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Volume ONE Edition 3 of 5 2015

 

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INSIDE THIS ISSUE

​Key Issues to Consider Before Signing an Employment Contract​ ​
By Gary N. McAbee, DO, JD, FAAP​

​As newly trained pediatricians/pediatric sub-specialists enter the work force, they need to be aware that medicine has become increasingly business-oriented.  Contemporary physician employment contracts are fraught with "red flags." The contract is the only document that specifies one's job description and benefits – promises given orally may be difficult to enforce because they are difficult to prove later. A contract could be one page long or thirty pages.

It is important to read your contract carefully and analyze every single clause. Your employment contract is likely to be written with terms that are much more favorable to your employer than to you. It is important to try to negotiate as many terms as possible so that it is more favorable to you.

Some examples of important issues found in employment contracts include the following.

  1. Malpractice insurance: Be sure to know who pays for this, what the policy limits are, and the fiscal stability of the company. The contract should specify who pays for any possible deductibles before or after contract termination. You should also be "covered" under your employer's general liability policy which will cover other alleged acts of negligence (e.g. a patient breaking a wrist after tripping on a damaged rug in your office).
  2. "Tail" coverage: Your malpractice insurance may require "tail" coverage if you leave the position. A "tail" covers you for any malpractice lawsuits filed against you after your malpractice insurance is no longer in effect (which may be the day you leave your position). Because lawsuits can be filed many years after the alleged malpractice, it is important to have this "tail" coverage. It can be very expensive and you want to make sure that you are not responsible for paying for it. Remember, young pediatricians are much more "mobile" than they used to be and it is conceivable that you may have several employers over your career. 
  3. Be wary of clauses that will require you to pay for your employer's legal bills if a lawsuit occurs by either party for breach of the contract. A vindictive employer can drag a lawsuit on for years, costing you large legal fees. It happens!
  4. A restrictive covenant or non-compete agreement is likely to be included in the contract. If you leave the practice, this will prevent you from practicing within a certain distance from the practice for a certain period of time. If the clause is reasonable regarding the time or distance, it is likely to be legally binding. The "reasonableness" of a restrictive covenant will vary according to the geographic region. For instance, a restrictive covenant of 50 miles for a general pediatrician in rural Montana may be considered "reasonable," but the same distance in New York City may not. Sometimes a restrictive covenant will include a "damage" clause. For example, it may require you to pay damages equivalent to six months of salary if you violate the covenant.
  5. General pediatricians tend to receiv e many after-hours phone calls from parents. If a cell phone is not provided by your employer, your hours included on your monthly personal cell phone bill may be "used up" very quickly by these "on-call" phone calls.
  6. "Moonlighting": the contract should specify whether you are permitted to work elsewhere on your "days off."  Be sure that you have malpractice coverage for any "moonlighting" jobs as it is unlikely that your primary employer's malpractice insurance will cover you for this.
  7. Termination: The contract will likely have a "termination for cause" clause. This will specify reasons when you can be terminated; these tend to be very similar from contract to contract.  However, you may want a "termination without cause" clause as well.  This gives an employer freedom to terminate you without a reason, and it has less stigma associated with it. Often, there is a window of time associated it with it, e.g."termination without cause can occur with four months' notice." The time period is important: too short of notice gives you less time to seek another employment opportunity; too long of a notice may cause you to lose an opportunity because the new employer does not want to wait so long for you to start employment. Most contemporary contracts include both a "termination with cause" and "termination without cause" clause.  Remember: if an employer wants to terminate you, they will. Always try to leave on good terms. 
  8. There is a trend to base salary on work productivity.  Thus, a base salary will be given with "bonus" money dependent on reaching a certain amount of relative value units, or RVUs , or achieving other quality or cost incentives. If you are not familiar with the RVU system, you need to become familiar with it.  Although it is considered an "objective" way to assess productivity, there are flaws with a RVU-based salary system.  It is preferable to get as high of a guaranteed base salary as possible.  

There are many other issues that may arise in an employment contract. These are just some representative examples. It would be wise to have an attorney who specializes in this area review your contract. You may not understand the ramifications of some of the clauses which are written with "legal language" which can have a significant impact on your future. It will be money well spent.  

Dr McAbee served as Chairperson of the AAP Committee on Medical Liability and Risk Management from 2004-2008. 

This column is for informational use only and should not be relied on for legal advice as a different rule of law may apply in your state. Consult an attorney for specific information.

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Electronic Health Record Use among Early Career Pediatricians - New Data from PLACES 
Ashley Miller MD, FAAP
PLACES Project Advisory Committee
SOECP Member Since: February 2014

Physician use of electronic health record (EHR) systems has shown to be both positively and negatively related to work and satisfaction.  What are the experiences of early career pediatricians with EHRs?

