Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Join us as we delve into the evolving landscape of physician employment agreements with Dennis Hursh, an attorney. Discover the significance of the new Individual Specialty Residency Program Agreements that compensate physicians for mentoring residents. We explore the potential long-term impacts on medical education, the challenges of implementing these agreements, and their implications for physician morale and job satisfaction. Gain valuable advice on negotiating employment contracts and understand how these changes reflect a broader recognition of physicians’ professionalism and contributions beyond direct patient care.

Dennis Hursh is a veteran attorney with over 40 years of experience in health law. He is founder, Physician Agreements Health Law, which offers a fixed fee review of physician employment agreements to protect physicians in one of the biggest transactions of their careers. He can also be reached on Facebook and LinkedIn.

He discusses the KevinMD article, “The tiniest ray of hope for reasonable physician compensation?”

Our presenting sponsor is Nuance, a Microsoft company.

Do you spend more time on administrative tasks like clinical documentation than you do with patients? You’re not alone. Clinicians report spending up to two hours on administrative tasks for each hour of care provided. Nuance, a Microsoft company, is committed to helping clinicians restore the balance with Dragon Ambient eXperience – or DAX for short. DAX is an AI-powered, voice-enabled solution that helps physicians cut documentation time in half. DAX Copilot combines proven conversational and ambient AI with the most advanced generative AI in a mobile application that integrates directly with your existing workflows. DAX Copilot can be easily enabled within the workflow of the Dragon Medical application to bring the power of ambient technology to more clinicians faster while leveraging the proven and powerful capabilities used by over 550,000 physicians.

Explore DAX Copilot today. Visit https://nuance.com/daxinaction to see a 12-minute DAX Copilot demo. Discover clinical documentation that writes itself and reclaim your work-life balance.

VISIT SPONSOR → https://nuance.com/daxinaction

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://kevinmd.com/cme

I’m partnering with Learner+ to offer clinicians access to an AI-powered reflective portfolio that rewards CME/CE credits from meaningful reflections. Find out more: https://kevinmd.com/learnerplus

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Dennis Hursh. He’s a health law attorney, talks about all things physician contracts, has given so much great advice to our listeners about what to look for when they’re negotiating a physician contract. Most recent KevinMD article is “The tiniest ray of hope for reasonable physician compensation?” Dennis, welcome back to the show.

Dennis Hursh: Oh thanks, it’s good to be here.

Kevin Pho: So your most recent one, like I said, “The tiniest ray of hope for reasonable physician compensation?” What’s this one about?

Dennis Hursh: Well, weirdly, I’ve started to see a few agreements that are titled something like specialty residency supervision agreement. And the bottom line is they’re paying physicians for supervising residents. Which, to me, again, does this change everything? No, it’s not huge. But that’s always been something, it was just part of your job. You know, we pay you a salary, you do lots of things, you chart, you teach residents, you know, maybe you do unlimited call. It’s just one of the things you do. So I was very encouraged to see that somebody’s actually paying for that.

Kevin Pho: So is this a relatively new phenomenon? And if so, what was it like before this for these academic physicians who would have to mentor and supervise medical students and residents?

Dennis Hursh: Well, very significantly, this wasn’t an academic contract, this was a for-profit hospital. So it’s just like it used to be. I was looking back at my blog, and it was, I don’t know, 20, might have been 30 years ago, I did a big blog post, OIG authorizes call pay for physicians. You know, that was a big deal, because you just did that, and we can’t pay you for it because that’s fraud and abuse. Obviously that’s changed over the years. Hopefully this will change too.

You know, it’s always been, you have certain administrative duties. As I said, we expect you to chart, we don’t pay you for it. We expect you to see patients, you know, that’s sort of what you do. And of course you supervise residents that are tagging along with you. Which, if you’re on a salary, is one thing, but physicians that are being paid on production have the same thing too. And you know, your production slows up if you have to stop and say, do you know why I did that, why, you know, and discuss and work with the residents.

So I think it’s great. Again, it’s just something that’s always been part of the job, that a couple institutions are starting to realize should be compensated.

Kevin Pho: So in this particular agreement, the individual specialty residency program agreements, what were some of the responsibilities that were outlined, and how were they compensated?

