In the media, lawyers and doctors are often portrayed as adversaries. Headlines read of legal battles between patients and physicians, as well as class action lawsuits, but readers tend to forget that lawyers play an important part on both sides of the argument. Becoming a doctor is a difficult undertaking, and not just because of medical school. There are so many legal aspects of the business to consider, and they’re constantly changing alongside legislation and healthcare reform. To help you keep abreast of all this while focusing on the medical aspects of the field, consider taking the advice of someone who concentrates in that area of the business—like a lawyer. Here are a few things to keep in mind before you sign an employment contract to work for someone else or before starting your own medical practice:
First, read your contract, especially if it’s your initial offer as an attending physician. Employment contracts in the medical field are often complex due to the many responsibilities associated with the position. Experts recommend paying for full legal advice from a lawyer with experience in physicians’ issues to review these documents before you sign. It may be expensive upfront, but it could save you much trouble and money down the road. Three things to pay attention to within the contract include compensation, termination clauses, and something known as “restrictive covenants.” From an outsider’s perspective, compensation for doctors is a nonissue. It’s one of the highest paid fields in the United States, but when you’re starting out (and paying off monumental student loan debt), locking in a salary can be a big deal. Some contracts have explicitly stated salaries, while others are income-driven. The length of the contract matters, too, because you might find yourself locked into a position/salary for 5 years before you can make a change. For most jobs, when the atmosphere becomes undesirable, or a better offer comes along, you simply take it. For doctors, again this process is typically agreed upon and spelled out before you even begin the first job.
It’s important to note who can initiate termination, when, and whether it can occur “with cause” or “without cause.” “Without cause” means the hospital or practice can terminate your contact at any time, for any reason. While in some ways this simplifies things, it’s also wise to temper that with a notice requirement, so you’ll have 3 to 6 months to look for another position before losing income. “With cause” requires the employer to spell out the reason for termination, in no uncertain terms. Be aware, these disclosures can be brought up in a court of law should an angry patient seek direct retribution once you’re not longer linked to them. So far, these terms only apply when it’s the employer’s decision to discontinue your position, but what if you want to leave of your own accord? Potentially, to accept another, more favorable offer, or strike out on your own. That’s where the “restrictive covenants” come into play. Known also as non-compete clauses, they prohibit the doctor from taking his/her patients when relocating to a different practice. From the employer’s perspective, this clause makes perfect sense. They’re spending a lot of time and money to train their new hires; they don’t want them to up and leave 6 months after they’ve gotten the experience on their résumés. However, the physicians are putting in a lot of effort, as well, building relationships with their patients. In the past, courts have recognized both sides of the argument, requiring such clauses to have a specific time limit, with some states barring such provisions altogether on the basis of free trade. Want to learn more about the details? This should prove to be a good resource to start with, though it in no way replaces true legal counsel: http://www.huffingtonpost.com/entry/free-legal-advice_us_59c2b3f4e4b0c87def8834b8.
So why should doctors put up with all the legalities that accompany working for a larger practice and/or hospital? Well, unfortunately, starting your own practice requires wading through even more legal matters, and we won’t even get into hospitals here. With the advent of the Affordable Care Act, every medical practice is now required to have an Electronic Health Record (EHR). The EHR is the new version of a patient’s medical history files, but’s all electronic now, as the name would imply. When combined with HIPAA (Health Insurance Portability and Accountability Act of 1996), this means doctors also have to implement advanced cyber security protocols to ensure the safety of their patients’ personal information. Neither measure is particularly cheap. Now, add in the cost of the staff needed to manage all of these new systems, along with malpractice insurance, real estate, new equipment, cleaning and disposal fees, and you’re facing a hefty overhead. Some quote around $30,000 per month in static expenses just to cover a simple practice in today’s technological world. Then you have to keep abreast of all of the changes in the industry yourself, while shouldering all of the liability—again by yourself. Here’s just a glimpse of the many things you would have to concern yourself with as the practice owner: https://www.hg.org/medical-law.html. Now, you might understand why so many doctors are leaving the world of private practice in favor of chain clinics.
While medical expertise may be your forte, few doctors are also lawyers. So, rather than take on these weighty decisions by yourself, reach out to a professional who can help review the paperwork and present the different options before you from a legal perspective. Doctors and lawyers aren’t that different, after all. So, when they choose to cooperate, the need for litigation drops dramatically.