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LIFE AFTER RESIDENCYWhy be a hospitalist with EmCare
Pawan Dhawan MD, MBAExecutive Vice President
EmCare - Alliance Division
Page 1
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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
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.
Page 3
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
Page 4
Compensation by Region-2013 SHM
Page 6
Region Pacific Mountain
SW Midwest SE NE
Mean pay $256,000 $246,000 $270,000 $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
Career Growth as a Hospitalist
1.Academics
2.Leadership
3.Performance Improvement/Quality Improvement
4.Consultative Services
5.Health Care Information and Technology
Page 7
Where should I work-
•Geographic preferences
•Family issues
•Cost of Living
•Compensation
•Benefits
Page 10
Types of Hospitalist Practices•Individual/Solo
•Hospital Employed
•Private Practice Groups
•National Groups
Page 11
Practice Characteristics1.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
Page 13
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
Page 14
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-2Compensation
•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
Page 16
What should I look for in a contract -3Malpractice 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
Page 17
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
Page 18
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
Page 19
What should I look for in a contract -6Termination
•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 contract1. 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 -21. 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.
Page 22
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
Page 23
Why EmCare1. 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
Page 24