Malpractice

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It takes about four-and-a-half years from the start of a lawsuit to the end, and the average cost to the defense in legal fees was $94,284 in 2004, according to the American Medical Association. - http://www.forbes.com/2008/05/05/physicians-training-prospects-lead-careers-cx _tw_0505doctors.html - limit to 600 patients - must have hospital nearby - andrews texas, alpine, stanton, Harlingen, Texas (best choice?) - http://www.areavibes.com/tx/ - http://www.texastribune.org/2010/01/07/tough-to-recruit-doctors-in-rural-texas / - http://www.usatoday.com/story/money/business/2012/10/20/doctors-shortage-least -most/1644837/ - http://ifmofsa.com/ - http://www.medscape.com/viewarticle/758140_1 (Cash-Only Practices: Doctors Are Rethinking Their Objections) - https://pcdsimplicity.com/medical_homes/integrative-family-medicine - http://www.mysanantonio.com/news/local_news/article/Sick-of-status-quo-doctors -test-no-insurance-3500678.php#photo-2842062 - http://www.drgregmaul.com/AboutUs/DiscountedCashPayProgram.aspx (founder is 62 in 2013, only did an internship) http://www.kevinmd.com/blog/2012/04/future-medicine-aspiring-young-doctors.html Hospital Privileges: ability to use the hospital facilities (but does it increas e income) http://www.tmb.state.tx.us/consumers/faq/malpq.php Malpractice Questions Does TMB keep any statistics on medical malpractice claims filed against phy sicians? TMB no longer produces this report; historical reports from 1986-2003 are av ailable through open records request by contacting [email protected] Do I have to go through the Medical Board to file a liability claim against my physician? No, the Medical Board does not evaluate, give advice, or handle civil liabil ity claims. Those are heard in the civil courts. Has my physician ever been sued? TMB is required by law to "review the medical competency of a physician agai nst whom three or more expert reports under Section 74.351, Civil Practice and R emedies Code, have been filed in three separate lawsuits within a five-year peri od " If such a review leads to disciplinary action, it appears in the physician s Pr ofile. Otherwise TMB cannot make such information public. To learn if your physi cian has been sued, contact the Clerk of Courts in the county where the physicia n practices. Does a physician have to have malpractice insurance? Texas statutes do not require physicians to carry malpractice insurance. Man y hospitals, however, will require a physician to carry malpractice insurance as a requirement for privileges at the hospital. http://www.medscape.com/viewarticle/735134_2 Will Self-Insuring Avert a Lawsuit?

For physicians who are not burdened by any legal requirement, it may be tempting to "self-insure," in hopes that the absence of any available pot of money will dissuade a plaintiff's attorney from filing a suit. Unfortunately, a plaintiff's attorney usually will not know whether a physician carries insurance until afte r a lawsuit is initiated. To address this concern, some physicians have posted s igns in their offices to notify patients that they do not carry professional lia bility insurance. Doctors need to consider the effect of those signs on an indiv idual practice and the physician/patient relationship. Another option for physicians who wish to go bare is to purchase a "defense-only " policy. These policies pay for the defense of a negligence suit, but do not of fer any indemnity in the event of a payout. The theory is that plaintiff's attor neys will not waste valuable resources chasing down an individual without the me ans to pay for a large verdict, but who does have the resources, through his or her policy, to defend the case through trial. This tactic also comes with significant risk, though, especially where the physi cian either has substantial assets that may be attached, or the likelihood of ea rning significant monies during the remainder of his or her practice. Any judgme nt will lead to a lien on a physician's assets, including receivables, and even garnishment of future wages. Younger physicians, with large earnings potential, will find it difficult to have these liens discharged in bankruptcy. -------------------------------------------BE doctors pay 15% more for malpractice insurance than BC doctors -------------------------------------------I don't know what the requirements are in MA, but I have been taking time off fr om residency as well in Maryland. After getting my license, I soon found out tha t it is VERY difficult to actually find permanent work with just 1 year of resid ency. What I have been doing is mostly employee physicals through temp agencies. These jobs usually last around 3-4 days and come up every few months or so, but the pay is incredible. I make as much money in those 3-4 days as I did in an en tire month of residency. Also, you don't have to worry about malpractice insuran ce because you are covered by the temp agencies, and the risk of being sued is e xtremely low because you are not diagnosing or prescribing anything. Another job I've been in talks with recently has been with a radiology center looking for a doc to just be present on the premises in case someone has an allergic reaction . They are currently looking into malpractice options for me. Another option is a company called MDSI which does disability physicals, but they are only located in certain states. http://forums.studentdoctor.net/showthread.php?t=305437 I know a GP who has a great job at a correctional facility. He basically sends h is complicated cases to other doctors anyway... Agree with everyone above. There are other avenues to explore though (I am not a dvocating all as being on the ethical high-ground) 1. Get training in cosmetics and go into medical spa stuff (and know that you ar en't anywhere near a plastic surgeon) 2. Get training in CAM stuff and go into practice (knowing that you'll be scammi ng a large number of patients to varying degrees) 3. Become a weed doctor.

