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Human Resources: When You Must Fire a Physician<
by: Robert Anthony
No medical practice enjoys the thought of severing ties with one of its physicians, but sometimes it's the only practical solution to a bad situation. Perhaps the practice has repeatedly tried to work with a troublesome physician without success, or maybe the doctor has committed some unpardonable offense - whatever the case, there are some circumstances in which a practice must let a physician go. We all start relationships - whether they are personal or business-oriented - with the best of intentions. But every relationship encounters trouble, and sometimes that trouble just can't be worked through, says Paul Angotti, president of the medical practice consulting firm Management Design LLC in Monument, Colo. "It's analogous to a marriage," Angotti says of the working relationship between physicians. "It needs to be a trusting relationship, where doctors trust their patients to the other doctor when they're on vacation, and the other doctor is on call. ... Sometimes it just doesn't work out; sometimes there are personality conflicts." If your practice had to fire a physician, would you know what to do? Do you know what steps you need to take to protect your practice from a lawsuit? Even if there are no problems now, you should know how to protect your practice in case problems arise in the future. How did you get there? While there are any number of reasons a practice may want to dismiss a physician, most experts agree it usually takes an egregious offense - or series of offenses - before such situations come to the point of terminating employment. "It takes very, very bad behavior to get fired as a physician," agrees Jeffrey Denning, a management consultant at Practice Performance Group in La Jolla, Calif. There are obvious reasons for termination, such as losing an insurance contract, a Medicare license, or privileges at a hospital. All of these can mean a financial loss for the practice, and that makes the physician a liability rather than an asset. More often, though, the actions that drive a practice to consider firing a physician fall under the broad heading of "anti-group behavior." These offenses are sometimes more subjective in nature than losing hospital privileges, but they are the types of actions that work counter to the group's overall harmony and mission. Take, for example, the doctor who harasses clinical staff. Whether he is actively berating medical assistants or merely badgering nurses into providing preferential treatment ahead of the practice's other doctors, it is clear that such behavior falls outside of what the practice deems acceptable. On the other hand, a rude exchange with front-office staff isn't the same thing as losing your Medicare license. Or is it? Some reasons for termination are easier to prove than others. When a doctor loses hospital privileges, for example, the hospital usually sends a letter stating the loss of privileges and documenting the reasons for it. The same is true for the loss of an insurance contract or a Medicare or DEA license. In each of those cases, the practice will have written corroboration by an outside party that can be used to demonstrate justifiable grounds for dismissal. In the case of the doctor who is verbally abusing clinical staff, though, it is likely that such behavior has occurred more than once. Unless you are thorough about documenting every instance of abuse, it is easy for discussions to degenerate into "he-said, she-said" arguments. That's why it's important to follow an established process for termination. Get everything in writing Chances are, whether the offending physician is a partner in the practice or a full-time employee, that he or she has an employment contract. A good physician employment contract will specify a variety of possible causes for termination, including scenarios< |
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