What Physician Assistant Expenses Should an Employer Pay For? | Employee Expenses

What business expenses should be reimbursed by your employer regarding a physician assistant employment agreement?  I’ll just run through the list of the most common business expenses that we typically see within our practice. Each sort of employment relationship is unique. And so, there could be not included in this list. So, you just must consider your needs to carry out the duties that you’re employed for. And then whatever that is, that should really be the business expenses that you’re getting reimbursed for. But starting from the biggest amounts of money. And I’ll work my way down.

Tax and Value of Business Expense

The biggest one is relocation expenses. Sometimes this is considered a business expense. If you’re going to be moving from out of state or across the country, that is one thing that your employer can reimburse you for. This is typically given as either a relocation bonus or relocation reimbursement, but either way that it’s structured, you just want to be careful because this is a large amount of money, I’ve seen anywhere from 10,000 to 20,000. You’re given that money up front or you’re reimbursed directly, but normally, you must stay employed with your employer for anywhere from one to three years. And if you terminate that agreement early, you may be required to pay back a prorated amount for how long you’ve been there, or you may have to pay back the entire amount. So, you just want to keep an eye on that, make sure you read your employment contract very carefully so that you know what you’re signing and what the consequences are if you do decide to terminate your agreement early.

The next business expense typically is any type of licensing fees or dues. If you need a DEA license or need to be credentialed with insurance companies, Medicaid, Medicare, any sort of state agencies, things like that, that’s always normally reimbursed and that should be reimbursed. That is one thing that should always be done because you need that to provide your services. So, they should reimburse you and these can get costly. Now, occasionally I’ve seen an employment agreement where you’re given some type of reimbursement allowance. You’re given up to 5,000 for all your licensing and fees, other times your employer, and I would say most times, your employer will just say that they will reimburse you 100% for any of those costs. Other topics of interest include:

• What Benefits Should be included in a Physician Assistant Offer Letter?
• How Much PTO Should a Physician Assistant Get?

Then moving along, your CME allowance, and continuing medical education. You must do this to keep your license and provide your services, so therefore you’re considered an employee. Your employer should be reimbursing you for this. Again, this is structured normally as an allowance anywhere from $3,000 to $5,000 annually. Sometimes it must be approved for what you’re using those funds for, other times it doesn’t. Again, you want to read your employment agreement. And then also, normally you’re given PTO time to go ahead and take those CME courses or conferences because if you’re not, you have to take vacation time and that’s actually money being taken away from you. So, CME also is very important. If you need a cell phone for your work, cell phone usage sometimes can be reimbursed, or they may provide you with one directly.

Technology, so laptops, if you’re provided with one or they’re going to reimburse you for using your own, that’s rare in healthcare. You’re normally provided one directly from the company. And then also travel expenses. Sometimes if you have some type of mobile practice or you’re going to be providing services at multiple clinics, sometimes travel expenses are also reimbursed. And this is what I was talking about at the beginning. Every situation is unique. And so, there may be expenses that are unique to your situation. You just need to look at what you need to provide the services that you have agreed for your employment.

Negotiating a Physician Assistant Contract With Employers

How to negotiate an employment agreement for a physician assistant? When you are negotiating the terms of your employment, the two things you really want to keep in mind are, one, what type of leverage do you have? And two, what are really the most important things that you want to throw that leverage towards, to get the best deal for yourself, and what do you want to negotiate? What can you negotiate? What’s typically negotiated within the industry? Let’s first start with leverage. How much leverage do you have? Well, let’s first think about that. You are a physician assistant, and, in most states, you need some type of supervising physician. So, you want to keep that in mind. And then also, are you right out of school?

You’re going to need a lot of direct supervision. Are you experienced and you can just step into that role? How specialized are you? Again, this all just depends on your state. But really what you’re looking at is how much oversight you need, how much training, or can you just start providing care and collecting for your services? That’s how you judge how much leverage you have. Now, let’s talk about negotiation. I get questions from clients all the time: can I negotiate? Is this something am I going to upset this prospective future employer? And I would say, no, it is customary within your industry to negotiate the terms of your employment contracts. Most of the time they’ll hand you or send you an employment contract and give you one or two weeks to look it over, consider it, and consult with legal counsel, that’s me, and come back with any terms.

