What goes into your compensation figure?

Your compensation will vary according to personal and situational factors and nationwide trends. Here’s what you need to know and expect.

By Scott Files | Fall 2016 | Vital Stats

 

In today’s competitive market, physician compensation can vary based on a variety of factors. The Affordable Care Act has created an increased need for physicians in all specialties, but knowing what to expect when it comes to compensation can be difficult. Of course experience affects what you’re worth to an employer, but there are other factors, too, including location and demand. And you have factors to consider beyond salary—signing and performance bonuses will also affect your overall compensation.

Physician compensation in high-demand specialties

Based on a national sample of physician and advanced practitioner searches, Merritt Hawkins’ 2015 Review of Physician and Advanced Practitioner Recruiting Incentives provides an indication of the types of physicians currently in greatest demand, along with the types of medical settings in which they are recruited.

The chart below shows the average compensation package for physicians for that survey’s top four most in-demand physician specialties, not including production bonuses or benefits.

As you can see, compensation ranges vary widely, even within specialties. For example, a family practice physician can expect an annual salary range between $130,000 and $330,000, with an average of $198,000 per year. The upper and lower limits of this model differ by more than 250 percent, further demonstrating that other factors are in play when determining overall compensation.

Other factors that affect compensation

What are those other factors? To varying degrees, all of the following developments have had an impact on the recruiting incentives offered to physicians:

  • Continued expansion of the Affordable Care Act
  • The accelerating closure of rural hospitals
  • The implementation of population health management through integrated organizations, such as accountable care organizations
  • The expansion of telemedicine, with one third of physicians now using some form
  • Increased scope of practice and demand for advanced practitioners, such as PAs and NPs (NPs can now practice independently in more than 20 states.)

The health care system continues to evolve, but whether care is delivered in small, independent and unconnected silos, orin vast, integrated health systems, and regardless of whether volume or value is rewarded, physicians will be the paramount providers of care and drivers of health care economics.

According to the Boston University School of Public Health, physicians receive or direct 87 percent of all personal spending on health care in the current volume-driven system through hospital admissions, test orders, prescriptions, procedures, treatment plans and related activities. The total combined economic output of patient care physicians in the U.S. is $1.6 trillion, and each physician generates a per capita economic output of $2.2 million while supporting approximately 14 jobs, according to the American Medical Association’s 2014 Economic Impact Study.

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Final thoughts

As a practicing physician, you have lots of options regarding your career. Keep in mind that your skills are in high need, and compensation will vary. The key takeaway is to make sure that you are informed on the recruiting incentives that are being offered in the area where you would like to practice.

There is always room for negotiation, and benefits—including longer vacation time and performance bonuses—can also be factors in determining which type of positions are more in line with not only your career aspirations, but also your specific lifestyle.

 

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Tamika Blackburn, M.D.

Fall 2016 | Snapshot

 

Tamika Blackburn, M.D.

Tamika Blackburn, M.D.

Specialty: Internal Medicine

Employer: ProHealth, Wethersfield, Connecticut

Education: Medical school: New York University School of Medicine (2005)

Residency: Yale University, Primary Care Internal Medicine Program (2008)

Blackburn enjoys traveling, exploring new culinary delights, dancing, and spending time with her husband, Tyson Davila.

What surprised you about your first post-residency job search? Many of the academic medicine positions would not even respond back unless my residency program director or chair of the department of medicine initiated the inquiry. This surprised me because I thought a competitive CV, experience and good qualifications were all that were needed to land a dream job. In the end I realized I still needed an advocate to help get past the barriers.

What’s your advice for residents beginning the job search? Don’t rule out opportunities right away. You may have the idea to go into academic medicine in an urban center, but perhaps private practice, rural medicine or hospital medicine may be a better fit. Be open-minded and explore your options.

Anything particularly unique about your job search? I searched websites such as PracticeLink.com, ads posted at national conferences and ads in journals for a few months to get a general overview as to what was out there before doing a more active search. I also spoke to colleagues to elicit their experience in working with different organizations.

