Vol. 3, Issue 1 Digital Edition of Oncology Fellow Advisor

ONCOLOGYFellow

Vol. 3, Issue 1

S UPPORT & INFORMATION FOR THE NEXT GENERATION OF ONCOLOGY PRACTITIONERS

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Career Paths

Fellowship Training

MENTOR MEMOS

Practicing oncologists discuss the importance of mentorship and how it shaped their careers.

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FELLOWSHIP TRAINING

Useful medical apps to aid oncologists-in-training.

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PHYSICIAN FINANCE

An in-depth discussion on medical malpractice insurance, including how current trends will 6 affect the industry.

advisor

Mentor Memos

Survey Says

Physician Finance

Preparation Is Key for Contract Negotiations

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hen it’s time for all of that training and education to start paying off with a career in medicine, many newly minted oncologists may wish they also had studied the art of the deal, according to experts in contract negotiations. “Unfortunately, nobody coming out of training is taught what to look for in these contracts. They teach them all about medicine and everything they need to know to diagnose and treat, but nobody bothers to teach them what to do now that they’ve got a job offer, and how the heck to make see Negotiations, page 7

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Add Leadership Skills to Your CV

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hether their ultimate career goal is to chair an oncology department at a major teaching hospital, work in private practice, or win the Nobel Prize in medicine or physiology for their discoveries, having solid leadership skills can help oncology fellows achieve it.

Leadership is hard to define, but we all recognize the trait when we see it.

Although it’s not written on the diploma, fellows are expected to be leaders the minute they earn the right to be called “Doctor.� “If you’re a physician, you’re a leader. You may not think of yourself

as a leader, but others look to you as a leader, even as a fellow, whether it’s nurses, mid-level professionals, or technicians, you are looked upon as a leader,� said Steven M. Sperling, PhD, president of Executive Development Group, LLC, a management consulting firm specializing in providing customized physician and administrative leadership programs for academic medical centers, cancer centers, and health care systems.

Bookshelves are crowded with titles offering generic advice about what it means to be a leader, but all of that ink see Leadership, page 5

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MENTOR MEMOS

Oncology Fellow Advisor • Vol. 3, Issue 1

Oncologists Look Back at Mentors Who Helped Them Succeed

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transplant fellowship, and is a 2011 recipient of an ASCO he knowledge students gain in medical school usually Young Investigator Award. is imparted by classroom instruction—one teacher, Although some fellowship programs have a formalized many learners. But once students advance into fellowstructure for matching fellows with mentors, many felships, navigating the subtleties of oncology, choosing lows find their mentors through a more casual approach. research opportunities, and making good career deci“Find someone who has a history of being a good mentor sions often requires the more individually tailored comand who is conducting research in an area that you’re munications found in good mentoring relationships.1 interested in and ask if they have a project you could The presence of a mentor is well recognized in helping work on, or if they could help you develop a project you oncology fellows to become involved in research.1 But might have,” Dr. Hershman suggested. mentors also guide fellows in career-related decisions, Dr. Jaglowski took a rather haphazard approach to clinical work, patient care, and other areas where they finding a mentor. “Part of the moral of my story is that may need a bit of help.2 “Because the field of oncology is just showing up is so imporso complex, it’s hard to do it on tant,” she said. While doing your own without any advice,” an outpatient rotation during said Dawn Hershman, MD, asso“It’s easy in the first few years to her intern year, Dr. Jaglowski ciate professor of medicine at simply wandered into the first Columbia University College of be swept into other things, and hematology office space she Physicians and Surgeons, New my mentor has helped me make found and asked of the doctor York City, and a member of the sure I’m on the right path.” there, who happened to be a American Society of Clinical leading expert in CLL, “Hey, Oncology (ASCO)’s Leadership —Kevin Kalinsky, MD can I work with you?”

Development Program.

The 2 have been working “The mentor is critical to serve together now for 7 years. as a role model for the men“I wouldn’t have gotten the tee not just in terms of acaYoung Investigator Award demic accomplishments, but without him, and I wouldn’t also in terms of defining perhave gotten the American sonal goals,” she said. “It’s also Society of Hematology about the personal relationship [Scholar] Award without him,” and having someone help guide she said. you and focus you rather than Dr. Jaglowski was fortunate it being about somebody telling to find a mentor with whom you exactly what to do. A lot of she was comfortable—an what a mentor does is to proexpert in what she wanted to vide encouragement and help do, with a track record of menthe mentee figure out what they toring young oncologists and want to do so they have all the the time and energy to help opportunities they need to be her out. Most fellows, however, successful.” should not count on stumbling When Samantha Jaglowski, onto the perfect mentor.

