Should I stay or should I go?

[texas2008pa]

I currently work for 2 docs in a private, adult neurology group. Salary = 85K per year. Employed 3 years with no raise. The first year I had to ask for a review. One month later, we finally sat down at my insistence. Since they didn't give me a raise, they thought throwing me a $1000 bonus would suffice. I felt insulted. The following year I was given an additional 5 days of vacation in lieu of a raise. While thankful for the extra vacation, still insulted that no raise offered. They offer an RVU based bonus program, but due to low pt volume, I rarely qualify for even the lowest bonus tier. Volume is low as we are highly specialized and see very complicated patients. NP are 1 hour visits and f/u pts are 30 mins. My scheduler also does a poor job of filling my schedule.

 

Here's the deal: I am certainly comfortable in this position. Decent pay, great hours, and great location ( i can walk to work). I respect my SPs as they are intelligent clinicians and loved by their patients. They are highly respected in their field. They are friendly, easy going, and a breeze to work with. I have learned a TON and have formed great relationships with my patients. BUT, at the end of the day I don't feel valued or appreciated. I don't feel like a vital part of the practice. I'm bitter because I haven't had a raise in 3 years. Not even so much as a Christmas bonus. Heck, they don't even give me a card or gift. I am currently on maternity leave (unpaid, of course) and really feel like now is the time for me to see what else is out there. I'm just curious what you would do...Am I being silly for feeling unappreciated? Would you move on? I feel like there is no opportunity for growth in this job.

[rev ronin]

If you want more money, drive more revenue. Why should they give you a raise? Is there some magical raise fairy that gives out raises "just because"? You blame your scheduler, instead of working with your employers for a win-win: more work for you => more revenue for them => more reason to give you a raise.

[jdenning]

I work in neurology and also see a lot of very complicated patients. Make sure you bill them as such and you can increase your revenue.

 

The bigger question is: What else have you done to make yourself valuable?

 

My SPs know that I will handle things - urgent calls from patients, calls from ER, looking after refills/phone notes etc for the other providers as well as myself. I'm also the clinician who works in a lot of urgent appointment requests. I am busier than I know what to do with but that's a good place to be. I have worked my tail off and because of that I've had raises every year. Not a lot in the bonus department but my CME is covered and I feel very secure in my position.

 

I took 2 unpaid maternity leaves....and was told how much I was missed upon my return. Nice to be needed.

 

Keep the big picture in mind - being able to walk to work (especially when you have young kids) is INVALUABLE. Your perspective on work may change once you are juggling both....

 

Good luck

[True Anomaly]

Is this an average salary for neurology? It seems rather shocking to me to see a PA in Texas in such a specialty with that salary. I would think neurology would command a larger than average salary, and last time I looked 85K was what a new grad ON AVERAGE could command. I may be doing ER, but I work in Pennsylvania which is one of the lowest-paying states in the country, and I have absolutely no RVU's or bonus production- and I'm still making 90K+.

 

Definitely take the above advice, but also look at AAPA salary data, and ask your classmates (assuming you went to PA school in Texas). You'll need some objective data to help make your case in salary discussions with the docs. Best of luck

[rcdavis]

Boiled down, there are essentially only two reasons practice physicians hire PAs:

 

1. To help the doc(s) get out of the office earlier, spend less time on call, etc... The PA is the practice " relief valve". The PA generates FREE TIME, not income

 

2. To increase the number of patients seen by The practice, at less of a cost or intrusion into the practice than a new MD would impose. The PA is an INCOME generator.

 

In model number one, as rev noted, you may not be justifying a raise in that you are both not generating the income to warrant a raise, nor are fully spending your day producing... Not your fault, you are the release valve..

 

In model number two, the same applies... Assume that you have to produce $3-4 dollars in income for every $1 you are paid... Are you generating that much to even warrant $85k?

 

Just askin

 

Now, the intangibles of the practice.. Walking to work, great guys, learning a ton, go a long way....

You have to ask yourself, what amount of money would compensate for the loss of these things???

Would an extra $15k be worth working for a ****ty group or practice where there was tension, arguments, or you were treated poorly?

 

I know.. You cannot eat good will, but not getting a ulcer has to be worth something....

 

Sounds to me like you have been hired for model #1.... And, as you say the practice is slow anyhow, they may not consider your presence nor The free time time you provide them, worth much more than what you are being paid.

 

 

This is a classic case of the tension between ractice happiness and recompensation.

 

So, I would advise you consider your work place model, determine what your position is, and adjust accordingly.

 

Good luck.

[Hemegroup]

Boiled down, there are essentially only two reasons practice physicians hire PAs:

 

1. To help the doc(s) get out of the office earlier, spend less time on call, etc... The PA is the practice " relief valve". The PA generates FREE TIME, not income

 

2. To increase the number of patients seen by The practice, at less of a cost or intrusion into the practice than a new MD would impose. The PA is an INCOME generator.

