Physician Employment: 4 Tips for Successful Contract Negotiation

Ensuring a successful long-term job begins by negotiating a sustainable long-term contract.  Fierce Practice Management has interviewed 2 experts in the physician non-clinical marketplace to determine 4 tips for successful contract negotiation.

Willaim Cors, Chief Medical Quality Officer of Pocono Health System in East Stroudsburg, PA, and Dean Nicastro, a healthcare attorney with Pierce & Mandell in Boston have both commented on ways to ensure a successful physician-hospital alignment before the physician starts employment.  These experts offer you the following 4 tips for negotiating a satisfying and surprise-free physician employment contract.

The 4 tips are:

1) Begin Negotiations with your Offer Letter
2) Read and Appreciate what you are Signing
3) Know the Most Important Provisions to Address
4) Recognize the Contract's Purpose

The article goes on to elaborate on each tip.  It is crucial for physicians to have a full understanding of the entire employment agreement and contract prior to starting to ensure a successful, long-term employee engagement.

Read the full article at Fierce Practice Management, or click here: http://www.fiercepracticemanagement.com/story/physician-employment-4-tips-successful-contract-negotiation/2012-11-05?utm_medium=nl&utm_source=internal

How Healthcare Reform will Influence Private Practices

The annual MGMA conference in San Antonio offered several sessions regarding different strategies practices can use to thrive in the uncertain healthcare market.

Chuck Peck and Deborah Walker Keegan, PhD, FACMPE are two presenters during the MGMA conference that spoke about ways private practices can continue to be profitable if healthcare reform is fully implemented.

To read more about their presentations and suggestions for private practices to remain strong through healthcare reform read an article at Physician's Practice, or click here: http://www.physicianspractice.com/mgma12/how-healthcare-reform-will-influence-private-practices?GUID=98C7CA21-2AF6-465B-A27F-FC956DFC383F&rememberme=1&ts=22102012

What Makes a Private Practice Successful?

Even in this changing economic and healthcare environment there are some private practices that are thriving.  Although many practices are merging or being bought out by larger health systems, there are some very successful groups that will continue competing in a private model.

What makes a private practice successful   How can they stay competitive when hospitals are becoming the driving force in communities?  MedScape has just published an article on how private practices can continue to be successful.  

The article reminds us that even a physician practice is still a business, and it should be run like a business at it's core.  One of the keys to cultivating a profitable practice lies in understanding, accepting, and embracing the fact that a medical office is still a business. 

Successful practices plan for long-term growth and have immediate and mid-range action plans that advance their longer-term objectives.  Profitable practices also know how to attract attention.  Some practices tout the expertise or specialized skills of individual physicians, who have name-recognition in their community. Others tap their social and professional networks to attract new patients. Still others differentiate themselves through effective advertising that highlights their unique offerings.

Rock-solid practices don't waste their time on guesswork, they depend on data.  They know their charge volume and payer mix and how long it takes to get paid by a particular payer for a specific procedure. Success depends on having the right data at the right time and trying to make the right decisions with it. 

Read the full article at MedScape, or click here: http://www.medscape.com/viewarticle/772563_1

Turning Hospital-Physician Conflict into Collaboration

This economic climate has more potential for change than anything we have seen recently.  With the possible dramatic changes in healthcare including changing reimbursement models, possible Medicare changes, ACOs, and even the trend towards hospital employments, physicians are bracing themselves on how to be stable in a shifting environment.

Physician's Practice has published an article on how physician's can pro-actively embrace these changes, including new ways of collaborating with hospitals and health systems as opposed to fighting the relationships, to plan for a positive change in an uncertain healthcare environment.



