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Do you get an annual raise? Or bonuses? I used to work for larger companies and got a yearly raise, but now working for a smaller company for 2 and a half years and NO raise at all. Anyone else??

 

 

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annual raise should be there, but it is not, sort of the norm where I have been

Yet we are not paid like a doc, but told to do all their work

 

I would be polite but somewhat insist on a review and raise....  but you are unlikely to get it....

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When I was in a small private practice I was never offered a raise. I would periodically review collections and my visits and use it to get an increase. Now I work for a giant corporation and we get 3% annually if you have a perfect annual review.

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On 6/18/2019 at 8:56 AM, Cideous said:

Only get raises when I renegotiate my contract.  Other then that, am on my own.

I go over this with students before they graduate. This is a good reason to think about how long you want the term of your contract to be. While it might seem like there is security in a longer contract, it's an easy way for admin to stall salary conversations for a while. 

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10 minutes ago, SHU-CH said:

I go over this with students before they graduate. This is a good reason to think about how long you want the term of your contract to be. While it might seem like there is security in a longer contract, it's an easy way for admin to stall salary conversations for a while. 

What you say is true, but in the corporate world of medicine there is VERY LITTLE negotiation.  Basically you are presented with a contract and it's take it or leave it.  The only wiggle room I have had is in base salary/hourly wage.  CME/PTO/contract length are all take it or leave it factors, and over the years (if you've read any of my posts lol) I have been lamenting them all doing down down down year after year.

 

This did not use to be the norm.  Before doc's all sold their practices to corporate investor groups and our field became woefully over-saturated with providers looking for jobs, we had a fair amount of bargaining power.  Not anymore.

Edited by Cideous
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I work for a smaller private company. I ask to sit down annually for a review and I use that to also present my case for a raise. I have gotten one every year but one. The year I didn't get one, I negotiated better hours. 

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How's the old saying go? "

When negotiating for increased compensation you get money, time or power, pick one."

Or something like that. 

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Thanks for the input guys! I feel like I’m fairly compensated so I’m not as frustrated as I could be. But I do know my performance is great and I make them lots of money seeing 25-33 pts a day so I’m worth it as we all are!


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1 hour ago, jcash said:

Thanks for the input guys! I feel like I’m fairly compensated so I’m not as frustrated as I could be. But I do know my performance is great and I make them lots of money seeing 25-33 pts a day so I’m worth it as we all are!


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Wow!!! You are insane for seeing that many a day. How can you give good quality of care every 7 minutes or less? Plus if you are truly seeing that many people you should be rolling in the money. 

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Wow!!! You are insane for seeing that many a day. How can you give good quality of care every 7 minutes or less? Plus if you are truly seeing that many people you should be rolling in the money. 



I work in pediatrics. So sometimes it’s not too bad to see that many simple ear infections and well child checks. But then there are days when it’s RSV, flu, neb treatment, send child to ER, etc so there are very stressful days too. And yes I’m sure I’m making the practice a ton of money..... no bonuses for me though.....
How many patients do you see in a day?


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5 hours ago, jcash said:

 

 


I work in pediatrics. So sometimes it’s not too bad to see that many simple ear infections and well child checks. But then there are days when it’s RSV, flu, neb treatment, send child to ER, etc so there are very stressful days too. And yes I’m sure I’m making the practice a ton of money..... no bonuses for me though.....
How many patients do you see in a day?


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I'm sorry but how could you possibly give good quality well child checks in 7 minutes? Are you excluding the charting, screenings and assessments, reviewing growth charts? Where I work, the providers who do these quick WCCs are usually the ones who miss autism, metabolic syndrome, etc. 

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7 hours ago, jcash said:

 

 


I work in pediatrics. So sometimes it’s not too bad to see that many simple ear infections and well child checks. But then there are days when it’s RSV, flu, neb treatment, send child to ER, etc so there are very stressful days too. And yes I’m sure I’m making the practice a ton of money..... no bonuses for me though.....
How many patients do you see in a day?


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I work family medicine...9 hour days.  I see approximately 18-20 patients per day.  Obviously isn't quite the same as strict pediatrics, but can say that I would absolutely refuse to have a schedule that allowed for more than 25 patients.  Not because I don't want to work hard...but because of my sanity and quality of care.  You are literally RUNNING around which is not good medicine and not good for preventing "moral injury."  Your patients need more time than 5-10 minutes, but unfortunately what you describe is more and more commonplace.  I never understood how he did it, but a pediatrician that was part of the practice at my old job would see 35-40 patients per 8 hour day and would lose it if his schedule wasn't full.

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we get a raise of 1k/yr for years 1-5, 2k/yr 6-10 , and 3k/yr 10+. also cost of living adjustment. Ive been with the group 8 years

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10 hours ago, jcash said:

 

 


I work in pediatrics. So sometimes it’s not too bad to see that many simple ear infections and well child checks. But then there are days when it’s RSV, flu, neb treatment, send child to ER, etc so there are very stressful days too. And yes I’m sure I’m making the practice a ton of money..... no bonuses for me though.....
How many patients do you see in a day?


