Medicolegal Issues

Your First Job


Within the next few months, many of you will have a new job as an attending hospitalist. As daunting as that may seem, now is the time to think about what you can do to ensure a smooth transition and successful beginning to your career.

Although residency prepared you to face the medical challenges ahead, here are 10 pointers that may help as you move to the next stage of your professional life.


Prior to committing to your first job out of residency, review the contract with a keen eye. Get the advice of a healthcare lawyer before signing a contract and agreeing to the stated conditions. This can prove invaluable especially during contract negotiations. Pay particular attention to the following items:

Malpractice Policies

Identify the type of malpractice coverage your employer provides. The types include:

  • Occurrence malpractice insurance: Provides coverage of claims regardless of when the claim was filed for incidents occurring during the policy period. This insurance will offer seamless coverage even in the event of an insurance policy or job change.
  • Claims-made insurance: Provides coverage of a claim only if the incident occurred and the claim was filed during the policy period. If your claims-made policy is canceled or expired, then coverage no longer exists for any filed claims. “Tail” coverage (liability insurance) is needed at this point.
  • Liability insurance: Provides continued coverage against claims after your claims-made policy has ended. It can be expensive, but prevents gaps in coverage and protects the physician in the event of litigation.

If your contract states you will be provided a claims-made malpractice policy, get details about your liability insurance in writing. Find out how much liability insurance costs, who pays for it, and what affects the cost if you must pay for it. These variables can include tenure with the group as well as circumstances for departure from the group.

Restrictive Covenants

Also called noncompete clauses, these prevent hospitalists from practicing within a geographic region of a previous employer for a certain amount of time. Most noncompete clauses are enforceable by law.

Understand the terms of any restrictive covenant and make sure you’re comfortable with them. Carefully assess any geographic restrictions and how long you’ll remain subject to them. Given the dynamic environment of hospital medicine and the growing demand for hospitalists, these clauses are especially vital.

1) Familiarize yourself with the licensing/credentialing process: Do not underestimate the amount of time it takes to get this paperwork approved—up to six months in some cases. Many new hires’ first days on the job are delayed because they didn’t complete this step. Check with state licensing boards for special requirements unique to that state. Also, every hospital has its own gauntlet of infectious disease, HIPAA, and information- technology hoops to jump through. Getting your applications in as early as possible puts you in position to begin on your planned start date and prevent last-minute catastrophes for your new program.

2) Gain valuable insight through observation: Study your current hospitalist group to gain perspective that will help in your new setting. All programs and hospitals operate differently and have room for quality/process improvement. Interview hospitalists, ask questions, and observe the workflow in your current hospital(s) to help in your new job.

3) Contemplate your career direction: Think strategically about your strengths and plans. Although you will learn an incredible amount about hospital medicine careers after you begin, having a sense of direction will help your new group and its leadership get you where you want to be. Making connections and making your goals known within your new program before you start will put your new career on the right path.

4) Seek mentors: Having mentors from your prior program and your new program is a key to a healthy and happy career. Choose people you respect and pick their brains about their careers, how they acquired their skills, and how they would advise you to do the same. Good mentors will help you for many years, and the most valuable may be the ones who have known you throughout your residency. Nurture and maintain these relationships even if you are moving on to new horizons. Inquire whether your new program has a mentorship structure or if your new group leader can recommend someone who shares common interests and goals.

5) Study SHM’s Core Com-petencies: Although you may have trepidation about your medical skills and knowledge as you move into uncharted waters, step back and relax. Know that you are prepared. That said, you can always learn more. One excellent resource is The Core Competencies in Hospital Medicine: A Framework for Curriculum Development (available on SHM’s Web site, This is a set of standards with which programs can teach hospital medicine and you can learn the scope of expectations and competencies for someone in your position.

6) Understand the nuts and bolts of your new program: Although there are many things you will learn on the job, gain an appreciation for some of the following before your first day:

  • Billing: If this is your responsibility, you need to learn a little about this before you start, preferably from one of your future colleagues.
  • Reimbursement structure: Find out how your productivity is tracked and rewarded. You’d be amazed how variable this can be.
  • Time allotment: How are administrative, research, committee and teaching time balanced against your clinical time?

7) Get to know your new hospital: Before hitting the wards it pays to do a little homework on your new workplace. Do you have access to a medical library, journals, UpToDate, or other online databases? If not, do you need to purchase this access on your own? Many programs have academic funds allotted so you can use those resources. Also, familiarize yourself with the local antibiogram, formularies, guidelines, and order sets. Most facilities have tools specific to their hospital. Know how these affect you in your new role. Prior to starting, you will also want to be sufficiently oriented to any computer systems and understand how they’re used for documentation and order entry, and for viewing lab, radiology, and microbiology results.

8) Shadow a hospitalist: Spending a few hours with someone during a typical hospitalist work day will give you an idea of the pace of the work, the layout of the hospital and floors, the medical and ancillary staff you will work with, and the patient population. This will prompt questions you hadn’t thought of previously.

9) Prepare for each specific role: Hospitalists wear many hats, including teaching attending, non-teaching attending, consultant, researcher, committee member, and hospital medicine leader. Each role carries specific responsibilities and expectations. Prior to each new role, train with someone who leads that service or knows the job intimately.

10) Comprehend your benefits: Does your employer have a retirement program? Do they match retirement contributions? How does the malpractice insurance work? A meeting with human resources will usually help you arrange your health, dental, malpractice, and disability insurance prior to your start date. TH

Dr. Chacko is chair of SHM’s young physician committee and the hospitalist program medical director for Preferred Health Partners in New York City. Dr. Markoff is an assistant professor of medicine and associate director of the hospitalist service at the Mount Sinai Hospital in New York City. Dr. Sliwka is a hospitalist and assistant professor of clinical medicine at the University of California, San Francisco Medical Center.

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