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  • Michael Jones
  • January 09, 2019 02:18:33 PM
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A Little About Us

Healthcare Career Resources is a blog for those who work in the healthcare industry. We cover topics ranging from current events to medical humor as well as more career focused topics such as job search and interview tips. We also publish articles written for healthcare human resources and physician recruiters.

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    Contract Negotiation Tips for Resident Physicians

    Little to no time is devoted to helping resident physicians understand the complexity and tactics of negotiating their first job. Having sat on both sides of the table, the following are a few thoughts from 20 plus years of interesting career...

    Group of resident physicians in a group photo
    lenetstan/123RF.com

    Little to no time is devoted to helping resident physicians understand the complexity and tactics of negotiating their first job. As resident doctors, the salary is etched in stone, and there is nothing to negotiate.

    Don’t expect your residency faculty will happily divulge their compensation package. Although this is a natural tendency for most when discussing their work, it is only one career satisfaction element as relationships, appreciation, work-life balance, and equality rank at the top.

    Having sat on both sides of the table, the following are a few thoughts from 20 plus years of interesting career discussions. The ideas may not all resonate but focus on mindset over money.

     

    Know Your Non-negotiables

    It may be tempting to sell your soul to get the perceived dream job, but there are always costs to bear. Agreeing to work more night and weekend shifts to land in your favorite city may sound good at first, but trust others who have gone before that this will create a sour attitude quickly. Life changes, and your family will grow tired of your absence.

    Decision making for one is exponentially easier than long-range planning involving a significant other, kids, or aging parents. Pause and look into the future five years and overlay the expectations of the current job offering on those plans and dreams.

     

    Listen More

    Remember that, more likely than not, a number has already been inked before you entered the room. Listen carefully for clues, as there may be room to ask for more. It’s also critical to do your market research and network with others who can share valuable information. During the negotiation process, you will find that information is a powerful ally.

    The opportunity to discover clues will present itself depending on the skill of the interviewer. You can find the specific needs of the organization or group.
    -We lost one of our dedicated night physicians due to health reasons, and our group is planning an expansion to another location
    -Our group presented a well-received EMR study at the medical informatics conference last month
    -We plan to add wound care in-home care services to our clinical offerings

    You may note an area of particular interest where you can add previous experience or expertise and solve their problem and secure additional perks in the process. You might find yourself heading up a new program or project.

     

    Honest Humility

    Although a certain competency level is assumed after completion of residency, you will be unlikely to be the group’s new rock star. After meeting several of the other physicians in the group, you should understand whether mentorship is available. There is still a lot to learn. Having a professional mentor will smooth out the inevitable rough areas as a new attending.

     

    Breathe Into Resistance

    Doctors interrupt patients in 11 seconds on average. Resist this tendency. Take a slow breath, pause, and focus on what is being communicated. A lot can be learned by listening to the gaps. Let the interviewer fill in the gaps, and you may be surprised at what’s on the negotiating table.

     

    Refuse the Golden Handcuffs

    A plethora of retirement options exist but be wary of those requiring a specific time commitment. Many professionals have found themselves tied to a job they despise due to vesting requirements for specific financial plans.

    Don’t guess. Ask pointed questions and consult a financial advisor if you’re unclear what you were looking at. (link to my article of 60k flush)

     

    Not a Zero-Sum Game

    Ideally, both parties leave the table satisfied. Chances are this will not be your final position, and negotiations are not winner take all.  Resist the zero-sum fallacy.

     

    Concessions

    Unless the group is desperate to fill a position, you may find yourself making certain concessions. Resist the temptation to accept these as permanent and be sure to negotiate a timeframe to review certain aspects of your contract. According to a Medicus study, 20% of physicians plan a job change in the next 12 months. Someday this will likely be you.

     

    Good Luck

    Trust in your knowledge and skills. Enjoy the process but never forget your non-negotiables.


    Editor’s note: The author is neither an attorney nor a financial planner, and it is expected the reader will consult their own professionals on making decisions or reviewing contracts.


    How to Tell if a Hospital’s Culture is a Good Fit for You

    Culture is the unmeasurable experience of being there day to day. Fortunately, unmeasurable doesn’t mean undiscoverable. You can gain insight into the culture of a prospective workplace before you sign a contract by implementing the following...

    A physician evaluating work culture with thumbs up and thumbs down
    Luis Molinero Martínez/123RF.com

    Job interviews are like speed dates that result in marriage.

    Both sides spend the interview trying to develop enough insight to make an informed decision. Everyone shows off his/her best attributes while tactfully unveiling the other person’s worst. The dance ends with both parties asking themselves the same question: Do I want to spend my life with this person?

    Or, if you work in medicine: Do I want to spend a few years with this person? 

