Malpractice Insurance and Tail Coverage

[air bud]

Since more and more people around here are switching jobs, I thought this thread might be helpful. I know tail coverage is dependent on the state you practice in as well as how long you have been out. Does anyone have any experience with stand alone tail coverage? From what I have read they can be cheaper than getting from current provider, but carry other legal risks? I am currently awaiting a quote from my carrier.....more than a little nervous. Unfortunately my current job does not provide tail. My new job does not provide nose, they do provide tail. I tried to negotiate them paying the tail but they said your very nice signing bonus is more than enough o to cover it. So anyone want to guess what it will be for a pod 1.5 years out? I have been told 10k is average malpractice a year for pods? Also, I did talk with a insurance company who said up to 5 years increases from low to higher then plateaus at 5 and considered mature? Somebody tell me I am not going to have to pay 10k for a tail policy....
That is like .7 of a Bitcoin.....annnnnnnnnnnnd it's gone - ok that like 7000 bitcoin

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[NatCh]

Ouch. I left my first practice after a couple of years and had to pay tail on my own. It was through OUM at the time. Not fun. Which insurance company are you using?

 

[air bud]

Ouch. I left my first practice after a couple of years and had to pay tail on my own. It was through OUM at the time. Not fun. Which insurance company are you using?

Well I am more optimistic this morning. I was doing some more research into my policy which is by Medical Protective company (I guess one of the big ones). Apparently my state has a fund that helps over insure all providers in the state including MD DO dentist, DC nurse anesthesia pods etc. As far as I can tell, it provides tail coverage if you leave the state and/or stop practicing. I will get more info when I actually tell my employer I am leaving and can ask questions, but right now I have coverage through MedPro for 200,000/600,000. The state fund provides additional coverage of 800k/2,400k. Obviously I will talk to a lawyer familiar with medical insurance in my state, but I am pretty excited. Just means I can lose more money on Bitcoin

 

[dtrack22]

Tail coverage is usually at or slightly above 100% of one year's premium, paid up front and in full. I would be surprised if it is $10k. Your yearly malpractice premium shouldn't be that much in year 2.

Ankle Breaker can probably loan you some BTC to pay for your tail since he's on his way to lamboland too...

 

[ExperiencedDPM]

Depending on the state and insurer, tail coverage can be up to 2.5 x your premium, which is based often on the highest premium in the previous 5 years.

We’ve had associates who owed over $20,000. We paid the tail and deducted it from the paycheck for the first year.

If you can and it’s available, I would highly recommend occurrence policies vs claims made. Some claims made companies will provide free tail coverage if you were with the company more than 5 years AND you retire.

I know all the pros and cons of both types and I have always only had occurrence. When you retire or change jobs, etc., you are covered forever.

And unfortunately, many of you are changing jobs.

 

[air bud]

Basics of Patient Compensation Funds By State

This is really interesting. There are many states that's have these PCFs that essentially end up as a provider funded umbrella policy for everyone esle. States differ, but it seems to me that it acts as a community funded tail policy. If you live in one of these states, you may be in luck.

I am hoping to have my situation resolved soon. Hoping it's in my favor due to some very very lucky timing and circumstances.

 

[ldsrmdude]

FWIW, I think my tail coverage was about $6500, having been in practice for just less than 2 years when I switched. Sounds like a similar situation to your original post, I paid it with bonus money.

 

[ExperiencedDPM]

Hmmm. Ankle Breaker leaving his position, Airbud leaving and Jewonthis leaving.

It would be great for the younger docs on here to have a quick synopsis from each of you relating your top 5 or so reasons for leaving your current position. This can be a great learning experience.

 

[air bud]

1. Ortho
2. My state's laws
3. Ortho
4. People in my group used to the my state's laws who refer stuff to ortho.
5. Guess?

 

[ExperiencedDPM]

1. Ortho
2. My state's laws
3. Ortho
4. People in my group used to the my state's laws who refer stuff to ortho.
5. Guess?

Thanks. Hope all goes well at your new position.

 

[dtrack22]

I'm leaving because I am not fairly compensated for the work I do at this Podiatrist's office. No ortho issues or state scope issues. It's all about the benjamins

 

[bunNfxr]

1. Ortho
2. My state's laws
3. Ortho
4. People in my group used to the my state's laws who refer stuff to ortho.
5. Guess?

What is the issue with ortho?

 

[NatCh]

Corollary question: Was anybody satisfied with his or her first practice situation out of training?

