Critical Access Hospital ER APC Ave Salary Poll-please respond

[thulegreen1101]

I am a 2nd coverage ER PA at a Critical Access Hospital in the midwest. There is very limited data available specific to average salary for ER APCss in Critical Access hospitals in the US.

I understand there are a number of variables, including cost of living, average PA salary per state etc. This is very generalized poll that I recognize has many flaws. 

I am simply curious what other regions pay their ER PAs in Critical Access Hospitals. For those who work as an Emergency Medicine NP or PA in a critical access hospital, please consider responding to this poll. The intent of this poll is to spur conversation and hopefully encourage larger organizations, such as SEMPA to consider collecting more data specific to practice acuity, type of facility, and levels of responsibility etc. My impression, after attending the SEMPA conference, is that ER APCs in critical access hospitals in the US are grossly underpaid considering the patient volume, the level of responsibility and acuity they are expected to manage.

*Image offers reference to definition of various regions in the US.

Edited May 12, 2022 by thulegreen1101
spelling error

[thulegreen1101]

I am limited to 3 questions on this poll. Would love to see a formal poll that includes level of acuity seen, ave. # of patients daily, residency vs no residency etc. This is just a very basic poll. 

[rev ronin]

14 hours ago, thulegreen1101 said:

I am limited to 3 questions on this poll. Would love to see a formal poll that includes level of acuity seen, ave. # of patients daily, residency vs no residency etc. This is just a very basic poll. 

You can feel free to construct it in SurveyMonkey and link to it here.

[LT_Oneal_PAC]

7 years experience, 4 years EM. EM residency trained, to which I attribute all my success. Some would say I’m significantly under paid, but I’m probably 90th percentile for the area. Hard to negotiate tougher than I have and they treat me so damn well. There’s no doubt though I’m making them crazy money though for the amount of crit care I bill vs my overhead.
 

77.25 per hour. NP counter parts make 72.25 and 75.25. More years experience, but lack some EM/critical care skills.
 

1.5x pay for anything over 72 hours in 2 week period. 5k annual bonus with very very low requirements (not even sure what they are but I always get it, one NP is not because there don’t come to single Med staff meeting). 336 hours of PTO annually given all up front at start of fiscal year. Defined benefit pension. High deductible HSA plan insurance. 2.5k CME and 3 days CME PTO. Life and disability paid. Occurrence malpractice 1m/3m coverage

Full Med staff voting privileges, but APPs cannot make quorum or sit on credentialing. I’m actively working to change that. 

free cafeteria food delivered to my office, my favorite perk

Solo provider level 4. Low volume but high acuity with no higher level for 1 hour drive, 1.5 hours to trauma center from the our facility, but we also get some from just over state border because they are even further away from any medical facility. 8-12 patients per 24 hours. 72 hour shifts every 2 weeks, but we are moving to a 24h x2 per week due to increasing volumes.

No acuity restriction. Only required back up called for neonatal ESI level one, imminent deliveries, and mass casualty events. Full EM credentials, basically any procedure or pathology you can imagine, I’m cleared.
 

EM provider does the admission, so we decide what stays or goes, but no rounding (though we did up until COVID burned us all to a crisp). Take floor calls at night. Only absolute restriction is no vents due to Limited RT staff and floor capped at 10 due to limited nursing staff. No surgical capability, but we keep most SBO. With COVID causing bed shortages, we’ve become even more comfortable with NSTEMIs and strokes that have to wait for transfer. A few of us are also utilized as a consultive service by hospitalists for advanced procedures. 

MRI available once per week. CT and XR 24 hours. US during day 4 days per week. Echo twice per month. Can only CTA the torso. Good EM labs but poor IM lab tests and many basic IM diagnostics are send outs. Good pharmacy stock of critical care meds. 
 