Employment and Proper Pay

Sometimes you do want to negotiate. There are things that you should advocate for. Sometimes there also might be terms that you don’t understand, and you need clarification for, or you need this employer to define for you. There are some negotiations and back and forth. That’s customary, you should not feel that you’re going to upset them and they’re going to resend this offer. That’s just simply not the case. You’re always going to negotiate some part of your employment contract and your employer expects this. They do not expect you to just sign on the dotted line and agree to all the terms. That’s extremely rare. And I think your employer would be surprised if you came back with that. Now, let’s talk about what we’re going to negotiate. Most people, when they think of negotiation, they think of their base salary. The big money amount on their employment agreement, that’s what they want to negotiate first.

They want to use all their negotiation power for how much money they’re going to be receiving. If you feel like you’re not getting compensated how you should, you absolutely should advocate for yourself and try to negotiate that amount. But what I look for and I think is the most important to negotiate is sometimes it’s the non-compete clause. That’s the first thing that I would probably negotiate. Because a lot of people don’t think about the non-compete clause until their contract ends. And you can negotiate a couple of different parts of the non-compete clause. Normally, it starts with how long does the non-compete? Is it enforceable? Once your contract terminates, your non-compete will start. It’s anywhere from one to three years I’ve seen on a contract. I would never want anything over 12 months. I would push for 12 months or six months, honestly, but most people are going to agree to 12 months.

So, I would always negotiate down the time. How long are you restricted from competing with this employer? Then next I’m going to look at the locations that the restricted area attaches to. And the restricted area is normally within a mile radius. So, anywhere from 3 to 10 miles, you are restricted from practicing from a three-mile radius from this location. If the miles are unreasonable, anything over 20 miles, in my opinion, is likely unreasonable. You would want to negotiate down that amount. And then you’re also going to look at how many locations is that restriction attached to. If it’s only one location, that’s great. But if you start having that area or restricted area attached to any location you provide services for or any location of the practice, then you’re knocking out huge areas. That can really be unreasonable.

And, it’s going to be really hard and stressful for you to find work after this employment agreement terminates. So, the first thing I always look for and try to negotiate is the non-compete clause. In some states, it’s unenforceable and that’s great. You just want to check your state law or check with an attorney. They can advise you on that. But the non-compete clause, absolutely, I always look for that. Then the next thing I’m going to look for is how do you get out of this agreement? Most employment contracts should have something that’s called a without cause termination, which means you can injure employment with your group for any reason or no reason at all. And you just have to give a specific amount of notice prior to the termination. If your contract does not have this included, I would absolutely negotiate. This would be a huge red flag for me because you just don’t have a crystal ball.

It might not be a good fit; you might need to move out of the area because of family issues or personal reasons. You just don’t know. And so, if you don’t have a without cause termination, you’re really stuck in this contract until the end or you’re at the mercy of your employer, begging them to let you out of it. So, I would always negotiate a without cause termination. The third on my list probably would be your compensation. Sometimes the base is most important. In your compensation model. Normally, for a physician assistant, you’re normally paid either salary, hourly or per shift, or like a daily rate. It’s normally a flat fee. You’re not normally compensated for collections, productions, or RVUS. So, you are going to be negotiating that base amount.

You want to do your research. Are you in a desirable area? Are you in a high-need area? What experience are you bringing to the table? All of those you want to consider when you’re asking for an increase in that base salary. And if you feel like upon your research that you think you should advocate for more, then you absolutely should. Another thing you want to consider when you’re negotiating is looking at your bonuses. That could be a relocation bonus, it could be a signing bonus, or sometimes they even call it a commencement bonus. You’re going to get a certain amount of money upfront. If you’re moving to a new area, I would absolutely negotiate a relocation allowance or bonus or something like that, just so that you’re getting funds that will help you with the transition into this new area.

That is something I would negotiate. Then two, your signing bonus. Just about every contract I see for a healthcare provider has some type of signing bonus. If you don’t have one, I would ask for one. That’s something you should negotiate. But with all these bonuses, with the funds that you receive upfront for starting or commencing your employment, you want to be careful because there’s normally some type of payback provision, which means you have to stay employed with your employer for a certain period. It’s normally anywhere from one to three years. You want to read that carefully. You may have to pay back your entire signing bonus if you terminate at any time within that one to three-year window. If I were negotiating, I would ask for that amount to be prorated, which means that for every month that you stay employed, a fraction of that amount is forgiven, so you don’t have to pay back the full amount.

There are a lot of things you can negotiate. You also don’t want to forget about those ancillary benefits or sort of employment costs. Things that need to get reimbursed like your continuing education, your licensing fees, your dues, and DEA license are very expensive right now. You should negotiate that your employer reimburses you for that. So, you just want to keep all of that in mind and not just focus on your base salary.

