Many hospitals these days are staffed by employed physicians and independent doctors, but that doesn’t mean they all enjoy the same protections from hospital manipulation and termination.
“One of the major concerns of hospital employment is that the hospital may have a lot of influence over the doctor because they can fire her,” said Elizabeth A. Snelson, president of Legal Counsel for the Medical Staff PLLC, which specializes in working with medical staffs, medical societies and medical staff professionals.
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Snelson is the author of the AMA Physicians’ Guide to Hospital Employment Contracts (PDF), free for AMA members, which provides expert guidance to physicians contemplating, entering into or working under employment contracts with hospitals or related entities.
“They can't fire the independent surgeon. They can go after her, sure—they can abuse peer review to limit her privileges, and they can direct referrals to their employed surgeon instead,” Snelson said. “But an employee can get fired on Tuesday just because it's Tuesday, if her contract permits.”
All of which points to a crucial step in the hospital employment contracting process: If you’re considering hospital employment, you need to see the medical staff bylaws.
Beware of how hospitals operateIt might not always be obvious which physicians on the medical staff are employed and which are independent, Snelson noted. For example, it wouldn’t be unusual to find a hospital where an entire department, such as pediatrics, is employed but everyone else is independent.
This can have implications for quality of care, patient safety and physician autonomy. The big worry: Instead of the medical staff credentials committee doing what it is supposed to do—i.e., determining whether a doctor meets the medical staff’s qualifications—the employed members of the committee could be pressured to do just the opposite.
“If, say, an employed physician is on the medical staff credentials committee and the hospital is spending a lot of money in recruiting fees to get an elusive pediatric neurologist, the hospital’s administrators might tell the employed physician, ‘We know she’s not the best pediatric neurologist on the planet, but we want you to waive the requirements because we want her. And if you don't vote the way we want you to, we'll fire you,’” she said.
Learn about the AMA Organized Medical Staff Section, which gives voice to—and advocates on—issues that affect physicians affiliated with medical staffs, whether employed or in private practice.
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