 

In model number one, as rev noted, you may not be justifying a raise in that you are both not generating the income to warrant a raise, nor are fully spending your day producing... Not your fault, you are the release valve..

 

In model number two, the same applies... Assume that you have to produce $3-4 dollars in income for every $1 you are paid... Are you generating that much to even warrant $85k?

 

Just askin

 

Now, the intangibles of the practice.. Walking to work, great guys, learning a ton, go a long way....

You have to ask yourself, what amount of money would compensate for the loss of these things???

Would an extra $15k be worth working for a ****ty group or practice where there was tension, arguments, or you were treated poorly?

 

I know.. You cannot eat good will, but not getting a ulcer has to be worth something....

 

Sounds to me like you have been hired for model #1.... And, as you say the practice is slow anyhow, they may not consider your presence nor The free time time you provide them, worth much more than what you are being paid.

 

 

This is a classic case of the tension between ractice happiness and recompensation.

 

So, I would advise you consider your work place model, determine what your position is, and adjust accordingly.

 

Good luck.

 

Very, very nicely stated. Always make the best of the world you operate it, for your patients and for yourself. Maybe as RC suggested, you can look with a fresh eye at your work environment and devise a plan to help increase productivity as well as comprehensiveness. Sounds like a fun challenge and could certainly give you a 'makeover' in the eyes of your employers.

[EMEDPA]

Some places just don't give raises but increase take home based on productivity. at my current job all the pa's in the practice make the same/hr both the guy here for 22 yrs and the guy we have had for 6 months. production tends to be better for the veterans but not always.

[kidnid]

As a fellow female PA also with kids. I would ask if the convinience of good work environment makes it soo much easy esp with kids and responsibilites!. If you change your jobs yes there are chances you will get higer pay, but might have lot more work too !. So you have to analyse that too. But it would not hurt to look arround and see what kind of jobs out there?? good luck !

BTW-- 85k is not a bad sal in TX esp for neurology. If it involved surgeries/spine then there are chances you might get paid more. There are some sub-sep out there that pay more like: derm, pain, cardio, psych etc. Where as some sub-spec pay less in comparison like: nephro, rehab med, etc. Again the location also matters rural vs city vs burbs.

[Contrarian]

... [brevity edit]... I'm bitter because I haven't had a raise in 3 years... [brevity edit]...

 

 

Umm... sounds like you DID get a raise... since YOU state that YOU were given an additional 5 days of vacation.

 

Thats 5 days of Pay for no additional work. Thats five days you can stay at home in your Pajammas, sleep in and play with the baby while being paid for 8hrs per day of those 5 days...

 

Its mostly about perspective.

 

Entitled maybe...???

[Febrifuge]

I started at the top of this thread thinking "holy crap, $85k sounds low, although I don't know the region or the specialty."

 

Then as I kept reading, my opinion shifted. You can walk to work, your day isn't busy, and they gave you more time off when you asked. By all means feel free to look around and see what's out there... but bear in mind, plenty of people would feel like you have it pretty darn good. And they'd be right.

 

Rcdavis' bit about knowing what sort of function you fulfill for the practice is spot-on. It seems as though that might be where the disconnect is happening. Maybe you could even sit down with these amazing, smart, easygoing docs over lunch or after work sometime and have a friendly and honest chat about it. If you're not feeling appreciated, they need to hear that -- but they also need the chance to explain why from their POV things are fine. It could be that you're providing some measure of value to the practice each year that makes $85k a really good deal.

 

And hey, maybe you can keep that same $85k and work two long days a week, two short ones, and take a day off to be with the baby. Win-win.

[jdenning]

Sit down and do some brain storming with your docs and find out what function you fill for the practice and ask them what they see you doing to help build the practice. Or better yet approach them with an idea about set up a program or clinic that you might run - headache, back pain, epilepsy, parkinson's or dementia or whatever - and then get REALLY good at that one niche - to the point that you're an indispensable part of the practice and then they can't imagine things without you. That gives you lots of negotiating room. I started with just the Parkinson's clinic and have now branched out into several other areas so it's a lot more interesting. The group I work with have amazingly accommodated my every request to increase or decrease my hours and now I only have to go in 3 days per week. I work 2 half days from home and I still get paid for a full time position.

 

There's lots of negotiating room out there and there's a good possibility you can work it to your advantage.

[texas2008pa]

Boiled down, there are essentially only two reasons practice physicians hire PAs:

 

1. To help the doc(s) get out of the office earlier, spend less time on call, etc... The PA is the practice " relief valve". The PA generates FREE TIME, not income

 

2. To increase the number of patients seen by The practice, at less of a cost or intrusion into the practice than a new MD would impose. The PA is an INCOME generator.

