Job "Must Haves"

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Jeff698

Jeff698

EM/EMS nerd
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  1. Attending Physician
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Greenshirt made a comment in the 'letter to my patient' thread about requiring on call psych in any job he took.

This got me thinking because I've made the same comment about other things recently as I being contemplating my upcoming job hunt.

What types of things are y'all gonna want to see in a contract that you're evaluating (or have evaluated)?

I'll start. So far, my list includes:

1) a SANE program and,
2) dedicated billing coders.

I'm sure there are more but my brain is in neutral after my long string of nights and swings comes to an end.

Take care,
Jeff
 
Jeff698 said:
Greenshirt made a comment in the 'letter to my patient' thread about requiring on call psych in any job he took.

This got me thinking because I've made the same comment about other things recently as I being contemplating my upcoming job hunt.

What types of things are y'all gonna want to see in a contract that you're evaluating (or have evaluated)?

I'll start. So far, my list includes:

1) a SANE program and,
2) dedicated billing coders.

I'm sure there are more but my brain is in neutral after my long string of nights and swings comes to an end.

Take care,
Jeff
Click to expand...

If you go academic then overtime pay is a "must have". Believe it or not, there are academic places where your shift schedule is set and if you pick-up an extra shift, you do not get extra pay. Likewise if a grant pays for some of your time and you do not reduce your hours, you do not get extra pay.

- H
 
What I can think of post call 😴

1. On Call Psych
2. Not responsible for floor codes and ED at same time (if single coverage)
3. Coders/Billers
4. absolutely love to have a EMR or Dictation system...otherwise I will require a personal scribe.

5. 😀 A CNA/Tech that is dedicated to handing out the juice / peanuts / blankets / dvd players / tissues / phones / free meds / and just generally making all the patients happy since that is more important than quality care. I mean patient satisfaction is starting to be tied to our reimbursement so lets spend 7bucks on someone who can be the ED Flight Attendant. :idea:
 
Red Runner said:
What I can think of post call 😴

5. 😀 A CNA/Tech that is dedicated to handing out the juice / peanuts / blankets / dvd players / tissues / phones / free meds / and just generally making all the patients happy since that is more important than quality care. I mean patient satisfaction is starting to be tied to our reimbursement so lets spend 7bucks on someone who can be the ED Flight Attendant. :idea:
Click to expand...

No need for a CNA/Tech.
They're called eager pre-med volunteers and they're free.
 
On call sub specialists: ENT, Ortho, Ob/Gyn, Uro, GI, Cards, Surg.

Believe me these are not a given. You get used to working without them but it's uber stressful.

Some type of fee for service incentive. Lots of groups where the leadership gets big stipends and don't feel any $ crunch don't want to tie pay to productivity because they are not productive. Without incentives you get lots of cherry picking and lots of bad signouts.

Contracted minimum hours. If you have no guarantee of hours you (especially as the new guy) can be reduced to 0 if the census falls, a senior guy wants more shifts, etc. I've seen it happen.

Gotta go. More as I think of it. Great Thread! Sticky worthy.
 
docB said:
On call sub specialists: ENT, Ortho, Ob/Gyn, Uro, GI, Cards, Surg.

Believe me these are not a given. You get used to working without them but it's uber stressful.

Some type of fee for service incentive. Lots of groups where the leadership gets big stipends and don't feel any $ crunch don't want to tie pay to productivity because they are not productive. Without incentives you get lots of cherry picking and lots of bad signouts.

Contracted minimum hours. If you have no guarantee of hours you (especially as the new guy) can be reduced to 0 if the census falls, a senior guy wants more shifts, etc. I've seen it happen.

Gotta go. More as I think of it. Great Thread! Sticky worthy.
Click to expand...

Tail coverage.
 
RNs or Techs in the ED who are experts at peripheral IV access. And they are allowed to do EJ's. Where I did residency in Tampa, the RN's couldn't do EJ's, which meant I would have to. Where I'm at now, the techs can do them, and they are huge time savers for me. I've even taught them how to do u/s guided peripheral access.

The ability to look up all old dictations, CTs, and ER charts, quickly.

On call ortho.

Q
 
I work in a huge academic center with everything and a small community ED with no backup.

It's tough working without backup, but you also get to do more. Besides, there's really nothing you can't stabilize and transfer. If you can't stabilize it, they were probably going to die anyway.

The only real life-threatening problem that EM docs or stabilize can't fix is UGIB. On-call GI would be nice. I'd really like to have on-call OB because high risk deliveries suck and I don't do enough to feel remotely comfortable.

Other stuff can be packaged and sent. And my referral center is 20 miles away...

I'd say a must-have for any job is happy docs and happy staff. Just like residency, get a feel for how happy the docs are, especially the recent hires. If they're happy, you'll probably be happy.
 
Tail coverage, health and disability, 401K with matching. These are all important. They are all money though. I don't know that I would consider any of them a flat go/no go item but you have to consider them really carefully. More pay can make up for less benefits and vice versa. The trick is figuring out what the benefits are worth and comparing apples to apples.

The best way to really know how much a given benefit is worth is to get quotes for how much it would cost to buy the benefit yourself.
 
YOU MUST MUST MUST...have a covered tail.

I am on my SECOND job out of residency and tail coverage is premium.

Set schedules are ideal and are certainly preferable to the month to month "all over the place" schedule.

