Established in 1844, our Journal is one of the oldest in the country. To learn more about the Journal and how to submit articles, please visit https://lsms.org/page/JLSMS.
LOUISIANA NEW PHYSICIAN’S GUIDE
2022
La State Med Soc NEW PHYSICIAN’S GUIDE 1
At Campus Federal, we strive to make a difference in our members’ lives and provide more than financial services. Our Residency Loans give you options and the freedom to make the right choices for this next stage of your life. Three and five year residency loans are available. Our three year Residency Loan allows you to borrow up to $45,000 with advances of $15,000 per year. Plus, payments won’t begin until up to 90 days after you complete your residency. Our five year Residency Loan allows you to borrow up to $75,000 with interest only payments starting in the beginning of your fourth residency year. Apply online, by phone or visit us today! NEED FUNDS FOR RELOCATION OR LIVING EXPENSES? RESIDENCY LOANS
CampusFederal.org | 888.769.8841 | BusinessDevelopment@CampusFederal.org Branch locations available in Baton Rouge, New Orleans and Shreveport
APR=Annual Percentage Rate. APR is variable and may increase after consummation of loan. Residency Loan APR is indexed to Wall Street Journal Prime Rate (WSJP) with a floor of 5% and based on underwriting and credit qualifications. Interest accrues over the life of the loan. Principal advanced plus interest accrued is due on the last day of residency. Residency payout loans available with first payment due up to 90 days from the loan date. Membership and Credit Approval required.
TABLE OF CONTENTS
The Louisiana State Medical Society wants to make your transition into the medical professional as smooth as possible. We understand there are many steps before settling into a medical practice, and we would like to help. In this edition of the New Physician’s Guide, we have included a variety of information covering items regarding obtaining your license, reviewing contracts, Louisiana’s medical structure, and much more.
05 FOR THE MEDICAL STUDENT
CHOOSING A MEDICAL SPECIALTY......................................05 APPLYING FOR A RESIDENCY PROGRAM...........................06 INTERVIEWING FOR RESIDENCY............................................10
12 FOR THE RESIDENT
LICENSURE AND CERTIFICATION REQUIREMENTS........12 COMPARING MEDICAL PRACTICE SETTINGS...................15 STARTING YOUR JOB SEARCH................................................17 EMPLOYMENT CONTRACTS....................................................18
21 FOR THE PHYSICIAN
INSURANCE CONSIDERATIONS.............................................21 BILLING AND REIMBURSEMENT............................................21 CONTINUING MEDICAL EDUCATION (CME).....................23
26 GENERAL INFORMATION
MEDICAID AND MEDICARE.....................................................26 HEALTHY LOUISIANA.................................................................27 LAWS AND REGULATION..........................................................28 HEALTHCARE PROFESSIONALS FOUNDATION...............35
36 GENERAL RESOURCES
La State Med Soc NEW PHYSICIAN’S GUIDE 3
WHY JOIN LSMS?
WHO WE ARE
Jeff Williams Executive Vice President & CEO jeff@lsms.org Lauren Bailey Vice President, Legal Affairs lbailey@lsms.org
The primary focus for all physicians is the ability to provide quality care to patients. Access to care, for both insured and uninsured patients, is an ongoing issue that presents itself in the legislature in a variety of ways. Healthcare policy issues are numerous, diverse, and shaped by all branches of government. The LSMS continually advocates on behalf of physicians on the following issues:
• Preserving the integrity of the Practice of Medicine
Maria Bowen Vice President, Governmental Affairs mbowen@lsms.org Terri Watson Vice President, Administration & Member Services terri@lsms.org
• Protecting patient safety by ensuring the right professional is providing the right care permitted by his or her education, training, and skills
• Protecting the Cap - medical liability insurance
• Ensuring an adequate healthcare workforce
• Stabilizing Louisiana’s Medicaid Program by Engaging Providers
Jeremy Lapeyrouse Director, HealthSYNC jeremy@lsms.org
• Ensuring fair and transparent insurance markets for patients, employers, and physicians
Sarah Vidrine Manager, Operations & Special Projects svidrine@lsms.org Amy Tyrrell Manager, Membership & Marketing atyrrell@lsms.org
• Reducing red tape, regulations, and the hassle factor
• Making Medicaid Sustainable
BENEFITS Membership in The Louisiana State Medical Society allows physicians and physicians- in-training an opportunity to shape and impact their profession. LSMS members represent the entire state, all specialties, and diverse group of practice settings within the healthcare community. As a member of LSMS, we encourage your involvement to extend far beyond simply paying dues. Get the most out of your LSMS membership by taking advantage of many benefits, such as countless leadership opportunities, valuable resources, exclusive publications, and professional development tools.
