HCA Resident Stipend

[AFugaxx]

I'm a rising R2 and just heard about a monthly stipend (~$2000) that is offered by HCA (the company has hospitals in 20 states). It requires that for 2 years after graduation you be on staff at a HCA hospital (meaning you admit your patients there but you don't have to be a hospitalist). It's really tempting but the concerns I have are as follows:
1) What if I decide to do something else when I'm done? I could be careful and not use most of the money and invest it in high-yield accounts/CDs/etc but I would still have to pay taxes on it.
2) Is working for a for-profit hospital in line with my vision of caring for the underserved? I have only limited experience with non-profit hospitals so it's difficult to know if there is a significant difference. However our residents do admit for attendings whose patients are primarily medicare/medicaid.

Any input would be appreciated as I'm trying to make a decision on this soon...

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[lowbudget]

Blood money.

They pay you $2k in exchange for your admissions? Come on. You need to ask more questions. Does not pass the smell test.

 

[JackADeli]

Blood money.

They pay you $2k in exchange for your admissions? Come on. You need to ask more questions. Does not pass the smell test.

Actually, paying a stipend is not unheard of or inherantly unethical. Plenty of hospitals and even private groups will do it in an effort to secure well trained physicians.... especially in areas that lack providers. Many HCA hospitals do not want to employ physicians but do want to populate their community with enough providers. Consider that the military pays stipends and demands more then you practice within their community.

No, it is not for your admissions. I believe that would be a Stark law violation. You need to maintain good staff privileges with their hospital/hospital system. It does not preclude you from admitting to other local hospitals. Keep in mind, they can pay you a stipend while in residency or pay for bonuses and start up costs after you graduate. Neither obligate you to exclusively admit to their hospital. If you feel dirty and bribed/coerced to admit based on your stipend, you should feel the same way if you accept a hospital bonus and/or practice start-up funding.

From an ethics standpoint, you would be enterring a contract. This is a longterm decision. If one chooses to make this agreement it should be with that understanding. Read the contract and understand the terms. You should not be making this decision with plans on how to renege on the deal. These hospitals and practices are trying to set up longterm strategic plans to provide care to a community. Again, it is akin to the military paying a stipend or medical students (and residents) accepting special financial aid as part of an agreement to practice in a certain field and/or geographic area.

 

[lowbudget]

Are you sure the stipend is not meant to induce/bribe/kickback admissions? How do you know? From the way it's presented by the OP it sure sounds like it. Even if it's intention is not "meant" to the appearance of a conflict is enough to get in trouble.

If I were the OP I'd ask a lot of questions & find out what the invisible strings attached are. This isn't a "signing bonus" or a military stipend.

Put it this way. My hospital does not pay me money to be on staff to do admissions. I had hospital privileges at one hospital that paid me to be on call, yes. On staff, no. There's a thread in the Gen Res forum where a few of the surgeons actually have to pay a fee to be on staff. Why the hell would they pay you just to have privileges? Just sounds too good to be true.

 

[JackADeli]

Are you sure the stipend is not meant to induce/bribe/kickback admissions? How do you know? From the way it's presented by the OP it sure sounds like it. Even if it's intention is not "meant" to the appearance of a conflict is enough to get in trouble...

I have dealt with HCA before. It really is the ~same enticement as if they fronted you starting a practice in the community. You will be required to maintain a practice within that community region and be credentialed "staff". You can do a google search under HCA.
http://www.practicewithus.com/stipend/Resident_Fellowship_Stipend_Flier.pdf
Their stipend program is public information and not particularly ~amazing or too good to be true. Yes, they would love you to refer patients to their hospital for the labs, CT scans, etc... Chances are you will do that if you are in their region and they are close....

If I were the OP I'd ask a lot of questions & find out what the invisible strings attached are. This isn't a "signing bonus" or a military stipend...

I agree.... ALWAYS ask alot of questions. One thing I know from dealing with HCA and other large hospital corporations, they usually even provide an allowance for a contract attorney!

This is very similar to the enticement by signing bonuses and practice start-up, first year funding, etc... with 2-5yr forgiveness periods. Not like the military in the fact that you are fully owned by the military.

...My hospital does not pay me money to be on staff to do admissions. I had hospital privileges at one hospital that paid me to be on call, yes. On staff, no. There's a thread in the Gen Res forum where a few of the surgeons actually have to pay a fee to be on staff. Why the hell would they pay you just to have privileges? Just sounds too good to be true.

