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Can You Be a Doctor With a Felony? (Will a Medical Board ALLOW It)

Blog, Physician
Can-you-be-a-Physician-with-a-Felony-banner

Can doctors become a physician with a past felony on record? This is not going to be a state-specific discussion. Every medical board in every different state has different rules. I would suggest specifically reaching out and trying to find what the rules are as far as felony bars for physicians. This is going to be kind of a general discussion of what you need to think about if you have a felony in your past. You’re either maybe in medical school, in residency, or fellowship. Then you’re ultimately going to have to apply potentially to a new licensing board and kind of how they’ll think about that.

What Was the Degree of Felony Did the Doctor Have on Criminal Record?

The first thing is what type of felony it was. There are degrees of felonies, obviously. What you specifically did, is going to impact whether a board feels like they should give you a license or not. Any kind of violent crime is difficult. If it’s kind of drug or substance abuse related, that’s usually much easier to deal with. Think about this from the board’s perspective.

Let’s just assume there are no laws on the books that say a physician who applies for a license in this state is just absolutely barred if they have a past felony. It’s very unlikely that the board that you’re going to be applying to has a rule like that. Most medical boards will look at each case on a case-by-case basis. There may be rules that state if the physician is currently licensed. Then gets a felony, then it might be an automatic revocation. But most of them don’t just simply bar any kind of applications for past felonies.

Can You Be a Doctor With a Felony?

Becoming a doctor with a felony on your record can be challenging but is not impossible. Medical schools often conduct background checks on applicants, and convictions related to drug offenses, sexual misconduct, or violent crimes may result in rejection. However, each case is evaluated individually, and factors such as the nature of the felony, time elapsed since the conviction, and the applicant’s rehabilitation efforts may be taken into account. It is crucial for applicants with a felony history to be transparent about their past, demonstrate personal growth, and show a strong commitment to the medical profession. While the path may be difficult, a felony does not automatically disqualify someone from pursuing a career as a doctor.

How will the Medical Board Look at Doctor During Medical License Defense?

As I said before, they’re going to look at, alright, well, what was the felony? And then, how long ago did it happen? How many different criminal incidents were there? And then certainly, as I said before, the type. Any kind of felony-related incident or conviction that the physician rehabilitates from is going to be something that the board will be willing to work with. And as I said before, if it’s substance abuse or drug-related, well, that’s easy to rehabilitate from. You go to AA (Alcoholics Anonymous) or NA (Narcotics Anonymous), you go to therapy or group counseling. You take random drug screens. And you stop doing drugs or drinking alcohol. And you can show a prolonged period of sobriety.

All these things are the things that the board is going to care about. And they’re going to check into certainly. If you did have a drug-related felony and then had to go to rehab or an intensive outpatient treatment program, or something like that, they’re going to want to see proof that you did all of those things. So, you want to certainly keep all the records associated with any kind of rehab that you have.

Now, what if it’s something different that you can’t rehabilitate from? Like I said before, a violent crime, assault, domestic violence, something like that. Well, you need to show that things have changed in your life from what happened at the time until the time that you apply. So the board can see you’ve at least learned from the incident. And have grown from it, and they may have incorporated positive changes into your life. That show that you have, I guess, made positive steps since the felony occurred.

Can You Get a Medical License With a Misdemeanor?

Obtaining a medical license with a misdemeanor on your record can be challenging but is not necessarily prohibitive. State medical boards evaluate applicants on a case-by-case basis, taking into consideration the nature of the misdemeanor, the number of offenses, and the time elapsed since the conviction. Other factors, such as the applicant’s rehabilitation efforts, remorse, and dedication to the medical profession, may also influence the board’s decision. It is essential for applicants with a misdemeanor to be honest about their past, demonstrate personal growth, and maintain a strong commitment to their medical career. While a misdemeanor may complicate the licensing process, it does not automatically disqualify an individual from obtaining a medical license.

What Does The Medical Board Want To See?

The board wants to see that a physician is regulatable. Then ultimately, they’re able to provide safe patient care in the medical field. That’s the stated mission of every medical licensing board, to protect the public. They’re not there to protect the doctor. If their mission is to protect the public, you need to make certain that the board understands and feels comfortable issuing the license. So that public safety is not going to be an issue.

Now, how to handle this? Obviously, many people go into medical school, and then they might go into a residency in a different state. And then they plan on going into a different state when they ultimately finish training. Think about the state that you’re going to have to get a physician’s medical license if you’re going into training. That’s going to be the first hurdle on the road to becoming a professional. So, you probably need to reach out to an attorney in the state where you’re going into training. Then just see, is the past felony going to be an impediment to me getting my license?

What if I Can Get Licensed in One State?

If you can get a license in one state, it’s more likely than not that it won’t be an issue in another state. It’s just kind of common sense. That if one state feels comfortable issuing a license to a doctor that the other state will likely feel comfortable as well. Now, they’re not beholden to any other state. Just because you got a license in one state doesn’t mean you’re going to get it in every state that you apply to. But in my experience handling these kinds of medical board cases, it is likely that if board members see. Alright, well, they already have a license.

They got through training with value problems, it’s been three or four years. So it probably means this person is safe to practice. And then they’re more likely to issue the license or not. As I said before, reach out to an attorney who handles medical board issues in the state where you’re going to get your training permit originally.