    Healthcare providers talk openly about their jobs. We walk into interviews knowing the tangible things a job may offer—things like pay, schedules, or benefits. By the time we walk through the interview door, we know the market and where a potential employer fits into the landscape.

    The intangibles, however, aren’t as accessible. These are the unspoken aspects of a new job that take time to be decoded. Tangibles may get us through the door but it’s the intangibles that make us want to stay. 

    In a life partner, those features are collectively called personality. In a job, they’re called culture. 

    Stories and traditions are the fabric of organizational culture. It’s the terminology and environment of the workplace. The way people address one another. How rules are enforced or how independent people are. It’s the attitude and the vibe of a workplace.

    Culture is the unmeasurable experience of being there day to day.

    Fortunately, unmeasurable doesn’t mean undiscoverable. You can gain insight into the culture of a prospective workplace before you sign a contract by implementing the following strategies.

    Know what you want before the interview

    “If you don’t know where you are going, any road will get you there.”

    – Lewis Carroll

    Envision your perfect job well before you start the search. Imagine it in as much detail as you are able.

    If you don’t know what you want, you’re going to have a much harder time knowing what questions to ask and the implications of the answers you receive.

    Be unapologetically honest with yourself. You are envisioning the ideal job for you, not negotiating one in real life—so be deliberate and conscientious when you answer the question:

    What does my dream job look like? 

    How often and hard do you really want to work? What kind of patients do you hate seeing? What age of co-workers do you most identify with?

    Is creativity important to you? Make sure it’s included. Do you want to go back to school for photography and need a job that’s flexible enough to support that dream? Be sure your new job allows you to do this.

    Or, maybe you need a specific job title now to get your dream job tomorrow.

    Being honest with yourself in the early stages of the job search is critical. The job you want exists but it won’t be handed to you; you will need to craft it from the jobs available to you— but you’ll have to know what you’re looking for to make it a reality.

    Example scenario: I interviewed at an academic medical center that was trying to promote a “research-oriented culture.” This meant that I’d be assigned to a research team that meets at least monthly to ensure that everyone was constantly publishing. This was in addition to mandatory weekly didactics and bi-weekly journal clubs. 

    I knew that I wanted to travel and needed a significant amount of freedom. I also knew I did not want to be required to attend meetings every week, regardless of the need to meet. That culture was too structured; too constant and too rigid. I knew early that I wouldn’t fit in well and didn’t take the job, despite my desire to work in academic medicine. 

    The Value of Job Shadowing

    If it’s possible, spend time observing the unit you’re applying for.

    When we’re entering medicine, we shadow to gain insight and exposure to the field and possibly to gain letters of recommendation.

    Shadowing a prospective workplace is slightly different. You’ve already gained the medical knowledge; what you’re observing are the interpersonal interactions, learning how employees treat each other and the patients. You want to leave with a sense of the climate, urgency and professionalism. Through observing, you see how (or if) people solve problems and what kind of problems they face.

    Observing your prospective team in action lets you determine whether you can see yourself as a member.

    Most importantly, shadowing lets you meet the patients. Hospitals have different proportions of similar patients. Providers generally know what types of patients they like working with. The demographics cared for, the types of medical problems typically seen, the acuity of patients—shadowing for even one shift could save months of working with patients you aren’t comfortable with.

    Locums positions can provide a similar opportunity for physicians and APPs. Short term contracts may be available at the organization you’re considering joining. If these are available, you can work in the organization on a temporary basis before making any major commitment. This is a particularly attractive option if you’re looking at moving to a new region where the facility itself may not be as important as figuring out whether you want a new locale.

    Example scenario: We were considering a move to a different part of the state. I found out that a hospital in the new region was hiring locums so I took a four month contract with the locums company. 

    In those months, I learned everything I needed to know about the culture of that facilityfrom work ethic and professionalism to the quality of care. 

    I also learned about schools, crime, places to live, recreation, family lifebasically, anything I needed to know to make the decision to move. I did all of this with no real commitment and while being paid to be there. 

    I also learned about the patients served in that area and whether I would be a good fit for that patient population. The experience taught me the value of a locums position when considering a lifestyle change. 

    Evaluate the processes you have been exposed to

    You will have been given samples of a company’s culture by the time you interview.

    How did the company contact you? Personally or through form letters?

    Were you forced to make an online profile, upload a resume, then manually enter the same information from your resume onto your profile and then watch a short video about the company’s mission before you were allowed to click “submit”?

    And after all that, were you forced to endure back-and-forth emails with a recruiter who didn’t really understand your questions?

    That experience speaks volumes.

    Or, were they personal? When you were called and invited to the interview, did they greet you at the door of the facility?

    The hiring experience is your first impression of the organization. If it’s clunky, they will never have a second chance to make it.