4. Get into CAM and be a weed doctor http://www.pressherald.com/news/physician-finds-niche-dispensing-marijuana_201012-12.html http://www.drsulak.com/the-practice/practitioners/dustin-sulak/ http://forums.studentdoctor.net/showthread.php?t=827410 1) Join the military and be a general medical officer. Provide primary care to a ctive duty servicemen either in garisson or in a warzone. Think of it as adolesc ent medicine with a particularly healthy patient population Unfortunately if you don't get board certfied there is a limit to how far they will promote you. 2) Do primary care in undesirable areas. Really undesirable, like rural flyover country 3) Prison medicine. If you prefer working at a larger medical center, most priso ns systms hire Internship only docs for their primary care slots. 4) Drug medicine: if you're not that ethical, you can make a good living writing a series of perscriptions for methadone or, in California, for Pot. This should not be confused with a career in actual rehabiliations centers, which generally hire fellowship trained psychiatrists. 5) Cosmetic procedures. Anything defined as a 'cosmetic procedure' like hair tra nsplant surgery, laser skin resurfacing, or botox isn't yet under the umbrella o f a particular residency, but is still practiced by anyone with a license. For p ractical purposes, of course, you probably want to do some kind of an apprentice ship under someone who knows what they're doing first. 6) Anything you want, if you're willing to set up your own shop operate with exp ensive/no malpractice insurance. A medical license entitles you do anything medi cal, and perscribe any drug. Residencies are trade organizations and your diplom a from them has no actual legal standing. If you're willing to set up shop on yo ur own you can, theoretically, set up practice as a neurosurgeon, nephrologist, or whatever. Down the street from my medical school there was a dermatology prac tice run by a guy who had no training other than an Internship in Neurosurgery. It drove ther dermatologists nuts (they may also have had a point about his comp etence) but there was nothing they could do about it. He was a doctor, and a doc tor can practice any part of the field of medicine. Now arguing that you met the 'standard of care' to a jury, or obtaining malpractice insurance, is of course a whole other animal. I think you provided a good overall run through of options. I'd also like to add that doing medical evaluations for Medicare, disability, etc pays moderately de cently. You can also be a "medical director" for spa type places (you don't even need to open the spa yourself/invest any $$), just need to supervise it, and ca n make a cool 5-10 grand at some places, you can also work in healthcare consult ing which has become a boom industry recently and pays more than many specialtie s sadly, work for epic, look into healthcare management, etc http://forums.studentdoctor.net/showthread.php?t=958909 when i did my IM rotation we had to do an attachment out in the community. i got sent to some building to work in an outpatient IM office. in another part of th is building was a slick office that was a "medical spa". its waiting room looked like the lobby of 5-star hotel. i later learned the doctor for the medical spa had either quit or been dismissed after her internship year and never finish a r esidency. all she did all day was botox for women and sell them beauty products. apparently it costs a few hundred per botox treatment and it takes 10 minutes o r so to do. cash up front, son. she herself looked like a supermodel and drove a new McLaren SLR. oh and the office hours posted on the door of her spa? mon-thu

rs 10 a.m.-4 p.m. http://forums.studentdoctor.net/showthread.php?t=715860&page=2 1. 2. 3. 4. automated sales recurring revenue no A/R sell tools, not dig for gold

