Compensation Question

[ventana]

Well finally feel like I have a home (after I tried a few specialties I am back in primary care)

 

the only bad thing is the pay.

 

So to ask people what I should ask for in my upcoming review

 

Currently:

10yr PA

Outpatient IM/FP

See 25-28 patients per day

36hr work week

4 x 8hr day work week in office plus 1/2 day in NH

 

$84k, 4weeks, 2000k CME, full health for myself and family with no cost to me

 

 

 

 

Two sides of the debate - nationally FP/IM only gets mid 90's and I am just below this but when I figure what I am generating for the practice (min 100 patients per week at $60-figure mostly level 3 but some 2's) is $6000 per week for 44 weeks is 264,000 per year(minimum) of income and I figure I use 105,000(84,000+15k health+5k bennies).

 

Now I realize I need to cover 2x's my cost so that is 210,000 but there is another 50k floating around that I am trying to get the gumption up to ask for part of.

 

Anyone have any decent bonus structures for IM/FP?

 

Should I just be happy where at? (BTW my last job was EM and I was at 120,000 so this was hard swallow but worth it as I am happy) Just don't want to give my services away and also want to set up a correct pay scale for newer grads.....

 

 

thoughts......

[ventana]

bump bump bump

[bradtPA]

Consider structuring a bonus on a sliding scale of productivity. For example, you collect 10% of all collections from $200-250K, 15% from $250K-300K, 20% over $300k. Drawbacks to this is you have to have access to your billings and no way for them to cook the books to show you are collecting less than you really are.

 

And no, don't be happy at where you are, you deserve better IMHO. After my first year I was able to ask for a $12,000 increase from $70K to 82K plus bonus (last years bonus ended up being $6K). You have 8 years of experience on me, that should be worth something.....

[bradtPA]

Sorry, double post

[sbellin]

The national average $90k+ may not apply to your geographic area. Look at the census report from the AAPA and find more accurate numbers. You may get insight into what to do there.

[doubledown10]

Don't be afraid to ask for more money, as long as it's reasonable. And make sure that you drive across the point that you're not a new graduate, that you actually produce and move the meat. But like the sbellin said, it might not apply to your part of the world. When I was working in Texas I was making money hand over fist in EM. Move to CA and not so much. So it might be all about where you're at. But whatever you do, don't sell yourself or your experience short.

[coloradopa]

Well finally feel like I have a home (after I tried a few specialties I am back in primary care)

 

the only bad thing is the pay.

 

So to ask people what I should ask for in my upcoming review

 

Currently:

10yr PA

Outpatient IM/FP

See 25-28 patients per day

36hr work week

4 x 8hr day work week in office plus 1/2 day in NH

 

$84k, 4weeks, 2000k CME, full health for myself and family with no cost to me

 

 

 

 

Two sides of the debate - nationally FP/IM only gets mid 90's and I am just below this but when I figure what I am generating for the practice (min 100 patients per week at $60-figure mostly level 3 but some 2's) is $6000 per week for 44 weeks is 264,000 per year(minimum) of income and I figure I use 105,000(84,000+15k health+5k bennies).

 

Now I realize I need to cover 2x's my cost so that is 210,000 but there is another 50k floating around that I am trying to get the gumption up to ask for part of.

 

Anyone have any decent bonus structures for IM/FP?

 

Should I just be happy where at? (BTW my last job was EM and I was at 120,000 so this was hard swallow but worth it as I am happy) Just don't want to give my services away and also want to set up a correct pay scale for newer grads.....

 

 

thoughts......

I think that you are probably underestimating the costs the practice pays for you. Right off the bat there is around 8% of your salary that goes to Social security, Medicare, unemployment, and Workmens comp. The insurance costs are pretty close. Overall the average is 1.2 to 1.4 times your salary. For you this would run from $100k to $118k. If you have any kind of retirement or matching that costs also so many medical practices use 1.5x salary. For you that would be $126k. The other side that really eats into family practice is practice costs. Lets say you have a four provider practice. You have four MAs at $20/hour including benefits. An office manger at $30/hr. A front desk person @$18/hr, someone doing auths $18/hr and a biller @$25/hr. And thats a pretty lean office. So for every provider you are carrying another $80k in salaries alone. Then you have the building, the computers, the lights, the tongue depressors etc. So generally the cost of a provider is around double the providers cost for the other costs. A surgery office can easily be on the lower end of the scale. FP and IM because of all the auths tend to be on the heavier side. I've seen FP offices with 4 support staff per provider (the national average is 3.9).

