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Review of Process
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Search job sources
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Query letter, calls and send resumes
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Follow-up phone calls to make appointment
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Information finding - Pre Interview
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First Interview
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Follow up letter or call
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Negotiating offer
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Offer acceptance or rejection
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Get it in writing
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Make plans to start
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Sources for Locating Jobs
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Network: Other PA's who live in the area
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Cold calling, State association listings (become a member)
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Hospital, technical and pharmaceutical personnel in area
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Search firms
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Online
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Interview (before) - Know the practice….
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Ask the practice manager or the recruiter
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How many physicians? PA's? NP's etc?
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What specialties are involved in practice? (large group)
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History of practice? Growing? Stable? Decline?
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Any new personnel? Docs? PA's? recently…
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Lost any docs? PA's? from the practice? Why?
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Rule of Thumb: The farther you travel for interview…the
more you should know.
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Identify Aspects of You that Distinguish You
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Special training or experience
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Same work ethic as practice (have you asked the question before hand)
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Equipment expertise (that they use)
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Managerial skill (they may need)
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Language skills (they need)
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Ask about YOUR patient care responsibility
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Number of patients per day expectation
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Call: How often, with whom, phone/ER?
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Any coverage for you when you are gone?
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Age distribution of patients?
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Diseases encountered most?
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% Medicare, Medicaid, Managed Care, Cash pay
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After the interview…
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You must continue to establish you professional approach to this position
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Send a follow-up letter , or
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Send a letter of acceptance, or
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Send a letter of decline
Secrets of Negotiation: The
Art of the Deal
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Steve Cohen, M.S., PA-C
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Nova Southeastern University PA Program
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Negotiation: The Reality
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You are negotiating all the time
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Everything you want is owned or controlled by someone else
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Three critical factors:
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Power - tendency to want to retain
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Information - he who has…has power
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Time - Is it on your side?
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The Negotiation Issues
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Never narrow down to only one issue
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Different people want different things
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First, establish yours
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Establish (in your mind) the needs of the employer
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Salary "price" is not always all - important
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Look at the "package" value
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Stages of Every Negotiation
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Learn your opponents goals
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(Ask and do your homework)
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Establish what you want -
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Gather information about opponent and his/her needs
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Reach for compromise
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Good Negotiators…
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…know that both sides are under pressure
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Don't feel intimidated
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…Practice negotiation to get better at it
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…Don't take it personal or get emotional
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They are not offering "such & such" to offend you
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Be willing to create a Fair/Fair situation
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Win / win may NOT be realistic
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Power Distribution in Negotiation
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The PA Employer
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Title, reward, punish, reverent, charismatic, expertise
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You can retain….
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Situation and information power…
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Time (buy it): " This is embarrassing but I need to discus this with…"
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How to Gather Information
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Ask open-ended questions
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Repeat statements as questions
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Ask for responses
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Ask for restatements
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Ask other who have dealt with the employer
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Ask opponents subordinates
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Successful Negotiation Characteristics
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Both sides feel….
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Sense of accomplishment
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Cared about and for
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The other side was fair
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That dealing in the future would be advantageous
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That the other side will keep the bargain
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But….get it in writing anyway
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Skills in Negotiating a "Decent" Offer
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Refer to a higher authority (your wife, husband or family)
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Never say yes to the first offer
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The value of a service diminishes after services have been performed
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Always maintain walk-away power
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I can really be fine if I don't take this job
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Make a big deal out of any concession you make
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…and get a counter concession
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If I do this for you….what will you do for me?
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Don't be first to name a price
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Be the one who writes the contract
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The person under the greatest time constraint generally loses
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Never reveal you have a deadline
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Try not to negotiate over the phone (body language)
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Stay positive and unemotional
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Keep looking for creative concessions and trade
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Salary too low, but my concerns lie in my families health insurance
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Be patient and respectful - People make concessions to those they like
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Crunch the numbers before you go out - Know what you need to live
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Start high to avoid "I'll bet I could have gotten more…" syndrome
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Leave the other side thinking "I have done well"…
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Don't surprise the other party when you show up
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I didn't tell you, but I can't come without 6 weeks CME per year
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Before countering a bad offer…Ask…Would you reconsider?
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Principle bargaining is better that loud or hard bargaining
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Don't state you final offer first (What will you come to work for?)
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The Contract
- Susan Woomer, PA, JD (article in packet)
- Letters of agreement are binding contracts
- If it's not in writing, it didn't happen or wasn't said
- The contract should follow the letter of agreement
- You may have to ask for it
- Decision time - go to work without, expect in on arrival…or?