    Case study with good processes: I was working locums in a different state. Credentialing took about two months. A month before my first shift, I received a manila envelope with detailed instructions telling me when and where to show up with a diagram telling me where to park.

    When I arrived, a representative from the medical staff office was waiting for me in the main entrance, knew my name, and greeted me warmly. She took me through a personal tour of the facility that ended in the quality department. 

    When I arrived, my identification, parking tags, computer, and gym access were ready to go. They walked me through the quality metrics and focused on which processes in the ED those metrics correlate to. The CEO arrived during the meeting and introduced himself. He already knew me by name, where I came from, and what I was doing there. He then welcomed me to join him during their weekly medical staff meetingshe explained they were voluntary, breakfast would be provided, and he would love it if I could attend a few. 

    I was then escorted to my first shift where the medical director was waiting for me. I logged in to the EMR and began a training shift. The entire experience was seamless, totally integrated and welcoming. 

    Case study with not so good processes: One facility took roughly eight months to credential its providers. There was no clear interview process (either you didn’t interview or would have an informal interview with an available member of leadership). Credentialing paperwork wasn’t clear, and when it was completed, providers weren’t notified. Not only were providers not notified, but their information wasn’t forwarded on to other relevant departments (like IT or parking). It was essentially up to the providers to call and constantly remind the hospital of their application.

    There was no orientation process and no on-boarding for providers. 

    A provider would know everything he/she needed about this organization’s culture by simply looking at their hiring process!

    Learn how people advance

    “If you don’t design your own life plan, chances are you’ll fall into someone else’s plan. And guess what they have planned for you? Not much.”

    – Jim Rohn

    Think of career advancement as the continuation of your hiring process.

    Advancement could mean new skills, education or projects. It could also refer to job titles and hierarchy. Whatever form of advancement is important to you, how do employees achieve it?

    For example, are the doctors sent to an annual leadership course to become better team managers? Are nurses trained in quality improvement training to oversee critical processes?

    Through what mechanism does an Assistant VP become a VP? Is it time, productivity, or does someone else have to quit to make room?

    Learning how people advance is a great window into the structure, performance evaluation, and culture of an organization—but if you don’t know where you want to wind up, it will be hard to judge the answer.

    Case study: I interviewed at a faith-based organization. I learned during the interview that unless I was a member of this faith, I would not be able to ascend beyond the position I was interviewing. In other words, I would have the same job in ten years that I was currently interviewing for. 

    Although I can respect their values, the impossibility of career growth made that organization a poor fit for me. 

    Questions to Ask to Reveal Work Culture

    It’s your job and your time—ask relevant questions during an interview to get a sense of the culture. There are plenty of sample lists online, but a few examples are:

    “What’s the best part about working in this environment that I won’t be able to see from just a walk around the office?”

    “What are the most common complaints employees make about your culture?”

    and,

    “How often does the staff meet?”

    or,

    “When and how do people like to give and receive feedback?”

    “What’s one thing you would change about the company if you could?”

    “What was the department’s biggest challenge last year and what did you learn from it?”

    These questions ask for examples of the culture without directly asking “What’s your culture like?” They require the interviewer to show (not tell) you the climate of the organization..

    Case study: I interviewed a physician who had an interest in international medicine. This meant that she would have to leave the department for weeks at a time, several times per year. She asked for specific information about scheduling practices, whether other people have international interests, and whether they have been able to achieve their goals. She also asked what the perception of the other members of the group is regarding those with international interests. 

    By asking about examples and details, she gleaned much more information than asking “Would I be able to work in international medicine?” 

    Do your research

    Don’t be shy to tap your network if it includes potential co-workers. Contact them to learn about life at the company. This is especially true for ex-employees, if they are in your network. Be willing to take people with direct experience of the organization to lunch and explore their decisions to stay or leave.

    There are also plenty of indirect, online resources that let you learn about a company before you sign the contract:

    Sites like Glassdoor, Indeed or Kununu provide reviews of companies, written by current and past employees. Read through these as you would any review—you’re looking for an overall sense of the organization; don’t let one review (good or bad) color your impression of the entire organization.

    Also, sites like HealthGrades, Medicare.Gov or LeapFrog provide quality, safety and patient experience data. These sites don’t use employee reviews, but they do give you an indirect sense of how the company performs. If the hospital has high grades on multiple platforms, there’s a good chance it’s a high performing organization.

    Case Study: The website of the hospital itself is also telling. I interviewed at a hospital that did not have a working website. When I interviewed there, it was clearthe website wasn’t the only thing that was untended.

    I interviewed at another facility that didn’t include emergency providers in its online directory of medical staff. For an institution where the overwhelming majority of inpatients come through the ED, this oversight spoke volumes. 

