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  1. I have a new job offer and had some questions with regards to negotiating the malpractice coverage The offer states that I would be covered under the group's malpractice policy using the group's standard policy and limits. I need to clarify the type of insurance policy but I am assuming it is a claim's made policy. The contract states that upon termination the employee "shall secure at their own expense malpractice insurance tail coverage if required." This would be a dream job for me and I absolutely intend on staying with this position for the foreseeable future, but I am not comfortable going into a contract/position without any tail coverage guaranteed as it seems the cost is quite high to obtain this once leaving. While I know I could negotiate for a future employer to pay this I don't know how common or expected that would be. I am thinking of negotiating for them to pay tail coverage OR negotiating for them to pay the premiums for my own occurrence-based policy (which would likely be through the AAPA) so that I would not have to worry about tail coverage if there comes a time I change positions. Thoughts on this? Should I not worry about the tail coverage issue and move forward with the contract if they decline my requests? Thank you!
  2. Communication and Dangerous Medical Errors Robert M. Blumm, MA, PA, DFAAPA, PA-C Emeritus Communication is as old as the human race and has always played a part in our lives: from early writing on the walls of caves in pictures, to smoke signals, the printing press, Morse Code, the welcoming of Alexander Bell's telephone and, of course, all of the enhancements that we have today, including that annoying cell phone with its robocalls. The purpose of communication is to share a message and to get a response. The key to communication is not mere hearing, but the focused act of listening, responding, and returning information. How often do we go to a store, give an order, only to have the clerk say, “What did you want?” They have not listened to what you ordered. This is unacceptable in a medical practice. Just yesterday, as I began to write this article, I was informed of a medical error which caused a patient a greater morbidity risk because the message that was given was not relayed and the patient trusted the nurse who gave the response. We all know Mrs Jones; Mrs Jones called the gastroenterologist three days ago with the complaint of minimal left lower quadrant pain, severe bloating, gas, was afebrile and had unusual bowel movements. Mrs. Jones called her doctor when she realized that she was not healing spontaneously and needed the attention of a specialist rather than running to an Emergency Room. The nurse said the doctor was booked, but that she would double her up sometime that day or the next day and to wait for a call. The call did not come that day or the next. When the patient was finally seen as an emergency, she was beyond Flagyl and Cipro as she now had a perforated diverticulum. If the patient had been seen as she had been promised, the need for emergency surgical intervention might well have been averted. This is only one of the hundreds of errors that can occur when employees in our offices drop the ball or when we do not have protocols in place. Every time that a PA or an NP orders blood labs, urine, radiological studies, special consultations or has a patient that has been discharged from the hospital, they should be notified by the provider or designated office person as to the results and what they may mean. Telling a patient that their WBC is 16,000 is not the same as saying that it is abnormally high and indicates an infection. When a patient reports a problem or calls to say their blood glucose is 50 or 350, these are examples of hypo and hyperglycemia and they will need to speak to a provider for directions and follow-up. All responses need to be placed in a log with the signature of the person making the call and what they told the patient. Hospital discharge patients require the same procedure to assure them that you are concerned and that they have had their questions addressed. These are written procedures and protocols and your health care system probably has forms for this for their own follow up. What if your office workers are not diligent to maintain this type of record? You, as the provider or owner of your practice are 100% responsible and, therefore, you need to have the proper liability insurance. You will also need to discharge that employee from your practice setting. What is the best type of insurance to have for these potential problems as well as the many others that you may encounter as you practice medicine or nursing? My suggestion would be an occurrence policy, and not just any occurrence policy or one from your healthcare system, but a personal liability insurance policy that specifically names you as the covered and owner of the policy. What company would I choose? A company with a reputation for honesty, paying their claims, securing excellent attorney’s and having the ability to pay claims without bankruptcy. I would choose a company called CM&F, Personal Liability Insurance experts with a 70 year history of excellence and an A++ (Superior) rating by A.M. Best. Why this company? Because it is proven and has cared for nurses, PAs and NPs throughout its history and is a committed family-owned business.
