Negotiations

1) Practice
  A) other PAs? Are you the only midlevel, will you be interacting with other midlevels?
  B) who are your supervising physicians? are you PA for a single physician or the group?
2) Experience with PAs. Are you going to be the first PA they hire?
  A) orientation program in place?
  B) Delegation of Services Agreement
3) Salary
  A) hourly vs. salary
  B) vacation time
  C) CME reimbursement. While you are on the subject, might as well ask if they will pay uniform and DEA stuff.
  D) re-evaluations? every 6 months? 1 year?
  E) Are you an employee or a partner?
  F) profit sharing?
  G) loan repayment? And if so, what is the time committment?
4) Orientation
  A) is there a transition period to give you time to learn? Have realistic expectations for yourself but keep your employer in mind. It would be a good idea to have 1-2 months of orientation before you start seeing patients for yourself.
5) EMR. Odds are that you will need some sort of training on this.
6) Hospital privileges?
7) Expectations
  A) what are they expecting from you? Are they expecting you to see 20, 30 patients a day? Are you expected to do preliminary readings for imaging? What about hospital admissions?
  B) patient load?
  C) on-call schedule?
8) Malpractice
  A) who is the carrier?
  B) what is the coverage?
  C) how much?
  D) tail-coverage?

This is just an outline of what to expect. There is considerable variances, depending on if you'll be in surgery vs. dermatology. I think the most important thing as a new graduate is to take a look at the work environment, a good indicator is how the other medical staff is being treated. If the MAs look disheveled and unhappy, odds are that you will too. Be realistic about your productivity and make sure you can communicate with your employer and supervising physician. If you can't talk to them because they keep blowing you off, what's going to happen if you have a sick patient and need advise?

The Transition

I was so excited when I graduated from my program..freedom from CDMT and Harrison's.

I couldn't wait to relax and party.......



but the truth is, the end of the road is CLOSE!
Here's a checklist of what's next:

1) PANCE
2) state license
3) NPI
4) DEA
5) Credentials
6) BLS, ACLS


1) PANCE. cost $475
   http://www.nccpa.net/Pance.aspx

2) state license (I only included CA and NV, each state varies!)
  A) California Department of Consumer Affairs. cost $225-274.
        1) Notarization. cost $10-25
        2) LiveScan fingerprint. cost $20-40
http://www.pac.ca.gov/applicants/applicant_faqs.shtml

  B) Nevada. cost $300
       1) registration fee $400
       2) background fee $75
       3) REQUIRES A SUPERVISING PHYSICIAN FOR STATE LICENSE.
       4) REQUIRES EVIDENCE OF MALPRACTICE FOR STATE LICENSE.
       5) Notarization. cost $10-25
http://www.medboard.nv.gov/New_OtherForms.htm

3) National Provider Identification. This is your unique identifier when billing medicare.
  A) requires state license
  B) notarization. cost $10-25
https://npiregistry.cms.hhs.gov/NPPESRegistry/NPIRegistryHome.do

4) DEA. cost $731/3 years
http://www.deadiversion.usdoj.gov/drugreg/reg_apps/onlineforms.htm
  A) controlled substances course (CALIFORNIA ONLY). cost $180-310 (OPTIONAL)
http://www.capanet.org/Conferences/Controlled-Substances-Education-Course/

5) Credentials. If you will be doing any inpatient care, you will have to apply for privileges at that medical center. This is a long process, anywhere from 2-4 months. cost $100-400.
  A) Background check. cost $75-100

6) By know your BLS has expired, and you'll need to renew. Depending on what position you take, ACLS may be required.
  A) BLS/ACLS. cost $85-250.


Total cost...at least $1731.
Being a physician assistant, priceless.


Now this is variable, some providers will help you pay for somethings. You may end up in outpatient and won't need hospital privileges. Others will reimburse after a period of employment....Your mileage will vary
This isn't intended on scaring you, but it's a reminder that you will still have costs when school is out.
Please plan accordingly because there may be a lag-time between getting hired and jumping through all the loops to get all the legal stuff out of the way to practice medicine.