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Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
I want at least $270,000
I want at least $270,000
I’ll work 65 hours a week. I w
ant
I’ll work 65 hours a week. I w
ant
to pay off my loans.
to pay off my loans.
I don’t want to
work any
I don’t want to
work any
weekends
weekends
What is an independent
contractor?
Finally I can get that
Finally I can get that
BM
WB
MW
I wan
t to
be a
dire
ctor
som
eday
I wan
t to
be a
dire
ctor
som
eday
I don’t know where to I don’t know where to start !start !
I nee
d to
be
near
the
I nee
d to
be
near
the
wat
erw
ater
I want to
do
I want to
do
nightsnights
I want to be just like D
r.
I want to be just like D
r.
Sexton
Sexton
I do not want to do researchI do not want to do research
I nee
d to
I nee
d to
trave
l
trave
l
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job….So You Want A Job….
• Myths / Mistakes– Being a doctor will make you richBeing a doctor will make you rich– Buying the huge house and car if you have Buying the huge house and car if you have
loansloans– Buying a house before you work there Buying a house before you work there
(careful)(careful)– Working 70 hrs a week for three years to pay Working 70 hrs a week for three years to pay
back your loansback your loans– Not having financial educationNot having financial education
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Realities– You will probably work half the weekends the You will probably work half the weekends the
rest of your liferest of your life– You will work half the holidays the rest of your You will work half the holidays the rest of your
lifelife– Your schedule is usually very flexibleYour schedule is usually very flexible– Niches are great, but also lock you in.Niches are great, but also lock you in.– You can work anywhere you want in the USYou can work anywhere you want in the US– You most likely will rarely be on callYou most likely will rarely be on call
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A job…So You Want A job…
• Realities– You will work with great docsYou will work with great docs– You will work slugsYou will work slugs– Residents can save you or kill youResidents can save you or kill you– Get to know residents before you give them Get to know residents before you give them
autonomyautonomy– Contracts are not always as negotiable as the books Contracts are not always as negotiable as the books
tell youtell you– You won’t be able to take most deductions that the You won’t be able to take most deductions that the
rest of the world gets for tax purposesrest of the world gets for tax purposes
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
Mind searchingMind searching
Job searchingJob searching
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Mind searchingMind searching1.What do you want in 1.What do you want in
lifelife
2.What do you need in 2.What do you need in life (Finances, etc)life (Finances, etc)
3. Discuss the above 3. Discuss the above with your significant with your significant otherother
4. What type of EM job 4. What type of EM job do you want - do you want - short/long termshort/long term
• Job searchingJob searching
1.Prepare your CV1.Prepare your CV
2.Job Searching Time2.Job Searching Time
3. Interviewing3. Interviewing
4. Contract reviewing4. Contract reviewing
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
MIND SEARCHING
• Mind Searching– Priorities in lifePriorities in life– Geographical areaGeographical area– FinancesFinances
• Assets – Liabilities = Net Worth
– Significant OtherSignificant Other– What type of job do you wantWhat type of job do you want
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• MIND SEARCHING– Decide what type of ED job you wantDecide what type of ED job you want
• Pace• Setting• Level of care/type of hospital• Academic job (usually hospital employee)
– Teaching– Administration– Research– Clinical
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• MIND SEARCHING– Decide what type of ED job you wantDecide what type of ED job you want
• Purely Clinical– Group member (or start your own group)– Hospital Employee
• Independent Contractor• Open your own urgent Care Center
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
JOB SEARCHING1. CVCV
2. Job Search3. Interview
4. Contract Review
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Preparing your CV– Prepare your CV according to your job typePrepare your CV according to your job type
• Yourself• Agency• Always Chronological with each section
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• What should be in a resident’s CV– GENERAL RULESGENERAL RULES
• WHITE PAPER• Put degrees behind your name!• Font no smaller than 12• Beginning and end dates (or present) for
everything – no gaps from undergrad on• Put city and state for all institutions
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Sections – preferably in this order– Training and EducationTraining and Education– Professional ExperienceProfessional Experience– Additional Work ExperienceAdditional Work Experience– Certification and LicensureCertification and Licensure– Research and Publications (can use Research and Publications (can use
