mgriffiths Posted March 7, 2018 Share Posted March 7, 2018 I work in family medicine, in a somewhat rural location of Michigan (~25,000 in the county, but we do pull patients from outside the county). While it is rural, it is considered a vacation destination Spring, Summer, Fall - but winter kind of sucks...I have been here almost 1 year and starting some plans for contract/salary negotiation. I enjoy my job overall, and don't have plans on leaving. I am supported and we practice EBM, and everything is thankfully NOT about money. Current salary: $85,000 Bonus: $15/RVU over 333 per month (last year was $10/RVU over 333/month and averaged probably $1000 on months I didn't take vacation) Loan repayment: $10,000 annually until loans gone (around $49,500 left) - loan repayment is nice, but I would love to just get rid of the loans now altogether, they're annoying CME: 5 days, $2500 - I use my UpToDate offered through the clinic for CME, but do plan to go to a conference when I see one that interests me PTO: 3 weeks vacation, 5 sick days - sick paid out at end of year if not used Health Insurance: $432 per paycheck, 26 checks per year - this is for family, as employee only $23/paycheck, but it's decent insurance and practice covers the majority of deductible (can't remember the numbers exactly off-hand) Malpractice 100% covered In the last year the only raise has been the increase in bonus from $10 to $15, but this was for all the extenders. My bonus would likely have been a bit more anyway as I had some months as I first started that were a bit lower as I built my patient panel, but obviously will increase quite a bit with the $15/RVU. I just don't like the 20% straight income tax on bonuses. Shortly after starting I was placed in charge of cleaning up another provider's patient panel after she was fired (inappropriate prescription writing, among other things). It was a ton of work and very mentally taxing. Starting in April I am actually moving to another clinic where I will be a solo provider 2-3 days per week, where as now I am one of 4 in the clinic. Again, replacing someone who is leaving (not fired). I offered to make the move to be helpful, but it is being treated as somewhat of a promotion as I will be solo now. Also, MI just passed a law that all patient's on narcotics must be seen on a monthly basis. I have offered to complete all monthly narcotics visits for all 6 providers (2 of which are physician owners of the practice), which will increase my patient load by approximately 100 visits per week. They will be easy, quick appointments, but somewhat mind numbing. At the same time I will almost hit the RVU bonus level with those visits alone - which will significantly increase my bonus per month, estimating at least ~$2500/month, but this is not yet solidified. No one else wants this responsibility and the ones I would be covering for absolutely love the idea. My thoughts were to request a $12,000 base salary increase, and hope that we settle around $10,000. My basis is I have been the most productive extender in the entire practice (out of approximately 20) since starting (I graduated 12/2016 and worked ortho for a short time before joining this practice 5/2017), the responsibility put on me from the provider who was fired, taking on a full panel of patients from a provider who is leaving, moving into a solo position, and reminding them that a $15/RVU bonus is really only $12 due to straight tax rate. The other thought I plan to mention is that part of this bonus is to make it a bit easier for me to purchase/build a home, therefore I'm making a commitment to stay here long term. The average tenure for a newly hired PA/NP is around 3-4 years, but if someone reaches 5 years then they tend to stay "forever." I think it's worth mentioning since it's a rural location so selling a home can take some time (average is around 2 years). Thoughts? Is this unreasonable assuming my income is going to increase with the narcotics patients anyway? Please feel free to ask for any other pertinent info I left off, and thanks in advance. Link to comment Share on other sites More sharing options...
mgriffiths Posted March 7, 2018 Author Share Posted March 7, 2018 I guess one thing I should add, I am specifically not requesting an increase in vacation because I barely used all of my time this past year. The unfortunate result of having a bonus is that any time I take vacation I am losing RVUs and therefore decreasing my bonus, if I achieve one at all. It's actually quite annoying, but at the same time I like having the external force to be happy when my day is busier and frustrated when I have a bunch of no-shows or just lighter in general. Link to comment Share on other sites More sharing options...
Arthropathy Posted March 8, 2018 Share Posted March 8, 2018 20 narcotic refills a day? When will you have time to see real patients? Link to comment Share on other sites More sharing options...
marktheshark89 Posted March 8, 2018 Share Posted March 8, 2018 Seeing all the narc patients is an easy way to get flagged and reviewed by insurance companies and various agencies also. I’d never agree to that. Link to comment Share on other sites More sharing options...
SedRate Posted March 8, 2018 Share Posted March 8, 2018 I don't think it's unreasonable. You've taken on and cleaned up another's panel, you'll be flying solo at another clinic, and you're offering to take on a niche panel that others would prefer to avoid which makes you valuable. However as Mark said, seeing that many narc refills might get you flagged. Also, some PAs are limited in their chronic pain management scripts. Do you know if that might be a problem? Link to comment Share on other sites More sharing options...
mgriffiths Posted March 8, 2018 Author Share Posted March 8, 2018 7 hours ago, Sed said: I don't think it's unreasonable. You've taken on and cleaned up another's panel, you'll be flying solo at another clinic, and you're offering to take on a niche panel that others would prefer to avoid which makes you valuable. However as Mark said, seeing that many narc refills might get you flagged. Also, some PAs are limited in their chronic pain management scripts. Do you know if that might be a problem? I know in MI we are not limited, but the narc patients aren't actually becoming "my patients." The plan is that when I see the patient each month I send the PCP a refill request. This way I am not actually the one filling the prescription itself - so my number of narc scripts per month actually isn't changing. Seeing massive numbers of narc patients is never the problem, but filling all of those narcotics could be - hence "the plan." These would just be quick appointments to fulfill the state standard and review the chart to ensure the narc contract is up to date, review the report for who is prescribing patient's controlled substances (make sure they're not double-dipping), drug screen if needed, etc. Nothing else will be discussed and if the patient arrives and has dangerously high BP or something they would immediately be treated as a same day by one of the other providers. Initially the plan was 10 minute appointments, but that has been changed to 12 minutes to help some. The charting will be super quick and the visit is even faster. It will take my nurse longer to get vitals than the visit will for me. Link to comment Share on other sites More sharing options...
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