now that you know this, and know that doc/wife managed practices are bad news, just show up to work, do your best, and look for a new job.

[True Anomaly]

On 9/6/2017 at 11:59 PM, EMEDPA said:

the only time a training salary is acceptable is in an approved residency program, leading to a certificate or advanced degree...

do you think new physicians in practice accept training salaries?

E took the words right out of my mouth

[camoman1234]

12 hours ago, EMEDPA said:

I meant after medschool and residency....I am aware of how medschool and residency work. Keep in mind many residents make 100k/yr moonlighting after internship.

That is moonlighting, which is extra time >80 hrs/week

[EMEDPA]

21 hours ago, camoman1234 said:

That is moonlighting, which is extra time >80 hrs/week

depends on the residency. most have tough internship years, but many FP residencies are pretty cush after pgy-1 like 50-60 hrs/week, allowing one to work at an urgent care or rural ER, etc nights/weekends. I have worked at 2 places with residency programs and frequently was in the hospital more than the pgy 2 and pgy 3 residents.