According to new data from the AAP Pediatrician Life and Career Experience Study (PLACES) 2014 annual spring survey, 80% of the PLACES pediatricians reported that all their medical records are electronic, 15% reported that part are paper and part are electronic, and 5% reported that they are not using EHRs (Figure 1). The survey revealed that PLACES pediatricians working in practice-based settings were equally likely as those not in practice-based settings (e.g., hospitals or clinics) to report that all medical records at their setting are electronic (78% vs 81%, respectively). But they were less likely to report using part paper and part electronic (12% vs 17%, respectively), and more likely to report not using EHRs at all (10% vs 3%).  

Among pediatricians who use EHRs, 87% said they often rely heavily on computer-based information when seeing patients, and 53% said EHRs often improve their billing.  Forty percent thought that their EHR often slows them down during clinical care, and few (37%) felt that it often improves their job satisfaction.  PLACES pediatricians in the 2009-2011 residency graduates cohort (mean age = 35 years) were more likely than the 2002-2004 residency graduates cohort (mean age = 42 years) to report often relying on EHRs during patient care (90% vs 85%, respectively) and less likely to report that EHRs often slow them down when providing care (36% vs 44%), see Figure 2.  Pediatricians in practice-based settings were less likely than those in other settings to often rely heavily on computer-based information (84% vs 90%, respectively) and more likely to say EHRs often improve their billing (60% vs 48%).​

Figure 1. Early career pediatrician report of Electronic Health Record (EHR) use (n=1,537)


Figure 2.  Early career pediatrician report of EHR use and its impact on their work and job satisfaction (n=1,451)


About PLACES: PLACES is a longitudinal study that was launched by the AAP in 2012 to track the work and life experiences of early career pediatricians; 1,800 pediatrician participants are asked to complete 2 surveys each year.  Nine in 10 participants completed the 2014 spring survey. Thanks to all our PLACES participants! 

PLACES Pediatrician Life and Career Experience Study


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Senior Moments
Richard G. Wicklund, MD, FAAP

Greetings from the SOSM (Section on Senior Members) to the SOECP (Section on Early Career Physicians).

Our section of the American Academy of Pediatrics has about 1500 members, ages 55-65-75-85 and up. We are expecting a bulge in membership as the "baby boomers" mature. The oldest pediatrician in the world was Dr. Leila Denmark of Atlanta, who died in 2012 at the age of 114 years and 60 days. She continued to practice pediatrics until she retired at age 103. My opinion is that a career in pediatrics is about the best job or profession that a person could imagine or hope for. I was fortunate to start most days of my career examining newborn babies and then seeing children and young families all day in a general pediatrics practice. 

  • Recent: At the AAP National Conference & Exhibition (NCE) in San Diego in October, the SOSM had a great half-day educational session. Prevention of heart disease and cognitive decline were discussed, along with dermatology issues. Good diet and regular exercise were recommended. Sound familiar? And look out for sunshine!
  • The NCE meeting was highlighted by a talk by Hillary Clinton, a 5K fun run, an evening visit to the USS Midway aircraft carrier, and a wealth of plenary and other sessions. I especially enjoyed a panel on gender variance and uncertainty and transgender issues by young people and their parents. The international reception featured an amazing Mariachi orchestra from Chula Vista, CA. Plenty of new material for me…
  • The SOSM presented the AAP Child Advocacy Award to Dr. Susan Boulter, who has been a tireless advocate for children and children's issues throughout her career at the community, state, and national levels.
  • My generation of physicians has largely eliminated H. Flu meningitis and decreased meningococcal meningitis. We have learned how to prevent most lung cancers and many stomach cancers. Much of the tragedy of SIDS can be prevented by sleep positioning. We know how to prevent fetal alcohol syndrome, the scientific part, that is. Challenges remain; prevention of osteoarthritis and "autoimmune" diseases, breast cancer, Alzheimer's, and on and on….

Stay involved with the AAP. Attend CME programs regularly in nice places. And before you know it, you'll qualify for SOSM membership!

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Advocacy Swagger

Tyler K. Smith, MD, MPH, FAAP
SOECP Member Since:  June 2011

This year's American Academy of Pediatrics (AAP) Annual Advocacy Day drew the most diverse group of child advocates to date. Medical students, residents, fellowship trainees, and young physicians, as well as nurse practitioners, nutritionists, psychologists, and social workers, convened in Washington, D.C., on January 23, 2015, to encourage congressional support for the reauthorization of funding for the Children's Health Insurance Program (CHIP). CHIP is scheduled to end September 30, 2015.