Now, some medical boards have stricter scrutiny when you’re applying for a full license. Once you’re done with training versus just issuing a training permit or whatever kind of provisional license they have in that state to complete your residency. It just makes sense to reach out to a medical board attorney in the near state. And just walk through all these things. If they have experience with the board, they should know the answers to those questions. Like, for people that have had this in their past, this is kind of what the board has done.

The Advice of a Lawyer to a Future Doctor

No attorney is going to be able to give you a 100% guarantee that you’re going to get a license. If you’ve had something in your past, such as a felony. They cannot do that. So, you just need to kind of assess all the information you have available to you. Then make an informed decision. 

If you’re reading this blog, and you’re thinking, alright, I don’t even know if I should go to medical school because of a past felony. Well, once again, reach out to a board attorney in the state that maybe you’re going to school in. Then they can walk you through the scenario.

Being a felon is not a complete bar to having a medical license and being a physician. But obviously, it does have some major roadblocks associated with it. Not only with getting a medical license. But when you start applying for jobs in the medical field as a physician as well. 

And when they do a criminal background check, they’re going to see that you have a felony conviction. And you’re going to have to have a good explanation about what happened. For all the things you had to show the board about your rehabilitation, it’ll likely be the same scenario with an employer walking through. Most employers are more understanding than the medical licensing board. But it’s going to be something you’re most likely going to have to deal with for the rest of your career. 

Let Us Help You

Anyway, if you have any questions about employment contracts or medical board issues, we’re in Arizona. So, keep that in mind. Hopefully, my information was kind of a good general primer on what to do if you have a felony in your past. And you’re thinking of becoming a physician, maybe you’re in training and then get a felony. Or maybe you are a doctor with a criminal record.

Other Blogs of Interest

  • Should an Arizona Physician Ever Surrender Their License?
  • Is a Letter of Reprimand from the Arizona Medical Board Public?
  • Types of Arizona Medical Board Practice Restrictions
disappointed physician

What Happens When a Doctor in Arizona is Under Investigation? | AZ Medical Investigations

Our firm regularly represents physicians and physician assistants under investigation with the Arizona Medical Board. Or the Arizona Regulatory Board of Physician Assistants. I thought it might be helpful to provide a brief overview of what to expect should a complaint be filed against your license. 

The initial process involves the board staff members informing you that a complaint has been filed. And notifying you in writing that they will determine whether the allegations warrant a further investigation. Upon determination that the allegations warrant further investigation, you will receive an additional letter stating the nature of the allegations. Indicating that you, as the licensee, have an opportunity to respond in writing to the allegations by a certain date. 

In addition to your written response. The board staff member assigned to your investigation may also subpoena patient charts and other relevant documentation. Or obtain statements from third-party witnesses or opinions from outside medical consultants. Once the investigation process has been completed, the board staff member in charge of your investigation will notify you. Stating that the investigation has been closed. And that the complaint has been forwarded to the staff investigative review committee to determine further action.

Can You Sue Someone for Filing a False Complaint With the Arizona Medical Board?

Our firm represents physicians before the Arizona medical board and the osteopathic board. We’ve been representing healthcare providers in Arizona for over a decade now. And one thing that comes up semi-frequently is the question. Can you sue someone for filing a false board complaint in Arizona? Pretty simple question. The answer is yes, but there are some caveats we will go over right now. Every board has a statute. They’re in the Arizona revised statutes, which lay the groundwork for what the board can and can’t do. In the statute for the Arizona medical board, there’s a section. I’m going to read it, which says any person or entity that reports or provides information to the board in good faith. That person is not subject to an action for civil damages.

Arizona Medical Board

In summary, anyone who files a board complaint in good faith can’t be sued for civil damages. The most important part of that section is good faith. What is good faith? This means if someone honestly believes that the physician committed misconduct, did something illegal, or violated the statute. They’re immune from civil damages. The only way that a physician could sue someone for filing a board complaint is if it was false and in bad faith. People can file a good faith complaint with bad intentions. You could have a patient who wants to stick it to the doctor, a competitor physician who’s doing the same, or an employer who is somehow upset about their relationship terminating.

Licensing Board Complaint

If any of those people filed a good faith argument, they believed that whatever the physician did could violate the statute. They’d be immune from a civil lawsuit. If you sue the person, you must prove they acted in bad faith. They knew that what they were alleging was false. Potentially they made up falsehoods and used that as a basis for a complaint. There was a case in the mid-two thousand. That kind of worked its way up to the court of appeals in Arizona. And basically, it was one physician who filed a board complaint against a competitor physician. They’re in the same specialty, fighting for patients in the same area, and alleged some things. And the physician who had the complaint. Filed against him and filed a lawsuit against the other doctor. They stated that the other party did not submit the complaint in good faith.

Are There Any Mistakes Physicians Make?

And therefore, he suffered some damage. I’m just going to read what the counts of that lawsuit are. Right? Some counts for the lawsuit are:

  • The alleged defamation
  • False light invasion of privacy 
  • Wrongful institution
  • Maintenance of an administrative proceeding 
  • Intentional interference with prospective contractual to business relationships
  • Injurious falsehood

What the court held, though, was the first count. Was the complaint filed in good faith or not? And the court said, yes, it was. They’re saying even if some of the things alleged by the person who filed the complaint were untrue. They believed they were true. They made at least a minimum amount of verification of the facts. And therefore, the other party filed the complaint in good faith. And so the physician who filed the complaint against him couldn’t recover any damages.