  3. Hi all, I'm a new grad PA with a recent job offer in my desired specialty and location but offers only to pay for claims based malpractice without tail. I would be practicing in a tier 3 location and specialty (meaning I need the most expensive form of malpractice). I looked into purchasing my own occurrence based malpractice and it is wildly expensive (it would be almost 10% of my salary) and the physician I would be working for refused to help me pay for it. I am practicing in a state that only allows someone to sue practitioners within 3 years after the supposed incident or 1 year after the incident was discovered. I am wondering your thoughts on this situation - would you bite the bullet and pay for your own occurrence based plan? or would you let the physician pay for the claims based insurance, knowing you would have to pick up the tail if you left? Lastly, if I were to pay for a tail after leaving, how many years would you suggest I buy the tail for? Thank you all!
  4. I've been using CM&F for some years. As a part-time PA, occurrence $500,000/ $1, 000, 000 policy they want $3,060 for the year. Cinch, a Berkshire Hathaway Specialty Insurance, sent me an offer of $500, 000/ $1,000,000, part time worker for $2196 -- $864 (30%) difference! It covers reputation insurance, licensing board and HIPAA claims. Has anyone used the Cinch malpractice? Any comments? I am leaning towards making the switch to Cinch.
  5. Hello all, I'm in a bit of a pickle. New grad here. I just left a small clinic after four months because it wasn't a great environment in general (I won't get into details, but they were incredibly disorganized and the clinic was poorly run. Had I not had financial obligations, I would have left after about a month). While I was there, I was covered under the clinic's malpractice policy and didn't have a policy of my own. The clinic claimed I would be fine without the individual policy, but I'm trusting what the clinic said less and less. I believe their policy is claims made. Here are my questions: 1. I don't have any suits filed against me. Can I get a retroactive individual policy? Can I go elsewhere or do I need to get it from the clinic's company? 2. How do I ensure that I continue to be covered if the clinic's policy is canceled? That's what I'm most nervous about. I have no idea if the clinic will remain open and I don't want to risk not having coverage. Is there any way I can find out if the coverage gets canceled? 3. What kind of information regarding the policy do I need to get from my former employer? Do I need a company and policy number on hand? In retrospect, I probably should have done my research a bit better at first, but being a new grad I trusted my clinic and everyone who worked there as they're way more experienced than I am. However, after working there for a few months they seem to not always know what they're talking about. Is it a bad idea to stay under my clinic's policy if I have a similar situation in the future?
  6. Hi everyone, I am a new graduate, and I just received an Ortho PA job offer in coastal California. I will start training (same salary) as soon as I finish my boards, while I am waiting for my licenses to process. The job is M-F from 8-5. OR 1-2 days/week, but not when I initially start. Call time was not mentioned in the contract, but it's about once/month (no additional pay) What's offered: - Base Salary: 100k - At-will contract; If I stay less than a year, then I have to repay the licenses, relocation bonus, CME. etc. back to the employer. - Health insurance, vision, and dental - Incentive bonus: available after 3 months (PA's at the company said that I probably wouldn't reach the bonus requirement until 9-12 months) - PTO: 10 days/year (accrue on a pro-rated semi-monthly basis from the date employment commences) - 9 paid holidays - sick days: 5 days/year (accrue after 3 months) - CME: $2,500 and 5 days off (in addition to the 10 days PTO) - All licenses covered: reimbursement for Board expenses, initial licenses and license renewals, including D.E.A. and California license - $4,000 relocation bonus - Three memberships reimbursed: example AMA or CMA - Gas reimbursement: I have to drive to the satellite locations a few days/week. - Malpractice: company covers professional liability insurance with tail coverage What's not offered: - retirement (401k) What do you think of this offer? Any feedback is greatly appreciated!
