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KMKPA

Experienced PA Bonus Structure Help

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Hey all, 

I have been a PA for 9 years now (1yr cardiac sx, 4yrs EM, 4yrs ortho hand) and just took a new position about one year ago in a new specialty.  I went from Hand surgery/upper extremity ortho to ENT.  I have a good salary and when I started, the bonus structure was TBD as I am their first APP.  My position is unique as they wanted a PA to help offload consults and hospital rounds in the afternoon so the on call physician doesn't get stuck doing everything after their day. I typically see patients in the morning and occasionally in the afternoon (only until about 230pm to allow for time to go to the various hospitals depending on what has come in for the day).  Sometimes I am super busy in the afternoon and cannot get to everything (but I leave around 5pm, although, some weeks my days are longer, regardless) and other times there isn't much to do and I will help out one of the docs with their PM clinic or catch up on patient phone calls, notes, etc.  LSome weeks I am bored in the afternoon but they want me to be 'available.'  I help out in surgery, but rarely, despite 5yrs of OR experience.  I was completely new to ENT, so, to some extent, I had to be taught a lot this past year, however, on the other hand, I have lots of experience with abscess drainage, hospital familiarity, etc, so, a lot of things did not have to be taught.  

I just had my annual review and I have received pretty much all positive remarks.  They are thrilled to have a PA and wonder why they didn't hire one sooner.  They are a pretty old school private practice, so, a lot of the physicians don't prefer me to first assist them in the OR (they help each other out), which would be another way for me to make $$ for the practice.  For this past year, they have given me a 5k bonus (I'm ok with that given my learning curve).  I currently make 105k for 4.5d a week, plus $1800 cellphone reimbursement, laptop, and 4 weeks vacation.  We discussed a bonus structure moving forward and I was asked what I thought was an appropriate bonus.  I said 5-10% annually.  I have my numbers, also, and in just 3 quarters, I have almost earned my salary and I am projected to pay for myself in charges with a full year of work, despite some afternoons not having much to do and having to train office staff that I am a provider and how to schedule me patients, etc.  The issue is, they want to provide a bonus quarterly based on 'how they think I'm doing."  There will be a low tier, middle tier, and high tier.  They said most of the time, the expectation is that I will probably get middle tier $$ and usually only reach the highest tier if I seem to have an exceptional quarter.  They also said putting in more face time with the physician partners in the office to 'help them out' in the afternoon when I'm not busy in a hospital can be a real boost.  Some of our docs love it when I help and other docs don't seem to really want a PA in their office flow...they are used to doing everything themselves and it is awkward.

The issue is, I am not entirely comfortable with the idea of my bonus being based solely on subjective opinions of the partners.  Some seasons are busier than others with the number of consults that come in and while I try to see everything that we get, sometimes I physically cannot make it to 4 different hospital facilities in an afternoon (for consults ranging from epistaxis management to abscess drainage to trach care). When I asked about a bonus based on productivity, however, they said they don't want to incentivize my office productivity because they care more about me being available to help out in the hospital to offset having to see consults after their main office day. I just have no control over the subjective opinions of the physicians and I also don't have control over what comes in from the hospitals.  They are open to ideas, but, I don't have any.

Can anyone provide any sort of alternative bonus structure?  

THANKS!

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I read this and have waited to respond as I was hoping someone else would have a golden nugget to drop, because unfortunately I don't.  I completely agree that having an arbitrary bonus system is ridiculous, I have passed on jobs for this exact reason.

I guess the best advice I can give is to make that bonus as small a percentage of your income as possible, and instead increase your base salary.  In the process of the conversation I would also be forced to ask the following, "If you were being paid a bonus, would you be willing for it to be based on 'how they think I'm doing?'"

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Perhaps you can suggest a bonus based off of your total collections, something like 25-50% after you cover your cost. Or maybe develop a system to quantify how much coverage you provided and tasks you relieved from the docs. That way you can present it (quarterly?) for bonus consideration.

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Bonus should be absolutely objective and not up to the opinion of someone.  The partners in the practice aren't paid by how good a doctor he or she is right?  They obviously make their money by how much they bill/collect.  

 

Ideally, your bonus should be structured on billing/collection as well, but it's tricky if you do not have a full schedule or aren't busy all the time.  It should be more dependent on the group practice as a whole if you don't have a full schedule, since it is their job to utilize you and give you patients.  In this situation, you may not even want a bonus incentive at all and just negotiate for a fixed raise annually.

 

As someone who has worked in ENT for a few years, you should be getting paid more.  In clinic, you are doing a performing a procedure on 50-75% of your patients, which brings in A LOT of money.  And on the other patients where you are not doing procedures, you are freeing the docs up from those patients so they can slice up patients or do other patients which makes them A LOT of money.  You should also be push harder to be a first assist.  It's such a waste money-wise to have two surgeons in most head and neck surgeries (the only exception really is free flaps and major facial reconstructions).  

 

Once you get more experienced, I bet you they will want you to take overnight call as well (if you don't already).  You should be prepared for that and have a proposal ready.

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