Discussion Question #2
Chapter 10, which discusses medical staff organization and physician liability, is the chapter that most closely relates to my area of practice. Currently, I work as a Management Associate in the Physician and ACP Recruitment and Retention department at Carolinas HealthCare System in Charlotte, NC. One group within my department is responsible for recruiting all the physicians and ACPs for the entire health system. The term ACP stands for Advanced Clinical Practitioners and includes Nurse Practitioners, Physician Assistants, Nurse Midwives, and Certified Registered Nurse Anesthetists. Another group within my department works to integrate or onboard physicians and ACPs in to the system and implements retention programs focused on retaining our physicians and ACPs once they are a part of the system. A large part of my work is focused in this area, on retention efforts. I work closely with the System’s Medical Group leadership to develop and implement physician and ACP engagement and wellness strategies geared at increasing engagement and reducing turnover. The other group in my department handles physician and ACP contracts for the system.
There are many legal and ethical considerations that must made by recruitment teams, medical staff departments, and hospital/practice administrators when recruiting and employing physicians and ACPs. From the very beginning of the process, recruiters and hiring managers must be mindful of the tendency to unintentionally, or in some cases intentionally, discriminate against candidates based on the recruiter or hiring manager’s preferences for the type of candidate they feel would be the best fit for their organization. An article in the Journal of Legal Medicine referred to this tendency as the homogenization process. The factors involved in this process include: the applicant’s possible tendency to look for organizations that match their own characteristics and values, the tendency of organizations to employ people they think will “fit in”, and the tendency of individuals who do not “fit in” to leave the organization. Overtime the organization will begin to mirror the characteristics and values of those responsible for recruiting and making hiring decisions and exclude those who do not (Björklund, Bäckström, & Wolgast, 2012). In the Bible, we are told not to do things such as this. In James 2:8-9, it says “If you really keep the royal law found in Scripture, “Love your neighbor as yourself,” you are doing right. But if you show favoritism, you sin and are convicted by the law as lawbreakers” (James 2:8-9, New International Version).
The first step in the recruitment process is the screening of candidates. This must also be approached with legal considerations in mind. Recruiters must thoroughly screen candidates to ensure they meet, at least, the basic qualifications for employment. This includes verification of proper licensure and board certification as well as completion of background checks and reference checks. A license is a legal authorization provided by a government agency allowing an individual to practice a given occupation that requires a high level of specialized skill (Thompson & Robin, 2012). Having a license ensures a uniform standard of practice and assures patients that the person delivering their care is properly trained. All states have laws and rules that oversee all healthcare practitioners and the medical board is granted power to regulate those that practice within each state (Thompson & Robin, 2012). Completing these checks and ensuring that practitioners are licensed, certified, and in good stating with the medical board is one of the most important steps made by a healthcare system to provide the highest quality care to its patients. Reference and background checks are also very important considering the organization can be held liable if a physician or ACP is negligent in the care they provide (Pozgar, 2016). When a patient goes to a hospital they should be able to assume that the hospital stands behind those in its employ and has verified their abilities and standing within their practice and the community. If they do not do their due diligence they are essentially lying to their patients when they say the goal is to provide the highest quality care. Being truthful in our ways should always be top priority. In Ephesians, we are told, “therefore each of you must put off falsehood and speak truthfully to your neighbor, for we are all members of one body” (Ephesians 4:25, New International Version).
The next part of the recruitment process that requires legal consideration is the employment agreement and contract negotiation phase. At most organizations, the recruiter is not very involved in the contract negotiation. It is usually handled by a contract or legal office, human resources, or the hiring manger/administrator. It is common for physicians to seek legal counsel when discussing specific areas of their contract including discussions about restrictive covenants, salary, and malpractice insurance. Restrictive covenants limit physicians and ACPs from working with the organization’s competitor. For the organization, restrictive covenants help to relieve stress regarding the potential leak of patient information and/or information about the organization’s business practices. For physicians and ACPs, particularly those that provide hospital based services, these covenants can be worrisome because if they were ever terminated they would potentially have to build their practice all over again (Blustein & Ancona, 2010). A second point of contention can be salary negotiations. Employers usually want to link salary to productivity whereas employees prefer a fixed based salary. One way that this issue is usually worked out is for the organization to offer a base salary with opportunity for incentive. If the physician produces above their base they are provided supplementary income (Blustein & Ancona, 2010). Additionally, the negotiation of malpractice insurance coverage and payment can cause debate between the employer and employees. The type of coverage provided is usually what can cause disagreement. Claims-made policies cover physicians if an alleged act occurs and is reported while the policy is in effect. Occurrence coverage covers physicians while the policy is in effect, regardless of when it is reported. Physicians and ACPs usually prefer occurrence coverage but it is more expensive and employers are often unwilling to pay for it (Blustein & Ancona, 2010).
Once contract negotiations are complete, the contract is signed, and the physician and/or ACP is hired they must go through the credentialing and privileging process. The Journal of Continuing Education in Nursing defines credentialing as “a process used to designate that a recognized entity has met established standards as determined by a governmental or nongovernmental agent qualified to carry out development and implementation of these standards” (Dickerson, 2012). According to Pozgar, the delineation of clinical privileges is “the process by which medical staff determines precisely what procedures a physician is authorized to perform” (Pozgar, 2016). Ensuring that physicians and ACPs are properly credentialed and privileged is of the upmost importance considering the possible law suits that could occur if a physician or ACP were to practice outside of their scope of care and cause injury to a patient. It is also best practice for organizations to review physicians and ACPs credentials at least every two years to ensure high quality performance and care to patients (Pozgar, 2016).
Many of the responsibilities of the department that I work for do not allow for much contact with patients; however, the work that that we do ensures that the patients of the system have access to the most qualified providers. At each of our team meetings we do what is called a “Connect to Purpose” where a teammate will share an experience they have had at the hospital or at a practice that reminds us how our work is connected to the mission of the organization. Sometimes it can be easy to forget when you work in an office building but these stories help to bring purpose to why we do what we do.
Björklund, F., Bäckström, M., & Wolgast, S. (2012). Company Norms Affect Which Traits are Preferred in Job Candidates and May Cause Employment Discrimination. Journal of Psychology, 146(6), 579-594.
Blustein, A., & Ancona, L. (2010). Physician employment contracts. Journal of the American College of Radiology, 7(1), 533-535.
Dickerson, Pamela S,PhD., R.N.-B.C. (2012). Credentialing: Understanding the terms. The Journal of Continuing Education in Nursing, 43(5), 197-8.
Pozgar, G. D. (2016). Navigate 2 Premier Access for Legal aspects of health care administration (12th ed.). Burlington, MA: Jones & Bartlett. ISBN: 9781284120110.
Thompson, J. N., & Robin, L. A. (2012) State medical boards. Future challenges for regulation and quality enhancement of medical care. The Journal of Legal Medicine,33(1), 93-114.