Do not sign for a sign on bonus with a clause stating "pro rated payback for X number of years of service"

No buy in for partnership is ideal.

Profit sharing.

An understanding of your payor mix.

THE PHYSICIAN MUST UNDERSTAND CODING. Those who code do not necessarily understand medical complexity...you do. If you want to bill for Critical Care, you better know what and how to document.
 
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They're right. Tail is absolutely essential. Happy docs and tail.
 
beyond all hope said:
They're right. Tail is absolutely essential. Happy docs and tail.
Click to expand...

Absolutely. I think gettin' tail would increase the desirability of any job. Of course, tail and strippers would be the best😀 Would this be something I could negotiate into a contract?
 
I stand by my assertion that tail coverage is desirable but not an absolute pass/no pass on a job. It's a money issue. For example:
If a tail after 5 years would cost you $50K and the job offers to pay you $15K more a year than the other job ($15K so your net would be ~$10K) then aren't you in the same place after 5 years?

Some people might consider a tail provided by the job to be mandatory (I wanted one because I hate shopping for insurance in the retail market) but others might not.

A few other things to think of: If a job isn't offering a tail you might want to find out why? Does the group have such a bad med mal record that they can't get tails?

You should also be careful about signing on with a group that will buy your tail but only after some time period like 5 years. Some unethical groups lure people in (this is similar to the "partnership track" bait and switch) then get rid of them at 4.75 years and then they don't have to pay anything. Tail coverage is cheaper for fewer years so they really ought to cover you from the start.
 
Here's another two (somewhat mentioned before):

1) How shifts are schdeuled (day/eveing, # hrs): By senoirity or equally?
2) Biling/coding: handled by hospital vs. physician group vs. salaried?
 
If you are more than single covered, find out how the patients are distributed. For example, in the "honors system", it is up to everyone to pick up charts on their own. There really is no good to this system, and promotes cherry picking and laziness amongst the more senior partners while you are getting spanked...

I personally like having the charge nurse assigning patients in a round robin style. So for example, you will get every 3rd patient if you are triple covered...Having the patients assigned in a fair manner eliminates the cherry picking.....

Not a deal breaker, but you sure will stew as you are working your ass off and your co-worker is taking their sweet ass time sewing a simple lac, disappearing for a while, etc....

As far a tail, with my job, I have to pay malpractice and tail...Luckily relatively inexpensive in CA. Our insurance company waives tail at 55yo or 15yrs with them....I don't mind paying this since I am FFS and getting all my collections minus minimal group overhead costs.....

A cheaper alternative to tail is if you switch jobs and insurance companies, get a nose coverage policy. It is cheaper than tail, but essentially the same coverage with your new malpractice carrier.

Other things that are important is the ability to get scans at night, and get them read....We have Night Shift radiologists, so this is very convenient...

Other small perks, such as free or discounted food at the cafeteria, preferential parking area, a doctors area to do charting, plenty of computers (we have Ibex e-charts, so need lots of computers), and the ability to access the computer charts from home. This is priceless, saving me time from being at the hospital when doing my charting....
 
Here are a couple of things that would make things great:

Rapid IM and OB follow-up for uninsured patients/those without reliable PCP
Clinical care coordinator who helps people without insurance/money find a PCP for future follow-up and care
MRI which isn't difficult to get
CT-angio (and someone to read it) for low risk chest pain patients (triple rule out)

Those would be on my wish list but not deal breakers. Will probably have to live without all of the above once I move on.
 
New EM PGY-1 here....

forgive my ignorance, but what exactly is tail and nose coverage. I know it has to do with malpractice coverage, but I'm still not 100% clear what you guys are talking about.

Thanks.
 
Mighty Mouse said:
New EM PGY-1 here....

forgive my ignorance, but what exactly is tail and nose coverage. I know it has to do with malpractice coverage, but I'm still not 100% clear what you guys are talking about.

Thanks.
Click to expand...
There are two types of malpractice insurance coverage. The difference is one covers you for the stuff that happened while you were covered, even if the lawsuit doesn't get filed 'til years later, and the other doesn't. "Occurance" coverage covers you forever (or at least until the end of the statute of limitations) for anything that happened while you were working under the policy. It's what you'd like to have but it's very expensive and tough to get these days. "Claims made" is the name for the other type of policy. It covers you for any claims made against you during the policy. It's the most common type of policy now. The problem is obviously that if you change jobs and med mal policies you can get sued for a case you saw under the old policy and you won't be covered. To address this problem (and make money doing it) the insurance companies offer "tail" coverage. A "tail" policy will cover you for any lawsuits that might be filed against you that would otherwise be uncovered because you were under a claims made policy. A "nose" policy is the same thing except that you are buying it from whoever you are paying for your new policy so you should get a better deal. "Nose" is just a fancy way of saying you're buying your tail and your new insurance together.
 
How long do people typically carry malpractice insurance following retirement? I suppose it would be cheaper since you are just getting tail coverage, but would also be an irritation.
 
thank you very much for your explanation.
 
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Dakota said:
How long do people typically carry malpractice insurance following retirement? I suppose it would be cheaper since you are just getting tail coverage, but would also be an irritation.
Click to expand...
Generally when you buy a tail you are spending a set amount to cover you for what you did under a certain policy. I don't think they're really set up to be paid anually until you think the risk is gone. I could be wrong.
 
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