Preventing Burnout Now

Vocational burnout does not only happen mid-career. Residents and young physicians should be aware of burnout so that they can prevent its onset, but also because a career in medicine presents many of the job stressors that typically lead to burnout.

According to a study by the Journal of the American Medical Association, factors such as childhood development, personality traits, and family stress can contribute to burnout, but there are also certain work stressors that are common to most physicians. Perceived (and actual) work demands, financial deficits, Medicare audits, and concern about fraud, abuse, and malpractice suits are some factors that make burnout especially dangerous to physicians. Feeling lack of control in the work environment also increases the likelihood of burnout.

Medical school and residency can be so physically and emotionally exhausting that many physicians are prone to burnout before their careers start. The dean of the Vanderbilt University School of Medicine outlines that notion and also examines some of the preventative measures that can be taken to help defuse physician burnout.

The aforementioned JAMA article mentions specific ways that both physicians and health care organizations can prevent burnout. Physicians must find ways to limit their workload and seek sources of renewal, which could include exercise, time with family and friends, or maintaining a positive outlook/philosophy. Organizations can establish mentor programs and support groups, introduce sabbatical programs, and/or require physicians to have their own primary care physician. There are also workshops and courses designed to help physicians or students struggling with burnout.

If you feel vulnerable to burnout, a Maslach Burnout Inventory survey is a tool that assesses exhaustion levels and feelings of personal accomplishment.

Burnout can lead to physical or emotional problems with your health at home and in the workplace. There is no comprehensive cure or single preventative measure, so carefully evaluate where your stressors come from and how you can best respond to them.

From an insurance standpoint, it's imperative to obtain disability coverage prior to any psychological evaluation or treatments. Insurance carriers will view the treatment as an increased risk for future disability and either exclude mental claims or deny coverage all together.

What to Look for in Your First Job after Residency

The successful transition from residency to practicing physician is littered with numerous hurdles and questions. Responsibilities such as creating a CV, interviewing, negotiating your first contract, and considering malpractice and disability insurance are important, but perhaps the most obvious task is finding the right job. Just as significant as how to look for a job is what to look for in a job.

A publication by Medical Doctor Associates on transitioning out of residency advises how to clearly define what you are looking for and narrow your job search. The section on negotiation suggests not necessarily taking the best financial offer, a notion that is also echoed in an article from the New England Journal of Medical, which cautions about the realities of the first year of practice. It profiles Jennifer Shu, M.D., who is the current chair of the American Medical Association’s Young Physicians Section. Based on her own experience, she recommends taking your time to evaluate options and doing your homework before diving into a career.

PAIRO, a medical organization based in Ontario, offers tips for evaluating practice opportunities that are relevant no matter what country you want to practice in. Their website poses some great questions to consider, and break down various practice management issues into three categories: Personal and Family Issues; Professional and Vocational Satisfaction Issues; and Income issues.

The American College of Physicians outlines and analyzes six resources that you can turn to not just for finding jobs, but also for advice, contacts, and information. These resources include professional organizations, attending physicians and residency alumni, professional publications, physician recruiters, database companies, and the Internet.

After years of schooling and training, you should be excited to start your career as a practicing physician; however, don’t let that excitement rush you through the process of finding the right job for you.

RAC: How the Tax Relief and Health Care Act of 2006 Will Affect You

Medicare’s use of recovery audit contractors (“RAC”) is a polarizing subject. By recovering Medicare’s overpayments to physicians and other medical entities, RAC will save an estimated $10 billion over the next five years. Those savings should lower Medicare premiums. On the other hand, some physicians question the motives of RAC and see them as privately contracted “bounty hunters.” RAC have incentive-based pay—on average about 25 percent of the amount of recovered overpayments.

RAC are part of the Medicare Modernization Act of 2003, but have only been investigating overpayments to physicians since spring of 2005 in just three states: California, Florida, and New York… for now.

Less than a week ago, however, the U.S. House of Representatives approved the Tax Relief and Health Care Act of 2006, which calls for RAC to be expanded to all states no later than January 1, 2010 (see pages 163 – 167 of the legislative text). Dealing with RAC will soon be a reality for physicians nationwide.

Being proactive is ideal. When a Medicare overpayment is discovered, return the money before an audit can even take place. A recent article in Physician’s News Digest details who to notify and when.

Bruce A. Levy, an attorney specializing in health care fraud investigation and compliance, recommends three steps that can “audit proof” a practice. First of all, procedural codes and diagnosis codes should accurately describe services provided; beware of slightly differing codes or code modifiers. Additionally, taking detailed notes and documenting charts will help justify a physician’s actions, if audited. Finally, a voluntary compliance plan can be implemented to reduce billing errors and prevent erroneous claims. David Glaser, another attorney, also offers his advice for how to handle a Medicare audit.

