New Grad PA

[PinchandBurn]

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I am an awesome nurse practitioner who never complains and is very dedicated to getting work done.

We just hired a physician assistant that is a new grad literally 2 months and. She is already talking about how she does not have any worklife balance, which we highlighted to her and healthcare is more like work life integration

She wants to get administrative time to do her notes. Currently we are paying her about $50 an hour. And she has literally no experience we have to teach her everything from scratch. I wanted to be somewhat fair so did give her about 2 hours of administrative time and additional 3 hours for doing notes.

She currently sees about 3 patients in 1 hr. how would you guys all do this because to most of us and even to my nurse practitioner completing notes is sort of just baked into the whole thing. Also I can see how she is probably overwhelmed now because she is in the learning phase but in a private practice setting I am not certain if it is feasible to pay her to do her notes.

Alternatively I was thinking about salary and her and paying her about $85,000 a year for 32 hours of clinical time. This way notes are done on her own time.

Any thoughts

 

[Ducttape]

8 to 4 job. last patient 3:20 (or 3 if you are generous). she has the last hour or so to do notes.



or tell her to get tough, and recount how you did 28 hour shifts for 3 months in a row before you got a weekend off but were still on call...

 

[PinchandBurn]

8 to 4 job. last patient 3:20 (or 3 if you are generous). she has the last hour or so to do notes.



or tell her to get tough, and recount how you did 28 hour shifts for 3 months in a row before you got a weeke

8 to 4 job. last patient 3:20 (or 3 if you are generous). she has the last hour or so to do notes.



or tell her to get tough, and recount how you did 28 hour shifts for 3 months in a row before you got a weekend off but were still on call...

agreed.

problem is she's like "its illegal" to do non paid work. As in doing notes and completing documentation.

Interestingly, most of us PP docs/NPs we all do notes at home. 9 to 5 or 8 to 3 is when we see patients. We try to do get some notes done, but we all think it's part of the job to get the notes/documentation done on "our own time". It's unthinkable any other way....

 

[eyeeye_captain]

I feel like the answer is obvious as a PP owner in another field.

Start looking for her replacement and then fire her as soon as you have a new hire. If she’s already causing this much trouble, and appears to be a bad fit on both sides, she’s probably going to quit on you within the next few months anyway. Then you’ll be behind the eight ball if you really need the help.

 

[callmeanesthesia]

agreed.

problem is she's like "its illegal" to do non paid work. As in doing notes and completing documentation.

Interestingly, most of us PP docs/NPs we all do notes at home. 9 to 5 or 8 to 3 is when we see patients. We try to do get some notes done, but we all think it's part of the job to get the notes/documentation done on "our own time". It's unthinkable any other way....

Unless she’s hourly (very unlikely), it’s not illegal and she needs to be educated on that asap.

 

[Ducttape]

there does seem to be a generational perspective also.

my gut impression is that Gen Zers are much more about maintaining that work-life balance ie keeping work at work in very defined time blocks, and i think her complaints are iin line this social more. i highly doubt you will ever get her to come in on her time off or that she will willingly see a patient during protected time.



please dont ignore your current NP by providing benefits to the new PA without appropriately showing appreciation to your NP. i suspect that in the end, it will be your NP and yourself left in the office.

 

[lobelsteve]

agreed.

problem is she's like "its illegal" to do non paid work. As in doing notes and completing documentation.

Interestingly, most of us PP docs/NPs we all do notes at home. 9 to 5 or 8 to 3 is when we see patients. We try to do get some notes done, but we all think it's part of the job to get the notes/documentation done on "our own time". It's unthinkable any other way....

I never do notes or anything clinical outside the office. I get in at 630 and leave at 330. Patients scheduled 730-315. Lunch is 1120-1230.

 

[Dr. Ice]

The generational perspective exists because according to Elon money is not going to matter eventually and neither will anyone’s 401ks…

 

[RoloTomassi]

You can't give her special treatment that your NP doesn't get. Can she spend some time with the NP so she can see how it's done, what's expected?

 

[MitchLevi]

This will not end up well.

She will have to be replaced.

Make sure you are documenting all of these conversations. When you fire her, which will happen at some point, you need the paper trail.

 

[SpineandWine]

Salary at $50/hour seems very low.
That’s less than 100k at 40 hours/week with 4 week vacations.

 

[Snowmen96]

So, just to make it clear, you hired a new graduate without any experience, and are paying her subpar hourly salary, and are expecting her to be at the level of your experienced NP without having to train this new graduate, and also want her to do charting, which is actual work, without even giving her the subpar hourly salary that you are paying her the rest of the time?

 

[PinchandBurn]

So, just to make it clear, you hired a new graduate without any experience, and are paying her subpar hourly salary, and are expecting her to be at the level of your experienced NP without having to train this new graduate, and also want her to do charting, which is actual work, without even giving her the subpar hourly salary that you are paying her the rest of the time?

