Unique aspects of a hospitalist contract

When compared to other specialties in medicine, the hospitalist position is relatively new. Developed out of a need to meet the surging demand for inpatient services, the hospitalist plays a vital role in responding to acute cases that require 24/7 attention.

The uniqueness of the hospitalist's position does not just end at the actual job duties, but extends to the employment contract as well. There are a few key areas that require extra attention when reviewing and negotiating a contract as a hospitalist, these include: work schedule, productivity and the non-compete.

Work schedule & time off
Hospitalists differ in that they typically are scheduled in shifts, such as seven days on/seven days off, rather than a typical 8am-5pm, Monday through Friday schedule. This model was created because it is attractive to physicians who want a fixed and predictable schedule. Looking at this without context, it would seem that this schedule allows for plenty of free time when compared with another physician who may work a more traditional schedule. However, when calculating the hourly total, hospitalists could actually be working much more. This is due to the fact that there may be an expectation that a hospitalist will cover a 24 hour shift. This setup can skew what appears to be "time-off" and result in hospitalists not being offered fair vacation or CME time.

If a hospitalist is part of a group, they may be able to prevent this 24 hour coverage expectation by relying on non-physician providers or specialty providers that are willing to cover nights. Or, they can share the load with fellow hospitalists by rotating night coverage within the group. Regardless, if the schedule is based in shifts, there should be a well-defined explanation of the hourly work expectations. This allows for an apples to apples comparison to physicians in other specialties and creates leverage when negotiating vacation and CME time.

As mentioned before, a hospitalist's schedule will probably be shift-based. The most popular way to schedule these shifts is either five days on /five days off or seven days on/seven days off. Again, it may appear to be an appealing schedule, but it does not always provide the greatest satisfaction as far as work/life balance or income potential. For instance, if every hospitalist in a group or hospital is locked into the same shift schedule then that reduces the opportunities for any one physician to log extra hours and increase income. Figuring out whether there is potential to pick up extra shifts or swap shifts with fellow hospitalists is key in making sure the contract is flexible enough and fair.

When negotiating a contract, it is important to have clearly defined guidelines when it comes to productivity and how it will be measured. A hospitalist's production will be dependent on the inpatient volume of the hospital. Sometimes there may be a full service, while other days may be much slower. Hospitalists should get an idea of the maximum and minimum number of patients expected to be covered so that they are not spread too thin when the volume gets too high or punished when the volume gets too low. One preferred method of productivity measurement for many hospitalists is payment according to relative value units (RVUs), as opposed to being paid hourly. An RVU system will provide a clear understanding of the number of patient encounters and provide an accurate production number for reference.

A physician working as a hospitalist is also able to work in an outpatient/clinical setting. The non-compete clause of any hospitalist contract should be reviewed carefully by a healthcare attorney to determine whether or not an outpatient position would violate the non-compete. Many physicians do not intend to work as a hospitalist long term, generally because having to work 12 to 14 hours a day, with the possibility of 24 hour call, does not necessarily fit well with daily personal responsibilities of their family. This makes understanding a hospitalist non-compete crucial to any contract analysis.

Hospitalists have unique needs when it comes to their contractual obligations, especially in regards to their productivity, work schedule and their non-competes post termination. Whether increasing schedule flexibility or boosting income, hospitalists should understand the basics of what sets them apart from other physicians. Keeping these aspects in mind when it is time for contract negotiations can be vital in securing a job that benefits both the physician and the employer.

Kyle Claussen, JD is the Vice President of Resolve Physician Agency and a seasoned physician contract attorney who adds tremendous value to Resolve clients through guidance on the intricacies of physician-employment agreements. Kyle is one of the leading physician contract attorneys in the nation and has assisted thousands of physicians across all specialties.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.​

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