How did PracticeLink help you in your job search? It allowed me to search for jobs online without pressure from recruiters calling me all the time. On the other hand, if I wanted to be contacted directly, I could post my CV and have it distributed to recruiters. If I wanted more information, I could click on the request form or call the recruiter. I also enjoyed the articles published in PracticeLink Magazine on writing an effective CV, interviewing and reviewing contracts. Finally, I went to a regional job fair that offered a seminar on the basic steps to the job search.

 

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What it’s like to work at an FQHC

By Marcia Travelstead | Career Move | Fall 2016

 

Daniel Bow, D.O.

“Most of us go into medicine to help others, and this is a great opportunity to do just that,” says Daniel Bow, D.O. · Photo by Nicole Haley

Name: Daniel Bow, D.O.

Work: Internal Medicine physician, Baldwin Family Health Care, Baldwin, Michigan

Undergraduate: Eastern Michigan University, Ypsilanti, Michigan

Med School: Michigan State University, East Lansing, Michigan

Residency: Botsford General Hospital, Farmington Hills, Michigan

Federally Qualified Health Centers (FQHCs) like Family Health Care (FHC) in Baldwin, Michigan, are vital to rural areas. Health centers must meet specific criteria to qualify as FQHCs, including serving underserved populations, offering sliding fee scales, providing comprehensive services, having ongoing quality assurance programs and having governing boards of directors. Physicians who have federal loans may be particularly interested because FQHCs are able to help with the loan repayment of their employed physicians. Baldwin FHC, where Bow practices, is the third-oldest FQHC in the country. The National Health Service Corps, which connected Bow with Baldwin FHC, offers tax-free loan repayment to health care providers who choose to go where they are most needed including NHSC-approved FQHCs.

How did you become an FQHC physician? There are different routes to be taken. For me, I found Baldwin Family Health Care while I was a student at Michigan State. I joined the National Health Service Corps, and they connected me with Baldwin. So the National Health Service Corps paid for some of my schooling. At Baldwin, money has been provided to pay back my student loans while I am working. I believe the state of Michigan has a similar program.

What is your workweek like? I work [a] set workweek, [and] there’s a call schedule to be available to patients after hours to answer questions. There are two other physicians at the center in addition to a physician assistant and a nurse practitioner. [Among] all of us, we handle the call schedule. We rotate for a full week [among] the five of us.

What do you like best about working for an FQHC? That’s easy to answer: mainly the patients. They’re basically hardworking people who live in underserved areas. A lot of them don’t even have the resources that would possibly be available to them elsewhere. I feel like I’m making more of a difference to the people living in an underserved area.

Is there anything you don’t like? The commute. … I don’t live in the same area due to family constraints. That, in a way, can be a challenge, but it can also be mind-cleansing. The commute is the biggest thing—just getting there. However, that’s the whole point of the health center. It’s sometimes a difficult area to get to. That’s why there can be difficulty recruiting. Yet that shouldn’t sway anybody because I think the benefits far outweigh the bad.

What advice do you have for physicians interested in FQHCs? Regarding this or any other job, I would say to visit and do your footwork, investigate and make sure that where you are going is where you want to be. When I teamed up with NHSC, Baldwin FHC was not the only FQHC that I was able to visit. There are other places that are HPSA-qualified [Health Professional Shortage Areas]. I visited all of the places and went to the Upper Peninsula of Michigan, which is pretty remote. I decided on Baldwin FHC because of the benefits the practice offers.

Would any specialty be able to work for an FQHC? It’s mostly primary care. When I say primary care, I’m talking about family practice. I believe pediatrics, internal medicine, gynecology and psychiatry are applicable. I don’t think it applies to orthopedics or surgeons.

What surprised you? Being in an area where I thought there wouldn’t be resources, I was surprised at the number of resources that were actually available. For instance, we actually have a dental center in the same building. So if a patient has a dental need, it’s just down the hall. The resources are a little more than if I were in a private practice. In the U.S., the funding for mental health has really been cut back over the years. In our clinic, because of a grant and the work of the CEO and CMO, we have a behavioral health specialist on site. They’ve been working very hard to foster this because there are a lot of mental health issues out there. It’s a nice bonus to have those specialties readily available for patients. We also provide pharmacy, radiology and laboratory services on-site—kind of one-stop shopping for our patients’ health care needs.

Anything else? If a physician is looking to make a difference, this is the type of facility he or she would want to work in. Most of us go into medicine to help others, and this is a great opportunity to do just that.

