Transition from Resident to Attending

Physician contracting: Job duties and liability insurance


What hours will you be responsible for being on call? And what are the two kinds of medical liability insurance?

In an episode of the AMA’s “Making the Rounds” podcast, AMA senior attorney Wes Cleveland looks at how you can negotiate your duties as part of your employment contract and also touches on liability insurance.

Cleveland has been a practicing attorney for over 23 years and, prior to joining the AMA, worked for the Texas attorney general, the Texas Medical Association and in private practice representing physicians. This episode is the fifth in a six-part series on navigating contract negotiations from start to finish.

Below is a lightly edited full transcript of his presentation. You can also listen to the full episode on Apple Podcasts, Google Play or Spotify and explore our Career Planning Resource.

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Wes Cleveland: Let's talk about some of your duties. It's important to know, obviously, what's going to be expected of you. Obviously, you're going to be providing direct patient care or some kind of patient care. It will depend on your specialty, of course, whether it's indirect or direct. One of the biggest questions that many physicians have is, what is their call responsibility going to be? It's important to have this set up, because it can be a significant obligation on your part. So, look for the call provisions.

Understand what your obligations are going to be there. I think, particularly, it’s important to make sure, to the extent possible, that call will be equitably shared by the physicians who are responsible with you for call. And then, depending on the number of physicians you're sharing call with, you might want to see if you can place a maximum amount of time that you will be obligated to provide call over a specific period of time.

Also, we've already touched on this earlier, but make sure you understand what is going to be required of you in terms of the times when you're going to be obligated, and also the locations. For example, like I said before, you may be obligated to work full time, but what does that mean? Does full time mean an 8 to 5, 9 to 5? Or does it also include 8 to 5 and working evenings or working weekends? Again, in this respect, the definitions regarding your duties are very important to make sure that you know this so you can fully understand what's going to be expected of you.

Making the Rounds Podcast

In the first episode of season 1 of the new Making the Rounds podcast, AMA senior attorney Wes Cleveland provides tips on what to consider before you begin the contracting process.

One thing that's becoming more and more important is committee work. Again, I think this will be particularly important as your employer and payers continue to move towards this value-based purchasing model, away from fee-for-service. There's going to be committee work in terms of developing the appropriate quality metrics that the employer is going to use, the utilization measures that are going to be used, patient satisfaction measures that are going to be used, all of those kinds of issues.

And the question is, how much committee work are you going to be responsible for participating in, and if you're going to be compensated by that? Or what role is that going to play in any compensation methodology? It's important to keep in mind because those hours devoted to that committee work can end up being extensive.

Also, one final thing. Sometimes your duties might be listed in an appendix of the employment agreement. I'd say, in that case, or in any case generally, the thing you want to make sure is that your duties will not be altered or changed unless you and your employer mutually agree to that.

Now, let’s talk about medical liability insurance. I'll give you a little description of both kinds of medical liability insurance and then the one issue you really want to be looking at.

There are two kinds of medical liability insurance. One is called occurrence coverage. Occurrence coverage typically is more expensive than its alternative, which is claims-made coverage. And occurrence coverage applies to any alleged mistake or error that you may have made while the policy was enforced, regardless of when the claim was made.

Claims-made insurance coverage is a little bit different. … It covers the time period in which an alleged error was made if the claim is also made—the claim for that error or that medical liability claim—during the period of time in which the policy is in effect.

And if this isn't all clear to you, we do have some other resources. We'll explain the difference to you. But, then the issue that comes up with a claims-made policy is that you can have a situation arise when you may have become involved in an alleged mistake, or error, while the policy was in place. But the claim might be filed later and not during the time in which the policy was in place. In that case, you wouldn't have medical liability insurance coverage that covers you for that alleged error.

What's needed then is if you leave an employer, there's something that needs to be purchased that's called tail coverage. And the tail coverage will cover the instances where a claim was filed after the policy is no longer in force, or in cases where the policy isn't going to cover potential liability because the claim was not filed during the time in which the policy was in effect.

That can be expensive, so typically, an employee contract won't mention who was responsible for this tail coverage.

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This is something that you'll probably want to talk about with the employer. I would say, not possibly want to talk about—you will want to talk about with an employer, because it can be expensive.

Now, it may be the case that your next employer will pay for that tail, and sometimes that's called nose coverage. But, it's important to understand who's going to be obligated to pay for that coverage, whether it's the employer who's going to pay for it afterwards, or whether it's going to be you who's going to pay for it. Just in case a subsequent employer isn't going to pay for the nose coverage, it's important to have that figured out. Because, like I say, it can be expensive. So, have that addressed in the contract, regardless of who's going to pay for it. You don't want to get in a dispute about that.

One of the things we find is that initially the responsibility ... for paying for a tail belongs to the physician. But as the physician continues to work and works longer, a number of years at the employer, the employer becomes more and more and more responsible for paying the tail coverage, should the physician leave the employer.

You can listen to this episode and all “Making the Rounds” podcasts on Apple Podcasts, Google Play or Spotify.