Read the full article in Physician's Practice, or click here: http://www.physicianspractice.com/mgma12/turning-hospital-physician-conflict-collaboration?GUID=98C7CA21-2AF6-465B-A27F-FC956DFC383F&rememberme=1&ts=19102012

How Oncologists Are Bypassing Employment Trend

While physicians overall are shifting from private practice to employment, large numbers of oncologists are bucking the employment trend, choosing to band together instead of selling to a hospital system. At the beginning of 2012, 10 private oncology practices united under a single provider identification number and a single tax ID to become Regional Cancer Care Associates (RC2A). The group now includes nearly 80 oncologists, 500 employees, and close to 300 chemotherapy chairs at 20 sites, stretching the length of New Jersey. There are plans to add 2 more practices by the end of the year, bringing the total number of physicians to over 100.

The merger of practices into RC2A was a way of getting ready for the era of accountable care. As ACOs take hold as a central component of healthcare reform, providers will have to focus more on care coordination and on collaboration, no matter where patients come from or are referred to. Beyond economics, the new practice wants to improve the quality of care and advance research as well. Licitra says the practice is looking also at ways to reduce hospitalizations to ensure a better quality of life for people being treated for cancer. 

Read the full article in MedScape, or click here: http://www.medscape.com/viewarticle/768815

Increase in Physician Practice Mergers and Acquisitions Expected to Continue

According to data released this July by Irving Levin Associates, a research firm based in Norwalk, Connecticut, there is an increase in the amount of money spent on medical practice mergers and acquisitions from the second quarter of 2012 compared with the same period in 2011.

A hospital or health system purchasing an existing practice is another way hospital employment is increasing in physician employment models.


Read the full article in American Medical News, or click here: http://www.ama-assn.org/amednews/2012/08/13/bisd0814.htm?utm_source=nwltr&utm_medium=heds-txt&utm_campaign=20120820

6 Critical Questions for Residents to Ask When Evaluating a Physician Practice

There are many criteria any physician needs to ask his or herself prior to selecting their first job out of training.

It is hard to consider every factor when evaluating several different opportunities; here is a checklist from Adventures in Medicine noting a few key points in evaluating an offer.

Read the full article by clicking here: http://www.adventuresinmedicine.net/doctor-career/6-critical-questions-to-ask-when-evaluating-a-practice/?goback=%2Egde_76194_member_147576360

Competition Increases for Physician Recruitment

For either Family Practice and Internal Medicine physicians as well as Surgeons and Specialists, now is the time to start recruiting for physician openings starting in 2013 or even 2014.

Hospitals and groups that are able to anticipate future need and willing to sign physicians in excess of 1 year prior to their availability will get the best choice of top physicians out of leading training programs.

Many 2013 residency or fellowship graduates have already signed with positions to start next summer, many others are in the process of interviewing and selecting positions to start once they complete their training.

Read more in an article from Physician's Practice by clicking here: http://www.physicianspractice.com/blog/content/article/1462168/2095255

Solo Private Practice Not Dead

Despite the recent media attention to the transition of hospital employment and the solo practice physician completely phasing out, there is and will always be a market available to those physicians in any specialty who wish to run a solo practice.

Market trends are making it harder to stay competitive and with all of the attention to quality of life hospital employed opportunities are becoming more appealing to many physicians, however there will always be room for those physicians who wish to operate a private and even solo practice.

Healthcare Finance News has published a recent article on how solo practice physicians can thrive in even this market, and how there will be room for a solo model in any market condition.  Solo physicians may have to shift to adjust to market trends and stay competitive, but they will never be completely phased out.

Read the full article by clicking here:
http://www.healthcarefinancenews.com/news/solo-practice-physicians-im-not-dead?goback=%2Egde_3898461_member_141158532

Physician Recruitment: Hospital vs. Private Practices

Recently there has been a lot of media attention on the continuing trend of hospital employment and also the decrease in the private practice.  In an article published today from American Medical News it is suggested that hospitals are much more aggressive in recruiting physicians than their private practice counterparts, attributing increasing growth to more progressive recruiting.

Hospitals also more frequently utilize agencies to help fill their physician openings, helping present more hospital employed positions to active candidates through physician staffing agencies.

