Implementing the Affordable Care Act

Following the election, the Obama administration moves forward with insurance mandates, Medicaid expansion, insurance exchanges and more.

By Jeff Atkinson | Reform Recap | Uncategorized | Winter 2013

 

With the reelection of President Obama and the upholding of most provisions of the Affordable Care Act by the U.S. Supreme Court, the path for continued implementation of the act has been cleared, although implementation is likely to take longer than originally hoped by the Obama administration.

A key feature of the act is expanding health insurance for more than 30 million people who are currently without health insurance. This will be accomplished in several ways.

Individual mandate in 2014

The individual mandate for persons to acquire health insurance if it is not provided by their employers or other sources is scheduled to take effect January 1, 2014. The mandate applies to persons who are required to file federal tax returns. (In 2012, that threshold was $9,000 for individuals under 65, and $19,000 for married persons under 65 filing jointly.)

The penalty for people who do not obtain health insurance starts low and grows higher. In 2014, the penalty will be $95 per adult or 1 percent of family income, whichever is greater. In 2016, the penalty will be $695 per adult or 2.5 percent of family income, whichever is greater. The penalty was upheld by the Supreme Court in 2012 as a constitutional use of Congress’ taxing power. A potential problem for effective implementation of the act is that the penalties are low enough that some people may choose to pay the penalties rather than spend a larger amount on health insurance.

Employers of more than 50 people also are required to provide health insurance to their employees or pay a penalty of $3,000 per worker per year for each employee that received a tax credit for purchasing the employee’s own insurance.

Medicaid expansion

The Medicaid program will be expanded to cover individuals and families who are at 133 percent of the poverty level. In 2012, 133 percent of the poverty level is $14,856 for an individual and $30,657 for a family of four in the 40 contiguous states—and higher dollar amounts for Alaska and Hawaii. The expansion of the Medicaid program will cover about 17 million more people and also is scheduled to take effect in 2014.

Republican governors in six southern states (Florida, Georgia, Louisiana, Mississippi, South Carolina, Texas) have threatened to block Medicaid expansion in their states, even though the federal government will pay the added costs of expansion until 2016. It is possible that state legislatures in those states may override the governors or induce the governors to change their minds.

For people with incomes above the eligibility level for Medicaid, tax credits will be available to help pay for health insurance. The tax credits apply to persons with incomes up to 400 percent of the poverty level. (In 2012, 400 percent of the poverty level is $44,680 for an individual and $92,200 for a family of four.)

Establishing insurance exchanges

The uncertainty of whether President Obama or Mitt Romney would win the election caused a showdown in implementation of some parts of the Affordable Care Act. States were supposed to decide in November whether they would establish their own insurance exchanges, establish exchanges in cooperation with the federal government, or leave the establishment of exchanges to the federal government.

Insurance exchanges would facilitate purchase of health insurance by individuals and small employers by spreading the risk to larger groups and (hopefully) making insurance less expensive than it would be under the current system of purchasing insurance for individuals and small employers.

Approximately one-third of states have announced plans for establishing insurance exchanges. For the remainder of states, the Obama administration has granted an extension of time to decide whether to establish insurance exchanges. Generally, Republican states are more likely to be undecided or not willing to establish their own exchanges. If a state does not establish its own exchange, the federal government will.

New regulations on the horizon

Implementing the Patient Protection and Affordable Care Act (or any complex new law) requires a lot of regulations to work out the details. Since health care reform was a highly controversial issue in the election, the Obama administration slowed down the release of new regulations in the months prior to the election, probably to avoid yet more controversy.

Now that the election is over, the pace of new regulations and proposed regulations will increase. Subjects of the regulations will include the specific “essential benefits package” that health insurance plans must cover, exceptions to the insurance mandate for individuals and employers, excise taxes on medical devices, and the requirements of non-for-profit hospitals to maintain tax-exempt status.

Payments to physicians

Payments to physicians for primary care will rise under the Affordable Care Act. Effective January 1, 2013, Medicaid payment rates for primary care providers will be set at 100 percent of the Medicare rates. The increased payments will apply to family medicine, general internal medicine and pediatric medicine. The federal government will pay all of the added costs from the increased rates through the end of 2014 at which time some of the added costs may shift to the states.

Although there is added emphasis on primary care and increased payments to primary care providers, cost containment is a high priority under the Affordable Care Act. Methods for containing costs while promoting quality care include increased use of bundled payments and payments to accountable care organizations (ACOs).

With bundled payments, groups of providers—including hospitals, physicians and home care agencies—will receive a fixed sum for a patient’s inpatient care and post acute care services rather than individual payments for each service performed. Depending on the plan to which providers agree, payments may be increased or decreased depending on whether the providers meet quality and cost-containment goals.

A Medicare pilot program for bundled payments will begin in 2013. One of the challenges will be to develop equitable systems for dividing the fixed payments between providers. If the bundled payments work out, their use will be expanded, both by the government as well as private insurers.

Jeff Atkinson (JAtkin747@aol.com) teaches health care law at DePaul University College of Law in Chicago.

 

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Live and Practice: Family friendly spots for physicians

Four cities where nature and humans seem to collaborate to provide an environment conducive to family well-being.

By Eileen Lockwood | Live & Practice | Winter 2013

 

Remember Cinderella, the stepchild literally from the fireplace cinders who triumphed in the end when she enchanted the handsome prince? This is the happy life of the fairy tale world.

But wait! Some of the make-believe may be seguing into reality. The good life seems to have become a fixture in some American cities, thanks to a convergence of energetic citizens, dedicated government, good schools, concerned employers and, in some cases, almost-heavenly natural surroundings.

PracticeLink searched the country and focused on four communities that seem to meet these family-friendly qualifications. It’s time to meet Hagerstown, Md.; Provo, Utah; Rochester, N.Y.; and Kansas City, Mo.

The Hub City
Hagerstown, Md.

An aerial photo of Hagerstown’s main street can be misleading. Low-slung buildings, a liberal sprinkling of leafed-out trees and a few cars cruising through an intersection seem like the hallmarks of a sleepy, out-of-the-way burg. “I can’t think of a time except really early morning when it’s not busy,” says Richard Wright, the communications officer for Washington County Public Schools (headquartered in Hagerstown).

Near that intersection, reports Sidney Gale, physician recruiter for Meritus Medical Center, there are businesses, a TV station, the visitors bureau and a thriving coffee shop, not to mention popular restaurants. A nearby two-block area is home to the Arts and Entertainment District, the Maryland Symphony Orchestra and the Maryland Theatre, all with healthy servings of music and stage shows. A recent newcomer in the district is the Barbara Ingram School for the Arts, a perfect location for dedicated students.

Not many GPS degrees away, cars, patients, doctors and nurses come and go in the thriving 55-acre Meritus complex. Hagerstown’s population may be small (about 40,000), but Meritus offers care to a metro-area population of more than 269,000 and is the hub for much of western Maryland and nearby Pennsylvania and West Virginia areas. The stage is also set for an ever-increasing patient population. Located in the Cumberland Valley between the Allegheny and Blue Ridge Mountains and not far from the celebrated Skyline Drive, the area is cited as Maryland’s fastest-growing metro area.

In its new quarters since 2010, Meritus provides care facilitated by the latest state-of-the-art technology. Imaging and lab facilities, computerized physician order entry, electronic documentation and even a pneumatic tube system that cuts wait time for medications are all strategically located near the ER. A connecting building, the huge, “full-service” Robinwood Professional Center, houses 125 care providers, lab facility, pharmacy, medical devices dispensary and offices for home health services, not to mention a café for hungry patients and professionals.

“I call it the Mall of Doctors,” says family specialist Joseph Asuncion, M.D. “It’s one-stop shopping. You can find any specialist you need there.”

Joseph Asuncion, M.D., and his family enjoy all that Hagerstown, Md., has to offer—from the Maryland Symphony Orchestra to hiking nearby.

Asuncion is well acquainted with this northern part of Maryland, where the “skinny” area of the state begins and then meanders to the west. He arrived with his parents at age 6 and grew up in the area. When his parents wanted him to touch base with his heritage, he returned to the Philippines to study medicine, but the lure of Maryland was too strong to resist. He began practicing in Frederick, 25 miles south of Hagerstown, but after 15 years, he joined Meritus. Two years later, weary of the 40-minute commute, he moved his family north. “A lot of patients followed me from Frederick,” he says. “They said, ‘You look a lot happier.’ And I am.”

The grand hospital facilities were by no means the only draw for him and his family, although he adds, “They take care of the doctors. Good pay, a good office, good facilities and good workers. (Professionally), what else could you ask?”

Hagerstown has been a good family location for him, and the Asuncions have taken ample advantage of the Maryland Symphony Orchestra, “wonderful plays and shows” and “terrific restaurants.” Not to mention other educational offerings. For instance, says Gale, the recruiter, “Hagerstown has the most certified museums of any county in Maryland.”

“Here,” Asuncion says, “you have the city life but basically the outdoor life, too. The mountains are within 30 minutes, it’s an hour to major ski areas and it’s two hours to the beach. We take advantage of it all!” Not to mention the proximity of Baltimore and D.C. On a recent Washington trip, he was fascinated with the International Spy Museum in particular. “I was actually crawling in the duct work with our daughter and spying on people,” he says with a laugh.

Education is also alive and well—and thriving—with a total of 46 public and at least 13 private schools, including several gifted or magnet institutions as well as schools for those who might have fallen into the cracks along the way. There’s an evening high school for those who want to retake courses or accumulate additional credits, a “non-traditional” night school for those unable to attend during regular hours and a “family center” for young parents to finish their education at times when they can find babysitters. “We worked hard to develop programs to fit students who may not fit into traditional settings,” says Wright at the education office. “We want them to have a great start in their next phase of life.”