    Other facilities have streamlined, clear, relevant, patient-friendly websites. These sites give you the sense that the organization enjoys seeing patients, wants to empower them, and is grateful for its providers. 

    There is a national shortage of nurses and doctors. When you go on an interview, remember that they need you more than you need them.

    There’s no reason to settle for a culture that doesn’t support you.


    Pros and Cons of Traveling Healthcare Jobs During the Pandemic

    There are both significant benefits and significant risks with taking travel healthcare jobs, especially so in the midst of a pandemic, and healthcare professionals should weigh these risk before deciding if a travel job is right for them.

    Group of travel nurses, physicians, and mid-level providers
    pitinan/123RF.com

    The COVID-19 pandemic has affected jobs in every sector of the economy. While initially it seemed that healthcare jobs would likely be among the least affected, even healthcare professionals have found their jobs affected.

    The effects of the COVID-19 pandemic on healthcare workers has varied based on the fluctuations of needs. In some areas, lockdowns closed outpatient procedures and significantly reduced patient volumes. In other areas, the increasing number of COVID-19 cases has led to a spike in patient volumes that has been difficult for healthcare organizations to accommodate.

    As patient volumes and organization-specific needs change, healthcare workers around the country have experienced changes from being furloughed or laid off to having to work extra, mandatory shifts. As needs change, healthcare workers have had to accommodate these changes and have experienced disruptions to their normal work hours and pay.

     

    Travel Healthcare Jobs

    One potential strategy that some have pursued during the pandemic is to work in a travel job. Travel jobs typically involve a short-term work assignment in an area other than where the healthcare worker lives. These assignments may vary in length but are typically about three months.

    To meet the changes in demand for healthcare workers, the US Department of Health and Human Services (HHS) is temporarily allowing healthcare workers to practice across state lines in areas where they are not licensed, as long as they have the needed licensure in another state. This has made travel jobs much more flexible during the COVID-19 pandemic than has previously been the case.

    Most travel jobs are temporary contracts that are obtained through a travel agency. Nursing has traditionally been the area of healthcare that has the greatest number of travel jobs available, due both to the need for nurses and to the ease of obtaining interstate licensure, compared to mid-level providers and physicians.

     

    Benefits of Travel Jobs

    There are several benefits to travel jobs that make pursuing them more appealing to healthcare workers.

    Income

    One of the greatest benefits of travel jobs is the increased ability to make a greater income. Travel jobs pay more in general for healthcare workers than traditional jobs because they are filling a specific need. Especially in areas that have a very high demand due to the COVID-19 pandemic, pay may be significantly higher than normal wages. For example, in New York City during the height of the COVID-19 pandemic, RNs were able to make over $5,000 a week – an amount that is slightly more than the average monthly wage of a typical RN.

    Perks

    Travel jobs have several unique perks. Paid travel, paid accommodations, and tax benefits are often a part of travel assignments. Travel agencies also often offer day one health insurance and other benefits that are comparable to most healthcare employers.

    Experience

    Traveling to COVID-19 epicenters allows healthcare professionals the opportunity to gain a unique, once-in-a-lifetime experience in caring for COVID-19 infected patients at a pandemic epicenter. This clinical experience can be very valuable and will likely enhance an individual’s ability as a healthcare professional.

     

    Considerations for Travel Jobs

    While there are some distinct benefits of travel healthcare jobs, there are some potential downsides that should be considered.

    Risk of Infection

    Because of the relatively uncontrolled clinical environments and global supply shortages that have occurred from the pandemic and are affecting disease epicenters, there is a greater risk of contracting COVID-19. The increased number of patients further increases this risk. Travel agencies may have you sign a waiver, releasing them and the clinical site from liability and indicating that you understand potential supply issues and possible risks of contracting COVID-19. These risks should be taken into consideration before traveling to a disease epicenter.

    Travel Restrictions

    While travel for healthcare personnel has been widely accommodated, traveling healthcare workers may not have the chance to see the sights or experience the area they will be in like they would have during a normal situation. This can lead to a travel assignment primarily being either working or living in a lockdown environment.

    Weighing the Risks and Benefits

    There are both significant benefits and significant risks with taking travel healthcare jobs, especially so in the midst of a pandemic, and healthcare professionals should weigh these risk before deciding if a travel job is right for them.


    Healthcare Workers and Vaccines: What you Need to Know

    At times, vaccines can become a controversial topic. People often have strong opinions about where protecting society as a whole stops and an individual’s rights start. With COVID-19 in the news and the potential for a vaccine, the topic is not going away any time...

    A healthcare provider prepares a vaccine injection
    olegdudko/123RF.com

    At times, vaccines can become a controversial topic. People often have strong opinions about where protecting society as a whole stops and an individual’s rights start. With COVID-19 in the news and the potential for a vaccine, the topic is not going away any time soon.

