Since the physician job search is at its peak nowadays, I am posting a list of topics on physician job search, including physician employment contract etc. I hope summarizing them here will make it easy for everyone to access these articles. I am a physician myself and these articles are written without bias or conflict of interest. However all articles are subject to the disclaimer posted on this website. With our next post, I will resume talking more about starting your own medical practice.
Physician’s job hunting timeline
Getting your job application ready
Writing a good cover letter
What do physician employers want?
How to handle the telephone interview
Anatomy of a physician job interview
In the restaurant with physician employers
Do’s and Don’ts in a doctor job interview
Interview Dress Code for Doctors
Evaluating a physician job opportunity
Physician Employment Benefits
Using an attorney to review your physician employment contract
Understanding physician employment contract
Physician Contract Negotiations
How to negotiate physician employment contract
Getting ready for your first physician job
Carl Armato is the President and CEO of NovantHealth, Inc. He is one of the few CEOs who actually keep their employees informed about his views about the company and how it is run. This article written by him, for the employees of Novant, is reprinted with his permission and with credit to Paul Harvey.
FoodMed Regional Grocery Center
Trying to explain how hospitals are paid for their services is a daunting assignment. Few if any businesses are paid for their products or services in the same way as a hospital.
Several decades ago radio personality Paul Harvey explained what it would be like if other companies were paid like hospitals. Novant staff have updated the comparison below, using a grocery store as the example. I hope you find this insightful.
It’s your first day on the job as checkout cashier for FoodMed Regional Grocery Center. Four customers have lined up with their carts at your cash register. Here’s what happens.
Customer #1 gathered $100 of groceries. She tells you that she will pay only $85. You tell your manager about this odd situation, but she frowns and informs you that the store is powerless. And because she bought lima beans and cod, you must call a jammed 1-800 number to get approval to sell her these items. (Medicaid)
Customer #2 heaps his cart full of groceries. Because he stayed in the store longer than two hours, he can take as much food as he wants to, but you can only charge him $90. Four of 10 customers pay for their groceries “by the cart,” so you pray that an equal number of appetite-suppressed customers shop at your store as do hungry people to balance things out. For this same group of customers, if your store spent any money on advertising, legal fees and community education, the customers who shopped in your cereal and canned goods section can deduct these types of expenses from their final bill because they don’t believe your store needs to spend money on that kind of stuff. In addition, if you allow customers to use your store phones, as a convenience for local calls, you must conduct an audit that determines what portion of your total phone bill is attributable to this nice gesture by your store. And those customers mentioned above can also deduct that telephone cost from their food bill. (Medicare)
Customer #3 also has $100 of groceries, mainly bread, milk, vegetables and other foods essential for good health. She cannot afford to pay even $5. Your store believes it’s important to help those in need, so you inform her that the groceries today are free. (Uninsured with low-income)
Customer #4 buys $100 of groceries. You’ve been instructed to charge this fourth customer $140 because the first three customers did not fully pay their bills. The customer pays you a small amount; your store must collect the remainder of the bill later on, typically waiting 60-90 days for payment. These customers that you are overcharging are getting madder and madder, and several are refusing to make up the difference. One even launched a media campaign to put pressure on your supermarket so you would lower its prices, too. (Commercial insurance)
Based upon these confusing payment scenarios, you can see why the healthcare industry is working to transform itself. On a final note, each of the four customers described above, regardless of his or her ability to pay, deserves remarkable service from highly skilled employees and partners.
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Have you been targeted by a scamster. Chances are you were and you didn’t even know. Here I am going to list some common scams, medical residents may become a target of. Many of these attempts I have personally experienced or seen someone else get into.
1) WHOLE LIFE INSURANCE: When I was a medical resident, one insurance salesman wasted a whole day of mine to convince me to buy a “Whole Life Insurance”. He said it has ‘Cash Value’, and the earlier I buy it my rates will be cheaper. Some of my friends did buy it but they could not maintain the high payments of a ‘Whole Life Insurance’ – which are almost as huge as car payments. The truth is there is not enough residency stipend to maintain these payments. And most likely you will end up dropping it. I prefer a 30 year term life insurance as it is cheaper to maintain and runs out once there is a good likelihood of all debts being paid off.
Here is the link from MSN to learn more about Types of Life Insurances.
2) OPEN RETIREMENT ACCOUNT WITH US: One Insurance salesman wanted me to open a retirement account with his firm. He was well versed with the benefits offered by my residency program, including a matched 401K, which almost nobody saved into. Yet he conveniently forgot to mention it to me.
Ask your Residency Progam Coordinator about the benefis offered by your residency program. And save money in the 401K, especially if it is matched. Even if you want to open IRA then go to low cost funds like www.Vanguard.com .