The pleasant, family-friendly life was not always thus in this strategically located city near the Potomac River. In 1762, a multitasking German immigrant (farmer, fur trader, politician) from Pennsylvania, Jonathan Hager, acquired 10,000 acres and laid out a plan for a new town. He had cleverly set up shop at the crossroads of an important Native American trade route. The town became a transportation hub, especially after three railroads converged in a wagon wheel pattern.

But the happy ending became a distant dream with the start of the Civil War. Hagerstown’s excellent trading location in the Cumberland Valley between the Blue Ridge and Allegheny Mountains became an excellent strategic military location. The inescapable conclusion: Not one, but four major campaigns, including the Battle of Antietam, the one-day bloodiest conflict on American soil. The city itself was occupied off and on, and local doctors and citizens aided men from both sides. After the war, some 2,800 Confederate soldiers were buried in a special section of the city’s Rose Hill Cemetery.

Today the area’s natural beauty and opportunities for hiking and other mountain activities are natural draws for residents—and vacationers. The city business climate includes branches of several national corporations, including Volvo Powertrain, First Data, FedEx Ground and a Staples distribution center, as well as state and federal government enclaves. But, lest we forget, a Civil War Plaques District serves as a reminder of bad times past.

Battle reenactments also draw large attendances. Although the subject is serious, Asuncion recalls one expedition with a twist. “It was so real,” he remembers. “You had a line of a hundred guys in front of you, with a hundred people aiming guns at you. Cannons were going off on the hill. People were marching. Then it brought you back to reality—when a yellow fire truck came down the hill!”

Welcome Home!
Provo, Utah

“Welcome Home” is Provo’s new slogan, complete with bright artwork symbolizing water, mountains and sunrays. It’s part of a new city makeover plan, “Vision 2030,” with the tagline, “How well are we doing, and how can we improve?”

However, it’s hard to believe that there’s room for much more enhancement, beginning with the environment. City spokesperson Helen Anderson reels off the natural assets of the area—mountains, lakes, bike trails, climbing…But that’s just a start. Provo is located in the Utah Valley beneath Mount Timpanogos, a massive, rugged peak of the Wasatch Range at the western edge of the Rockies. It’s an inspiring setting for the circular, high-spired white Provo Utah Temple that stands out against the stark gray mountain. The great outdoors is a perfect accompaniment, filled with mountain and riverside trails, fly-fishing, inner tube floating, boating, trail riding and journeys of exploration along picturesque highways.

Actor Robert Redford’s Sundance Ski Resort is a mere half-hour northeast of Provo Canyon and offers a surprising lineup of other amenities, such as a summer theater, Utah Symphony concerts, an author series, and, of course, the well-known Sundance Film Festival.

Jordan Blanchard, M.D., notes that his residency program has been particularly family friendly. He plans to practice in rural Idaho after residency.

All of the above enhance the good life for Stephen Welsh, M.D., and Jordan Blanchard, M.D.  Both are outdoors oriented and in family medicine residency programs at the Utah Valley Medical Center and have settled on specific career paths. “Growing up,” says Welsh, “I wanted to do something where I was with people. I didn’t want to sit at a desk. I love a long-term relationship with people, because it keeps primary medicine more interesting. In Provo, it’s also fun to take care of a population that cares about its health and people who listen to my advice.”

Says Blanchard, “I want to go rural in Idaho.” More specifically, he’s looking to a career life in the ER.

As homegrown Utahans, they’ve long been aware of Provo’s assets and outdoor advantages. Welsh’s undergraduate experience was at Brigham Young University, the Mormon-founded and oriented institution that has become the city’s signature identity. Blanchard attended BYU-Idaho. Both earned medical degrees at the University of Utah in Salt Lake City. They’re each married, with children (three for Welsh, four for Blanchard), whom they enjoy introducing to the great outdoors just beyond their doorsteps. “Probably our favorite thing,” reports Welsh, “is the mountains. It’s only takes about 20 minutes to get up to a canyon, and we go hiking a lot.” The ambience includes “really cool parks in the mountains where we take the kids to play and see the leaves.”

For special excursions, two choices are within easy reach. Welsh’s wife takes the brood to Seven Peaks, a water and amusement park. For an even bigger treat, both the Welshes and the Blanchards take a short ride to Thanksgiving Point, a 312-acre wonderland with activities for all ages, including a demonstration farm, the Museum of Ancient Life (a huge collection of mounted dinosaurs), a new Museum of Natural Curiosity and 55 acres of gardens. A yearlong family pass is a bargain at $175.

Provo parents are committed to quality education for their children. Almost all schools have been built since the 1990s, and four since 2002. The oldest (1931) has been retrofitted with an iPad and Apple TV to connect students with teachers, and some schools boast several desktops in each room. But Laken Cannon, community relations director for the system, credits the 90+ percent graduation rate not only to “phenomenal classroom instruction,” but to the many volunteers. “One thing I really appreciate is that we have such involved parents,” Cannon notes, also citing at least one unusual program. “One school is across from the BYU law school, and every fourth grader is assigned a law student as a kind of big brother who will help with homework if needed or simply play catch with a group. It’s someone they can look up to who is doing something good.”

Meanwhile, back at the hospital, Blanchard had discovered a heartwarming adjunct to his job—an unusually family-friendly program. He recently noted, “My wife went to lunch today with the head of the residency program and the other wives. He wanted to check up on how things are going.” But there’s more. “Almost every week, the spouses go out for lunch. There are picnics, and they get together with the kids for play groups or at the park.”

The hospital itself is one of 22 facilities operated by Intermountain Healthcare, an organization that enjoyed a moment of national recognition when, in the first presidential debate, Mitt Romney equated it with other celebrated American clinics. Utah Valley Regional Medical Center strives to deliver “quality care at the lowest appropriate cost.” It’s now a Level II trauma center with several programs of excellence, plus a 24-hour life-flight service and 12-hour InstaCare on the BYU campus.

Recent additions include a sleep center, expanded NICU and an emergency baby-delivery simulation program. A new outpatient center incorporates, among others, a women’s center, same-day surgery, sports medicine and orthopedic procedures.

About eight years ago, Intermountain also started its LiVe program to improve fitness and eating habits among teens. An intriguing and popular feature is a group of mobile vending machines. The contents are packaged to look like cookies and candy, with no coins required. The packages contain helpful health tips.

An outsider impression about friendly places is probably that they must all be small towns. Not so in this case. The Provo population is about 112,000, and the metro totals some 527,000. Another surprise, for its size: the strong sense of patriotism, which culminates every year in the huge America’s Freedom Festival.

Also, in its size group, Provo is considered the most conservative city in the U.S. However, that doesn’t dim its friendly reputation—for everyone, including thousands of foreign students who attend BYU. There’s also the nearby Mormon missionary training center.

As for the “Welcome Home” slogan, it translates to newcomers as well. “People not familiar with Utah might think there’s a lack of diversity here,” says Welsh, “but Provo especially is one of the most diverse areas in the state.” For his family, proof is just up the street. “We have neighbors from Nepal and Mongolia.”

Flower City
Rochester, N.Y.

Considering the array of floral-related events in Rochester, N.Y., it’s easy to joke that the flower population is exponentially larger than the people population. Exhibit A: the 10-day Lilac Festival in May, a fixture since 1898. Today, it’s become an “international springtime party,” headquartered among some 1,200 lilac bushes in the city’s Highland Park.

The Maplewood Rose Celebration takes over in June, offering jazz, wine and a Father’s Day Picnic in a setting of 5,000-plus roses. Flower City Days at the Market absorb five Sundays in May and June, when growers show off hundreds of plants at the huge Rochester Public Market. And there’s more: seemingly insatiable floral devotees attend garden talks in spring, summer and fall.

The flower scene, of course, is just one of Rochester’s considerable assets, both natural and manmade. Early settlers—and travelers—were attracted by the High Falls of the Genesee River, which flows through the city. The falls’ 96-foot drop created an ideal location for many gristmills—and prompted the city’s previous nickname, the Flour City. Other manufacturing followed, but the business climate eventually concentrated on technology, as in Kodak, Xerox and Bausch and Lomb, the company that progressed from monocles to contact lenses, implants and many other vision-related products.

Not surprisingly, this trio attracted some of the best and brightest employees. “Kodak is in trouble (these days),” noted Mayor Thomas Richards in his 2012 state of the city address, “but its workers have provided the area with an extremely skilled workforce that has been able to rebound into other industries.”

One way or another, Rochester is now noted for the fifth most patents per capita in the U.S., and as one of the top 20 most innovative cities, according to a city spokesman. Hand in hand with the technical brainpower is an unusual number of colleges in the area, but with a special spotlight on the University of Rochester and Rochester Institute of Technology.

Ana Molovic-Kokovic, M.D., and family enjoy Rochester’s many cultural activities.

This concentration was important in the decision of internist Ana Molovic-Kokovic, M.D., to accept a position with Rochester General Hospital after finishing a residency in New York City’s crowded borough of The Bronx. “With a bachelor’s degree in mechanical engineering from my country, Serbia, my husband was looking to continue his education,” she says. In fact, thinking ahead for her daughter’s education, she was pleased to learn that all of the Rochester public schools are rated among the hundred best in the nation, according to U.S. News and World Report. (Suburbs such as Brighton, Fairport and Pittsford are often cited among the best.) Overall, the city is “not quite the same as Boston or other big cities,” she says, “but big cities have crowds and long commutes. Here there’s no rush hour. And it’s only 17 to 20 minutes from my home to the hospital.”

She cites two other major motivations: “I wanted to be in the Northeast. I like New York State for many reasons, and I wanted to live somewhere at a lower pace where it was more affordable and easy to start a new family.”

Molovic-Kokovic soon discovered other serendipities for children. Her daughter, almost 3, is enrolled in music classes for children at the Eastman School of Music. For fun and fascination, she “absolutely loves” the immense National Museum of Play, an endlessly fascinating playground, featuring not only a collection of some 400,000 toys but many captivating interactive opportunities, from “Sesame Street” to the history of video games. Its architecture alone is irresistible. A huge tumbling set of colorful blocks houses one display area, a caterpillar-like corridor links buildings and a wing-shaped structure encloses a butterfly garden.