    If you’re a healthcare worker, vaccine requirements are likely not new to you. But can employers mandate vaccines, and can you refuse? Keep reading to find out more.

    Vaccine recommendations for healthcare workers

    The Centers for Disease Control and Prevention recommend healthcare workers get the following vaccines:

    • Hepatitis B
    • MMR (Measles, mumps, and rubella)
    • Flu
    • Chickenpox
    • Tdap (Tetanus, diphtheria, pertussis)
    • Meningococcal

    The flu vaccine, which is offered yearly, has come into debate as more healthcare facilities across the country enact policies for mandatory vaccines for healthcare workers.

    One of the arguments for mandatory vaccines is that it is the responsibility of  healthcare providers to vaccinate and protect patients from getting the disease. By refusing vaccination, it may cause harm and violate their duty as a healthcare worker to do no harm.

    On the flip side of the debate is by mandating a vaccine, it strips workers of their rights to make their own health care decisions. Additionally, if an individual opposes a vaccine due to medical concerns or religious reasons, and he would lose his job, the mandate is discriminatory. Whichever side of the debate you fall on, there appear to be legitimate arguments for both sides.

    Are any vaccines mandatory?

    The answer to whether vaccines are mandatory for healthcare workers is yes and no, which may sound confusing. That is because laws vary by state. Further variations exist on which vaccines are required and allowable exemptions.

    Many healthcare facilities, including acute care hospitals and skilled nursing facilities, have implemented vaccine requirements due to mandates enacted by state regulations. The mandates may include assessing employees’ immunizations records, offering vaccines, and in some cases, ensuring vaccinations.

    But vaccine mandates are not entirely uniform across the country. State laws vary for mandatory vaccines for healthcare workers. Plus, within a state, individual employers also set policies that may involve mandatory vaccines.

    According to the Centers for Disease Control and Prevention (CDC), currently 15 states have laws that require healthcare workers to have certain immunizations for employment.

    But within each state, the law usually includes some type of exemption. The allowed exemptions may also vary. Some states are stricter than others on allowable exemptions. To further complicate things, if a state is under a “state of emergency,” such as with COVID-19, other mandates may be enacted to protect public health, which may impact enforcing vaccines.

    To determine the rules in your state, you can check with the Centers for Disease Control and Prevention. The CDC lists individual states and mandates for vaccines, including the flu. You can also check with the department of public health within your state.

    Do you have the right to refuse?

    If you live in a state that requires mandatory vaccines for healthcare workers, can you refuse? You may be able to decline based on allowable exemptions. Again, state laws vary on exemptions.

    Exemptions may include the following:

    Medical exemptions: All states that have a mandatory vaccine requirement allow a medical exemption. A medical exemption indicates that the vaccine is medically contraindicated. You will have to have a healthcare provider sign a form that states the vaccine is contraindicated for you.

    Religious exemption: Most states also have a religious exemption. You may have to bring in a letter from your religious leader. The rules for how to get an exemption based on religious beliefs vary, so check with your state.

    Philosophical exemption: Some states also allow for a philosophical exemption. This is an exemption based on a person’s personal belief that he/she is opposed to immunizations. Not all states allow a philosophical exemption.

    Healthcare facility policies differ in handling employees that require an exemption. Usually, you need to declare in writing that you decline the vaccine. You may have to state what you are basing the exemption on (religious, medical, or philosophical). You also may be required to provide proof for a medical exemption.

    In some cases, your facility may have specific policies in place for people that do not get a vaccine due to an exemption. For example, many hospitals make staff wear a surgical mask at work for the entire flu season if they refuse a flu vaccine.

    Can your facility fire you?

    Healthcare facilities have fired employees that refused to comply with mandatory vaccine requirements. Individual cases vary, but some involved employees did not get an exemption and did not get the vaccine. Lawsuits often ensued to varying degrees of success.

    The bottom line is, it’s possible to be fired if you do not comply and do not get an exemption for mandatory vaccines in certain states. It’s best to check with your human resource department and get their policy in writing before fighting any vaccine mandates. Also, check your bargaining agreement if you are represented by a union.

     

    It is hard to say what the future holds when it comes to mandatory vaccines for healthcare workers. If a COVID-19 vaccine becomes available, healthcare workers are likely to be one of the first populations vaccinated. Whether that vaccination will be mandatory is not clear.

    Only time will tell the direction that mandatory vaccines will take. One thing we do know is that learning as much as possible about a particular vaccine, including the risks and benefits, helps you make an informed decision.