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I am currently leaving my practice and my last day is 1st week of August. I work for a slave mill of seeing patients and he wants at least 26 ppd. I have been here 4 years and I refuse to see that many. The only way that worked here prior is because the clinic had several hundred people on schedule II medications and you would walk in hand them a script and walk out the door. They just lined out the door for their script. Now that I have < 40 people on schedule II compared to > 300 I have a great mix of peds to adults. I see on average 18-19 PPD which is crazy busy. We also PAPER chart which is very easy (yes we are a certified rural health clinic) and we get paid 60 cents on the dollar for visits and I still gross just over $400K per year (I bill out >$600K per year), but I do a decent amount of procedures. I wish you luck on not missing something in the peds population when you have 5 minutes to see that patient. How do you get all your paperwork, charting, reviewing, labs, referrals, phone calls, refills, imaging, etc when you are seeing that many patients per day?

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these types of threads make me sad

 

 

I truly believe that the takeover of medicine by corporations is the reason for this

 

and the solution is to unionize.... sad but true... 

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On 6/21/2019 at 10:03 AM, ventana said:

these types of threads make me sad

 

 

I truly believe that the takeover of medicine by corporations is the reason for this

 

and the solution is to unionize.... sad but true... 

Completely agree.

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I work family medicine...9 hour days.  I see approximately 18-20 patients per day.  Obviously isn't quite the same as strict pediatrics, but can say that I would absolutely refuse to have a schedule that allowed for more than 25 patients.  Not because I don't want to work hard...but because of my sanity and quality of care.  You are literally RUNNING around which is not good medicine and not good for preventing "moral injury."  Your patients need more time than 5-10 minutes, but unfortunately what you describe is more and more commonplace.  I never understood how he did it, but a pediatrician that was part of the practice at my old job would see 35-40 patients per 8 hour day and would lose it if his schedule wasn't full.


Honestly I’ve never had a job seeing less than this amount. I started in OB gyn and saw 22-30 pts per day. Then urgent care seeing 30-50 pts in 12 plus hour shift by myself and now peds. I have asked for more admin time because on top of that schedule I still have labs and X-ray US to go through. I typically sacrifice any personal time for my pts. I hate making people wait and hate to have my MA stay late. But I am very thorough with my pts and always make sure they get what they need which unfortunately leads to me losing out on time with my family. I have friends who see more. I’m exhausted overwhelmed but sometimes feel like this is the norm which is terrible. I’m going down to part time soon. It’s funny because after my first year they said I “broke even” on my generated revenue compared to my salary. WTF?!? I know that’s not true! I make them tons of money. Way more than my salary.


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1 hour ago, jcash said:

 

 It’s funny because after my first year they said I “broke even” on my generated revenue compared to my salary. WTF?!?

 

That was horseshit.  Break even...not seeing that many patients a day.

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13 hours ago, jcash said:

Honestly I’ve never had a job seeing less than this amount. I started in OB gyn and saw 22-30 pts per day. Then urgent care seeing 30-50 pts in 12 plus hour shift by myself and now peds. I have asked for more admin time because on top of that schedule I still have labs and X-ray US to go through. I typically sacrifice any personal time for my pts. I hate making people wait and hate to have my MA stay late. But I am very thorough with my pts and always make sure they get what they need which unfortunately leads to me losing out on time with my family. I have friends who see more. I’m exhausted overwhelmed but sometimes feel like this is the norm which is terrible. I’m going down to part time soon. It’s funny because after my first year they said I “broke even” on my generated revenue compared to my salary. WTF?!? I know that’s not true! I make them tons of money. Way more than my salary.

 

As Cideous said...their statement about you breaking even is ridiculous, unless they are billing "incident to" and not giving you credit for those RVUs, which is also ridiculous.

 

But, you have experience that helped you learn how to be efficient in healthcare...that is awesome.  My first job out of school was ortho, and while the job itself was awful, the learning experience of how to be efficient seeing ~50 patients per day was invaluable.  Obviously, as I stated above I don't see near that in FM, and NEVER will, but the experience of learning to stay on topic, stay focused, and chart efficiently helped me A TON.

 

With that said, peds is such a different ballgame than OB/GYN and UC.  I could definitely see how 22-30 in OB/GYN is doable, depending on how the practice/schedule is set up.  Again, 30-50 in UC is extremely doable.  50 on a regular basis would be soul-crushing, but 30 in 12 hours isn't bad...Peds is different, unless the practice is set up to only see patients for single things...like one day we do WCC exam and then another day do the screening stuff...but I highly doubt that is the case because I don't think parents/patients would stand for it.  It is "better" that you are giving up your personal time to complete paperwork in terms of patient safety, but if you haven't already you are definitely set up for extreme "moral injury."