The original museum was established by super-philanthropist Margaret Woodbury Strong, whose most prominent philanthropy has been Strong Memorial Hospital, flagship facility of the University of Rochester School of Medicine and Dentistry. It’s noted for its tertiary—and quaternary—care, especially research and treatments above and beyond other hospitals in the region. Also in the UR orbit is Highland Hospital, one of the first homeopathic hospitals in the U.S. when it opened in 1889.

Current excitement is about the groundbreaking for a third UR facility, the 245,000 square-foot Golisano Children’s Hospital, thanks to the generosity of yet another benefactor. The university’s largest capital project in history, Golisano Children’s will include 52 private rooms, a greatly expanded NICU and a “hospitality” suite almost equal to an extended-stay motel.

Rochester General, where Molovic-Kokovic practices, has been noted for its “unparalleled level of personalized attention and compassionate care.” Spokesman Marty Aarons also notes that it’s been cited the most visitor-friendly hospital in Rochester and among the top four in New York State. One example is a new service—Tuesday afternoon tea and scones for patients and visitors.

The list of General’s quality care awards runs as long as three pages. One “item” is its strategic RIT alliance to collaborate on biomedical research. Two unusual “offerings” are a school of medical technology and a two-year youth apprenticeship program for up to 32 high school students that provides 10-week rotations through
20 departments. Director Kimberlyn McDonald notes that all participants for the last seven years have been accepted to college.

The medical technology school, begun in 1934, is probably the second oldest in the U.S. and still survives in a time when many hospitals have eliminated the sequence. “In this economy, it is a wonderful thing to be in this major,” says the program director, Nancy Mitchell. “The day they finish (the program) they can step into a position.”

But medical care and tech business startups are not the only evidence that Rochester is alive and well and keeping up with the times. More than 50 renewal and reconstruction projects are marked on a city business/redevelopment map.

There’s no shortage of leisure activity, either, including 80 or 90 city-sponsored annual events. In addition, special events range from a cookie contest to a summer concert series at High Falls, plus professional sports teams to follow, golf courses and summer swimming programs at 24 locations. Or, a simple but favorite activity of the Molovic-Kokovic family—walking and jogging along the banks of the Erie Canal.

City of Fountains
Kansas City, Mo.

This Midwestern American city on the banks of the Missouri River features at least 250 fountains.

This is a thriving metropolis surrounded by suburbs on both sides of the Kansas-Missouri state line. Its can-do attitude has spawned public and private funds to build spectacular entertainment centers such as the new Kauffman Center for the Performing Arts and the huge, rubber-tire-shaped Sprint Center.

You could say that Kansas City has not one, but four downtowns, starting with the original business district near the Missouri River.

The Crown Center area is about 30 blocks south, followed by the Westport District, the 1800s jumping-off point for four historic westbound trails.

Finally, edging a picturesque creek, is the Country Club Plaza, an upscale version of a Spanish marketplace with hanging flower baskets, sculptures, fountains and art tiles. One land developer has noted, “The Plaza has had the longest life of any planned shopping center in the history of the world.”

While he’s impressed by all of the above, Greg Canty, M.D., succinctly sums up his impression of the city. “The nicest thing is meeting nice Midwestern people.”
He adds, “It’s a very easy city to live in. There’s a short commute time, and there’s hardly anyplace where traffic is so bad that it makes you late.”

Canty moved his family into Brookside, one of some 200 designated city neighborhoods, this one a comfortable 1930s-oriented area with cozy shops and restaurants. Although he doesn’t give high marks to the school district, he notes that “Most folks choose private schools.” As an alternative, the Missouri Charter Public School Association lists 24 schools in the area. Kansas City public schools, unfortunately, have been on a rocky road for some time, with at least two dozen superintendents in the last 40 years and significant low academic performance that has led the state education board to rescind the district’s accreditation.

Not all is gloom, though, says Kent Yocum, a teaching and learning coach in a neighboring district who lives in the Coleman Highlands. “There certainly are superstars (as well as) some not pulling their weight. I really don’t think it’s probably any different from any other environment.”

Canty, who grew up and was educated in Kentucky, moved to Kansas City two years ago to become medical director for the sports medicine program at Children’s Mercy Hospital, focusing on adolescent and school-age athletes. He has since hired two more specialists and expects to be seeking more. “The clinic is full about every day,” he reports.
Like other KC hospitals, Children’s Mercy has satellite facilities in other metro locations. Among other services, it treats 90 percent of area pediatric cancer patients and boasts the highest survival rates (also 90 percent) in the country…a third of the way into a 15-year major expansion plan.

It wouldn’t be too much of a stretch to rename the city Hospital Town, considering the number of facilities per capita in Kansas City proper, plus several in adjoining suburbs, as well as the colossal University of Kansas Medical Center just across the border.

The largest, in terms of beds (611 at last count), is easily Saint Luke’s Hospital, the flagship of a network of 10. It’s one of only three Missouri hospitals to receive a Malcolm Baldrige Award. Among its more advanced services are kidney, heart and, as of 2012, liver transplants, the latter requiring one of the shortest wait times in the U.S.

With more than 80 smoke-grilled pork bistros and 35 jazz clubs and restaurants, not to mention dozens of other leisure-time possibilities, it’s hard to believe anyone who says he’s bored in Kansas City.

 

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Finding a practice that fits your life

A myriad of practice options await depending on the kind of lifestyle you’re looking for.

By Karen Childress | Feature Articles | Winter 2013

 

Whether you’re looking for your first practice opportunity or your fifth, options abound. What constitutes the “perfect job” depends entirely on your practice style, personality, values, and how hard you want to work.

Edgar Bulloch, M.D., provides care to the uninsured, low income or medically underserved. A volunteer experience at a free clinic in med school piqued his interest in this kind of practice opportunity.

It’s no secret that more physicians are opting for employed positions today, viewing them as more secure and having a lower hassle factor. But even within the realm of employed opportunities, there is a wide variety of choices offering greater and lesser degrees of autonomy, security, recognition and income. And each comes with its unique challenges and benefits.
In this article, we profile five physicians working in five very different settings: the military, locum tenens, a rural clinic, correctional medicine, and in a big city clinic caring for underserved patients.

Their stories illustrate just how varied careers in medicine can be and underscore the fact that doctors have plenty of latitude when it comes to how and where to practice.

Serving the underserved
As a medical student, Edgar Bulloch, M.D., volunteered at a free clinic where he treated uninsured patients who might not otherwise have been able to afford medical care. This experience piqued his interest in working with underserved populations. “That’s what initially drew me in. I had very good mentors in that program. They were doing so much for patients, for no compensation,” says Bulloch.

When he completed his OB/GYN residency at Texas Tech University Health Sciences Center in El Paso two years ago, Bulloch, 35, considered an academic career where he would have been both teaching and caring for underserved patients. But as he began exploring practice options, he heard about an opening at Family Health Centers of San Diego (FHCSD). A nonprofit federally qualified health center (the second largest in the country), FHCSD was founded in 1970 and has 33 sites, including 13 primary care clinics, in and around the San Diego area. Their mission includes providing comprehensive care for uninsured, low income, and medically underserved patients.

“It was the first interview I went on and I really enjoyed everyone I met,” Bulloch says.

After going on a few other interviews, Bulloch decided that Family Health Centers was the best fit for how he wanted to practice medicine. “FHCSD has great support staff and I felt that I could do everything needed for the patients,” says Bulloch.

Too often, low-income pregnant women receive little if any prenatal care and simply show up in hospital ERs in active labor—a less-than-desirable situation to be sure. “Here, they’re getting comprehensive visits throughout their pregnancies and we have a better understanding of patients when they go into labor. This means safer deliveries and better outcomes,” says Bulloch.
At FHCSD, patients have access not only to physicians, but also to health educators, nutritionists and social workers. “Each patient has a case manager,” says Bulloch. “If they need help finding insurance or getting on MediCal, they’re not alone. There are so many resources available to patients and I really like that.” Bulloch is fluent in Spanish, which serves him well in caring for a large Hispanic population. Translators are available for caregivers who are less fluent in the wide variety of languages spoken throughout San Diego County.

Due to inflexible work schedules and lack of transportation or childcare, ensuring continuity of care can sometimes be a challenge for doctors working with low-income patient populations. Bulloch says compliance is not a big problem at FHCSD. “We have a young, healthy population of pregnant women and most patients trust you and do what they need to do.” It helps that FHCSD has unique incentive programs for women that encourages them to receive comprehensive prenatal care. Patients receive Baby Bucks when they keep appointments, “money” they use to buy everything from diapers to baby clothes at FHCSD’s Baby Boutiques stocked with items donated by the community. Women also receive a free car seat for their newborn if they attend all of their prenatal appointments.

FHCSD has nine OB/GYNs on staff who rotate through all of the system’s clinics that provide obstetrical services. This allows women to meet each doctor at least once over the course of her pregnancy so that when it’s time to deliver, she is in the capable hands of a physician with whom she’s familiar. Bulloch holds privileges at several area hospitals. His practice is about 75 percent obstetrics and 25 percent gynecology.

Bulloch finds his work so satisfying that he’s helped recruit two OB/GYNs who were a year behind him in training to join FHCSD. Because of the system’s status as a federally qualified health center, professional liability insurance is covered by the government. This allows FHCSD to offer competitive salaries. “I could probably earn a little more working in another group, but that’s not why I went into medicine,” says Bulloch. “The program of care here is so integrated that I don’t have to worry about business and can focus on finding the right diagnosis and treatment for each patient. It’s very rewarding.”

Duty to country
When he’s not serving his country on the other side of the globe, Lt. Col. (Dr.) James Sebesta, M.D., practices general and bariatric surgery at Madigan Army Medical Center in Tacoma, Wash., where he lives with his wife, Janelle, and their six children. Sebesta, 48, always planned to go to medical school, but he didn’t necessarily have his sights set on a military career. “A friend was going to check out the Uniformed Services University of the Health Sciences in Bethesda and I went along, thinking it would be a free trip to D.C. I fell in love with the school,” says Sebesta.

