Rural Midlevel Abuse

[MedicineFoundMe]

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I'm sick of hearing and personally experience rural hospitals who are hiring PA and NPs to work in clinic and take hospital/ED call and bundling it all together. Administrators all think this is how it should be done, and NPs and PAs just accept it as the norm. Well, I'm here to tell you the norm is gonna have to change, and I'll form a rural NP/PA union if I have to.

I have seen these positions offered to PA/NPs for $75-$85K/yr to INCLUDE your call. DON'T DO THIS!!! You must realize that these hospitals pay $50-$100/hr round the clock for locum doc/pa/nps. So when they require you to do the common 2 days a week or one week per month, you are essentially volunteering all that time and getting woke up all through the night (and don't let them tell you you won't get called that much). Or at $50/hour and 2 days per week you are working in the clinic for FREE.

NPs and PAs now hear this: You are worth every bit of $75K/yr to work in the clinic alone to START. This should go up to $100k+/yr for clinic alone after you negotiate a productivity plan (you should get a fair amount of what you do.... somewhere around 1/3 of what you generate). Then, you also should get $40/hr for your call coverage if you are doing ANY call.

There are governmental cost-based reimbursement programs already in place to pay you this FAIR wage. If you are in this situation and are getting screwed, think about what I've said, and go to your docs/nps/pas that you work with and get them on the same page and go to admin and watch it fall on their deaf ears at first. But, if you play your cards right, you may just make it happen.

 

[deleted6669]

the last time I had a job like that( I quit) the on call rate was 5/hr then straight pay for any hrs worked. call was 2 nights/week AND 1 weekend/month. really sucked.

 

[MedicineFoundMe]

the last time I had a job like that( I quit) the on call rate was 5/hr then straight pay for any hrs worked. call was 2 nights/week AND 1 weekend/month. really sucked.

Good for you for quitting. I wish all NPs/PAs would so the same in similar situations and force reasonable treatment in those areas.

 

[Febrifuge]

See, this is exactly why I come to SDN. This is the stuff they won't teach me in school.

It may be way early for me to be thinking of this, since I'm about to begin PA school and we may not be able to say a lot about the job market of 2009. But even so, how much of this contract-negotiation stuff is gamesmanship? If I accept a job like the one you describe (out of, I would imagine, fear of being unemployed, massive loan debt, a baby planned for 2009, etc), and then I work for a year and threaten to quit, would your typical employer be likely to "see the light" and sweeten my deal?

Or will they find some other new-grad sucker, while I face a brief period of job-searching and interviewing?

 

[MedicineFoundMe]

See, this is exactly why I come to SDN. This is the stuff they won't teach me in school.

It may be way early for me to be thinking of this, since I'm about to begin PA school and we may not be able to say a lot about the job market of 2009. But even so, how much of this contract-negotiation stuff is gamesmanship? If I accept a job like the one you describe (out of, I would imagine, fear of being unemployed, massive loan debt, a baby planned for 2009, etc), and then I work for a year and threaten to quit, would your typical employer be likely to "see the light" and sweeten my deal?

Or will they find some other new-grad sucker, while I face a brief period of job-searching and interviewing?

Depends on who carries the power. Most of the time in small communities, it's the board, made up of local businesspeople. But they are influenced by the docs, especially if they've been there a while. So, you have to play your cards right... ie befriend the people in power so anyone who gets in your way is moved out of the way. If it's a situation where the administrator is the only one in power, you're SOL. They are the only ones that believe everyone except themselves in the hospital should be on minimum wage. They don't care if you're good or smart... hell they wouldn't know a good provider if they cracked their chest. And even if they could tell the difference between a good one and a *****, they wouldn't care.

You may even have to play dirty (you've seen Shawshank Redemption where the local contractor gives the warden a pie with an envelope inside, right?)

 

[chimichanga]

Depends on who carries the power. Most of the time in small communities, it's the board, made up of local businesspeople. But they are influenced by the docs, especially if they've been there a while. So, you have to play your cards right... ie befriend the people in power so anyone who gets in your way is moved out of the way. If it's a situation where the administrator is the only one in power, you're SOL. They are the only ones that believe everyone except themselves in the hospital should be on minimum wage. They don't care if you're good or smart... hell they wouldn't know a good provider if they cracked their chest. And even if they could tell the difference between a good one and a *****, they wouldn't care.

You may even have to play dirty (you've seen Shawshank Redemption where the local contractor gives the warden a pie with an envelope inside, right?)

are we to accept this distorted reality in our small towns???

I hate the player more than the game...I can live with the game, but if you play it??

shame on you...

 

[MedicineFoundMe]

are we to accept this distorted reality in our small towns???

I hate the player more than the game...I can live with the game, but if you play it??

shame on you...

Distorted reality? Only to those with crossed eyes.

And hating players, games, blah blah.... WHAT?!?! If you can live with a game without players, then it really isn't a game and therefore doesn't exist, right? I LOVE Texas Hold Em when there are no players. Then a bunch of card players come in and screw it all up....

 

[alpha62]

they're right. rural health isn't a utopia.

Everybody thinks working in a small town is going to be like Northern Exposure. Quaint little hamlets full of colorful characters.

Nothing of the sort. Usually these poverty pockets are controlled by a group of good old boys that want to keep the status quo i.e. keep everybody else poor, pay their employees nothing and keep the gov't (that means you bud) servicing their work force with S.S., SSI, welfare, medicaid, ect.

an oh yeah, I've worked those outfits before RHC then ER call introduced after they've got you out there in the middle of nowhere.

Get used to hearing " my family has been here for 200 years blah, blah, blah. and yeah, I grew up in a hick town in the midwest like that.

