HELP SOON, Need immediate help with contract negotiations

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Hi,

Just a little background I am a FNP with 2 years of experience and I currently work in ENT and the hospital owns the practice and since I am not getting alot of patients in ENT they want me to work in their primary care clinics 2 days a week and the rest in ENT.

My issue is they gave me a proposal letter but are not increasing my salary, will add more money for CEU's, and give me mileage reimbursement..

My other issue is: LIABILITY? I feel since I am using 2 differnt skill sets and 2 different specialities(because believe me they are way different) that I should be compensated..I feel i'm setting my self up for a problem and am worried about the follow up for the patients especially if I am only there 2 days a week?

I have a meeting with the "big wigs" this week and need to have a plan and I already have a bunch of questions but need help in getting salary numbers etc...i went to salary.com and my salary is way under the average although they said in my proposal that I was in the median range...PLEASE HELP!!! KJ

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Hi,

Just a little background I am a FNP with 2 years of experience and I currently work in ENT and the hospital owns the practice and since I am not getting alot of patients in ENT they want me to work in their primary care clinics 2 days a week and the rest in ENT.

My issue is they gave me a proposal letter but are not increasing my salary, will add more money for CEU's, and give me mileage reimbursement..

My other issue is: LIABILITY? I feel since I am using 2 differnt skill sets and 2 different specialities(because believe me they are way different) that I should be compensated..I feel i'm setting my self up for a problem and am worried about the follow up for the patients especially if I am only there 2 days a week?

I have a meeting with the "big wigs" this week and need to have a plan and I already have a bunch of questions but need help in getting salary numbers etc...i went to salary.com and my salary is way under the average although they said in my proposal that I was in the median range...PLEASE HELP!!! KJ

Most salary surveys for ENT pay around the same as primary care. So if you are going from 5 days a week ENT to 3 days ENT and 2 days primary care most places would give you about the same. As far as liability that is the function of . Although usually if a position has more liability it is reflected in the salary. I'm not sure what you mean here. As far as follow up that would depend on the clinic policies and procedures. If they have had part time workers there before they should have a method of dealing with follow up. Presumably you are not the only provider there.

For what its worth the AAPA data for ENT shows a mean salary of $87k vs FNP of $84k vs $91k for all comers (2008 data). For PAs at least Salary.com is notoriously unreliable. You can also look at the Advance for NP data but I doubt it has ENT.

David Carpenter, PA-C

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david thanks, what I'm concerned about is if I am there only once a week who is going to follow up on my labs, radiology results or are they going to have to wait a week? Also with the nursing home I am concerned with call since I already do call for ENT_ so I get paid 86000 now do you believe I dhould play the PA card ? Can I get access to that info?

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david thanks, what I'm concerned about is if I am there only once a week who is going to follow up on my labs, radiology results or are they going to have to wait a week? Also with the nursing home I am concerned with call since I already do call for ENT_ so I get paid 86000 now do you believe I dhould play the PA card ? Can I get access to that info?

The information is publicly available here:

2008 Specialty Reports - American Academy of Physician Assistants (AAPA)

ENT is bottom right FP is bottom left (note this is 2008 data). I'm a little confused since you said you were going to do primary care 2 days a week. Also you said you were doing primary care so I don't see where nursing homes come in to play. Like I said above there should be procedures in place where someone reviews any labs or tests for critical results, the rest can wait for your return depending on the policy.

As far as playing the PA card the problem is that you have access to the basic data, but you don't have access to the regional data or the salary associated with years of service. That data is only available to AAPA members. $86k is within the range for ENT. Its worth a try to get more money, but if they have MGMA data or actually know what the local rate is like I said you are within the median range if you were a PA.

David Carpenter, PA-c

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sorry didn't specify I currently am in a ent but they want me one day a week at a urgent care and one day a week at a nursing home- does this change any factors? I know for a fact they don't have anything in place for follow ups(very disorganized) and should I increase my malpractice insur?

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sorry didn't specify I currently am in a ent but they want me one day a week at a urgent care and one day a week at a nursing home- does this change any factors? I know for a fact they don't have anything in place for follow ups(very disorganized) and should I increase my malpractice insur?

In urgent care usually things are dealt with right there. It would be unusual to have to follow up labs or xrays (except for final read). Nursing home is different. I would insist that they put a system in place so that the follow up is covered (their disorganization is not your problem). Couch it in terms of institutional and personal liability. Failure to follow up is one of the largest areas of claims. In the nursing home population its also a big JC issue. If they are out of compliance on their policies suggest that they get into compliance before moving into the job. As far as , as long as you are around 1 mil/3 mil you are probably fine (normal disclaimer not a lawyer etc). You do need to make sure that these additional duties are covered by your malpractice insurance. In some states malpractice for nursing homes approaches OB/GYN (the ones with the billboards that say has your loved one gotten an ulcer. We'll sue).

David Carpenter, PA-C

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Specializes in Adult primary care, college health.

I don't know if this is possible, considering some of the things you've referenced regarding how well-run (or not) this place is, but I think I'd be more concerned with making sure they put systems in place to ensure you can do your job well, at least moreso than looking for increased pay...

Does this hospital have an EMR that allows you to logon remotely from the site you're in that day to check on labs/imaging/etc from the other locations? I've worked in settings previously where the providers worked in different facilities each day of the week, but it worked b/c we were all able to logon to our EMR - used for all our patients - from wherever we were. There was also some time built into our days to do this - maybe you can ask that they consider this?

I think a key question you'd want to ask yourself, though, is: if this is a place where you're feeling like the structure is enough of a mess to lead you to consider increasing your , is this a place you really want to be working? Is it maybe time to consider looking for a new position altogether? I spent about 3 months working in an office where I lacked enough confidence in the practice's ability to support my work - and ensure that we together provided safe care - that I decided to purchase independent malpractice insurance. Something I probably should have done a long time ago, but for me it was an "a-ha" moment, and soon afterwards I decided it was time for me to go.

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thanks for the posts - I will ask about their plan for follow up and we do have Emr but lab corp and quest aren't connected yet so if they get the labs at the hosp I am good otherwise I fall into the no follow up hole

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I agree with the poster that the key issue here seems to be how disorganized the employer is and the pay is secondary to that problem. I work at a very poorly run stingy place and even we have systems in place to cover for providers who aren't in the clinic that day.

I think you're better off focusing on finding a new employer the way you've described the place:eek:

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