Professional Activities if not enough)Professional Activities if not enough)
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Sections in this order (cont)– Awards and HonorsAwards and Honors– Professional MembershipsProfessional Memberships– Personal (Marital status,kids,spouse,hobbies, Personal (Marital status,kids,spouse,hobbies, ties to ties to
the areathe area). Most can be discussed in an interview.). Most can be discussed in an interview.– No references-Put “References available upon No references-Put “References available upon
request”. Have a separate piece of paper available request”. Have a separate piece of paper available with all contacts, their institutions, correct addresses with all contacts, their institutions, correct addresses and phone numbersand phone numbers
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
JOB SEARCHING1. CV
2. Job SearchJob Search3. Interview
4. Contract Review
So You Want A Job…So You Want A Job…
• Job searching– Sources to startSources to start
• Your geographic area hospitals• Your residency hospital• Multiple ED magazines• Various ED organization publications• Recruiters• Online job search sites• Word of mouth
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Job Searching– ALWAYS keep in mind your priorities, ie, type ALWAYS keep in mind your priorities, ie, type
of job, area, etc. from your MIND of job, area, etc. from your MIND SEARCHING resultsSEARCHING results
– Will save you a LOT of time, money and Will save you a LOT of time, money and stressstress
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Job Searching
• Know what minimum salary you would accept ($150k-$400+)– TOTAL COMPENSATION “Package”TOTAL COMPENSATION “Package”
• All salary, benefits, malpractice • MUST ask what is included in the package
– Actual salary and bonusesActual salary and bonuses– If it seems too good to be true, it might be true If it seems too good to be true, it might be true
but it more than likely is not goodbut it more than likely is not good
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
No blind CV mailings! You’re wasting your time.
Look up the hospitals in your preferred area that you may think fit your priorities
– Make a checklist and fill in all areas for Make a checklist and fill in all areas for each placeeach place
– CALL the directors of the ED’s directlyCALL the directors of the ED’s directly
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• What do you say when you call?– State who you are and where in your career State who you are and where in your career
you are – do you have a minuteyou are – do you have a minute– Why you are calling-interested in the area, Why you are calling-interested in the area,
looking for possible employment if they have looking for possible employment if they have OR foresee any in the near futureOR foresee any in the near future
– Sometimes they will direct you to more Sometimes they will direct you to more appropriate hiring source, ie. human appropriate hiring source, ie. human resources, recruiterresources, recruiter
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Ask, if there are openings, would they mind if you sent them a CV and HOW they want you to send it. Ask if they use a recruiter (or does the hospital), or should you send it directly to them.
• Use a brief cover letter separate from your CV. Remind them of your brief phone conversation, and your interest.
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• A word about RECRUITERS !!– Rule number one – finish all mind searching tasks Rule number one – finish all mind searching tasks
before even calling them, or they will mind search for before even calling them, or they will mind search for you. you. KNOW EXACTLY WHAT YOU WANT BEFORE KNOW EXACTLY WHAT YOU WANT BEFORE YOU UTILIZE THEMYOU UTILIZE THEM
– Their job should be to find a job that fits into what you Their job should be to find a job that fits into what you want, not figure out what type of job you wantwant, not figure out what type of job you want
– Can save you a lot of leg work in an unfamiliar area.Can save you a lot of leg work in an unfamiliar area.– Some places have hired recruiters to find them docs, Some places have hired recruiters to find them docs,
and they will defer you to them, so they get paid. and they will defer you to them, so they get paid. That’s fine.That’s fine.
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• A word about recruiters– They get paid ONLY if you sign a contractThey get paid ONLY if you sign a contract– They will be pushy to get you an interviewThey will be pushy to get you an interview– Best advice - get ALL the information about Best advice - get ALL the information about
the job BEFORE you accept the interview. the job BEFORE you accept the interview. Don’t waste your time interviewing places that Don’t waste your time interviewing places that don’t fit what you want.don’t fit what you want.