MD, first met her mentor, she “Often you see both residents and fellows working with had some idea of what her interests were, but still needed the first person they talk to instead of really investigating help focusing on a research and career path that could who is doing the best research,” Dr. Hershman said. “You put her in reach of her goals. need to talk to a lot of people to make sure it’s the right “I have a tendency to go off in a lot of different direcfit. Somebody could be an outstanding researcher, but tions,” she said. Her mentor helped guide her toward not necessarily be able to devote the time it takes to be chronic lymphocytic leukemia (CLL) and CLL transplants, a good mentor.” as well as Phase I and II drug development.

Often it takes more than one good mentor to foster an “He really helped me streamline my focus,” said Dr. oncology fellow in all the areas where they might need Jaglowski, who is currently doing a blood and marrow Oncology Fellow Advisor ® is brought to you as a professional courtesy. This content is selected and controlled by McMahon Publishing and is funded by Lilly USA.

MENTOR MEMOS

Vol. 3, Issue 1 • Oncology Fellow Advisor

guidance. “Ultimately, no one person can be everything to someone else,� Dr. Hershman said. “You may need different mentors for different aspects of your career.�

A fellow may turn to one mentor for advice on grant writing, another for instruction on conducting a clinical trial, or for tips on being a better teacher or the best way to manage patients. Fellows may even identify a mentor to help them with personal issues. “You have to know who to go to for what type of guidance you are seeking,�

Dr. Hershman said.

When Kevin Kalinsky, MD, began his fellowship, he sought a mentor for research and clinical work. Deciding he needed additional basic science experience, he spent an extra year of fellowship training in the breast program at Memorial Sloan-Kettering Cancer Center in New York City, working with additional mentors who helped him with science research and patient management. “They all very much shaped my direction and helped guide me to my current interests,� Dr. Kalinsky said. “I think by having several mentors, you are able to identify through them characteristics in yourself that you want to foster in order to develop your career and pass on to others in training.�

Now finishing his second year as a junior faculty member at Columbia University Medical Center in New York City and mentoring fellows himself, Dr. Kalinsky recognizes the need for mentoring relationships even after fellowship. “It’s easy in the first few years to be swept into other things, and my mentor has helped me make sure I’m on the right path.�

The mentoring relationship clearly serves the mentee, but it is not a one-way street. “Mentees have to recognize that mentors do what they do voluntarily and it often requires a lot of work and time, so it’s important for the mentee to understand that and express appreciation,� Dr. Hershman said.

Mentees also can help set the stage for the mentoring relationship by identifying what their needs are early on (eg, meeting once a month, frequent email communications) and determining if the mentor can realistically meet those needs.1 “Often the process helps a mentee identify what it is they really want to do long-term. There are a lot of different pathways one can take and the fellow has to spend a lot of time thinking about what they want their career to be and how they envision their future,� said Dr. Hershman.

References 1. www.onclive.com/publications/oncology-fellows/2010/ August-2010/The-Importance-of-Mentoring-in-Preparingthe-Next-Generation-of-Oncologists (Jones_2011). Accessed June 6, 2011.

2. www.medicine.wisc.edu/home/hemonc/fellowshiphandbookfocusmentorship (Albertini_2010). Accessed June 6, 2011.

Editorial Board Karin Hahn, MD Associate Program Director, The University of Texas MD Anderson Hematology/Oncology Fellowship Chief of Medical Oncology Associate Professor Lyndon B. Johnson General Hospital Houston, Texas Jamal Rahaman, MD Fellowship Director Division of Gynecologic Oncology Associate Clinical Professor of Obstetrics, Gynecology, and Reproductive Science Mount Sinai School of Medicine New York, New York Andrew D. Seidman, MD Attending Physician, Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center Professor of Medicine Weill Cornell Medical College New York, New York

Marc Stewart, MD Program Director, Hematology/Oncology Fellowship University of Washington/Fred Hutchinson Cancer Research Center Medical Director, Seattle Cancer Care Alliance Professor of Medicine, University of Washington Seattle, Washington Copyright Š 2011

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FELLOWSHIP TRAINING

Oncology Fellow Advisor • Vol. 3, Issue 1

Mobile Apps for the Oncology Fellow

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or some busy oncology fellows, smartphone apps may only seem useful for getting directions or looking up a random topic on Google. However, quite a few mobile apps now are available to aid them in their daily work.