To be eligible to serve with IHS as an allopathic or osteopathic physician, grad uates must complete at least one year in an approved graduate clinical training program. Completion of post-graduate training is a critical factor in identifica tion of the practice in which the scholarship obligation is to be fulfilled. Sch olarship recipients who elect to serve after only one year of graduate clinical training will compete with board eligible practitioners for a limited number of vacancies and may experience difficulty in identifying assignments in which to s erve. Therefore, in order to become fully qualified practitioners, graduates are encouraged to complete training in an approved specialty. http://www.ihs.gov/scholarship/payback.cfm? Like you said, she is a licensed MD. While definately not recommended or encoura ged she could still work as a physician. The jobs would be limited, but I person ally know 2 physicians that did not complete 3 year residencies, but function in the role of a family practice physician in rural areas. There are alot of peopl e who have no comprehension of the true need of physicians in many rural areas. One of the docs is my brother in law so I speak with some experience. There were certain family needs that forced him to not finish. He currently works in a cli nic as well as takes call in local ED for 5-6 shifts per month. Easily makes ove r 200K and is very happy. While there will be people who read this post with dis gust, he is serving in an otherwise underserved community. He is the only doc in a town of 2000 people, 15 miles from the nearest 20 bed hospital, 50 miles from a hospital with an ICU or cardiac/stroke care. Would you rather see a MD who we nt through 4 years of med school and 1+ years of residency or go a clinic staffe d only by a NP whose preceptor is 50 miles away? This path is not for everyone and if she is not up for something like this then maybe the research or medi-spa route would be the way to go. You don't even need an MD to do those jobs http://forums.studentdoctor.net/showthread.php?t=899869 1. Just because an LT company is talking to you, that doesn't mean they are goin g to find you a job. 2. It is very atypical to sign a contract with an LT company. Usually they find a practice opportunity, and you sign a contract about that job / position. If th ey are having you sign a contract just with them, why? 3. No matter what, make sure that anything you sign doesn't cost you money. You shouldn't have to pay for anything -- licensing, travel, etc. It also shouldn't prevent you from finding your own job, or working with a different LT company. Here are my Tips / Traps for Locum positions that I share with my residents. In the spirit of fluu disclosure, I didn't write this -- one of my graduating resid ents who did a year of LT before fellowship did: Locum Tenens: Don t Get Screwed Before making even that first call to a locum tenens company, you need to be pre

pared. Hopefully this will help. 1. What is locum tenens? As a locum tenens doctor, you will be an independent contractor. The locums comp any will hook you up with a job somewhere, but you are not an employee of the lo cums company nor the firm/hospital where you work. This is important to realize because (a) you will be in a higher tax bracket, (b) you get no benefits (e.g. y ou must buy your own health insurance), and (c) you get paid by the hour, so if you don t work (e.g. on a sick day), you don t get paid. 2. What happens when I call the company for the first time? You will be connected with a recruiter. Make no mistake about it: this person is not your friend. You must approach your dealings with this person as if you are dealing with a car salesperson; a healthy dose of skepticism is a must. That be ing said, you want to be civil, because the recruiter is not going to want to su lly the company s reputation by placing a rude doctor who has the potential to pis s off the people in the practice in which (s)he is placed. The recruiter will as k you a bunch of questions about what you are looking for (hospitalist vs. outpa tient vs. mixed), which geographic areas you are interested in, etc. Think about what you want BEFORE making the call. These recruiters love it if it seems like you don t know what you want. Why? They will TELL you what you want, talking up v arious jobs they couldn t get anyone else to take. They figure, since you are wish y-washy, it will be easier to push you into what they need to fill. 3. Government jobs vs. private practice. The advantage to working for the govt (i.e. for a VA hospital or clinic) is that you only need ONE state medical license in any state and you can then work at any V A in the country. Also, it is likely that the VA will let you use their DEA #, w hich is a huge plus coming right out of residency, because your own DEA # can ta ke a LONG time to come through. The disadvantage to working for the govt is that the salary is less and everything that the locums company provides for you (apt , rental car, etc) is going to be more no-frills. For example, most private-prac tice outpatient salaries are about $60/hr, whereas the VA outpatient work usuall y pays $45-50/hr. Private-practice jobs will give you a bigger, nicer car with p ower windows, while the VA jobs will give you a Chevy Cavalier with manual windo ws. Get the picture? All that being said, the job descriptions for the govt jobs seem to be more standard than the private-practice jobs. There seems to be high er potential to be abused in a private job, where they can basically set any sch edule for you they want, as long as you agree to it and sign the contract. As yo u all know, outpatient clerks, nurses, etc. at the VA start to disappear around 4pm, which means that your hours will be more predictable. Also keep in mind tha t you will get holidays off when you work for the govt. If you want to go private, make sure you find out from the recruiter how long it usually takes to get a license in the state you want to work. For example, CA c an take up to 9 mos, whereas some other states have special locums/temp licenses that can come through in 1-2 mos. This brings me to the next point: 4. How many licenses should I get? The recruiter may try to get you to sign up for a few licenses up front. This wi ll be tempting, because they handle most of the paperwork. Also, they will try t o stick a clause in the contract that says something to the effect of if you don t work in a state where we get you a license, then you must reimburse us for the c ost of that license. Negotiate that point; they should pay for at least one or tw o licenses for you as a cost of doing business. Also, keep this in mind: a wise man once said, Be careful about signing up for licenses you may not use; they wil l haunt you for the rest of your life. As much as I hate to admit it, he is right . Even if you don t USE a license, once it is issued, you will have to include it on every form you ever fill out for the rest of your life. This will possibly de lay your various applications for various things while your history in every state