As a physician, you may disagree with RAC and how Medicare overpayments are investigated. In light of the actions of Congress, it will be important to adjust and take preemptive measures, especially since Medicare overpayments are not uncommon.

Business Overhead Expense Insurance For Your Practice

A practice that relies on a small number of people (or one person) to produce revenue is economically vulnerable if one of those individuals becomes disabled. Business expenses are just as relentless for those who suffer a disability. A business overhead expense (“BOE”) disability policy will cover ongoing operating expenses for a disabled practice-owning physician.

If the insured does become disabled, a BOE policy pays a monthly benefit based on business expenses, not anticipated profits. The following business overhead expenses are covered by BOE insurance:

- Rent or Mortgage Payments
- Employee Salaries and Benefits
- Utility Bills
- Property Taxes
- Accounting Fees, Legal Fees, and Professional Dues
- Malpractice and Other Business Insurance Premiums
- Maintenance and Janitorial Services
- Depreciation
- Interest on Business Debts
- Office Supplies
- Other Fixed Expenses that are Ordinary, Necessary, and Tax Deductible

Some policies even cover the salary of a temporary employee hired to do the duties of the disabled. Income taxes, the cost of inventory, and the cost of furniture are a few expenses that are not covered.

It is advantageous to purchase a BOE insurance policy when you are younger. Not only will you get lower rates, but additional coverage can be purchased later without providing further evidence of medical insurability.

BOE insurance does not protect your ability to generate income—that is what a personal disability policy does. Instead, it allows you to keep your practice open, or at least pay for its expenses until you recover. In the case of a long-term disability, it offers you up to two years to make a business decision about your practice without worrying about accruing debt from business expenses.

Your practice should allow you to earn income, not be a financial parasite if you become disabled. BOE insurance doesn’t just protect your practice… it protects you.

Choosing a Specialty

It is interesting that even when lumped into relatively general groups, no single specialty dominates the field of medicine. There are many different types of medical specialties, as demonstrated by the American Medical Association’s dizzying list of national medical specialty society websites. The AMA also has a list of the most frequently entered specialties. If you are a medical student or a resident without a specific career path, there are many factors to consider when choosing a specialty.

Some of the first questions usually asked about a specialty concern earning power. The Association of American Medical Colleges has various specialty pages with salary ranges, as well as training, residency, workforce information, and links to the official academies, boards, and associations of each specialty. While money is important, there are other issues to consider.

The September 2004 issue of Academic Psychiatry did a study comparing burnout rates among residents in different specialties. Though it is a relatively small sample size, the results are interesting. Another study was done on the influence of malpractice risk on specialty choice.

If you want to speak with and learn more from representatives from primary care and specialty organizations, the American Medical Student Association has a Residency Fair & Specialty Showcase scheduled for March 2007 in Arlington, VA. This great resource, which offers an impressive lineup of events that span five days, gives you the opportunity to ask specific questions and get more of a feel for each specialty.

Aside from the statistics and opinions that you read or hear, never forget to factor in your level of interest in a specialty. Enjoying your career in medicine is just as important as salary and job outlook.

Malpractice Claims and How To Prevent Them

The origins of professional malpractice date back to early eighteenth century English legal theory. Medical malpractice claims are prevalent 300 years later and do not figure to disappear any time soon.

The increase of medical malpractice lawsuits has cyclical ramifications that affect several parties. Insurance companies are forced to raise premiums so that they can operate profitably. In turn, physician fees increase, which has an impact on patients. Physicians have to deal with the stresses of potential legal problems, not to mention the financial risks of settling or losing a lawsuit. Besides the fiscal damage, physicians that make payments connected to malpractice settlements or judgments are also included in the National Practitioner Data Bank. That information is available to hospitals and state licensure boards, and may soon be available to the public.

Preventing a malpractice suit can be as simple as increasing the clarity of your notes, improving communication, fixing lapses in patient service, or even apologizing, but there are other measures you can take to avoid non-clinical errors that could lead to a lawsuit. You can also contact your county bar association to get a referral to an asset protection attorney, because each case of alleged malpractice is unique, as are malpractice insurance policies. The pros and cons of a consent to settle clause in a liability policy is just one example of an issue that you may need advice about.

As the average claim payment and the volume of malpractice suits have increased, malpractice insurance premiums have also been on the rise. The good news is that the cost of medical malpractice insurance premiums is finally stabilizing. Unfortunately, the danger of being sued for malpractice is still just as great. Eliminating the risk of being sued for malpractice is impossible, but reducing risk and protecting yourself is not.