Job Requirements - Reasonable?

[hiiamalysha]

Hi all,

I am a relatively newer PA. I practiced in FM for one year and have now been in Ortho for 5 months. I LOVE Ortho, but am curious if my job is the norm of what is to be expected in an Ortho Position because I feel overworked and under compensated, but I may have just been spoiled in Family Med. 

I work usually average of 60 hours per week. I’m in the OR Mon and Wed. Clinic only Tues, Thurs, and Friday. I see 16-18 patients on my half days Wednesday, finish clinic by 1 and then in the OR the rest of the day. Other clinic days the Doc, I and another PA split up around 50 patients. I make 90K per year with 10 day PTO (which has to be taken when my Doc is on vacation or I don’t get paid for the time he is gone), $2000 for CME. I am on call two nights per week every week and every third weekend (paid $100 extra for weekends). I am required to get all my vitals and room my patients. The other PA and I do all the hospital rounding and all the patient tasks and administrative things as we do not have an MA. The docs MA has been told not to help us except the one half day we have, which she usually doesn’t help me on those days anyways. 

 

I’ve been reading the forum and the pay seems to be in the ball park of others, but I definitely feel like an “assistant” and not treated as a provider. Also, the clinic is so busy that we (the other PA and I) constantly feel overwhelmed, like there is definitely not even time in our day to get everything done. Just would love to hear others thoughts and experiences in an Ortho clinic. 

 

Thanks!!

 

[Arthropathy]

Pay is good but your getting punked.

-no MA? Seriously?

-half day clinic (which sounds packed!) + travel time to the OR? Clinic till 1 then OR "the rest of the day", how many hours/cases is that? Does the surgeon ever work that schedule? Doubt it.

- are you billing incident to? Do you have access to your collections?

- that much call is worth an extra year of salary. Surgeon is getting paid > $1000/day to be on call. Not saying office call is worth that much, but that's a lot of nights you can't "let loose" or leave town. 

- vacation...those are YOUR days to use,  not his. 

- bottom line: this dude sucked you in with a good salary and is milking your labor to make his OR schedule packed and maximize his profit for as long as he can until you "see the light" and bounce out for greener pastures, at which point he hires some one else and the carousel goes round and round. 

 

Take the money, get some good experience. Don't get angry but look for another gig that pays better with less work, get a good reference, leave on good terms. Use this experience to negotiate at your next job for good compensation and a reasonable schedule. Check out this recent thread 

 

[hiiamalysha]

Thanks Orthohand for your thoughts!

This doctor has gone through a TON of PAs. That was a red flag to me when I was hired and I asked about it, but didn’t press the issue much. Now I am seeing why. I just plan to keep on trucking through until another opportunity presents itself with the hopes that, as you said, I can gain some great experience and hopefully a good reference. I appreciate your advice!! 

[DizzyJ]

The pay sucks. $90k is not good if

you're working 60 hours a week in ortho. 

[SedRate]

So you're only doing cases on Mon and half-day Wed and then you're seeing about 15+ patients Tues, Wed, Thurs and Fri? Is this a sports med or total practice? What are you billing out and collecting? 

The pay is low for 60 hours. That breaks down to roughly $60,000 for workweek of 40 hours, which is crap. No MA? That's crap. Is call 24 hours, just office call, etc? Ten days PTO is crap as is having to take them during the doc's PTO. High turnover is a huge red flag. 

I agree with the above: move on. He's abusing you and enjoying the money you're bringing in for him. Find someone who's willing to bring you on as more of a partner and not a cog in the wheel. 

[hiiamalysha]

Yes. Monday and Wednesday are OR days usually all total joints, maybe one hip scope. We also do cases on usually one or two Fridays of the month too and those are usually sport days. What do you mean what am I billing out and collecting? And yes 15+ patients typically, usually more.

Call is office and hospital call. Thank goodness I haven’t been called in to do a consult though cause we don’t do trauma/ER, but I have been called about consulting a couple of times on OR days for hip pain or our previous patient that is in ER/admitted. It’s just calls from the hospital regarding our surgical patients usually.

 

Thanks for the reply and thoughts Sed! 

[SedRate]

On 1/29/2018 at 6:59 PM, hiiamalysha said:

Yes. Monday and Wednesday are OR days usually all total joints, maybe one hip scope. We also do cases on usually one or two Fridays of the month too and those are usually sport days. What do you mean what am I billing out and collecting? And yes 15+ patients typically, usually more.

Call is office and hospital call. Thank goodness I haven’t been called in to do a consult though cause we don’t do trauma/ER, but I have been called about consulting a couple of times on OR days for hip pain or our previous patient that is in ER/admitted. It’s just calls from the hospital regarding our surgical patients usually.

 

Thanks for the reply and thoughts Sed! 

When you see a patient in the office or hospital, you (or your company) bill out a code that is reimbursed to the company. When you assist on a case, the practice bills for your assist fee and collects it. What are your collections, meaning how much is the practice being reimbursed for your services? Do you have access to your collections numbers? This will tell you how much the practice is bringing in for the work you do for them, and it should be commiserate with your salary. If it isn't, they aren't likely paying you enough. There are other factors, too, such as benefits, but yours aren't impressive... At least not what you've provided to us for review. Also, take into consideration how busy you are and feeling overwhelmed. You're likely being overworked, especially since he's not providing enough support staff for you. That's another 35k + benefits he's saving by not hiring an MA and putting that burden on you. Lots to think about!

[hiiamalysha]

Right. I figured that the reimbursement was the typical 85% of Physician fee. On tues and Thursday clinic days I’m guessing they bill all patients under him as 100%.  I have never asked or thought too, but definitely sounds like something I should do. This experience is definitely a good lesson for me! Thanks again!! 

[SedRate]

1 hour ago, hiiamalysha said:

Right. I figured that the reimbursement was the typical 85% of Physician fee. On tues and Thursday clinic days I’m guessing they bill all patients under him as 100%.  I have never asked or thought too, but definitely sounds like something I should do. This experience is definitely a good lesson for me! Thanks again!! 

Reimbursement for PAs is 85% for your own patient visits. If they're billing your visits under him at the physician rate, this could be incident-to billing, and there are certain criteria that must be met in order to do this. Be very careful about just going along with this. If your practice is not meeting all the criteria, it could be considered fraudulent billing. 

If they are billing under him and criteria are met, it may prove difficult to calculate your earnings. And it may be even more difficult if they don't show you the numbers. A little bit of work on your end can help give you insight into your actual worth.

[AbeTheBabe]

Where are you located? That's a crap salary for such long hours. I just started my second year as a PA (started in Ortho) and I'm making 105K salary + 10% of collections (so more like 125K total) + 16 days PTO + $2K/5daysCME and I only work about 45 hours a week. Granted I'm in a HCOL area, but still. 

[Hope137]

@AbeTheBabe

 

how does collections work for your practice?

 

 

[AbeTheBabe]

We switched over to RVUs as we joined a bigger health system. We now get 10-12% of "collections" which are basically wRVUs being paid out at about 90 dollars per RVU.