Kathy Luttrell Coordinator, Accounting kathy@lsms.org
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CHOOSING A MEDICAL SPECIALTY Starting a career in medicine can be very exciting, but it can also be overwhelming. This invaluable resource will guide you from medical school to life as a new physician. Preparing for your career while you are still in school is paramount for your success in your profession. Choosing a specialty is the first step. You must consider your history, your interests, your experience, the amount of training required, and the financial commitments involved. Students often change their minds several times before finding the right specialty for them.
NARROW YOUR OPTIONS
An early decision when choosing a specialty is deciding between surgical and non- surgical specialties. This decision will narrow down your options quickly. Clinical rotations will provide you an opportunity to really see what life in a specialty would be like. Keeping an open mind during this process is important for reaching a final decision. Researching each specialty can also be helpful. Finding descriptions, talking to physicians in different specialties, and talking to other residents can help you reach your specialty match. The final decision must be yours! Once you have a specialty in mind, although it may change, you can start applying for residency. For a full listing of medical specialties, visit www.aamc.org. When choosing a residency, consideration of prospective fellowships after residency and the time it might take to complete those fellowships is also important. For example, most radiology subspecialties involve a one year fellowship after the completion of residency, while a cardiology or gastroenterology fellowship that follows a three year internal medicine residency will typically last three years. Therefore, all three of these example career paths would involve six years of post-graduate training between residency and fellowship. MEDICAL SPECIALTY REFERENCE GUIDE
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APPLYING FOR A RESIDENCY PROGRAM
YOUR APPLICATION
The Electronic Residency Application Service (ERAS) is the most common tool for managing this process. It is available to U.S. students through the dean’s office. International Medical Graduates (IMGs) can access it through the Educational Commission for Foreign Medical Graduates (ECFMG). Before you submit an application, make sure the program you are interested in uses ERAS, what the deadline is, and the requirements to be eligible for the program. After contacting the dean’s office, the rest of this process can be completed online through ERAS. The cost of ERAS covers your registration and application fees for up to 10 programs. Once you have exceeded 10 programs, additional costs may occur. Once the fee has been paid, no refunds are available. An additional application fee is required for international medical graduates. It is important to take all relevant factors into consideration when choosing the number of programs to which you wish to apply. Location is an easy way to narrow down your program choices. If you will be a couple matching, consider applying to up to twice the amount of programs that an individual match participant would. After completing your application, the only thing left to do is wait. It on average takes four-to-six weeks to receive results from your interviews. If for some reason you don’t hear from ERAS during this time, contact them and request the status of your application.
ANTICIPATE DELAYS DURING THE APPLICATION PROCESS AND START EARLY SO YOU HAVE TIME TO RESOLVE THEM.
WRITING YOUR PERSONAL STATEMENT
Your personal statement should be a written description or essay that includes your achievements, accomplishments, and interests in the residency program or job. This is an important part of your application process. You should write a specific personal statement for each specialty or residency program for which you choose to apply. Start early to give yourself time to receive feedback from your advisors and instructors. A personal statement should flow smoothly while explaining your reasoning for choosing that specialty or residency program. Your passion, work ethic, personality, and desire to make a positive contribution to the field should be obvious to the reader. Include relevant life experiences, clinical work, and research that make you stand out. It’s important to use the personal statement as a way to highlight things that make a candidate unique and might not be apparent from lines on a CV. Readers don’t just want to see a personal statement be an expanded/reiterated CV – they want to know other things about a candidate’s character and passions that are noteworthy and distinct.
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PERSONAL STATEMENT EXAMPLE
NAME A. LASTNAME, MD Street Address City, State, Zip Code Cell: (###)###-#### Email: email@address.com
Month, year
Name of Recipient (Get the recipient’s name, NOT To Whom It May Concern) Title Address City
Dear Mr./Ms. Name,
It seems as though the course of my life and professional career up to this point has been in preparation for (job title, or words to that effect. Tell exactly how you heard about this residency program or what made you choose this specialty).
My first love is health care (or words to that effect). From the time I was (explain your initial interest in medicine with passion. Don’t rehash your resume, make a personal connection). In addition to my education and health care experience listed on my enclosed/attached resume, (tell a little personal information about yourself that might not jump off your resume). The opportunity to apply for the (residency program) is a dream come true (or words to that effect). I believe my experience will (explain why all of your life lessons, education, and experience make you the perfect candidate). Please feel free to contact me at any time at ###-###-#### or by email at email@address.com. I look forward to hearing from you soon.
Thank you for your consideration. Sincerely,
First M.I. Last Name
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PREPARING A CURRICULUM VITAE (CV)
A curriculum vitae (CV) is an overview of your accomplishments. Throughout your career, you will use your CV, so update it frequently to reflect your accomplishments and experience.
A CV is similar to a resume, but there are notable differences, such as:
• Education is ALWAYS listed first on a CV.
• A CV rarely lists an objective or includes long narratives (That is for your cover letter to include). • Listing references by name is more common in a CV. If you conducted research under a certain professor, include their name and title. • A CV can sometimes take up to three pages or more, although the length of your CV is not the focus. Therefore, include present and relevant experience first.
