Employed Physicians

Physicians are increasingly entering into employment relationships.

Employment opportunities come in various forms whether it is a multi-physician practice, hospital, NPHC, or other arrangement. The reasons some physicians seek employment, as opposed to remaining in private practice, include stagnant reimbursement rates, rising costs of private practice, complexity and cost of quality payment programs, and better work-life balance.  If you are preparing to interview for a new role, consider reviewing the Physician Interview Tips created by HCMS. Once in an employment arrangement, you may find yourself in a situation where you are conducting interviews. HCMS’ Physician Interviewing Physician Tips provides guidance for conducting interviews.

Employment and contractual relationships can benefit physicians and their patients, but such arrangements can also present unique challenges to physicians' ethical, professional, and financial interests. One has to weigh the pros and cons to determine if this kind of arrangement is a good fit. HCMS has created an Employment Offers Evaluation Tool to assist in evaluating multiple job offers.

 

Work Productivity Calculator
Group Practice Employment
Hospital Employment
Negotiation
Resources

  

Work Productivity Calculator

  • HCMS Work Relative Value Unit (RVU) Calculator - HCMS has developed a work RVU calculator to help Harris County physicians in locality 18 determine their work RVUs. The calculator includes 40 different specialties based upon the top 50 codes for their particular specialty. Plus, if a particular code is not listed within the top 50 codes additional codes can be added to help determine work productivity based upon the work RVU. To learn more about our wRVU calculator, watch the short informational video below. 



Group Practice Employment

Hospital Employment

Negotiating Employment Agreements, Compensation, and Benefits

 Elements to Consider When Negotiating an Employment Contract
  • Compensation - Find out how other physicians with similar skills in the region are being compensated to ensure base salary.
  • Benefits - Look at what is being offered such as health insurance, license fees, medical staff dues, stipend for continuing medical education (CME), paid time off, and retirement options.
  • Schedule and Call - Be open to scheduling provisions and call obligations, ensuring that it will be written out in the employment agreement of what the physician can offer.
  • Terms and Termination - Some organizations will have a set term the physician is obligated to stay. However, depending on the agreement, termination requires a written notice usually 30 to 90 days prior to the termination date. Be sure to check how long physicians must stay under the agreement before termination.
  • Restrictive Covenants - Termination of employment organizations can impose restrictive covenants to protect their interest against competitions. Negotiating can limit how far the restrictive covenant is enforced.
Types of Compensation Models/Methods
  • Fixed Compensation
  • Fixed Compensation with bonus
  • Productivity Compensation
    • Compensation based on a percentage collected from the services rendered. Cons of the method is payer mix, contract rates, effectiveness of the billing and collection departments.
    • Compensation based on a percentage of profits less expenses. Cons of the method is the physician does not have control over expenses. In addition, the contract needs to clearly identify expenses that will contributed to the physician and it also needs to specify income.
    • Compensation based on work relative value unit (wRVUs). Work RVUs are developed by published by Centers of Medicare and Medicaid Services. Cons wRVUs can slightly change every year and sometimes Medicare does not assign wRVUs to codes that Medicare doesn't reimburse for. This is the method often implemented by Hospitals and institutional employers. The devil is in the details with this type of arrangement. Some things to consider are discussed in this Physicians Practice article. 
Restrictive Covenants A restrictive covenant, or non-compete clause, is a contractual provision that prevents the physician from practicing in a specified geographic area for a period of time when the physician's employment terminates. They are protective mechanisms to shield the employer's patient bases and referral sources from competition. Rules for Nonprofit Health Organizations (NPHC) 

Resources

Harris County Medical Society Texas Medical Association American Medical Association Miscellaneous