in which you are licensed is checked out. 5. When I am presented with an opportunity by a locums company, how long should I commit for? This is a highly personal decision. Your chances of a practice wanting you are b etter if you commit up-front to a longer tour of duty. Obviously, the practice w ants to train as few people as possible, so if you say you can work from Sept-Ja n and another doctor says she can only work from Sept-Nov, you will probably get the job. But, make sure you know everything about the job before committing to longer than a month or two. 6. Talk to the supervising doctor at the practice/hospital at which you re thinkin g about working. OK, so the recruiter calls you with a job opportunity that sounds pretty good. I strongly recommend asking for a contact person at the job. These recruiters kno w almost nothing about how a practice or hospital really works when it comes to call schedules and censuses, etc. You want to have a list of questions and get t hem all answered by someone who KNOWS i.e. someone who works there. Take notes whi le you talk to this person everything they say will need to go into the contract y ou sign later. Beware, the recruiter may want to keep you away from a contact pe rson, telling you something like, We try to get as complete a description of the job as we can, to make it easier for you. Nonsense. They just don t want you findin g anything out that you may not like, which would kill the deal. Better to find out before you move across the country. In a normal job interview, you would pro bably never ask some of the things up-front that you MUST ask when you are deali ng with a locum tenens situation. Do NOT be shy about nailing down the details o f call, hours, number of patients you will be expected to see, etc. If you don t a sk, the practice WILL take advantage of you. Think about it they re paying for your time, and they don t need you to be really happy if you re only going to be there a couple of months, so their goal is to milk as much work out of you as is possibl e in the specified time period. Remember, if you are talking to them on the phon e, it is because the recruiter has already presented you to that practice, and the practice likes what they see on paper. They will hire you without ever speaking to you that s how locums works. So don t worry about talking to them about job specif ics. 7. Don t just get it in writing, get it in writing EARLY. The locums company will ask for a verbal commitment from you as soon as a practi ce indicates that they want you. Once you give your commitment, you are already in a weaker position to bargain. The locums company can and will wait until the very l ast minute to present you with a contract. Then, at that last minute, they will put things in there that shouldn t be and eliminate other things that should be. Y es, the famed bait and switch. They figure you ve been counting on this job and will sign just about anything. DO NOT BECOME A VICTIM OF THIS! Early on, you need to type up those notes you took about the job details and e-mail them over to the recruiter. Ask the recruiter to add a little sentence in there about how the det ails as you have described them look about right. If they try to change things w hen you actually get the contract, you will at least be able to show them what t hey previously agreed to, which may make it a little easier to get it into the c ontract as it should be. Also, make sure you get some sort of e-mail or prelimina ry contract early on that includes all the details of payment, termination clause s, etc. For example, perhaps you are negotiating for a govt outpatient job that will be paying $50/hr. Make sure you know IN ADVANCE whether this job pays overt ime, and at what rate. If overtime hours (anything over 40 hrs per week, usually ) are billed at the standard rate instead of 60, 70, or even time and a half, yo u want to know that up-front, so that maybe you can find a different job that pa ys overtime hours at a higher rate. Make sure you ASK about the holiday policy. What is standard for private practice contracts may not apply to some govt contr acts. For example, holiday pay is often 1 ½ times the usual salary. If you don t wor k on a holiday, but you have to work the day before or the day after a holiday,

