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March 1, 2021

Before you go…

 

Portrait of female nurse / doctor with face mask

Physicians are committed to and want to heal people - even, for many, outside of their "main" job. During their "spare" time, these physicians take on medical mission work both in the United States and abroad.

But before you take on any extracurricular activities, there are several important factors you must address.

The COVID-19 travel conundrum

Travel abroad hasn’t always been possible through pandemic. Even if you can physically get to another country, the United States may have restrictions on re-entering, regardless of the reason for your travel.

There may also be required quarantines if you arrive in another country before you could actually start treating patients, or before you can resume your main employment when you return home.

Even if a state doesn’t have formal quarantine guidelines, many hospitals and private practices have established requirements to ensure the safety of their own patient populations for physicians who have been out of state and/or abroad.

Before committing to go on a medical mission, confirm the COVID-19 circumstances both in your home community and the one you’re planning to visit.

PPE provisions

By now, many hospitals and private practices have addressed their supply chain needs to ensure physicians and staff have access to necessary personal protective equipment and the proper disposal of the same.

Before committing to travel on a medical mission, ensure the destination has the necessary and adequate ongoing supply of PPE for both you and the other staff. Moreover, ensure there is adequate and available testing protocols in place for all patients (and family members/friends) who will access the facility or clinic where the patient is being treated.

Your main employment agreement

Even without COVID, there are several primary considerations you need to address before accepting a medical mission.

Are you able to work elsewhere? Many employment agreements expressly preclude a physician from working for any other employer while working for the main employer. Alternatively, the employment agreement may require you to get written permission from your main employer before accepting a medical mission assignment.

Can you accept payment for participating in the mission? Though many physicians take on these medical missions for no pay, some opportunities may provide compensation. Similar to the discussion regarding outside employment generally, some employers may insist that any remuneration from the medical mission be paid to the physician’s main employer.

How does going on the mission affect your overall annual vacation and leave allotment? Many employers do not provide additional leave time - no matter how commendable the initiative may be - for a physician to partake in a medical mission. Assuming that is the employer’s position, balance your vacation and continuing medical education plans and commitments with your desire to participate in a medical mission. This is particularly true if participating in the medical mission will require a front-end or back-end quarantine period.

Does your medical liability insurance cover your activities during the mission? In most circumstances, your employer’s professional liability coverage will not cover your actions while participating in a medical mission. Your employer’s liability coverage may cover your medical mission activities if you provide the remuneration (if any) back to your main employer. Confirm that the sponsor of the medical mission (if there is one) has provided written proof of professional liability insurance that covers every act or omission before you agree to provide any services, and that the organization will immediately inform you if there is any change in such coverage. This caveat applies no matter the location in which you’re providing services, whether close to home or abroad.

Will your employer make a charitable donation to the mission? If your employer is able (and willing) to economically support and/or provide necessary PPE or other supplies, it could be a win-win-win for you, your employer and the medical mission organization.

Is any follow-up care required? Because you will likely only be on-site for a short period of time, it is important the sponsoring organization make arrangements for all follow-up care that patients may need post-procedure.

Even with increased use of telehealth as treatment protocol, you may not have the luxury of providing follow-up care to any patients.

Now, perhaps more than ever, physicians are in the spotlight because of the extraordinary commitment, dedication and compassion being exhibited by many throughout the COVID-19 crisis.

Physicians who are able and interested in giving back through a medical mission deserve additional praise. Before committing to a medical mission, be sure to understand the impact of COVID on your travel plans and provisions in your employment agreement that need to be addressed.

Bruce D. Armon is the chair of the health law practice for Saul Ewing Arnstein & Lehr. Bruce advises health care providers including physician groups and physicians with respect to transactional, regulatory and compliance issues.



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