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How to leave gracefully???


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I've been in my current position for 5 years. I was the first PA in our Neurology practice and started part time with just Parkinson's disease. Over time things have changed to the point where I see most diagnoses and carry my own panel of PD patients. I was allowed to be a newbie (ie time to learn and come up to speed gradually) mostly thanks to extra funding for my position through our affiliation with a big health care system (Providence, for those of you in the NW.) My position grew in 2009 to 4 days per week and I carry my own patient panel and do all sorts of work for multiple physicians and see much more than just Parkinson's disease now. I've learned on my own. It's been fun and for the most part I know my work has been valued. My SP has been mostly responsible for things happening for me and I am quite grateful for the opportunity I've had. He treats me well I think because I'm a PA and not an MD. If I was one of the MDs and part of his "club" he might treat me differently....not sure. I have worked my tail off and I would like to think I'm a valuable part of the practice. It will be yet another blow if I leave.

 

It's been hard is trying to juggle the demands of work and home. I had another baby last year, and after maternity leave tried to come back 4 days per week. I'm trying to cut back to 3 days per week and there are days it works better than others. It's one thing to expand a practice but trying to contract it has been challenging. It's like trying to do the same amount of work in less time, so it's really not any easier. I'm tired much of the time, and that's not a big deal in and of itself, but it means I'm closer to my tolerance threshold all the time. Throw in some days of really nasty traffic getting to and from and I'm often wondering what I'm doing all this for.

 

Since I've been there, the group of physicians I work with seems to be disintegrating. 5 have left and one is going on maternity leave and may or may not come back. One of our docs has just left medicine altogether to stay home with her kids. It's mind boggling to me that one would commit to medical school, residency, and fellowship and then walk away. There are definite circumstances to this but that's another story. Providence is cutting off funding for the Parkinson's program and our group is probably going to have to move.

 

I was at at a CME meeting not that long ago and met a really nice doc who is part of a neurology group 15 minutes away from me. They've always thought about bringing in a PA or NP but never knew how to get someone inexperienced in neurology to integrate with their practice. I explained what I do with my current group and he gave me his card and told me to call him. I didn't know how serious he was and didn't think much of it but thought that it's always good to follow up on options. We talked a few times and exchanged some e mails, then he told me to call their practice manager and set up a meeting. I went in well prepared and explained what I do and what I can do. I basically laid out a plan or business model if you will. Anyway, they were a really nice group of docs and things went well. The office manager e mailed me later that they would like references. It might take some roundtable discussion to make sure that we're talking apples to apples but I fully expect them to come up with an offer. And probably sooner rather than later.

 

So the question is...what to do? In a way I would feel guilty moving to another practice because they would get the benefit of my training. I'm quite sure if I let my director and SP know that I have an offer from another group that they will counter, and I'll be in the difficult (but enviable) position of being able to choose. I'm trying to go about this very cautiously however and want to make absolutely sure I understand how this other practice works before making any changes. I don't want to make a leap and then discover that they're a bunch of jerks who will make my life miserable. I'd rather stay with the situation I know. But that means sticking with status quo and all the same issues don't go away. Sometimes more money makes the issues go away but not always.

 

So, if I choose to leave, what kind of notice is reasonable? I'm an employee of the practice, not a shareholder or partner and I don't have a contract. So it seems to me that I could give 2 weeks notice and be out of there, but that doesn't seem right to me. On the other hand giving a couple of months seems awkward. And then I will probably need to train someone. But I can't leave my patients in a lurch, can I?? I don't know. If I do leave, I want it to be on good terms. Does that seem possible???

 

Sorry for the ramble....just looking for some insight. Thanks

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It's time to move on--gracefully :)

Opportunities present themselves and sounds like a great one has landed in your lap. You've earned this by virtue of your diligence and loyalty to your first employer, so don't feel too guilty about moving on. Give appropriate notice (negotiate this with the new practice)--90 days is the industry standard, especially given the long relationships you have built with your patient panel. You will need to let them know and transfer their care to someone else within the group. You should evaluate your current contract to make sure you haven't signed a non-compete clause.

If all looks good, and it works for your family, then thank your current supervisor for his mentorship and explain to him (gently) all the reasons you are ready to move on.