 

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Decision tools and medical calculators to use at the point of care

These three apps help you make informed decisions about imaging, diagnoses, treatment and more.

By Iltifat Husain, M.D. | Fall 2016 | Tech Notes

 

In this edition of Tech Notes, we’ll cover three great medical apps that can make you into a more efficient physician: MDCalc, Ottawa Rules and SmartIntern Sepsis. Each of these apps is focused on helping health care providers practice evidence-based medicine. In addition to providing a wealth of information, these apps can be used quickly at the point of care. All of these apps are also free to download and use.

MDCalc: Medical Calculators, Scores, and Clinical Decision Support

MDCalc

Price: Free. App Store Link: apple.co/1Lm4Nac Android Link: Currently not available

It’s hard to find a practicing physician who hasn’t been to MDCalc.com. The popular physician-run website is a go-to for finding medical calculators and clinical decision tools. Thanks to a recent release, the website is now available as an app, also called MDCalc.

This app is now a must-have for any physician; it provides access to nearly every type of medical calculator or decision tool. Although popular clinical decision apps such as Medscape, UpToDate and DynaMed also have their own calculators, MDCalc makes the process much easier because it lets you enter data into decision tools with just one click.

What further separates MDCalc from other medical calculator apps is the amount of evidence-based medicine it teaches. Every clinical decision tool within the app has a section dedicated to the evidence behind the actual equation. Some clinical decision calculators within the app—such as Wells’ Criteria—even have direct quotes from the tool’s creators.

The app is currently free, but in the past the developers have mentioned in its App Store description that they may charge for it in the future.

Ways the app could improve. Unfortunately this app is currently unavailable on Android.

Key ways to use the app. You will no longer need to search for decision tools on Google or on the actual MDCalc.com website. The app loads quickly, and you can use its search function to find the clinical decision tool or medical calculator you want. I would also recommend using this app to learn more about clinical decision tools. If you’re a physician new to the iPhone, this is definitely the most important medical app to download.

Ottawa Rules

Ottowa Rules

Price: Free. App Store Link: apple.co/2a3YHKN Android Link: bit.ly/2auaR3L

In medical school every physician gets taught the decision tools related to the Ottawa rules, which include C-spine, knee and ankle rules. Instead of having to look up these clinical decision tools online, you can now access the Ottawa rules from this free app provided by the Ottawa Hospital Research Institute itself.

Though the app can be used simply to access the tools, it’s much more than that. The app also has videos and commentary that provide a wealth of information about the rules. The videos in particular are a great touch because they explain in great detail the nuances behind the rules.

Ways the app could improve. Overall the app is slick, but it would be helpful if it gave you access to the criteria more quickly. Right now it’s faster to use the MDCalc app or another medical calculator’s decision tools at the point of care. The Ottawa Rules app does, however, contain a wealth of valuable information that still makes it a critical download for those who use these tools.

Key way to use the app. At this time the best way to use this app is for educational purposes. The app is free to download. There are some great figures and algorithms included, and the videos, though not flashy, provide contain great content.

SmartIntern Sepsis

SmartIntern Sepsis

Price: Free. App Store Link: apple.co/2anvtIx Android Link: Not available.

Earlier this year a consensus group published changes to the definition of sepsis in the Journal of the American Medical Association (JAMA), calling for a move away from systemic inflammatory response syndrome criteria in favor of the sequential organ failure assessment score. Also known as “Sepsis 3.0,” this is the first set of new guidelines since 2003.

The SmartIntern Sepsis app takes the new sepsis guidelines and puts them into easily understandable formats. It also has built-in calculators. In addition, the app has educational aspects to it, helping health care providers better understand the new guidelines. There is some controversy surrounding the Sepsis 3.0 guidelines, so it would be prudent for health care providers to read the JAMA study in detail.

Ways the app could improve. Though this app isn’t as popular as MDCalc, it, too, is not available for Android devices.

Key ways to use the app. If you are trying to implement the new Sepsis 3.0 guidelines, this app will help you calculate scores and learn the new algorithms. This app is focused on emergency medicine physicians, critical care physicians and hospitalists.

Iltifat Husain, M.D., is the editor-in-chief and founder of iMedicalApps.com, the leading physician publication on digital medicine, and an assistant professor of emergency medicine at Wake Forest University School of Medicine.