 

On the other end you hopefully are underestimating what you bring in. Nationally in 2009 a 99213 brought in $63 and a 99212 brought in around $40. If you are a pure medicare provider then your $60 per patient is ballpark. However if you are getting some percentage above Medicare then you should be making more. Also the nursing home visits pay fairly well. Even after the 15% PA discount I would hope that you are bringing in more like $275-300k. Net revenue for FP physicians is estimated at around $450k. Total revenue is estimated by some to be around $1.2 million per year. Part of this is you seem to be seeing exclusively follow up patients which will lower your revenue. Also you seem to be undercoding. Nationally 34% of patients in Medicare had level 4 return E/M visits. Take a look at this to see where you fit:

http://blogs.aafp.org/fpm/gettingpaid/entry/for_whom_the_bell_curve

 

Bottom line there may be some money available. I stress may. Two issues. It is going to depend on your payor mix. Also remember that every dollar you make is one less dollar that the physician makes. If its some kind of partnership or corporate owned facility they may not care as much. It tends to be an issue in small practices (in my experience). I would echo getting a dedicated salary survey from AAPA and see where you fit among PAs in your area in terms of patients seen and salary. Try to get your salary up to at least 50%. The bonus models I have seen generally entail a percentage of collections above a base amount. Say 10% of collections above $200k. Or a certain amount per patient seen above the average. First you need to get the salary numbers and see if you fit. The real problem is there isn't a lot of money in primary care. Your current salary would be a reasonable FP salary some places.

 

David Carpenter, PA-C

[ventana]

Dave,

Thanks for the reply - specific to my situation - only 4% match for 401k, and I was using the medicare rates as that by default underestimates the reimbursement - as for costs - they run a tight ship - 14 providers, 16 lay staff - just about 1:1

 

Also in talking with other FP doc's they tend to take home between 40-50% of their collections if they are paid on collections..... sort of figure PA's should be on a similiar pay scale as we are a revenue source (maybe giving 5-10% to the SP so 40% of collections) which if I am conservative estimate of $300k in receipts would be $120k......

 

I have always gotten the AAPA salary data and do indeed have the newest one already - problem I have is this shows the average and in prior jobs I have been at the 75-90% in speciality practice and to go to the 50% percentile and to primary care is a bit tough to swallow when I know I am clearing over 100k profit for them.......

 

Any numbers for the # of patients seen a week to bonus over?

Seems maybe 80 patients a week as baseline and then $25/patient after that????

 

 

I think that you are probably underestimating the costs the practice pays for you. Right off the bat there is around 8% of your salary that goes to Social security, Medicare, unemployment, and Workmens comp. The insurance costs are pretty close. Overall the average is 1.2 to 1.4 times your salary. For you this would run from $100k to $118k. If you have any kind of retirement or matching that costs also so many medical practices use 1.5x salary. For you that would be $126k. The other side that really eats into family practice is practice costs. Lets say you have a four provider practice. You have four MAs at $20/hour including benefits. An office manger at $30/hr. A front desk person @$18/hr, someone doing auths $18/hr and a biller @$25/hr. And thats a pretty lean office. So for every provider you are carrying another $80k in salaries alone. Then you have the building, the computers, the lights, the tongue depressors etc. So generally the cost of a provider is around double the providers cost for the other costs. A surgery office can easily be on the lower end of the scale. FP and IM because of all the auths tend to be on the heavier side. I've seen FP offices with 4 support staff per provider (the national average is 3.9).

 

On the other end you hopefully are underestimating what you bring in. Nationally in 2009 a 99213 brought in $63 and a 99212 brought in around $40. If you are a pure medicare provider then your $60 per patient is ballpark. However if you are getting some percentage above Medicare then you should be making more. Also the nursing home visits pay fairly well. Even after the 15% PA discount I would hope that you are bringing in more like $275-300k. Net revenue for FP physicians is estimated at around $450k. Total revenue is estimated by some to be around $1.2 million per year. Part of this is you seem to be seeing exclusively follow up patients which will lower your revenue. Also you seem to be undercoding. Nationally 34% of patients in Medicare had level 4 return E/M visits. Take a look at this to see where you fit:

http://blogs.aafp.org/fpm/gettingpaid/entry/for_whom_the_bell_curve

 

Bottom line there may be some money available. I stress may. Two issues. It is going to depend on your payor mix. Also remember that every dollar you make is one less dollar that the physician makes. If its some kind of partnership or corporate owned facility they may not care as much. It tends to be an issue in small practices (in my experience). I would echo getting a dedicated salary survey from AAPA and see where you fit among PAs in your area in terms of patients seen and salary. Try to get your salary up to at least 50%. The bonus models I have seen generally entail a percentage of collections above a base amount. Say 10% of collections above $200k. Or a certain amount per patient seen above the average. First you need to get the salary numbers and see if you fit. The real problem is there isn't a lot of money in primary care. Your current salary would be a reasonable FP salary some places.

 

David Carpenter, PA-C