Following medical school, Sebesta did his internship year at Madigan and then went on a two-year tour as a medical officer before returning to Madigan to complete his surgical residency in 2002. He’s been there ever since, but again, this was not necessarily his original plan.

“I thought I’d do my payback time and then figure out what to do next,” he says. But as that juncture neared, Sebesta did some career soul searching. “I broke out a piece of paper and wrote down everything I wanted in a job. I wanted to train residents, do research, and take care of patients how I thought they needed to be taken care of. I realized that I had the perfect job, that I was doing it right now,” says Sebesta. He’s now been a physician officer for 10 years and enjoys caring for members of the military, their families and military retirees.

Sebesta appreciates the fact that, even though there is a certain level of bureaucracy associated with being in the military and budgets are often tight, he doesn’t have to deal with the business side of practice. “I get to focus on medicine,” he says. His schedule is not unlike that of a civilian physician. “We divide call up between partners. There are 10 of us now because no one is deployed. I take call one weekend a month or every other month and three to four weeknights a month,” Sebesta says.

Having been deployed four times (once to Iraq and three times to Afghanistan), Sebesta says deployment is both the best and the worst part of being a military doctor. “They send you to bad places and you’re in harm’s way, but you get to do amazing things to save lives. Being away from the family is hard, but it’s an adventure, sort of like a six-month camping trip,” he says. Physicians who serve in the Army are not permanently attached to a single unit for deployment. Instead, when they’re needed to go overseas, they’re assigned to a unit for a period of time. Sebesta’s deployments have been between six and eight months in length.

Related: Military careers for physicians ow.ly/e2NYr
Dr. Red, White and Blue ow.ly/e2Ocf

Returning stateside after a deployment is an interesting experience. “The practice side is easy. You just jump back in and start working,” says Sebesta. At home, re-entry can be a bit more challenging. “The family has figured out their own rhythm of doing things. You slowly move yourself back into that and figure out where you fit in,” he says.
Sebesta advises physicians considering a military career to get in touch with a recruiter.

“Based on the needs of the Army, the doctor’s skills, and how long they’ve practiced, they get a rank, go through officer basic training, learn how to put on the uniform, and start practicing medicine,” he says. Basic training? For doctors, it’s not like you’ve seen in the movies. “I stayed at the Holiday Inn,” says Sebesta. “They’re not yelling at you or shaving your head.”

Sebesta is passionate about his career as a military physician. “It has its challenges with deployments and budget issues, but the vast majority of us love being here,” he says. “For me, it’s a great place to practice medicine.”

On the road

Kristen Kent, M.D., works as a locum tenens physician.

Kristen Kent, M.D., is 37, single, enjoys traveling, and is taking full advantage of the fact that at this stage in her life she has the flexibility to practice medicine on her own terms.
Kent completed her emergency medicine residency at the University of Massachusetts Memorial Medical Center in Worcester in 2006. While in training, she moonlighted as a locum tenens physician and enjoyed it enough to go that route full time upon completing her training. “Then I joined a group in Cincinnati and worked with them for a while before going back to locum tenens,” says Kent.

“I feel like I have a lot of flexibility with my schedule,” says Kent. For example, she had no issues taking time off recently to go on a cruise with her dad.

Kent currently works in two locations—one near her home in Ohio and the other on Cape Cod—through LocumTenens.com and Vista. Her assignments generally run for at least three months, and she’s had offers to stay on permanently several times. For now, she’s keeping her options open and continuing to work locums. “I get to practice in different environments and I get to travel,” says Kent, who is hoping to work in Alaska next summer and will likely accept engagements in Illinois in the meantime.

Kent typically works between 100 and 140 hours a month, which is considered full time for emergency medicine. “I still work nights and weekends and holidays, but I have flexibility with my schedule,” she says. “I can fit in other things while I’m working. In Cape Cod, I work for four days and then have four days off.”

The biggest challenge of working locum tenens, says Kent, is getting to know the culture and systems at each new location. “Every place is a little different in how they manage patients. Some have hospitalists and some have private physicians who admit,” says Kent. “And things are not always as they were presented. You have to be flexible.”

RELATED: Will work for travel ow.ly/e2SnQ
Career move: Locum tenens ow.ly/e2S9c

Kent says any physician considering locum tenens should give it a try. “It’s an excellent opportunity. You get to travel wherever you want, even outside the U.S.,” she says. “I moved a lot growing up and I like seeing different places, regions of the country and cultures. My friends joke that I can sit in an airport and guess where people are from based on their accents and shoes.”

Care without judgment
Internist Norman Johnson, M.D., was in private practice in 1994 when he first became acquainted with correctional medicine. “A friend worked in a prison and when he had patients who needed to be hospitalized, I’d admit them,” says Johnson. He quickly recognized that prisons and jails needed better systems for delivering care to their unique patient populations, and in 1995 he co-founded Health Professionals LTD.

In 2002 he founded Advanced Correctional Healthcare, a company that designs programs and provides risk management services for correctional facilities. In the interim, Johnson worked in jails and prisons for 15 years and continues that practice on a part-time basis today.

Johnson says the ideal doctor to work in a correctional facility is a primary care physician who has the ability to demonstrate empathy and also be somewhat parental.

“These patients are less likely to participate in their own care, and we’re charged with giving them everything they need, sometimes whether they want it or not,” says Johnson. “We have to do the right thing, while keeping in mind the cost to taxpayers and governments, both in dollars and in time.” Johnson’s philosophy is that individuals who are incarcerated, regardless of whether or not they’ve been found guilty of a crime, deserve quality medical care and respect.

Caring for incarcerated patients has challenges and rewards. “These patients come in on inappropriate drugs and they’ll want narcotics for minor problems,” says Johnson. “Many of them had doctors on the outside but they may have been non-compliant and not paying attention to their health. We get a shot at educating them. Patients in our jails get healthier. Their diabetes and hypertension improve while they’re inside,” says Johnson, adding that even “frequent flyers” who are released and then return to jail often come back in better health than when they were first seen within the system.

RELATED: Career move: Correctional medicine ow.ly/e2QUu

“As the economy has worsened and states have done away with mental health programs, a lot of mentally ill patients are pouring into jails. Many of these people shouldn’t be there,” says Johnson. In this case, the goal is to get them on an appropriate drug regimen and link them with community services. “We cannot legally advocate for them, but we can work with the legal system to give them mental and medical health parameters so that they can sort things out,” says Johnson.

In the world of correctional medicine, prisons and jails are quite different. “Prisons are large and doctors usually work 40-hour weeks,” says Johnson. “Nurses line everything up, patients are pre-screened, protocols are followed, and if anyone gets really sick they’re sent to a hospital.” Physicians working in prisons do take after-hours call, except in facilities that are large enough to have doctors on duty 24/7.

Most jails are smaller than prisons and a full-time correctional physician might cover several facilities, traveling between as many as 25 over the course of a week checking in on and caring for inmates. “These doctors don’t see as many patients face-to-face because they’re spending time traveling,” says Johnson.

Interestingly, jail doctors tend to earn more than their colleagues who work full time in a single prison. “Correctional doctors earn based on the number of hours they work,” says Johnson. “If they’re in a prison, they’re likely salaried and earning in the range of $120,000 to $170,000 a year. Jail doctors are in the $150,000 to $200,000 range.”

Johnson says burnout among correctional physicians is not as high as one might imagine. Most facilities have nurses on staff and systems in place that make practicing medicine in the setting quite manageable. “You learn how to work with these patients,” says Johnson. “You cannot allow yourself to get hardened and think that everyone you see is manipulating you. You’ll miss something if that happens.”

The rural life

The idyllic setting of Northern Idaho is the perfect location for Troy Geyman, M.D., and his rural practice. Geyman, wife, Luann, and their 12 children enjoy living on their ranch—away from big cities but in close relationship with the people he treats.

Family physician Troy Geyman, M.D., practices medicine in keeping with what your imagination likely conjures up when you hear the term “country doctor.” He covers his own practice in Bonners Ferry, Idaho, 24 hours a day, seven days a week, every day of the year. “It’s part of the job. You just do it,” he says of his practice choice. Geyman has admitting privileges at his local 20-bed critical access hospital and completes rounds each morning. He does get coverage from another local doctor for inpatients when he leaves town, but even then remains available by phone for calls about patients. “I don’t do house visits though. The county’s too large for that,” says Geyman.

Following medical school at the University of Arizona in Tucson, Geyman completed his family medicine residency at Self Memorial Hospital in rural South Carolina and then worked at a community health center in rural Michigan before settling in northern Idaho, about 20 miles from the Canadian border. He’s been there for 10 years. “I like doing the full range of practice,” says Geyman. He typically sees 45 to 50 patients a day, holds places in the schedule for walk-ins, and performs a wide range of procedures. Obstetrics is the one aspect of family medicine Geyman does not offer because the service is not available at his local hospital.

RELATED: Rural medicine: You can go home again ow.ly/e2UDo

Geyman appreciates the community-oriented aspect of practicing medicine in a rural area. He takes care of entire families and everyone in Bonners Ferry pretty much knows everyone else. “In more populated areas most people don’t even know their neighbors, let alone have a lot of relatives in the community,” says Geyman. He sees his patients around town outside the office on a daily basis. “That’s more positive than negative,” says Geyman, who does occasionally get medical questions from patients when he’s out and about. He takes that in stride. “I enjoy seeing patients and having that interaction,” he says.

Rural living suits the entire family. Geyman and his wife, Luann, have 12 children ranging in age from 4 to 22. Luann homeschools the children and everyone pitches in to take care of their sizable mountain ranch that features sheep, cattle and a pond. “The kids have responsibilities and chores and raise animals that depend on them,” says Geyman. “We have the ability to hunt and fish and hike out here. I can work in the morning and be on a mountain peak two hours later.”