They are not going to pay him to be on-staff when he graduates.... unless he is accepting hospital employment. They are paying him a recruitment bonus NOW to practice and be credentialed hospital staff in their catchment area upon graduation . The details and fine points will vary from hospital to hospital. I have not been asked to pay any staff privilege dues.... so, I can not speak to what is done by some hospitals.

 

[EdibleEgg]

I don't know anything about HCA, but I would be careful about this. I don't think there is inherently anything wrong with the offer. They can't require you to admit to a specific hospital. That's definitely a Stark violation. However, do you know you want to work in an area with a HCA hospital nearby? How is this agreement going to affect any future negotiations? 50K doesn't really go very far when you are starting a practice. If you know what you want to do and this can be an add on.... then great. Otherwise, start moonlighting and leave your options open.

 

[lowbudget]

Fair enough. I'm not saying this money (which, btw , is a lot of money... what, 24k per year?) is crooked or whatever. I'm just saying that for residents who don't know what Stark is, now is the time to pay attention & know exactly what this money means & be willing to walk away from it. In the real world, it's every person for themselves so be careful of blood money.

That said, if my memory serves correctly from reading WSJ, HCA isn't exactly the Boy Scout Altar Boy in the hospital business. They've had a long history of fraud & abuse with Medicare with federal agents involvement & FBI raids... I think the largest in history... (advise: Google "HCA fraud"). It's worth it to do your research before you start sleeping with someone just because you're desperate for money.

 

[JackADeli]

...I'm just saying that for residents who don't know what Stark is, now is the time to pay attention & know exactly what this money means & be willing to walk away from it. In the real world, it's every person for themselves so be careful of blood money...

Absolutely recommend ALL physicians become more involved. I would however encourage backing off assertions with loaded terms, i.e. "blood money". By the same token, accepting a $20K signing bonus with a private single/multi-specialty group is also "blood money"! Such a group would absolutely expect you to use their in house facilities, subspecialists, etc...

...It's worth it to do your research before you start sleeping with someone just because you're desperate for money.

Always agree. ALL physicians need to take some accountability and investigate what they are signing onto.

By the way, the stipend program, open and easily viewed by the public has certainly been examined for legality and Stark laws. Especially, if as you say HCA is intensely looked at by federal agencies. I am not saying anyone should accept this offer, I am not saying it is a good or bad offer, I am not saying HCA is the best slice of toast. I am saying, everyone should look at the options out there and not presume a position that somehow all these offers are corrupt and/or illegal. I understand some prefer solo/private practice, etc.... That does not make all corporations/hospitals the enemy. There are good and bad to accepting differing levels of hospital/corporate involvement in your practice. It can be as direct as being employed or as little as subsidizing a private group to higher another physician.

 

[EdibleEgg]

Absolutely recommend ALL physicians become more involved. I would however encourage backing off assertions with loaded terms, i.e. "blood money". By the same token, accepting a $20K signing bonus with a private single/multi-specialty group is also "blood money"! Such a group would absolutely expect you to use their in house facilities, subspecialists, etc...Always agree. ALL physicians need to take some accountability and investigate what they are signing onto.

By the way, the stipend program, open and easily viewed by the public has certainly been examined for legality and Stark laws. Especially, if as you say HCA is intensely looked at by federal agencies. I am not saying anyone should accept this offer, I am not saying it is a good or bad offer, I am not saying HCA is the best slice of toast. I am saying, everyone should look at the options out there and not presume a position that somehow all these offers are corrupt and/or illegal. I understand some prefer solo/private practice, etc.... That does not make all corporations/hospitals the enemy. There are good and bad to accepting differing levels of hospital/corporate involvement in your practice. It can be as direct as being employed or as little as subsidizing a private group to higher another physician.

WOW.... I completely agree. Stipends/bonuses are not inherently evil. Hospital systems make a lot of money from a supportive primary care base. However, you must have an idea of what you are getting into. As an example my partner and I both grew up in the town where we now practice. We were both given the option of a stipend during medical school, she knew she wanted to return and took the stipend. I wasn't so sure and turned it down. However, the hospital also offered an income guarantee when we returned. My negotiated income was more than twice what she was offered, and that difference was much more than the stipend she received. I wish I could say it was more than dumb luck, but I'm now glad I didn't commit to early.

By the way, 50k is a lot of money, it's just not a lot compared to the cost of starting a practice.