• CVs should be neatly organized with clear headings.
• Bullet points are common in resumes but less common in a CV.
DO’S AND DON’TS OF CV
DO INCLUDE
DON’T INCLUDE
• Your full legal name • Contact Information • Education • Certification and licensure • Postgraduate training • Practice experience • Professional or teaching appointments • Research and publications • Accomplishments • Professional society memberships • Personal and professional references
• Anticipated compensation • Reasons for leaving previous positions • Personal health problems or disabilities • Examination scores • License or DEA number • Race • Religion • Age • Place of birth • Citizenship • Marital status
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CV EXAMPLE
NAME A. LASTNAME, MD Street Address City, State, Zip Code Cell: (###)###-#### Email: email@address.com
EDUCATION
B.S. Degree, 1995 Biology, Louisiana State University, Baton Rouge, LA M.D., 1999, Tulane University, New Orleans, LA
PROFESSIONAL DEVELOPMENT
American College of Physicians Internal Medicine Meeting, April 2006 Internal Medicine and Primary Care Update CME, September 2009
PROFESSIONAL MEMBERSHIPS
Louisiana State Medical Society American Medical Association American College of Physicians
HONORS AND AWARDS
Outstanding Medical Student Scholarship, 1996 First Place, Louisiana Internal Medicine Residency Paper Competition, 2001
PUBLICATIONS
“Breakthroughs in Geriatric Internal Medicine”, Physicians Digest
PRESENTATIONS “Hidden Symptoms” American College of Physicians Internal Medicine Meeting, April 2006 “Communicating with your Geriatric Patients” Internal Medicine and Primary Care Update CME, September 2009
COMMUNITY SERVICE
National Down Syndrome Association LSU Alumni Association Krewe of Orion
ADDITIONAL SKILLS
Fluent in Spanish
La State Med Soc NEW PHYSICIAN’S GUIDE 9
REQUESTING LETTERS OF RECOMMENDATION
i TIPS FOR RESIDENCY INTERVIEWS:
Your letters of recommendation can be different depending on the program for which you are applying. Always check your program requirements before reaching out to people to write them. Letters from attending physicians carry more weight in this process than letters from senior residents. However, you should always choose individuals who know you well enough that they can write about your specific qualities and experiences instead of generalities as they pertain to the program. When asking someone to write a recommendation, include supporting materials so the writer can reference them for specific accomplishments. This should include your most recent CV and personal statement. The number of recommendations you need varies by the program. It is standard for you to get at least one letter from a faculty member on an advanced rotation in the specialty that you are applying. If you have experience outside of the clinical field, you can seek out professionals from research positions, societies, volunteer, or international work to submit a letter as well. ERAS will control which letters go to which programs. INTERVIEWING FOR RESIDENCY First impressions are important during your residency interview. Your interview begins the moment you make contact with the program. From the receptionist to the program coordinator that meets you in the lobby, everyone who you come in contact with can affect your interview outcome, so it is important to treat everyone with patience and respect.
• Wear formal business attire
• Remember to smile and maintain eye contact
• Being nervous is normal - take deep breaths to calm your nerves • Be familiar with your application packet and prepared for background questions • Practice answering common residency interview questions • If asked about a weakness, use the opportunity to discuss a weakness that developed into a strength
RESEARCH RESIDENCY PROGRAMS
You must research each program thoroughly before you interview. Research should include the institution, the program itself, and staff in order to identify trends and issues to discuss in the interview. Are there trends or specific qualities this program tends to seek out? This information can help you pick which of your experiences and qualities to highlight in order to be chosen. Current residents in the program are a great resource for additional insight into the program as well.
YOUR SOCIAL MEDIA PRESENCE
Your social media presence can affect your interview. Interviewers often review your various sites in order to learn more about potential residents. Medical boards monitor these sites as well. Make sure your account is private or only post content that you would be comfortable for all to view.
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POTENTIAL TYPES OF QUESTIONS TO ASK YOUR INTERVIEWER:
THE IDEAL CANDIDATE...
Types of required rotations
LISTENS, CARES, AND COMMUNICATES.
Amount and type of elective rotations
PLAYS NICE WITH OTHERS. Hospitals not only want doctors who can communicate well with patients, but who can get along with each other and who are willing to be part of the team. COMES HIGHLY RECOMMENDED. Make sure to give some thought to the professional recommendation you list on your job application. Hospitals are looking for doctors who listen to patients, who are invested in their health, and who know how to clearly communicate about their care.
Amount and type of supervision on rotations
Call schedule
Board pass rate and job placement for previous residents in the program
Resident responsibilities for patient management
Amount of turnover in program directors and faculty
Balance of inpatient and outpatient responsibilities on various rotations
Structure and topics of formal educational curriculum
Leave policies for vacation, maternity/paternity leave and participation in education conferences
IS EHR READY.
