We are coming closer to the advent of sixty years of the PA and NP professions. Soon there will be six decades of both of these fine clinicians and a history of how they have changed the landscape of healthcare, both in the United States and abroad. We began as a thought and a dream which became a seed, that when buried in the soil of the need for extending healthcare, has grown exponentially and has become a viable answer to the problems of treating the sick and maintaining health to the citizens of our country and the world. Physicians are leaving their profession in droves; specialties that were considered trophies in the past, such as emergency medicine and ob/gyn, are finding empty slots for residencies for physicians. We are steadily prepared by education and training to fill many of these slots. We have an exciting sense of anticipation for the future of our professions. So, why this title for this short missive and just exactly what am I attempting to disclose to my readers?
“Because grandparents are usually free to love, guide and befriend the young without having to take daily responsibility for them, they can often reach out past pride and fear of failure and close the space between generations.” – Jimmy Carter
I think this quote reflects how both I and many of my fellow seasoned colleagues feel. We are not an invisible presence in your lives; we have made the decision to mentor and to make ourselves available to any of our new colleagues as they embark on their careers or are in the first decade of learning and progressing in their chosen craft. We have many experiences to share but high among them is to suggest how legal guidance as you start this journey can benefit you. To this end, I am answering this: how do I find legal counsel and who will help me with contracts, decisions and provide answers to the questions that have already surfaced or those which I may anticipate? So many who are beginning their professional journey are delighted at that opportunity to join a practice, a team, a physician. But it is at that moment that one is most in need of expert legal advocacy and advice. Both professions are in dire need of this direction and I will attempt to just whet your appetite on this subject.
When I first embarked into private practice, a contract that enumerated my duties, salary, vacation, CME and all of the other things that are necessary for success, did not exist. I was not thinking of malpractice insurance, health insurance, disability insurance; the only tail that I was aware of existed on animals and there was no trail. I was a trailblazer, and the first PA that I knew of who was going to be hired by a surgeon who fortunately had his own dreams of future success and what he required to attain it. I was the commodity, the person, the individual whom he could train and create as a shadow of his image and who would be accepted by his patients and afford him a more leisure lifestyle. He and I received the first national award, the Paragon Award, for the Physician PA team. Our relationship existed from 1972 until December of 2019. Not all love stories are like this and believe me, at times it was not a love story, but a commitment, one which we both held until I decided to retire. But here is an example of the generational gap: you need a contract.
A contract should express your desires for practice, lifestyle and security. There are many dimensions to making a contract, but first among them is self-examination and the consideration of personal goals such as location and the ability to change employers without legal implications. One should consider their ability to easily transfer to another location or another state because of the relocation of their significant other or their spouse. Last but not least, you need to ask yourself if you can balance your schedule to allow for personal time, vacation, family responsibilities, spiritual commitments, continued medical education, and the ability to choose just exactly how much call you will be required to take during your week or month. If you are the inquisitive type of individual, you may desire to research your potential employer, their Healthgrades, their reputation in the patient and medical community. and their prior history of working with a PA or NP.
You are now going to consider getting legal counsel, but you are searching for more than a JD degree. It is a wise decision to evaluate your choice on the experience that this person has both in the present and the past in working for a NP or PA. Just as we have specialties and sub-specialties, the same exist in the legal world. You will require a healthcare attorney who has experience in working with physicians and hospitals and medical centers, who knows the bylaws of both, and the limitations for practicing at the top of your license. It is imperative to make your decision based on their contract experience and how they can or are willing to negotiate the best situation, for you, the client. Making your decision based on these considerations is no less important than choosing your partner, purchasing your house, your car or deciding in what country you want to practice. This is your opportunity to be the driving force of this relationship and to be sure that your choice is not overly aggressive or is lacking the ability to trade places. There must be mutual empathy, the ability to place yourself in another person’s shoes. Henry Ford commented, “If there is any success in life, it lies in the ability to put yourself in the other person’s place and to see things from their point of view-as well as your own.” Lastly, before contacting the attorney, is a very basic yet important question, what is the cost to hire this person and will there be subsequent charges for their services regarding your contract?
It is generally a known fact, that people have a tendency to exaggerate their skills or experiences. I have seen this with physicians and surgeons who have exaggerated the number of interventions or surgical cases they have performed. I have seen this when I employed PAs and discovered in an hour interview that many exaggerated their experience or skills. In surgery, you can talk the talk, but I can observe a person on their first case and quickly ascertain if they have embellished their history and experience. This can also be true of an attorney that you wish to utilize to jump start your practice. Does that attorney both draft and renew contracts? How many contracts does he present to a professional on a monthly and annual basis? Can this fact be verified? Ask for a list of referrals. Is there a website for their practice?
An important fact will be to discover by your personal communication, how quickly will this potential employee respond to phone calls? How long will it take to complete the contact and negotiations? Last but not least will be suggestions on salary, benefits and malpractice insurance. It is an accomplishment to obtain a good fit in your first employment but, more important than securing employment, is to know that someone is looking out for your long term goals, which are to enjoy your practice, develop new skills, have mentoring on evaluating your patients, and a concern for your legal safety. Most employers will offer malpractice insurance, but this is an apple to pears consideration. Is that insurance comprehensive? Does it require you to have a tail and, if so, who pays for this? Occurrence policies are the royalty of malpractice policies and there are no limitations as to their time enforcement. Occurrence policies are also more expensive which is why you require an upfront understanding of what legal protection you will be offered or can request. If there is to be no communication of the type of insurance you will be offered, you can ask if it is possible to purchase a personal liability policy and discover if they will pay at least fifty percent of this policy. Only you can control your future and this is the time to be in the driver’s seat. Some state that you should not put all your eggs in one basket, yet there exists another philosophy that is usually forgotten but is imperative for success. “Concentrate: put all your eggs in one basket, and watch that basket.” – Andrew Carnegie
Ultimately, you need to envision what you are seeking; you need to be able to see it in your sleep and in your waking hours; you need to believe in your vision and then, like a parachutist, jump through the door and trust your preparation and your equipment.
Written For CM&F By: Robert M. Blumm, PA, DFAAPA, PA-C Emeritus
CM&F Clinical Advisor