 

[alpha62]

go to physician assistant forum for your daily dose of sugar coated "reality"

are we to accept this distorted reality in our small towns???

I hate the player more than the game...I can live with the game, but if you play it??

shame on you...

 

[a_ditchdoc]

I am not trying to start a feud but, from what I have seen, rural towns can often hire a FP physician for little over 100k per year. I know that NP/PA's work hard, and they are essential for healthcare, but it does not seem to make financial sense to pay them the starting salary of a family medicine physician. Unfortunately, the backbone of the NP and PA profession is that they can do a similiar job as physicians for less pay. Physicians and hospitals alike know this and use them to line their pockets. However, if the salary gap narrows too much, and they are no longer deemed profitable, midlevels may find it more difficult to gain employment.

 

[alpha62]

You raise a good point, but I'm still not concerned about the MDs

1) the crop of self-entitled brats they're training now days won't go to remote areas in the first place.
2) none of the medical students want FP in the second place.

I am not trying to start a feud but, from what I have seen, rural towns can often hire a FP physician for little over 100k per year. I know that NP/PA's work hard, and they are essential for healthcare, but it does not seem to make financial sense to pay them the starting salary of a family medicine physician. Unfortunately, the backbone of the NP and PA profession is that they can do a similiar job as physicians for less pay. Physicians and hospitals alike know this and use them to line their pockets. However, if the salary gap narrows too much, and they are no longer deemed profitable, midlevels may find it more difficult to gain employment.

 

[jaydoc07]

Actually 2,299 medical students matched into FM this year, above the average for the last 5-6 years.

Second, a good number of the "self-entitled brats" in my class going into FM want to return to a rural community. I really hope none of them ever have to work with someone who has such an attitude.

 

[Therapist4Chnge]

That is just common business sense...which unfortunately many people have not had much experience with. If i saw that offer, I'd say "thanks, but no thanks". I mean....for an hourly job (whether it is hourly or an annualized salary based on an hourly rate) that is completely unacceptable.

-t

 

[alpha62]

Starting out in FP in school is one thing. Finishing and then working there is another.

How many of those students are females ? Let's see what happens after the babies come.

Actually 2,299 medical students matched into FM this year, above the average for the last 5-6 years.

Second, a good number of the "self-entitled brats" in my class going into FM want to return to a rural community. I really hope none of them ever have to work with someone who has such an attitude.

 

[alpha62]

A cry for help from the ivory tower:

http://seattlepi.nwsource.com/national/305247_students27.html

 

[a_ditchdoc]

I suppose alpha62 has answered the primary question of this thread, "Why are some midlevels abused." With an attitude like his, who wouldn't want to abuse him? 🙂

C'mon alpha, can't we play nice without getting all pissy? Noone was trying to be offensive and you felt it necessaryto make derogatory comments about other medical professionals. You don't have to agree with what is posted, but neither do you have to attack those that post it.

 

[jaydoc07]

I completely agree that my generation as a whole has increased narcissism, but I don't think that study you present projects to medical students as a whole. In fact, I would venture a guess that those students matching to FP are on a whole less narcissistic than the remainder of the MDs.

Ans just for clarification, the students I mentioned are not starting out FP in med school, they are starting residency, meaning that they WILL ultimately practice primary care.

An addition, I would say about half of whom I am speaking of are female, a good proportion of which already have children. I hardly think child bearing will disuade any of them from achieving their goal.

 

[alpha62]

I provided the article to support my argument.

I suppose alpha62 has answered the primary question of this thread, "Why are some midlevels abused." With an attitude like his, who wouldn't want to abuse him? 🙂

C'mon alpha, can't we play nice without getting all pissy? Noone was trying to be offensive and you felt it necessaryto make derogatory comments about other medical professionals. You don't have to agree with what is posted, but neither do you have to attack those that post it.

 

[alpha62]

Bearing children doesn't prohibt participation in a medical career. Caring for them properly might.

You might grow tired of picking up the slack of a fellow partner because she's constantly going home to take care of the kids. Worse, bring the kid to work (I've seen that one before) or worse, you are a military medical officer that keeps getting stuck with deployments while the females camp out in family practice back in the rear.

The issue is PA job security and as long as these social factors are present, they'll probably always be jobs for PAs willing to go anywhere, anytime, and show up for work day in and day out.

Was that less "pissy" now ? Or is none of this actually true or is there anybody else out there this hasn't happened to besides me ?

I completely agree that my generation as a whole has increased narcissism, but I don't think that study you present projects to medical students as a whole. In fact, I would venture a guess that those students matching to FP are on a whole less narcissistic than the remainder of the MDs.

Ans just for clarification, the students I mentioned are not starting out FP in med school, they are starting residency, meaning that they WILL ultimately practice primary care.

An addition, I would say about half of whom I am speaking of are female, a good proportion of which already have children. I hardly think child bearing will disuade any of them from achieving their goal.

 

[a_ditchdoc]

Of course, the article you cited referred to all college students, not specifically medical students. So, I guess it is a fair assumption that NP and PA students are narcissists as well and would prefer not to have to work in rural settings or family practice?

Did you have a bad day? Want to tell us about it?

 

[alpha62]

Nits make lice.

Of course, the article you cited referred to all college students, not specifically medical students. So, I guess it is a fair assumption that NP and PA students are narcissists as well and would prefer not to have to work in rural settings or family practice?

Did you have a bad day? Want to tell us about it?

 

[a_ditchdoc]

Fair enough...

 

[alpha62]

Hey, I'm a troll, that's what I do.

I crawl out from under the bridge and eat unsuspecting rubes that are walking down the yellow brick road thinking all is right with the world. 😳

Fair enough...