Handheld technology can help improve physicians’ workflow and possibly patient care. A systematic review of 13 studies suggested that hospital-based physicians who use handheld technology may have faster response times, fewer medication errors, and better data accessibility and management.1 These compact, lightweight, portable computers have caught many physicians’ fancy.

In the United States, 75% of physicians currently own an iPhone, iPad, or iPod; 30% own an iPad and another 28% plan to buy one by the end of the year.2 “Most oncologists and oncology fellows have good access to drug references, literature searching, and clinical calculators through their laptop or desktop, using the enterprise software associated with the practice. However, having a useful app when questions come up on call, after hours, or when seeing patients in outreach environments is valuable for most oncologists,” said Michael Fisch, MD, MPH, chair, Department of General Oncology, University of Texas MD Anderson Cancer Center in Houston.

Dr. Fisch suggested that useful apps for oncology fellows include a good drug reference and a suite of calculators, such as those for body surface area, body mass index, glomerular filtration rate, fractional excretion of sodium, and the Child-Pugh score for liver disease.

Below are several app summaries based on reviews by iMedicalApps.com, a physician-run Web site that provides commentary on mobile medical technology. Unless otherwise stated, all apps are free and are available for the iPhone, iPad, and Android operating systems.

In the drug reference category, Medscape is the go-to app, according to Amit Patel, MD, staff writer for iMedicalApps.com and a first-year internal medicine resident at Washington University’s Barnes-Jewish Hospital in St. Louis. The app is constantly updated and references more than 7,000 medications, providing details on dosing, prices, and drug–drug interactions (30 drug entries can be simultaneously processed).3,4 Epocrates Rx, an old favorite, continues to be a solid choice among the available drug reference apps. Although Medscape may provide information that is more complete for physicians, especially when pertaining to drug interactions, Epocrates Rx offers a unique pill identifier that can name medications based on descriptions and pill images, according to Dr. Patel.5 Micromedex is another highly regarded drug reference app.3,5 Although it lacks a powerful drug interaction checker, it offers a strong search function and streamlined information on mechanisms of action, dosing, and side effects, said Dr. Patel.

Although Epocrates Rx comes with a medical calculator (MedMath), it is not as comprehensive as other stand-alone calculator apps, noted Dr. Patel. Calculate by QxMD,3,6 for example, boasts a collection of more than 150 medical calculators. Although it does not provide written formulas or aids to help interpret results like MedMath and MedCalc do, it does offer relevant citations and PubMed links. If Calculate by QxMD’s is not adequate, Dr. Patel and his colleagues suggest trying MedCalc, available for 99 cents.6 Another useful app is PubMed Mobile, which brings the quintessential medical literature search tool to your mobile device.3 It offers basic searches but does not support every search parameter available on the desktop version, such as date published, said Dr. Patel. The version of the app is available at www.ncbi.nlm.nih.gov/m/pubmed.

For language translation, physicians should consider MediBabble, Dr. Patel said. Currently available for only the iPhone and iPad, the app offers 2,000 physician-approved queries and directives that English-speaking physicians can use to communicate with patients who speak Spanish, Cantonese, Mandarin, Russian, or Haitian Creole.3 For oncology fellows who do find mobile apps useful or want to try them out in daily practice, Dr. Fisch advises against accessing apps in the presence of patients. “The use of this type of resource may cause a crisis of confidence in some patients who might view this sort of reference utilization as less than fully rigorous,” he said.

References 1. Prgomet M, Georgiou A, Westbrook JI. The impact of mobile handheld technology on hospital physicians’ work practices and patient care: a systematic review. J Am Med Inform Assoc. 2009;16(6):792-801.

2. Seventy-five percent of US physicians own some form of Apple device according to new Manhattan Research study. http://manhattanresearch.com/News-and-Events/ Press-Releases/physician-iphone-ipad-adoption. Accessed June 7, 2011.