    Read Also

    Nurses who fight the flu shot

    Staying Healthy in Healthcare


    9 Essential Skills Medical Schools Don’t Teach and How to Overcome the Knowledge Deficit

    Medical schools teach medical content well, but they miss the mark when it comes to teaching the practical side of medicine. Questions like How should I manage my income? What should I look for in a contract? or What happens when I’m sued? are left unanswered. Physicians generally learn these lessons on the job and make avoidable mistakes along the way. The following are nine skills I wish I would have learned before leaving medical...

    A young physician looking confused
    Luis Molinero Martínez/123RF.com

    Medical schools teach medical content well, but they miss the mark when it comes to teaching the practical side of medicine. Questions like How should I manage my income? What should I look for in a contract? or What happens when I’m sued? are left unanswered. Physicians generally learn these lessons on the job and make avoidable mistakes along the way.

    Below are nine skills I wish I would have learned before leaving medical school.

     

    Money management

    Physicians are notoriously bad with money.

    We go through college and medical school with no or low income, enter residency with modest income and then start our first “real job” making an average of $313,000 per year.

    We take on about $250,000 in debt from medical school which we’ll pay back over the decades after residency. During the same time, we’re also likely to make financially significant decisions like getting married, starting a family or purchasing a home.

    Medical schools generally do not train doctors to manage the money they make or how to strategically manage the debt they incur.

    What can you do?

    It’s never too late to learn.

    The White Coat Investor’s blog and book have a ton of relevant information. Other medical blogs like KevinMD or Doximity also have physician-centric financial articles. Classic books like Rich Dad, Poor Dad or Think and Grow Rich are just two of many books available on personal finance.

    More formally, personal finance courses or MBA programs are available to learn personal finance.

     

    Negotiation

    “…you don’t get what you deserve, you get what you negotiate.”

    — Chester L. Karrass

    Physician negotiations start with entering medical school and continues through to contracts for residency and jobs.

    Patient encounters are negotiations; getting patients to understand the physician’s perspective and physicians understanding their perspective is a negotiation.

    Outside of medicine, physicians find that everything seems to cost more when people learn they’re a doctor. Simple home repairs, getting your car worked on—it’s amazing how quickly inflation happens when one is wearing scrubs.

    Learning to negotiate interpersonally and professionally is a critical skill for physicians – one we shouldn’t need to learn on the job.

    What can you do?

    Negotiation is a learned skill—the more you do it, the better you become. The good news is that there are ample opportunities to practice; the key is starting to look at everyday interactions as negotiations.

    One negotiates with friends, with family, with every purchase, cell phone plans—there are countless ways to exercise the negotiation muscle.

    There are also thousands of informal articles on how to become a better negotiator. Or, negotiations skills can be learned through books, trainings or conferences.

     

    How to Read a Contract

    Contracts set the terms of the job and how the payment will happen.

    Contracts can describe the terms of hiring, firing, incentives, what a physician can do in their spare time, whether they can work anywhere else, who owns the ideas a physician has, how bonuses are paid, how the physician’s productivity will be measured and how consequences are managed.

    Contracts are the paperwork that allow for any work a physician may undertake; medical schools are missing the mark by not explaining them.

    What can you do?

    It depends on how much of a contract expert you want to be. The easy answer is to read the contract and then hire an expert – an attorney with experience in physician contracts.

    Several resources are available for self-study, however. Plenty of informal articles and guides exist on the topic, many of which conclude by recommending hiring an attorney. The AMA has several resources, including books and guides on contracts.

     

    How to Run a Business

    From basic, early questions like Should I form an LLC? to more complex questions like how to be an effective leader or how to manage your practice physicians can leave medical school underprepared for the career ahead of them.

    Even though more physicians are employed than those in private practice, there is a pressing need for business literacy. Physicians who are in private practice need to know how those practices should be run; how to staff, billing and coding, credentialing with providers, negotiating reimbursements—often, physicians figure these things out as they go along.

    Employed physicians would also benefit from business know-how. Understanding how hospitals are paid, how to budget, or how rates are negotiated may not be directly linked to clinical care but can put providers on the same page as administrators and help make the approach to medicine more complete.

    What can you do?

    There is no one way to start a business, and non-physicians in business also have to “figure it out.” The experience of on-the-job- training for business isn’t unique to physicians.

    The goal isn’t that physicians leave medical school with business degrees; it’s to help them understand that they need to learn this.

    There are plenty of books, blogs and conferences dedicated to practice management.

     

    How lawsuits/investigations work:

    According to the AMA, over a third of physicians have been sued at some point.

    The good news is:

    “Sixty-eight percent of closed claims were dropped, dismissed or withdrawn in 2015… …Of the 7 percent of medical liability claims decided by a trial verdict, the vast majority—88 percent—were won by the defendants (physicians).”

    Regardless of the low odds of being successfully sued, legal proceedings can be harrowing. The threat of malpractice is only complicated by a total lack of familiarity with the legal proceedings themselves.

