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LIFE AFTER RESIDENCY
Why be a hospitalist with EmCare
Pawan Dhawan MD, MBA
Executive Vice President
EmCare - Alliance Division
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Now that residency is over- What are my options
1. Fellowship
2. Academics-Clinical Educator
3. Primary Care
4. Hospitalist
5. Research
6. Locums / Enterpeneurship / Others
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What is a Hospitalist
The term "hospitalist" refers to physicians whose practice emphasizes providing care for
hospitalized patients.
Wachter RM, Goldman L. The emerging role of "hospitalists"in the American health care
system. N Engl J Med 1996;335:514-7.
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Why Be a Hospitalist
1. Familiarity - You’ve been doing Hospitalist work during residency
2. Pays better
3. Career Growth
4. In Demand specialty
5. Lots of Flexibility
6. Can do something very very meaningful
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Adapted Dr Neese Slides 2014 Presentation
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Compensation by Region-2013 SHM
Region
Mean pay
Pacific
$256,000
Mountai
n
SW
$246,000 $270,000
Midwest
SE
NE
$248,000
$261,000
$229,000
encounter/shift
14
15.4
18
16
17
15.8
shifts/month
15.3
15
16
15.7
17.1
16.4
Adapted Dr Neese Slides 2014 Presentation
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Career Growth as a Hospitalist
1. Academics
2. Leadership
3. Performance Improvement/Quality Improvement
4. Consultative Services
5. Health Care Information and Technology
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Adapted Dr Neese Slides 2014 Presentation
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Hospitalist Career Satisfaction SHM 2013 Data
Adapted from Dr Nesse’s 2014 presentation
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Where should I work• Geographic preferences
• Family issues
• Cost of Living
• Compensation
• Benefits
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Types of Hospitalist Practices
• Individual/Solo
• Hospital Employed
• Private Practice Groups
• National Groups
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Adapted From Dr Neese 2014 presentation
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Practice Characteristics
1. SCHEDULE
2. VOLUME
3. COLLEAGUES
4. Size of Group
5. Leadership
6. Stability- How many have left group? Why?
7. Career Growth Opportunities
8. Nursing
9. Case management
10. Specialist Support
11. Moonlighting Opportunities
A good time to ask these questions is during initial phone interview
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Interview
1. Meet the colleagues
2. Meet the nursing staff
3. Meet case management staff
4. Meet the admin team
5. Take contact info
6. What procedures will be required if any
7. What kind of support clinical and non clinical will I have
8. Who will do the billing / Is there a software for billing / Will somebody train for billing and coding
9. What kind of orientation will I have - Will I get paid for orientation
10. How does the EMR look
11. See the Hospital / cafeteria / call rooms / offices / Parking spots
12. Tour with a realtor / See the city
13. Ask yourself-Will I fit in / Will I be happy / Will my career grow
If still some questions ask for a second interview
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What should I look for in a contract-1
Why is a contract needed
• Protects the institution/group
• Protects the physician
• Legal and third party payor requirements
Type of Employment
• Hospital vs. Group
• Independent Contractor
Responsibilities
•
Scheduling –Hours/weekends/nights
• QI, Compliance with policies
• Education--Staff, residents, interns
• Medical Records completion
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What should I look for in a contract-2
Compensation
• Salary
• Fee for Service Billing
• Hourly rate
• Guarantee
• Incentives/Bonuses
Benefits
•
Vacation
•
Maternity/Paternity Leave/ Military Leave/Personal Time off
• CME dues and Time off
• Licensure Fees
• Society/Professional organisation fees
• 401 k-Match
• Phones/Pagers
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What should I look for in a contract -3
Malpractice Insurance
• Claims vs. Occurrence
• Tail coverage
1.
When does it start immediately or after few years of start
Bonus/Incentive Structure
•
How will the data be gathered
•
When will the bonus be paid eg after 2 months of data
•
When do the incentives/bonuses start
1. From 1st patient or after a threshold eg 4k RVUs
•
Metrics
•
Individual vs Group Based
1. Pt satisfaction
2. Core Measures
3. DC Summaries to PCP
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What should I look for in a contract-4
Sign On Bonuses
• $1000-$20,000
• Moving expenses
• Loan repayment
Insurance
• Health/Dental - Individual or Family
• Life insurance
• Disability insurance
• Unemployment insurance
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What should I look for in a contract -5
• Non-compete agreement
•
Time, distance
•
Solicitation of employees, patients
•
Liquidated damages
• Term
•
Fixed term-year
•
Renewed automatically or not
•
Notification time for termination – 90-120 days
•
Timing of new contract negotiations – 60-120 days
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What should I look for in a contract -6
Termination
• Without cause
1. Any time without reason-How much is notice period 3/4/6 months
• With cause
1.
Loss or negotiation of license
2.
Loss or restriction of hospital privileges
3.
Professional liability insurance or claims
4.
Impairment
5.
Professional misconduct
6.
Death/disability
7.
Failure to perform
8.
Criminal activity
9.
Breach of contract
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What next after I have the contract
1. Who is the contact person
•
Recruiter
•
Medical Director
•
Department Chairman
•
Likely not a colleague in new practice
2. Review the contract carefully
3. Ask a lot of questions
4. Get contract reviewed by a professional attorney
5. Ask a lot of questions again
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What next after I have the contract -2
1. Does the contract need any addendums or modifications after the discussion
2. Sign and send back
3. Start the licensing process
•
FCVS
•
State Licenses
•
Federal DEA/State Controlled substance licenses
4. Start the credentialing process-3-6 months
5. Lots and lots of paperwork. Get your pen ready.
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Timeline
• Research - 1 month
• Interview - 1 month
• Negotiate Contract terms and conditions 15 days - 1 month
• Licensing and Credentialing 2-6 months
• Moving and Starting 1-2 months
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Why EmCare
1. Large National Company- Part of Envision Health
•
AMR, EmCare, Evolution Health, Reimbursement Technologies
•
750 client contracts, 500 hospitals, 42 states
•
Run by Physicians
2. Excellent compensation
3. Excellent Career Growth Opportunities
4. Well structured and secure
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Thank You!
Thank you, Dr. Stoev and Dr. Neese