“Some people come out here to vacation for a week, but we want to live like this every day,” says Geyman. If he and his wife want to get away to enjoy something that a city offers, they drive a couple of hours to Spokane or Coeur d’Alene. “We look at the big picture of living rural, what that means, like not having easy access to shopping,” says Geyman. “I might have to avoid hitting a deer or elk or moose driving to work, but I’m not fighting traffic and dealing with road rage.”

Karen Childress is an award-winning freelance writer who contributes regularly to PracticeLink Magazine.

 

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Uncle Sam and your job options

Considering your next career move? Consider the tax implications.

By Elizabeth A. Mullen and Bruce D. Armon | Legal Matters | Winter 2013

 

There are two certainties in life: death and taxes. While you can possibly prolong the former, the latter can’t be avoided—but it can be mitigated.

Whether you are just starting your career or considering a strategic move, there are tax implications that you should consider in addition to the many logistic and practice-oriented decisions that are inherent in any career move. Addressing the tax implications of these opportunities before you sign any employment contract or go too far down the path of business planning will protect you financially and may present additional opportunities for you and your practice.

Careful tax planning is imperative to good business practices. Though this article outlines certain potential tax issues for physicians to consider, the authors urge readers to consult an experienced tax advisor to discuss the tax implications of every business opportunity.

When presented with an opportunity to join an existing practice, work for a hospital or start your own practice, there are several tax issues that you should consider.

Moving expenses

The job of your dreams might be beyond your commuting radius. As a result, you may need to pack yourself and your family and move to another part of the state—or country—at a significant cost.

Some of the expenses you incur as part of your relocation may be deductible on your personal income tax return. In other instances, your new employer may offer to pay your moving expenses or reimburse you for certain costs incurred. Keep all receipts and invoices associated with your move.

Individuals are often permitted to deduct reasonable expenses of moving household goods and personal effects from their former residence to the new residence. This includes packing and crating charges, connecting or disconnecting utilities, transportation to the new residence from the former residence, and in-transit storage and insurance for the household goods and personal effects owned by the taxpayer. Individuals may also be permitted to deduct reasonable expenses of traveling (including lodging) from their former residence to the new place of residence. Note, this does not include expenses for meals during that transition.

Oftentimes, the employment contract may specify that moving expenses will be paid by your prospective employer. Alternatively, an employer may reimburse certain expenses, or up to a certain limit. These expenses should be excluded from your wages as a non-taxable fringe benefit, so long as the payments constitute qualified moving expense reimbursements for IRS purposes. There are certain items that the IRS does not consider approved moving expenses (e.g. certain storage charges, pre-move house hunting expenses, expenses of obtaining a new driver’s license, expenses of buying or selling a home or entering into or breaking a lease). Accordingly, if your prospective employer agrees to coordinate your relocation or to reimburse you for the costs you incur, you should ask how those costs or reimbursements will be accounted for or reported for tax purposes.

Income guarantee agreements

Income guarantee agreements are a common arrangement used by hospitals to attract you to the hospital’s service area in order to meet community health care needs. In conjunction with a private practice in the hospital’s service area that will offer you an employment agreement, these income guarantee agreements will contain many provisions that may be misunderstood.

Income guarantee agreements differ from one hospital to the next. Generally, the hospital will offer you a guaranteed salary and incremental practice expenses for a defined period of time, which will be offset by any revenue generated by your clinical efforts and include a maximum hospital contribution. In return, you agree to build and maintain your medical practice within the hospital’s service area for a certain period of time. After the guarantee period ends, you will agree to either repay the hospital (plus interest) for the amount you borrowed during the guarantee period, or the hospital may forgive repayment over time if you continue to work full time in the hospital’s service area and fulfill other requirements that may be imposed.

The tax implications of an income guarantee provision are often triggered as amounts are forgiven, although the specific tax consequences will differ based on the specific terms of the agreement.

In most cases, the income guarantee is structured as a loan and the hospital will be required to issue a Form 1099 each calendar year for the forgiven guaranteed amount—plus interest. The hospital will send a copy of the Form 1099 to you and to the IRS. You will be required to include the reported amount as income each year and pay federal and state income taxes thereon. Of course, paying taxes on the loan amount forgiven is preferable to paying back principal and interest to the loaning hospital. It is important that you and your tax advisor, on the one hand, and the hospital and their legal counsel, on the other hand, agree on the tax implications of the income guarantee agreement, the repayment and/or forgiveness of any funds advanced, and how the arrangement will be reported for tax purposes. The hospital will certainly work with experienced counsel to draft its income guarantee agreements; you, too, should have counsel who protects your interests.

Employee or independent contractor

When accepting a position with a hospital or a medical practice, you and your tax advisor and the organization with which you are negotiating a service contract should discuss your status as an employee or an independent contractor—not only for income tax purposes, but also for purposes of benefits, professional liability insurance, and any restrictive covenants. The IRS and each state taxing authority has its own unique rules and regulations that address the classification of workers for income tax purposes.
Based on an examination of cases and rulings, the IRS developed a 20-Factor Test that it often uses to determine whether an employee-employer relationship exists. More recently, those factors have been divided into three categories—behavioral control, financial control and relationship of the parties.

The most important point for physicians to remember is that your status as an independent contractor or employee will depend almost entirely on the specific facts of your business opportunity.

When dealing with physicians, the IRS considers factors such as the degree to which the physician has been integrated into the organization—whether a hospital or a medical practice; the substantial nature, regularity and continuity of the physician’s work for the organization involved; the authority reserved by the organization to require the physician to comply with its general policies; and the degree to which the physician has been afforded the rights and privileges generally established for physicians of the organization. The IRS and state taxing authorities will consider the degree of control that the organization has over a physician’s performance of his medical duties in addition to the physician’s financial investment in the business and the contractual nature of the relationship between the physician and the organization.

If you are treated as an employee of an organization, you will receive a Form W-2 from your employer and have payroll taxes—including wage withholding and FICA—withheld from your paycheck each pay period. If you are treated as an independent contractor, you will not receive a Form W-2 and will not have payroll taxes withheld from your compensation. An independent contractor can expect to receive a Form 1099 from the organization and to pay self-employment tax on compensation. You will have quarterly tax deposit obligations and you must budget cash flow accordingly.

The tax consequences and obligations differ significantly depending on how a physician is classified, and penalties for misclassifying a service provider can be significant.

Choice of entity

The prospect of starting your own medical practice or joining an existing practice can raise multiple issues—whether to affiliate other physicians, the optimal location, branding, funding or loan procurement and selecting the best vendors. Notwithstanding all of these important decisions, arguably the first issue you should address is the organizational form of the medical practice. For instance, if you choose to form a limited liability company, a partnership (if more than one physician is an “owner” of the entity), or a professional corporation, each structure has unique characteristics for federal and state tax purposes that affect the way the business of the practice is conducted and how the “owners” are taxed on earnings.

Owners of a limited liability company are called “members.” Partners form a partnership, and shareholders or stockholders own a professional corporation. Depending upon the state where you practice medicine, there may be restrictions relating to whether a non-physician can be your co-owner in the medical practice.

Most physicians will find it preferable to conduct business using a “pass through” entity that is not itself subject to income tax. Pass-through entities include partnerships and limited liability companies that are treated as partnerships (“LLCs”).

These entities do not pay federal income tax; rather, the income, deductions, gain, losses and credits of these entities “pass through” to the owners who pay any resulting income tax. Conversely, most corporations are subject to income tax. As a result, any income earned by such a corporation is subject to tax at the corporate income tax rates, and any dividend paid by the corporation to its shareholders is subject to tax at the shareholder level. Accordingly, a corporation may not be the optimal choice of entity for a medical practice.

In order to avoid this double taxation and to maximize the profits available for distribution to owner-physicians, a pass-through entity is often preferable. Partnerships and LLCs also offer physicians greater flexibility in terms of practice management, growth, and compensation/profit-sharing options.

Taxing issues

For most physicians, the opportunity for a job search will materialize numerous times throughout your career.

Each of the issues discussed  has its own complexities and needs to be assessed in light of the specific facts and circumstances. Uncle Sam will always be entitled to his fair tax share, but with careful tax planning and the assistance of experienced advisors, you can help ensure you are not taxed to death and can enjoy the success of your work effort.

Elizabeth A. Mullen (emullen@saul.com) is special counsel in Saul Ewing’s Washington, D.C., office and a member of the firm’s tax practice. Bruce D. Armon (barmon@saul.com) is managing partner of Saul Ewing’s Philadelphia office and co-chair of the firm’s health law practice group.

 

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Sam H. Saadat, M.D.

Snapshot | Winter 2013

 

“PracticeLink allowed me to take control of my job search and target my career needs to land the perfect position.”

WORK: Tri-Area Community
Health Center, Floyd, Va.

EDUCATION/TRAINING:
Medical school and residency: West Virginia School of Medicine, Morgantown, W.Va.

Graduated in 1998 with Residence of the Year award from the Department of Family Medicine.

Diplomate of American Board of Quality Assurance Utilization Review Physicians and certified in age management medicine through Cenegenics.

IN PRACTICE SINCE: 1998
Saadat is an avid table tennis player and enjoys hiking, biking, swimming and spending time with family and friends.

What’s your advice for residents who are beginning their job search?

Value your skills and proudly negotiate for your worth…you earned it! But don’t just look at the gross pay of any job. A better way would be to look at the net take-home pay along with your satisfaction at that particular job. You really need to take into account if you have a job that pays for the following items: your educational loans, malpractice insurance premiums, paid vacations, cme costs, medical license fees, DEA renewal expenses, membership fees to medical organizations, health/dental/vision insurance premiums. Also pay special attention to the retirement benefit structure as it makes a big difference in the bottom line.

Spend a few days at the practice site to become familiar with your potential colleagues, patient demographics, patient flow and the scope of care within the clinic. Join them at lunch a couple of times during the week to get to know the nurses, lab and X-ray techs, front office staff and the office manager.