– Make sure the director reviews your CV Make sure the director reviews your CV before you get an interviewbefore you get an interview
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• A word about recruiters– You should always speak to a director at some point You should always speak to a director at some point
before your interviewbefore your interview– Recruiters RARELY tell you the negatives – or act like Recruiters RARELY tell you the negatives – or act like
they don’t know about that particular issuethey don’t know about that particular issue– They are NOT to speak with your significant other on They are NOT to speak with your significant other on
the phonethe phone– Each recruiter only covers a specific geographical Each recruiter only covers a specific geographical
area for their firmarea for their firm– They do NOT know specifics about benefits and are They do NOT know specifics about benefits and are
NOT at liberty to discuss salariesNOT at liberty to discuss salaries
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• A word about recruiters– If a hospital or group uses a recruiter, don’t try If a hospital or group uses a recruiter, don’t try
to circumvent themto circumvent them– Hospital recruiters are usually less pushy and Hospital recruiters are usually less pushy and
more helpful / private recruiters are pushy and more helpful / private recruiters are pushy and often not too patientoften not too patient
– If a recruiter gets pushy, tell them you are not If a recruiter gets pushy, tell them you are not in hurryin hurry
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
JOB SEARCHING1. CV
2. Job Search3. InterviewInterview
4. Contract Review
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
THE INTERVIEW
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Be prepared for the interview-STRONGLY suggest bring significant other if a new area
• Most have decided they want you – the interview is to 1) Confirm they want you, and 2) for you to get more information, and a feel for them-to see if YOU want the job
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Interview– Leave extra time to check out the areaLeave extra time to check out the area– Don’t be lateDon’t be late– Make sure you are interestedMake sure you are interested– Be relaxed – they don’t want anyone uptightBe relaxed – they don’t want anyone uptight– Bring questions – nothing wrong with bringing Bring questions – nothing wrong with bringing
a piece of paper with questionsa piece of paper with questions
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• The Interview– Be open and frank about any concerns you Be open and frank about any concerns you
havehave– If you don’t understand all the benefits, ask If you don’t understand all the benefits, ask
who you can talk to (human resources, etc)who you can talk to (human resources, etc)– Find out how long they have been there ie, Find out how long they have been there ie,
the group, the director, why did they switch to the group, the director, why did they switch to the present groupthe present group
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• The Interview– Ask if there any major problems they see with the 1) Ask if there any major problems they see with the 1)
facility/space, 2) relationship with the hospital facility/space, 2) relationship with the hospital administration 3) relationship with medical staff 4) administration 3) relationship with medical staff 4) nursing staff/staffing 5) ancillary staff 6)on call nursing staff/staffing 5) ancillary staff 6)on call response- AND how do they plan on fixing themresponse- AND how do they plan on fixing them
– Let them know if you are interested in any specific Let them know if you are interested in any specific non-clinical responsibilities / administration. But non-clinical responsibilities / administration. But DON’T make a bunch of promises. Your first year will DON’T make a bunch of promises. Your first year will be tough.be tough.
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• The Interview– Get a broad overview on how they do scheduling-ask Get a broad overview on how they do scheduling-ask
for a name who does the schedule to talk tofor a name who does the schedule to talk to– Leave salary to last - ask if this would be the Leave salary to last - ask if this would be the
appropriate time to inquire about compensation appropriate time to inquire about compensation – Don’t sign anything at the interviewDon’t sign anything at the interview– If they offer you a job, say “I think the interview has If they offer you a job, say “I think the interview has
been positive up to now, but before I give you a final been positive up to now, but before I give you a final answer, I would like to go over the contract in detail.” answer, I would like to go over the contract in detail.” Could they send you a contract to read over? When is Could they send you a contract to read over? When is the latest they need to hear back from you?the latest they need to hear back from you?
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
JOB SEARCHING1. CV
2. Job Search3. Interview
4. Contract ReviewContract Review
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
GETTING the OFFER and REVIEWING the
CONTRACT
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…• If you get a contract, you have been offered a
job – it’s all in your hands now• Get a lawyer – They won’t know the ED
specific stuff, but get them to go over legal jargon, esp. termination, waiver, restrictive covenant (noncompete), due process clauses and how accounts receivable are handled—careful with partnership jargon
• Benefit specifics usually are NOT in the contract, only that the group will supply certain benefits – get the specifics from the benefits specialist
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Reviewing your contract terms– PartiesParties– Obligations / ConditionsObligations / Conditions– SchedulingScheduling– Compensation / Fee Compensation / Fee
assignmentassignment– Liability InsuranceLiability Insurance– TerminationTermination– Medical staff Privileges / Medical staff Privileges /
Due ProcessDue Process
– IndemnificationIndemnification– MiscellaneousMiscellaneous
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Parties– Physician employment statusPhysician employment status
• Employee – should be clearly stated• Partner -define• Independent contractor – careful!
