Looking for advice…

[dspicer716]

 

Hello All,

Looking for seasoned physician assistant guidance regarding my current position. Bear with me, lots of information following to set the stage. 

I've been a physician assistant working in emergency medicine for just over 3 years, currently employed at a small hospital just north of Boston, MA. The position I'm working at full time is also my first job out of school. When I started, our ED had just around 17 rooms, 8 hallway beds. Our PA group consisted of 7 PAs. Usually 2 mid-levels, 2 Attendings, +/- medicine intern from the hours of 7a-10p, transitioning to 1 Attending and 1 PA or intern on the overnight shift from 10p-7a.

Since starting, our ED has been under remodeling and has increased in size to 33 rooms, 12 hallway beds. Since January 2023, our provider group ownership (MDs and PAs) changed and many changes to the group and compensation have come with that.

First, two of our PAs (newest hires) were let go bringing the group down to 5. Two of the remaining 5 have left to start families/pursue careers in other specialties. We have a hired only 1 new PA since bringing the group total to 4. From the information we have been given by leadership, it does not appear that we have plans to hire any new providers. With the change, it has become increasingly difficult to take any time off, get shift coverage if needed, and we are now working longer shifts and more hours per month.

Before this transition, as a newer provider I was making ~ 120K annually with option for overtime pay. We had an annual salary adjustment for cost of living and a 3% match on a 403B in addition to earned time. We additionally received a semi-annual bonus (not sure how this was calculated) but usually amounted to around $5-7K. Since the transition, my salary has essentially stayed the same - they have removed the annual cost of living adjustment, we have lost earned time, no possibility for overtime pay, no option for bonus,  but an employer 403B contribution of 12%.

The loss of earned time really hit home after a recent week long vacation; I returned and have worked 16 shifts in the last 19 days, one of these days was following an overnight shift and was basically a wash. 

Attending physician compensation has also changed. They still make a very comfortable salary but now RVUs comprise a big part of their compensation. This has visibly resulted in frustration and even verbal arguments among the attendings. Their shift length and hours worked has not been impacted (8 hour shifts). The physician assistants are not compensated any differently regardless of #patients seen/hour, procedures performed, etc. For the PAs that have stayed on, many of us just feel like we are filling the pockets of our Attending counterparts with $$$ for the work and efforts we put forth while they text, crossword, browse the internet, etc. 

I guess my big question is this - does this seem like a sinking ship for a relatively new physician assistant? My heart is telling me the leadership is doing everything possible to make our lives as miserable as can be to have us voluntarily leave. We have lost earned time, option for overtime pay, cost of living adjustment, bonus pay and our hours and patient volume have increased substantially.

I have started looking around for other positions outside of the metropolitan area where friends have told me their pay, hours, group size, etc. are all much more structured with essentially the same or greater autonomy. 

Would you stay in this position and wait to see if any adjustments are made? Leave for what might be greener pastures at a different hospital?

This is my first gig out of school. I'm not sure that the "devil I don't know" will be any better than what I have currently. I'm hoping one or several of y'all out there can offer some seasoned advice/guidance. 

Thanks for reading,

Dan 

Edited September 28, 2023 by dspicer716
Type O

[SedRate]

I'm not in EM but there are indeed greener pastures, especially in regards to pay and time off. And it sounds like they aren't interested in cultivating a great work environment. Hopefully some of the experienced EM folks will chime in. 

Know your worth and what you contribute to a company.

Personally, I'd bounce if I was in a similar situation. 

[rev ronin]

4 hours ago, dspicer716 said:

This is my first gig out of school. I'm not sure that the "devil I don't know" will be any better than what I have currently.

Based on my personal experience, you'll be good at avoiding that particular bad situation in the future, but will find new and different bad situations in the future jobs you hold. Eventually, you will be able to see ALL the possible problems, and decide to either tolerate some vs. others, or instead go into business for yourself. Harder to do that in EM than some other specialties, but some of our peers have done so.

Best wishes!

[EMEDPA]

There are lots of great jobs north of you in ME, VT, and NH. Maybe look into those. More work for less money is a pretty good reason to leave, although a 12% 403 B contribution is better than avg these days. As Rev said, it's all about what you can tolerate. I worked a similar position for 15 years. I don't work there anymore. 

[sas5814]

In general I won't work anywhere where this is no hourly compensation of some kind. If you are on salary with no OT, no comp time etc you are in a perfect position to get abused. I'm still on my first cuppa coffee but it sounds like you took a net loss for more work. That is a non-starter. Especially if it was done without any discussion or negotiation. That is prime proof that your organization sees you as an expendable commodity and not as a valued resource.

[TWR]

I will say once again that joining a union would avoid so many pitfalls mentioned above.  We are definitely being abused in many(most??) work situations and would not be tolerated if we were unionized.  The more PAs and NPs we pump out annually gives corporate medicine free rein to just say "you don't like it. LEAVE"  Next PA please.  Situation similar to auto workers where CEO's (bosses) make 300% or more than the people that make their salary for them, same or worse in corporate medicine.  IMHO!

[SedRate]

1 hour ago, Hemmingway said:

In general I won't work anywhere where this is no hourly compensation of some kind. If you are on salary with no OT, no comp time etc you are in a perfect position to get abused. I'm still on my first cuppa coffee but it sounds like you took a net loss for more work. That is a non-starter. Especially if it was done without any discussion or negotiation. That is prime proof that your organization sees you as an expendable commodity and not as a valued resource.

Agree. I've learned/experienced this along the way. 

Edited September 28, 2023 by SedRate

[rev ronin]

10 hours ago, TWR said:

Situation similar to auto workers where CEO's (bosses) make 300% or more than the people that make their salary for them, same or worse in corporate medicine.

00

Here are the two extra zeroes: 300x, 30000%

[ohiovolffemtp]

The only way you'll know the color of the grass on the other side of the fence is if you look.  With 3 years EM experience, you've moved most of the way from "new grad" to "experienced hire".  Most places consider 3-5 years EM experience to be an experienced hire.  There's a much larger set of opportunities for experienced hire.  I get emails & texts from head hunters and locums companies most days.

So, start looking.  Over time, you'll get a feel for what's out there.  If you're willing to relocate and/or travel you'll find that there are lots more well paying opportunities.  My personal experience: I make 1/3 more traveling to rural critical access hospitals than I did working in a very busy high acuity level III trauma center in SW Ohio.  My 12 hour shifts are 12 paid hours, not the 10 paid hours requiring 12 hours of work I had before.

I don't know the Boston area and right now you only know your facility.  Find out who staffs the different ED's and start talking to them.  Expand the geography of your search as far as you can.  Once you've looked around, then you can make an informed choice.  If you have some free time, you can start working PRN at a site to get a feel for it before trying to go FT there.

[ventana]

offer a pay cut (yes that is what they did) is insane in the current job market

last job offered me a 19% pay cut - I let my feet do the talking

 

Do a good job

work hard

send out CV

Leave on a good note (yes you are working for the doc's)

[BirdDogPA]

Get comfortable with sick patients and managing a department. Find a solid single coverage location and you’ll never go back. Haven’t work a shift with a doc in probably 3 years and never plan to again. It’s nothing personal towards them it just bussiness ( finances and lifestyle).