Time Off from a Health Care Practice

How much paid time off should a physician assistant get? What is the industry standard as far as time off goes? Well, first, you’re only going to get paid time off if you are an employee. If you are an independent contractor and receive a 1099 at the end of the year, it is very unlikely that you’re going to be given any paid time off at all. There are many PAs that work as independent contractors, especially those in the surgical specialties. They are only working sporadically, maybe a couple of weekends a month, or even only a couple of days a month. And in that scenario, if you’re an independent contractor, you are not going to get paid time off. This discussion will be about employed physician assistants who receive normal paid time off.

Paid time off is broken down into four categories: vacation, sick days, holidays, and then continuing education. And most employers will then give a certain number of days for each of those things. There are other employers, especially if you’re working for maybe a big hospital or hospital network, where they’ll have what’s called a pure PTO system. And in that system, there’s basically one giant bucket of time. And then any time you’re out of the office, you take that out of the bucket, it doesn’t matter what you’ve gone for. It doesn’t matter if it’s sick days or you’re on vacation, or you’re doing continuing education. If you’re not in the office, you’re taking time out of that one bucket. Now, if it’s not like that, let’s break down what’s kind of normal for each of those. The total time off for a PA should be somewhere between like 20 to 30 days.

When you add up all those four things, sick days, holidays, vacation, and CE, it should be somewhere between 20 to 30 days. I find most employers will give 10 vacation days. Now, some states have laws about how many sick days an employer is required to provide. But usually, it’s somewhere between three to five sick days. Again, somewhere between three to five days for continuing education, five would be on the high side for a PA. And then holidays, however many holidays that the office observes, which is usually somewhere between six to seven. So, let’s just say you add up 10 vacation days and six federal holidays, that’s 16. You get three sick days, that’s 19. You get three days for CE, that’s 22. 

Does a Physician Assistant Repay a Bonus if the Contract is Terminated? | Repayment by a Physician Assistant

Does a physician assistant have to pay back their bonus if they terminate their employment agreement early? The answer to this is it’s likely. Now, again, every employment agreement is different but from our experience and most employment agreements that we have reviewed over the years, normally when there’s some type of bonus. And when I mean bonus, I’m talking about a sign-on bonus, commencement bonus, any type where you get a bonus upon signing or upon starting your employment, there’s normally some type of payback provision or payback language or forgiveness of the amount language in your employment agreement. So, you always want to make sure you read your benefits carefully.

How Much Paid Time Off Should a Physician Assistant Get? | PA Vacation and Paid Time

How much paid time off should a physician assistant get? What is the industry standard as far as time off goes? Well, first, you’re only going to get paid time off if you are an employee. If you are an independent contractor and receive a 1099 at the end of the year, it is very unlikely that you’re going to be given any paid time off at all. There are many PAs that work as independent contractors, especially those in the surgical specialties. They are only working sporadically, maybe a couple of weekends a month, or even only a couple of days a month. And in that scenario, if you’re an independent contractor, you are not going to get paid time off. This discussion will be about employed physician assistants who receive normal paid time off as part of their professional benefits offered.

Should a Physician Assistant be Reimbursed for Moving Expenses? | Medical Relocation Reimbursement

Should a physician assistant be reimbursed for relocation expenses? The answer is yes, you should be reimbursed. If you are moving to a new area, out of state, across the state, or across the country, you should absolutely be reimbursed for those relocation expenses. However, it can look unique in your employment agreement. There are lots of different ways to structure this and I’ll go through the most common ones that I have seen. I’ll start off. The first way is probably the most common; it’s considered a relocation bonus, or they’ll call it a relocation allowance. And what this looks like is you’re normally offered anywhere from 10 to 20,000 upfront, the company will just, or your employer will pay you directly that amount of money.

What Benefits Should Go In a Physician Assistant Offer Letter? | PA Offer Letter Benefits

What benefits should be in an offer letter for a physician assistant? First, let’s start with what is an offer letter? Sometimes it goes by different names: offer letter, letter of intent, intent to negotiate. That goes on from there, but an offer letter starts the process for your employment and for your employment agreement. Normally, in an offer letter, it’s going to be short and sort of like an outline of what they’re offering you in their employment agreement. Normally, in an offer letter, you’re going to first get your compensation. Normally, your base compensation, and then there may be additional bonuses for production or collections. And that should also be included in the offer letter.

Consultation with Chelle Law

When your Physician Assistant agreement is reviewed by a contract review attorney, you will find financial benefits which end up outweighing the cost of the review. Leave it to the experts. If you are in need of assistance with an employment agreement or contract review schedule a Physician Assistant Contract Lawyer with Chelle Law today!