– Contract relationshipContract relationship• Physician with
– Hospital– Private group– Contract management company (Megagroup)– Locum Tenens group
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Group vs hospital as the employerGroups will contract with hospital to supply a Groups will contract with hospital to supply a
service with docs they hire, bill and collect for service with docs they hire, bill and collect for their own professional fees (profee), buy all their own professional fees (profee), buy all benefits, insurance, retirement plans benefits, insurance, retirement plans themselves. Hospital agrees to supply facility, themselves. Hospital agrees to supply facility, nurse staff, ancillary services, often does their nurse staff, ancillary services, often does their own credentialing. Have a final say fire/hire. A own credentialing. Have a final say fire/hire. A group has a president/chair, a hospital hires a group has a president/chair, a hospital hires a director for the ED (often the same person)director for the ED (often the same person)
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Group vs hospital as the employer– A hospital hires all the docs, bills and collects A hospital hires all the docs, bills and collects
for all their professional services, supplies all for all their professional services, supplies all benefits, insurance, retirement plans, keeps a benefits, insurance, retirement plans, keeps a certain amt for administrative fees, and hands certain amt for administrative fees, and hands out the rest to the docs as compensation. out the rest to the docs as compensation. Hospitals are notoriously less efficient at Hospitals are notoriously less efficient at billing and collecting than hired billing billing and collecting than hired billing companies.companies.
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• A physician as an independent contractor– Agrees on a contract with a group (small or Agrees on a contract with a group (small or
mega) or hospital to perform his/her service. mega) or hospital to perform his/her service. Hospital supplies all facilities, staff, ancillary Hospital supplies all facilities, staff, ancillary services, and the doc bills and collects all his services, and the doc bills and collects all his services himself-pays all his own expenses, services himself-pays all his own expenses, you should buy your own malpractice.you should buy your own malpractice.
– Strict regulations reg. definition of Strict regulations reg. definition of independence-for tax deduction purposesindependence-for tax deduction purposes
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• 20 Point Rule – IRS Guidelines – help them decide if you are functioning independently or as an employee
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Facts that provide evidence of the degree of control and independence fall into three categories:
• Behavioral: Does the company control or have the right to control what the worker does and how the worker does his or her job?
• Financial: Are the business aspects of the worker’s job controlled by the payer? (these include things like how worker is paid, whether expenses are reimbursed, who provides tools/supplies, etc.)
• Type of Relationship: Are there written contracts or employee type benefits (i.e. pension plan, insurance, vacation pay, etc.)? Will the relationship continue and is the work performed a key aspect of the business?
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
•Explanation of rules for independent contractor status:
– http://www.irs.gov/Businesses/Small-Businesses-&-Self-Employed/Independent-Contractor-Defined
– Publication 15-APublication 15-A– http://www.irs.gov/Businesses/Small-Business
es-&-Self-Employed/Independent-Contractor-Self-Employed-or-Employee
– http://www.irs.gov/taxtopics/tc762.htmlhttp://www.irs.gov/taxtopics/tc762.html
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Independent contractor– Sometimes less risky if you incorporate Sometimes less risky if you incorporate
yourself as a P.C. or private corporationyourself as a P.C. or private corporation– Your corporation then is contracting to work, Your corporation then is contracting to work,
not you – and you enter into an employee not you – and you enter into an employee relationship with your new corporationrelationship with your new corporation
– Protects you from audit, heavy back taxes Protects you from audit, heavy back taxes and fines.and fines.