Child advocates began the day with a training session offered by the AAP Department of Federal Affairs staff about how to lobby medical issues on Capitol Hill. AAP powerhouse advocates, including AAP Committee on Federal Government Affairs Chairperson Marsha Raulerson, MD, FAAP, AAP Subcommittee on Access Chairperson Molly Droge, MD, FAAP, and AAP Past National President Renee Jenkins, MD, FAAP, provided presentations about their experiences advocating for children in their local community and on Capitol Hill. Attendees role-played talking points about CHIP funding to further prepare for visits with congressional staffers.

For many participants, this was their first visit to the Hill, and some were a little nervous. However, armed with training, facts, and figures, plus a little "advocacy swagger," Advocacy Day participants converged on the Hill to the offices of congressional leaders and stressed the importance of reauthorization of CHIP funding. 

During the day's debriefing, participants agreed that visits were overall successful, as most leaders supported continued CHIP funding. Staffers also provided participants with helpful and supportive suggestions for potential next steps. As child experts, it is our job, responsibility, and duty to advocate for the health and well-being of all children. By meeting with elected officials and community leaders prepped with child health information and a little "advocacy swagger," there is no limit to our abilities to advocate for children. 

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District III Update

Tyler Kimberly Smith, MD, MPH, FAAP
District III, Executive Committee, Section on Early Physicians 
SOECP Member Since: June 2011

My name is Tyler Kimberly Smith, MD, MPH, and I am the District 3 Representative for the Section on Early Career Physicians (SOECP). District 3 represents Early Career Physicians (ECPs) in Delaware, the District of Columbia, Maryland, New Jersey, Pennsylvania, and West Virginia. In our district, we are working to encourage and retain the active participation of ECPs in local chapters, the district, and the national AAP through advocacy and leadership. 

The district is currently working to organize our ECP leaders and will begin monthly conference calls starting this month to discuss the issues of YPs and to disseminate information. Any ECP interested in participating in the calls, please feel free to contact me for conference call information. Thank you to the ECP chapter representatives for your support and volunteerism in the district; your efforts and energies are greatly appreciated. Please feel free to contact your ECP chapter representative or me for opportunities to become more involved in Dynamic District 3!

Sincerely with Smiles,

Tyler

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YP Member Spotlight - District III

Julie Ellis, MD, FAAP
SOECP Member Since:  March 2015

Who are you?  I am Julie Ellis, MD, a pediatrician at Mercy Medical Center in Baltimore in the Pediatric Urgent Care (PUC). I have also been the Chair for the Maryland Chapter's Section on Early Career Physicians for the last 5 years.

Who or what influenced your career? Drs. Ronald Gutberlet and Susan Dulkerian were big influences in my life. As a college student, I spent a summer with them as an intern in the Department of Pediatrics at Mercy Medical Center. I knew I wanted to go into medicine, but didn't have much real life experience. Thanks to them, I had an incredible experience learning what it was like to be a physician. They both became life-long mentors and have supported me throughout medical school, residency, and to this day.

How did you become involved in the American Academy of Pediatrics (AAP)? I became interested in the AAP during residency as a way to advocate for children. When I graduated from residency and was looking for a job as a pediatrician, I found the perfect fit with Dr. Daniel Levy's office. He was the President of the Maryland Chapter of the AAP at the time and was a terrific mentor for me as I was starting out in the AAP. He encouraged me to get involved in advocacy and invited me to meetings, conferences, and events.

What is your favorite book and/or favorite travel destination?  To Kill a Mockingbird by Harper Lee is my favorite book. I read it at a young age and the stark reality of such injustice told through the eyes of a child was one of the defining moments of my life. I remember thinking at that moment that I wanted to make this world a better place. Becoming a pediatrician and a child advocate through the AAP are two of the many ways I tried to follow through on that dream. (The Harry Potter books are my second favorite!)

I love to travel anywhere and everywhere, but scuba diving in the Caribbean is the best!

What is your favorite developmental milestone?  My favorite developmental stage is between years 2 and 3. I love to watch kids' language skills and cognition develop and see their true personalities evolve. It's amazing how much they learn each month. Plus, some of the things they say are just hilarious!

What is the best part of your job?  I love taking care of patients. It is just that simple. I also love teaching, and it is a big part of our Pediatrics Department. Both pediatric residents and medical students from the University of Maryland rotate through our PUC. Additionally, I regularly precept and mentor nurse practitioner, physician assistant, undergraduate, and high school students interested in pediatrics. I feel very blessed to love what I do, and I hope to give others a chance to see if they love it too!

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EDITOR'S NOTE

​Please be advised that as of the February 2015 edition the Volume number for the first five editions will now be labeled Volume ONE. The second set of editions, 6 - 10, will be Volume TWO. This change is being made so that the newsletter Volume numbers coincide with the calendar year.

For information on your SOECP Executive Committee and their contact information, click here.​

Opinions expressed are those of the authors and not necessarily those of the American Academy of Pediatrics. The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. 
 
Copyright © 2014 American Academy of Pediatrics Section on Early Career Physicians

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