Selecting Your Employer
Finding the "Least-Threatening" Institution

Are you a "match" for your employer? There's more than pay involved. Far more

In the next few years, as Obamacare gets further entrenched, and with developments conditioned by MACRA and other threats to private practice, physicians will be considering applying for employment at a hospital or clinic. You might be one of those. Finding your next employer is the most important decision you made since you entered medical school, because selecting the wrong one may quite likely end your career as a doctor.

There are a number of factors that enter this decision, the most important one is finding the employer who is LEAST likely to throw you under the bus in an adverse situation they either manufacture or one that comes from the "outside." All potential employers will throw you away if necessary. That's a given. But some, for example those specialties that have a geographical mal-distribution, will be more "protected" than others. One key is to find a geography where you are valued. But before you consider that, you must also consider the application process itself and look for danger signals. Here are a few:

• An extremely involved or onerous proctoring system for surgeons to qualify past probation
  
  One OB, who had both a residency in OB and fellowships in fertility medicine was held to 75 proctored deliveries! This doctor chose to practice in Dallas, which has an over-abundance of physicians in her specialty. If you join the OB staff in this hospital, you are not really wanted. A reasonable question could be asked: "Why did they hire her in the first place? Why didn't she see the danger signals?"
  
  
• Pay that is either too high or too low
  
  If you are in a specialty that is highly desired but the pay is too high, it is unlikely that the institution will be able to continue to support you without your bringing in enormous numbers of patients. This institution will have an "unwritten policy" that you do outreach to bring in patients for them. Unless you are prepared to do this, you will be terminated. Remember, all that is necessary for them to get rid of you is to Data Bank you. Data Banking is the "easiest" way for any employer to be rid of you. Any "cause" can be trumped up against you. You have no Constitutional rights.
  
  
• A history of frequent problems and "discharges" of other physicians
  
  Some hospitals and institutions have a revolving door. If they lose many physicians year after year, you have to think that there are "reasons" for this. Why do you believe you will be any different from them?
  
  
• How many of their employed physicians have they Data Banked?
  
  It is very difficult to find out how many physicians the institution you want to work at got Data Banked? But one orthopod found out too late that data banking was very common in his hospital. A danger sign of this is finding out that many surgeons at the hospital lost their malpractice insurance. One of the chief reasons why physicians lose their liability insurance is from being Data Banked.
  
  
• Are there existing lawsuits against the employer by their employees?
  
  If ancillary employees are constantly suing their employer, you might think that the institution is "trying" to maintain quality. But a more likely explanation is that they tolerate intra-employee abuse or they do not have an adequate educational program for their employees. You may end up in the middle of this and be totally blindsided when your employer demands you testify against an ancillary employee.
  
  
• Are you the ONLY specialty person they have in your specialty?
  
  If you are the only employee in your specialty covering your employer's institution, you will have to "cover" every exigency and emergency yourself. This means no time off and the responsibility to take-on borderline cases because you have nobody else to refer to. This situation does not occur in large hospitals, but rural institutions in disadvantaged, poor communities face this because few physicians want to practice there.
  
  
• Are there Government actions against your employer?
  
  Any employer which is facing Government actions against them may put YOU in the middle of defending them, as a condition of your employment. You need to know if Government actions have occurred against them in the past, and their nature. (Temporary) loss of accreditation is at the top of this list of concerns. There are often explanations for this, but in many cases this is caused by poor management. YOUR own professional status can become "infected" by this process. 
  
  
• Are there any whistle blowers who have been terminated?
  
  If you ask whistle-blowers if "it was worth it" the majority will say it was not, even if they obtained a large settlement from the process. This is because there is an enormous personal price to pay for making the decision to become one. Most whistle-blowers have to face a very long period of time before their case becomes "resolved." Sometimes it is five or more years as it winds its way through the courts. This will utterly consume their lives. Most of the time there are good reasons for the whistle-blower to make that choice. You may be called upon by your employer to testify against them, even if you believe they were right.
  
  
• Have any physicians under their employ in the past committed suicide?
  
  Data-banking and sham-peer review are USED as a tool by employers and hospitals to assist in their terminating physician employees. This has two benefits to them:
  
  
  • You will have less likelihood of success in a lawsuit against them.
  • You will become deeply involved in finding a way to keep practicing as a physician. As your income declines, you will not be able to finance a lawsuit against them.
     
    Many employers will NOT hire a Data Banked physician. Licensing of DB'd physicians is still possible, but it is not easy and often requires a personal appearance before a licensing board to "explain." Data-Banking is an issue that requires many pages to discuss. Suffice to say that hospitals and institutions are NOW using this as a weapon against you, even if completely unwarranted. Government is complicit in this and protects them.
    Remember, if the hospital uses Data Banking as an employer's policy, why do YOU think you are any different from the others?
    
  
  
• Will you be called upon to testify against other physicians who have been terminated?
  
  In the defense of a surgeon who was called to a military tribunal over his surgical history, several other employees testified against him. Even worse, those employees were "charged" with the obligation of finding "fault" with his operative choices and chart notes. The case was originally brought against him by a nurse-director of quality assurance. She was not a physician; nor did she ever observe his surgery techniques!
  His surgical privileges were (temporarily) denied and he left immediately. But this tribunal action followed him for 5 years after he left associated military employ. He was called upon to explain it in front of his licensing board. Fortunately he prevailed. But it was by no means a certain result...

  Over-all, it cost him nearly 100k to repair.

Summary:

If you believe that your "problems" associated with your now private practice will "end" when you become employed, think again. Your selection of your employer is the most important decision you can make and requires enormous investigative efforts. The resources of your employer dwarf yours. Yet, you need to learn about them in detail.

Ultra-high risk employers:

1. Large corporate chains that are out-site operated
2. Facilities that offer critical care as an advertised specialty
3. Any facility that offers "income guarantee or low interest personal loans"
4. Any facility that refuses to permit residents or interns
5. Native American healthcare clinics and hospitals hire "under-probation." They will just Data Bank anyone they want to get rid of.
6. If you get hired by a group practice, who is "fronting the funds?" If the hospital is fronting the money, they have a much greater likelihood of Data Banking you as a "tactic."
   

Some years ago, physicians wanted to find access to information about hospitals who Data Banked physicians at a higher rate, as a registry. So far this has not been enacted. The contract you obtain from your new employer is nebulous and means virtually nothing, because if you sue them, you will find it almost impossible to obtain another hospital position.

Authors: Michael M. Rosenblatt, DPM

Richard Willner, DPM, Center for Peer Review Justice

(Disclaimer: Neither of the authors of this article are lawyers. This article is not intended for legal advice. If you have a legal question, you are strongly advised to hire a licensed attorney in the locality where you live or intend to practice.)

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