Experienced Family Practice PA Re-negotiation

[keisha12]

I have 7 years experience as a PA (1 year General Surgery, 3 years IM private practice, and now 3 years at my current position in a family medicine outpatient clinic) in rural Kentucky. It is time for contract negotiations after 3 years of work here. I am outpatient only with no call, 4 days per week; averaging 18-20 patients per clinic day. My base salary is $93k, Encounter based bonuses ($16.59 per encounter over minimum 663 per quarter which does not prove profitable for me so basically my salary is less than $97k total), $2500 CME plus 40 hours PTO, 24 days PTO plus 12 sick days, Malpractice and license fees paid. Insurance and retirement are self funded. No 401k. I have continuously had superior provider ratings, increased clinic volume (with the highest in the local system for at least one year), diligent with completion of charts and never take days off. Recommendations on asking for raise? 

[DarwinStarwin]

Is that pretty standard for someone with your # of years experience, in family med in your area? Per the AAPA salary report?

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[AbeTheBabe]

On average how many hours do you work on those 4 days? The insurance/retirement situation likely costs you 5-10K compared to other offers with full benefits. The days off are great though, you're getting 6 weeks PTO, 1 week CME, 3 weeks sick, and maybe even holidays which you didn't mention. But, there's no way to answer this unless you look at other options in the area and what they are paying. Check the AAPA salary report. If you don't get the raise you are looking for, make sure you start taking that time off and take advantage of your benefits.

[mgriffiths]

On 6/12/2019 at 11:50 AM, keisha12 said:

Encounter based bonuses ($16.59 per encounter over minimum 663 per quarter which does not prove profitable for me so basically my salary is less than $97k total)

You've gotten some good advice, but I will add that this stupid bonus should be a major focus.  Assuming you stay with your current employer, if a bonus only pays the provider with "increased clinic volume (with the highest in the local system for at least one year)" approximately $4k per year it is beyond broken.  You need to push for this to either be reworked, or for you to be removed from the bonus system entirely and instead paid just a straight salary.  Think about it this way...you say you "never take days off" (which by the way isn't healthy or good - think "moral injury").  You are basically forfeiting your 10 weeks of PTO (yes, I'm lumping your vacation, CME, and sick time together) to make an extra 4.3% salary...NOT worth it.  You could moonlight at an UC and make WAY more than $4k in just a few of those 10 weeks of PTO (or at least should make more than $4k).

In reality, it's hard to give specific input on what your raise should be, because COL is variable, and what other jobs are available that don't require a move?  But, you say you have been with your employer for 3 years and I'm assuming you have not received any raises since your start date.  Just a COL raise to keep up with inflation (2-3%) over 3 years should warrant a salary of $100,150.83 (I used a 2.5% raise annually for 3 years), and that is ignoring the fact that you obviously have a VERY established patient base and are making your employer a VAST amount of money.  Being conservative, you are producing approximately 4,940 RVUs annually (19 patients per day x 4 days per week x 52 weeks x 1.25 RVUs per patient).  That is above the 99th percentile for productivity for ALL primary care "producers."  Assuming your employer makes $30 of PROFIT per RVU (generally a LOW estimate) you are producing almost $150k of profit...and that is already taking into consideration lost revenue from non-payment, your costs (salary, CME, malpractice, etc.), costs of running the practice (MAs, front desk, lights, etc.), and billing/management - and their profit is likely at least $5-10k more as AbeTheBabe stated due to the no insurance stupidity.

 

If you can't tell...you are being taken advantage of, and I've been there.  Doesn't mean you should leave...but you need to be firm and ready to...I recently left a "good employer" and for the same exact job with LESS stress I am making 30% more...Yes, I had to move, but completely worth it.

[keisha12]

16 hours ago, DarwinStarwin said:

Is that pretty standard for someone with your # of years experience, in family med in your area? Per the AAPA salary report?

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I am in the lower percentile for my location and experience.

[keisha12]

2 hours ago, mgriffiths said:

You've gotten some good advice, but I will add that this stupid bonus should be a major focus.  Assuming you stay with your current employer, if a bonus only pays the provider with "increased clinic volume (with the highest in the local system for at least one year)" approximately $4k per year it is beyond broken.  You need to push for this to either be reworked, or for you to be removed from the bonus system entirely and instead paid just a straight salary.  Think about it this way...you say you "never take days off" (which by the way isn't healthy or good - think "moral injury").  You are basically forfeiting your 10 weeks of PTO (yes, I'm lumping your vacation, CME, and sick time together) to make an extra 4.3% salary...NOT worth it.  You could moonlight at an UC and make WAY more than $4k in just a few of those 10 weeks of PTO (or at least should make more than $4k).

In reality, it's hard to give specific input on what your raise should be, because COL is variable, and what other jobs are available that don't require a move?  But, you say you have been with your employer for 3 years and I'm assuming you have not received any raises since your start date.  Just a COL raise to keep up with inflation (2-3%) over 3 years should warrant a salary of $100,150.83 (I used a 2.5% raise annually for 3 years), and that is ignoring the fact that you obviously have a VERY established patient base and are making your employer a VAST amount of money.  Being conservative, you are producing approximately 4,940 RVUs annually (19 patients per day x 4 days per week x 52 weeks x 1.25 RVUs per patient).  That is above the 99th percentile for productivity for ALL primary care "producers."  Assuming your employer makes $30 of PROFIT per RVU (generally a LOW estimate) you are producing almost $150k of profit...and that is already taking into consideration lost revenue from non-payment, your costs (salary, CME, malpractice, etc.), costs of running the practice (MAs, front desk, lights, etc.), and billing/management - and their profit is likely at least $5-10k more as AbeTheBabe stated due to the no insurance stupidity.

 

If you can't tell...you are being taken advantage of, and I've been there.  Doesn't mean you should leave...but you need to be firm and ready to...I recently left a "good employer" and for the same exact job with LESS stress I am making 30% more...Yes, I had to move, but completely worth it.

Wow, thank you for your detailed breakdown. Lots of things I had not thought of myself. I will be using some of these numbers as I compile my requests. Aside from my annual summer vacation (1 week), I lose a lot of PTO and sick time. Very informative response. Thank you.