Going to prn and they won't pay me more.

[sailordeac]

Posting this bit of a rant partially because it's a bit of a cautionary tale and partially because it's comical.

I work for an ortho group that is owned by a large hospital. I did not sign a contract when I accepted the position; none of the PAs are on contract. We have a wide scope of practice here, complete autonomy in the lvl 1 trauma bay, and a good amount of OR time. This was an awesome job. Unfortunately, over the past two years, APP leadership at the hospital level reorganized. The admin NP (who btw I'm not sure has ever worked clinically) apparently thinks that all the APPs on every hospital service should be treated exactly the same with a blanket policy for everyone, and the hospital is in charge of hiring/firing APPs, not the ortho group. She says our service line isn't making the hospital enough money so they can't justify hiring us more help, even though we are a hugely busy ortho trauma service and we don't have a residency. Our docs "can't" operate without a FA so we scrub non reimbursable cases and it takes several of us rounding every day (which is labor that has to be done but not making the hospital money because all those patients are global).

On top of this reorganization we've just had more and more dumped on our plate in terms of call coverage for a couple satellite hospitals we cover, added new ortho urgent care locations to cover, added more surgeons but no new PAs - and we're now being asked to work at least two, if not four weekend days a month on top of overtime during the week (and no extra weekdays off for being on for the weekend). It's simply not tenable and I along with two others put in our notice last month. So, the people who are left are kind of screwed in terms of coverage, but I'm hoping it's an impetus for change to make the hospital wake up and improve things for them.

I got a gig at the ED group across town at the "fancy" hospital. The benefits are FAR better. The pay is not out of this world since I don't have a ton of EM experience but it's a little better than my ortho hourly (minus all the call pay I'm currently making for the ridiculous amount of call that I don't want to take). The docs seem great and really laid back and the PAs told me they really aren't super stressed. Most importantly, they're an independent democratic group and they work really hard to find PAs that want to stay for a long time. I'm really hoping I can just let go of some of the stress I've been carrying around.

Academically, I'm quite passionate about ortho and my happy place is in the OR. There's a couple of surgeons I love working with so I offered to stay on per diem for OR help. Since they're going to be extremely short staffed, and I don't get any benefits anymore other than malpractice, one would think they might at least pay me more? I'm not even asking for $80/hr which is my current on call pay. Which is an amount less than they're paying all the OR and ED RN travelers. Nah, hospital HR says it's my normal hourly pay. Comical. 

I'm a very loyal conscientious person and felt really guilty at first about leaving...but with that, I think I may just talk to my friends at the ortho private practice in town and see if they need OR coverage when their PAs are out on vacation. I can about guarantee they'd pay me more.

Moral of the story for me, anyhow:

1) I'm not sure I would take a job again that didn't offer me an employment contract to sign that delineated exactly what my conditions of employment and work responsibilities are. And if those changed, I would want to sign an updated contract.

2) I'm of two minds about working for a big hospital system like this again as a practice employee. I think I'd want to feel out carefully how the leadership is and how much autonomy the individual practice versus the hospital has before I accept a position again. These big hospitals don't seem to care how experienced or how valuable you are to the team.

Edited November 18, 2021 by sailordeac

[Cideous]

You lost me at "NP Admin...". lol

Edited November 18, 2021 by Cideous

[MediMike]

2 hours ago, sailordeac said:

Posting this bit of a rant partially because it's a bit of a cautionary tale and partially because it's comical.

I work for an ortho group that is owned by a large hospital. I did not sign a contract when I accepted the position; none of the PAs are on contract. We have a wide scope of practice here, complete autonomy in the lvl 1 trauma bay, and a good amount of OR time. This was an awesome job. Unfortunately, over the past two years, APP leadership at the hospital level reorganized. The admin NP (who btw I'm not sure has ever worked clinically) apparently thinks that all the APPs on every hospital service should be treated exactly the same with a blanket policy for everyone, and the hospital is in charge of hiring/firing APPs, not the ortho group. She says our service line isn't making the hospital enough money so they can't justify hiring us more help, even though we are a hugely busy ortho trauma service and we don't have a residency. Our docs "can't" operate without a FA so we scrub non reimbursable cases and it takes several of us rounding every day (which is labor that has to be done but not making the hospital money because all those patients are global).

