Every hospital employment contract must have an attachment

Hospital employment contracts are difficult enough for doctors to understand on their own, but there is a second document that should always accompany a draft contract for review: the medical staff bylaws. Otherwise, the contract may not be what it seems.

“It’s important for new doctors, especially those completing residency, to know that even though they’ve been hired by a hospital, that doesn’t necessarily mean they’re on the medical staff,” said Elizabeth A. Snelson, president of Legal. Attorney at Medical Staff PLLC, specializing in working with medical staff, medical societies and medical staff professionals.

Snelson is the author of the AMA Physicians’ Guide to Hospital Employment Contracts (PDF), free to AMA members, provides expert guidance to physicians contemplating, entering into, or working under employment contracts with hospitals or related entities.

“The hospital administrator doesn’t make that decision, he has to ask the medical staff,” he said. “The request goes to a committee of the medical staff, which accredits the doctor and then votes. If approved, it is sent to the hospital board, which also votes on it. This is a complex and time-consuming process.”

To really know where they stand with hospital labor contracts, doctors should look at medical staff bylaws.

Download the newly revised AMA Physician’s Guide to Medical Staff Organization Bylaws (PDF), which is also free for members.

It may seem ironic that a hospital administrator can spend $200,000 or more hiring a doctor without the guarantee of getting that doctor on the medical staff, but that can easily happen. After all, the last thing doctors want on the medical staff is a doctor who is not up to par.

“Medical staff may say they cannot recommend the candidate for privileges because the physician is not board certified in a particular specialty, or has not seen enough cases, or has not published enough,” Snelson said. “It’s important for medical staff that their bylaws say that unless they have approved privileges, the new hire is not going to get them.”

But not all medical staff bylaws do, and depending on how they’re written, the board can even overrule medical staff and authorize privileges anyway.

“There’s this tension between the medical staff organization, which is responsible for quality, and the business side, which might say, ‘We need a doctor right now, even if they’re not that big,'” Snelson said. “That’s why the medical staff needs to be independent and be able to say, No, you can’t override our clinical judgment about who can be on the medical staff.”

Learn more about the AMA Organized Medical Staff Section, which provides a voice and advocates for issues affecting physicians affiliated with the medical staff, whether employed or in private practice.

“A physician who has been in practice a little bit should be familiar with these concepts, but a resident probably isn’t,” Snelson said. “Residents shouldn’t have a medical staff member because otherwise they could end up in the National Practitioner Data Bank because of an everyday resident error. So they might not even know they have to have a medical staff application to practice in a hospital.”

This is especially relevant for young doctors who would be uprooting their families for a new job, he noted.

“A signed contract is not enough,” he said. “It should address the fact that they also have to apply for medical staff, a process that can take six to eight months.”

This is just another reason why doctors should not use ordinary employment lawyers to review their contracts, Snelson noted. Most ordinary employment involves only two parties, but hospital employment is unique.

“In a hospital, there’s the chief, the general manager and the board, and the medical employee, and then there’s also the medical staff,” he said. “Use a physician employment attorney.”

The AMA has assembled a variety of resources to help physicians thrive in the workplace. That includes development Annotated Group Practice Labor Agreement Model (PDF) and presents an expert perspective on collective bargaining for physicians.

Learn more from the AMA about understanding physician employment contracts.