 

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How physicians get paid

Before you can evaluate your offers, you need to understand the lingo used.

By Matt Wiggins | Fall 2016 | Financial Fitness

 

“Why is it that so many of us think that compensation is only about numbers?” asked one internal medicine resident recently. I stared, not knowing how to immediately answer. After helping thousands of physicians with their contracts through the years, I should have a great answer. Then it struck me!

My answer: Most doctors are led to believe that their struggles through training are due to a number, their training program salary, and that everything will be solved by a new number, their attending income.

This means that many physicians probably focus on the numbers in their contracts without understanding the legal apparatus around them. After all, won’t it be the attending income number that helps you pay off your debt? Won’t it be the sign-on bonus number that allows you to cover the expenses during your transition into this next (or first) job?

Compensation types

The best place to start is by understanding the different types of compensation.

Sign-On Bonuses. A true sign-on bonus is given to you within a short amount of time after you sign the contract. A commencement bonus is given to you within a short amount of time after starting your work with the new employer. A sign-on bonus is often preferred as it may give you some cash during a period when you may not be earning any money. A commencement bonus is often preferred by employers since they don’t have to pay it until you are actually working. If you find yourself negotiating between the two, you may have to compromise and take half after you sign and half once you start.

Guaranteed Salary. When it comes to physicians and finances, this is one of the all-time favorite word combinations. Think about it: You have the word “salary” preceded by the word “guaranteed.” Both are good words, and both connote “security.” This is simply a number that is guaranteed by the employer to be paid to you over the course of the contract. Once the contract is signed, it typically can’t be altered by performance or changes within the employer for the duration of the contract. As specialization increases, it seems that guaranteed salaries are less prevalent. Family practice and general internal medicine doctors will most likely see this type of compensation while interventional cardiologists and neurosurgeons will most likely see the next type of compensation: productivity-based.

Productivity-Based Salary. This is when compensation gets exciting and scary altogether. If you are or will be working for an employer that pays you based on your production, you may have the ability to make more money than if you were on a guaranteed salary. However, you also have more risk. If your production is higher than expected, you will be compensated for it and earn more than some of your guaranteed-salary counterparts. If your performance lags behind expectations, so will your income. The most common metrics for evaluating performance are net collections and RVUs although other models, such as capitation methods, are also used.

Productivity Bonuses. By now, some of you are probably thinking that productivity-based income sounds scary and complicated and you will be glad to not have to keep up with such a thing. However, even those of you on guaranteed salaries may have bonuses tied to some production metric. These bonuses are similar to the salary formulas above in that you will only be paid a bonus if your production exceeds the expected metric and covers the base guaranteed salary you are being paid.

Traps and Pitfalls to Avoid

Now I’ll share with you some of the frequent compensation traps and pitfalls we find in physician contracts.

Repayment Obligations. Several years ago, a doctor came to us and told us a story that should cause trepidation in every physician. He had signed his first contract out of training and was looking forward to moving back to his hometown and working as an orthopedic surgeon with the only practice in town. His salary was stated as $500,000 a year. He thought it was a fair offer and signed without much analysis. However, during the course of his first year in practice, some unforeseen matters arose, and he was unable to work as much as was expected. He kept getting paid his salary, for which he was very grateful. However, at the end of the year, the practice sent him a notification that he owed them $300,000! His salary had a repayment obligation on it and, at the end of the year, they would pay him or require from him a surplus or shortfall based on his production. He did not have $300,000 in his checking account and had to borrow the money on top of his already burdensome student debt.

This story is not uncommon and applies to salaries, bonuses and other benefits. Anything you receive from the employer could be required to be paid back in part or full if you are unable to satisfy certain terms of your contract. It’s worth noting that this doctor was savvier than most we encounter and still made this mistake.

Not Knowing or Tracking the Metric. One of the necessities of all sporting events is that the score be kept by an impartial observer or equally by a party from each participating person or team. In the case of production-based salaries or bonuses, many doctors allow one team, the employer, to make the point system and keep score without the doctor, or a representative of the doctor (CPA, attorney, etc.), understanding the system or keeping score simultaneously. One of the top reasons physicians leave their current employers is due to unmet expectations. One of the most prevalent unmet expectations is income and comes from physicians not understanding or keeping track of the variable parts of their compensation.