Topics of particular interest to you
Facilities will train new physicians on their EHRs, and that is easier if the doctor is already familiar with the particular software, or is at least willing to learn without complaining.
IS HIGHLY ADAPTABLE.
IS WILLING TO SHARE IDEAS. Every hospital wants a doctor who will come in and make positive change — but not necessarily on the first day. Sharing new ideas is a good idea, but generally only after there has been time for the existing team and the new doctor to get to know each other. Recruiters love candidates who are open to change and who will adapt to new systems, policies, patient volumes, or anything else that may pop up.
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Visit physicianspractice.com/blog/six-characteristics.com to see more.
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LICENSURE AND CERTIFICATION REQUIREMENTS
THE LOUISIANA STATE BOARD OF MEDICAL EXAMINERS
The Louisiana State Board of Medical Examiners (LSBME) issues all medical licenses in the state of Louisiana. The LSBME processes hundreds of applications for licensure. Visit lsbme.la.gov to find the LSBME specific application and documents.
The board conducts a thorough evaluation of:
• Credentials • Employment of Work History
• Malpractice History • Disciplinary History
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IMPORTANT TIP: Make multiple copies of your diploma (shrink down to fit on a standard letter size (8.5 X 11) piece of paper before you frame it. This will save time and hassle later.
Present to the Louisiana State Board of Medical Examiners (LSBME) a valid diploma from a medical college in good standing with the LSBME or have been actively engaged in the practice of medicine, in a manner determined by the LSBME to have been satisfactory.
OBTAINING A TRAINING PERMIT
The process of obtaining a training permit can be challenging and time consuming. To help make sure you are submitting all the necessary documents, below is a checklist of required items for the application process. For LSU Health School of Medicine and Tulane School of Medicine graduates who match to Louisiana-based residency programs, each medical school hosts a LSBME application fair after Match Day to assist with the compilation of the items required by the LSBME for receiving a training permit in Louisiana.
U.S. MEDICAL SCHOOL GRADUATES
Checklist for an initial Louisiana training permit (PGY):
• Complete the required LSBME online application
• Complete and mail: • LSBME Oath
• LSBME Third Party Authorization document • Certificate of Dean/Registrar with recent photo attached • Background Check • Notarized Birth Certificate
• Initial fee of $50
i BASIC QUALIFICATIONS FOR A LOUISIANA MEDICAL LICENSE: • Be 21 years of age • Be a citizen of the United States • Be of good moral character
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INTERNATIONAL MEDICAL GRADUATES
The LSBME may issue a Graduate Education Temporary Permit (GETP) to an international medical graduate (a graduate of a medical school located outside of the United States, Canada, and Puerto Rico) for the purpose of enrolling and participating in an accredited program of postgraduate medical education (residency or fellowship) at a Louisiana medical school, college, or other accredited medical institution. Qualifications for International Medical Graduates to Obtain a GETP License from LSBME:
• Be at least 21 years of age and of good moral character.
• Be a citizen of the United States or possess valid and current legal authority to reside and work in the United States duly issued by the commissioner of the Immigration and Naturalization Service. • Possess a Doctor of Medicine degree duly issued by a medical school approved by the board. This diploma must be in English; if not, must be accompanied by a certified translation into English. • Possess a standard Educational Council for Foreign Medical Graduates (ECFMG) certificate. • Have received written commitment from an accredited Louisiana medical school, college or other accredited medical institution formally appointing the IMG to a postgraduate medical education training program which is conducted by such medical school and is not on probation status with the ACGME. This letter must be signed by the director of the program and must be mailed directly to the LSBME.
• Pay the appropriate non-refundable fee of $200.00.
Checklist for an initial GETP license:
• Complete the required LSBME online application
• Complete and mail: • LSBME Oath
• LSBME Third Party Authorization document • Certificate of Dean/Registrar with recent photo attached • Background check • Valid Visa • Certified birth certificate
• Personal appearance with a member of the LSBME
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FULL ACTIVE LICENSURE
i *MORE INFORMATION ON FCVS APPLICATION:
Once a physician in training completes his or her training and they plan to practice medicine in the state of Louisiana, a full active license must be applied for.
Applicants who complete the FCVS verification process establish a permanent, lifetime portfolio of primary- source verified credentials - allowing easy and cost- effective access to medical credentials whenever they are needed. This service is especially valuable to those physicians graduating from medical school outside the United States or Canada, where verification can be time-consuming, costly and difficult. It is also extremely useful for those applicants applying to several state boards simultaneously, or those whose postgraduate training programs have closed.
Checklist for an initial full active license:
• Complete the required LSBME online application
• Complete and mail: • LSBME Oath
• LSBME Third Party Authorization document • Statement of legal name • Federation Credentials Verification Service (FCVS) Application* • Background check
The LSMBE may design or administer its own examination, or it may use examinations from any national examining agency, either public or private as long as such examinations are, in its view, sufficient for such purpose.