3. Patel A. Top 10 iPhone medical apps for internal medicine physicians and residents. http://www.imedicalapps. com/2011/05/top-iphone-medical-apps-internal-medicinephysicians-residents. Accessed June 7, 2011.

4. Patel A. The number one downloaded medical app for the iPhone—Medscape [App Review]. http://www.imedicalapps. com/2010/05/medscape-iphone-medical-app-review.

Accessed June 7, 2011.

5. Patel A. Analysis of Free Drug Medical Reference Apps: Epocrates, Lexi-Comp, Medscape, Micromedex, Pepid, Skyscape. http://www.imedicalapps.com/2010/12/comparison-of-six-reference-tools-for-the-iphone-epocrates-lexicomp-medscape-micromedex-pepid-skyscape-iphone-app.

Accessed June 7, 2011.

6. Patel A. The best free medical calculator apps for the iPhone. http://www.imedicalapps.com/2011/03/best-freemedical-calculator-apps-iphone. Accessed June 7, 2011.

Oncology Fellow Advisor ® is brought to you as a professional courtesy. This content is selected and controlled by McMahon Publishing and is funded by Lilly USA.

CAREER PATHS

Vol. 3, Issue 1 • Oncology Fellow Advisor

Leadership

Table 1. Nonprofit Organizations Offering Physician Leadership Training continued from page 1

can be distilled down to 3 easy-to-grasp but not-so-easyto-achieve concepts: 1. Effective communication 2. Conflict management 3. Collaboration The day-to-day demands on an oncology fellow may be different from those of a Fortune 500 executive, but the basic skill set is the same. Yet the hardest part, said Dr. Sperling, often is convincing both management and fellows themselves that oncologists in the making can benefit from leadership training.

“Given the tight resources that most institutions currently face, many don’t invest in their mid-level or senior faculty, and so investment in fellows is something for which you really need to have a vision, to say ‘We’re educating the future’ as opposed to asking what’s the return on investing in people who are going to leave in a couple of years,” he said.

For their part, fellows need to understand that leadership skills are a means to achieving an end: being a better physician or researcher.

“At the simplest level, there’s a self-interest in being more effective. Knowing how to reduce conflicts that waste time enables one to concentrate on what they need to achieve,” Dr. Sperling said.

Physician leaders must balance efficiency and education to ensure team development and excellent patient care.1 Additionally, more effective collaboration means better patient care by helping oncologists learn how to work in concert with nurses, support staff, and colleagues across multiple disciplines to provide coordinated care for patients with complex medical needs.2 Senior leadership and faculty development at the University of Texas MD Anderson Cancer Center in Houston, worked with Dr. Sperling and his organization to establish leadership development programs. There, various levels of leadership training are offered to faculty members starting out on their academic careers, mid-level faculty, and senior staff in formal leadership positions or on the leadership track. The programs are open to both clinical and nonclinical staff in the leadership pipeline.

An oncologic reconstructive surgeon who recently completed the program, dubbed “Faculty Leadership Academy,” acknowledged that it requires a major commitment on the part of faculty and the hospital.

“It’s a significant cost to the institution, but the institution is so dedicated to training from within people who they feel have leadership ability, who can contribute, and it’s a tremendous course,” said Steven J. Kronowitz, MD, professor of plastic surgery at MD Anderson. “I think everyone who comes in brings different skills. We get a

Organization

Web site

American Society of Clinical Oncology

asco.org

American College of Physician Executives

acpe.org

Physicians for a National Health Program

pnhp.org

Robert Wood Johnson Foundation

rwjcsp.unc.edu

360 [degree] analysis from all of our peers, including our colleagues in addition to people who work under us, our direct reports, as well as from our managers.”

Dr. Kronowitz said that the training has had a positive effect on his day-to-day life as one of 19 plastic surgeons in a group practice. As part of the training, he received about 25 reviews of his skills and leadership style from peers, staff members who report directly to him, nurses, and his superiors at MD Anderson.

For this innovator who is constantly testing new ways of doing things, the training has helped him both “sell” his ideas to others and learn how to incorporate the ideas and suggestions of others into his overall goals.