I'm in my third practice.

 

[air bud]

Corollary question: Was anybody satisfied with his or her first practice situation out of training?

I'm in my third practice.

Great point. I think the average time of stay at first place is 2.75 years (all doctor's). Great reminder to live like a resident for 3 to 5 years, you never know how things are going to work out. I wanted to rent but not a lot of options in my city. So I bought and 80k house. I put it on the market yesterday and is gone in 24 hours. A 300k house would be there for months

 

[NatCh]

Great point. I think the average time of stay at first place is 2.75 years (all doctor's). Great reminder to live like a resident for 3 to 5 years, you never know how things are going to work out. I wanted to rent but not a lot of options in my city. So I bought and 80k house. I put it on the market yesterday and is gone in 24 hours. A 300k house would be there for months

Most DPMs that I know aren't in their first practice. My first gig was two years but I knew that was going to be short term as my wife and I had plans to move away. My second practice, where I was an Associate, lasted about 3 years until I couldn't take it any more. One of my bosses was very condescending and treated me like an apprentice, ranking just below the Receptionist on the totem pole. One of the weird things he wanted me to do was to deliver foot-shaped cookies to referral sources every Christmas while dressed like Santa. F that!!! I'm not even Christian. I'd save a few boxes of those stupid (but tasty) cookies for myself then dump the rest in a trashcan.

I really think that what will make people happy in their occupation is not simply making a lot of money (because there never seems to be quite enough and someone else always makes more) but to do something that feels meaningful and to feel like you have some control over your own destiny.

 

[ExperiencedDPM]

Most DPMs that I know aren't in their first practice. My first gig was two years but I knew that was going to be short term as my wife and I had plans to move away. My second practice, where I was an Associate, lasted about 3 years until I couldn't take it any more. One of my bosses was very condescending and treated me like an apprentice, ranking just below the Receptionist on the totem pole. One of the weird things he wanted me to do was to deliver foot-shaped cookies to referral sources every Christmas while dressed like Santa. F that!!! I'm not even Christian. I'd save a few boxes of those stupid (but tasty) cookies for myself then dump the rest in a trashcan.

I really think that what will make people happy in their occupation is not simply making a lot of money (because there never seems to be quite enough and someone else always makes more) but to do something that feels meaningful and to feel like you have some control over your own destiny.

Delivering foot shaped cookies? Just be happy your boss wasn’t a urologist.

 

[NatCh]

Delivering foot shaped cookies? Just be happy your boss wasn’t a urologist.

Ha!!!

Harry Balszac, MD

 

[air bud]

Delivering foot shaped cookies? Just be happy your boss wasn’t a urologist.

ExperienceDPM wins the internet today

 

[hypermobility]

My first gig lasted 2.5 years as an associate. I was tired of driving all the time to various clinics which was not presented to me before I started (was told I would be at one location), only getting the new patients the practice owner didn't want, questionable billing and coding practices, and having to sell foot pads/scrubs/exfollients to EVERYONE. I needed a job out of residency and obtained that, but then also bounced out of there as fast as I contractually could.

My best advice to anyone looking to become an associate: SHORT CONTRACT LENGTH. It may sound enticing to have a contract for years for stability, but if it goes south, those years seem like forever.

 

[ExperiencedDPM]

Ha!!!

Harry Balszac, MD

Now you’re learning grasshopper.

Hugh G. Rection, MD
Urology

 

[NatCh]

My first gig lasted 2.5 years as an associate. I was tired of driving all the time to various clinics which was not presented to me before I started (was told I would be at one location), only getting the new patients the practice owner didn't want, questionable billing and coding practices, and having to sell foot pads/scrubs/exfollients to EVERYONE. I needed a job out of residency and obtained that, but then also bounced out of there as fast as I contractually could.

My best advice to anyone looking to become an associate: SHORT CONTRACT LENGTH. It may sound enticing to have a contract for years for stability, but if it goes south, those years seem like forever.

Look at your avatar! Oh my God.

Now you’re learning grasshopper.

I'm learning from the best.

 

[Creflo]

Natch I was OK with delivering foot cookies, I can deal with that, but dressed in a Santa Suit, that's the all time funniest thing I've ever read on SDN. Grand prize.

After my military time I interviewed with several different podiatrists in my town, and it seems like all of them had bad blood for others in town that they used to work for and got screwed over by.