Firstly we have trained her for 3months under direct supervision of me and my NP. Also i have been available all the time.

I have paid for her DEA, paid for various CME courses and controlled subs course. I have connected her with various reps to go to their courses and learn.

Listen I understand that she needs more training. I'm willing to do that. That's why she's $50/hr. Btw this is market for a new grad. She even said she didnt get a call from anyone else when she was applying. Most of the hospitals are saturated.

I think my biggest mistake was that I always assumed people just did their notes. When I was an employed doc I charted MINIMUM 10 hrs weekly "off the clock". If you didnt do that and wanted to mk sure all your notes were done in clinic, I would have been able to see less patients. That number is probably like 12 hrs now in PP.

Most NPs/Pas I have interacted with and who my colleagues have talked about all do this (do notes on their own time). Is that what most of your PAs/nps do? I genuinely dont want to screw her over. I also dont want to train someone else all over. In PP training someone is very time costly .

 

[Ducttape]

again, this has that feel of the generational gap, and i dont think you will be able to overcome it.


i wonder if there is another gap to consider.

i dont get the feeling that most new PAs get integrated into the classic healthcare model that occurs on the floors with inpatient hospitalized patients.

when taking care of hospitalized patients, no one gets "protected time to do notes". this PA may have gone through PA school without any exposure to note taking while on shift, unlike what every doctor and nurse would do (which is to write notes in between bites of food or after the shift is over).

 

[MitchLevi]

i wonder if there is another gap to consider.

LOL

 

[po_boy]

agreed.

problem is she's like "its illegal" to do non paid work. As in doing notes and completing documentation.

Interestingly, most of us PP docs/NPs we all do notes at home. 9 to 5 or 8 to 3 is when we see patients. We try to do get some notes done, but we all think it's part of the job to get the notes/documentation done on "our own time". It's unthinkable any other way....

If you have to do notes at home, you're doing it wrong.

 

[Baron S]

That PA is generating $300+/hr in revenue and getting paid $50/hr and you are complaining about her inefficiencies.

 

[clubdeac]

Maybe they need better training programs instead of superficial cursory training and licensure that allows them to bounce bw any specialty they desire while having to learn the specifics and intricacies on the job. Just an idea

 

[Drd105]

This sounds a lot like my current NP- I’m in PP currently looking for a replacement. This was my first mid-level hire and I was thinking maybe I need to switch it up to PA and new grad…however the generational issues seem very important to consider. My NP texted Tuesday afternoon (which she had off as pre-planned vaca) and said, “my car is in the shop and won’t be ready until tomorrow so I need to cancel the patients for tomorrow, thanks!” I said, “um you have 20 people on your schedule, take an uber and do your job and pick up the car end of patients (last patient 3:20).” She said, “I need to take care of ME, so NO I won’t be coming in.” She is Gen X with millennial/gen z spirit I guess?

 

[eyeeye_captain]

This sounds a lot like my current NP- I’m in PP currently looking for a replacement. This was my first mid-level hire and I was thinking maybe I need to switch it up to PA and new grad…however the generational issues seem very important to consider. My NP texted Tuesday afternoon (which she had off as pre-planned vaca) and said, “my car is in the shop and won’t be ready until tomorrow so I need to cancel the patients for tomorrow, thanks!” I said, “um you have 20 people on your schedule, take an uber and do your job and pick up the car end of patients (last patient 3:20).” She said, “I need to take care of ME, so NO I won’t be coming in.” She is Gen X with millennial/gen z spirit I guess?

Why would you need work ethic when you already have the heart of a nurse?

 

[po_boy]

This sounds a lot like my current NP- I’m in PP currently looking for a replacement. This was my first mid-level hire and I was thinking maybe I need to switch it up to PA and new grad…however the generational issues seem very important to consider. My NP texted Tuesday afternoon (which she had off as pre-planned vaca) and said, “my car is in the shop and won’t be ready until tomorrow so I need to cancel the patients for tomorrow, thanks!” I said, “um you have 20 people on your schedule, take an uber and do your job and pick up the car end of patients (last patient 3:20).” She said, “I need to take care of ME, so NO I won’t be coming in.” She is Gen X with millennial/gen z spirit I guess?

So you fired her right ?

 

[BobBarker]

I would tell her not to come back.

 

[Drd105]

So you fired her right ?

We started the paper trail with HR- I’m trying to find a replacement now…it would be hard for me to cover all the patients right now. I wish I could tell her not to come back …but the nail is def in the coffin for this relationship. Just looking over the contract now it says I have to give her 60 days notice even with breach (which includes tardiness).

 

[BobBarker]

Just give the 60 days Monday and suck it up for a month or two. I ran solo for around 3 months and it was a lot of work but less stressful overall than it was previously.