We have a case currently with the Arizona medical board. We’re representing a client. I won’t get into the details of it. However, I can give broad strokes. In this case, a patient alleged that our client gave them on a certain date, a specific procedure. Then, there was a negative outcome during the procedure, after a review of the medical records. Our client never saw the patient on the alleged date. Never even provided the procedure alleged by the patient. And then, obviously, the bad outcome didn’t occur either. So, did that person file a complaint in bad faith? Well, we believe, yes. As I stated before, when looking at whether a complaint is filed in good or bad faith. Do you need to look at whether the person who filed the complaint attempted to verify any of the information?

Medical Board Complaints

In this case, obviously, no. What could someone do to verify the information? They could call the office and verify when they saw the physician. Request the medical records, review those, and talk to the people involved. A minimum base amount of effort needs to be given to verify allegations. And if the complainant, the person who files a complaint, doesn’t do any of that. Then that certainly allows whoever had the complaint filed against them to argue that it was filed in bad faith. 

This is a fairly nuanced topic. In summary, can you sue someone for filing a false board complaint in Arizona? The answer is yes, you can, under certain circumstances. But it’s an interesting topic to discuss. As I stated, my firm Chelle Law represents physicians before the Arizona medical board and osteopath boards. If you have any questions, we’re certainly happy to answer them. Just give us a call, the number is listed below in the description, or you can visit us on our website, Chelle law.com, C H E L L E law.com. Hopefully, this is informative. Please comment if you have suggestions for other topics you want me to discuss. I’ll be happy to do that. So anyway, thanks for listening, and take care.

What Criminal Charges Should a Physician Report to the Arizona Medical Board?

What types of criminal charges must physicians report to the Arizona Medical Board? To put it another way, imagine you are a doctor who has been arrested and charged with a crime. Now, what are your reporting obligations to your licensing board? 

Arizona Statute

In Arizona, we have a statute called A.R.S. 32-3208. It governs the reporting of criminal charges by all Arizona health care professionals to their regulatory boards. Essentially, this statute states that if charged with a felony or misdemeanor, that may affect patient safety. A practitioner or provider must report those criminal charges to their regulatory board. It must be in writing and within ten working days upon the filing of charges.

Many people are unaware that they must do so. Many practitioners mistakenly believe they must only report the final disposition of a criminal case. Or any conviction resulting from criminal charges. However, this is not the case.

Under the statutory language, a provider must report any criminal charges filed within ten working days. The statutes here go even further. It is unprofessional for providers not to say these criminal charges to their regulatory board.

Look Up Information About Reportable Offenses

Consider the following scenario: you are arrested and charged with a misdemeanor. Or any other felony that may seriously affect patient health and safety. In that case, you must notify the medical board within ten business days. It’s worth noting that the language surrounding the misdemeanor charge that may seriously affect a patient’s safety appears to be very limiting. Still, visit the website of the Arizona Medical Board. They do provide a list of reportable misdemeanor offenses. 

According to the statute, these are misdemeanors that may jeopardize patient safety. The list includes a wide range of offenses. In that case, don’t assume that the misdemeanor they’ve charged you won’t impact patient health and safety. And it will also relieve you of the obligation to notify the medical board about the charge. Say they charged you with a crime, or you are a physician who needs help self-reporting to the Arizona medical board. Please do not hesitate to get in touch with us.

What is a Summary Suspension by the Arizona Medical Board?

What is a Summary Suspension by the Arizona Medical Board License Suspension

What is a summary suspension for a physician licensed with the Arizona Medical Board? What does that process look like? And what can a physician expect if they find themselves in a proceeding to suspend their license summarily? 

To Protect Public Health, Safety, and Welfare

A summary suspension is an emergency action the Arizona Medical Board takes. Suppose they believe that public health, safety, and welfare require emergency action against a physician’s license to restrict all or some of their practice. So, this is an action the board takes before the allegations of unprofessional conduct are fully investigated. The physician has had an opportunity for a formal interview or hearing on the allegations.

Suppose the board feels the allegations are serious enough. So severe that they cannot put off action against the license until the investigation has concluded. In that case, they can summarily suspend. If they believe that harm could come to the public while board staff is completing their investigation into the allegations. It can be an action the board staff recommends to the board to restrict the physician’s ability to practice thoroughly. It could be an action the board staff takes. Should a physician refuse to sign an interim practice restriction during the investigation?

Suppose the board staff receives a complaint with serious allegations. If they’re concerned about the physician’s ability to practice, they can offer an interim practice restriction. To prohibit or limit some of that physician’s practice activities while they gather more information about the allegations. 

Say a physician refuses to sign an interim practice restriction offered by board staff during the investigation. The board staff’s recourse at that point is to proceed with a summary suspension of the physician’s license. This again is asking the board to suspend and restrict the physician’s ability to practice pending a formal administrative hearing into the allegations.

Right by Statute 

Suppose the board summarily suspends a physician’s license and finds that emergency action is required to protect the public’s health, safety, and welfare. The physician has a right by statute to have an administrative hearing on the allegations. And within 60 days of the summary suspension. At that point, should the board vote to immediately suspend the physician’s license, they would refer the matter to the office of administrative hearings for a full evidentiary hearing.