“The most important thing that I learned was that it’s great to have a vision, but what’s important is you have to have buy-in and you have to have everyone be part of that vision, and it’s important to stay open and have everyone’s ideas come to the forefront, to really put the best things forward,” he said.

Another important lesson for learning leadership is “Physician, know thyself.”

“What we do increases self-awareness and self-insight, that’s step 1 in any leadership journey. If you don’t know yourself and the impact you potentially have on others, and that people have different styles of relating to each other, you can’t be an effective leader,” Dr. Sperling said.

The American Society of Clinical Oncology, in collaboration with Dr. Sperling’s group, offers an intensive leadership training course for early career oncologists and a 2-day seminar for other physicians wishing to develop their leadership skills.3 Other professional societies, academic medical centers, and for-profit companies also offer leadership training for oncologists and other professionals (Table 1).

References 1. Majmudar A, Jain AK, Caudry J, Schwartz RW. High performance teams and the physician leader: an overview.

J Surg Edc. 2010;67(4):205-209.

2. Rose L. Interprofessional collaboration in the ICU: how to define? Nurs Crit Care. 2011;16(1)5-10.

3. Leadership Training. American Society of Clinical Oncology. http://www.asco.org/ASCOv2/Education+%26+Training/ Training/Leadership+Training. Accessed June 3, 2011.

Oncology Fellow Advisor ® is brought to you as a professional courtesy. This content is selected and controlled by McMahon Publishing and is funded by Lilly USA.

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PHYSICIAN FINANCE

Oncology Fellow Advisor • Vol. 3, Issue 1

Large Group Practices Change Face of Malpractice Insurance

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for lawsuits due to their “deeper pockets.” Dr. Legant ncology fellows about to enter clinical practice offered potential tips to avoid litigation in Table 2.4 face a shifting landscape, as solo practitioners and small group practices are being supplanted by large These arrangements may jeopardize the future of group practices. Small practices will have several chalseveral physician-run medical malpractice companies, lenges related to malpractice coverage. Interviews with 2 because large groups tend to be self-insured. Commercial experts in the field highlighted several current trends that interests of these larger groups may not be as sympawill affect malpractice. thetic to individual physicians’ interests as current physiFellows should be aware of the available types of malcian-run insurers. practice insurance, which include 2 types of professional “We may see consolidation of physician-run enterprises liability insurance: occurrence or claims-made.1 Although across many states, which will be driven by the exit of physicians from the independent market,” Dr. Legant said. medical oncologists are less likely to be under litigation According to Marge Beazley, practice administrator than physicians in other specialties and traditionally have for Cancer Care of Western North Carolina (WNC) and enjoyed relatively low malpractice premiums similar to those upcoming president of the North Carolina Oncology of nonprocedural internists, being sued is still a possibility.

Management Society, “The pool of insurers is shrinking.

Potential areas of litigation in oncology include delay in Now states have to choose between 3 or 4 carriers, wherediagnosis, errors in chemotherapy dosing, pain control, and as in the past there was more informed consent.2 of a choice. Fellows going Oncology Fellow Advisor “We may see consolidation of physicianinto practice may find it difspoke with Patricia Legant, run enterprises across many states, which ficult to get the coverage MD, PhD, a solo practitiothey need, and it is going to ner in medical oncology in will be driven by the exit of physicians be more expensive.”

Salt Lake City, who emphafrom the independent market.”