On top of this reorganization we've just had more and more dumped on our plate in terms of call coverage for a couple satellite hospitals we cover, added new ortho urgent care locations to cover, added more surgeons but no new PAs - and we're now being asked to work at least two, if not four weekend days a month on top of overtime during the week (and no extra weekdays off for being on for the weekend). It's simply not tenable and I along with two others put in our notice last month. So, the people who are left are kind of screwed in terms of coverage, but I'm hoping it's an impetus for change to make the hospital wake up and improve things for them.

I got a gig at the ED group across town at the "fancy" hospital. The benefits are FAR better. The pay is not out of this world since I don't have a ton of EM experience but it's a little better than my ortho hourly (minus all the call pay I'm currently making for the ridiculous amount of call that I don't want to take). The docs seem great and really laid back and the PAs told me they really aren't super stressed. Most importantly, they're an independent democratic group and they work really hard to find PAs that want to stay for a long time. I'm really hoping I can just let go of some of the stress I've been carrying around.

Academically, I'm quite passionate about ortho and my happy place is in the OR. There's a couple of surgeons I love working with so I offered to stay on per diem for OR help. Since they're going to be extremely short staffed, and I don't get any benefits anymore other than malpractice, one would think they might at least pay me more? I'm not even asking for $80/hr which is my current on call pay. Which is an amount less than they're paying all the OR and ED RN travelers. Nah, hospital HR says it's my normal hourly pay. Comical. 

I'm a very loyal conscientious person and felt really guilty at first about leaving...but with that, I think I may just talk to my friends at the ortho private practice in town and see if they need OR coverage when their PAs are out on vacation. I can about guarantee they'd pay me more.

Moral of the story for me, anyhow:

1) I'm not sure I would take a job again that didn't offer me an employment contract to sign that delineated exactly what my conditions of employment and work responsibilities are. And if those changed, I would want to sign an updated contract.

2) I'm of two minds about working for a big hospital system like this again as a practice employee. I think I'd want to feel out carefully how the leadership is and how much autonomy the individual practice versus the hospital has before I accept a position again. These big hospitals don't seem to care how experienced or how valuable you are to the team.

Unfortunately it's challenging to get a contract that explicitly delineates exact duties, almost always a clause in there where they can expand your responsibilities, dealing with that currently.

Prior job I dropped down to per diem as well and exact same thing. Lost all benefits and kept the same hourly. Finished out my agreed upon time and bounced without looking back.

Bigger the system the less they care. Congrats on the new gig!

[ohiovolffemtp]

At least in EM, I've found contracts don't really offer much protection.  The employer will change contract terms and tell you that unless you agree to the new terms by a given date, they'll stop scheduling you after that date.

On a practical basis, the only leverage you have is your ability to leave and find another job. That varies by location, how the COVID-19 epidemic is doing, etc.

[ventana]

1. I have never liked unions
2. employers have lost their minds in demands and changes
3. We need to give serious consideration to joining unions to prevent all t his crap.  .   

[kargiver]

Big hospital - you are a cog.  Nothing more.  Your degree of guilt on leaving should be about... zero.  Because its what they think of you as well.  They think its business.  And it is.  

Go do EM - you'll do tons of ortho.  Just not OR stuff.

And NP admin?  Nope.  See you later...

G

[AbeTheBabe]

On 11/18/2021 at 1:25 PM, ventana said:

1. I have never liked unions
2. employers have lost their minds in demands and changes
3. We need to give serious consideration to joining unions to prevent all t his crap.  .   

After 5 years of private practice ortho, I'm in a union ortho job now. They pay/benefits are incredible compared to my last job and I'm hoping I stay here until I retire. The docs have more pull than us with the hospital, PAs are much better off in a union. Our union is strong because it includes nurses, strength in number. We almost striked last week, thankfully it didn't come to that.

[ventana]

18 hours ago, AbeTheBabe said:

After 5 years of private practice ortho, I'm in a union ortho job now. They pay/benefits are incredible compared to my last job and I'm hoping I stay here until I retire. The docs have more pull than us with the hospital, PAs are much better off in a union. Our union is strong because it includes nurses, strength in number. We almost striked last week, thankfully it didn't come to that.

yup that is where the future is - sadly unions are now needed in health care.....

[sas5814]

10 minutes ago, ventana said:

yup that is where the future is - sadly unions are now needed in health care.....

I was sooooo opposed to unions until I worked for a large medical corp. They are Godless, soulless money making machines. The only defense for the individual employee is a union.