1. Elizabeth “Libby” Snelson, Esq. Legal Counsel to the Medical Staff

2. Is Hospital Employment for You?

3.   Limited influence in decision-making — 45 percent  More limited income potential — 44 percent  Too many rules — 34 percent  Less control over work/schedule — 32 percent  Being "bossed around" by management — 30 percent  Less/lack of autonomy — 27 percent  Too much administrative work — 16 percent  Burdensome productivity formula — 14 percent  Unpleasant office culture — 11 percent  Less interesting work — 5 percent  Other — 6 percent Medscape Employed Physicians Report 2014 10 Top Disadvantages

4.   Not having to deal with the business of running a practice — 58 percent  Not having to deal with insurers and billing — 45 percent  Guaranteed income and/or even cash flow — 42 percent  Good benefits package — 28 percent  Malpractice coverage — 25 percent  More regular hours — 23 percent  Limited or no night call duties — 17 percent  Collegiality — 16 percent  Staff provided by employer — 15 percent  Signing bonus — 2 percent  Other — 4 percent Medscape Employed Physicians Report 2014 10 Top Benefits

5. Issues to Think About In Your Personal Contract REMUNERATION & BENEFITS  What, How and When  Bonuses/Loans  Deductions for Buy-In, Insurance Coverage, etc.  Personal and Dependent Health Coverage  Pension, Disability and Life Insurance WORKING CONDITIONS  Type/Location Of Services  Call Schedule, Vacations and Holidays HIDDEN COSTS  Application Fees and Dues  Professional Liability Insurance  Equipment TERMINATION  Cause/Without Cause  Notice Provisions  Covenant Not to Compete  Being Fired  Effect on Medical Staff Membership

6.  HIRE A LAWYER

7.   Experienced representing physicians  Experienced with hospital employment HIRE A LAWYER

9. Former St Vincent’s Hospital Normandy MO

10.  Hospital Employment  Credentialing Standards  Disciplinary Requirements  Medical Staff Self-Governance

11.   Hospital Medical Staff Relations  Employed physicians should be members of the organized medical staffs of the hospitals or health systems with which they have contractual or financial arrangements, should be subject to the bylaws of those medical staffs, and should conduct their professional activities according to the bylaws, standards, rules, and regulations and policies adopted by those medical staffs.  Regardless of the employment status of its individual members, the organized medical staff remains responsible for the provision of quality care and must work collectively to improve patient care and outcomes.  Employed physicians who are members of the organized medical staff should be free to exercise their personal and professional judgment in voting, speaking, and advocating on any matter regarding medical staff matters and should not be deemed in breach of their employment agreements, nor be retaliated against by their employers, for asserting these interests.  Employers should seek the input of the medical staff prior to the initiation, renewal, or termination of exclusive employment contracts. AMA PRINCIPLES FOR PHYSICIAN EMPLOYMENT

12.  Put It In Medical Staff Bylaws BYLAWS APPLY “Members employed by the hospital, on a full-time or part-time basis, to provide clinical services to patients or to provide back-up call or other coverage, referred to as “employed members,” must meet all qualifications in, and otherwise comply with, the medical staff bylaws.”

13.  COORDINATE INCENTIVES “Any incentive offered by the hospital to any employed, contracted or other medical staff member is subject to review and authorization by the Medical Executive Committee to assure that it will not adversely affect patient care.” Put It In Medical Staff Bylaws.2

14.  INCLUSIVE LEADERSHIP “Employed members may qualify for election to medical staff leadership and appointment to committees, but must disclose their employment relationships as potential conflicts of interest and to allow for balance in committee appointments.” Put It In Medical Staff Bylaws.3

15.  Put It In Medical Staff Bylaws.4 PROTECT EMPLOYEES “Employed members will not be subject to employment termination or other penalties as a result of carrying out leadership and other medical staff responsibilities in good faith.”

16.  PEER REVIEW MATTERS  “Selection of peer reviewers, including hearing committee membership, cannot be limited to members who are either employed by or under contract to the hospital.”  “Employed members are not exempt from corrective action, and are entitled to the same rights of hearing and appeals provided in these bylaws to all members.” Put It In Medical Staff Bylaws.5

17.  Unless specified otherwise in the employment agreement, upon termination of employment with or without cause, an employed physician should not be required to resign his or her hospital medical staff membership or any of the clinical privileges held during the term of employment, unless an independent action of the medical staff calls for such action, and the physician has been afforded full due process under the medical staff bylaws. AMA PRINCIPLES FOR PHYSICIAN EMPLOYMENT

18.   Annotated Model Physician-Hospital Employment Agreement www.ama-assn.org/go/employment  AMA Principles of Physician Employment www.ama-assn.org/go/employment  Physicians’ Guide to Organized Medical Staff Bylaws www.ama-assn.org Resources

19.  ELIZABETH A. SNELSON, ESQ. LEGAL COUNSEL TO THE MEDICAL STAFF easesq@snelsonlaw.com find me on facebook at snelsonlaw