By statute, that hearing must be held within 60 days of the summary suspension by the board. Should you find yourself under investigation by the Arizona Medical Board. Or in the process of summary suspension proceedings or a subsequent formal hearing after you’ve been summarily suspended. Please do not hesitate to contact our firm if you need advice or assistance.

How Can a Doctor be Terminated for Cause?

What are the ways a physician can be terminated with a cause?  In any contract, there are several mechanisms to terminate a physician. One is without-cause termination. Which means either party can terminate the agreement with a certain amount of notice to the other party. Usually, that’s 60 or 90 days. 

That’s where most terminations are going to occur, and it’s almost always on the physician’s side as well. The physician, for whatever reason, is unhappy, has a better opportunity, or just moves for the family. They give without-cause termination, they work out the 60 days, and then they move on. Also, in every physician contract, there’s going to be what’s called “with-cause termination.”

And there are two different parts to that. One, you’ll have a termination with a cause that can be an immediate termination. Meaning the employer doesn’t have to provide any notice to the physician. Two, it can be with-cause termination with the need to cure. 

So, in a contractual context, a cure period is simply a period where if someone is alleging the other party in breach of contract. They usually get somewhere between 15 to 30 days to fix the breach. Then, if the breach is cured, they move on, and they can no longer terminate the contract for-cause. I would say the normal thing in people’s minds. As far as for-cause termination are kind of the following. I’ll just go through what is listed in nearly every physician contract.

With Cause Termination

In the contract, it’s going to say the employer can terminate this contract with-cause with no notice required, and it’s usually at their discretion. So, they don’t have to fire the physician immediately, but they can. Kind of the obvious things are, if the physician loses their medical license, they can no longer practice as a physician, an obvious termination. They lose their DEA registration, so they’re no longer allowed to prescribe drugs. 

That’s a problem for most physicians. And so, that would be immediate termination. They die, they are permanently disabled, and they are uninsurable. This means that if a physician continuously gets judgments due to medical malpractice, at some point, the insurance companies are going to say, we’re not going to insure you anymore. And no employer is going to keep a physician that doesn’t have malpractice insurance. 

So, it’s another thing they can terminate immediately. Generally, a felony conviction is another thing. Sometimes, a state medical board will have laws that state that if the physician is convicted of a felony, it’s an auto revocation of their medical license. In other states, it must go through an investigation for them to determine if that’s necessary. 

But for the most part, if you’re convicted of a felony, that’s something that results in the employer terminating a physician. In substance abuse, there might be either a moral clause or a clause about the physician being impaired in some way. I mean, for the most part, people think of impairment as far as substance abuse, drugs, alcohol, something like that. But like prescription drug abuse, it could also be psychological if someone is having mental health issues and they’re unable to practice safely. That could be an impairment.

Permanent Disability

And then, I said permanent disability before. If you’re in a specialty that requires, say, a surgeon requires your hands, and you have nerve damage in your hands, then that will result in the revocation of a physician’s medical license resulting that the doctor can’t be a surgeon anymore. 

Well, obviously, they can terminate the contract for that. As I stated before, most of the time, if there’s some other kind of breach, let’s say a physician is refusing to take calls, maybe they’re acting inappropriately towards staff, they’re not fulfilling the required days, hours, that type of thing.

If there’s volume expectation and they are far below that, in those scenarios, the employer will usually give, as I said before, a written notice that they have a certain number of days to fix whatever the issue is. And then, if it’s fixed, the employer still could terminate them, but they would likely do it without-cause since there are no workarounds to terminate them for a cause. So, that’s a little breakdown of how physicians can be terminated with-cause, for-cause. However, you want to characterize it.

Arizona Medical Board Questions?

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Physician Options When Offered Salary Reduction Due to COVID | Salaries of Physicians

Physician, Blog

Since COVID-19 began, physicians have faced unprecedented challenges like all health care workers. Being offered a salary reduction is one of them. Many of these physicians have the same story, with most employers offering them a temporary 10% salary reduction through the end of 2020. Some employers have offered entirely new Employment Agreements with substantially different compensation systems. (These new agreements either reduce base compensation drastically or shift the entire compensation structure to a production-based system. If a long-term reduction in volume necessitates the employer to create future compensation reductions, a pure production-based compensation system would negatively affect the physician’s overall compensation.

This is all dependent upon:

  • The specialty the physician is in, and it’s been negatively affected by Covid-19.
  • Where they practice geographically
  • How COVID-19 has impacted the region and the number of Covid-19 patients it has.  (This may have caused short-term cancellations of elective surgeries and other related procedures).

The most frequent question our attorney’s are asked, should a physician unilaterally accept a salary reduction, or are there other options?

Physician Without Cause Termination

Every Physician Employment Agreement (Agreement) contains a without cause termination clause. Without cause termination allows either party to terminate the Agreement for any reason with some notice to the other party. 60 to 90 days notice is the industry standard. So, if the physician refuses to accept the salary decrease, one option for the employer would be to simply exercise the without-cause termination clause and terminate the Agreement. This is the likeliest scenario if the physician refuses to accept the salary reduction.

The downside for the physician, if the employer exercises the without-cause termination clause, is that all restrictive covenants (non-compete, non-solicit) will still apply in this situation. Additionally, any repayment obligations (signing bonus or relocation assistance) will still likely be enforced. There is nothing a physician can do to stop their employer from exercising without cause termination.