  7. Hey has anyone seen this site? http://shifttales.com/ Seems interesting. They have a system for documenting issues that come up with ED visits that aren't directly related to patient care, or might be a malpractice concern in the future. Is anyone on it? Using the interface?
  8. I just heard from my new employer - a large hospital corporation - that HR thinks that it will take up to 90 days for me to be added to insurance payors after my credentialing paperwork is sent to them. I figured that as a new PA there would be fewer issues as far as the insurance was concerned because there are no disputes or claims, etc, against me. Also, the workplace does not accept Medicaid patients. How long does it take? Or how long did it take for you? I am concerned about being without a job over the holidays. I expected to start in November, but the doctor went on vacation before signing my SP forms. Ugh. Times are already financially tough in my household for my family.
  9. Hi everyone, I'm hoping for some advice in an area with which I am not familiar. I am starting physician assistant school in a few weeks and I'm very interested in emergency medicine. Some of the ER docs who I was previously working with as a scribe have offered to allow me to return to the ER on weekends as my schedule allows to get some practice doing histories, physicals and learning basic procedures on real patients --- sort of like a clinical rotation, I suppose, with the MD in the exam room, watching and listening the entire time. I am planning to take them up on this generous offer, as I am eager to learn and I want as much exposure to the ER as possible while i am in school. However, I would hate for one of the doctors to be held 100% accountable if I were to make a serious mistake. Is there such a thing as malpractice insurance for physician assistant students? If so, which insurance company has the best reputation for this purpose? Thank you in advance for your help!
  10. Yet another malpractice coverage question, but I haven't seen this one anywhere else on the forum. Kindly redirect me if I've missed it. I'm starting a new job and looking into doing the smart thing this time and getting my own policy. They would not offer tail coverage if/when I move on. No surprises there. For whatever reason they have started on my application with their group anyways and provided me the application to finish filling out. The statement below may have me reconsidering... "COPIC does not provide “tail” coverage to allied health professionals. As long as your employer or contracting physician purchases “tail” coverage at the time of termination of their coverage with COPIC, you will be provided coverage in the future for unknown claims that may have occurred during the period of time you provided such medical services. If your employer or contracting physician does not purchase “tail” coverage at the termination of their coverage with COPIC, you will not be provided coverage for any unknown future claims. You may wish to request from your employer or contracting physician a written confirmation that “tail” coverage will be purchased at the time of termination of their coverage with COPIC." I can't help but be skeptical based on what I've read and heard before about PA coverage. It's a surgical position and having my own policy would be MUCH more expensive. How much of that they would cover is a whole other can of worms. Any input much appreciated!!!!!!
  11. To all considering applying to PA school through CASPA in the 2015-2016 application cycle: the CASPA application for the starting class of 2016 (or January 2017) will open on April 22, 2015. The CASPA application platform will be updated with this new cycle, which will offer many exciting features for both applicants and programs, including a new and improved user interface, design, and customizable options. The change to this new platform will NOT allow for any re-applicants regardless if you have applied in the current CASPA cycle. ALL applicants will be required to begin a completely new application when the 2015-2016 cycle opens on April 22. CASPA will be unable to make exceptions to this so please keep this in mind when considering applying in the new cycle. We know you will be pleased with all of the system and application updates. You can contact me directly with any questions - danielle@PAEAonline.org Danielle Di Silvestro Director, Applicant & Student Services Physician Assistant Education Association
  12. Dear Dr. __________, I am a student majoring in ____ at _____ University who is very interested in careers in medicine. One of the executive members of a student-run organization known as ______ suggested that I contact you for a potential shadowing opportunity. I am writing in hopes of requesting for such an opportunity to gain a deeper insight on what practice of medicine truly entails. I would be extremely grateful if you allowed me to quietly observe you as you go about your usual schedule. If possible, it would also be helpful if I could ask you questions I might have after observing your work day and in general about your career experiences. This experience would be invaluable in acquiring a transparent perspective on your profession and discovering my fit for this career path. As your time is extremely valuable, I hope to accommodate your schedule if you would consider my application. Thank you for your time and consideration in advance. If you prefer to contact me, I can be reached at (phone number) or via e-mail at (Email address). I look forward to your response! Sincerely, Bob Smith Thank you guys in advance!