 

I hate to say it, but this sounds like you are being taken advantage of.  You said earlier you feel that you are "fairly compensated" but you posted here about the lack of annual raises for 2.5 years...those seem contradictory.  Maybe you are well compensated, but if you see on average 25ppd for just 4 days per week for 45 weeks at an average RVU of 1 per patient, that is 4,500 RVUs per year.  That is FAR above average, and while peds generally has lower RVUs per patient than FM and IM my calculation is using VERY conservative numbers, using 7 weeks of PTO, your lower number for average patients, and I would expect your RVU per patient to be higher than 1.  So, it is extremely possible that you are producing 5400+ RVUs annually (same calculation, just using 30ppd).  At an extremely conservative estimate of $30/RVU of PROFIT and using the more conservative number of 4500 RVUS you are making the practice at minimum $135,000/year...again of PROFIT!

 

Note: profit is after practice costs like your salary, malpractice, building, EMR, MAs, front desk, billing, etc.

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On 6/22/2019 at 10:01 PM, jcash said:

 


Honestly I’ve never had a job seeing less than this amount. I started in OB gyn and saw 22-30 pts per day. Then urgent care seeing 30-50 pts in 12 plus hour shift by myself and now peds. I have asked for more admin time because on top of that schedule I still have labs and X-ray US to go through. I typically sacrifice any personal time for my pts. I hate making people wait and hate to have my MA stay late. But I am very thorough with my pts and always make sure they get what they need which unfortunately leads to me losing out on time with my family. I have friends who see more. I’m exhausted overwhelmed but sometimes feel like this is the norm which is terrible. I’m going down to part time soon. It’s funny because after my first year they said I “broke even” on my generated revenue compared to my salary. WTF?!? I know that’s not true! I make them tons of money. Way more than my salary.


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their definition of "break even"

 

salary 100k

overhead 100k

administrator salry 100k

 

 

so you get 100k but generate 300k and that is "breaking even"

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As Cideous said...their statement about you breaking even is ridiculous, unless they are billing "incident to" and not giving you credit for those RVUs, which is also ridiculous.
 
But, you have experience that helped you learn how to be efficient in healthcare...that is awesome.  My first job out of school was ortho, and while the job itself was awful, the learning experience of how to be efficient seeing ~50 patients per day was invaluable.  Obviously, as I stated above I don't see near that in FM, and NEVER will, but the experience of learning to stay on topic, stay focused, and chart efficiently helped me A TON.
 
With that said, peds is such a different ballgame than OB/GYN and UC.  I could definitely see how 22-30 in OB/GYN is doable, depending on how the practice/schedule is set up.  Again, 30-50 in UC is extremely doable.  50 on a regular basis would be soul-crushing, but 30 in 12 hours isn't bad...Peds is different, unless the practice is set up to only see patients for single things...like one day we do WCC exam and then another day do the screening stuff...but I highly doubt that is the case because I don't think parents/patients would stand for it.  It is "better" that you are giving up your personal time to complete paperwork in terms of patient safety, but if you haven't already you are definitely set up for extreme "moral injury."
 
I hate to say it, but this sounds like you are being taken advantage of.  You said earlier you feel that you are "fairly compensated" but you posted here about the lack of annual raises for 2.5 years...those seem contradictory.  Maybe you are well compensated, but if you see on average 25ppd for just 4 days per week for 45 weeks at an average RVU of 1 per patient, that is 4,500 RVUs per year.  That is FAR above average, and while peds generally has lower RVUs per patient than FM and IM my calculation is using VERY conservative numbers, using 7 weeks of PTO, your lower number for average patients, and I would expect your RVU per patient to be higher than 1.  So, it is extremely possible that you are producing 5400+ RVUs annually (same calculation, just using 30ppd).  At an extremely conservative estimate of $30/RVU of PROFIT and using the more conservative number of 4500 RVUS you are making the practice at minimum $135,000/year...again of PROFIT!
 
Note: profit is after practice costs like your salary, malpractice, building, EMR, MAs, front desk, billing, etc.


Whoa! Thank you for all that math and help. I feel like I know this somewhat in my head just knowing what I bill out per day but seeing it as an RVU is really helpful!

It’s Saturday today and I am just trying to recover from my work week. I’m exhausted and nearly burned out after being a PA for only nearly 8 years. I appreciate the feedback on patient load. It’s rough as I’ve asked for more admin time or decrease on patient load and they act like that’s such a crazy thought. The only upside to this practice is I can say if patients are too much or have too many issues for me and just be doctor only. I’ve worked at other practices that make me see patients that are way beyond my scope of practice which was very stressful.

Thanks everyone!


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oh yeah

only way you really get a raise is to change positions....

 

otherwise the bean counters will propose your "raise" comes from seeing more patients or working extra - both of which enrich them more then you....

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