Dennis Hursh: Well, they were compensated roughly the same as what you would get for a medical directorship. They limited it to eight hours a month, which, you know, again, it’s a drop in the bucket, but again, it’s eight hours that you always used to do uncompensated. And really the only requirement was that you fill out the ACGME forms and you provide documentation. And they didn’t define any documentation, and in my mind documentation could be morning rounds on Monday, you know, hour and a half. I have no reason to believe that they would kick that back as saying that’s inadequate.

Kevin Pho: And when this first came across your desk, what was your initial reaction?

Dennis Hursh: I just looked at it and I thought, wow, what is this? He said, oh, have you seen a lot of these? And the first one, I said, no, I’ve never seen it before in my life.

So I assumed it was going to be something like the administrative director, what’s it, the DIO, I forget what you call it, the person in charge of the residency program for ACGME. But it isn’t. This is a physician, a practicing physician, who is just going to get compensated for supervising residents. No administrative duties in the ACGME program at all.

Kevin Pho: Now, was this in the context of a primary care specialty program, was it a surgical specialty program? What kind of residency program was this?

Dennis Hursh: This was anesthesia, the first one I saw. And again, paid roughly what an anesthesiologist medical director gets on a per hour basis. So in my mind it really is just gravy. I mean, this was, you know, certainly the job he came from, and most positions I see, that’s just part of the job. And as I said, it’s particularly frustrating when you’re getting compensated on wRVUs, that we just pretend that you can be just as efficient, you know, while you’re teaching the next generation.

Kevin Pho: Now, was this a single institution, or do you see this as a trend where more institutions are adopting something like this?

Dennis Hursh: I’ve seen it as a single institution, but I think it has to catch on. I mean, it’s the kind of thing that a physician gets two job offers, he’s certainly going to mention, you know, hey, at the other place they’re paying me to teach residents too. So I think it has to catch on. I really think it is.

And as I said, this isn’t like, oh wow, what a real, you know, pennies from heaven for physicians. It’s a very important job that you’re doing. It’s just you’ve always had to do it for free, and now they’re giving you some money for it. So I think that’s great.

Kevin Pho: Now, is something like this changing the advice you’re giving to, say, academic physicians whose job is also to supervise residents? Do you think that there’s any hope for these academic physicians?

Dennis Hursh: I think there’s hope for everybody. I mean, I’m putting it in every review. Every review I do now is like, I am seeing compensation for teaching residents, you know, roughly this much per hour. So far nobody’s come back and said, yeah, you’re right, I guess we’ll pay you for that. But I do think it’s the kind of thing, as I said, you got two offers, you tell somebody the other guys are paying me for this. I think it has to spread.

Kevin Pho: So let’s take a look at a larger picture for these physicians who are working at centers where they have to supervise residents, or they have a lot of teaching requirements. Now, you said a lot of them are based on productivity. So during the negotiation phase, when they’re talking about contracts and these two responsibilities are in tension, how do you advise physicians to navigate that contract so that the teaching and administrative responsibilities don’t conflict so much with their productivity requirements?

Dennis Hursh: Well, again, I think now we can honestly say people are getting paid for that. It’s just like medical director. You could say, well, you’re a physician, so you treat patients, you know, we’re running the program, you’re going to be in charge of that, you know, you do call, all those things. There was a time when that was just part of the job and no extra pay. And slowly it’s changing. Again, you now see call compensation, it’s pretty standard. You know, you see medical directorship compensation. And hopefully now you’ll start to see residency supervision compensation.

Kevin Pho: You’ve been doing this for a long time. Now in general, how long does it take for something like this, like you said call compensation, how long does that take to become ingrained into a standard contract?

Dennis Hursh: Years and years. The larger centers tend to do it first. I think the first time somebody says I got an offer over here that’s paying for that, you say, you know, the hospital says I never heard of that, forget it. But I think the larger centers that start to hear that a couple of times, it’s going to get in there. And eventually once the larger institutions do it, it filters down to the smaller. But I mean, if in five years it’s common, I think that would be rapid adoption.