  13. Anybody out there doing rapid strep tests from your home (obviously during off hours) I live in a small community and there is a demand for someone to provide rapid strep tests, and if positive to prescribe ABX. approximately 10 per week. Assuming I can get my supervising physician to agree, I imagine malpractice would still be an issue. anyone with experience with this?
  14. First, I'll start by saying that I have learned so much these last couple weeks, will never make this mistake again, and should ALWAYS get everything in writing.... The situation is this... I work per-diem in two different hospitals (where my malpractice is covered by them) and I work part-time for all of this; 9/2011 I started working for an MD doing Sleep medicine, and he got me a claims made part-time (<24hrs/wk) policy. He paid it for two years, though I only worked for him for one. 12/2012 I started working for MD seeing patients in Nursing homes and rehabs until 4/2014 In May of this year I started training with a dermatologist, who has never had a PA. I have no contract (I know, I'm a fool). He is very old school, we were going off each other's word, and I am far too trusting. Sept. my malpractice is up for renewal, and since he is likely selling the practice he did not want to pay it, he passes the buck and they don't yet want to be responsible for it. I would have 7 more payments/years until my tail is included. So, currently my policy is lapsed (though may very well be reinstated if full payment is made within next month), an I have not been able to work for him. He (and potential new MD buying practice) want me to switch to MLMIC and have an occurrence policy, which is better, BUT but that would mean that one of us (or maybe a combination) would pay for the tail. So, I plan to tell him that if he wants me working for him, he has to help with the tail. But, this guy is SO cheap, uncommunicative etc. that I may be better off just leaving him and running for the hills, but I want to try to get some money for the tail and there is a good opportunity with new people, though he would still have to be my SP. The lack of contract sucks because I cannot hold him to paying my tail or anything, but perhaps he would pay it and not make me sign a contract that I have to stay working with him for a certain period of time. I KNOW the new MD will present an offer letter to me (assuming they want me to stay, and have me sign something). I am waiting to hear the cost of my tail from my carrier, but as of now I just fear the worst. For what it's worth, I don't think I'd be sued, but no one ever thinks that... I don't want to take the risk. So, any advice on how to ask for tail coverage now? any other comments/advice? I am so stressed here... :(
  15. Hey Folks, Recent graduate received job offer with Ortho/Trauma. I will perform hospital round, first assist & clinic. Training Period Base Pay: 46,000 Base Pay: 92,000 [based on 50 hr work week], range of 50-55hrs CME: $2000, 5days PTO: 15 vacation Days, 4 Personal 7 Holidays off Call: 1/7 Days. Weekend Call 1/8 weekends. No add'l pay Bonus consideration: after 1 year Thoughts?
  16. After browsing through the forum and doing some google searching, I still feel like I am a little confused regarding malpractice coverage and tail coverage. Please fill in gaps or educate me where my knowledge is incorrect. Occurence coverage = You are covered for any filed suit on you between the dates of your coverage. E.g. I was covered from 2009-2010 by occurence coverage, a suit was filed in 2012 for an issue that arose in 2009, I am covered with occurence insurance. Claims made = You are covered for any filed suit if you currently are carrying the policy. E.g. I worked with claims made coverage from 2009-2010. A suit was filed in 2010 while I was working and carrying claims made coverage. I am covered with claims made malpractice insurance. In this instance, I would not be covered if this same suit was filed outside of the 2009-2010 period while I had claims made malpractice insurance. Claims made with tail coverage = You are covered for any filed suit while you carried the policy and the tail covers any suit filed after the policy ended. E.g. I worked with claims made coverage with a tail from 2009-2010. A suit was filed in 2012 for an issue that arose in 2009. I would be covered by a claims made policy with a tail. My confusion comes regarding having tail coverage as a new graduate. I have read that you don't need it as there is no past practice to raise concern of a lawsuit and I have read you should push for it in a contract. Thoughts? I have also been told that if I were to change careers, that it is standard that the next employer would provide tail coverage for my previous employment (this is what I was told regarding a recent contract I was offered). This doesn't make sense to me as I thought the tail coverage was specifically for the period after the stated malpractice insurance that it covers. Wouldn't the case above be an example of nose coverage? and is this actually common practice? Finally, if you have claims made coverage at one career and then switch careers where you are provided claims made coverage again, is your current second policy going to cover any suits filed during your first career? I.e. You would still need tail coverage for the first job, correct? Sorry for the wall of text. I think this is a point of confusion for a lot of new graduates and young PAs and I'm sure many of us would thoroughly appreciate a better understanding of these issues if someone could provide them. Thanks so much!