[ohiovolffemtp]

My company staffs critical access hospitals in AZ, NM, CO, MI, up until recently IN, about to start in KS and WV.  Our typical model is a 12 day doc shift with a PA/NP covering the 12 hour overnight shift.  Doc gets called back for a few things: codes, level 1 traumas, child birth, thrombolytics.  If available, PA/NP can be called in during the day if it gets crazy, though this is rare.  Depending on site, we also cover the floor at night.  Volumes vary by site, but 10-14/shift common.

Pay depends upon site, typically $85-100/hour.  Benefits include health insurance (high deductible w. HSA), vision, and dental all at no cost, 3% employer contribution to 401K with no match required, long term disability and med mal with tail also provided at no cost.

Started doing this after 5 years experience in a busy high acuity level III trauma center.  Also, let's just say more years of doing fire/EMS than the median age of my PA school classmates.  No EM PA residency, though it sure would have helped, but family priorities precluded.

BTW, there is a rural EM special interest group that meets at SEMPA.  You could come to the next meeting and make your suggestions - they would be welcome.

[EMEDPA]

Many folks who work rural coverage have much more than 10 years of experience. I would add a 10-20, 20-30, etc. Also would add a category for solo coverage vs double coverage. There are roughly 10,000 EMPAs in the country(probably more like 11,000 now). At last count 2-2.5% worked solo, so fewer than 300 folks nationwide.

[EMEDPA]

Well, low powered survey so far, but happy to see no ridiculously low salaries. I just met a PA 4 years out of school who was offered an ICU position for $38/hr. Sher didn't take it, but she considered it.

[rev ronin]

4 hours ago, EMEDPA said:

I just met a PA 4 years out of school who was offered an ICU position for $38/hr.

I was making more than that 10y ago as a family med new grad. ICU? What, do they think ICU PAs grow on trees? After Covid? Sheesh.

[ohiovolffemtp]

6 hours ago, EMEDPA said:

Well, low powered survey so far, but happy to see no ridiculously low salaries. I just met a PA 4 years out of school who was offered an ICU position for $38/hr. Sher didn't take it, but she considered it.

That's less than the RN's are making, much less the travel RN's.

I'm seeing the staffing companies that staff the community hospital ED's in SW Ohio pay their EM PA's $65-75/hour, $80 if they're having a hard time filling the positions.  Going a bit north, the pay does go down to the $50-65/hour range.  Indiana seems to be $65-75/hour, KY a bit less.

[EMEDPA]

13 hours ago, ohiovolffemtp said:

That's less than the RN's are making, much less the travel RN's.

I'm seeing the staffing companies that staff the community hospital ED's in SW Ohio pay their EM PA's $65-75/hour, $80 if they're having a hard time filling the positions.  Going a bit north, the pay does go down to the $50-65/hour range.  Indiana seems to be $65-75/hour, KY a bit less.

She is in KY.

[Boatswain2PA]

I'm late to the party but filled out.

Single coverage, 48-72 hour shifts.  Average 8-10 patients per day, but have seen 20/day.  High acuity, no local ACLS for transfers.  1.5 hours go secondary hospitals, 2.5 hours to tertiary care (drive time). 

About $90/hour for 8 24hr shifts a month.  Goes up if I do more than 8. 

No benefits other than disability, and they reimburse licensure, etc.  They offer health insurance, but I declined (have Tricare) so they added a few $/hour.  No PTO, CME, etc.

Biggest benefit - this place is a well run team.  The CEO is a RN who has been the CEO for >10 years (almost unheard of in healthcare), and has come to the ED during codes (etc) and actually HELPED (got on phone to help arrange transfer, etc).  The CNO/DON pulls a shift a week on the floor AND a shift a week in the ED.  We have limited resources, are a long way from anywhere, but we all strive to be great, improve each other, but give grace when we make mistakes. 

This is REALLY rare in healthcare.  I mean REALLLLY rare.  Most hospitals I have worked in are utterly devoid of good leadership from the management team, resulting in the typical backstabbing/mistrust/write-ups/surprise firings/nepotism/etc that is so common.