1) Apply and obtain a full unrestricted license as soon as possible within in your state. Some require only 1 year, others 2 years, and lesser so 3 years of post graduate training. Some states have differences for US grads compared to IMG.
2) Apply to get your own DEA
3) Complete your CME for suboxone, and submit that to thru SAMHSA, to get your x-number. Read those forms carefully and make sure none of the boxes are checked that list your address or put you on the database. You can always update that in years to come. Doing it now, makes you run down the clock for 1 year duration to be able to apply for the upgrade to 100 patient limit.
4) You shouldn't need to do insurance credentialing, that should be handled by the hospital (i.e. medical group affiliated with the hospital group) handing you forms and various things to sign and complete. Anticipate that most jobs will sign you up for medicaid and medicare. Be aware of this once done with residency, especially for those people who are planning on the cash only career trajectory. You will then need to Opt Out of medicare and make sure you close down your medicaid status. But doing so can have ramifications (that's worthy of its own thread topic).
5) If moonlighting at a hospital you will be provided a hospital privileges application. Get used to these forms, probably won't be the last time you see one... Now the good news is there is a repository agency called CAQH. Go to this
website and get registered. Keep the login info and your password. You can dump all your usual factoid information into it. Then once done with residency you'll update it accordingly and it can expedite your applications for hospital privileges and some insurance paneling. But don't surprised if each of those entities still make you repeat it all ... insert expletive here. You can let the hospital credentialing specialist know, "hey, I'm already active on CAQH and here's my ID number."
6) be careful about the places that offer liability insurance. You better make sure it is an
occurence based insurance, not a
claims made. Google these and read up about them. You need to know the differences between these insurances. You may find a job prospect has a claims made coverage, but once you leave you'll need to buy a tail coverage and that cost could negate all the money you just earned... Now some hospitals will be self insurance. Which basically means they've dumped a bunch of their own money into their own bucket and that supplies their liability coverage. They can be shady with this, and have the policy facesheet (sometimes called Certificate of Insurability- COI) as claims made but they tell you verbally its occurence based. You need to get that in writing from the corporate lawyer, or underwriter that it is indeed an occurence based coverage or some other language that you have tail coverage with their self insurance even after you leave. Some of these employers can be sneaking - I had one employer say that if you leave before 3 years you have to buy the tail insurance, but if you stay with them for 3 or more years then you've got the tail coverage.
7) Every single year you need to get a copy of the COI and you keep filed away. I suggest you get a thumb drive, or hard drive, or some means of saving all this stuff. You will perpetually need to produce historic COI from past employment.
8) If you need to buy your own insurance you can get discounts for part time, early career, possibly resident status, etc. (this is also worthy of its own thread topic)
9) I suggest you don't moonlight unless you can really pack in the hours. Sometimes these extra costs of liability insurance can eat into your earnings, and can't hurt to make a quick spreadsheet and see if the numbers check out. For me, I had doubled and started approaching triple my resident salary back in the day and it was definitely worth it.
10) I suggest avoiding too many gigs. Try to focus on 1 gig that will provide you with the hours. You don't want to get pulled in too many different directions.
11) don't be afraid to go to your PD and have a business plan that involves setting up your own cash practice. Emphasize the learning clinically, and for business. Emphasize you understand any screw ups will mean your head rolls. Alleviate concerns that it will not overlap with your servitude to them during business hours, and only on your off time. If you don't plan to stick around after residency, you'll need to have a younger resident lined up whose willing to declare they'll take over for you once you leave. Think of it like a resident clinic that gets handed down, but autonomous and better money. Luminello can be a great EMR for this type of set up.
12) You will find challenging cases when moonlighting. Don't be afraid to go to an attending for a hypothetical curbside, have the decency to frame it, and keep it as hypothetical with your verbiage. Dr. Z, I have a hypothetical clinical situation I came up with this AM while eating breakfast, Patient Y presents with.... and I would managed with plan Q. What do you think about this hypothetical situation I envisioned during breakfast this morning?
13) when you leave residency and there area you did your training, don't forget to close down your hospital privileges with the medical staff office. Get that letter that states your privileges are closed there, and add to your stack of documents to hang on to. Also talk with the folks in the med staff office, and write down the contact information of how future state medical boards, or future hospitals, or future employers will go about contacting them to get reports on your now historic privileges with them. This will you save you future headaches...
