From a legal standpoint, this language raises several issues. First, the responsibility for supervising a mid-level provider may increase liability for the physician if the mid-level provider commits medical errors. The language in state Medical Practice Acts generally makes physicians legally liable for the actions of the mid-level providers they supervise, which could put the physician in the position of having to defend a malpractice claim from a patient the physician never even examined. In addition, professional repercussions can occur with mid-level provider supervision.

For example, just a few months ago, the Nevada State Medical Board took action against a physician’s license and alleged that the physician committed medical malpractice for failing to supervise adequately a physician assistant who provided “improper patient care.” Finally, billing for services provided by mid-level providers can sometimes be tricky. A group or hospital that inappropriately bills the government at physician rates when patients received mid-level care may expose the supervising physician to a government audit and penalties for false claims.

This caveat does not mean that physicians should choose not to work with mid-level providers, only that physicians must not take the duty of supervising mid-level providers lightly. Assuring that mid-level providers have adequate malpractice insurance, that the employer has specific policies in place regarding a mid-level provider’s scope of practice, and that the mid-level provider has agreed not to exceed that scope of practice may help to mitigate a physician’s risk in agreeing to supervise mid-level providers.

Exclusivity

More and more hospitals are demanding that emergency physicians refrain from moonlighting at other facilities. In most industries, such a request may not have significant repercussions, but the economics of physician employment are different from those in most other industries. Consider the following contract language: Without prior written consent from CORPORATION, EMPLOYEE agrees not to be gainfully employed as a physician for any entity other than CORPORATION.

Think about how long it took you to get staff privileges at your current hospital. You had to fill out the hospital application. Then the medical staff office had to contact your previous hospitals and references. Then you had to apply for and receive billing numbers. Then your completed file had to be presented to multiple committees that meet once per quarter. Only then did you receive your privileges. It is not unusual for the credentialing process to take many months.

Now suppose that you are immediately terminated for cause from the only hospital where you hold privileges. You would have to first find another facility looking for an emergency physician. Then you would have to apply for staff privileges at that facility, meaning that for several months you would have no income stream while you waited for the credentialing process to be completed. Then you’d have to get on the emergency department schedule and work for a month before you received your first paycheck. Do you have the financial reserves to pay your bills for several months without any income?