AGREEMENTS FOR PHYSICIAN ASSISTANTS
Employment agreement, what are they and how they benefit
both physicians and physician assistant. You are listening to ReachMD, The Channel
for Medical Professionals. Welcome to the Clinician's Roundtable. I am Lisa
D'Andrea, your host and with me today
is Michele Roth-Kauffman. Michele is a physical assistant and an attorney.
She is the Director of the Physician Assistant Program at Gannon University and
the author of the Physician Assistant Business Practice and Legal Guide.
Today, we are discussing PA employment agreement.
Hi, Michele welcome to
Hi Lisa, how are you?
Let's discuss the anatomy of the contract. There are many
important topics that should be included, but compensation is a topic that
causes more anxiety and disagreements than any other issues. How do you
suggest entering into the conversation about compensation and can you list the
pieces that should be included in the contract?
Regarding compensation, I think it's important for both the
PA and the physician to do a little homework. You can go to AATA's web site
and you can find the census and that will show you what PAs are making in an
overall range. A lot of states also will put out for a nominal fee, I believe
the Pennsylvania Society Physician Assistants for 35 dollars. You can obtain a
salary scale for all the PAs in the state and for in their individual
specialties because different specialties do have a different salary apply to
them. Most often, people who are in surgical settings make higher salaries
than anyone who is in family practice, but again they should both know about
what that salary should be and it depends to also, are you dealing with a new
grad or are you dealing with somebody who has worked in that area because
someone who has worked in that area obviously is going to take less time to
train and they will command a higher salary and for a person, who has been out
there, they should come armed to their contract negotiations with how they are
going to benefit the practice, how they see themselves bringing actually funds
into the practice because obviously the physician is going to want to have the
PA salary and benefits, you know, covered by the revenue that the physician
assistant is bringing into the practice. So, the more information they have
the easier the discussion will be.
Right, but you would probably need a bit of a clause and
they are to cover if this contract will continue for the next year or the next
6 months if it is not renewed by the state. You don't want it to just end.
You want the PA to be covered by a contract and you know how hectic things can
get if you don't get to the contract, you don't want it to just end. So, there
needs to be a clause that it carries over. Now, you can, if you want to, do a
3-year agreement or a 5-year agreement and have some type of built-in schedule
for increases. You know, you might have increases in vacation, you might have
increases in salary, you may have increases in bonuses and it can be tied to
the productivity or it can be tied to the rate of inflation or it can be just
the set number, they will get a 5% raise each year, they will get a 10% raise
each year. So, that way you can individualize the contract. It can't go for
any length of time. You don't want it to be too lengthy, but you don't want it
to be too short either.
Defining scope of practice is an important part of the
physician-PA relationship. Could you define what that means and should it be
written in a contract?
The scope of practice of a physician assistant first starts
with state law. The physician assisting has to work within the scope of
practice defined by state law. Okay, then if they work for a hospital or if
they work for a supervising physician, that hospital or that supervising
physician can then limit their scope within the state guideline. So, a
physician assistant can never do more than what it says in the state laws and
the regulations by the medical board, but a physician can decide that I want to
employ you as a PA, I want to employ you to do my patient education and see my
patients; however, I do not want you to write prescriptions. So, even if they
are allowed by state law, a physician can make a decision to limit that PA's
scope of practice.
That is usually in a separate agreement. That usually
really does not have anything to do with the contract itself. For instance in
Pennsylvania, we have to have a working agreement with our supervising
physician and that has to go to the medical board and has to be approved by the
medical board and so that can create additional issues because you do state the
supervising capacity in that work agreement, so I have seen instances where you
had an practice hire a new grad and they state in their working agreement they
are going to see every patient that this physician assistant sees. Well, 3
years later, they are not still seeing every patient that that physician
assistant sees, that physician assistant has his or her own patient load, but
they have forgotten to go back and change their supervising agreement with the
medical board and that opens up the supervising physician to a malpractice
action for failure to supervise. So, it's very important that any type of
working agreement that you have, whether it's maintained within the office or
if it's at the medical board that it is being followed, that it is also
reviewed on an annual basis and that changes are made appropriately and again I
can't stress enough that if you have a written agreement as to scope of
practice that it's being followed.
In the case of termination, how do you handle the payment of
bonuses, severance pay, vacation, or sick time reimbursement?
Again, there should be a clause within the agreement that
states that up until the time of termination, any accrued vacation time, any
accrued sick time and bonuses would be calculated up until that date of
employment and the physician assistant should be then paid for that with their
last check, but again you wouldn't want that in the employment contract. In
the event that the physician assistant is not paid, they then have a cause of
action to move forward on in order to get their moneys from the practice.
If they are terminated for cause, again they are still
eligible for anything they have earned up until the point that they are
terminated for cause. So, again, they should also have a clause in the
contract that states that they will be paid in full until the time of
And if they don't have that written in their contract and
they are terminated, what is the responsibility than of the supervising
Again, that would be based on more of an individual basis.
You would have to see the reasons for termination. Did the PA cause some loss
to the practice that they are offsetting with those moneys? So, that might be
something that again would need to be settled either in a court or by
I want to thank my guest, Michele Roth-Kauffman for coming
on the show. I am Lisa D’Andrea and you have been listening to The Clinician’s
Roundtable on ReachMD, the Channel for Medical Professionals. Please visit our
web site at reachmd.com, which features our entire library through on-demand
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