Doctor Employment Lawyer Blog

This morning I attended the Crains Chicago Business Physicians Breakfast, where the panel primarily focused on the business of medicine and the impact of technology and the health care. Although the impact of these issues may not be easily discernable in a physician's employment agreement, they will directly impact your time and productivity.

New doctors should be especially concerned about the impact of technology on their employment because, although there are technologies that create efficiency, many new technologies are implemented in response to new bureaucratic requirements for documentation. This means you could be spending more time imputing data and less time caring for patients. And, if your compensation is based solely on your own (and not the practice group's) productivity, you could be losing the ability to earn a fair and decent salary.

No matter how thoroughly you investigate a practice group, hospital or other employer, as a doctor you may someday be faced with an ethical dilemma regarding patient care, resident hours, billing, referral arrangements or other practices. Knowing how to make a report and to whom can affect the legal protections available to you as well as the ramifications on your future career.

A physician's first step should be to investigate and determine whether the issue is a legal issue, a safety issue or a personal ethics issue. All three are extremely important, but there are whistleblower laws in place to protect you when the issue affects public funds and public safety. Personal ethics issues may or may not have such protections, depending on the specifics of the concern.

Next, you should think about the ramifications that a report will have. Will it promote the change you believe is necessary or will it cause further damage to yourself or others?

Most importantly, you need to determine where to turn. Some issues are best addressed directly with your employer. But, there are issues that need to be reported to authorities. Regardless, you should approach an attorney or other professional whom you trust and fully explore all available avenues.

For those of us that live in or around an urban area, getting from point A to point B on a daily basis means navigating down streets and around buildings. Hover cars have yet to be invented and evolution has yet to bring us wings. Nevertheless, when it comes to non-compete agreements, the distance is almost always as the crow flies.

Most non-compete provisions prohibit the physician from working within a specified mile radius of the place of employment. That single word "radius" can add a lot of area to the restriction.

This can be especially crucial if you signed an agreement with a 10 mile radius restriction and you accept a job that is 13 miles away by car. Many physicians are under the impression that the 13 mile driving distance puts the new job beyond the restricted area. The fact is that a 13 mile drive can easily be within a 10 mile radius depending on available roadways. That can be a very expensive mistake for a physician who is sued for violating a non-compete.

It is the time of year when physicians are completing their residencies and locating new positions. And, even those that are not moving on, usually find themselves faced with an annual contract negotiation. Yet, surprisingly, most physicians do not take the time to review their agreements and fully understand their obligations.

This is especially true when the physician has been with the employer for many years and complacency has set it. Just because you didn't read the last agreement does not mean you should continue to sign everything your employer places in front of you.

If you get only one thing from this blog, get this: Read your agreement.

Most physician employment contracts allow either party to terminate the agreement at any time by giving a certain amount of written notice. The notice period is typically 90 or 180 days. However, many physicians do not understand that the notice period is not a guarantee that he or she can work through that period.

I recently spoke with a physician who was shocked when her employer exercised the 90 day notice period by providing written notice and asking her to immediately leave the practice. The physician was paid during the notice period, but no notice of her departure was provided to patients or referring doctors. She was understandably upset because her patients were left with the impression that she did not even give them the courtesy of letting them know she was leaving.

This physician had believed that the notice period was a promise that she could continue to work for her employer during the 90 day period and use that time to inform patients and referring doctors of her departure. Instead, she was discovered that, as long as she was paid through the notice period, the employer was not under any obligation to allow her to treat patients during that period. Nor was her employer required to work with her to notify patients or referring doctors of her departure.

Leaving a practice without any notice to your patients or referral relationships is likely to damage relationships that may have taken years to cultivate. Patients don't usually understand that the employer owns patient information and a doctor likely will not have access to such information after leaving a practice.

The lack of notice can be damaging to the employer as well. Patients often impute the conduct of a treating physician to the practice as a whole. Leaving a patient wondering what happened to his or her physician is not likely to create a trusting doctor-patient relationship.

Working out an agreement about how to notify patients and referring physicians regarding a physician's departure at the start of the employment relationship is beneficial to all parties. It allows the doctor and the employer to protect their reputations and minimize patient confusion. It ensures patients are informed about whom they can contact about their treatment issues. And, it ensures that referring doctors know who will be taking over the departing physician's practice.

Of course, trying to work out those details at the end of an employment relationship is usually an exercise in futility.

Many hospitals start the hiring process by providing a physician with a Memorandum of Understanding. This documents usually lays out all of the terms that will be formalized in the final employment agreement. Since the Memorandum of Understanding is not an employment agreement, many physicians mistakenly believe that they can sign without obligating themselves to anything that would affect the employment agreement.

Memorandum of Understandings are the first step in the process of negotiation. It is the document that defines the basic provisions of the agreement. Often times, it will set forth key items such as the term of the agreement, compensation, duties, malpractice insurance, and even restrictive covenants. While it's true that the memorandum is not binding, signing it signals to the hospital or practice that you accept the details of employment as written and they can proceed to use those provisions in the final agreement.

Attempting to negotiate terms of the employment contract after you agreed to such terms in the memorandum puts a physician at a serious disadvantage. You're not barred from negotiating provisions, but you likely lose some credibility if you agree to terms in one document, but reject them in the actual contract.

I recently heard a story about a General Surgeon who signed her private practice employment contract without reading anything other than the compensation section. It turns out that the agreement she signed states that she was hired as a Primary Care Physician.

While this may not affect her employment at first, it could be an issue is things between her and her employer ever turn sour. Just like any other career, when a doctor starts a new job everything is exciting and positive. However, after the honeymoon phase ends and both sides reveals their flaws, things may not be so rosy. Errors like this one in your Physician Employment Contract could give your employer an opportunity to terminate your employment without any of the benefits for which you may have contracted.

Furthermore, if the employment contract is so inapplicable that even your specialty is incorrect, what else may be wrong? Are call duties clearly spelled out? Is the non-compete limited in scope? These are all important issues that can affect your employment and your future career. Make sure you know what you are getting into before you sign.

It may seem like selecting your area of specialty is the largest career defining decision as a physician, but the choices do not end there. You may go into private practice, academics, hospital practice, a partnership or a solo practice. And, once you decide on the type of practice you want to have or be involved with, there are a number of different factors that can affect your job satisfaction.

Many physicians believe that, other than your specialty and the type of practice, all you need to worry about is the contract. While a contract can address many areas of concern, it can't address everything. Just like any other profession, a physician's office is made up of people. There are hierarchies, cliques, processes, and policies. Knowing the office that you are planning to enter and understanding the practice's culture are key determinants of job satisfaction.

Always research prospective employers. Ask to meet with each of the practice's physicians and a member or two of the staff. Ask specific questions about expectations for new physicians and the support that the practice will provide you to meet those expectations. The more you know about the employer, the better you can negotiate your contract. If you know that the practice shifts the heaviest on-call duties to new physicians, you can try to negotiate an equal call distribution. Similarly, if you know that the practice only provides the marketing support it is contractually required to provide, you can try to negotiate a specific marketing budget or specific initiatives.