Also, spend a few hundred to have an attorney review your employment contract. It’s a good idea to call an attorney you know who doesn’t do that kind of work, but who can recommend someone in town who can.

Keep in mind that there is a life outside of medicine, so investigate the amenities available in that location. A realtor may be very helpful to you in that regard.

What surprised you about your first post-residency job or job search?

I was shocked by how well residency had prepared me for my first job. Enjoy your first job; you are most likely overqualified in terms of medical knowledge and you will find work hours and intensity much less demanding than residency.

What do you wish they had taught in med school but didn’t?

Practice management, contract negotiation and the training to assess financial data of different positions with respect to take home salary and retirement benefits.

Anything different about your job search?

I was online looking for clinical and non-clinical jobs, and PracticeLink showed up in one of those searches. I decided to give it a try. PracticeLink allowed me to take control of my job search and target my career needs to land the perfect position.

 

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Practice choices by career status

Vital Stats | Winter 2013

 

 

 

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Job searching? How to use PracticeLink.com

Feature Articles | Winter 2013

 

1 Start your job search today at PracticeLink.com. Registration is not required. If you do choose to register, you’ll be able to manage all of your recruiter messages from one central dashboard. We’ll also email you the new openings in your specialty so you never miss an opportunity. Your profile also lets you easily save and respond to the jobs that interest you most.

2 Call our friendly Physician Relations Team at (800) 776-8383 for free job-search help with no placement fees, ever.

3 Find easy access to employers actively recruiting for your specialty in PracticeLink Magazine.

4 In print, online, mobile…the career resources of PracticeLink are available anytime, anywhere. Search “PracticeLink” for our free Android or Apple app.

5 Send us your job-search questions! Email helpdesk@PracticeLink.com with any of your questions about PracticeLink or your job search.

 

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The qualities of a winning physician CV

Tailoring a CV toward your employer and lifestyle needs can set you on the fast track to a new position.

By Anish Majumdar | Feature Articles | Winter 2013

 

A physician seeking a job out of residency or fellowship. A veteran emergency medicine M.D. seeking a locum tenens assignment. A plastic surgeon trying to join an established group.

What do these people have in common? All will, in attempting to develop careers within an industry in flux, come face-to-face with hiring practices that are changing just as rapidly. Nowhere is this more true than in the case of a physician’s CV. Make no mistake: Regardless of specialty or background, the days of simply listing your training and contact information on a sheet of paper, sending it out, and expecting the phone to start ringing are over.

“The factors that go into who to hire have changed as the relationship between physicians and the entities that write their paychecks have changed,” says Tommy Bohannon, divisional VP of hospital-based recruiting for Merritt Hawkins in Dallas. “Now that the industry has moved toward hospital or large group employment of physicians, it has definitely become more of an HR-type corporate vetting process. They’re looking for more of a fit from a personality and culture standpoint.”

In my capacity as a Certified Professional Resume Writer (CPRW) and owner of ResumeOrbit.com, a career development firm, I’ve had the opportunity to work closely with physicians across the United States in developing job search documents that both communicate unique value and present it within a format that’s preferred by recruiters and employers.

It can be a challenging process. For one thing, the gap between possessing experience and successfully presenting it on the page can be large indeed, particularly when dealing with a business document that comes with a daunting set of rules and standards. Oftentimes physicians will contact me after having pulled their hair out for weeks trying to write a CV themselves, shoehorning as many (frequently contradictory) “CV best practices” they could before realizing the document just didn’t hold together.

“There’s no one format,” says Arlene Macellaro, director of physician recruitment at Augusta Health in Orlando. “I’ve seen all lengths and approaches. If the right qualities are there, I’ll be contacting you.”

Quality 1

Sense of self
Richard Sheff, M.D., author of Doctor Confidential: Secrets Behind the Veil, has traveled a unique road over the course of 30-plus years practicing family medicine. In addition to being a published author and former professor at Tufts University School of Medicine in Boston, he is currently serving as chairman and executive director of The Greeley Company, a health care consulting and education firm. Though the particular challenges he’s faced have varied widely, the impetus behind all of them remains the same. “I had

Throughout your entire job search, keep your passion for medicine at the forefront. “It’s not about employment, it’s about being the solution.” — Richard Sheff, M.D.

a moment of clarity back in med school that family medicine was what I needed to do. Everything I’ve done since that point has come out of real love for the specialty and wanting to contribute in a meaningful way.” He urges physicians entering the health care industry to keep that passion at the forefront of their search efforts. “It’s not about employment—there’s a physician shortage on the horizon; you will be employed. It’s about being the solution.”

RELATED: CV essentials ow.ly/e2B1D

Develop an opening paragraph
Creating a succinct and focused opening paragraph at the start of a CV is an excellent way to establish a framework for the document and communicate what sets you apart.

“Start with the basics: specialty, subspecialty and training,” advises Macellaro. “Also, if you have a work visa issue or won’t be available until a certain date, I need to know that too as soon as possible.”

Beyond the basics, it’s a good idea to highlight three to four key areas of excellence that can then be expanded upon within the work history section of the document. For candidates with a limited work history, it is perfectly acceptable to offer a quick rundown of particular areas of interest. Here’s an example of an effective opening paragraph for a physician seeking a Non-Invasive Cardiologist position:

Board-certified Non-Invasive Cardiologist with 7 years’ experience launching successful Cardiac MRI and Cardiac CTA programs, recruiting physicians and medical staff, and implementing viable protocols and Standard Operating Procedures (SOPs). Specialist in deploying a multidisciplinary approach to addressing patient needs such as heart disease, diabetes and metabolic disorders. Internal Medicine Residency: University of Alabama. M.D.: University of Oklahoma. Available 4/13.

Be bold in expressing accomplishments
“I should be able to look at a CV and tell, at a glance, what the distinguishing characteristics of a physician are,” says Macellaro. “The easier it is for me to pick out these details, the more time I’m likely to spend evaluating it.”

Making strategic use of bullet points throughout your work history detailing noteworthy accomplishments is an effective way to differentiate yourself from the competition. Even without a lengthy work history, taking the time to highlight a special project you completed or a professional experience that had a profound impact sends a clear message that you’re a candidate on the rise. Here are three examples:

• Founded full-service anatomic laboratory within highly competitive market through developing physician referral network, delivering excellent patient care, and offering 24-hour turnaround time for test results versus 72-hour regional average.
 • Served in clinical supervisory capacity for implementation of 320 slice Toshiba scanner at ancillary hospital as part of overall cardiac CTA program.
• Developed focus on outcomes-based, resource-conscious medicine and received specialized training in outpatient minimally invasive gynecologic surgery.

Personal interests have a place
“I have definitely seen physicians land jobs because one of the key decision makers in the hiring process was a fellow member of an organization they’d listed on the CV, or else they shared a passion for a particular sport or activity,” says Bohannon. Though non-professional details should never constitute the bulk of a CV, including a “personal interests” or similar section at the tail end of the document can be a shortcut to making a connection, particularly when your candidacy relies heavily on perceived potential (read: limited work history). “One or two interesting details can make having a follow-up conversation that much more natural,” says Bohannon.

RELATED: Is your CV helping you? ow.ly/e2Bed

Quality 2

Stability
The oftentimes complex credentialing process a new physician hire must undergo necessitates full accountability on a CV. “Our credentialing process takes six months,” says Sharon McCleary, physician recruiter at Summit Health in Harrisburg, Pa., who recommends that residents and fellows allow themselves at least a year for the job search. “The more upfront a candidate is within their CV, particularly with regards to their career timeline, the easier the process becomes.”

List professional experience in reverse chronological order
Structuring your work history in reverse chronological order (most recent to least) is a proven way to quickly establish legitimacy. Think of every position as its own mini-section and include the following information:

√ Name of employer
√ Location (City, state)
√ Employment dates (Month/Year – Month/Year)
√ Approximately three to six lines describing unique responsibilities. An expert strategy is to expand upon some of the areas of excellence outlined in the opening paragraph.
√ Accomplishments (If available)

Address all work gaps longer than one month
“Any breaks in employment or training that aren’t addressed raises an immediate red flag,” says McCleary. “The truth is, leaving an uncomfortable incident off the CV doesn’t mean it disappears. It just means you’re giving up the opportunity to control its impact.”

Inserting a one or two-line “Career Note” directly within the work history or “Education” section of your CV is a simple way to address gaps. Here are three examples:

Career Note: Addressed family responsibilities while maintaining current knowledge of industry standards and practices (9/12-12/12).

Career Note: Completed rigorous physical training for Ironman Triathalon and attained personal goal of finishing (9/12-12/12).

Career Note: Traveled throughout Brazil and
Argentina, developing new friendships and expanding worldview (9/12-12/12).

Quality 3

Aligned with employer’s needs
Mark Friedman, M.D., cofounder and chief medical officer at First Stop Health, an online and telephonic health concierge service, is a master at projecting the right professional image to secure both clinical and non-clinical positions.

In addition to the above, Friedman is assistant clinical professor of emergency medicine at Quinnipiac University’s Frank Netter School of Medicine in Connecticut and actively pursuing locum tenens assignments.

Related: 8 quick tips for landing the job you want ow.ly/e2Bnq

He knows from experience just how widely the requirements of business, academic, and clinical roles can vary, and cautions physicians against using a “one size fits all” strategy for their CVs. “I’ve found it very helpful to use an ‘outside-in’ approach,” he says. “What’s the impression you want to leave? Yes, being thorough is important, but how you choose to present that information will set the stage for how you’re perceived.”

Use separate versions of your CV for different job targets

Arlene Macellaro, director of physician recruitment, Augusta Health

“It’s frequently easier for me to evaluate a physician with a limited work history as opposed to someone who’s been practicing for decades, because where the former might send me a two-page document outlining the basics, the latter might send me a 10-page document listing every aspect of every engagement and fellowship,” says Macellaro. “On a typical day I’ll deal with somewhere in the vicinity of 70 calls and 200 emails. Unless you make it clear exactly what you’re going after and why you’re a great fit, I’m probably not going to have the time to discern it.”

