There are so many intangibles associated with family medicine obstetrics and surgical family medicine obstetrics, that base salary is poor surrogate for the evaluation of any particular position. There are other professional assets and risks which should to be tallied.
Guaranteed-in-writing OB privileges based on current training,education,and proven ability before you move--If not STOP
Who covers the ectopics, bladder perf's, others? Is FP allowed to do them, do you transport, or is there a friendly surgeon? No emergency plan--STOP
Family practice group with at least one FP with Cesarean privileges--add 2 points
working for an OB-Gyn take away a point
working for a corporate hospital= neg
NHSC= neg 2 points
Will you glorify your spiritual goals--Priceless
Obtain data on last year's delivery volume--take away points for too many and too little; latter will not be sustainable and you will be sad to learn of hospital's plan to close OB in 2014.
Obtain data on the average reimbursement per delivery for the last year? Do the arithmetic.
Does the practice utilize coding savvy strategies about V23.89 situations? Are you allowed to manage GDM within family medicine or must they be referred?
call group too 1-3::: --take away points contingent upon your family situation, ambition, and health; or add points if total delivery volume is 120-150 per year. Goal 50 deliveries per year per MD; top end varies but you need to know your limits. Average pure OB in the USA does 11-12 per month.
Incentives for productivity with a clear system of accounting=+
Incentives for each delivery and Cesarean=+
No fair incentive for after hours and weekends = neg
Factor in physicians right to collect on ancillaries--office surgery, ultrasound scope of practice issues; No rights for revenue sharing of ancillaries = negative
Do have the right to manage the subsequent well child product or do these kids go to the corporate pediatrician-- if so your revenue is less= negative
What state are you in and what is the cost of average insurance with and without OB; you need to know what is paid for the margin needed to cover the OB portion; Do you expect $1M/3M annual or will you demand more coverage? Will the group require that you pay for more coverage?
Who pays the tail and what does it cost after 3,5, and 10 years?
And more
With best wishes for your professional success
Witness Protection Program
El Vez de la Noche
Memphis, Nashville, and International
I would like to, respectively disagree with one score . . . the neg 2 for NHSC. I work for the CHC in Salt Lake City. We have had NHSC loan repayment most of the 22 years I have worked here. It is a great place to work, and we have a long hx of long tenure amongst our docs. I am sure there are places that would not fit this description, but a blanket score making NHSC the single largest negative score seems over the top.
One benefit of working for a CHC (with or without loan repayment) is that it is the one place where, with FTCA as malpractice coverage it is possible to do OB part time! With no direct malpractice insurance it is possible for folks with young families or slowing down, or for whatever to do "enough" ob for clinical skills without having to do "enough" to cover a malpractice annual differential and there is never a tail.
Keith Horwood, MD
WMR Replies:
Fair enough, and I agree that NHSC is a noble endeavor, but, 1990--2010, of 8 NHSC-bound physicians we trained to be capable of surgical family medicine obstetrics, only two could be placed in a location where they were allowed to do any Cesareans.
Last year our NHSC placement did a total 3-4 deliveries for the year. This occurred after a lengthy written process in which many things were promised, but not delivered. I would welcome a list of NHSC assignments where our graduating fellows can indeed do all of the things we train them to do. I would be the first to help recruit for these places.
Could you tell me the name of a malpractice company in Utah,and what they charge for an average FPOB policy?
I have personally shopped for and purchased OB malpractice policies for people who work part time. I bought one this year. Physicians without any incentive to investigate options, particularly those bound by corporate[not NHSC] contracts, make poor shoppers.
Comments