I'm curious what's the deal in Connecticut, how can being in a certain state make things worse for pods?

 

[Creflo]

Hmmm. Ankle Breaker leaving his position, Airbud leaving and Jewonthis leaving.

It would be great for the younger docs on here to have a quick synopsis from each of you relating your top 5 or so reasons for leaving your current position. This can be a great learning experience.

I knew going in that at my first job out of residency I'd probably end up being somebody's bit.. So I figured why not be the military's bit.. and let it help pay for school. It was an excellent gig and I'm proud for the opportunity, but now I'm not as desperate when finding work than I would have been fresh out of residency. I feel for the guys right out of residency with hundreds of thousands of debt, it puts you in a poor bargaining position so its not surprising to me that so many are treated like crap.

 

[NatCh]

Natch I was OK with delivering foot cookies, I can deal with that, but dressed in a Santa Suit, that's the all time funniest thing I've ever read on SDN. Grand prize.

Ho ho ho? How about ho ho NO!?!?

 

[dtrack22]

My best advice to anyone looking to become an associate: SHORT CONTRACT LENGTH. It may sound enticing to have a contract for years for stability, but if it goes south, those years seem like forever.

This is something I think should be discussed more...mostly because I have some questions.

Does anyone actually have a contract with a podiatrist that has any repercussions for just quitting outside of the non compete? I’ve only read through the 6-7 podiatry group contracts that I’ve been offered at some point and none of them have any power to do anything if you just say “hey, I’m not working for you anymore” outside of not being able to work within a 5-15 mile radius of the clinic(s). And even then, the non compete is going to be in effect wether you finish out the contract or leave early, so I’m not sure why non compete is even an incentive to finish out a contract.

Hospital and MSG will will make you repay signing bonus $ so I get not wanting to break those ones. But if you are working for a podiatrist what in the contract is keeping you there?

 

[hypermobility]

This is something I think should be discussed more...mostly because I have some questions.

Does anyone actually have a contract with a podiatrist that has any repercussions for just quitting outside of the non compete? I’ve only read through the 6-7 podiatry group contracts that I’ve been offered at some point and none of them have any power to do anything if you just say “hey, I’m not working for you anymore” outside of not being able to work within a 5-15 mile radius of the clinic(s). And even then, the non compete is going to be in effect wether you finish out the contract or leave early, so I’m not sure why non compete is even an incentive to finish out a contract.

Hospital and MSG will will make you repay signing bonus $ so I get not wanting to break those ones. But if you are working for a podiatrist what in the contract is keeping you there?

quite a few associate type contracts have a "recovery of start-up expenses" clause, generally with a set amount of $, if the associate bails on the contract earlier than a defined period of time. This clause is typically enforceable, obviously dependent on which state the contract is executed.

 

[NatCh]

My previous Associate contract had a covenant not to compete that I had amended to state that it would be effective only if my employment were terminated with cause, since I pictured them hiring me, receiving my signed contract, then immediately turning around to terminate my employment effectively preventing me from coming to their town at all. It would've been a shady move on their part but I was living in AZ at the time where a lot of the DPMs I'd met were total shysters. That practice terminated my employment without cause, therefore my non-compete did not apply. I did not have any monetary penalties. All they wanted was their Santa costume back.

 

[Creflo]

All they wanted was their Santa costume back.

Second funniest post on sdn, this is killing me...

 

[air bud]

Well my saga has come to an end. As I had hoped, my states patient compensation fund provides tail coverage to me at no cost. There was a legal loophole in my contract that I could have exploited (with expensive legal representation) that would have made my employer have to pay it since technically the cancelled my contract (while expecting me to resign a new stockholder contract). This same loophole is now making them not able to dock my pay these next few months since I will be less busy. If I had terminated the contract they could have. Here is the words from the website for my state fund. Of note, if I were to maintain my current state license I would not be eligible. Each state that has a PCF is different.


"On and after July 1, 2014 health care providers who become inactive (i.e. discontinue their [MY STATE] practice, inactivate their active [MY STATE] license, and cancel their primary professional liability insurance coverage) are eligible for continued Fund coverage without any additional payment. This is similar to an extended reporting endorsement issued by a commercial insurer, but the coverage is statutory. There is no policy issued nor is there a premium payment required. "

 

[ExperiencedDPM]

Well my saga has come to an end. As I had hoped, my states patient compensation fund provides tail coverage to me at no cost. There was a legal loophole in my contract that I could have exploited (with expensive legal representation) that would have made my employer have to pay it since technically the cancelled my contract (while expecting me to resign a new stockholder contract). This same loophole is now making them not able to dock my pay these next few months since I will be less busy. If I had terminated the contract they could have. Here is the words from the website for my state fund. Of note, if I were to maintain my current state license I would not be eligible. Each state that has a PCF is different.


