On switching jobs and salaries.

[UpperLeftPAC]

I've recently been offered a new role in the ICU setting in the same city where I work as a hospitalist. The ICU is staffed by a private physician group. The offer was underwhelming and I'm getting ready to start the negotiating process- that's not what I'm looking for thoughts on, though I may post later in Contracts/Negotiations about it.

The position is awesome- lots of procedures, admissions, and general back up of the physicians. No pager/cross cover calls, just being available to nursing and sharing the load with the docs. They currently have three APPs and they are awesome, they all seem to be practicing at the top of their ability, and have amazing knowledge and skills that I'm dying to develop. I would likely be working primarily swing shifts, which means no daily rounding/progress notes for the most part.

But, like I said, the offer is underwhelming. Technically more salary, but quite a few more hours required each month so decreased hourly. I work currently as a hospitalist doing nights (employed by the hospital) in the same city at a smaller hospital and as is, I currently make about $8 more per hour, and that's before my guaranteed wage increase in October of this year. After the first year there would be a small raise but it would still be considerably less than I'm making now. Granted, my current wage does include a night differential, but even if I were working days I'd still be making more as a hospitalist after October of this year. I've drafted an email expressing my concerns to them and am having some APP friends who are better versed in negotiations look at it for me.

I guess I don't really have specific questions. Just looking for thoughts. Seems like crit care should be compensated more than general hospitalist medicine, doesn't it? There are no shift differentials for swing, and I thought that was usually an industry standard. Don't most of you get differentials for later shifts, and extra shifts? And I'm worried about accepting lower pay... as I think we are all aware, you make more money by switching jobs, and taking a pay cut to go somewhere else without guaranteed wage increases over time is not going to do much for my earning ability. 

[mgriffiths]

May or may not make sense, but there are some positions where the "powers at be" know (or think they know) their job is better than others available (hours, management, bonus, autonomy, education, etc.) and therefore they feel the lower pay is justified.  This may describe your situation, it may not.

[UGoLong]

The other day, I was talking with an old college friend. He had changed careers a few years in and had to take a substantial pay cut in the process, as well as a move to a higher cost of living city. His wife ultimately left him, at least partially because of the disruption. The guy loved his new job and, a decade later, became a partner in the very large firm. Needless to say, he also ended up making a lot of money.

I can't comment on your particular situation but I wanted to point out that a job change is not automatically a short-term (or maybe even a longer term) financial win. Sometimes it may turn out to be. Sometimes it might involve a short term (or maybe even a forever) financial loss. The real question is: what do you and your family want to do next and are you willing to pay the price.

[MediMike]

Congrats on the offer, underwhelming though it may seem. I can tell you that while it definitely seems like CC should get higher compensation for the acuity, wide knowledge base and procedural competency required it doesn't always seem to be true. 

Part of that may be that you are hired by a private practice, in my experience those salaries are generally on the lower side, other aspect could be a higher need for the standard hospitalist PA? The group I'm per diem with just renegotiated their contract simply to MATCH the hospitalist group in our organization if that goes to show you anything.

I'd be really interested to hear the details! Good luck!

[CritCareICU]

Congratulations on the job offer.  I can only speak about my current hospital, but you should be making more than a hospitalist AP.  At my hospital, the ICU and hospitalist teams are both paid by the hospital based on "tiers".  level I, II, and III.  III is the highest paid (ER, ICU, Trauma, NS, Surgery).  hospitalist is a level I, and I believe there is a 20K-25K annual difference in starting pay from level III. 

If I were you, I would maybe just express your excitement for the position and be honest that you are currently making more money now as a hospitalist.  also suggest hourly wage, as in ICU there are plenty of times you're held past your standard hours.  Especially if you're going to get trained in procedures, you will be billing for everything from CVC, A line, HD cath, thora, para, chest tube, conscious sedation, intubation, CPR, ETC; which means you're bring in a lot of money. Also, if your ICU responds to codes on the floor that's even more of a liability you should be compensated for.

