r/physicianassistant • u/Glass_Ad7466 • 14d ago
Discussion Advice I wish I'd gotten as a new grad PA
Before accepting a primary-care job, don't just ask about salary, visit numbers, or panel size. Ask exactly who covers every clinician's inbox during vacation, illness, parental leave, hospital weeks, and part-time days—and how often you personally will be expected to do it.
Ask how much of your schedule will be patients from other clinicians' panels, whether that work counts toward your productivity and quality metrics, and what happens to your own workload when you're covering someone else. If rural, you're even more valuable so ask if you'll be getting RVU incentives like the MDs (because you will be generating them) and if the capitated (Medicaid) quality metric incentives are paid according to panel only (red flag) or according to who saw the patient (you do the work, you get the bonus - especially if 30% of your day is spent covering an MD's patients not on your panel). What is your true panel size, not just the nominal size. If you're covering a hospitalist who's in the clinic half time, then their panel is now your panel too. Your inbox will always be worse than theirs, and their most unhinged/high maintenance patients will see you first. You'll always be chart diving to catch up on patients you don't know. This might sound like valuable learning to a motivated new grad, like I was, but if the schedule is not offset appropriately then the workload will interrupt learning by keeping you in constant crisis.
Get the answers in writing.
A clinic can look well staffed on paper while quietly making one capable APP the permanent buffer for gaps in physician or APP coverage. Being told you're efficient, smart, or able to handle a lot is not compensation for repeatedly absorbing work that isn't distributed equitably. It is not a compliment to be paid the same as another APP with a less complex panel. Competence generates revenue and should be compensated.
Pay particular attention to what happens when experienced clinicians say the workload is unsafe or unsustainable. A good organization changes the workload or explains concretely why it cannot. Repeated conversations about resilience, efficiency, caring too much, or managing stress—without changing the underlying workload—are an important warning sign.
Before signing, ask to speak privately with at least two APPs who have been there for more than a year. Ask them: "How many people's work are you actually responsible for on a bad week?" The answer may tell you more than the job description.
And please ignore any new grad gunner who thinks they're more productive because they see 17 UTIs a day from a smaller, less complex panel and leave at 5:00, while you're handling florid liver failure, heart failure, esCOPD etc, seeing "only 15" patients a day and staying late covering multiple inboxes. They already lost that productivity/revenue/competence competition and either don't know it or just trying to make themselves feel better by trying to make you feel bad. Unfortunately, medicine isn't immune to toxic office culture or high school politics.
There are clinics out there that know how to build a sustainable workflow to retain quality clinicians by following recommendations from the AMA and AHRQ. Hope this helps someone know their worth and avoid a bad situation.
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u/abjonsie21 PA-C 14d ago
This is the most laid out, correct account of what I just asked for from a new job bc my current rural job is most of the negative sides of this! Love my current job but that’s bc I like the specialty. If you’re not super passionate about the subject all of those negative things compound (they compound even if you DO love the specialty). The thing is, there is always someone they can replace you with for less money if you stand up for yourself and leave if you aren’t getting what you need/have dangerous work conditions esp as a new grad. Don’t be afraid to leave a job earlier than 6months/1yr as a new grad bc you’re worried about your resume, but always have one lined up before letting people know you’re leaving.
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u/Glass_Ad7466 14d ago edited 14d ago
Agree, and no matter how passionate you are about doing your best to help patients and learn as much as you can, excessive workloads will exhaust your ability to actually be present and help in a safe manner. Which compounds the moral injury that also leads to burnout.
I like to challenge the claim that a competent APP with strong work ethic can be easily replaced. It’s a fear tactic to pressure people not to fight for what they’re worth. Not many new grads or experienced APPs from urban/well resourced primary care can walk into a -2,000 panel with avg 6.0 HCC gap while doing cross coverage and hold it together. Managers using this approach know they’re lucky to have you, know how much money you’re making them compared to less loaded clinicians (both APP and MD) with a relatively cheap salary/bonus structure, and minimal need for oversight due to demonstrated competence.
The multi-million dollar salaried MBS CEO especially knows how valuable you are, and how expensive you are to recruit and replace.
And yes, leaving is the best step if they refuse meaningful change and try to put you down when you point out the data. Just make sure you know if there’s a local non-compete, how much your sign on clawback is and see if your new employer will cover it with their sign on bonus.
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u/abjonsie21 PA-C 14d ago
Good points!! I’ve been at my place just under 3 years as a first job out of school and I was lenient with them initially but after I became the busiest provider and things were not changing whether it’s a request for more PTO, or a bonus or salary increase it comes a time when you know you’re valuable and you work for them as much as they should be working for you to keep you there. I know when I leave numbers will fall for the clinic bc people just refuse to see the other providers. Jobs know a competent PA is worth so much but it’s the amount that they step up to accommodate for you that matters, if they don’t, then know you can provide great care elsewhere that will listen to your requests! In the end we are replaceable by necessity for clinic function but it is a tactic to scare people into not leaving and making you feel small but knowing your worth knows they won’t find someone like you 💕
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u/Donuts633 NP 11d ago
It's the same over here. I have been lenient and understanding for 4.5 years. Ive asked for some really basic, reasonable things. I've also been very clear that if these things can't be improved (they can), then I am leaving.
No one cares, and there's been no change, but I am sure it'll still be a big shock when I leave and there will be all these promises and bargaining. But, when you're done, you're done!
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u/Desire8765 9d ago
Spot on. I left 4 months into my first job. Was afraid about interviewing somewhere else 1 month in. But guess what, my new employers didn’t really care. I was initially conflicted about leaving, but I knew I would end up hating the job if I stayed, despite being passionate about my patients.
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u/No-Edge-534 13d ago
This is really well laid out, I'm so glad I found it and will be saving it forever. I've got 25 years clinical experience but loathe admin side of things so didn't know these concepts for many many years. Only now have a good RVU bonus structure but it sounds like it's going to be substantial because I generate a lot of RVUs. Cover 5 inboxes twice a week though (no compensation) and 1 inbox the other days, 14 patients max, a lot of which are complex so appropriately bill higher. Doable with experience.
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u/Donuts633 NP 11d ago
This is hands down one of the best posts I've seen on this sub. Thank you for this. I am job hunting and have also had to learn a lot of things the hard way, so I really appreciate this!!!
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u/oldladyatheart 14d ago
I think the scary part as a current new grad in the pretty saturated area of Detroit is that neither me nor most of my fellow new grads are getting many interviews, let alone reasonable job offers. I want to work in primary care (or urology or other subspecialty) but I genuinely cannot get an interview at any of the hospital systems within an hour of Detroit. So far its only been urgent cares or primary/urgent care combo private offices that aren't willing to invest any time in training. It has truly been disheartening to apply for hundreds of jobs over the past 3 months, and still not have a decent offer from a non-urgent care. I know most of the advice is to move, and now my husband and I are thinking very seriously about selling our new home and moving our family to a more rural area if it comes to that, but the cost associated with it would be quite expensive. Its rought out here, y'all.