Follow these tips to help ease the process of applying for medical licensure:
• Request a Copy of Current Medical License Requirements. When contacting a licensing board for the 1st time, request a copy of its current licensing requirements and the average time it takes to process applications. This helps prevent unreasonable expectations in processing time and gives a better idea of when to close a practice, plan a move or arrange a start date with a new employer to minimize financial loss. • Send Your CV. Physicians should provide the licensing board with a resume or curriculum vitae (CV) when they first make contact. This will allow a licensing board to evaluate potential problem areas early in the process. • Disclose All Information. Don’t try to hide potentially derogatory information from a licensing board. It is much better to come forward with the information, assist the board in obtaining records and other necessary data, and provide information about mitigating circumstances that would prevent license denial. • Follow up to Expedite the Process. Personally contacting and following up with the medical schools, training programs and appropriate hospitals will motivate these institutions to verify credentials more expeditiously. Following up with the licensing boards in other states where licenses are held also may assist in shortening the time for licensure. The Federation Credentials Verification Service (FCVS) provides a centralized process for state medical boards to obtain a verified record of a physician’s core medical credentials. Call FCVS at 888-275-3287 for more information. • Plan to Wait at Least 60 Days. Physicians should plan for at least a 60-day period from the time they submit a completed application for a license and the actual date licensure is granted. Physicians who are graduates of a medical school outside the United States should anticipate a slightly longer period. It takes time for the state medical licensing boards and their staff to fairly evaluate each application for licensure.
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COMPARING MEDICAL PRACTICE SETTINGS Physicians have numerous practice options, each offering a different degree of clinical autonomy and financial risk. Choosing a practice setting ultimately will be based on your professional and personal preferences. As a physician, your first decision should be whether you want to practice clinical medicine as your full-time duty or include non-clinical duties. You can be the owner of a solo practice, an equity owner in a group practice or an employee of a group practice, hospital, academic institution or health care system—which could be a private and public organization. If splitting your time with non-clinical duties, you should consider hospital systems or group practices that allow you to hold an administrative role or perform research. Keep in mind that opportunities will vary depending on medical specialty, geography, patient populations, and the health care market dynamic between providers and payers.
OWNING A MEDICAL PRACTICE
Owning a medical practice offers physicians the highest levels of autonomy and financial risk. If you choose to own a solo or a group medical practice, you will have to decide whether to establish a new practice, buy an existing practice, or buy into an existing practice as a partner.
ESTABLISHING A PRACTICE
Establishing a new practice starts by understanding the needs within the community. Is there an unmet need for your specialty in the area which could demand long hours, or will you be competing against established groups and needing to recruit patients? Your practice is your small business and you should understand the market for your services as you build your business model. Generally, establishing a practice will also carry a significant financial and administrative burden. For this reason, it is recommended that you have a year of savings to carry the practice through the first year. You will be responsible for meeting regulatory requirements and practice laws, as well as raising capital, hiring employees and negotiating contracts with insurance payers. This can be a time-consuming endeavor but ultimately provides you equity in your business and the ability to be your own boss.
BUYING A PRACTICE OR BUYING INTO A GROUP
Buying an existing practice that is already profitable or buying into a group practice as a partner still affords a physician a high degree of autonomy but lessens financial risk somewhat. Joining or taking over an established practice often has the added benefit of an established patient base, so your case load will be full when you start. In some cases, you may work for a medical group as an employee and later have the opportunity to become a partner. The financial risk and administrative burdens are shared in a group practice, but so are decisions regarding income distribution, insurance benefits for employees, financial investments, and day-to-day management of the practice. Before you buy an existing practice or join a group as a partner, it is important to consider the culture of the practice and how it fits your professional, personal and business needs and aspirations. If you are negotiating a contract with an established practice, be sure to work with an experienced physicians’ contract lawyer to carefully review income sharing, benefits, and other contract provisions.
PRACTICING MEDICINE AS AN EMPLOYEE
By becoming an employee of an organization such as a group practice, health care system, or government entity, you have an established patient base and increased income stability. Depending on the organization and the physician’s interest, there
La State Med Soc NEW PHYSICIAN’S GUIDE 15
may be leadership and management opportunities available to practicing physicians as well. Employed physicians frequently enjoy having a predictable schedule and low financial risk. In addition, you receive benefits such as malpractice, health and disability insurance, and you do not have to hire or manage ancillary staff; however, this also means you will not have direct control over office management and other practice issues. Employed physicians are also required to adhere to their organization’s resource utilization guidelines, quality assurance standards, and potential referral restrictions. They may have limited input into determining which payer contracts the practice chooses to pursue and are thus at a slightly higher risk of losing patients to insurance changes.
GROUP PRACTICE, HOSPITAL, OR HEALTH SYSTEM EMPLOYMENT
If you choose employment with a group practice, it may be a single or multi-specialty practice. The size and patient volume of some organizations may provide additional assistance to its clinicians and offer opportunities for expanding into other aspects of health care delivery, such as governance committees and working in non-clinical positions.