Assuming the Best. We all know what assuming does … and it can be costly when it involves physician compensation. Don’t assume anything when it comes to your compensation. There is much more than just numbers that impact your income. Miss those items, and your bank account may have the right to sue you for financial malpractice.

Matt Wiggins (mwiggins@oncalladvisors.com) is the lead advisor and partner at OnCall Advisors, which helps physicians educate themselves on the non-clinical aspects of their lives. For more information like this on other life in medicine topics, check out their “Attending Life” online video curriculum.

 

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How tight is the job market in your specialty? Fall 2016 issue

The PracticeLink Physician Recruitment Index can help you gauge the relative ease or difficulty of your job search.

Fall 2016 | PracticeLink Physician Recruitment Index

 

What’s your competition like?

For job-seekers of all kinds, it can be hard to know. A simple PracticeLink.com search for opportunities in your specialty will give you an indication of the demand for physicians like you, but without knowing who else is vying for those jobs, it’s hard to get an accurate picture of supply.

Challenging.jpg

The Most-Challenging-to-Recruit Specialties

How many other candidates in your specialty are actively looking for jobs at the same time? And how does that number correspond to the number of opportunities available?

That’s where the PracticeLink Physician Recruitment Index comes in. The Index is a relative indication of the ease or difficulty of job searches in various specialties based on supply and demand information gathered by the PracticeLink system quarterly. The larger the “Jobs per candidate” number for your specialty, the better your potential standing in the market.

The change in rank reflects the specialty’s movement since last quarter.

The Most-Challenging-to-Recruit Specialties are those specialties with the highest demand-to-supply ratio in the PracticeLink system. The specialties on this list likely won’t come as a surprise to candidates; they’re often narrow fields.

Demand

The Most-In-Demand Specialties

The Most-In-Demand Specialties represent the specialties that have the most jobs overall posted on PracticeLink—specialties for which the demand for physicians is highest. For the Index, we then rank those in‑demand specialties according to the supply. Those at the top represent specialties with the most jobs available and the fewest candidates per job.

After reading these Indexes, ask yourself: Do these Indexes match your experience of searching for a job in your specialty? Do you need to widen or narrow your job-search parameters as a result?

This PracticeLink Physician Recruitment Index was pulled July 6. Candidate ratios include physicians who have registered with PracticeLink.com within the past 24 months.

 

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The who, what and when of contract negotiations

Your first employment contract may look like it’s written in a foreign language. Here’s a guide to help you know what to look for and what to negotiate.

By Jeff Hinds, MHA | Fall 2016 | Job Doctor

 

Most physicians, particularly those finishing training and looking toward their first practices, have had years of medical training but almost no training about how to find a job—and, once they’ve been offered one, how to determine if contract terms are fair. Here’s some advice on what to look for in a contract and what to know as you head into negotiations.

The Parties Involved

The first step to navigate the negotiation process successfully is to understand who will be involved in the process. From the employer’s perspective, the exact title or role of the individual who handles negotiations will vary by organization—it may be an in-house recruiter, practice administrator, CFO, CEO, attorney or someone else entirely. Regardless of the title or role, it goes without saying that the employer will likely be better versed than you when it comes to the contractual terms within their agreement. It is also worth noting that the agreement was written by an attorney to help protect the interests of the employer. There is too much at risk professionally and personally for you not to ensure the same. Because of this, it is highly advisable that physicians also seek outside assistance from an attorney to help with contract review and negotiation. The investment is minimal when compared to the potential ramifications.

The Proper Timing

It is equally important to know when the actual negotiation process begins. Though certain contractual terms may be introduced early in the process, such as during phone interviews or site visits, formal negotiation of terms should occur later in the process after a contract offer has been made. There may be instances in which employers ask for your feedback on particular terms (e.g., compensation), but it is in your best interest simply to collect the information shared by the employer at that point and hold off on all negotiations until an offer is in hand. Otherwise, you run the risk of being too aggressive and losing a potential offer before it has even been made. Waiting until later in the process will also allow you ample time to collect or research market data, gain feedback from peers or advisers on questionable terms, and assess your overall leverage before determining what to negotiate and how aggressive you can actually be in negotiations.

