Why be a hospitalist with EmCare LIFE AFTER RESIDENCY Why be a hospitalist with EmCare Pawan Dhawan MD, MBA Executive Vice President EmCare - Alliance Division

Now that residency is over- What are my options Fellowship Academics-Clinical Educator Primary Care Hospitalist Research Locums / Enterpeneurship / Others

What is a Hospitalist The term "hospitalist" refers to physicians whose practice emphasizes providing care for hospitalized patients. Wachter RM, Goldman L. The emerging role of "hospitalists"in the American health care system. N Engl J Med 1996;335:514-7.

Why Be a Hospitalist Familiarity - You’ve been doing Hospitalist work during residency Pays better Career Growth In Demand specialty Lots of Flexibility Can do something very very meaningful

Adapted Dr Neese Slides 2014 Presentation

Compensation by Region-2013 SHM Pacific Mountain SW Midwest SE NE Mean pay $256,000 $246,000 $270,000 $248,000 $261,000 $229,000 encounter/shift 14 15.4 18 16 17 15.8 shifts/month 15.3 15 15.7 17.1 16.4 Adapted Dr Neese Slides 2014 Presentation

Career Growth as a Hospitalist Academics Leadership Performance Improvement/Quality Improvement Consultative Services Health Care Information and Technology

Adapted Dr Neese Slides 2014 Presentation

Hospitalist Career Satisfaction SHM 2013 Data Adapted from Dr Nesse’s 2014 presentation

Where should I work- Geographic preferences Family issues Cost of Living Compensation Benefits

Types of Hospitalist Practices Individual/Solo Hospital Employed Private Practice Groups National Groups

Adapted From Dr Neese 2014 presentation

Practice Characteristics SCHEDULE VOLUME COLLEAGUES Size of Group Leadership Stability- How many have left group? Why? Career Growth Opportunities Nursing Case management Specialist Support Moonlighting Opportunities A good time to ask these questions is during initial phone interview

Interview Meet the colleagues Meet the nursing staff Meet case management staff Meet the admin team Take contact info What procedures will be required if any What kind of support clinical and non clinical will I have Who will do the billing / Is there a software for billing / Will somebody train for billing and coding What kind of orientation will I have - Will I get paid for orientation How does the EMR look See the Hospital / cafeteria / call rooms / offices / Parking spots Tour with a realtor / See the city Ask yourself-Will I fit in / Will I be happy / Will my career grow If still some questions ask for a second interview

What should I look for in a contract-1 Why is a contract needed Protects the institution/group Protects the physician Legal and third party payor requirements Type of Employment Hospital vs. Group Independent Contractor Responsibilities Scheduling –Hours/weekends/nights QI, Compliance with policies Education--Staff, residents, interns Medical Records completion

What should I look for in a contract-2 Compensation Salary Fee for Service Billing Hourly rate Guarantee Incentives/Bonuses Benefits Vacation Maternity/Paternity Leave/ Military Leave/Personal Time off CME dues and Time off Licensure Fees Society/Professional organisation fees 401 k-Match Phones/Pagers

What should I look for in a contract -3 Malpractice Insurance Claims vs. Occurrence Tail coverage When does it start immediately or after few years of start Bonus/Incentive Structure How will the data be gathered When will the bonus be paid eg after 2 months of data When do the incentives/bonuses start From 1st patient or after a threshold eg 4k RVUs Metrics Individual vs Group Based Pt satisfaction Core Measures DC Summaries to PCP

What should I look for in a contract-4 Sign On Bonuses $1000-$20,000 Moving expenses Loan repayment Insurance Health/Dental - Individual or Family Life insurance Disability insurance Unemployment insurance

What should I look for in a contract -5 Non-compete agreement Time, distance Solicitation of employees, patients Liquidated damages Term Fixed term-year Renewed automatically or not Notification time for termination – 90-120 days Timing of new contract negotiations – 60-120 days

What should I look for in a contract -6 Termination Without cause Any time without reason-How much is notice period 3/4/6 months With cause Loss or negotiation of license Loss or restriction of hospital privileges Professional liability insurance or claims Impairment Professional misconduct Death/disability Failure to perform Criminal activity Breach of contract

What next after I have the contract Who is the contact person Recruiter Medical Director Department Chairman Likely not a colleague in new practice Review the contract carefully Ask a lot of questions Get contract reviewed by a professional attorney Ask a lot of questions again

What next after I have the contract -2 Does the contract need any addendums or modifications after the discussion Sign and send back Start the licensing process FCVS State Licenses Federal DEA/State Controlled substance licenses Start the credentialing process-3-6 months Lots and lots of paperwork. Get your pen ready.

Timeline Research - 1 month Interview - 1 month Negotiate Contract terms and conditions 15 days - 1 month Licensing and Credentialing 2-6 months Moving and Starting 1-2 months

Why EmCare Large National Company- Part of Envision Health AMR, EmCare, Evolution Health, Reimbursement Technologies 750 client contracts, 500 hospitals, 42 states Run by Physicians Excellent compensation Excellent Career Growth Opportunities Well structured and secure

Thank You! Thank you, Dr. Stoev and Dr. Neese