Before starting employment at the hospital, check the medical staff bylaws

AMA News Wire

Before starting employment at the hospital, check the medical staff bylaws

May 14, 2024

Many hospitals these days are staffed by both employed and independent physicians, but that doesn’t mean they all enjoy the same protections from hospital manipulation and disruption.

One of the main concerns of hospital employment is that the hospital can have too much influence over the doctor because they can fire him, said Elizabeth A. Snelson, president of Medical Staff Legal Counsel PLLC, which specializes in medical staffing. . , medical societies and medical staff professionals.

Snelson is the author of AMA Physicians Guide to hospital employment contracts (PDF), free to AMA members, which provides expert guidance for physicians considering, entering into, or working under employment contracts with hospitals or related entities.

They cannot fire the independent surgeon. They can go after her, sure they can abuse peer review to limit her privileges, and they can instead direct referrals to their own employed surgeon, Snelson said. But an employee can be fired on Tuesday just because it’s Tuesday, if her contract allows it.

All of this points to a crucial step in the hospital employment contracting process: If you are considering hospital employment, you should see the medical staff bylaws.

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

It may not always be clear which doctors on the medical staff are employed and which are independent, Snelson noted. For example, it would not be unusual to find a hospital where an entire department, such as pediatrics, is staffed, but everyone else is independent.

This may have implications for quality of care, patient safety and physician autonomy. Big concern: Instead of the medical staff credentialing committee doing what it’s supposed to do, eg, determine whether a doctor meets medical staff qualifications, the committee’s hired members may be pressured to done exactly the opposite.

If, say, an employed physician is on the medical staff credentialing committee and the hospital is spending a lot of money recruiting fees to get an elusive pediatric neurologist, hospital administrators can say to the employed physician: We we know she is not the best pediatric neurologist. on the planet, but we want you to drop the demands because we love it. And if you don’t vote the way we want, we’ll fire you, she said.

Learn about the Organized Medical Staff Section of the AMA, which gives voice to and advocates for issues affecting physicians associated with the medical staff, whether employed or in private practice.

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The medical staff should be the umbrella organization, Snelson said. It represents and sets the standard for all medical staff, not just freelancers but also employed doctors. Under that umbrella, employed physicians should have the same rights and protections as independent physicians. They should not be subject to manipulation by being discharged.

This is the purpose of AMA Physicians Guide to hospital employment contractsSnelson noted.

These are complicated issues. There’s a lot to think about, she said, noting how important it is to hire a doctor-friendly attorney to review any hospital employment contracts. We need doctors to understand that even if they read every word of the guide, they should hire an attorney to help with the contract before they sign it.

She encourages doctors to consult with a lawyer who understands employment contracts for hospital doctors. All those parts are necessary, she said.

The AMA has assembled a number of resources to help physicians thrive in the employment environment. This includes the development of Model Physician Group Practice Employment Agreement (PDF) and presents an expert perspective on collective bargaining for physicians.

Learn more with the AMA about understanding physician employment contracts.