There will always be a place for the private practice physician in every physician employment model environment, however to remain competitive and profitable and access the best physician candidates each type of employment model needs to be willing to mold to economic trends.

Read the full article by clicking here: http://www.ama-assn.org/amednews/2012/07/23/bil20723.htm

Contract Language: Negotiating Part-Time Employment for Physicians

There has been an increasing trend in part-time employment opportunities for physicians, both male and female physicians.  In order to balance a quality of life with dedicated time for both family and a medical practice, many physicians are seeking part-time opportunities.

According to a recent survey by the American Medical Group Management Association and Cejka Search, 21% percent of U.S. physicians are working part time, compared with 13% in 2005.


It's important for physicians to approach the contract negotiation process of part-time employment opportunities just as a full-time employment situation.  The same issues need to be determined and can also be negotiated during the signing process and before the physician commits to any agreement.  Employment status, compensation, benefits, and insurance all need to be in clear, written format, as well as the work expectations of the physician and other clinical issues such as call and restrictive covenants.


American Medical News has published an article outlining other issues to ensure a part-time employment contract is mutually beneficial to both parties.  Read the full article by clicking here: http://www.ama-assn.org/amednews/2012/07/16/bicb0716.htm

Physician Employment Models

Hospital employment is prevalent as the current most popular physician employment model, however there are still other models to consider.  The trend is cyclical as well, during any climate it's important for physicians to be aware of the strengths and weaknesses associated with all employment models before signing an employment agreement.

This article recently published in the New England Journal of Medicine elaborates on different types of employment models offered as well as an assessment of the risks and benefits associated with each respecitve model.

To read the full article click here: http://www.nejmcareercenter.org/article/6541/sustainable-income-understanding-the-benefits-and-risks-of-various-compensation-models/

Private Practices: How to Survive Alongside the Trend of Hospital Employment

There is so much press regarding the trend towards hospital employment, but for those physicians dedicated to a private practice model, how do you survive amongst all of the other local physicians becoming employed by the larger hospital systems?  As more and more physicians take positions in hospital groups, independent practitioners face an array of challenges. If you are a physician with a practice in an area where the hospitals have acquired many of the local physicians, you may be finding it increasingly difficult to survive.  To counterbalance the power of hospitals, private practice physicians and their partners can form a larger single-specialty group, an independent practice association (IPA), or some other clinical integration vehicle. As hospital competition grows, physicians in private models are finding other options to remain competitive and profitable.  Some options private practice physicians have in order to compete with local employed physicians are IPAs, physician-hospital organizations, and group practices without walls.  Smaller practices can unite to leverage themselves against larger, employed systems.  There will always be a place for the private practice physician, and private groups can remain profitable in every employment climate, although they may have to evolve with the times.   Read more in the MedScape article by clicking here: http://www.medscape.com/viewarticle/765250

2011 Physician Compensation Survey Data: Physicians Practice

Physician's Practice has published their 2011 survey results on physician compensation and how health form effected compensation last year, as well as future projections for how compensation may be directly effected in the years to come. The survey had participation of more than 1,700 doctors in every specialty.

The site has also created slides to determine how physicians are currently faring with the recent government changes implemented last year. They also provide information and guidance on how to cope with shifting reimbursement while maintaining income during transitions.

Access the full report by clicking here: http://www.physicianspractice.com/physician-compensation-survey/content/article/1462168/1979110?pageNumber=2

Physician Employment Outlook: Market Strong for Physicians Seeking Employment

The increase in demand for physicians continues to remain strong; data proves if you are a physician looking for a position it is a buyer's market. The most in-demand specialties continue to be Internal Medicine, Emergency Medicine, and Family Medicine physicians, however most all physician specialists will have their choices of employment options.

As always geography is the most limited option when evaluating physician opportunities, the larger and more desirable cities will always offer positions based on supply and demand, and there continues to be significant demand from physicians for bigger metropolitan areas with significant medical and educational presence. 

