Navigating Life After Residency: Hospitalist with EmCare

1. 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 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. Whatshould 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 – 90-120 days • Timing of new contract negotiations – 60-120 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