LIFE AFTER RESIDENCY Why be a hospitalist with EmCare Pawan Dhawan MD, MBA Executive Vice President EmCare - Alliance Division Page 1.

LIFE AFTER RESIDENCYWhy be a hospitalist with EmCare

Pawan Dhawan MD, MBAExecutive 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

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

Compensation by Region-2013 SHM

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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

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Adapted Dr Neese Slides 2014 Presentation

Hospitalist Career Satisfaction SHM 2013 Data

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Adapted from Dr Nesse’s 2014 presentation

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

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

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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-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

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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

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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 -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.

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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 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

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Thank You!

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Thank you, Dr. Stoev and Dr. Neese