Transition from Resident to Attending

Before inking hospital employment, check the medical staff bylaws

Timothy M. Smith , Contributing News Writer

AMA News Wire

Before inking hospital employment, check the medical staff bylaws

May 15, 2024

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.

Half the dues, all the AMA benefits!

  • Laurel Road student loan refinance: 0.25% rate discount.
  • Access to the JAMA Network™, ClassPass gym discounts & more!

Supporting you today. Protecting your future.

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.

Download the latest AMA Physician's Guide to Medical Staff Organization Bylaws (PDF), which is also free for AMA members.

It 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. 

Subscribe and thrive in residency

Get tips and insider advice from the AMA on navigating and making the most of medical residency—delivered to your inbox.

Illustration of resident looking at a diagnostic image

“The medical staff should be the umbrella organization,” Snelson said. “It represents and sets the standard for the entire medical staff—not just the independents, but also the employed doctors. Under that umbrella, employed physicians should have the same rights and protections that independent doctors do. They should not be subject to manipulation by being fired.”

That's the purpose of the AMA Physicians’ Guide to Hospital Employment Contracts, Snelson noted.

“These are complicated issues. There's a lot to think about,” she said, noting how important it is to hire a physician-friendly lawyer to review any hospital employment contract. “We need to physicians to understand that even if they read every word of the guide, they need to hire a lawyer for help with the contract before they sign it.”

She encourages physicians to consult with a lawyer who understands employment contracts for physicians by hospitals. “All those pieces” are needed, she said.

The AMA has assembled a variety of resources to help physicians flourish in the employment setting. That includes developing the Annotated Model Physician-Group Practice Employment Agreement (PDF) and featuring experts’ perspective on collective bargaining for physicians.

Learn more with the AMA about understanding physician employment contracts.