Employment Agreement Compensation Amendment During Coronavirus (COVID) Pandemic

Physicians who desire to stay with their current employer, but not accept a long-term salary reduction, can agree to an amendment. This amendment may contain a salary decrease for a limited period.  This gives the employer short-term cost relief but limits the amount of time the physician receives a reduced salary.

Peer Pressure by other Medical Staff Members

The final tactic employers utilize is pressuring the physician into taking a salary reduction by intimidation. Employers tell the physician they’re a bad colleague if they refuse a pay cut when other physicians have agreed without trepidation. The appearance of being a “bad teammate” applies pressure to physicians who are reluctant to agree on reducing compensation. This is an effective management tactic that each individual physician must consider.

Overall, there isn’t much a physician can do if their employer offers a unilateral compensation reduction if the employer if willing to terminate the Agreement.  However, physicians who work in specialties that are difficult to staff or in underserved areas where it is difficult to attract new physicians have a much better likelihood of refusing a unilateral pay cut and may not be terminated. As with any physician contract negotiation, leverage is everything.

Contact an Attorney

If you’re a physician with questions about your options or your contract, contact us today or schedule a consultation. 

Other Blogs of Interest

  • Should an Arizona Physician Ever Surrender Their License?
  • What Criminal Charges Should a Physician Report to the Arizona Medical Board?
  • What Should Go Into a Physician Assistant Termination Letter? | PA Resignation Letter Notice

How to Negotiate a Physician Salary | Negotiation for Physicians

How can a physician negotiate a better salary? As an initial matter, I don’t personally believe that the salary should be the driving factor in a decision for a physician. Suppose there’s an enormous gap, a hundred thousand dollars, maybe 50. But if it’s $10,000 just going with the job that offers the most when maybe the benefits are different. The work environment is different. The ability to learn, have a good mentor, a good teacher. I think all of those things are probably more important than just the absolute base salary amount, but it certainly is important. And so when someone asks me, all right, what do I do?

Physician Compensation Negotiations

How do I get a better salary? There are a couple of ways of doing it. One, you need to know your worth. How does a physician find out what’s a reasonable salary? Well, there’s data. The MGMA medical group management association is the industry standard regarding compensation numbers. It is not the be-all and end-all of whether something is fair or not. They break it down into regions: West, East, Midwest, Southwest, and those quadrants have different salary numbers. But the base salary could be great or not be great. That depends on whether there’s productivity compensation in the agreement or the potential for partnership. So, there are many scenarios where a physician is out of training and given a two-year, three-year agreement.

Physician Contract Salaries

That’s probably below what’s a reasonable or average amount for someone just coming out of training. With the carrot on the stick, if you take below market for these two or three years, you’ll get away above-market. Once you become a partner, be careful of the situation. Do you need to find out how many people are partners? How many people have they not offered partnership to? And then what will you make once you’ve become a partner? That’s certainly important. Now, as far as the MGMA numbers go, you can Google around and find them. I would say data from maybe a year or two old. I found that people are relying on 2020 numbers. They’re in trouble due to coronavirus (COVID). 

Some of the RVU compensation factor numbers are way out of whack. Some of the comps are just way out of whack. I would not use 2020 data. 2019 is probably the safest and most reliable number we have right now. 2021 wasn’t out yet while I was making this video. So, Google around. You can try and find some numbers. I’d say the best way to do this is to go out there and find multiple job offers and see what your initial offer is. And then also, anyone in training has other people in their specialty that are also looking for jobs. Talk to your colleagues and the people you’re training with. What offers have you received? Where have you been offered this? One difficult thing is that some people automatically think that they’re in a high-cost city and that they’ll make more.

Salary Rate in the City

And that’s not the case. It’s almost the opposite. Suppose you’re looking for a job in a city that’s a desirable location. The salaries are usually, or at least sometimes the salaries will be depressed. I live in Scottsdale, Arizona, which is a great place to live. And when I speak to physicians who are moving into the area. They get surprised sometimes because the salaries may not be adjusted to the cost of living in the area, California as well. Suppose you’re in San Diego or LA or even in San Francisco. In that case, the cost of living and housing is very high, but the salaries are not commensurate. You need to be aware that just because you’re in a bigger city with a higher cost of living doesn’t mean you’ll be making more. It’s the opposite.

How Health Specialist Negotiate?

If you’re in a rural location that’s hard to recruit, you will almost always make more money in those scenarios. So, if money is the bottom line you’re looking for. Then it would help if you looked in the smaller cities that are difficult to recruit. You will make more money on average if you’re going to a small rural community. That’s a fact. Once you have a number in mind, what do you do with the employer? You ask them for more. If the offer is 300 and you want 325, don’t ask for 325. You ask for more than that. So if they offer 300 and you want 325, then ask for 350, easy arithmetic, try to meet in the middle. 

Now there is a point where you will look either greedy or potentially just dumb if you’re asking if you received an offer of 300. You ask for 450. They’re going to say, well, that’s ridiculous for, it may even yank the offer.

Negotiation Based on Leverage

You need to know your value, and then specialty is also a big part of what kind of leverage you have. Leverage as the basis in any contract negotiation. Do you have it, or do you not? You have more leverage if you’re in a specialty that’s hard to recruit or in high demand. If you’re in a specialty that is plentiful or saturated in the market that you’re looking in, your leverage is less. So, you need to take that into account as well. Suppose you’re switching jobs in the community and bringing your patients with you. Then you’re worth more than someone coming into the community, like peds or primary care, that has to build up a patient base that takes time. 

