Office Hour July 2, 2026: Bonus Structures That Actually Work: Turning PA Productivity Data Into Smart Incentives

Caribbean Family Trip Discussion

Florence shared details about a recent family trip to the Caribbean for her daughter's 16th birthday, which cost more than expected despite not being all-inclusive. She discussed the relatively short 3-hour flight from New York to the Bahamas and mentioned returning to work the following Tuesday after the trip. The conversation concluded with both participants discussing their travel experiences and flight upgrade situations.

PA Bonus Structure Implementation

Florence discussed implementing a new bonus structure for her senior PA based on productivity, setting a benchmark of 885 completed visits over a four-month period. The PA exceeded expectations by completing 927 visits, earning a bonus of $42 (20 times the 42 visits over the benchmark). Jennie advised Florence that once bonus structures are implemented, they set concrete expectations that can be difficult to adjust later, and suggested considering differentials for specific days or adjusting the benchmark based on percentage increases.

Physician Assistant Performance Incentive Structure

Jennie and Florence discussed a performance incentive structure for a physician assistant, with Florence explaining her decision to set a $2,650 annual target based on $26.50 per patient, which represents a 5% increase from the previous year's performance. They analyzed scheduling patterns showing the actual patient volume averages 15-16 patients daily rather than the full 21 patients scheduled, leading to discussions about potential adjustments like double-booking patients or extending hours to meet targets. Jennie recommended creating a tiered incentive system where additional 5% increases would result in higher per-patient bonuses, suggesting a structured three-month review cycle and encouraging collaboration with the PA to identify optimal scheduling adjustments. The conversation concluded with Vineka joining to discuss her own hiring considerations for additional provider coverage, particularly to manage new patient acquisition and reduce burnout while maintaining her specialized TMS and Spravato patient panel.

Patient Wait Times Concerns

Vineka expressed concerns about losing high-value patients due to long wait times for new appointments, which are currently scheduled for September or October. She discussed the need to hire additional staff or consider locums to maintain business sustainability, though Jennie questioned whether there would be enough market share for a full-time provider. Vineka indicated she could potentially squeeze in emergency patients but has limited availability due to her current schedule and upcoming deposition.

Hiring Independent Provider Challenges

Vineka discussed her challenges with hiring an independent provider for her practice, expressing a preference for a part-time PA over a nurse practitioner while acknowledging she needs more growth before making significant changes to her systems. Jennie advised Vineka to research market rates for psychiatric mid-level providers by checking job postings on Indeed and potentially consulting MGMA data, suggesting she focus on outpatient settings rather than overnight or call coverage. Vineka revealed that hiring decisions have been delayed due to ongoing divorce proceedings, as the practice's sole provider status is a key point in the legal matter.

Part-Time Provider Evaluation Strategy

Jennie advised Vineka on how to evaluate adding a part-time provider, suggesting she calculate costs, assess revenue potential from 99213 visits, and determine break-even points. They discussed using Vineka's unused office space efficiently and potentially redistributing some of her stable patients to the new provider. Jennie emphasized that Vineka's and the new provider's roles would be distinct, with Vineka focusing on higher acuity patients while the new provider handles chronic stable visits.

PA Hiring and Training Strategies

Florence shared her experience with hiring and training PAs in her neurology practice, describing her preferred gradual onboarding approach where PAs start part-time and work alongside her before taking on independent patient panels. She explained how she uses a triage system to determine which patients new PAs can handle independently versus those requiring more supervision, particularly for complex cases involving conditions like Parkinson's disease and dementia. Florence recommended that Vineka should consider hiring a mid-level provider given her current wait times of 2-3 months, though noted that legal considerations from her divorce may impact timing.