Career Management for Family Physicians

I. Credentialing and Licensure
    A. Establish early contact with appropriate licensing authority and medical staff offices.
    B. Directory of licensing authorities published by AMA.
    C. Maintain good documentation of procedures.
    D. Persistent follow up with offices is essential.
    E. Make sure all parties have your current address and contact information
    F. Attend to DEA, and state controlled substances authority.
II. Contracting
    A. Start early to avoid negotiating disadvantage.
    B. Give careful thought ahead of time to what you really want.
    C. Get help to learn about the local career market.
        1. local medical society
        2. hospital physician liaison offices
        3. chamber of commerce
        4. ? physician recruiters
        5. attorneys
    D. Make sure to have any agreement reviewed by legal counsel prior to signing.
III. Personal Management
    A. Keep your personal medical and dental health up to date.
        1. appropriate health screening
        2. adequate rest, regular exercise
    B. Address need for personal and family time.
    C. Make sure your family is “on board” with your career plans, housing, location, etc.
IV. Long Range Planning
    A. Consider where you want to be in 20, 30, 40 years.
    B. Start doing today what you know you’ll need to do to get there
V. Competence Enhancement
    A. Be aware of CME requirements
        1. AAFP
        2. State licensing authority’s requirements
        3. Any hospital staff requirements
    B. How to obtain CME:
        1. Conferences
            a) local
            b) national
            c) international
        2. Teaching
        3. Self-study plans
            a) AAFP home study subscription
            b) Core Curriculum subscription
            c) Many journals now offer CME
        4. Most medical staffs sponsor some form of CME meetings
    C. Keeping Up
        1. Read about your patients’ problems as you encounter them.
        2. Use your Information Mastery skills. (Remember the usefulness equation?)
        3. Interaction with consultants (must still evaluate relevance and validity of information from consultants)
VI. Risk Management
    A. Requires continual vigilance.
        1. Maintaining patient satisfaction and good communication is fundamental.
        2. Constantly attend to quality documentation.
        3. Maintain a consistent system of delivering preventive services.
        4. Maintain and enhance your competence, and document it.
    B. Medical Liability Insurance
        1. It’s virtually impossible to practice in US without it.
        2. Two types:
            a) Claims made
            b) Occurrence
        3. Attend to consequences of changes in state residence, place of employment.
VII. Health Insurance Plan Registration
    A. Each different plan typically has its own credentialing and contracting mechanism.
    B. Includes Medicare, Medicaid administrators.
    C. Failure to complete will interfere with billing (and eating).
VIII. Personal Insurance Needs
    A. Disability insurance essential
        1. The best policies have specialty-specific definition of disability.
        2. Consider the impact of the waiting period--must survive on personal resources during the waiting period.
        3. Partial payment for partial disability.
        4. Should be able to cover enough of your usual income to allow you to pay your bills and living expenses.
    B. Life Insurance
        1. To provide for dependents when you die.
            a) pay outstanding debts
            b) provide for death expenses
            c) provide enough of an endowment for finance essential family living expenses, children’s education, etc.
        2. Many different type of life insurance:
            a) “term” is simplest, and least costly up front--a good way to buy a lot of coverage when you’re younger, but becomes very expensive when older.
            b) “whole life”--higher initial premiums finance “permanent” insurance, and the funds may sometimes be used to earn investment income.
            c) “universal life”
            d) others
            e) consult independent agents, abundant print resources for decision information about life insurance.
        3. May become less essential as you accumulate assets, pay off debt, and “launch” children.
    C. Medical/Dental insurance
    D. Homeowner’s insurance
    E. Auto insurance
    F. Umbrella liability insurance--consider having “personal” liability insurance in the same amount as medical liability insurance.
IX. Financial Management
    A. Think about, discuss, identify financial goals with your partner and family (if applicable).
        1. Cash reserve
        2. Debt repayment
        3. Savings for education, retirement
        4. Financial independence
        5. others
    B. Think through and implement a budget to work toward your goals--stick to it.
    C. Loan repayment assistance programs allow an earlier start on asset accumulation to meet your goals.
    D. Avoid the “entitlement” mentality.
    E. Investment strategies:
        1. depends on the “need horizon”--how soon will you need to use the asset(s).
        2. Historically, the stock market offers investment returns not matched by any other instrument, but offers limited security.
        3. Shorter-term investment (a few years’ horizon) require a higher level of security--use high quality bonds and savings instruments.
        4. Longer-term investment (>5-10 years) needs allow for more risk to maximize returns.
        5. Real estate investment requires specialized knowledge for success, and suffers from market cycles also.
        6. Choose an investment advisor who is paid by set fees or salary, not by commissions.
X. Personal Consultants
    A. Attorney--law have become quite specialized, and you may need different attorneys for different needs:
        1. Physician/managed care contracting.
        2. Medical liability defense
        3. Estate law
        4. Major purchases (e.g. home)
    B. Accountant
    C. Financial Planner
    D. Insurance Agent(s)