When applying for clinical positions, it is essential to emphasize board certifications, clinical qualifications and clinical engagements within the first page of the CV. It is also important to de-emphasize non-clinical experience within the work history section. A good approach here is to use the reverse chronological format for all relevant positions, followed by a “non-clinical experience” or similar section briefly summarizing this work in bullet points.

When applying for non-clinical positions, a candidate has more leeway in terms of what skills he or she chooses to emphasize in the opening paragraph and work history. However, it should be noted that clinical expertise carries weight regardless of the particular position being sought, so it should play a role no matter what opportunity you’re seeking.

“Often what I’ll do is attach my clinical CV to the end of the business résumé when submitting for a non-clinical position,” says Friedman. “That way I feel like all the bases are covered.”

Identify and integrate industry keywords
The key takeaway from a job market that is increasingly reliant on technology is the importance of developing a document that makes it simple for a reader to identify relevant industry terms and facilitates a positive decision about your worthiness as a candidate.

• Gather five to 10 relevant job postings to which you would seriously consider applying. Analyze the job description: Which skills are called out time and time again? At which of these skills are you particularly proficient? Jot down a quick list. For example, a Non-Invasive Cardiologist might end up with a list that looks something like this:

Cardiology program development
Protocol and SOP development
Medical and administrative staff leadership
Multidisciplinary coordination
Cardiovascular diagnostics and therapeutics
Staff recruiting/mentoring
Community partnerships
Patient management

• Insert a “Core competencies” section near the start of the CV that lists the keywords you’ve identified. This simple step both increases the odds of your CV passing a quick scan while enhancing the overall focus of the document.

• Be sure to elaborate on the keywords listed in your “Core Competencies” section within the work history section of your CV. This will provide the context a recruiter or hiring agent will be looking for when they review it for the first time. “If you take the time to ascertain your strengths, then figure out how they mesh with our needs and highlight that, you’re several steps ahead of the competition,” says Bohannon.

“Don’t tie your hopes to any one position. Be flexible. My story isn’t what I imagined it would be when I started as a physician: It’s better.” —Anthony Youn, M.D.

In his memoir, In Stitches (institchesbook.com), renowned plastic surgeon Anthony Youn, M.D., details the good, bad and frequently absurd experience that is medical school.
Like many young physicians, he entered the job market convinced that the hard years were behind him.

“Wrong!” he says during a call from his office at Youn Plastic Surgery in Troy, Mich. “I wanted to work in this area, so I sent my CV out to about 25 different groups. Nothing.” Faced with a nightmare scenario and the looming specter of more than $200,000 in student loans, Youn was forced to find the opportunity in adversity and bootstrap his own practice. Following some lean years that included renting office space from an anesthesiologist to see patients and bringing breakfast to the offices of family doctors for possible referrals, he broke through with an appearance on the reality show “Dr. 90210” in 2004. Appearances on many other shows followed, including “The Rachael Ray Show” and “The CBS Early Show,” resulting in rapid growth and establishing Youn as an expert in the field. “None of it would have happened if I hadn’t been able to find a job,” he says. “Don’t tie your hopes to any one position. Be flexible. My story isn’t what I imagined it would be when I started as a physician: It’s better.”

Anish Majumdar is a Certified Professional Resume Writer (CPRW) and owner of ResumeOrbit.com.

 

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Picking up your life…and moving it!

Nothing influences your quality of life as much as where you choose to live. But how can you relocate with minimal stress?

By By Anayat Durrani | Feature Articles | Winter 2013

 

Loss of a job. Divorce. Illness. Death of a loved one. All rank high on the list of the most stressful life events.

And then there’s moving.

It’s so stress-inducing, there’s even an “I hate moving” Facebook page to vent about it. YouTube is full of videos of people lamenting about their dreaded move.
Most will agree that moving is no fun. But with every move there are lessons to be learned—lessons that can improve your next one.

Moving wasn’t too bad for David V. Evans, M.D., an assistant professor at the Department of Family Medicine at the University of Washington School of Medicine. Evans spent 15 years practicing family medicine at Madras Medical Group in Madras, Ore., before he, his physician wife and their two kids uprooted and headed for Seattle in April 2012.

“The relocation was as easy as it could be considering we had lived in Madras for almost 15 years. We sold our house without much difficulty. That was fortunate especially given the economy in Madras,” says Evans. “The major challenges were being away from (my wife) Suzy and the kids for two and a half months and finding a house in Seattle.”

Thinking about moving? ‘‘Don’t fly in one day and out the next if you are unfamiliar with a place. Stay for a few days if you can. If you are still unsure, ask for a second interview even if the employer is ready to hire you.’’ — David Evans, M.D.
Evans and his family moved to Seattle from Oregon last year.

Evans says his new employer paid for the bulk of the move. His employer also picked the movers, who “thankfully” packed the family’s boxes. They were given a moving allowance, which Evans says they exceeded, though they were “willing to pay the extra to do less work.”

In his new job, Evans teaches family medicine in the residency program in addition to having a medical practice. Evans says he and his wife feel it was the right decision to move, adding, “so far so good.” He enjoys the challenges of his new job as well as the people with whom he works.

For other physicians facing relocation, Evans recommends taking some time at both the job site and the community to see if the move is right for them. He points out that observing the work environment is important as well.

“Do people seem happy? Is it unnecessarily chaotic? Talk to staff, not just docs. Talk to spouses. Talk to patients. They often have a different insight and can tell you about living in the community,” he says.

He also suggests asking to tour with a realtor as part of the interview. This allows time to discuss and discover community aspects such as schools, churches, activities and other factors that matter in the new location.

“Don’t fly in one day and out the next if you are unfamiliar with a place. Stay for a few days if you can,” says Evans. “If you are still unsure, ask for a second interview even if the employer is ready to hire you. You are interviewing them as much as the other way around.”

More physicians relocating
Of the physicians placed in 2011, 93 percent relocated to a new community for their new job, according to The Medicus Firm. That year, signing bonuses were offered to 88 percent of physicians placed, and relocation allowances increased.

When Julie Zacharias, D.O., was preparing for a move, she packed in a wedding as well. Zacharias moved from North Carolina to Nevada in 2011 to join Touro University Nevada College of Osteopathic Medicine (TUNCOM) as an assistant professor in the primary care department. Zacharias serves as a practicing physician providing on-site care at assisted living facilities, skilled nursing facilities and private homes.

How did her move go?

“Overall it was OK. I did not expect my belongings to take as long as it did to move out from North Carolina to Nevada—approximately two and a half weeks. It worked out OK because I had an extended stay in Texas,” Zacharias says. “I got married in between moving from North Carolina to Nevada. I also was lucky to have someone on the receiving end to let the movers in. My fiancé had already settled into our new house and was available to sign for my belongings.”

RELATED: Site visit savvy ow.ly/e0Yhi

Zacharias had planned to move to Las Vegas because her then-fiancé (now husband), who is in the military, was assigned there. She visited with a few of the faculty of Touro prior to interviewing and connected well with two physicians she met. She then set up an interview. Next was the move. She researched several different moving companies online, then arranged to have all her belongings shipped from North Carolina to Las Vegas.

“I had packed most of my belongings the week before the movers were supposed to arrive and placed all the boxes in my extra bedroom. I did have the movers pack dishes and picture frames,” she says. “The actual move was pretty painless with movers. My fiancé flew out to North Carolina to help drive.”

But like most moves, sometimes things don’t always go smoothly. She suggests letting movers pack most belongings. “It turns out that I am not the best packer, and a few things I packed ended up broken,” she says.

She notes that even if the movers pack all your things, she would still recommend packing and transporting your important documents and jewelry yourself.

RELATED: How to avoid a relocation nightmare ow.ly/e11dr

She also wishes she had hired someone to professionally clean the townhome she was renting in North Carolina. “My fiancé and I spent several hours cleaning after the movers left, before an 11-hour drive,” Zacharias says.

The total cost of her move was $1,100. She highly recommends that physicians do their research and compare prices when planning a move, adding, “It makes a big difference.”

Prepping for the move

Caroline Steffen, physician recruiter for DuPage Medical Group

Physician recruiter Caroline Steffen, with DuPage Medical Group in Illinois, says physicians should call at least three moving companies before deciding which to use. Request estimates and references, and make sure they are bonded.

“A typical moving allowance is $7,500 to $10,000 to cover the cost of the move,” Steffen says. “True costs can vary depending on how far you are moving and to what region of the country.”

Steffen says that, in many cases, practices and hospitals in metropolitan areas will not provide physicians a relocation allowance. Nor if the physician is already living in the area, or if the relocation is because of a spouse’s new position. Rural and medium-sized communities, she says, are more likely to have a relocation allowance in their standard employment offer.

“Physicians who are moving to join a new employer need to remember that their move is the second transaction they are having with their employer; the first is negotiating the employment agreement,” says Steffen. “How a physician handles the move with the employer can set the tone of the first few days at work.”

Yes, moving can be stressful. But, Steffen says, physicians who are demanding, spend too much on their move, or have excessive special requests “can put a bad taste in an employer’s mouth and make them question if they hired the right individual.”

Physicians with unique needs when moving should not expect their new employer to cover moving expenses of a sailboat, antique car or pool table, for example. Any special requests, she advises, should be brought up during the contract negotiation process so that it’s clear what will and won’t be covered in the moving allowance.

“Many employers have moving polices. Ask for a copy during contract negotiations so you have a clear understanding of what you are being offered in your moving allowance, and any restrictions there may be as well,” Steffen says.

Fawaz Ahmad, M.D., just relocated from Baltimore to Chicago in July 2012 to join DuPage Medical Group as a hospitalist. His start date was a month later, following completion of his boards. Ahmad received a relocation stipend and picked his own movers. However, he realized after talking to several moving companies that many were unable to accommodate the dates he needed, despite his scheduling a month in advance, due to high demand during the end of the month. Ahmad used Yelp and other online reviews to research moving companies but ended up with a few that could accommodate his schedule.