  17. Hi all. In my current position (my first job out of school - been there almost 3 years), my employer has stated I am covered by the hospital's malpractice policy, which has limits of 8M/24M. Admittedly, I had a very poor understanding of my insurance when I accepted the position. Over my time in this position, I became increasing curious of the details of the policy and after nearly 6 months of asking was supplied with only a letter stating I was covered by the policy and a form stating the above limits and that the policy is a claims-made policy. I am now in the process of transitioning to a new position at a new hospital, and will again be employed by the hospital and have been told I will be covered by the hospital's policy. Through my reading on the topic, it seems that I probably should have my own private policy (and should have for the past 3 years as well. This leads to several questions: 1. If you are a hospital-employed PA, how are you insured? Only hospital policy, or hospital policy + personal policy? 2. I am now leaving my first position and it seems to me that I am going to have to purchase tail insurance. Is this true? (I have already asked this question of my directors, and they are in the process of finding out) If so, how much can I expect to pay? 3. If you are hospital-employed and have a personal policy, do you pay for it or does your employer? 4. If you are hospital-employed, how much do you know about the hospital's insurance policy under which you are covered? 5. What is the best way to handle what looks to be a similar situation in my new position? Should I just purchase my own policy? Thanks for any help you can offer. I am also interested in any other knowledge wiser and/or more experienced others can impart on this particular topic.
  18. Negotiating a family practice job in the Mountain West as a new grad, trying to get a feel for a) How much liability insurance I need if I'm not covered under my employer and b) How much reimbursement per RVU I should expect. MedEdge offers a 100k/300k claims-made for pretty cheap but I've been told by some to purchase no less than 1M/3M... Any thoughts? I've also been offered a productivity bonus at $30/RVU. No info on thresholds or other specifics yet. Is $30 fair for family practice? I've heard pediatricans making $40 and orthopedic surgeons making $60/RVU to put it into perspective. Thank you.
  19. So I am looking for a little input on a huge problem... I have been working a FM job for 2 month now. I signed a 3 year contract that I had reviewed by an attorney that said it looked good, nothing out of the norm. There is a bi-weekly salary and a monthly stipend for signing a three year deal..... After the first week I realized that there was a huge problem... The bussiness manager whom I was told was in charge of "credentialing" had filled out nothing... no SP paperwork... no prescriptive authority.. no malpractice.... no healthcare... etc.. I had submitted all of my license info and a stack of other paperwork weeks before... I trained at one office for about 1 and 1/2 months... to get the flow and system down... I also covered for a bunch of vacations at other clinics.... My first day at my NEW assigned clinic I see 2 patients... my schedule is empty... and continues to be that way.. I get an email from the bussiness manager that I need to fill out the forms for malpractice again!!! Does this means I have no malpractice and I am on my own if something would go wrong?? My contract states that they will provide and cover all malpractice costs and provide tail coverage.... Is this reason enough to terminate the contract??? I want out bad and need to have "cause" or pay $8,000 in liquidated damages..... Any suggestions would be appreciated.... Scott
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