Hourly vs. Salaried: What to Know When Considering Your First PA Position|Be a Physician Assistant (2023)

Think back to your first job—the one you had as a teenager or young college student. If I had to hazard a guess, I’d bet it was anything but cushy.

While you may have worked in a decent place, you were likely paid by the hour, had no paid sick leave, and the “benefits,” if you were lucky enough to have any, were probably limited to an employee discount.

Back then, the idea of having a salary would have felt like something fancy. Something that a future version of yourself might one day enjoy.

Even after years spent gaining experience, maturing, and training, that impression can stick with us. We often associate a salary with entering the “professional” world.

And that viewpoint can influence your opinion of potential positions when you’re searching for and fielding offers for PA jobs as a near or new grad.

However, PA position pay structures (and the circumstances that drive them) are worth understanding. Because when it comes to hourly vs. salaried roles, the differences can’t be boiled down to a barebones position versus a more deluxe one.

And depending on your priorities, you may find yourself favoring or more often encountering one type over the other.

To help understand what is typical for a PA position that’s paid hourly, we first have to break a common misperception that might stem from your prior work experience.

PA positions paid by the hour are not devoid of standard employee benefits.

If you work part-time or full-time, you should expect to receive an equal level of benefits granted to salaried employees at the same institution or practice. Whether you’re a full-time hourly employee or salaried, your health insurance benefits, parental leave allowance, time off, CME funding, and the like would be comparable.

So why would an employer bother to make the distinction?

Some practice environments and staffing models are more conducive to hourly work than others, particularly those that provide daily services or 24/7 patient care.

These roles most commonly are found in urgent care, emergency medicine, and hospital-based positions involving shift work.

A full-time provider in this type of role might work an average of four 10-hour shifts or three 12-hour stretches in a week. Because patient care is delivered every day, your schedule could vary from week to week.

So, depending on the staffing model, you might work 50 hours one week and 30 hours the next or multiple days in a row, followed by a long stretch off.

When you work an extra shift on top of your regular commitment, you get paid for it (often at a higher overtime rate) -- which can be a notable benefit of an hourly position.

It may also be easier to take time off without dipping into vacation days or at least use fewer of them.

Many employers are flexible with hourly positions as long as you maintain your weekly average hours within a timeframe (often a set 2-week, 4-week, or monthly block) by working more before and after your planned time away.

When you’re offered a position with hourly pay, you’re usually provided with an annual “salary” amount, which you can expect to earn by the year’s end, assuming you maintain a standard 36-40 hour work week.

But having that annual number broken down to an hourly rate and being paid on that basis can allow for greater schedule flexibility and also create a stronger boundary between work time and personal time.

Just as hourly roles can be more commonly found in some specialties and practice environments, the same is true for salaried positions.

You’re more likely to find salaried PA roles in practice environments that maintain traditional outpatient office hours (Monday through Friday, 8 or 9am to 5 or 6pm) and where longer-term patient continuity helps improve the quality of care.

You might find these positions in primary care or clinic-based specialty practices, like endocrinology, gastroenterology, dermatology, or other similar subspecialties. You may also encounter salaried positions in surgical roles with a heavy outpatient component or that are in private practices.

With full-time salaried positions, you’re generally expected to work at least 40 hours a week.

Perhaps that means roughly 8-hour stints Monday through Friday, or four 10-hour stretches a week. Or, if part-time, you might work every Tuesday and Thursday.

However, unlike the variability often found with hourly positions, salaried roles typically involve a fixed schedule where you work the same days every week, making it easier to provide the patient continuity that the practice environment requires.

Using a standard 40-hour work week, there’s no distinct compensation difference between an hourly or salaried job -- geography and specialty will more significantly influence what you earn in any PA job.

But, especially as a new grad, it’s essential to understand how a salaried positioncouldchip away at your “hourly” earning rate so that you know how to protect against it.

As mentioned, a full-time salary-based PA is expected to work roughly 40 hours a week. On some lucky days, you could have the chance to head home early after wrapping up your daily tasks without having to put in a precise 40 hours for the week. But it can also mean (whether rarely or routinely) that you put in 50-60 hour weeks without any additional pay for the added work.

It could also mean that what feels like a small conciliation during a job offer, like having to work one weekend a month or take overnight call, becomes a greater expectation over time without an increase in compensation.

That’s not to say that any salaried position will take advantage of your strong work ethic.

However, as a newbie provider, it’s vital to fully comprehend the time commitment of any role and how that could shift over time.

To start, ask potential employers during an interview how providers spend the majority of their time and where the time crunches are. Inquire if they envision providers taking on additional responsibilities in the future or if the clinic schedule is expected to evolve or expand.

When you receive an offer, you can break down your anticipated annual salary projection to see the hourly rate. Be sure to account for the average weekly hours (also something to ask other providers during an interview) plus any additional time requirements of the role (like after-hours charting or weekend/night coverage).

While a high salary offer may be enticing, calculating an hourly rate reflective of your time obligationcan help you determine if it’s fair.A job may sound lucrative but may not be in reality when you factor in how much time you’d be exchanging for the pay.

A lower-salaried position with more robust parameters on your time could be more profitable in the end (and less likely to lead to burnout).

And a role with well-defined time boundaries could also allow you to pick up additional (paying) shifts in a part-time or per diem role if you are willing to work extra but prefer to be paid for your efforts.

As you approach the end of your PA training and begin looking to the future, plenty of variables are worth considering when choosing your first PA job.

Your personal practice environment and specialty preferences will have the greatest influence on whether the PA positions you find are hourly or salaried.

However, if you hope to maintain control of your time, be paid fairly, and reduce the risk of burnout as a new PA, you need to be wise about each compensation structure’s potential advantages and pitfalls.

When you understand the basics and ask the right questions before accepting a role, you’ll be well on your way to making the best choice for your first PA job.

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