    What happens when you receive a subpoena? How do you successfully undergo a deposition? Who can you talk to about the case? What are your rights?

    These questions pale in comparison to how physicians feel about being involved in a case with a bad outcome, and the subsequent mental health impacts.

    In the same vein are hospital investigations—not truly legal proceedings, but the provider’s care is being scrutinized. It’s a terrible experience to be the subject of a peer review case, a mortality review, a root cause analysis, or having your credentials threatened.

    These are all events for which a physician’s first exposure is when they’re the defendant. Given the prevalence of these proceedings, medical schools have an obligation to prepare physicians for the experience.

    What can you do?

    Fortunately, the opportunity to learn the process doesn’t have to wait until you’re in it.

    Within hospitals there are opportunities to serve on investigative committees. They go by different names: Peer Review Committee, a Quality Review, a Morbidity and Mortality, Performance Improvement Committee, Root Cause Analysis. Whatever your hospital calls it, get involved. This lets you see other people’s case reviews, familiarizes you with the process and, most importantly, will make a you a better doctor. 

    When you see care dissected, you see trends in the errors, you learn the terms and the triggers; you see the flaws in documentation and how things fell apart. When you have similar patients, you become keenly aware of how to avoid pitfalls. And when you become the subject of a review, it will not be unfamiliar waters.

    Outside of hospitals, experience can be gained in the legal world through expert witnessing and serving on medical review panels. Not having your care reviewed but seeing how care is reviewed gives you an insider’s eye on the process – what works and what doesn’t – so if you’re among the third of physicians sued, you’ll already be educated on what to expect.

     

    That Non-clinical Career Options Exist

    Medical school makes the path seem easy; there’s one choice: Go see patients.

    But in reality, there are many other options available. Physicians use some of these as side hustles, others become the main job with clinical work taking the supplemental role.

    Non-clinical choices include consulting, writing, expert witnessing, research, private industry, medical science liaisons, file review, pharmaceutical, medical devices, the list continues.

    What can you do?

    Look and you will find options for non-clinical jobs.

    SEAK leads the way for non-clinical conferences where physicians can learn about the options in general but also specific niche positions and how they work.

    Look for Zebras, Kevin MD, PassiveIncomeMD, White Coat Investor, and Physician Side Gigs are all great places to start looking for non-clinical job options. The SEAK website has a pretty extensive list of options (if you join the email list), and jobs can be found on any popular job search engine.

    There are even professional societies dedicated to non-clinical options such as the DropOutClub and The Society For Physicians With Non-Clinical Careers.

    If you look, you can find them!

     

    Managing Burnout

    According to the Medscape survey, over 50% of physicians experience at least one sign of burn out.

    This means that there’s a very good chance that you will also experience burn out. Burn out is defined as a constellation of symptoms of compassion fatigue, depersonalization, and cynicism.

    The time to treat your burnout is before it happens.

    By practicing mental hygiene, knowing signs, knowing what to look out for in a prospective job, how to ask questions about wellness, medical schools have an obligation to prepare their students for the lifestyle of medicine, not just he medical content.

    What can you do?

    It’s all about prevention and early identification. Physicians entering practice knowing about the likelihood of burn out would be more likely to be able to prevent burnout by maintaining a lifestyle outside of medicine: strong family connections, outside interests that help provide a more robust life than what is offered by the practice of medicine by itself.

    Plenty of resources exist for addressing physician burnout.

    Dr. Dike Drummond, MD, is a frequently cited leader in physician wellness and burn out. He holds annual conferences as well as having a plethora of resources available on his website, The Happy MD.

     

    Professionalism

    “Professionalism is not the job you do, it’s how you do the job”

    —Shiv Khera

    I’ve heard this story at a few conferences. It illustrates professionalism well….

    A patient came into the emergency department in the middle of the night with a very small laceration on her chin.

    The ER doctor who saw her wondered why she even came in—it was small enough to just need a bandaid or maybe some glue, but certainly didn’t require emergency medical attention.

    The patient, however, refused to be touched by anyone except a plastic surgeon and began loudly refusing care and demanding to have a plastic surgeon called to fix what really didn’t require care in the first place.

    The ER doctor’s hands were tied; he wakes up the plastic surgeon and, apologizing profusely, tells him the story.

    The surgeon replies with “Thank you for this consult” and within fifteen minutes is in the ER, hair combed, looking fresh and wearing a suit.

    He sits with the patient, listens to her concerns, puts on a full gown and applies glue and a bandage to the patient’s chin. He hands her his card and tells her he would like to see her in seven days time to ensure she is healing properly.

    And then he thanks her for letting him take care of her.

    The patient was ecstatic.

    That is professionalism. On the phone, in person, with the patient. Like Shiv Khera said: It’s not the job he had, it’s how he did it.