According to a recent article in Physician's Practice blog site, healthcare employment remains strong for physicians seeking positions, employers seeking physicians have a more tangible struggle identifying talent in such a competitive market. More physician positions are currently opening than physician candidates are available to fill them. Read the full article by clicking here: http://www.physicianspractice.com/blog/content/article/1462168/2073586

Further identifying the shortage, HEALTHeCAREERS released physician posting results from the first quarter of 2012 last week. Their data emphasizes growing evidence of a talent shortage among physicians, as well as nurses and health IT staff. According to the results of physician postings on their sites the healthcare industry continues to face a talent shortage, particularly among physicians and non-entry level nurses. Access the full report by clicking here: http://www.healthecareers.com/accp/article/healthecareers-network-releases-q1-2012-healthcare-jobs-snapshot/170269

Hospital Employment Contracts: Are They as Secure as Physicians Think?

In this healthcare environment where possible new changes in laws and the government could effect the future of healthcare, many physicians are seeking hospital employment to secure their positions. However it is crucial for physicians to have a good understanding of the employment agreement before they sign it to make sure the position is as secure as they think it will be.

In today's American Medical News an article highlights 2 traps in some hospital employment contracts many physican's dont realize until after they have already signed and started: All Physicians Sign the Same Contract and Employment by Hospitals is Less Risky than Private Practice.

Read the full article in American Medical News, or click here: http://www.ama-assn.org/amednews/2012/04/30/bicb0430.htm

Neurosurgery Market Watch

Third edition of Neurosurgery Market Watch now available online!

Our feature article is an analysis of hospital employment positions for Neurosurgeons. We have a new private practice featured in our practice profile, while health lawyer Roderick Holloman addresses contract and employment challenges in our Legal Corner column. And don’t forget to check out our standing sections, Where the Neurosurgery Jobs Are and the Featured Opportunity.

Click here to read the full issue: http://harlequinna.com/neurosurgery-market-watch/

Avoiding the Wrong Fit: A Physician’s Guide to Evaluating Culture

Assessing a physician opportunity is crucial to ensure a mutually beneficial relationship is established upon signing. Evaluating a group's culture to confirm both parties have the same vision and expectations during the interview process is a very important way to make sure the move is a long-term one.

There are many factors to consider in evaluating a physician job opportunity: community need, support, compensation, the core values of the group, mission, location, etc., however culture is one of the most important considerations.

This article in the New England Journal of Medicine elaborates on exploring the culture of a group during the interview process.


Read the full article by clicking here:
http://www.nejmcareercenter.org/article/5439/avoiding-the-wrong-fit-a-physician-s-guide-to-evaluating-culture/

Increase in Part-Time Physician Employment

While part-time has been a documented increasing trend amongst women physicians, a new study also determines there is an increase in part-time employment from male physicians as well. Some of the largest medical groups are increasing part-time employment for all experience levels of physicians, for both men and women.

The part-time employment situation can be mutually beneficial to both parties; at any stage of their career physicians have more flexibility and quality of life, while hospitals and medical groups have adequate coverage and patient care.

In 2011, part-time physicians represented 25% of the workforce in large groups, up from 13% in 2005, according to the latest physician retention survey conducted by the American Medical Group Association (AMGA) and Cejka Search.

Male physicians account for 62% of physicians in the groups responding to the survey. The percentage of male physicians who are part-time more than tripled from 2005 to 2011, increasing from 7% to 22%. The part-time rate for women physicians increased at a slower clip, from 29% to 44%. The survey shows that 3 in 4 groups offer a 4-day full-time work week.

Large medical groups and hospitals are currently transitioning employment options to attract new physicians and provide more flexible options for existing physicians, thus helping with retention. In 2011, the turnover rate was 6%, which was slightly down from 6.4% in 2005.

In this healthcare environment it is crucial for hospitals and medical groups to remain flexible and offer alternate employment options. Part-time employment is one way to appeal to many practicing physicians at any stage of their career.

