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Change in Practice Location: Advice


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So, I posted a few months ago that I was transitioning from FM to orthopedics.  The transition has gone smoothly and the department is great.  The 2 current surgeons are awesome and great teachers, and I have had some great conversations with the surgeon joining the practice soon (who I will be working with almost exclusively).  Overall an awesome switch.

But, I learned today that the real plan for me (and the third surgeon who starts in ~2 weeks) is to have 2 clinic days per week in some of the other clinics.  One is an extra 22.6 miles (45.2/day) and the other is an extra 11.9 miles (23.8/day).  That is 69 miles per week.  Overall, ends up being approximately $600/year in gas and "wear and tear" based on general numbers I've looked at online.  Using the IRS mileage rate of $0.575/mile for 2020 it's $1,785.38!

This is ignoring the time to drive an extra 69 miles each week.  I do think our clinic days will be slightly shorter to make up the driving time (they do this for some of the other specialists who drive), but that also then cuts into my productivity, and we are paid a productivity RVU bonus.

With all of this, I am pretty frustrated.  This was never discussed with me when I looked into transitioning, but definitely discussed with the new surgeon.  Now during this transition from FM to ortho I negotiated a $10,000 raise, and I am very aware that I am the HIGHEST paid APP within the entire hospital system (not including any RVU bonuses).  They do plan to increase the other ortho PA's and the ortho NP's salaries to match mine at the end of our fiscal year this year though.

My question, is this something to fight over?  Obviously I wouldn't start argumentatively, simply fact finding and casually ask about the clinic schedule and then mention the distance, but does that make sense?  The biggest thing is that I don't want to sour a good thing.  I make $120,000 base and assuming the surgeon doesn't screw me over in clinic (which I really do NOT expect based on our conversations) I will make a decent bonus.  Is it really worth it to fight over 600 "real"dollars, as the IRS mileage is an inflated number generally?  Just looking for some advice before sticking my nose in places.

Thanks in advance.

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I think it wouldn't hurt to let them know that the hit to your quality of life with the extra commute is something weighing on you. Also you expect the travel time to impact your RVUs as well.  If you were the only one with the raised salary, maybe it wouldn't be a big deal..but if everyone gets the raise then you'll be suffering more than the others who get to stay at the local clinic.  

But it also sounds like you're the new kid on the block (just transitioned from IM to ortho)....so be prepared for them to feel your lack of seniority doesn't give you much wiggle room.

At the end of the day, I guess you need to decide how much this commute and possible lost RVUs are offset by the satisfying new practice field/setting and the bumped salary.

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I am going to disagree.  I feel like those distances are actually pretty mild.  I can understand your frustration given it wasn't discussed with you and just an assumption you would do it.  That is poor form in my mind and hopefully not how things will be.  It sounds like the job otherwise is great and you are very happy with it, the salary and the benefits.  Therefore, I feel like this is pretty minor.  If I understand correctly, the furthest clinic would be an extra 12 miles away? In my mind that is piddly.  But maybe I just have a different perspective because I drive 70 miles a day to and from work.  

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If you are otherwise happy with the position, I would not want to "sour" things with a new clinic. However, with that said, a key question is did they know this in advance? Was it a true bait n switch or did this travel clinic come up as a late development after you were hired?  I've taken jobs in my career that were a bait n switch and as one hospital CEO told me (before I launched a lawsuit against them) "If we had told you the truth, you wouldn't have taken the position."  In that case, where it is an intentional deception, then they should, tactfully, be held accountable to treating PAs with respect by full disclosure. I was tactful in my case and when that didn't work, eventually I had to take them to court for breach of contract and I won.

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DogLovingPA and jmj11

With a night to think about it and after discussing with my wife, I think this is the route I will take.  The further clinic is an extra 22 miles (44 miles per day)...but again don't think it's worth souring the relationship.  Part of this is I don't think it was an intentional "bait and switch" more just an oversight and possibly just a simple (albeit frustrating) omission.

As the clinic schedule is put together I do plan to make a comment if driving time is not considered at all, as I specifically do not want an extra 60+ minutes of driving time taking away from family responsibilities.

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You can ask your employer if you can submit mileage reimbursement to them at the IRS rate, for travel clinics outside from your usual location. This has been common practices within two major hospital systems I've worked at. I deduct my usual commute of 9.5 miles when I travel to further locations.

I submit mileage for all travel...whether it's 10 miles further or my  usual assignment of every other week same day travel clinic of 235 miles roundtrip.

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