Learn to Walk Away From Unworthy Offers

Those are tips on getting a better salary and where to start. Contacting an attorney and getting a feel for the area might be helpful.

It’s fairly specialized in people that focus on physician contracts. You may not find somebody within the area you’re looking at, so maybe do a broader search. But anyway, the last point is that some employers will not negotiate. They’ll say it’s a take it or leave it to offer. You’ll then have to be willing to walk if you’re unhappy with your salary, but there are just simply people out there that say, no, we’re not negotiating. We’re offering what we offer, and I wouldn’t be offended by that. That’s just kind of the tech that they’re taking as far as employing somebody. 

So, don’t be surprised if you have an employer that says no, but if you’re unhappy with an offer, you need to be willing to walk as well. Accepting a deal that you think is well below your value is never a good feeling. Don’t just accept that because you need a job. Find the right job.

What Should be in a Telehealth Contract?

What should be in a telehealth contract? Telehealth is also known as telemedicine. The pandemic accelerated telemedicine and telehealth across all specialties. It is now possible to conduct practice in any specialty via telemedicine. Most of the state licensing boards, I would say, significantly increased the ability of physicians to utilize telemedicine. Whereas maybe, in some ways, it was prohibited in the past. I find that more and more people are contacting me to review telehealth employment contracts or telehealth independent contractor agreements. And some things need to be thought about before the physician enters them. There’s no huge difference between a telehealth contract and just a normal employment contract.

The Big Difference in Telehealth Contract

If you join a hospital network or a private physician-owned group, the agreements will be relatively the same, with one big exception. And this is the reason why I wanted to talk about this today. The following sentence goes for any physician contract. In the typical agreement, you’re going to have: the term, how long it last, how to terminate the contract, what the compensation is going to be, whether there are any benefits, what the employer is going to pay for, so licensing, DEA, society, associations, continuing medical education, time off potentially. However, it’s a little different for most telehealth agreements. And then, the big one is the non-compete. Now, I wish I had a bright line answer: Okay, this is how it works with telehealth agreements, but I don’t.

Non-Compete Clause

First, non-competes or at least non-compete law is probably one of the only things that change from state to state. If you were to review a physician contract, nothing would be state-specific for the most part. It’s all the same. However, each state views non-competes differently. There are very few states, but some completely prohibit non-competes for physician employment contracts. So, California, New Mexico, Massachusetts, and then there are varying degrees of what’s considered a reasonable enforceable non-compete based upon the state. The tricky part with telemedicine or telehealth is determining where the non-compete applies. If you think of a normal non-compete, it’s going to say:

  • For this period
  • After the contract terminates
  • Usually, one year, sometimes up to two
  • The physician can’t compete
  • Can’t either work within their specialty
  • In a specific geographic area
  • Somewhere between 5 to 15 miles from their primary practice location
  • You just stick a pin in a map, put 15 miles around it, and then that’s where the physician cannot work during the period of the non-compete.

Why is the Non-Compete Clause Complicated in Telemedicine?

Well, that doesn’t work in telehealth. I find that most physicians who are working in telehealth usually are licensed in multiple states. And so, let’s say they live in Florida, they’re licensed in Florida, but they’re also licensed in Georgia and South Carolina. The telehealth company services all those states. And so, the physician has no say in where the patient is located. And then they’re just seeing the patients that are in a queue. Different telehealth companies do it differently. Some literally the physician when they’re available or when they want to, they’ll just log in, there’s a queue of patients.

And then they tee up whoever is available and do the consult or whatever they do. Others will have, like in, maybe telepsych. They’ll have a set patient base for which they continuously see and write scripts—the difference between a normal non-compete, where it’s just a region. And most of the telehealth agreements will say, you cannot compete with current patients or provide care to current patients in this state that you’re providing care for us. Or you can’t work for another telehealth company that competes in the state that we’re currently in. 

They’re much broader and, in my opinion, much more unenforceable than a standard one year, 10 to 15 miles. Now, these are just working their way through the court systems in various states. And in some states, it’s completely open as far as whether these are enforceable or if there’s a way of making the non-compete enforceable by limiting the area. 

Some Examples Why It’s Complicated

But let’s give a couple of scenarios. Let’s say a physician is doing radiology while living in Georgia but then doing reads from multiple states nearby. And then, the radiology company offers a non-compete. It states that the physician can’t work for any other competing radiology company where you’re doing reads in different states. Or you can’t provide radiology services for any of the facilities that that company has been doing reads for over the last year. Or some scenario like that. I mean, you can see how complicated it can get. If someone leaves the first job, they move to a second job.

They have no control over which facilities they’re providing medical care for the patients they’re seeing or anything like that. And then maybe there’s some change in a business relationship. And so, there may be no problems in the first six months of the non-compete. Then, in the second half, maybe your new company starts servicing the old organizations that your first radiology job is servicing. What do you have to do? Do you have to stop providing health care for those places? Was there any caveat in the original non-compete that the physician would be free to provide medical care to those facilities if the contracts ended? Another one would be if it were just a patient base. Let’s say it’s telepsych. The telepsych company would say the physician can’t provide medical healthcare to any patient that received services from the telepsych company within the last year.