Kevin Pho: So we’re speaking in the summer of 2024. Do these physicians looking for teaching positions, do they have the power? Are these academic programs having trouble finding physicians? Because if there’s just so many physicians looking for jobs, like I can’t imagine they’re going to change and adjust our contracts too much. What’s the landscape currently, what’s the demand like?

Dennis Hursh: Well, it depends on the specialty. There’s some specialties that there’s more of them, and it also depends on the location. I mean, if you want to go to Northern Michigan you are going to get paid fabulously well, because people are not kicking down the doors to get there. You want to be in Manhattan or San Diego, you’re not going to be paid as well. So it’s supply and demand.

I wouldn’t expect San Diego and Manhattan to start paying for supervision of residents. Certainly Northern Michigan will, and I think it’s going to go into the hinterlands a little bit. But it’s supply and demand. There’s not enough physicians in the country to begin with, and there’s places that physicians just don’t want to go. You know, J-1 waivers help a little bit to get people in there, but there’s just a tremendous shortage. And I think the smaller and less desirable locations are going to start adopting this because they have to.

Kevin Pho: So again, let’s go back to this specialty residency program agreement that you mentioned at this one place. So putting aside the fact that this is just a bonus, this is proverbial gravy as you put it, is this a fair way to compensate physicians to supervise residents? Is this the way that you would draw it up? Are there any benchmarks perhaps that you would like to see instituted? Is that the way you’d draw it up?

Dennis Hursh: Well, if I were doing it, I would actually keep track of all the supervision you were doing. I mean, this particular one was something like eight hours a month, which, you know, as I said, I’m sure that’s the first week of the month. So I would have more careful, or more exact, limitations on how much you can do.

The money is generally reasonable. It’s what you pay a medical director, which isn’t great, but at the same time it’s not the old days where everything you did administratively used to be $100. I remember it seemed like 10, 15 years before we moved off of that, that was just a standard. So it’s getting there. But yeah, I would have you paid for all of it, not let’s pretend you’re only doing eight hours a month of it. And the compensation, I think as long as it’s close to what a medical director gets, is not bad.

Kevin Pho: So for these physicians who have to do these teaching requirements going into negotiation, just tell us some of the questions they should be asking their potential employer as they negotiate for that position.

Dennis Hursh: Well, I think you just ask, how much do I get paid for supervising residents, you know, how does that work? And I’m sure, most places are going to get a blank look, it’s just that’s what you do.

But you know, if you look at your contract, I don’t know if you’re in an academic center, most physicians at most hospitals have that requirement, because most of them have some programs, you know, that residents come in. So this literally affects just about everybody in a hospital setting. I think you just have to ask, OK, seeing residents, what do I get paid for that? You know, especially if I’m getting compensated on wRVUs, you know, you have to pay me for this, because this is definitely going to slow down my production. And I think, what do you pay, how much documentation do you require, and it shouldn’t be much. And I think those are the big things, how much and documentation.

Kevin Pho: So given again your perspective on the industry, doing this for decades, do you think that this is something that’s going to catch on like call compensation?

Dennis Hursh: I think it will, just because it has to. You know, you’ve got two offers at two different places, you are going to bring it up. You know, hey, the other guys are paying me just about the same, it’s pretty much the same except they’re paying me to supervise residents. I mean, it may not immediately be, OK, we’ll pay you to supervise residents. We may have to say, OK, you get eight hours a month at this much an hour, we’ll increase your salary. But I think it’s got to have impact.

Kevin Pho: We’re talking to Dennis Hursh. He is a health law attorney. Today’s KevinMD article is “The tiniest ray of hope for reasonable physician compensation?” Dennis, as always, we’ll end with some of your take-home messages to the KevinMD audience.

Dennis Hursh: Well, don’t assume anything. It used to be you assumed you always did call for free. Now we’ve established that excess call you should get paid for. Again, I think look at your duties and don’t be afraid to ask, what am I compensated for this, especially if I’m compensated on productivity? You want me to supervise residents, what are you going to pay me for that? Again, they can always say no or nothing, but if you don’t ask, you get zero percent of what you don’t ask for. So you know, ask for what you’re worth. And we’ve just now discovered that people are paying for supervising residents, so definitely ask for it.

Kevin Pho: Dennis, as always, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.

Dennis Hursh: Oh, it’s my pleasure.