“From a previous personal bad experience with in-town moves, I would highly recommend using an online review to research the movers you are hiring,” Ahmad says. “I only packed our valuables and the few items that we would need through the month before we could move into our apartment. Everything else was packed by the movers.”
Ahmad says it’s “very difficult to have a completely hectic-free relocation experience.” His biggest unexpected surprise was that he was not able to find an apartment that he liked for the move date that he wanted because the rental market in Chicago was so competitive.

“And because we had to give two months’ notice with our current landlord, they had already leased our apartment and could not extend our lease,” he says. “We ended up having a month overlap between our move-out and move-in date. This resulted in having to find temp housing for a month as well as having to negotiate storage costs for a month with our movers.”

Expect the unexpected
When moving, anything can happen.

Sharon Dionne, a physician recruiter for St. Joseph Hospital in New Hampshire, has heard her share of moving horror stories from physicians. She recalls one physician who had extensive damage during a move. Another had water damage on items in storage. These events, however, happened years before the hospital entered into a national moving agreement. Now they work with United Van Lines through local carrier Diggins & Rose.

“They provide us with a discount and allow the physician to have them direct bill us to their max benefit,” says Dionne. “The most important factor is to deal with a reputable mover, as mistakes can happen that can really be a problem, such as damaged goods and delays in schedules.”

Sometimes things arrive broken or don’t go according to plan. She recommends that physicians purchase protection as part of the cost of their move to cover any damages.
“We have that automatically included in our agreement with United Van Lines. Normal packing and moving are included along with a car carrier, temporary housing, storage, etc., as long as they do not exceed their total benefit,” Dionne says.

With so much focused on moving and unpacking, little time is often left for physicians to get settled in and acquainted with their new location. Ahmad had the advantage of already being familiar with Chicago, but says, “because of the boards, I haven’t had much time to enjoy Chicago or get settled in yet.”

Evans, who moved with his wife and kids to Seattle, says they are still exploring the area. From previous experience, he says, “It takes about a year to really get settled into a new town.”
Zacharias planned ahead so that she would have time to relax before she jumped into her new job in Las Vegas. “After I had officially moved in, I had planned to have about three weeks off prior to starting my new job, which helped quite a bit,” she says. “Also, my husband had been in Las Vegas for several months already, which was great. In regards to work, Touro was great having the first few weeks be a settling-in period. I met with HR and had a few sessions learning the EMR, which helped when clinic started.”

Adriana Tobar, M.D., has moved from Ecuador to New Jersey to Illinois, where she now calls home. Finding a support system in your new town, she says, is a huge benefit.

Moving with family
Adriana Tobar, M.D., is a family medicine physician who lives in Illinois and commutes to her job at Dean Health System in Wisconsin. She originally moved with her husband and then-3-year-old daughter from Ecuador to New Jersey in 2001 to study for the boards. They lived in New Jersey for two years, then moved to Illinois in 2003. Though she did get a bonus when they moved to Illinois, they decided to pack themselves to save money and shipped a few items they had from New Jersey.

Moving was not entirely easy on her family.

“For physicians or residents who move, I think there are several stressors the family members struggle with that tend to be overlooked,” Tobar says. “My husband helped quite a bit with exploring around, but it was very difficult initially for him. I was at work as a first-year resident, my daughter was at school, and he couldn’t work or study for six months until the visa was approved.”

A support network helped them ease into their new location.

Often, joining activities and clubs, church groups, sports and cultural centers can help smooth a transition into a new town.

“When we arrived, there were three doctors—one from Dominican Republic, one from Venezuela and one from Argentina—who really helped us to not feel so alone and to settle down,” Tobar says. “They were like family. I think it is extremely important to find a support system to help with the transition: church, sports, etc.”

Moving can sometimes be tough on the family. That’s a topic “Jane” has blogged about on her anonymous blog, “From a Doctor’s Wife.”
She started the blog during her husband’s fifth year of residency as a way to reach out to other wives and significant others who don’t have support networks, and also “as a way to scream into my pillow.”

RELATED: How to avoid relocation shock ow.ly/e1aE5

Her family recently moved for a fellowship over the summer. She has a countdown clock widget on her website counting down the days, hours, minutes and seconds until the fellowship ends.
“We have moved three times in eight years, with our fourth move coming next summer. For me, the worst part of moving has been driving across the country. Packing and unpacking is the easy part,” says Jane. “I start the process earlier than most would, but it has proved invaluable every time. More work in the beginning means less work at the end.”

For her last move, they sold their house a few months before they needed to relocate. Her husband stayed in student housing and she and their four kids went out of state to stay with family. The hospital for fellowship didn’t cover moving expenses, so they used PODS. They were provided a container to load and unload. She and her husband packed their own boxes and saved money using spare boxes her husband brought home from the hospital.

RELATED: The trailing family ow.ly/e12W4

“They drop off a box, we fill it over the course of several days, they pick it up, store it, and deliver it when we need it,” Jane says. “For us, this method fit our budget, our storage needs, and meant we didn’t have to drive a truck or move between a storage unit and moving truck. In the end, our moving expenses for storage/transportation of the POD came in at about $3,200. We were very pleased.”

Jane says moving so far has been fairly easy on her kids, ages 1 to 7, because they are still young. When they first arrived in their new city, the family made sure to explore the area and see all the fun things near which they lived.

“We sought out our church community as soon as we arrived, and have made friends there for ourselves and our children. Finding a local network of people to help you navigate a new city is priceless,” says Jane. “We found out the best days to hit the children’s museum, what times to avoid grocery shopping, where to pick up the kids’ school uniforms inexpensively, and info on free things to do around the city.”

Their next move will be for her husband’s first post-training job in summer 2013. Being super-organized has paid off. Having either donated unwanted items or boxed up, labeled and put aside items not in use, Jane doesn’t feel concerned or stressed about the next move.

“We did so much work this last time I think we will be in a position to say, ‘Box it up, it all goes,’” says Jane. “Movers will most likely be included in our offer, but we could easily do it ourselves—and honestly, we probably will. I like knowing what is in the boxes!”

Keeping a positive outlook and sense of humor can help keep the moving woes at bay. So can keeping in mind that moving is a temporary situation that will bring you to your next stage in your career and life. Being well-organized and preparing in advance can go a long way in making the move smoother and less stressful.

 

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Your before, during and after moving guide

Relocating can be overwhelming, but by planning ahead and breaking it down into manageable tasks, you can assure a smooth transition into your new home.

By John Boozer, Nilson Van & Storage/Mayflower Van Lines | Feature Articles | Winter 2013

 

Part I

Well before your move…
• When getting quotes, show the representative from the moving company everything that will be moved including items in the attic, basement, garages, storage areas, sheds, etc.
• Once you have chosen your carrier, obtain and read the three “pre-move required documents” from your carrier. These documents include your “Rights and Responsibilities” and Ready-to-Move brochures. These are required documents for every interstate shipment.
• Take an objective look at what you own. Decide what must go and what can be left behind. Books you’ve read and will never read again? Do you really need the pan with the broken handle or the children’s long neglected games? Remember: extra weight costs more money.
• Carry valuable jewelry with you. If you’ve hidden any valuables around the house, be sure to collect them before leaving.
• Animals cannot be moved in a moving van. If you’re not taking your pets by car, make other transportation arrangements. Because some states require up-to-date health certificates and rabies inoculations, it’s a good idea to take your pets to the veterinarian prior to the move to ensure that you have the proper documents.
• Leave your plants behind. state laws prohibit the entry of house plants, and most plants will not live through being transported in the moving van. Consider giving your plants to a friend or a local charity if you cannot transport them yourself.
• Send change-of-address cards to national newspapers and magazines. Cancel delivery of local newspapers, and settle your accounts.
• Make final packing decisions. Clean and clear your home, including closets, basements and attics. Check with your carrier representative for a complete list of items not to pack.
• Transfer all current prescriptions to a drugstore in your new town.
• Check your safety deposit boxes. You also should call your bank to find out how to transfer your accounts.
• If you plan to pay for your move by credit card, you must arrange it with your carrier representative because authorization is required prior to loading the van.

 

Download and share this
helpful article at ow.ly/g4T4d

 

Part II

RIGHT Before your move…
______ Schedule to have your utilities (electric, gas, phone, etc.) disconnected or transferred to the new owner the day after your scheduled move-out.
______ Empty, defrost and clean your refrigerator and freezer and clean your stove—all at least 24 hours before moving to let them air out.
______ Prepare a “Trip Kit” for moving day. This kit should contain the things you’ll need before your belongings arrive at your new home. Some suggested items are soap, toilet paper, travel alarm clock, snacks, bottled water and a first aid kit.
______ On move-out day, be on hand when the movers arrive. If you are not able to be there, it’s important to have a trusted adult on hand who will authorize decisions about your move. Let your carrier representative know the name of the person who will be there on the day of your move. Be sure that the spokesperson you have chosen knows exactly what to do.
______ Provide your new phone number and make sure to bring your carrier representative’s contact information. The driver will contact you 24 hours prior to their expected arrival.

On move-in day…
• Be sure you are there when the movers arrive. You or an adult representative will need to be there to accept the delivery and pay the charges. You will be asked to note any changes in the condition of you goods indicated on the inventory at the time of loading and to note any missing items at the time of delivery.

√ Plan to sign the following paperwork:

Inventory of Goods: This document is a description of the condition of your belongings. You’ll be asked to sign it to acknowledge receipt of your goods upon unloading.
Bill of Lading: This is the shipping document that establishes the legal terms of your moving service.
Additional Services Performed: This is used to verify the services the carrier performed other than loading and transporting your things. Please examine it carefully before you sign, making sure that you understand what you’re being charged for.

John Boozer (Jboozer@nilsonvan.com) is director of corporate accounts for Nilson Van & Storage/Mayflower Van Lines.

 

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