Physicians Do Not Have Control Over the Patients They See in Telehealth

And not even specific to the physician, just any services from their company. Well, once again, let’s say the physician leaves. They have no control over who the patients are that they see. They have no idea of who the previous companies were that the patients used. So, how do you determine or track whether they’re breaking the non-compete or not? And then another factor is how to track everything. Like how would an employer who made a physician sign a non-compete? How would they know if that physician is servicing patients in a new position? It would be challenging. So, I wish I had an answer: yes, it’s enforceable, or no, it’s not. The courts have to go through these areas and then decide on, alright, this is what would be considered enforceable.

And this is what would be considered not. Now, I think it makes sense for the physician to bring up these issues to their company before signing the non-compete and get into those scenarios and say, well, how am I supposed to if our company provided medical healthcare to someone? Then I switched to a different company, and it’s a patient I never had, I had no relationship with, but they utilized another physician in the organization. I mean, there are so many different complications when it comes to this. 

Have a Lawyer Look at the Contract Before Signing

So, it would probably make sense to get it looked at before signing the non-compete. But I guess there will be some limitations from what some of the bigger telehealth companies are making physicians sign right now. Putting a blanket, you can’t work for another telehealth company in the entire state. I don’t think that’s going to hold up at all. It will have to be limited, most likely by geography in some way, which in these scenarios may be impossible to do. So, that’s a brief breakdown of what should be a telehealth contract with a significant focus on the non-compete because that’s the most important part.

Are Doctors Independent Contractors or Employees? | Independent Contractor or Employee for Doctors

Are physicians employees or independent contractors? Kind of a simple explanation. It depends upon the contract that you signed. Most physicians will be employees, meaning they must sign an employment agreement with a new employer. For some specialties like dermatology and anesthesiology. Those two are much more likely to be engaged as independent contractors than employees. Physicians can be hired as an employee and independent contractors as well. It just depends upon what contract they signed. Let’s go through each one. 

Doctor as Employee 

In an employment agreement, the physician is an employee. They’ll receive a W-2, they’ll receive employee benefits: health, vision, dental, life, disability, and then have their medical license and DEA registration. There’ll be some amount paid for continuing medical education. They’ll also receive paid time off. Anyone who signed an employment agreement would typically get all the expected benefits of being an employee. The salary structure, usually, would be or could be a base salary,  based on net-collections, RVU. Or it could be a combination of all three. It just depends. But in a normal situation, if you’re joining a hospital, a physician-owned practice, or a medical healthcare network. You’re almost always going to be an employee. 

Doctor as Independent Contractor

Let’s take anesthesiologists, for instance. Maybe they’re moonlighting on the side, infrequently working for a group, or they signed an independent contractor agreement. So, the legal distinction between independent contractors and employees will be. Instead of receiving a W-2 at the end of the year, physicians would receive 1099. In that scenario, the employer will take no taxes from whatever they earn. They get a check. Then they’re responsible for paying the taxes to the state. If you’re in a state that has that, then obviously, the federal government as well. In an independent contractor agreement, physicians usually have to pay for their own licensing and DEA registration. They won’t get time off, and they won’t receive any benefits.

The employer will usually pay for the malpractice insurance policy. But then you also must think about that scenario, alright, well, who pays for tail insurance? The normal compensation structure in an independent contractor agreement wouldn’t be a base salary but usually net collections-based or encounter-based. 

You would get a flat fee for doing a certain service, something like that. Ideally, in an independent contractor agreement, you’re supposedly able to get in and out of it without hassle. The schedule should be up to physicians. The IRS has a 20-factor test to determine whether someone is an employee or an independent contractor. The physician practices utilize independent contractor agreements. The benefit to them is they don’t have to pay employment tax on any of the wages they provide to physicians. And they don’t have to give any benefits.

Chelle Law will provide a physician contract review to identify the areas that could improve. And to assist you in negotiating the best contract possible today. 

Benefits Independent Contractors Get

The benefit to the physicians of utilizing the independent contractor agreement is usually a little better compensation. The percentages for net-collections might be a little bit higher. The RVU thresholds might be a little bit lower. And the compensation factor for the RVUs might be a little bit higher. They would generally create an LLC or something similar. Then be able to deduct all of the expenses associated with their practice for that employer. They could claim the things I just talked about. Licensing, DEA, if they have paid for malpractice, any business expenses, office, whatever it is. They could theoretically deduct those over time. 

Which of the Two Is Better for Doctors?

Which one is better? Being an employee or independent contractor? Generally, I find physicians will come out ahead under an employment agreement versus an independent contractor agreement. In some scenarios, they’re just not going to have the choice. The employer could say you will only be an independent contractor for us. We will never issue an employment agreement to you, take it, or leave it. And in that scenario, the physician must decide. 

One thing that comes up occasionally is someone who’s never been a 1099 employee. They’ve never been independent contractors before. They’re getting all this money from the job that they’re providing. Then at the end of the year, they think, oh man, I didn’t either budget for this. Or, I wasn’t sending in the quarterly earnings to the IRS. They get to the end of the year and haven’t saved all their money. So, ensure that you are budgeting if you’re working as a 1099 employee. Setting aside whatever amount is necessary to pay the taxes.