GOVERNMENT ENTITY EMPLOYMENT
You can become an employee of various government entities, including the Veteran Affairs health care system, state or local health departments or federally qualified health centers and community health networks. All of these entities provide increased government oversight to a physician, which usually decreases autonomy within the practice setting. Additionally, the physician’s role may involve more administrative duties and decreased patient contact, especially within health departments.
WORKING IN ACADEMIA
As an employee of an academic institution, you could have the opportunity to see patients, conduct research, be in close proximity to individuals of multiple specialties and teach or mentor future physicians. Your responsibilities will differ both by institution as well as by the specific role for which you are hired. This means you might have an academic appointment but still primarily see patients or have a research lab with minimal patient contact. Academic institutions have complex leadership structures. There may be leadership and management opportunities available that can require little to almost all of a physician’s time, but they may also be very limited in number or require years within the system before a promotion. You may also have decreased clinical autonomy. Academic institutions hire physicians into full-time clinical tracks, or their time between clinical roles and either research, teaching, or administration. While every center is different, it is important to ask about the tracks and the possibility of promotion or tenure. Those who can establish seniority or tenure are often granted the flexibility to manage their own time and projects with reduced pressure to meet goals and deadlines.
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STARTING YOUR JOB SEARCH As you launch into your final push to become a board-certified provider and find that perfect job match, so many decisions have to be made. What type of practice do you see yourself in? Where? For how much? Gathering the answers to these questions takes time and effort but are critical to making your decision easier in the long run.
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IMPORTANT TIP: Don’t forget that licensing and credentialing can be a lengthy process, so set yourself up to have everything in place to start practicing once you’re ready.
DON’T DELAY – START YOUR JOB SEARCH EARLY
Residents often wait until the end of their residency to explore opportunities then experience frustration when they must wait to begin practicing. Many practices begin their hiring process one-to-two years before an expected opening. Be proactive and keep an eye on opportunities that interest you. If you find something that grabs your attention, reach out and gather more details.
IMPORTANT TIP: Ask to be added to any event calendars or email blasts from your recruiter to stay connected.
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GET TO KNOW YOUR RECRUITER (AND LET YOUR RECRUITER GET TO KNOW YOU!)
Recruiters are the conduit to finding the right position for you. They know the organization inside and out and are going to match up providers with the type of environment that best fits their needs. Whether you are interested in practicing with a specific group or hospital, building a relationship with a recruiter is critical to finding the ideal job for you. Connect with recruiters and let them know your preferred practice settings. When the perfect option arises, you will be top-of-mind for them.
ATTEND RESIDENCY DINNERS
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IMPORTANT TIP: Do you attend specialty
It can be extremely difficult to learn the culture of a practice based simply upon online research. Many groups hold events to introduce residents to their practices. These dinners and events offer the chance to see first-hand the culture of the practice and offer you the option to ask specific questions. Often, there is an opportunity for one- on-one conversations that can also help determine if the practice is the right fit for you.
conferences? If so, stop by to speak with the recruiters in attendance to get a feel for the team. One-on-one conversations provide a wealth of information about the practice, as well as visibility for you as a potential candidate.
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DECIDE WHAT MATTERS MOST TO YOU
i IMPORTANT TIP:
For some physicians, compensation is the top factor to consider and for others, location is all that matters. There are so many factors to consider and you need to prioritize your practice “wish list” to assess opportunities that arise.
If you aren’t 100 percent sure on what factors are important to you, consider becoming part of a travel team to explore different practice settings. This will allow you to narrow down what you want in your career, as well as what you do not.
There are many factors to consider – some include:
• Geographic location
• Practice setting – single specialty group, multi-specialty group, hospital/clinic
• Employment model – W-2 vs 1099
• Compensation
• Schedule / flexibility
• Opportunities for career growth
• Personal development opportunities
• CME provisions
• Hospital size
• Subspecialty support
• Documentation system
• Malpractice insurance – Is it provided?
PERSONAL ASSESSMENT
At last you are ready to start looking for a job, right? Not so fast! There is one more step that will help prepare for your search. You, your significant other and/or family members should sit down and determine what you are really looking for in a practice and community. This will allow you to identify your needs and your wants so you can stay focused during your search and help you to be more articulate with potential employers. EMPLOYMENT CONTRACTS Employment compensation and contracts can be difficult to understand. Remembering a few basics can help you in the process whether you are a new or experienced physician.
UNDERSTAND YOUR COMPENSATION
You should fully understand and be comfortable with how your compensation is structured. If not, ask someone to walk through it with you using numeric examples. Before you agree to an employment contract, you should be familiar with the median salary range for a physician in your specialty in that geographic location. If you don’t know what your skills are worth in the local market, you won’t know if the compensation offered by the practice or employer is fair.