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Obligations / Duties / Conditions Precedent– Provide services during hrs scheduledProvide services during hrs scheduled– Any outside the EDAny outside the ED– Med staff membership, Licenses, etcMed staff membership, Licenses, etc– ACLS,ATLS,PALS, or is ABEM/ABOEM cert enoughACLS,ATLS,PALS, or is ABEM/ABOEM cert enough– Teaching / research/administrativeTeaching / research/administrative– Spec job descriptionsSpec job descriptions– On call dutiesOn call duties– ***Med Staff by-laws***Med Staff by-laws
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Scheduling– Guaranteed min number of hours-week/month/yearGuaranteed min number of hours-week/month/year– Max hours required as wellMax hours required as well– ***Total hours required in the year***Total hours required in the year– Total vacation ,CME time allowed-must add up - Total vacation ,CME time allowed-must add up - you you
are paid for what you work, not for vacationare paid for what you work, not for vacation– On call hours affect total hours? What are docs On call hours affect total hours? What are docs
allowed to call out for? allowed to call out for? – Vacation /weekend requirements often not in the Vacation /weekend requirements often not in the
contractcontract– COVERAGE IS EVERYTHING – census means COVERAGE IS EVERYTHING – census means
nothingnothing
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• “Paid vacation”– LOOK AT LOOK AT TOTAL HOURSTOTAL HOURS and and TOTAL SALARYTOTAL SALARY – Paid vacation Paid vacation moniesmonies are usually INCLUDED in your are usually INCLUDED in your
salarysalary– Vacation Vacation timetime is usually INCLUDED in your total is usually INCLUDED in your total
hourshours– SO ignore them for the time beingSO ignore them for the time being– May want to ask how your hours will get shifted when May want to ask how your hours will get shifted when
you take vacation and how flexible they are with what you take vacation and how flexible they are with what months you take them inmonths you take them in
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So you want a job…So you want a job…• Compensation / Fee Assignment
– Assign you rights to collect fees from patients and Assign you rights to collect fees from patients and payors to the hospital or group (unless indep contr)payors to the hospital or group (unless indep contr)
– Watch for kickbacks-receiving money for referralsWatch for kickbacks-receiving money for referrals– CompensationCompensation– Bonuses / incentiveBonuses / incentive– Nonclinical compensationNonclinical compensation– Benefits – Life ? ($1220) / Disability?($5000) / Benefits – Life ? ($1220) / Disability?($5000) /
Health($6-12,000)/Dental (us not incl) Health($6-12,000)/Dental (us not incl) – CME ($2-5000), licensure fees, prof duesCME ($2-5000), licensure fees, prof dues
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want a Job…So You Want a Job…
• Compensation– If your salary is $270,000 and you are If your salary is $270,000 and you are
required to work 1760 hrs for the year, their required to work 1760 hrs for the year, their budget for you is $153.30 / hour. Make sure budget for you is $153.30 / hour. Make sure you do not have to take out your OWN health you do not have to take out your OWN health insurance, life insurance, disability (deducted insurance, life insurance, disability (deducted from your paycheck) from your paycheck)
– Life, disability, vision often get offered to you Life, disability, vision often get offered to you at a discount rate, and you can elect to get at a discount rate, and you can elect to get THAT taken out of your checksTHAT taken out of your checks
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Ex 1. 1840 hrs/year – 6 weeks paid vacation / 1 week CME – Salary $200,000 ($108.69/ hr)
• Ex 2. 1700 hrs/year – 4 weeks paid vacation – Salary $200,000 ($117.64/hr)
• Ex 3. Night shift only – 1700 hrs/year – 4 weeks vacation – differential extra $10/hr – Base salary $170,000 ($100/hr) W nights (110/hr-or extra $17,000)
• Ex 4. Night shift only – 1440 hrs/year – 6 weeks vacation allowed / 1 CME allowed – no differential – Salary $210,000 ($145.83/hr)
• Ex 5. 2080 hrs/year – 7 weeks paid vacation/ 1 week CME – Salary $270,000 ($129.81/hr)
So You Want a Job…So You Want a Job…
• A word about RVU’s– Relative Value Units (work, practice, liability Relative Value Units (work, practice, liability
components)components)– Mcare pays appr. $37 per RVU depending on year Mcare pays appr. $37 per RVU depending on year
and geogr. area.and geogr. area.– Level of service from 1-5/Cr Care for a patient Level of service from 1-5/Cr Care for a patient
generate appr. 0.6 – 6 RVU’s, (not incl procedures)generate appr. 0.6 – 6 RVU’s, (not incl procedures)– Private ins. companies pay higher (110-200% MCare)Private ins. companies pay higher (110-200% MCare)– Your pay should be based on RVU’s CHARGED Your pay should be based on RVU’s CHARGED notnot
COLLECTED-prob based on WORK RVU’sCOLLECTED-prob based on WORK RVU’s
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…• Liability Insurance
– $30-55,000 total– private is required and Medicare $30-55,000 total– private is required and Medicare requires contribution for a blanket fund separately-requires contribution for a blanket fund separately-Almost ALL employers/groups will supply malpractice Almost ALL employers/groups will supply malpractice for you (although comes out of the pot in the group’s for you (although comes out of the pot in the group’s profits)profits)