- Avoid "non-compete" clauses
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What should be in the contract?
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Official relationship with physician, group or corp.
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Terms of employment
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Start date
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Probation period
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Criteria for probationary review
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Duration of contract
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Annual review
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Salary increases
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Contract Issues
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Clinical responsibilities and supervision
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Supervising and consulting physician responsibilities
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Job description or expected duties
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Work hours
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Call hours
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PA-NP cross coverage
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Work sites
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Travel
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Contract Issues
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Compensation = Salary, Benefits and Intangibles (Education)
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Calculation method
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Bonus & Incentives
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1998-2000 AAPA Census Survey
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Primary Employer - 32-40 hrs per week minimum
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Range $32,000 - 100,000+
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Mean ALL (experienced and not) $62, 000 - $65,000
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Mean ALL surgery = $68,000
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Mean ALL Family Medicine & moonlighters = $57,000
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15% report working more than one job
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New Grads: $54,000 - $55,500
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Surgery: $57,500
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REALISTIC GOAL = $53,000-56,000 to start
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Lower for underserved or with great benefits
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Salary : Factors That May Influence
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Experience
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Increase with experience to 18 years
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Specialty
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Primary care < specialty and surgery
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Available persons to fill position
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More applicants = lower start salary
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Geography
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Increase with cost of living
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Population
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(-)5.5% for rural & (+)7.7% for urban
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Practice Setting
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Hospital better benefits, less salary?
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Call Hours
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(+) 13% for call average; Understand how assigned for you.
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Compensation and Contract/Letter of Agreement Arrangements
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Salary
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Salary plus bonus (+$6,018)
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Salary plus % profit
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Salary plus % revenue
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Partnership (<2% all PA's in practice)
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Supervisory Responsibility (you over anyone else?)
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Anyway to increase income?
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Extra call
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Exceeding patient expectations
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Language skills
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Administrative skills
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Exceeding expected income
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Individual medical insurance ($1500)
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Family medical insurance ($3000)
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Dental insurance ($300-500)
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Vision insurance
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Disability insurance
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Malpractice insurance ($2000-4000)
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Occurrence type - shoot for them paying for AAPA policy
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Ask for copy of certificates
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Term Life insurance
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Automobile insurance
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Profit sharing
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End of year bonus (production)
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Retirement fund / matching?
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State license fees including script fees
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Hospital and medical staff application fees
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Automobile costs and insurance
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NCCPA Recertification Fee and Registration
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Association: AAPA and FAPA dues
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Books and professional journals
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Sick leave (7-10 days / additive) and limits
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Vacation (15-18 days per year)
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CME (5.9 days and $1100)
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Separate from vacation
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Maternity leave (5.6 weeks)
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Military
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Reserve, full time issues?
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Contract renewal and termination conditions
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Evaluation criteria
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Termination "for cause" specifics
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Termination without cause: notice, compensation/benefit buyout
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"Contract is total agreement" ; limits verbal changes
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Changes signed by both parties; in writing
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Signatures and Date
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In Summary…
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Review by lawyer? (Experience with agreements for medicine)
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Discuss with intention to get "fair" agreement
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Always be able to "walk-away" & have "no-deal" as an option
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Figure your bottom-line BEFORE you discuss
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Never agree at the table…
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Defer to "higher authority"
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If it feels bad…you don't have to take the job.
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Last Pointers:
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Tap into the network of the employers in the geographic region
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Have an alternate - increases walk away power
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Introduce salary suggestion by the month (5000 per month
= 60,000 per year)
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Consider a non-traditional job (may be your fall back?)
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Sell yourself and showcase your assets
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Tap into the hidden job market
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Educate potential employers - information sheet
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Print CV and information sheet on "feel good-look good" paper
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Answer in 50 second to 2 minute burst (not too short - hiding
or too long)
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Be prepared and research the employer - Medline search your
interviewer
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"I can't really answei that until I understand the full scope
of my duties"
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"That is a good opening offer - I'll need some time to discuss
that with my…
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Don't give up prematurely - it's a job to look for a job
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Be proactive and persistent
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Keep up the contact - thank you letters, phone calls', etc.
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Go into large offices and ask "Do you need help?"
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Register with online services and headhunters (increase network)
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Keep CV/Resume to medical, one-pagers
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Consider a business card with pager/cell phone number
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Carry CV/Information sheet at all times
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Keep the AAPA Fast Fax number - 703-336-5550 or 800-286-2272
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Join your state association and AAPA
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Become an expert on your doc : Research on Medline
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Take the high road: Don't argue or discuss the merits of
hiring a PA over other providers
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