ResolvePhysician Agency

Residents are Not Studentspage 6

Tax Time:

HPhysicians Tend to Eat Their OwnHard core administrators can be difficult to deal with, there’s no doubt. But when it comes to the biggest challenge most physicians face in their careers with interpersonal rela-tionships in the workplace, adminis-trators are often times not the biggest foes—your physician colleagues are!

It’s true, physicians tend to eat their own. I’m not talking about Dr. Hannibal Lecter, the cannibal-istic psychiatrist played by Anthony Hopkins on the big screen. That’s the literal extreme. I’m talking about how physicians treat each other during the course of their careers and the brutal toll they take on each other, often over the most trivial of things. One perceived slight to the wrong, vindictive, insecure colleague can land a physician in a world of trouble. Suddenly, complaints begin to appear about the quality of care being delivered to patients that prompts an internal peer review.

You might be an excellent physician who is incredibly conscientious about the care you deliver to your patients but give the slightest opening to one of these disaffected colleagues to offer their own subjective interpretation about a patient’s care, or less than

perfect outcome, and you’re in the soup having to defend yourself from career disaster.

Think this is farfetched? Think again. As a career adviser, I hear countless horror stories from physicians who get blindsided and they want to know where to go from here. Most of the time, unfortunately, I don’t hear from them until they are late in the game and have either left their current employer or group over it or are in the process of doing so. At that point, it’s difficult to do much about the current situation except salvage what you can to be certain the physician is still marketable for the next job opportunity. The real key, however, is to protect yourself against this kind of scenario before it gets out of hand. Here are just a few of the key things to do that will help.

The AgreementFirst, make certain you have a good employment agreement in place that gives you adequate due process. In the rest of society, anyone can sue for anything but it doesn’t mean they will win. The civil courts have a very struc-tured process in place to make certain that an impartial judge hears the case and everyone has the opportunity

to present their side of the story adequately. If your employment agreement doesn’t have a good structure for due process that will be adjudicated impartially you might be facing a kangaroo court. Peer review panels can be readily influ-enced by an aggravated colleague and power politics will often times be in play to predetermine outcomes, which will not likely go in your favor unless you’re the one wielding the political clout.

ConflictsSecond, try and short circuit disputes before they grow to tsunamilike proportions. Don’t let personality conflicts simmer and burn in hopes that the situation will just go away. They rarely ever spontaneously extin-

One perceived

slight to the wrong

vindictive colleague

can land a physician

in a world of

trouble.

guish themselves. Critically evaluate your own interactions with the disaffected colleague to assess where the trouble could hav started. Take ownership of your part of the problem and offer an olive branch to the other person as a way to throw some cold water on the hot coals. Most human beings, will have the natural inclina-tion to reciprocate and will either offer their own apology or their forgiveness. Don’t have expectations of an apology from them, however. Some people have a tough time with apologizing, even when they know they are wrong. Setting yourself up for disappointment with the expecta-tion of an apology can lead to stoking of the enragement fires within you which will only worsen the problem. Remember, the goal is not necessarily for some kind of self fulfilling feed-

back from the other person but rather to make certain the situation does not grow to cataclysmic proportions.

Get HelpLastly, you might consider involving a mediator or counselor if you are concerned that it will be too difficult to broach the subject on your own. Most physicians are nonconfronta-tional by nature and dealing with this kind of issue is incredibly diffi-cult. Your good intentions can end up backfiring with horrible conse-quences if the situation isn’t handled properly. Get some coaching from someone who has experience in this kind of situation and, most impor-tantly, doesn’t have an emotional stake in it. If you find you would like to get some help in one of these areas, Resolve can help. Please don’t

hesitate to contact us to see what kinds of guidance our professional agents might be able to provide. It’s a lot easier and less costly to extin-guish a minor fire early on versus burning down the whole forest later.