 

[buddababa]

This sounds a lot like my current NP- I’m in PP currently looking for a replacement. This was my first mid-level hire and I was thinking maybe I need to switch it up to PA and new grad…however the generational issues seem very important to consider. My NP texted Tuesday afternoon (which she had off as pre-planned vaca) and said, “my car is in the shop and won’t be ready until tomorrow so I need to cancel the patients for tomorrow, thanks!” I said, “um you have 20 people on your schedule, take an uber and do your job and pick up the car end of patients (last patient 3:20).” She said, “I need to take care of ME, so NO I won’t be coming in.” She is Gen X with millennial/gen z spirit I guess?

I would’ve fired her on the spot.

 

[Ducttape]

im missing something.

you are in PP but you have HR? is this some big group you are still part of?


if i were PP, i would have told her that i would pay for the uber to bring her to and from work. amazingly coincidental but her bonus for the year just so happens to be exactly minus how much it would cost for an uber to get her to and from work.

 

[BobBarker]

Most employers have a policy about call ins preceding and proceeding vacation days also. Since she just wanted another day off or didn’t return from her trip 90% likely.

 

[PinchandBurn]

Its funny when I was employed i would be harsh as some of the folks on here.

As an employed doc that was very busy, if someone like a RN called in, admin would pull the RN from another department to support me.


When you're in PP and realize you need people to show up and rehiring and retraining is hard, one learns to be more "flexible".

 

[CleanUp]

Its funny when I was employed i would be harsh as some of the folks on here.

As an employed doc that was very busy, if someone like a RN called in, admin would pull the RN from another department to support me.


When you're in PP and realize you need people to show up and rehiring and retraining is hard, one learns to be more "flexible".

In a perfect world in private practice there’s greater profit because things are more efficient and lean. More risk more reward.

What I am suggesting is you and other employed physicians are already paying for that RN in another department (as well as the admin). Not all may realize this.

 

[mille125]

Unless she’s hourly (very unlikely), it’s not illegal and she needs to be educated on that asap.

Its definitely not illegal as long as you are paying at least minimum wage.

 

[mille125]

Firstly we have trained her for 3months under direct supervision of me and my NP. Also i have been available all the time.

I have paid for her DEA, paid for various CME courses and controlled subs course. I have connected her with various reps to go to their courses and learn.

Listen I understand that she needs more training. I'm willing to do that. That's why she's $50/hr. Btw this is market for a new grad. She even said she didnt get a call from anyone else when she was applying. Most of the hospitals are saturated.

I think my biggest mistake was that I always assumed people just did their notes. When I was an employed doc I charted MINIMUM 10 hrs weekly "off the clock". If you didnt do that and wanted to mk sure all your notes were done in clinic, I would have been able to see less patients. That number is probably like 12 hrs now in PP.

Most NPs/Pas I have interacted with and who my colleagues have talked about all do this (do notes on their own time). Is that what most of your PAs/nps do? I genuinely dont want to screw her over. I also dont want to train someone else all over. In PP training someone is very time costly .

I have a truly hourly NP so she clocks out when notes are done. With ambient listening/AI scribing I have not taken any notes home even after seeing over 30 patients in a day..

The older days when I had salaried APPS, they all did notes on their time.

 

[mille125]

Its funny when I was employed i would be harsh as some of the folks on here.

As an employed doc that was very busy, if someone like a RN called in, admin would pull the RN from another department to support me.


When you're in PP and realize you need people to show up and rehiring and retraining is hard, one learns to be more "flexible".

Agree with you 100%.......

 

[eyeeye_captain]

When you're in PP and realize you need people to show up and rehiring and retraining is hard, one learns to be more "flexible".

To an extent. Flexible is dangerous.

When you give in to an employee who is a problem from day 1, they’ll keep asking for more. People like to slow down more than they ramp up. You’ve also set a precedent for any new employee if this one is still on board, and you better hope your NP keeps doing her thing. I’ve made leeway before, but only for reliable, established folks.

This sounds like a bad dating scenario where you really want to make it work with someone who isn’t that into you (the job).

 

[BobBarker]

Flexible is great when appropriate. We have a 9/10 front desk staff member. Patients love her. Gets her work done. She arrives at 8:25 due to taking her kids to school. We have someone cover her spot from 7am until she arrives. That is good flexible.

 

[nvrsumr]

Flexible. Had an employees 11 year old boy at the office all day. Played with the shop dog.

 

[mille125]

Flexible is great when appropriate. We have a 9/10 front desk staff member. Patients love her. Gets her work done. She arrives at 8:25 due to taking her kids to school. We have someone cover her spot from 7am until she arrives. That is good flexible.

I think you both are right. You have to have policies but your policies should not be overly rigid so that you lose a good employee over an issue that could be accomodated. Good employees are really hard to find.

 

[Drd105]

im missing something.

you are in PP but you have HR? is this some big group you are still part of?


if i were PP, i would have told her that i would pay for the uber to bring her to and from work. amazingly coincidental but her bonus for the year just so happens to be exactly minus how much it would cost for an uber to get her to and from work.

Yes- it is a large group with different specialties!