Best wishes :)

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Sadly medicine has become a business and you must look at it that way. Yes they have been good to you but as you said you are an employee and not a share holder. Be upfront and tell them you have a better offer and offer to do do what you can to make your leaving as pleasant as possible. Also remember the grass isn't always greener across the roas. Look carefully.

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Thanks Lisa, points well taken. I am going to be especially cautious about this and take a lot of time to make any decision. I already told the potential new practice that there is no hurry....

 

I think I'm most worried about my SP taking the whole thing personally. I have a hard time thinking of this as "business"

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How did your SP take it when the partners decided to leave? I agree, it is hard to think of it as business but what would the practice do if you became non productive? Most likely drop you like a hot brick because in the final analysis it is a business. Don't let misguided loyalty interfere with what is best for you and your family.

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The fact that you are considering these issues points to the inherent class that you have as a PA and as a person. It is VERY difficult to try and get a true picture of how a practice really works "behind the scenes"... unless you have access to one of the office personnel.. (perhaps network and see if anyone in your church etc knows someone who works there??)

Leaving is always a risk... the grass may not be truely greener at all.

My suggestions, during your sitdowns with the prospective new practice, is to be frank about what you expect from them. (be clear in your own mind about this before you start that conversation..)

 

Tell them what you will need inorder to be happy (hand holding? easy access to SP? progressive autonomy? Not having to present every patient?, etc), and try to get these requirements incorporated into your SPA.

 

How do they feel about you responding to consults? Will you be responding to consults, or merely acquiring a patient panel comprised of the clinic's current recurring patients? Will you see new patients? Will you be able to order testing directly without countersignatures (from the imaging center? Labcorps? )

 

As an aside, how are you handling the reference requests.. as I recall this was your first job (I think).. will you be giving the current group as references?

 

You certainly are approaching this in a manner which will burn no bridges.

 

If the current group tries to counteroffer, you might want to remind them that your leaving isn't so much predicated on the slaary or practice melieu as it is on the intangibles: the travel, the traffic, the dead time away from home and practice.

 

Good luck to you.

 

davis

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"I would feel guilty moving to another practice because they would get the benefit of my training."

 

I am a new grad, so take this with a grain of salt, but I have interviewed for jobs that required a 2-year commitment so that they would get their money back on me. After 5 years, I imagine they have made their money back several times.

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"I would feel guilty moving to another practice because they would get the benefit of my training."

 

I am a new grad, so take this with a grain of salt, but I have interviewed for jobs that required a 2-year commitment so that they would get their money back on me. After 5 years, I imagine they have made their money back several times.

 

Totally agree. You have more than repaid the value of their training.

 

You are a professional and a thoughtful lady, but you don't need to apologize for considering a change when there has been so much change in your employment environment.

 

Good luck!

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I can state they would not hesitate to fire you if the $$$ in the practice was going down....

 

It is business -

 

It is commendable to have loyalty and it is nice to go out on a great end note - but in no way are you obligated to stay......

 

 

Now for the good part - changing jobs is the easiest time to make career advancement. You are now fully trained and marketable - your comparison should be a the other practice hiring another neurologist - and hence instead of the $200k they would have to pay a doc they can pay you $150k.... Literally drive it off productivity..... also the most recent clinical news brought up an intersting point on fraudulent billing - as billing providers we all should DEMAND access to the bills/receipts and #'s that our employers are keeping - to protect our license...... with this info we can then see what we cost and generate.

 

Go in shooting for the moon - come up with a reasonable (but realize you should compare yourself to the doc's not to new grad PA's) salary and revenue stream - demand full access to all financials for your employment - get on productivity, get >5 weeks PTO, only go there if the schedule works.

 

In short this is the your opportunity to make your life better - make reasonable requests and go for it!

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Thanks all for your thoughtful comments. I suppose one of the advantages (there aren't many) of having so many docs leave is that I now have great references who are all outside the group. At least the rumor mill won't be churning that way.

 

I've been meaning to talk to our billing coder - I have never known whether any of my "incident to" charges are being changed to direct billing or if any have been disputed. So it's not (!) unreasonable to ask exactly how much we collect for all the 99214s I bill out.

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