The Negotiable Terms

Knowledge of which contractual items are actually negotiable is paramount heading into the negotiation process. Though most physician contracts nationwide are similar from a structural standpoint, there are some key provisions/terms that vary by organization and affect the overall quality of the offer. Below are examples of some key items that may be negotiable in any given contract. But again, it is highly advisable to obtain a qualified health care contract attorney to fully assess all terms and determine the most appropriate revisions to seek based on your unique situation.

Base Salary. How does the salary offered compare to published salary surveys and benchmarking data both nationally and regionally for the given specialty? What competing offers exist within the immediate area to determine market value and provide leverage?

Pre-Employment Compensation. What are standard signing bonus and relocation reimbursement amounts for the specialty and region? What is standard when it comes to student loan reimbursement and educational stipends?

Productivity Compensation. What are the metrics used to calculate productivity compensation, and are they reasonably attainable based on the market data available? Will a base salary remain in place for the duration of the contract term, or will compensation transition to productivity-only?

Termination Language. What termination with cause and termination without cause provisions exist, and are they adequately defined? Is there a notice and cure period in place that provides the physician with added protection from termination with cause?

Restrictive Covenant. Does the contract possess noncompete language, and are the time and distance restrictions reasonable? Do the restrictions apply to areas surrounding a single location or to areas surrounding multiple locations that are part of the employer’s network?

Professional Liability Insurance. What type of professional liability insurance will be provided—a claims-made or an occurrence policy? And if applicable, will the employer or the physician be responsible for the full (or partial) expense of acquiring tail coverage?

Scrutinizing your contract, even with a lawyer’s assistance, may seem laborious at first, but it’s time well spent. By negotiating contract terms before you sign, you will reap the benefits of a more advantageous agreement for years to come.

Jeff Hinds, MHA, is president at Premier Physician Agency, LLC, a national consulting firm specializing in physician job search and contracts.

 

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Signing a letter of intent

How does a letter of intent differ from an employment contract? We break down what you need to know.

By Kyle Claussen, J.D., LLM | Fall 2016 | Legal Matters

 

A letter of intent (LOI) or “offer letter” outlines the terms of employment in a much simpler format than what will be presented in a contract. The LOI is a preliminary document based on the mutual interest and good faith of both parties. It acts almost as an informal promise between you and your future employer and can be an important mental step toward solidifying an employment agreement. As helpful as an LOI can be in giving you a sense of the terms of your full contract, you do need to scrutinize the components of the LOI before signing. Here are some of the potential pitfalls of signing an LOI without proper review.

Know: What you’re signing

Generally, an LOI will not be legally binding. It references a future employment agreement that will effectuate employment. There are instances, however, in which certain provisions within the LOI can, in fact, be legally binding. These provisions may include that you will negotiate exclusively with this employer for some period of time or that the negotiations will remain confidential. It’s easy to assume that, because the LOI is less formal than the contract, you can just sign it and look at the contract terms more closely later. This can be a critical mistake, however, because it may cost you leverage when you negotiate some of those major employment terms down the road. Do not sign an LOI unless you are certain that key outlined components such as compensation will meet your needs.

Here is an example of an explicit statement included in an LOI that ensures it is not binding:

“The proposed terms of this letter of intent are non-binding and for discussion purposes only. It is the intent of the parties that these terms and conditions may be modified or changed, in whole or in part, pending a binding agreement to be negotiated and executed by the parties. Furthermore, nothing in this section shall be interpreted as obliging any of the parties to enter into any agreement.”

Check: Is your LOI tailored to you?

An LOI or contract may work for one physician and be totally incompatible for another. When looking at an LOI, it may be difficult to determine whether it’s based on a one-size-fits-all contract. Look out for provisions that don’t reflect the actual position or match your scope of practice. Reusing contract and LOI templates is a much more common practice than you may think. You will typically be able to discern how individualized your LOI is by how well the key terms in the letter seem to match your specific situation.

Understand: What’s not included

Remember that an LOI is not a comprehensive list of the terms of your employment. LOIs are typically composed of the highlights of an employment agreement, such as pay, benefits and length of contract. That means terms with a more negative connotation, such as termination provisions, will be saved for the contract.

