So goes The Rolling Stones’ famous song: "Time is on my side, yes, it is." When you’re looking to start a new job, there are certain things that should be done to ensure that time is on your side, too.
These guidelines apply before you start a job, while you are in that job, and when you decide to transition to the next job.
After you have received, reviewed, negotiated and executed an employment contract, there will be things you need to have in place before you can actually start work.
It is important to remember that a medical practice or medical facility is a business. If a physician can’t provide services and is not generating revenue, a smart businessperson will not let that physician start working for the organization until the provider can generate revenue.
Three items are generally essential to have before a physician can actually start a new job:
All three of these take time. If they are not each done properly, it may delay your start date.
Getting a state license is often a prerequisite to obtaining hospital credentials and third-party payer credentials.
Each state requires physicians to provide different information to obtain a state medical license. In addition to providing basic contact information, a physician will likely have to provide evidence of college and medical school graduation, residency training, test scores and perhaps a character reference.
You’ll want to ask the applicable state’s medical board for a copy of its current licensing requirements and the expected timeline to secure a medical license once the application is deemed complete.
Physicians may also choose to secure a state medical license through the Federation Credentials Verification Service (FCVS). Physicians who participate in the FCVS can aggregate a core set of information that is typically relied upon by state medical boards. It may take several months for you to secure a state medical license even if you submit a complete and accurate application and have nothing unusual to describe.
Once you have a state medical license in hand, you can go about securing hospital and other facility credentials and third-party payer credentials. These two sets of credentials can often be secured on parallel tracks. It is important for physicians to remember that obtaining these items is a privilege, not a right. A hospital or an ambulatory surgery center will likely ask you to complete a voluminous application with many "check the box" answers. If a physician answers a question in a certain manner, the physician may have to provide an explanation on a separate sheet of paper. A hospital or ambulatory surgery center does not want to be embarrassed in the future by a physician’s actions or inactions, so facilities reserve the right to ensure any member of their medical staffs is qualified as they deem appropriate. Similarly, a third-party payer may not make a physician a participating provider in its network until the physician has secured privileges in a hospital or ambulatory surgery center to provide the payer with assurance that another sophisticated organization has vetted the physician’s background.
It is imperative that the physician honestly answer each of the questions asked by a state medical board, a hospital and a third-party payer, even if the physician believes that the answer would not be viewed favorably. If anyone in these organizations thinks they are being misled, the timing of completing the process will likely slow dramatically. Similarly, if an organization learns in the future that a physician was dishonest in his or her credentialing materials, the consequences may be more severe than if the physician had answered honestly in the first instance.
"Now you always say that you wanna be free."
Your timing obligations do not end with the initial licensing and credentialing. Once you start the job, new timing issues emerge that are equally if not even more important than the pre-job matters.
Your contract may describe how many patient encounters must occur in an hour or a day or over the course of a contract year. Your failure to meet these thresholds may result in reduced pay or elimination of bonus opportunities.
The physician’s contract or the employer’s policies and procedures may specify how much vacation and continuing medical education and general leave time you may take. The contract may specify how much time must elapse before you may be considered for a promotion.
A physician will likely be expected to complete medical records and claims submissions in a timely manner. The timeliness requirement may be the same business day or within 48 hours of seeing a patient. If a physician does not complete the medical records completely and accurately so that the employer can submit the claim to the payer, the employer will not get paid for the services the physician provided. If the employer is not getting paid, the physician will likely not get paid - or worse, the physician may be in danger of losing the job.
"You’re searchin’ for good times, but just wait and see."
Your contract should state the length of the initial term and the renewal terms, and the timing of when a decision will be made as to whether the term renews.
Be aware of how much notice is required to leave a job without cause for both you and your employer. (The timing may not be the same.)
In situations where a physician has done something inappropriate and is concerned that his or her employer may terminate the contract, a physician should understand what constitutes "for cause" termination and whether they will get a second chance to correct a breach. The timing for "for cause" termination may be different from "without cause" termination.
A physician’s contract may include noncompete and nonsolicit clauses that prohibit the physician from working within a radius and contacting patients and referral sources for a designated period of time. Be sure to understand these restrictions before securing your next job.
"You can’t always get what you want."
The Rolling Stones had it right: You can’t always get what you want. However, you can achieve your professional goals by being proactive and securing a state license far enough in advance of a job switch to help ensure the timely receipt of necessary facility and third-party privileges. Understand the timeliness requirement embedded in the contract and the employer’s policies and procedures to ensure satisfaction during your job and to have a smooth transition to your next practice.
Bruce Armon, Esquire is a partner and chair of the Health Care Group and Karilynn Bayus, Esquire is an associate in the Health Care Group of the law firm Saul Ewing LLP. They assist physicians and medical practices with legal, regulatory and compliance issues.