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KNOW THE VALUE OF YOUR BENEFITS PACKAGE
i IMPORTANT TIP:
LSMS has partnered with the law firm of Butler Snow LLP to offer LSMS members their expertise in contract review and negotiations. For more information on special rates exclusively offered to LSMS members, contact LSMS Vice President of Administration & Member Services, Terri Watson at terri@lsms.org.
Benefits can add substantially to both your base compensation and how content you are in your new position. Learning what benefits are included in your compensation is an important step in understanding your employment contract. Examples of benefits include payment of your licensing fees and dues to professional societies, time off, funding to complete Continuing Medical Education requirements, liability insurance, disability insurance and payment of student loans. It is important to understand how these benefits work and what may be required of you to access them. For example, in return for your employer paying your student loans, are you expected to live within the geographical area for a certain number of years? Another example is liability insurance—is it part of your benefits package, and what are the terms of the coverage?
CONSULT AN EXPERT
While hiring a lawyer to review a contract is an added cost, the consequences of signing a long-term contract you don’t understand can be much more taxing on your career and your pocketbook. An experienced health care attorney in the state in which you plan to work can help you identify and resolve problematic contract provisions before they become an issue. Pay particular attention to any noncompete provisions which may apply upon termination of your employment, forcing you to leave your community. Employers may be willing to negotiate such contract terms. You can also find a physician mentor who has been through this process. Their perspective may help you avoid common pitfalls.
LIFE INSURANCE
Everyone needs life insurance and no less so a new-to-practice physician. If you should die, you want to make sure your family is provided for financially, especially if you are leaving them with large educational loans for which they’d be responsible. The amount of life insurance and the type you need depend on your individual circumstances. It’s best to consult with a financial advisor to help you calculate life insurance into your overall estate plan.
HEALTH INSURANCE
If you become an employed physician or part of a group practice, health insurance will likely be part of your total compensation package. If not, you will need to find suitable coverage for yourself and your family. Options range from traditional indemnity insurance to Health Maintenance Organizations (HMOs) and Preferred Provider Organization (PPOs). You will want to evaluate cost versus flexibility and choose the plan that best suits your needs.
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QUESTIONS TO CONSIDER
DISABILITY INSURANCE
What if you become able to work part-time? Can you draw partial disability payments?
Physician disability insurance protects your income in the event that you are no longer able to perform your medical specialty due to injury or illness. Also known as disability insurance for doctors and income protection, a physician disability insurance policy typically features a true own-occupation provision. You should consider purchasing a small policy as you enter residency and then upgrade it just before leaving residency. The younger you are, the healthier you are, the cheaper your premiums will be for the same benefit. Disability insurance may be one of your employee benefits or you may have to obtain it on your own. When comparing disability policies, be sure to evaluate the amount payable, the length of payout, the length of the waiting period and exclusions. Some policies provide for coordination of benefits, so that the amount of payments you receive from Social Security or other disability insurance would be deducted. If you’re in a solo practice, don’t forget “overhead” or business continuation insurance, which would allow your practice to continue to operate while you’re disabled.
Are premiums waived while you are disabled?
Is there an annual cost-of- living adjustment increase in benefits?
Is renewal guaranteed with a re-evaluation of your health?
LSMS MULTI-EMPLOYER 401(K) PLAN
The LSMS 401(K), the latest offering in LSMS’s suite of financial assistance tools, is built to offer superior retirement outcomes for practices of all sizes. Whether you are looking to lower your overall costs, reduce fiduciary liability or to improve your plan’s investment offering, the LSMS 401(k) has the solutions you need. This program is being offered to LSMS members only and is in collaboration with ACG Wealth. For more information, please contact Kevin Rainwater, Retirement Consultant, at krainwater@acgwealth.com.
Is there catastrophic coverage that would increase payments if you are cognitively disabled or need paid care?
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INSURANCE CONSIDERATIONS
Medical professional liability insurance coverage is for errors or omissions causing injury during the performance of a medical professional’s duties. Louisiana Medical Malpractice Insurance Company (LAMMICO) is the LSMS-preferred provider of Medical Malpractice insurance and rated “A” by A.M. Best.
TIPS TO REDUCE THE THREAT OF A MALPRACTICE CLAIM IN YOUR OFFICE
• Careful listening to patients can lead to a more timely and accurate diagnosis, as well as a more satisfied patient. • A calendar log or suspense sheet can be created to ensure timely follow- up on receipt of test results. • After reading incoming reports from labs and consultants, initial and date prior to filing. • When too rushed to write complete notes, remember dictated notes are quick, legible, and tend to be more descriptive than handwritten documentation. • Avoid any appearance of an altered record: never scratch out, erase or obliterate with “write-overs” or “white out.”
• Use a routine format to ensure complete and defensible medical records.
• Preprinted forms can be used to easily document after hours phone messages and can later be secured in the patient’s record. • Utilize the consent form recommended by the Louisiana Medical Disclosure Panel, in addition to progress notes, to best document informed consent discussions, always remembering not to imply or guarantee treatment will be complication free. • Remember to advocate for your patients and avoid the appearance that economic considerations override sound medical judgement.