Read more at MedScape, or click here:
http://www.medscape.com/viewarticle/760627

Physician Employment Model Cycles

There is recent press significantly documenting the trend to hospital employment. According to American Hospital Association data analyzed by Medscape Medical News, there is a 34% increase in physician employment by hospitals since 2000. However this trend is not revolutionary, like any sector physician employment also has cycles.

Our physician recruiting firm has absolutely seen an increase in hospital employment positions, however there are still some very strong and successful private practices that are stable, profitable, and offer many of the same appeals as hospital employment: specifically, quality of life. Private practices have a stereotype as physicians working long hours, however there are many private groups that offer shared call and very similar lifestyles compared with hospital employed groups.

Motivators for physicians seeking more private-based models are maintaining their independence, having more control of their income and day-to-day operations, and sometimes frustrations with hospital employed contracts and the feeling that the hospital isn't following through with some of the promises made during negotiations.

Hospital employment remains strong and a mutual choice amongst both physicians and hospitals; however there will always be other employment options in any cycle and economic environment, and there will always be physicians who thrive under a private model.


For more information, check out the article in MedScape Today, or click here:
http://www.medscape.com/viewarticle/757386

Physician Contract Language: Outside Work Activities

Traditionally many physicians have earned extra income with locums or moon-lighting opportunities. Some physicians have even occasionally or regularly been expert witnesses in trials, or particularly in more saturated and populated areas taken call at multiple hospitals. Many academic and even private based physicians also speak regularly at events.

In the current trend of hospital employment, are these avenues for earning extra income not permitted in the employment contracts? Sometimes in contracts physicians aren't permitted to earn extra income outside what is listed in their employment contracts, or even in more unique situations, sometimes any extra income earned may be the right or need to be shared with the entity that owns the employment contract, such as the hospital that employs the physician. Steven Harris, a partner at McDonald Hopkins in Chicago has recently written an article in American Medical News deciphering the language of outside work in physician employment contracts. According to the article, some employers prohibit engagement in outside activities and services altogether, while others permit certain activities that do not interfere with the physician's day-to-day responsibilities.

The article mentions further that physicians need to be aware of requirements that give the employer the right to approve or reject outside activities, prior to signing any agreement. The physician's desired activities should be specifically identified in the employment agreement as permitted activities, even if the physician does not necessarily plan on outside employment but may wish to in the future.

If an employer does permit the physician to earn income in outside work situations, it's also important to determine if income generated from such activities belongs to the physician or the employer.

The last question is whether outside activities are covered by the physician's liability insurance policy.

The article goes on to explain how important negotiations are before the physician signs; contract clauses describing what the physician can and cannot do outside of the employment relationship are of key importance. It is best to address these issues at the onset of the employer-employee relationship so that all parties are on the same page from the beginning.

Read the full article in American Medical News, or click here:
http://www.ama-assn.org/amednews/2012/03/05/bicb0305.htm

Recruiting During a Physician Shortage: Play Up Mission

We are in a physician shortage and there has been a lot of media attention on how to attract and retain physicians. However this article we found in NPR brought up a new idea to attract physicians, focus recruitment efforts to new candidates on highlighting missionary work, a reverse-recruitment model.

Hospitals in more rural areas having even more difficulty attracting new physicians have started offering potential candidates up to 8 weeks off to do missionary work overseas. The appeal of mission-based work has been effective with certain candidates, physicians can elect to do missionary work in under-served countries such as Haiti or Mexico.

Under healthcare reform, an estimated 32 million more Americans with health insurance is expected to strain the existing healthcare workforce.

We work with many physician candidates seeking missionary work or short-term locums assignments overseas in countries like Saudi Arabia, UAE, Kuwait, and Qatar. However hospitals highlighting these opportunities and providing significant time off for physicians to participate in missionary projects is a forward-thinking, innovative way to attract potential candidates.


