Today, many 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 have made since you entered medical school, because selecting the wrong one may end your career as a doctor. And even if a bad employer choice does not end your career, you may have a difficult experience in re-starting your career.
A number of factors enter into this decision. The most important is finding the employer who is least likely to throw you under the bus in an adverse situation that they either manufacture or that comes from “outside” your practice. All potential employers will throw you away if necessary. That’s a given. But some, for example, in 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:
1. An extremely involved or onerous proctoring system for surgeons to qualify after 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?”
2. 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 must do outreach to bring in patients for them. Unless you are prepared to do this, you may be terminated. Or at least, you will be miserable. Remember, all that is necessary for them to get rid of you is to suspend you, and in 30 days, they Data Bank you. Data Banking is the “easiest” way for any employer to get rid of you. Any “cause” can be trumped up against you. You have no constitutional rights. Your lawyer cannot “create” rights for you for which Congress has provided a carve-out in the Health Care Quality Improvement Act of 1986.
3. 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 those who have gone before you?
4. How many of their employed physicians have they Data Banked?
It is very difficult to find out how many physicians got Data Banked at the institution where you want to work. But one general surgeon 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.
5. 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 abuses or they do not have an adequate educational program for their employees. You may end up in the middle of major intra-employee conflicts and be totally blindsided when your employer demands that you testify against an ancillary employee.
6. Are you the only 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. You will be responsible 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.
7. Are there government actions against your employer?
Any employer that is facing government actions against them may throw you into the middle of defending them, as a condition of your employment. You need to know if government actions have occurred against the employer in the past and the nature of those actions. Temporary loss of accreditation is at the top of this list of concerns. There are often explanations for such actions, but in many cases the cause is poor management. Your own professional status can become “infected” by this process. If the hospital is understaffed, or if the other employees just don’t care, their poor performance can severely damage your career.
8. 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. It is rare for there to be any financial gain for the whistle-blower at all. There is an enormous personal price to pay for making the decision to become one of this group. 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 legal actions wind their way through the courts. This will utterly consume a whistle-blower’s life. 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.
9. Have any physicians under their employ in the past committed suicide?
Data Banking and sham peer reviews are used as a tool by employers and hospitals to assist in 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.
Most employers will not hire a Data Banked physician. Licensing of Data Banked physicians is still possible, but it is not easy and often requires a personal appearance before a licensing board to “explain” the reasons behind such action. Data Banking is an issue that requires many pages to discuss. Suffice it to say that hospitals and institutions are now using this as a weapon against you, even if completely unwarranted. Your government is complicit in this and protects them.
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Remember, if the hospital uses Data Banking as an employer’s policy, why do you think you are any different from the others?
10. 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 five years after he left associated military employment. 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 $100,000 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
- Employment contracts that are unfair, are unreasonable, have non-competes, or have red flags.
- Large hospital chains.
- Critical access hospitals, rural hospitals, and hospitals with a poor payer mix.
- Any facility that offers income guarantees or low-interest personal loans.
- Any facility that refuses to permit residents or interns.
- Native American health care clinics and hospitals hire under probation. They will just Data Bank anyone they want to get rid of.
- 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 by any state legislature. 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.
There are no secrets. People talk.
This essay is cited in the KevinMD record on physicians and administrators.
Richard A. Lawhern is a nationally recognized health care educator and patient advocate who has spent nearly three decades researching pain management and addiction policy. His extensive body of work, including over 300 published papers and interviews, reflects a deep critique of U.S. health care agencies and their approaches to chronic pain treatment. Now retired from formal academic and hospital affiliations, Richard continues to engage with professional and public audiences through platforms such as LinkedIn, Facebook, and his contributions to KevinMD. His advocacy extends to online communities like Protect People in Pain, where he works to elevate the voices of patients navigating restrictive opioid policies. Among his many publications is a guideline on opioid use for chronic non-cancer pain, reflecting his commitment to evidence-based reform in pain medicine.
Richard Willner is a health care executive.
