It is usually between November and February when calls come from physicians who are finishing up their residences, fellowships or first term of hospital or clinical employment. Understandably, they are each anxious to solidify the terms of their future professional engagement - particularly with respect to those just finishing their training - who have had limited opportunity to consider and plan the cascade of steps that will constitute their evolution and development as health care providers, employees of business owners. For some, the issues revolve around maximizing income out of the gate; for others, geographic flexibility may require substantial attention to restrictive covenant and non-solicitation provisions. Whereas, still for others, prospective elevation to ownership status may be of paramount concern, while to some, the issue of time flexibility is necessary because of other real-life factors. Our firm navigates these physicians through the process so they can attain a professional arrangement that best meets their needs.
Here, it is essential that we arrive on a reasonable agreement terms concerning our client’s right to access and copy patient records, billing records, and an accord of the client’s right of patient and staff solicitation upon termination of the employment relationship. Patient service productivity, often accomplished by the work of the physician's own hand, is somewhat correlated with that doctor’s financial contribution. Therefore, we typically explore the possibility of a physician compensation paradigm that blends productivity, substantive contribution, citizenship and a willingness to assume some of the less desirable work that is necessary for a practice to function.
The enjoyable part of this work is coming to work with the physician looking to take the first step toward hopefully a very long, rewarding and satisfying career. Real-life planning is very much a part of contract negotiations, and we encourage our clients to consider as many aspects of their personal plans while they are considering engagement with a new employer. Similarly, a health care provider that has been in the game for some time comes to us with a better sense of his or her options, abilities and the marketplace. As such, the discussion about expectations, as well as short and long-term plans, can be accomplished both efficiently and specifically for each individual. Here, we spend much less time on education and solely focus on advancing these clients to the next level of their game.
When appropriate, we believe in the Professional Service Agreement (PSA) allows a physician greater flexibility to work in one or more practices while also enjoying the benefits of a compensated hospital service affiliation. We frequently use PSA's to bind group practices to deliver services as captive agents of a hospital system and thus permit future flexibility for those physicians who do not want to remain controlled by the hospital. This is more in the nature of a practice leasing arrangement than a wholesale winding down of the practice entity with simultaneous transfer of the staff, patients, office facilities, equipment and patient care records to a hospital owned entity.
We also prefer use of PSA to create arrangements between or among practice entities to provide specialized professional services to patients of another practice. Here, of course, we are mindful of those regulations, statutes and rules which find their origins in the Stark laws and antikickback laws. We often find compliant ways to arrange the delivery of services while utilizing the PSA while remaining within the safe harbor of the antikickback laws.