One of the important terms that may be missing from your LOI is a noncompete agreement. Noncompete clauses, or restrictive covenants, prohibit a physician from practicing within a certain geographic area after leaving a practice. For example, being restricted from practicing within a 60-mile radius for two years may be more reasonable for a neurosurgeon than a family physician.

Another value point that may not be addressed in the LOI is malpractice tail coverage. Malpractice tail coverage is an extended reporting period endorsement, offered by a physician’s current malpractice insurance carrier, allowing you to extend coverage after you leave a practice. If you have a less expensive “claims-made” policy, then either you or your employer must purchase tail coverage upon termination of employment. If you have the more comprehensive “occurrence-based” policy, then you have malpractice coverage for any claim brought against you as long as you had that insurance carrier during the alleged event.

Know: You can still negotiate

As mentioned previously, an LOI generally won’t be binding on major terms. However, some employers will still see the agreement as a promise, and therefore it can be hard to go back and change or negotiate certain provisions later. Some employers feel as though signing an LOI means making a deal, but remember that signing does not obligate you to fulfill any LOI provisions that are not legally binding. Contract negotiation is not just a mere formality after you sign the letter of intent—it is a legitimate chance for you to adjust any part of the contract that doesn’t meet your needs.

The letter of intent is an important step in moving closer to employment. After you have taken a critical look at the LOI, considered potential pitfalls and signed it, try to begin the formal contract review and negotiation process as soon as possible. The LOI plays a central role in building momentum in the hiring process, and you don’t want the process to slow down or take up any more time than necessary.

Kyle Claussen, J.D., LLM is vice president at Resolve Physician Agency, Inc.

 

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Navigating the rapid growth of telemedicine

Telemedicine is a useful way to practice medicine, but physicians need to be aware of legal and regulatory issues regarding licensure, credentialing and malpractice liability.

By Jeff Atkinson | Fall 2016 | Reform Recap

 

Telemedicine is on the rise. From 2013 to 2015, the number of people using telemedicine increased from 10 million per year to 15 million, according to the American Telemedicine Association. More than half of U.S. hospitals use some form of telemedicine, and insurers are adding telemedicine coverage too.

There are multiple definitions of telemedicine (sometimes referred to as telehealth). The Centers for Medicare & Medicaid Services in its Medicaid regulations states:

Telemedicine seeks to improve a patient’s health by permitting two-way, real-time interactive communication between the patient and the physician or practitioner at the distant site. This electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment.

Cost-effective visits

Telemedicine is viewed as a cost-effective alternative to face-to-face meetings. It can be particularly important for providing care in rural areas and for patients who have mobility problems. Telemedicine may also encompass remote diagnostic services such as interpretation of imaging studies. Telemedicine is not a distinct specialty, but a method of delivering service.

Telemedicine has been found to be useful in many settings and situations, for instance:

  • For geriatric patients, a televisit may eliminate the need for hospitalization or a trip to the emergency room. This is particularly useful for patients in assisted-care facilities or nursing homes.
  • For patients who have access only to small community hospitals and need expertise beyond what those hospitals offer. In some cases, live consultations with physicians in larger hospitals could prevent these patients from needing to be transported to larger hospitals.
  • For patients who prefer the conveniences of being at home—or want access to medical help at late hours and on weekends—telemedicine provides an opportunity for them to consult with health care providers. In some cases, they can even attach medical equipment to their computers or telephones to transmit information to the providers. University of Iowa Health Care offers such a service to residents of the state via computer, tablet or smartphone, and patients pay a flat fee of $50 by credit card.

Variation in state laws

State laws vary considerably when it comes to telemedicine. A 2015 survey by the American Telemedicine Association reports that, regarding licensure and standards, “22 states averaged the highest ‘composite grade,’ suggesting a supportive landscape that accommodates telemedicine adoption and usage.” Twenty-six states and the District of Columbia were rated “in the middle with room for improvement,” and two states were described as having “many barriers for telemedicine and advancement.”

Texas and Alabama are the two states with the highest barriers. Texas’s barriers include a regulation by the state medical board that requires an in-person physical exam before telemedicine can be utilized. This regulation is being challenged under federal antitrust laws. A trial court enjoined enforcement of the regulations, and the state is appealing the decision (Teladoc, Inc. v. Texas Medical Board, 5th Circuit Court of Appeals, appeal docketed Jan. 8, 2016). Critics of the Texas regulation say the regulation stifles competition and interferes with access to care, particularly in remote areas of the state.

