1. Contract Negotiations Patrick J. Ivory, MPAS, PA-C

2. Contract Negotiations So you graduated from PA school, NOW WHAT???

3. Contract Negotiations Finding a job –Referrals from friends, relatives and colleagues –AAPA Journals, web site –HEAD HUNTERS / Internet –Military Recruiters –State PA organizations –Your Alma Mater –Your preceptors

4. Certification NCCPA –All 50 states and the District of Columbia have enabling legislation for AP’s to practice under the supervision of physicians. –The NCCPA is recognized by the states as the certifying body for PA’s –The US Government also recognizes the NCCPA

5. Licensure When you move to your planned state of residence –Obtain a copy of the state practice regulations fro PA’s. –Apply for Licensure if possible before you have a job. –Contact your state PA Society for a membership application (optional- but highly recommended)

6. Potential Employers Physicians in private solo practices Managed Care Organizations Integrated Health Systems The Military The Public Health Service Create your own position

7. Should I get a Written Contract? Contracts do not guarantee that issues will be avoided, but will enhance communications in labor disputes. Oral contracts are difficult to hold an employer to. Some organizations consider the PA as an employee and are covered under the employee benefit plan. No contract per se. Union or Not

8. Letters of Agreement These are documents which define your scope of practice and the relationship you have with the supervising physician. Describes you duties. Pennsylvania requires a letter of agreement to be approved by the State Board of Medicine.

9. Hospital Practice Get copy of the hospital By-laws to understand your status relative to the medical staff. Apply for privileges at the hospital. Facility can be more restrictive than state law, but cannot be less restrictive. Generally, your scope of practice will be consistent with the scope of your supervising physician.

10. Hospital Practice May be required to have a physical every two years. Usually, need to reapply for privileges every two years Must provide facility with credentials, certifications, etc. Must report having privileges being revoked, suspended or restrictive by other facilities Can be required to report incidences listed on the National Provider Data Bank

11. Components in the Contract Description of the practice Primary supervisor name, department and potential secondary supervisors Job description including specific duties Beginning date Work schedule Required or expected travel

12. Components in the Contract Salary –Base salary as an employee –Production based salary –On call pay and schedule –Bonus pay –Incentives –Review periods and process –Periodic increases –Profit sharing –Partnership –Pension & Retirement program Employer’s contribution –Sign On Bonus?

13. Benefits Vary by employer, can range from almost none to a complete package Some employers use a cafeteria plan – you pick what you want based on self perceived needs Can you periodically change your benefit plan?

14. Benefits Benefits Liability Insurance –Occurrence and Tail –Legal services provided –Your cost or is it totally provided by employer –Rider on supervisor’s policy or own policy Health and Dental Insurance –Employee only or family coverage –Employee contribution, deductible –Pharmacy coverage –Catastrophic coverage Disability Insurance Worker’s compensation

15. Benefits Life Insurance –Employee –Low cost family insurance –Death or disability while on job? Key Provider Insurance –In case of death of Physician or PA, the practice survives

16. Paid Time Off Vacation days Holidays Sick leave CME days Jury Duty Condolence days Humanitarian mission (i.e. Doctors without Borders) –Paid –unpaid –shared???

17. Reimbursement Benefit Interview expenses (travel, lodging, food, rental car) CME allowance Tuition assistance & forgiveness Professional dues/fees (AAPA, PSPA) Licensure, certification, credentialing fees Relocation and settlement allowance Technology (PDA, pager, cell phone, computer, ISP)

18. Personnel Policies Dispute resolution/ Grievance procedures Non-competition clauses/ restrictive covenants Termination procedures –Termination clause Resignation procedures

19. 2005 AAPA Census Data DescriptionMeanMedian Vacation Leave1715 Sick Leave109 CME Leave65

20. 2005 AAPA Census Data Description95- 100% 50-94%1-49% Not Reimbursed Liability97102 Ind. Health Ins503568 Family Health27311028 Dental3217929 Disability4514731 Life Insurance4114936 Retirement25213519 State License711127 Reimbursed by employer

21. 2005 AAPA Census Data Description95- 100% 50-94%1-49% Not reimbursed DEA Registration751024 NCCPA Fees631135 AAPA Dues631135 State Chapter561142 AAPA Conference 588430 Credentialing fee732123 Reimbursed by employer

22. Salary by years as a PA Less than one year $63,753 1-3 Years $69,501 4-6 $79,013 7-9 $81,619 10-12 $85,869 13-15 $77,952 16-18 $78,521 More than 18 years $84,256

23. 2007 AAPA Salary Survey SpecialtyPennsylvania Family Medicine$67,274 GIM$70,916 Emergency Med$83,098 Gen. Peds.$62,343 Gen. Surgery$71,907 Int. Med. Sub.$72,437 Ped. Sub.$70,693 Surg. Sun$81,003 OB/GYN$65,546 Occ. Med.$74,113

24. ??? Questions ??? Good luck on your PANCE