Worst Case Scenario for Independent Contractors

The worst thing that could happen for independent contractors. Get to the end of the year and not be there to pay taxes. So, can physicians be employees or independent contractors? Indeed, they could be either one. They could be both. If they work as employees somewhere else, moonlighting elsewhere as independent contractors. It simply comes down to what kind of agreement they signed. Independent contractor agreements are, in my opinion, much less complicated. Usually much shorter than employment agreements. Simply because they’re not going through all the benefits typical employees would receive from their employer. It’s generally easier to get through an independent contractor agreement, but certainly, there are negotiating points for each one. Anyway, that’s the difference between the two.

What Is the Best Physician Compensation Model? | Physician Compensation Models

What is the best physician compensation model? I wish I had a black and white answer, but it depends. Let’s work through the different types of physician compensation models and who can benefit from each. There are three main types of physician compensation models. 

3 Main Types of Physician Compensation Models

First, just a straight-based salary. You work for an employer. They pay you 300,000 a year. You do the work, that’s it. You get the straight base, no productivity incentives, compensation, nothing. Second, you could earn on net-collections. Whatever your services bring into the practice, you would get a percentage of that. Typically somewhere between 35% to 45%. And then lastly, RVUs. The physician produces work RVUs for every encounter and generates a certain amount based on the schedule released by CMS. Then there is the compensation factor. An actual monetary value multiplied by the RVUs generated times that compensation factor. That’s how much physicians will make. 

There are certainly hybrid models that combine one or all of these. It would be rare to have a compensation model with both net-collections and RVUs. That seldom happens. Maybe there would be a half-based salary minimum. And then the rest of your compensation would be tied to either net-collections or RVUs. I find that most physician-owned practices will have some productivity compensation and use net-collections. And then most hospital-based health network employment would utilize RVUs.

Why do they separate them? Not sure. But that’s just how it works in this industry. Which one is best? I think having a straight base salary with absolutely no performance incentives or productivity incentives doesn’t make sense to me. Now, if you’re a new physician coming into a new job. I’ll say, with the hospital, you’re establishing a practice in the area. There will almost always be an income guarantee for the first few years.

What Is the Best Productivity Model for Primary Care Physicians?

It usually takes 12 to 18 months for a practice to reach maturity. So, it only makes sense that physicians wouldn’t be placed on productivity compensation immediately. Especially primary care, cardiology, and any specialty where you must build up a patient base like ED or hospitalists. Those types of things where you’re just doing the work before you. You’re not building up a practice. You can hit the ground running. In those scenarios, it’s okay if it was in the RVU-based productivity model. But it makes no sense initially if you’re building up a practice. Many organizations will have an income guarantee for the first year or two. And transition into a hybrid of base salary plus RVUs. 

Let’s first take net-collections. The main point of negotiation in the net collections-based agreement is the percentage. When I speak to physicians, they’re taken aback upon seeing they’ll only make 35% of anything collected by the practice. However, overhead is expensive. 60% is not an unusual amount in physician practices. If the employer is going to have profit, they need a percentage within that area. As I said, usually somewhere between 35% and 45% is normal. You will not see a net collections-based agreement over 50%. And if they’re a good businessperson, honestly, anything over 40 to 45 wouldn’t make financial sense unless they’re efficient. 

Negotiate the Percentage of Collection

One thing to negotiate would be the percentage of collection the employer gives. It can either be calculated monthly, quarterly or yearly in some instances. And then it’s tier up, or there’s reconciliation at the end of those periods. So, the percentage will be the negotiating point if it’s a net collections-based agreement.

It can be just pure net-collections, meaning everything you bring in that’s what you make. Or maybe you have a base salary. And let’s say that any quarterly collected over $200,000. You get a percentage of whatever it is, in addition to your base salary. As far as RVUs are concerned, once again, you could be paid monthly, quarterly, or yearly if it’s reconciled. You’re not getting paid yearly, but they could reconcile it at that period. Usually, in an RVU-based contract, they would come up with a draw.

Let’s say you’re taking home 10,000 a month, no matter what. And then, at the end of the month or quarter, there’ll be a target. And then any RVUs generated above that target would be multiplied by that compensation factor. Then that’s what you would take home. So, what is the best? Well, as I said at the beginning, it depends upon the setting for the physicians. Net-collections based do not work in a hospital environment. So, if you are in a medical healthcare network hospital, it simply doesn’t work. RVU is the only thing that works in that environment. 

It All Depends on the Setting 

I think RVUs are fair, but you also must consider this. If you’re in a specialty like ED or hospitalists, and you’re only getting on RVUs. You could be completely screwed if the volume of the hospital is very low. If the sense is slow, if the ED is slow, there’s nothing you can do. In that scenario, you would not want to be paid purely on production. And honestly, it doesn’t happen very often, but I’ve seen it before. And it’s just a bad idea. 

Now, if you’re in primary care, you’re at the mercy of, is the office manager good? Is the office set up well, and are they efficient? Is the billing and collection department on top of it? If you’re on a net collection base agreement and the billing and collections department is terrible. Well, you’re the one going to suffer from that. So, I always try to work in a hybrid where you’ll get a guaranteed base. But if you perform over a certain amount, you’ll also reap the benefits of the production. I mean, it’s just human nature. If you can get a bonus, then most people are incentivized to work harder to get that bonus. 

That’s why most of these employers provide something like that. When you’re on a base salary, with no opportunity for production, you’re just doing work that’s in front of you. It’s just human nature that you likely won’t focus or work as hard if there’s no opportunity to make more. So, which one is better? It depends upon the setting. But all three can work perfectly for physicians if it fits the practice that they’re in.

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