However, if you're eager to learn critical care and procedures maybe jump on the position even if it means taking a cut.  a couple of years in the ICU will make you a strong clinician and you can easily maneuver within multiple different specialties.  GOOD LUCK!

[ArmyVetDude]

9 hours ago, CritCareICU said:

Congratulations on the job offer.  I can only speak about my current hospital, but you should be making more than a hospitalist AP.  At my hospital, the ICU and hospitalist teams are both paid by the hospital based on "tiers".  level I, II, and III.  III is the highest paid (ER, ICU, Trauma, NS, Surgery).  hospitalist is a level I, and I believe there is a 20K-25K annual difference in starting pay from level III. 

If I were you, I would maybe just express your excitement for the position and be honest that you are currently making more money now as a hospitalist.  also suggest hourly wage, as in ICU there are plenty of times you're held past your standard hours.  Especially if you're going to get trained in procedures, you will be billing for everything from CVC, A line, HD cath, thora, para, chest tube, conscious sedation, intubation, CPR, ETC; which means you're bring in a lot of money. Also, if your ICU responds to codes on the floor that's even more of a liability you should be compensated for.

However, if you're eager to learn critical care and procedures maybe jump on the position even if it means taking a cut.  a couple of years in the ICU will make you a strong clinician and you can easily maneuver within multiple different specialties.  GOOD LUCK!

Hospitals can decide to pay PA"s whatever they want. Arguing that one's work is in higher tier thus higher pay is not a valid reason

[charlottew]

At my hospital also, ICU PA's are paid more than PA's in other specialties. This is because ICU work is demonstrably more difficult than some of the other specialties, in terms of hours (we do overnights, most other PA's don't), patient acuity, complexity of decision making, having to coordinate with other services, etc. When ICU paid the same as the other specialties, there was a lot of turnover of ICU PA/NP's to other roles in the hospital  - same pay for less hassle, why wouldn't you switch? Now that the pay has been adjusted there's at least some disincentive from switching out of ICU.

[MT2PA]

I know you aren't looking for negotiation talk here but you'd be switching from the hospital to the private physician group - while pay may be different, so too may benefits.  Worth considering if you consider compensation to encompass more than just salary.

[UpperLeftPAC]

Thanks to all who replied to my original post. I have been absent from the forum for a bit, mostly due to things like wedding planning (!) and vacations, but did want to follow up. 

Ultimately I negotiated with the group and pointed out that it was technically an hourly paycut despite the increase in salary due to more hours, and additionally my benefits would cost me an additional $6K a year out of pocket, making for an overall very poor package. Part of the push behind negotiating was for the group to understand how poor their salary  was not just for me but for their current APPs.  There was some back and forth, which resulted in considerably larger signing and retention bonuses for me (yay!). I had a lengthy conversation with their CEO and received reassurances that they are committed to their APP program and know that to retain talent, they will have to increase pay, with plans to do so in June/July of this year after renegotiating their contract. No written guarantee of pay raise but.. well I'm gambling I guess. I took the job. Here's to hoping they were serious! I'm very excited to get into the critical care world.

 

[polarbebe]

Congratulations on accepting the offer.  Working with the sickest and most complex patients will make you a better clinician and help you get noticed if/when you move on (generally easier to move down in patient acuity then up).  

 

On 3/28/2019 at 2:00 PM, ArmyVetDude said:

Hospitals can decide to pay PA"s whatever they want. Arguing that one's work is in higher tier thus higher pay is not a valid reason

I agree hospitals can pay whatever they want but I disagree that working in a higher level acuity (critical care) does not demand higher compensation than a hospitalist AP.  Intensivists are paid higher than hospitalists for a reason (more training required and sicker patients with far less room for error).

Hospital will find retaining highly trained and experienced PAs to run an ICU very challenging without appropriate high level compensation as approximately 1% of PAs are in critical care... and the difference in care between a PA with 2-3 years of experience is very different from > 8-10+ years in a emergent life threatening scenario.

PAs are trained in primary care.  A new grad PA has to learn internal medicine then build upon that foundation to practice critical care.  In general critical care is one of the top 5 paying specialities.