3) PHYSICIAN RECRUITERS’ SCAM: In the final year of my residency a physician recruiter wanted me to go to an interview in a god forsaken place in he middle of no where. I told him even if I get a job there I will not take it. Yet he persisted. But so did I. I never went there as it would have been a waste of time. Later I find out that the physician recruiters sometimes get paid based on how many candidates they manage to get interviewed for a spot.
4) EARLY PARTNERSHIP: A friend of mine was offered an early partnership in a medical practice within six months of his employment. He was ecstatic. He signed it without realizing that a partnership does not have a base salary guarantee and his income instantly dropped into five digits, as he did not have enough patient base. Read my article on Timing your Partnership in a medical practice.
With all the sectors taking a hit, what is happening to physician jobs? Let us try to delve deeper to find the answer.
Healthcare is a resilient sector when it comes to an economic crisis. There are several reasons for it.
1) Healthcare is needed no matter what the economy is. (A very common argument!)
2) The government is a major customer of Healthcare and always retains a spending ability. The government purchases healthcare services through their Medicare and Medicaid Programs
3) The business of healthcare is not as leveraged like finance or construction or manufacturing. That means that we docs do not take too much loans, way beyond our capacity.
4) Banks continue to finance the medical practices due to the stable nature of the business.
Therefore the health care jobs did not go down with the economy. They actually went up by 3%. Yes! The Healthcare jobs were added in this economy.
Now lets talk about Physician Jobs. I do know of some of my friends having trouble finding physician jobs. I do know of hospitals putting hiring freeze on physicians. MGMA does not seem to have commented specifically on physician job data.
I believe that since the physicians are the most expensive piece of personnel in a medical practice or hospital there is some reluctance in hiring them, not knowing what the future holds.
As people lose jobs and their medical insurances, the commercial payers for a medical practice will decrease and cause a dent in the revenue. The workload of indigent care clinic is already increasing. If the recession last too long, then the medical community will definitely be affected.
GOOD NEWS! CareerMedicine renovation is almost complete. You can still visit the old version from the link below. But now you have all the articles available on the new version. We are now fixing broken links.:
We will be working all day to renovate the website. Any suggestions? Pl write it in comments. Thank you for your patience as we make CareerMedicine even better than before. Please come back to check us out. We value you readership.
We have had fun time writing articles on CareerMedicine.com. Recently the AAFP approved CME activity “Starting a Medical Practice” was a great success. The seminar was held in Rock Hill, SC. CareerMedicine receives hundreds of hits everyday from physicians trying the learn the ropes of Starting a Medical Practice or the tips and tricks of finding a physician job search.
The amount of articles on the website have reached such proportions that many good articles are difficult to find. So we are planning to change the website design to a magazine like website. In that format the readers of CareerMedicine.com will be able to access articles in different category much more easily.
But with a big change comes great challenges. We do expect the site to be down for few hours or a day when we make the change. Google search engine may drop us until it reregisters the new website. And most painful is that certain links to other articles in this website may not work.
So we ask you to be patient as we improve the performance of this website for your convenience. Please alert us in comments if you find that some links are not working. We will diligently fix them. If you have trouble getting to the website during this period, please copy the following URL.
So hold your breath and wait for the new CareerMedicine.com!!!
The truckload of documents on my table every single day waiting to be signed. Some are prescription refills, other are papers from the scooter people and not to mention those requests for prior authorization. Now if you have the same story there is a lot of risk hiding in those papers.
No doctor has time to read all of these papers. They all rummage through it and sign wherever the signature needs to go. After all there are atleast 100 or more signatures to be done everyday for which there is no compensation.
Among these papers are those sent by some shady vendors and companies. Here are few examples of those:
1) Diabetic Supplies:Diabetic Supply is a big business. That is why you hear those ads about free diabetic supply delivered to your door. Automatically! It is not that automatic. Once the patient requests diabetic supply from the company, they will send a form to the physician to sign. This form has the diagnosis codes and frequency of use, which is usually already filled out by the company salesmen. What they won’t tell you is that they documented the patient needs to check his or her sugar 5 times a day. Even when they are not on insulin. If you sign this form without correcting it, they will send the patient enough supply so they can check their sugars five time a day. This is called Upselling – Selling more than what someone needs. If Medicare comes after them, they have a good defence – “the doctor told us to do that!”
The doctor did not even have the time to read the form thoroughly and gets dinged for overutilization of medicare resources!!
2) Motorized Wheelchair and Scooters: You get these prefilled forms that patient needs a scooter. He may not need it. He probably will do fine with a manual wheel chair. But those sell cheap. So these wheelchair dealers will try to get you to sign a motorized wheel chair for the patient. If Medicare audits, then your neck is on the line.