States with laws or regulations that are friendlier to telemedicine do not require in-person visits as a precondition to telemedicine services. Laws in some states require insurance companies to pay for telemedicine on the same basis as face-to-face diagnosis and treatment (when telemedicine services are an appropriate standard of care for the issue at hand). Such laws are sometimes referred to as “telemedicine parity laws.”

Medicare and Medicaid will pay for telemedicine services, although in the case of Medicare, payment is often limited to services provided to rural Health Professional Shortage Areas. There are proposals before Congress and regulators to expand the telemedicine services for which government programs will pay.

Information on state laws pertaining to telemedicine can be obtained from the American Telemedicine Association State Policy Resource Center.

Malpractice issues

An aspect of parity relates to medical malpractice issues. A physician who engages in telemedicine in a state outside the state of the physician’s office will be deemed to have submitted him- or herself to the laws of the state in which the service is rendered, according to the American Health Lawyers Association.

Physicians practicing telemedicine out-of-state (or perhaps in a different area within their state) should consult with their malpractice insurance carriers regarding scope of coverage. Insurance rates may be different when practicing in more than one state.

In addition, informed consent from a patient should include discussion, when applicable, of the limitation of telemedicine compared to in-person visits.

Licensing and credentialing

Physicians considering using telemedicine to deliver care also need to be aware of licensing and credentialing issues. Many states require that, in addition to being licensed in the state where his or her office or hospital is located, the physician who delivers diagnosis or treatment via telemedicine must also be licensed in the state where the patient is located. The license may need to be a full license to practice medicine (such as in California), or it may be a limited license for telemedicine only (such as in Louisiana and Minnesota).

A related issue is credentialing. The Joint Commission on Accreditation of Health Care Organizations (JCAHO) allows, in some circumstances, an institution to rely on the accrediting process of the telemedicine provider if the provider’s institution is accredited by the JCAHO.

Communications technology has enhanced many aspects of life—health care included. In the decades to come, we can expect to see a continuation in the rapid growth of telemedicine.

Jeff Atkinson teaches health care law at DePaul University College of Law in Chicago.

 

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PracticeLink is a physician’s career resource

Wondering how PracticeLink can help you? Our physician relations manager explains what PracticeLink offers to job-seeking physicians.

By Brian Brown | Fall 2016 | PracticeLink Tips | Uncategorized

 

For more than 15 years, PracticeLink’s physician relations team has worked closely with physicians as they search for their first or next practice. Our physician-centered team is trained to help you navigate the job-search process and be a trusted lifelong career resource. More than 5,000 facilities representing more than 28,000 opportunities nationwide post their jobs on PracticeLink.com. We are proud to be the most widely used physician recruitment resource in the industry!

The in-house recruiters who post jobs on PracticeLink pay to post their opportunities, so PracticeLink is always free for physicians to use and enables you to connect directly with the employer. We are not third-party recruiters; we put you in direct contact with the employer or hiring organization.

What does PracticeLink do?

PracticeLink.com lets you easily search for a new practice by specialty, profession, geography, keyword and more. It is an easy, fast and free way to search and apply for jobs that interest you.

More than 80,000 residents, fellows and practicing physicians also receive PracticeLink Magazine, which features quarterly themed content that coincides with your job-search needs: Contracts & Compensation, Quality of Life, Job Search and Interview.

PracticeLink also hosts physician job fairs. At each event, we provide an educational seminar based on our 10-step timeline, “When to Do What in Your Job Search.” Find our upcoming job fairs at PracticeLink.com/JobFair.

Connect with us!

Start browsing jobs confidentially on PracticeLink.com, or create a free account for additional benefits, such as applying to jobs with one click; easily creating, saving and sending your CV to recruiters; and receiving alerts when new or updated jobs are posted in your specialty. We look forward to being able to help you manage your job search and find your dream practice!

Contact the team for free job-search help at (800) 776-8383 ext. 2, PhysicianRelations@PracticeLink.com, or PracticeLink.com/Physicians.

 

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