BILLING AND REIMBURSEMENT
An important part of today’s medical practice is getting reimbursed for services. The categories of physician reimbursement relationships are listed below.
TRADITIONAL INDEMNITY INSURANCE
The Louisiana market is dominated by Blue Cross Blue Shield of Louisiana, which offers traditional indemnity insurance, PPO, and HMO plans. Indemnity plans allow you to direct your own health care and visit almost any doctor or hospital you like. The insurance company then pays a set portion of your total charges. Indemnity plans are also referred to as “fee-for-service” plans.
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PREFERRED PHYSICIANS ORGANIZATIONS
A Preferred Physician Organization (PPO) is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or third-party to provide health care at reduced rates to the insurer’s or administrator’s clients.
CONTRACTING WITH HEALTH PLANS
Physicians must practice caution when entering a contract with health plans. Here are some things to keep in mind:
• Choose which third party payers with whom you are interested in contracting. You can do this by assessing the coverage of your patient population to see which 3rd parties are used most often. Usually, 50 responses or four weeks of data collection, via survey, should give you enough information to make a decision. • Research companies. Reach out to colleagues to see if they have contracts with insurance companies with whom you are interested in establishing contracts. If they do have contracts with any of these companies, request a contact name, phone, or email address. Also, ask them about their personal experience with the company. If none of your colleagues have similar practices, you can also reach out to your Medical Director. Insurance companies also have “provider lines” which you can call for information. Ask them if your practice will be considered a “medical practice” or an “ancillary practice.” They often have different employees handling these types of applications. • Contact insurance company. Try to get the name and number of a contact person and ask them to send you an application. Companies often ask for a letter from your clinic requesting to become a provider. • Get a NPI (National Provider Identifier) for practice and clinicians. A NPI is a 10-digit code identification number given to healthcare providers in the United States by the Centers for Medicare and Medicaid services (CMS). • Credential your clinicians. Register your clinicians with the Council for Affordable Quality Healthcare’s (CAQH) - Universal Provider Datasource (UDP). Keep copies of all clinical licenses, medical degrees, DEA information, overhead insurance coverage, board member’s information, hours of operations, NPIs, Tax ID Number, and SSN of managing officers. You will need these to complete the application. • The application. Keep a copy of your applications and attachments for your records. Follow up regularly with questions such as: • The status of your application. • When the board meets to approve new applications. • How long will it take to receive the fee schedule and contract (once your application is approved). • When you may begin charging the insurance company for their covered patients.
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• Review terms and rates. You should know the cost of your services and consider if the contract will generate non-covered services. Verify contract terms and confirm that your clinic or lab and finance department can meet these terms. Consider fee scheduling, infection control, licensing, quality assurance, site visit, and any other requirements stated in the contract. You may also contact a health care attorney to review the contract before you sign it as well. • Negotiate. After reviewing the contract, you can modify contract terms. Look for paragraphs that restrict your ability to collect reimbursement. Ensure that the third party payer agreement includes a description of covered services as well as a current fee schedule. • Signing the contract. Identify the person in your organization that is authorized to establish contracts and keep them informed throughout your efforts to obtain a contract. • Have contract on file. For periodic renewal and annual updating of fees, you must be able to readily access your contract. CONTINUING MEDICAL EDUCATION (CME) Continuing Medical Education (CME) is a very important part of your life as a physician. It allows you to maintain competence and learn about developing areas of medicine. CME comes in many forms: live events, written publications, online programs, audio, video, or various electronic media. The Louisiana State Board of Medical Examiners (LSBME) administrative rules require every physician seeking the renewal or reinstatement of licensure shall annually evidence and document, upon forms supplied by the board, the successful completion of not less than 20 hours of board-approved CME. An applicant for renewal of licensure who fails to evidence satisfaction of the continuing medical education requirements prescribed by these rules shall be given written notice of such failure by the board.
CONTROLLED DANGEROUS SUBSTANCE (CDS) LICENSE RENEWAL CME REQUIREMENT
Pursuant to Act 76 passed by the Louisiana Legislature during the Regular Legislative Session of 2017, all practitioners with a Controlled Dangerous Substance (CDS) license in Louisiana are now required to complete three hours of LSBME-approved continuing medical education (CME) for the 2019 renewal year. An authorized prescriber renewing his/her license for the first time in 2019 may be excused from the CME requirement upon submission of a certification attesting that he/she has not prescribed, administered, or dispensed any CDS during the entire year covered by the prescribers’ expiring license. The LSBME will verify this through the Louisiana Prescription Monitoring Program. An exempted licensee, who subsequently prescribes, administers, or dispenses a CDS shall satisfy the CME requirement as a condition to license renewal for the year immediately following that in which the CDS was prescribed, administered, or dispensed.
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