"On and after July 1, 2014 health care providers who become inactive (i.e. discontinue their [MY STATE] practice, inactivate their active [MY STATE] license, and cancel their primary professional liability insurance coverage) are eligible for continued Fund coverage without any additional payment. This is similar to an extended reporting endorsement issued by a commercial insurer, but the coverage is statutory. There is no policy issued nor is there a premium payment required. "

Interesting. Never knew this existed. Fortunately I’ve always carried occurrence polices, but it’s great information.

 

[ldsrmdude]

This is something I think should be discussed more...mostly because I have some questions.

Does anyone actually have a contract with a podiatrist that has any repercussions for just quitting outside of the non compete? I’ve only read through the 6-7 podiatry group contracts that I’ve been offered at some point and none of them have any power to do anything if you just say “hey, I’m not working for you anymore” outside of not being able to work within a 5-15 mile radius of the clinic(s). And even then, the non compete is going to be in effect wether you finish out the contract or leave early, so I’m not sure why non compete is even an incentive to finish out a contract.

Hospital and MSG will will make you repay signing bonus $ so I get not wanting to break those ones. But if you are working for a podiatrist what in the contract is keeping you there?

My initial private practice contract had a "recovery of start-up expenses" clause as well. Plus I had a sign-on bonus that was paid through one of the hospitals I work for that I would have had to pay back (pro-rated) part of the bonus if I left before 2 years.

When it comes to contract length, it doesn't just matter how long the actual contract is for, it's also about how much notice either party has to give in order to get out of the contract. For example, in my current contract, even though it's a multi-year contract, either party could end the contract with something like 3 months notice, without cause.

 

[air bud]

My initial private practice contract had a "recovery of start-up expenses" clause as well. Plus I had a sign-on bonus that was paid through one of the hospitals I work for that I would have had to pay back (pro-rated) part of the bonus if I left before 2 years.

When it comes to contract length, it doesn't just matter how long the actual contract is for, it's also about how much notice either party has to give in order to get out of the contract. For example, in my current contract, even though it's a multi-year contract, either party could end the contract with something like 3 months notice, without cause.

My current contract is 90 days. Since it included signing bonus it would have been prorated but I am completing contract. If I stayed here as stockholder is still was technically a 90 day contract, I could exit without cause with 90 days notice and no repercussions. My new employer is also 90 days. It is a series of 2 year contracts with a sunset clause. I think 90 days is pretty standard in any group (non pod) setting. Moral here is he pods are petty bi***es when it comes to co tracts?

 

[ldsrmdude]

Moral here is he pods are petty bi***es when it comes to co tracts?

Speaking solely from my n=1 experience, yes. The pod contract was light years away from the hospital contract, and not in a good way.

 

[dtrack22]

"recovery of start-up expenses" clause

Was this some pro-rated amount (like early termination fees from cable/internet providers)? Or just some flat amount that didn't change from day 1 to day 364?

Also curious to those that have contracts stating you need to give notice prior to termination, was there specific wording as to additional penalty if you did not provide said notice? Again, my sample size is small enough that I haven't seen a contract that had a recovery of expenses clause, but I know going over a couple contracts with my attorney revealed that without specific mention of penalty the 60 day or 90 day notice of termination on the employees end is meaningless.

 

[ldsrmdude]

Was this some pro-rated amount (like early termination fees from cable/internet providers)? Or just some flat amount that didn't change from day 1 to day 364?

Also curious to those that have contracts stating you need to give notice prior to termination, was there specific wording as to additional penalty if you did not provide said notice? Again, my sample size is small enough that I haven't seen a contract that had a recovery of expenses clause, but I know going over a couple contracts with my attorney revealed that without specific mention of penalty the 60 day or 90 day notice of termination on the employees end is meaningless.

I don't have my old contract in front of me right now, but I don't think it was pro-rated based on time but might have been pro-rated based on my earnings for the practice. I just looked at my current contract with the hospital, and there are no specific penalties associated with not fulfilling the 120 day obligation (I was wrong when I said 3 months earlier).