Question:
Is ours the only practice left that still arranges call by seniority? The practice founders take very little call but the new recruits cover a lot of hours. This used to be common, but now we are having a hard time recruiting, apparently because of this policy.
Answer:
Actually, quite a few practices still use the seniority model -- and you are absolutely right that it is a barrier to recruitment. In repeated surveys, fellows and residents say they are more likely to choose a practice based on lifestyle issues than even compensation.
Note that this is partly about wanting more free or family time than constant call allows, but it's also about not wanting to work in a job where one is seen like a serf bullied about by omniscient masters. Partners -- even "partner-someday" employees -- want to be treated like partners.
Some practices do manage to recruit more naive young physicians, but within a few months those recruits are writing to us asking how to get out of their contracts with these obnoxious senior physicians.
I understand how the senior physicians feel -- they put in their long hours when they were young, expecting more time off when their time came. It is not unfair of them, per se, to expect the payoff they worked for.
But the fact remains that the rules have changed. Together, groups need to work out a compromise that everyone can live with.
Question:
We are in the process of building a new clinic that will have an electronic medical record. We are interested in designs for exam rooms, in particular the work surface for the PC. Have you seen any changes that practices have made as they go to an EMR?
Answer:
The changes you'll need to make depend entirely on how you plan to use your EMR.
Ideally, if physicians will use the EMR in the exam room -- whether on a tablet, laptop, or desktop -- they should have room to set down their PC with sufficient space around it for paperwork. It's great if patients can be positioned so that the physician can sit next to them while using the EMR. Try to avoid forcing the physician to use the EMR with his back turned to the patient.
If the EMR will be used between visits, some practices use standing-room only "dictation pods." This is a space off the main exam room hallway with a small counter -- positioned high enough to use a PC on it while standing. Physicians can pop in there between visits for some privacy to create a chart without leaving the exam room area.
Question:
One of my partners decided to move out of state. Rather than replace him, we're just going to run a smaller practice. Because of this reduction, we are going to lay off a full-time employee. I'm very familiar with firing an employee, but want to know how laying off an employee differs from firing.
Answer:
Conducting a layoff is very similar to a termination. However, if the layoff is due to "lack of work," the employee is eligible for unemployment insurance and benefits continuation as a terminated employee. Be sure to provide the employee a letter explaining the reason for the separation -- "lack of work" -- and the details of the severance package (if any).
Question:
We started to offer the flu vaccine to serve the community. The cost is $20 cash-only; we don't do any billing. Since many of these patients have Medicare, is this allowed? People will pay $20, but Medicare may not pay that much.
Answer:
If flu shots are a covered service, you have to bill for them (otherwise you are essentially requiring the patient to pay for the service twice). If the flu shot is not a covered service, you can provide it as a self-pay or cash service.
Medicare pays for flu shots once every flu season. The shot can be given within the same calendar year and still be reimbursed. For example, a patient can have a flu shot in January 2004 and again in November 2004.
Be aware that you should not offer services to anyone for less than Medicare rates. You don't want to be seen as offering illegal incentives to patients.