3) Change Meds to Generic and save $$$: But they won’t tell who saves the dollars. The company or the patient. The patient many a times still pays the same. But if you sign it thinking patient would not mind saving this money, you will be in for a surprise. The Pharmacy will turn around and tell the patient that the doctor asked us to change it. The patients will be angry that they were not consulted before doing so.
4) Refill these prescriptions: Patients who have not followed up with you in a year may go to the pharmacy to see if they can get their meds. The pharmacist will send you a fax. Sign it for refills for next few months will increase your liability as you are now responsible for the side effects of the meds if not monitored. If such a request comes in just give out enough pills to give the patient time to et to your office. Definitely NO REFILLS!
Moral of the story: No one can read everything. But know what to check for each document before you sign it.
The days of Doctors’ reputation of having a bad handwriting are ending. You will not be writing anymore. Medicare is forcing all medical practices and hospitals to go paperless by 2012. That will be a revolutionary change in the way we practice medicine. There will be no more bulky medical records. You will not have to fight for a chart to write your note. Pages will not go missing from the chart. It will be utopia!
But with great benefits cones even greater demands. We all will have to stop writing. No more of the sloppy handwriting we are used to. In fact handwriting will soon disappear from the face of the earth. By now, I am sure, you know what I am getting to.
Every Doctor should learn typing. Once in practice you will need to see as many patient as possible in a day. Whether you own your practice or if you are an employed physician, you will be forced to see more patients as Medicare institutes more cuts in reimbursement. These cuts will have ripple effects and will reduce reimbursements in private insurance payments too.
Once we instituted EMR (Electronic Medical Record) in our medical practice, it was a wake up call for me. I started using my two index fingers and struggled to finish my chart. It also slowed me down. Then one of my friends Edward taught my how to use all of my fingers on the keyboard. Over next six months I noticed a dramatic change. I was typing as fast as patients were speaking. By the time the patient left the room the chart was already complete. It was a miracle. It was better than dictating or writing on the chart.
So for all those who are entering residency or into practice, hone your skills in typing. It will serve you well and make your more efficient. Two finger typing is not enough. You should be able to type without looking at the keyboard.
How should we negotiate with Medical Vendors. When you have your own medical practice and you will have to buy medical equipments and or Medical Services, you will find salesmen and coming in droves to your medical office to sell you almost anything under the sun.
Any time that you have to buy an equipment or service, you will have to do your homework. Just because one salesman gives you a price for a product, does not mean that is the market value of that product. People in the business community are well aware that physicians lack of training in the business aspect of anything. They use that to their full advantage by inflating the prices, selling unnecessary services, and even to the extent nickling and diming the doctors.
Always be paranoid and when dealing with business people. Even if it saves man appears to be your friend, he may not be so. Salesmen and are trained to develop a relationship with their customers on a friendly basis. And that is how they get their stuff sold.
Be aware of common sales techniques. It is important. For it will give you better handle on negotiations. Here are some of the commonly used sales techniques:
Upselling: It is a technique by which a salesman will sell you something more than what you initially asked for. For example when you go to buy food at a fast food restaurant, they ask you if you need French fries and Coke with it. Even though you did not initially plan to, there is a good chance you will say yes to the offer. This is Upselling.
Management fees: Somehow seems like all the doctors get charged management fees. Whenever we tried to buy a product or service, the salesman would tag on a management fee to the whole deal. If you look closely they charge anywhere between $100 to $200 management fee per hour. That is ridiculous. Even Physicians do not make that much for an hour anymore.
Inflating price then giving discount: Many times salesman will give you a very high price. Then he or she will deeply discount it for you for a limited period of time. It will make you feel you are getting a deal. You will be surprised, if you did some research, that even the deeply discounted price is much more than that product or service is available for elsewhere.
Deadlines: One of the favorite ways for the salesman to close a deal is by telling you that the offer is good until end of the week. In my opinion, if they can give you a product for X price this week, they should be able to give you the same product for X price next week.
Charging extra for various modules: Companies love to nickel and dime Physicians. This is especially true in the case of Electronic Medical records. The Electronic Medical records software is sold in various modules. Many of these modules are mandatory. This way they can bulk up on the total price without making the Physician realize it.
Appearing desperate: salesman may try to invoke your sympathy to be able to make a sale.
So once you know the common tactics the sales personnel uses, it will become easier for you to read in between the lines and continue to negotiate better through these gimmicks.
How do you make sure you’re getting a good price? Here are some pointers. Keep one practicing with every purchase you make and every time you will get better at it.
Get offers from three or four companies for a medical product or services. Never rely on bid from a single company or salesman only.
Go online, Google it, search and see how much the product or service is available online for.
Let the companies bidding for the purchase know that you have researched the price. Then ask them to beat the price.
Go for the lowest offer with the most reliable post sales service.
5) If two companies offer you the same price, go with the one which has been honest with the dealing during the process.
You can find medical vendors at directories such as VendorMD.com