Cord Harper is the CEO of Resolve Physician Agency, Inc. To discuss this article further please e-mail charper@resolvephysicianagency.com.

Make certain

you have a good

employment

agreement in place

that provides you

adequate due

process.

HRecruiting Firms A Solid Resource or a Waste of Time in Your Job Search?

Having previously worked for one of the nation’s largest physician recruiting firms and being groomed on that side of the table, it is difficult to admit that I was anything other than a solid resource for my physi-cian candidates. Even considering the notion that the countless hours that I spent conversing with these physi-cians could be construed as a waste of their time is difficult to swallow. However, having the opportunity to fully analyze this relationship from the physician’s perspective has led me to second guess these feelings. The reality is that the answer is probably somewhere in the middle (dependent upon your individual job search). But before engaging in any relation-ships with recruiters, there are some dynamics that you should know. Understanding the flaws of recruiting firms will arm you and allow you to determine whether it is worth your time to work with a particular recruiter (or any recruiters at all).

Strike 1A recruiter’s loyalty always lies with the employer.

Sure, you may get lucky and come across a very knowledgeable recruiter that is able to build an immediate level of trust. But at the end of the day, that very same recruiter is receiving his/ her pay check from the employer and not you. Again, they may be the nicest person you have

There are over 2,000 recruiting firms across

the country whose positions only

account for 1/4 of the actual job market.

ever met but there is no denying where their loyalties lie. Being loyal to you does not put food on their table nor pay their bills. When that final contract is extended, they could care less if you get the position over any of the other physicians that they are talking to.

Strike 2It’s a highly segmented market that requires a significant time commit-ment.

There are over 2,000 recruiting firms across the country whose positions only account for approximately 1/4 of the actual job market – giving you a very segmented and limited exposure to the full marketplace. Each firm

may only represent one or two job openings in your given specialty. Thus, you are going to have to contact a lot of recruiters and spend many hours doing so just to see a fraction of the openings that are out there. These firms can charge employers upwards of $20,000-$50,000 just to handle the searches for them. As such, hospitals and physician groups are incentiv-ized to attempt the recruitment on

their own before making that kind of investment. If that employer is located in a more desirable, destina-tion location, they have no difficulty filling the openings on their own and you will never see these positions going through a recruiting firm.

Strike 3Hospitals financially benefit from passing on candidates that come from most recruiters.

Most physicians are not aware that all recruiting firms are not created equal. There are actually two types of recruiting firms – retained and contingency – and the type of firm that you associate yourself with can greatly affect your chances of getting

a job. Retained recruiting firms (which only make up roughly 5% of the recruiting firm market) have a contractual relationship with the employer to serve as the exclusive agent for that particular job opening. Even though these firms are more expensive, the contracted recruiter will spend more time and energy focused on their search. As a result, these recruiters are more knowledge-

able about the employer and job opening and are more effective in selling that opportunity. On the flip side, the remaining ~95% of firms in existence have no established or exclusive relationship with the oppor-tunity that they are trying to sell you on. Instead, their approach is to get your CV, determine your preferred geographic location and then contact hospitals or groups in that area to sell you. While this may sound good for you on the surface, they are also charging the employers a lofty fee to sign you. As such, hospitals are quick to steer clear of any physician submitted by a contingency firm in hopes of finding a physician that they don’t have to pay for.

A recruiter’s Loyalty always lies with the employer.

Jeff Hinds is a Vice President of Resolve Physician Agency, Inc. He is an expert in the physician job market. To discuss this article further please email jhinds@resolvephysicianagency.com.

The U.S. Supreme Court held unani-mously on January 11, 2011 that medical residents should be character-ized as employees rather than students for Social Security tax purposes.