The third trend Dr. Legant sized trends in medicine that —Patricia Legant, MD, PhD cited is the progression are likely to affect malpractoward the adoption of electice coverage. The first is a Table 2. Dr. Legant’s Tips on Avoiding tronic health record (EHR) large increase in the numMalpractice Suits and Decreasing Liability systems, with unrestricted ber of cancer patients, both patient access to these newly diagnosed and surviAvoid burnout by caring sincerely for patients and maintaining a sense of humor. records. EHR systems help vors, at the same time that coordinate patient care with the oncology workforce is Offer quality care and good patient-physician communication. less fragmentation of servicdecreasing.3 Keep accurate medical records. es, but in her view, they have “These trends may lead Tie up all loose ends and use tracking systems for follow-up. several potential disadvanto longer waiting times for Don’t criticize your colleagues. tages. “Adopting electronic patients and an increasing records raises the issues of number of patients seen by Adapted from referemce 4. confidentiality and breach of midlevel providers such as privacy, as well as the difficulty of maintaining a delicate nurse practitioners and physician assistants, as well as balance of candor and accuracy of records relative to an increasing volume of patients for the remaining physipatient satisfaction and anxiety. Cancer care in particular cians to oversee and manage. These factors could lead to is fraught with patient anxiety, yet the record must conerrors and lower levels of patient satisfaction and to less tain truthful information about prognosis, and also medipatient loyalty to a particular provider,” Dr. Legant said. cally important topics like multiple missed appointments Another major trend is employment of physicians by and drug and alcohol abuse,” she noted. larger entities, including hospitals, health care systems (eg, Also, once records are online, patients can offer them Kaiser Permanente, Geisinger, Christiana), and large group to their lawyers. Doctors will become liable for their practices groups (eg, US Oncology). A potential upside statements that perhaps could be discussed with the of this trend is improved quality of care to the extent that patient in person in a more nuanced way, Dr. Legant said. care is driven by evidence-based guidelines, but there are several downsides, Dr. Legant continued. The new see Malpractice, page 8 employment arrangement may offer more plaintiff targets Oncology Fellow Advisor ® is brought to you as a professional courtesy. This content is selected and controlled by McMahon Publishing and is funded by Lilly USA.

Vol. 3, Issue 1 • Oncology Fellow Advisor

PHYSICIAN FINANCE

Negotiations

cell phones, CME, and other things that either hospitals or smaller practices don’t have the financial wherewithal to provide. continued from page 1 Another important factor to consider is that financial pressures may change how and where future physicians a decision about whether this is the right job and conwill practice, said David P. Ryan, MD, clinical director of tract for them,” said Gerry Oginski, Esq., an attorney in the Massachusetts General Hospital Cancer Center in Great Neck, NY, and author of The Doctor’s Employment Boston.

Contract Bible.

“I think there are going to be less and less private prac“Anybody can read a contract, but it’s understanding tice opportunities, because all of the private practices what’s in there and what’s missing that’s critical, and are very nervous about whether there will be a rush to that’s why you have to have somebody who’s knowledgehospital-based care. We’re seeing a lot of the hospitals able make that evaluation—just like if you have a brain trying to create their own cancer centers so that they problem you don’t go to a general practitioner to operate can control not only the quality of the care but also conon you,” he said. trol who receives the profits. We’re seeing, at least in Long before the contract is signed, and ideally before the Northeast, a movement from private practices into their training has been completed, oncology fellows should hospital-based programs. So identify where they want to the jobs that fellows are lookwork, what type of practice, how From The Doctor’s Employment ing at are more hospital-based much they hope to make, and Contract Bible by Gerry Oginski, Esq.a practices as opposed to private how hard they expect to work to Basic bare-bones items that must be practices,” he said. meet their compensation goals, contained in your contract: Dr. Ryan recommends that said Marc Stewart, MD, program Money: How much will they pay you? third-year fellows add to their director of hematology/oncolTerm: How many years will you be an employee? overstuffed brains yet one more ogy fellowship at the University Call schedule: Is it equal or tiered?

Vacation time: How much time will you get off per year? set of initials: RVUs (relative value of Washington/Fred Hutchinson Productivity: Is it a personal or a group productivity units). These are productivity Cancer Research Center, and scale (the difference is tremendous)? measures that take into account medical director of the Seattle Expenses: Will the group reimburse you, or pay for the reimbursement value associCancer Care Alliance. many of your job-related expenses? a ated with the services a particuHe recommends that a felUsed with permission. lar practice provides. The more low considering a job in private RVUs a physician produces, the practice should inquire about higher her or his value to the practice. the typical salary for the area and the location of the “I think from an administrative standpoint the last RVU practice from a senior fellow or those who have recently is always worth more, so you should try to negotiate a graduated and are in practice. step up: If you hit 2,000 RVUs then every RVU is worth Other relevant considerations in assessing a practice more, and if you hit 3,000 RVUs then the RVUs above include required productivity target, incentive plan, buythat are worth more. Administration doesn’t want to have in options, number of colleagues to share call, vacation to duplicate its efforts. You have fixed costs: a secretary, and practice support (physician assistants or nurse pracmedical malpractice, office space. Once you’ve covered titioners, CME time, etc.), and hospital- versus officethose fixed costs, the hospital is seeing a profit margin. based practice environment, noted Dr. Stewart.