– Two typesTwo types• Occurrence – will be covered for a case even after you
leave• Claims-made – you are only covered if claim is filed while
you are still there - so…you need to buy a second policy called a “tail” that covers you beyond that - can be different number of years, make sure they pay for that – can be very expensive ($20,000)
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Termination– Both parties usually want termination “without Both parties usually want termination “without
cause”cause”
This is difficult to avoid-so at least negotiate a This is difficult to avoid-so at least negotiate a reasonable notice time, and possibly reasonable notice time, and possibly severance package. Most have portion for severance package. Most have portion for termination for “cause "for reasonably termination for “cause "for reasonably unprofessional behavior – agree if reasonableunprofessional behavior – agree if reasonable
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Medical Staff Privileges / Due Process
– Most hospitals ask physician to also “waive” Most hospitals ask physician to also “waive” the right of due process” if arbitrarily the right of due process” if arbitrarily terminated – too expensive to go through – terminated – too expensive to go through – very rarely needs to be enforced - use to get a very rarely needs to be enforced - use to get a severance package possiblyseverance package possibly
• Medical Staff Privileges / Due Process– May want to negotiate a phrase like “only in May want to negotiate a phrase like “only in
the event the hospital cancels present group’s the event the hospital cancels present group’s contract, agree to waive due process for contract, agree to waive due process for termination…”termination…”
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Non-Competition (restrictive covenant)– No moonlighting for a competitor – No moonlighting for a competitor – reasonablereasonable– Cannot “steal” the contract away from the present Cannot “steal” the contract away from the present
CMG – CMG – reasonablereasonable– Do not reveal trade secrets or data to competitor - Do not reveal trade secrets or data to competitor -
reasonablereasonable– Cannot work for hospital or next group or “nearby” Cannot work for hospital or next group or “nearby”
after present relationship ends – after present relationship ends – NOT reasonableNOT reasonable, , esp for ED docs – unenforceable in some statesesp for ED docs – unenforceable in some states
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Indemnification– means you agree to pay the hospital or group
for any liabilities they incur as a result of your conduct. Means you “indemnify” them
– They should agree to the same– Rarely used, but stakes are high– Is not favorably looked upon in emergency
medicine contracts-YOUR malpractice does NOT cover indemnified costs !!!
• Hold Harmless– Where you agree to hold the group or hospital Where you agree to hold the group or hospital
not responsible or liable in case you cause an not responsible or liable in case you cause an injuryinjury
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A job…So You Want A job…
• Miscellaneous– “complete agreement” – all that is here is all
that is promised – protects against verbal agreements
– Don’t have a lawyer negotiate your contract – you know more about job market, compensation, scheduling – have them evaluate risks allocated to you and ambiguous clauses
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Helpful advice– Start off conservative / but order what you Start off conservative / but order what you
need onlyneed only• Your academic knowledge is prime• Your judgment is still largely undeveloped
– Take a financial management courseTake a financial management course– Maximize your pre-tax retirement plansMaximize your pre-tax retirement plans
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Helpful Advice
• You have 3 groups of customers you should always aim to please to keep your contract– The PatientsThe Patients– The Medical Staff (you get your patients from)The Medical Staff (you get your patients from)– The Hospital administration (incl ED director)The Hospital administration (incl ED director)
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• When privates / radiologists / vascular / ancillary techs are angry about admissions,tests, keep that their problem, not yours .
• You will be evaluated mostly on documentation, professionalism, Press-Ganey scores, production.
• Become involved with committees, administration at some level, try to be involved with hospital level as well as ED level.
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• Helpful Hints– Request schedule breaks to study for boards Request schedule breaks to study for boards
early (or in second interview)early (or in second interview)– Don’t take on too much non-clinical Don’t take on too much non-clinical
responsibilities your first year – it is not responsibilities your first year – it is not expected….just pass the boardsexpected….just pass the boards
– Have an outlet or twoHave an outlet or two
Joe Sexton, MDJoe Sexton, MDLehigh Valley Hospital and Health NetworkLehigh Valley Hospital and Health Network
So You Want A Job…So You Want A Job…
• It is rare to retire from your first EM job• Nothing is forever, and you can work
anywhere in the country• Remember, you are in the top 1 % of salaried
employees – don’t get greedy• A difference of $30,000 -50,000 between two
jobs is not gong to drastically change your life style, or make you rich.
• COVERAGE IS EVERYTHING