The ProblemAt issue in Mayo Foundation v. United States (09- 837), was whether medical residents qualified for the student exemption from Social Security taxes. Prior to 2004, medical residents were considered students for this purpose, and therefore were exempt from the Social Security tax. However, in 2004, the IRS issued regulations providing that a medical resident whose normal schedule requires him to perform services 40 or more hours per week is not a student and is therefore subject to the Social Security tax. The IRS explained that this analysis “is not affected by the fact that the services may have an educational, instructional, or training aspect.”

The DecisionMayo argued that the IRS regula-tion was invalid because it arbitrarily distinguishes between hands-on training and class room instruction. Mayo urged the IRS to engage in a case-by-case inquiry into whether an employee is considered a student. The Court disagreed and held that the

IRS has drawn a distinction between education and service, not between classroom instruction and hands-on training. The Court stated, “we do not doubt that Mayo’s residents are engaged in a valuable educational pursuit or that they are students of their craft. The question whether they are ‘students’ for [FICA] purposes, however, is a different matter. Because it is one to which

Congress has not directly spoken, and because the Treasury Department’s rule is a reasonable construction of what Congress has said [the regulation will be upheld].”

The Court also found that the full-time employee rule would improve the ease of administration of the tax and will avoid “the wasteful litigation and continuing uncertainty that would inevitably accompany a case-bycase approach.” Finally, the Court held that the rule “reasonably takes into account the Social Security Administration’s concern that exempting residents from FICA would deprive them and their families of vital social security disability and survivorship benefits.”

The ResultWhat does this mean for the IRS? The holding allows the IRS to continue

collecting over $700 million a year from medical residents under the Social Security tax. What does this mean for current residents? Finan-cially, not much, as they are already paying the FICA tax. However, this ruling allows medical residents the continued benefits of the Social Secu-rity disability and survivor benefits, the Family Medical Leave Act, access to employer health insurance plans, workers compensation protection against injury on the job, and the right to collectively bargain with the administration over salary, benefits and the conditions of employ-ment. In the end, these benefits are likely worth the tax you were already paying.

Residents are Not Students

Kyle Claussen is a Vice President of

Resolve Physician Agency, Inc. He is also an attorney

and has an LL.M. in Taxation. To discuss this

article further please e-mail kclaussen@resolvephysicianage

Tax Time

AA physician’s career, like that of most people, is only one part of life but certainly one that provides the means to enjoy the other aspects of living. Whether you are looking for a new opportunity or looking for profes-sional guidance to get better terms for your current opportunity, it all ends up at the same place — the negoti-ating table.

As a practicing Otolaryngolo-gist for more than 30 years I have experienced and observed physician inadequacy and lack of expertise in the area of employment agreement negotiations. Countless anecdotes have been noted from physicians listing off the many problems and difficulties encountered during the negotiation of their employment contracts. Unfortunately, these scenarios are not the rare exceptions but rather the all to common realities experienced by thousands of physi-cians every year.

The employer is a seasoned health-care executive who has invested years worth of education to train and prepare for these kinds of negotia-tions and has the experience of going through this same process dozens if not hundreds of times with other physicians. On your side of the table, its just you, faced with the challenge of negotiating an agreement worth hundreds of thousands of dollars, filled with legal complexities and vari-ables that most attorneys have a hard time understanding. As a physician, you have spent many years in medical school, residency, fellowship and practice to become the best clinician possible. Unfortunately, the rigorous demands of becoming a great clini-cian don’t leave much time to learn about the market for your services, nego-tiation skills, or the many

legal complexities that comprise your employment agreement.

This scenario is why I strongly believe physicians need better representation and also provides the vision behind Resolve Physician Agency. Resolve puts the power back into the hands of the physician by providing negotia-tion expertise, health care employ-ment experts and detailed knowledge of the marketplace for physicians on a national scale.

Our partnership approach with our clients is truly — a partnership for better living.

Sidney Christiansen, MD is the Founder and President

of Resolve Physician Agency, Inc. To discuss this

article further please e-mail sid@resolvephysicianagency.com

Sid’s CornerThe Need for the Physician Advocate

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