    What can you do?

    Being professional is like having manners. It’s really hard to see where you’re lacking—you just see the consequences when you are in the situation.

    Like any of the above skills not taught in medical school, a wealth of information is available online. But saying “Be more professional” is like telling a teenager to “have character”—it’s impossible for them to see where their character is lacking.

    The good news is that it’s easy to see professionalism in others, the plastic surgeon, for example. If you find these people, work with them. Work around them. See if they can mentor you. Watch how they handle situations and learn from them. Or, find a career coach to help you become more professional.

    Professionalism is like any of the above under-represented skills—it can be learned.

    It’s never too late to improve your skills.


    Practice Management Challenges of Covid-19

    The COVID-19 pandemic is confronting medical practices with unique operational challenges. Some practices have turned to telemedicine. Some providers are finding it difficult to continue operating at all, with sweeping cancellations of elective procedures and discouragement of in-person office...

    A practice manager stops dominoes from falling.
    Andrii Yalanskyi/123RF.co

    The COVID-19 pandemic is confronting medical practices with unique operational challenges. Some practices have turned to telemedicine. Some providers are finding it difficult to continue operating at all, with sweeping cancellations of elective procedures and discouragement of in-person office appointments. Economic fallout due to the virus’s effects on virtually every person, everywhere, is another concern facing all aspects of all healthcare systems.

    The American Medical Association has issued guidelines for managing the financial and operational consequences of the outbreak. The following matters should be considered.

     

    Business Insurance

    Ensure the practice’s business insurance covers COVID-19 related liabilities. This helps determine associated risks and is important in making business and operational decisions. Contact the practice’s insurance brokers for complete copies of all policies. Understand government emergency decrees. Track losses and expenses incurred for future claims. Consult legal counsel about exercising existing policies and how state government orders affect business operations. Providers who are called upon to assist with emergency care, especially outside of their usual clinical arrangements, should notify their liability carrier(s). Contact the U.S. Department of Health and Human Services for their published declaration of liability protection against certain medical countermeasures related to COVID-19.

     

    Financial Obligations and Contingency Planning

    To minimize potential economic risk, practices are encouraged to revise current financial plans to ensure their ongoing liquidity. It may protect a practice from revenue loss due to cancelled procedures, fewer outpatient visits, and closures. It is wise to develop a financial contingency plan based on minimum cash flows needed to continue operation. Examine existing loan documents and financial obligations to determine risk of default if revenue is being lost. Managing cash well is high priority; consider delaying payments of discretionary bonuses. Determine if you may request forbearance or forgiveness from lenders and creditors. Communicate with third parties before crisis occurs, which may increase the probability that your requests will be granted.

    Monitor resources that may become available to you, such as economic relief packages. The U.S. Small Business Administration has introduced low interest loans.

     

    Supplies

    There are global shortages of essential medical supplies, such as personal protective equipment. Evaluate current supplies, and project future needs. A decrease in office visits may decrease the practice’s supply needs. Determine how much cash can be devoted to stocking up on essentials. Contact vendors to ensure that you are listed among businesses to receive future supplies.

     

    Continuing Business Operations

    “Shelter in place” orders and their extensions may affect the ability to continue business operations. Healthcare services are usually designated as essential businesses, but the public may be unclear about the availability or safety of their usual services. Consult local counsel to determine how to apply executive orders affecting a practice.

     

    Communication with Patients

    Whether a practice is operating normally or offering telehealth services, it is essential to regularly communicate with patients – especially those at risk of adverse health consequences if their healthcare is interrupted. There is an increasing number of patients neglecting usual medical care because they fear contracting the virus in hospitals or medical facilities. Make your patients aware of the prevention and safety measures enforced at healthcare sites. They should be encouraged to maintain contact with their providers, via telehealth or in person when needed.

     

    Workflow

    To protect staff members, conserve valuable equipment and supplies, and reduce the safety and liability risk to your practice, providers are urged to follow the latest guidance issued by governmental agencies when reviewing scheduled visits and choosing which appointments to postpone, cancel, or proceed with as usual.

     

    Employee Management

    Keep employees informed about managing health and safety issues. Outline when they should not report to work. Specify leave policies. If it is necessary to furlough or terminate non-essential employees, seek legal counsel on business obligations and communication of employment status.

     

    The pandemic has created unprecedented policy and regulatory changes. It is essential for healthcare providers to stay current. As the COVID-19 outbreak evolves, more federal guidance and relief efforts are expected to offer further support.

    The CDC has issued interim guidance for management of health services: COVID-19 Guidance: Businesses and Employers | CDC.

    The U.S. Department of Labor has also published resources pertaining to employee furloughs and unemployment benefits as well as Guidance on Unemployment Insurance Flexibilities During COVID-19 Outbreak.


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