Read the full article in NPR, or click here:
http://www.npr.org/blogs/health/2012/02/02/145860801/how-one-hospital-entices-doctors-to-work-in-rural-america

Private/ Small Physician Practice Confidence Increase

Although hospital employment is rampant and there is a lot of media attention on the increase of hospital employment models, our firm still sees a significant number of private practices thriving in this economic environment as well as candidates seeking private or small group employment models.

We consider this an encouraging sign, and Healthcare IT has recently reported an increase of confidence in private and small group physician practices, attributed to implementing new technology. According to a recent article, 60% of physicians in small or medium-sized practices say technology has made things easier for them, and nearly half say business is better this year compared to last, according to a new survey released today by EMR vendor Practice Fusion.

Among findings from the poll:

-45% of physicians report that their practice is doing better this year compared to last year, while 14% report that their practice is doing worse and 33% report no change. (In the 2011 State of the Small Practice Survey, only 26% reported that their practice was doing better than the year before, while 41% reported doing worse.)
-60% of small practices report that new technology has made things easier.
-89% of doctors report being satisfied or extremely satisfied with their career despite challenges, a 20% increase from the year before.

Most practices ranked insurance and reimbursement as the top negative pressure (69%), followed by patient compliance issues (64%) and practice administration concerns (48 %).

Advancements in medicine (68%), patient compliance (53%) and improvement in the healthcare workforce (51%) were among the positive trends cited by physicians in this survey.

Read the full article at Healthcare IT News, or click here:
http://www.healthcareitnews.com/news/buoyed-it-small-practice-confidence

Physician Office Hiring Increase in 2011

Healthcare employment has been the one increasing consistency with the down job market. The Bureau of Labor and Statistics reports that 2011 has been the second highest year for healthcare employment over the past decade.

Over 67,000 jobs were added in physician offices in 2011 according to the BLS. Just over 89,000 jobs were added in hospitals; these figures are double and triple respectively the same figures from 2010.

General unemployment decreased nearly a percentage to 8.5% overall, however the healthcare sector remains strong and even continues to increase.

The BLS does not break down the individual positions in healthcare, but there continues to be a shortage both for physicians of all specialties as well as allied health and nursing positions. Another indicator of the increase of jobs in physician offices is the shift from inpatient to outpatient settings.

Read the full article in American Medical News, or click here:
http://www.ama-assn.org/amednews/2012/01/09/bisf0112.htm

Hospital Physician Employment Increase of 1/3

The increasing trend of physician employment models continues to grow with 32% jump from 2000-2010 data.

According to AHA Hospital Statistics, approximately 212,000 physicians were employed in 2010, which is nearly a one-third increase from the number of physicians employed by hospital systems in 2000. Nearly 20% of all physicians are employed by hospitals.

Although just over 55% of physicians are not employed or under contract with hospitals, the report reveals that in excess of 20% are covered by a group contract, just over 17% are directly employed, and just over 7% have individual contracts.

The trend of hospitals employing physicians continues to increase, however there is still a market for all types of employment models. Hospital employed models may appeal to physicians who desire to have more flexibility and security, however for the more independent and entrepreneurial-minded physician private models offer more control over running your practice.

There are also many compromises and alternatives benefitting both parties of partial- employment or shared call and expenses, even leasing your practice to a hospital as an alternative of full employment.

Read the full article at H & HN Daily, or click here: http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=1970001363

Second edition of Neurosurgery Market Watch now available online!

Our feature article is a comprehensive neurosurgery-specific RVU explanation and breakdown. Perry Hoeltzell, MD PhD shares his views in our candidate profile on his new position, while health lawyer Roderick Holloman addresses contract challenges in our Legal Corner column. And don’t forget to check out our standing sections, Physician Incentive Payments and the Featured Opportunity.

Click here to read the full issue: http://harlequinna.com/neurosurgery-market-watch/. To subscribe to the hard copy of our newsletter please email your address to info@harlequinna.com.