then you may be entitled to receive ½ the usual pay on the holiday (i.e. you get h alf pay for NOT going to work). Also, think about the termination clause. Usuall y, a practice has to give 30 days notice; beware the locums company that tries t o put in a clause that says you can be terminated at any time without notice or compensation. Many of these notice clauses are in the generic contract, but may be c onspicuously absent or radically changed when you receive your assignment-specif ic contract. You should also insist on a clause of your own: If the reality of th e practice fails to conform to the practice description that is in the contract, then the Physician [that s you] may terminate the contract with 10 days notice. 8. Contracts, malpractice, and payment. READ every line of the contract. Yes, most of it is a generic contract, but just about every line is negotiable. ASK about whether the locum tenens company s malp ractice insurance has a tail. That is, you want to make sure that no matter what h appens when, if you ever get sued, you ll be covered no exceptions. KNOW how and whe n you will get paid. If the practice takes its sweet time paying the locums comp any every two weeks, does the locums company guarantee your salary to be on time , since the check will likely come directly from the locums company? Worse yet, if the practice defaults, will the locums company pay you out of its pocket and deal with the practice later on the company s time, not yours? 9. Don t sign it if it isn t right. If the locums company tries to screw you at the last minute (or at any time, for that matter), don t sign the contract. So what if it s the day before you are sched uled to fly out to the practice? Insist that the locums company present you with a contract that you find acceptable. Do not get on a plane until that contract is signed and countersigned. Once you get to the practice location, you have no bargaining leverage whatsoever. Remember, the locums company s reputation depends on you being at the job as originally promised to the practice. The company will not let the deal fall through. You CAN hold the deal hostage if they are being unfair to you. They know you want the job, but if they think you re willing to kil l the deal on a certain point, they will cave to some extent. 10. Why so much space devoted to getting screwed by the locums company? It has to do with how the company gets paid. There are different financial situa tions for govt and private practice, but let s take the govt jobs as an example. G ovt jobs are often a bid. This means that several locums companies vie for the pri vilege of providing their physicians to that govt facility. Obviously, the compa ny with the best combination of a low bid and doctors that the facility is inter ested in will win the bid. So, let s say that Locums Company X successfully wins t he bid at a price of $90/hr. Company X will now receive $90/hr from the govt for every hour the physician works. So out of that $90/hr, Company X will pay the p hysician his/her hourly wage, buy the physician s round-trip airfare (if applicabl e), rent the physician a car, pay for a furnished apt and utilities, etc. You ca n see that, for every dollar Company X does NOT spend on the physician, that is a dollar that goes into Company X s pocket. Get ready to be nickel and dimed, peop le. Make sure you ask about EVERYTHING up-front. If you must have a certain amen ity (like a dishwasher or W/D) in your apt, make sure the recruiter knows that u p-front and that it will be a deal-breaker if they try to screw you. 11. With all this talk about getting screwed, why do locum tenens at all? Well, you can live in parts of the country you ve never seen before. You can make a lot of money and not have any expenses other than food, entertainment and, iro nically, personal medical insurance (malpractice is covered by the locums compan y). You can kill time while looking for a more permanent job or waiting to start a fellowship. If you are waiting for one year to start your fellowship, locums will be ideal, because most practices don t want to hire someone as a perm if that d octor will only be around for one year. Also, keep in mind that many practices h

ire locums docs with the intent of making them into perms, so you can try out a practice for a couple of months risk-free and then decide whether to join or not. http://forums.studentdoctor.net/showthread.php?t=765324 I know many a doc who simply did a prelim year, got a medical license then opene d a biz. In fact one of the most prosperous "dermatologists" in my community is one of those, much to the dismay of all the boarded dermies who were AOA and did fellowships.....its all MARKETING guys. Seriously, this guy graduated from some butt crack medical school too, but you would never know it from his super flash y website and ad campaign. If you really want to make the bucks, skip residency, its a waste. Stick to easy, cash paying modes of healtcare delivery. On the same note, I met a Vietnamese guy, around 25, did 1 year of gsurg, bailed and is now doing medical directorships for laser skin centers........net yearly pay: 1million+. all us working stiffs are pure suckers!!!! I know of a guy who graduated from our TY program about 10 years back and now pr actices as a GP. He now does a bunch of alternative stuff, like crystals and vit amin megadoses. Needless to say, he rakes in the cash. If you look at any income table for physicians, you'll find GPs mentioned. By de finition, they have not completed a residency but are board certified. http://forums.studentdoctor.net/showthread.php?t=327256

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