 

In model number one, as rev noted, you may not be justifying a raise in that you are both not generating the income to warrant a raise, nor are fully spending your day producing... Not your fault, you are the release valve..

 

In model number two, the same applies... Assume that you have to produce $3-4 dollars in income for every $1 you are paid... Are you generating that much to even warrant $85k?

 

Just askin

 

Now, the intangibles of the practice.. Walking to work, great guys, learning a ton, go a long way....

You have to ask yourself, what amount of money would compensate for the loss of these things???

Would an extra $15k be worth working for a ****ty group or practice where there was tension, arguments, or you were treated poorly?

 

I know.. You cannot eat good will, but not getting a ulcer has to be worth something....

 

Sounds to me like you have been hired for model #1.... And, as you say the practice is slow anyhow, they may not consider your presence nor The free time time you provide them, worth much more than what you are being paid.

 

 

This is a classic case of the tension between ractice happiness and recompensation.

 

So, I would advise you consider your work place model, determine what your position is, and adjust accordingly.

 

Good luck.

 

This makes perfect sense and, I agree, I definitely fall under model #1. I am a "relief valve" and that is where my docs see my value. Thanks for the perspective. I don't know that I am happy being a "relief valve".

 

To those who suggest that I form a niche for myself...I initiated a lumbar puncture "clinic" on Fridays and do the occasional skin biopsy for epidermal nerve fiber density testing. Our practice already has a thriving headache clinic, epilepsy specialist, sleep and MS center. My docs are the neuromuscular specialists in the group. There are other things that could be pursued to drive productivity and certainly this could be discussed, but just not sure how likely this is.

 

Since my original post, I have been in discussion with an ortho spine group to take on a clinic only position with a starting salary of $115K. This sounds too good to be true, but I meet with the surgeon and other PAs tomorrow and will hopefully gain a better understanding of what they are looking for. I cannot imagine a non-surgical PA making that salary, but we'll see.

 

Bottom line...despite the excellent quality of life I have now, I don't feel valuable when I'm sitting at work twiddling my thumbs waiting on my doc to see my new patient or reading journal articles all day. Granted that's not everyday, but it does seem to happen quite frequently. I want to be more than a glorified medical assistant whose value lies in refilling prescriptions, returning phone calls, reviewing labs, and signing disability paperwork. I want to be indispensable and I just don't know that I am in this position, nor that there is the potential to be.

[texas2008pa]

Sound advice...thanks!

[texas2008pa]

Sit down and do some brain storming with your docs and find out what function you fill for the practice and ask them what they see you doing to help build the practice. Or better yet approach them with an idea about set up a program or clinic that you might run - headache, back pain, epilepsy, parkinson's or dementia or whatever - and then get REALLY good at that one niche - to the point that you're an indispensable part of the practice and then they can't imagine things without you. That gives you lots of negotiating room. I started with just the Parkinson's clinic and have now branched out into several other areas so it's a lot more interesting. The group I work with have amazingly accommodated my every request to increase or decrease my hours and now I only have to go in 3 days per week. I work 2 half days from home and I still get paid for a full time position.

 

There's lots of negotiating room out there and there's a good possibility you can work it to your advantage.

 

Sound advice...thanks!

[whoRyou]

Is this an average salary for neurology? It seems rather shocking to me to see a PA in Texas in such a specialty with that salary. I would think neurology would command a larger than average salary, and last time I looked 85K was what a new grad ON AVERAGE could command. I may be doing ER, but I work in Pennsylvania which is one of the lowest-paying states in the country, and I have absolutely no RVU's or bonus production- and I'm still making 90K+.

 

Definitely take the above advice, but also look at AAPA salary data, and ask your classmates (assuming you went to PA school in Texas). You'll need some objective data to help make your case in salary discussions with the docs. Best of luck

Although I am NOT a PA yet and do live in Texas this subject matter caught my attention and found this http://www.aapa.org/uploadedFiles/content/News_and_Publications/For_the_Media/VitalStats_Factsheet.pdf and this http://www.aapa.org/uploadedFiles/content/Common/Files/2010_Census_Report_Final.pdf http://nurse-practitioners-and-physician-assistants.advanceweb.com/Salary-Information/Salary-Breakdown/New-PA-Graduate-Salaries-by-State-2009-2010.aspx I hope these help and not upset upset you (mind you none of these links are current).

[UGoLong]

Life is too short to stay in job you don't like, though you'd better be sure why you don't like it. You describe a place that sounds nice. If the physicians are so good to work with, sitting down and talking about how you feel would see to be a good idea.

 

Good luck!