So you should know that as an administrator, the last RVU Mr. Oginski noted that there are basic “bare-bones” is worth more to me than the first RVU,” Dr. Ryan said. items that should be included in every employment conAs to where the better-paying jobs are likely to be, “Go tract a physician signs, including salary, length of employWest (and South), young physician,” Dr. Ryan advises. ment, expectations about being on call, vacation time, “There are jobs galore in the southeast and the southproductivity measures, and expenses (sidebar).1 west.

Where you have a shrinking patient population, or “For doctors who are looking at what the dollar value where migration patterns are stable, the numbers will go of their salary will be, they should know that that is not up a little bit as the baby boomers age, but you’re not the be all and end all, because you have to look to see going to have the same negotiating power compared whether there is other value added with other things that with the locations that are having population growth and they’re offering, such as quality of life, lifestyle as a physiwhere people are desperate for an oncologist,” he said. cian in that particular practice, and what other benefits the group may be offering that similar groups who may be Reference paying more money simply can’t offer,” said Mr. Oginski.

For example, the practice may offer car or transporta1. Oginski, Gerald M. The Doctor’s Employment Contract Bible, 3rd ed. 2010; p. 129. tion allowances, reference materials, computer access, Oncology Fellow Advisor ® is brought to you as a professional courtesy. This content is selected and controlled by McMahon Publishing and is funded by Lilly USA.

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ONCOLOGYFellow S UPPORT & INFORMATION FOR THE NEXT GENERATION OF ONCOLOGY PRACTITIONERS

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Oncology Fellow Advisor • Vol. 3, Issue 1

Malpractice continued from page 6

The issue of quality of care versus the amount of reimbursement insurance companies are willing to pay will become an even more important issue that will affect the malpractice environment in the future, predicted Ms. Beazley.

“Although insurance companies may want to acknowledge quality practices that fulfill the American Society of Clinical Oncology’s QOPI [Quality Oncology Practice Initiative], the same companies want to pay for a generic equivalent, which has not been validated in the approved clinical trials. Insurance companies are striving to find a mechanism to treat patients according to [The National Comprehensive Cancer Network] guidelines and preserve the health care dollar at the same time,” she said.

“We’ve run up against this and negotiate with carriers and often come to an agreement,” she added.

Another thing oncology fellows should be aware of is that premiums vary by state and are based on frequency of claims, amount of awards, the legal climate, and whether a cap for pain and suffering exists. When a fellow is deciding whether to enter a practice, the premiums in that state are a factor to consider. Premiums for oncologists are generally similar to those for other internists who do not perform surgical procedures.

Ms. Beazley described her experience with malpractice premiums. “In Western North Carolina, we have a wonderful carrier that may hold/freeze premiums if the practice has not incurred any claims. As time with the company grows and the liability record remains clear, premiums are at a low risk for increasing. We have one

oncologist who has practiced for 25 years without an incident, and his premium is now $7,000 per year; this is very low compared with other physicians who are at higher risk,” she said.

Ms. Beazley is “aghast” at some premiums across the United States, some of which are up to 75% higher than what practitioners at WNC are paying. She declined to provide an actual figure for premiums in the practice she administers, but said that states that are more densely populated have increased fraud and abuse and higher liability premiums; examples are New York and Florida.

Ms. Beazley offered this advice: “Find a strong group in an area that allows you to practice the type of oncology you prefer: for example, urban area, hospital, but gives you the most protection—an umbrella of protection. Look at the number of doctors within that group who do not have blemishes on their records, and consult with them on your cases. I tell new oncologists to also review the state medical board regarding medical liability claims of the partners in the practice you are considering joining and ask the partners directly about any past liability claims. I find that most new fellows do not ask that question.”

References 1. Wormley JM. Malpractice insurance: what you need to know.

J Oncol Pract. 2007;3(5):274-277.

2. Legant P. Oncologists and medical malpractice. J Oncol Pract. 2006;2(4):164-169.

3. Shulman LN, Jacobs LA, Greenfield S, et al. Cancer care and cancer survivorship care in the United States: will we be able to care for these patients in the future? J Oncol Pract.

2009;5(3):119-123.

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