1. 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

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

3. 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.

4. 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

5. Adapted Dr Neese Slides 2014 Presentation

6. 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

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

8. Adapted Dr Neese Slides 2014 Presentation

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

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

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

12. Adapted From Dr Neese 2014 presentation

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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 – days
Timing of new contract negotiations – days

20. 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

21. 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

22. 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.

23. 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

24. 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

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