aged care companies or insurers and reimbursement issues as reasons they are no longer full or part owners of a medical practice.


Alexis Wiesenthal, MD, is a young internal medicine phy- sician who started out working with her father, Martin Wie- senthal, MD, in 2008. She opened her solo internal medicine practice in San Antonio last year. She employs a receptionist, medical assistant, and lab technician. She says many of her young physician colleagues start out in employed settings be- cause start-up costs associated with running a practice can be an impediment to independent practice.


“It is daunting when faced with the start-up costs, including changing from paper charts to electronic health records, nego- tiating contracts with insurance companies, finding employees, and budgeting for an office lease, liability insurance, medical equipment, and supplies. But I have found it is a satisfying and fulfilling challenge. I have truly enjoyed learning about all aspects of medical practice that I was not privy to before,” said Dr. Wiesenthal, a member of the Texas Medicine Editorial Board.


TMA Practice Consulting offers practice setup services for


Alexis Wiesenthal, MD


a fee. To schedule a practice setup or other service, call (800) 523-8776, or e-mail practice.consulting@texmed.org. Addi- tional information is available on the TMA website, http:// consulting.texmed.org. Employment isn’t in Dr. Wiesenthal’s future plans. “I hope to maintain a solo practice as long as I can. I feel I have more quality time with patients and enjoy a smaller, more efficient staff,” she said. Mr. Kreager says part of the reason many physicians choose to start their careers as employees has to do with the desire for work-life balance. “Physicians receive little to no training on running a busi- ness, are uncertain about the future of Medicare and Medicaid reimbursement, and have massive medical school debt to pay off. Hospital recruiters come along and offer these physicians a guaranteed salary, and it’s an appealing proposition,” he said. But, he warns, hospital recruiting agreements generally guarantee a physician’s salary for the first year only. In addi- tion to short-term income guarantees, these agreements typi- cally provide physicians with marketing assistance and liability insurance, cover relocation expenses, and may include a sign- ing bonus. While the perks are enticing, Mr. Kreager stresses that re- cruiting agreements likely will require repaying the benefits provided and impose a variety of condi- tions on the hospi- tal’s ongoing obliga- tions. These include requiring physicians to maintain a full- time practice in the hospital’s commu-


Douglas Curran, MD 18 TEXAS MEDICINE February 2013


nity, maintain medical licensure and enrollment in Medicare or Medicaid programs, and retain active staff privileges with the hospital.


“It’s a good idea for physicians to have an attorney look over not just the employment agreement but the recruiting agreement, as well. As with employment agreements, hospital recruiting agreements are negotiable. Keep in mind that the hospital system may comprise many institutions over a wide geographic area, so the contracting officer likely will resist changes that deviate from the hospital’s contracting policy or uniform provisions,” Mr. Kreager said.


Employment legislation


Physician employment was a hot topic in the 2011 legislative session. Lawmakers filed several bills related to the corporate practice of medicine. Senate bills 894 and 1661 by Sen. Robert Duncan (R-Lubbock) were passed. TMA supported both bills. TMA worked with the Texas Hospital Association (THA),


the Texas Organization of Rural & Community Hospitals (TORCH), Senator Duncan, and other legislative leaders in crafting SB 894. The legislation gives some rural hospitals greater latitude to employ doctors but imposes strong protec- tions for physicians’ clinical autonomy and independent medi- cal decision making. Under SB 894, sponsored in the House by Rep. Garnet Cole-


man (D-Houston), TMA agreed with TORCH and THA to allow employment by critical access and sole community hospitals, generally in counties of 50,000 or fewer residents. The bill contains strong protections for independent medical judgment and medical staff responsibility for all clinical policies from privileges to credentialing to utilization review. La Grange family physician Thomas Borgstedte, DO, is


chief medical officer of St. Mark’s Medical Center, one of the community hospitals taking advantage of the newfound abil- ity to employ physicians under SB 894. So far, St. Mark’s has recruited a pediatrician and an obstetrician-gynecologist into employed positions. “Moving forward, our ability to employ will help us compete for physicians,” Dr. Borgstedte said. TORCH Director of Government Relations Don McBeath says the rural hospitals pushed for the ability to employ physi- cians last session because younger physicians who are coming out of residency and recruited to small communities want to be employed. “The larger hospitals can create NPHCs more easily than the smaller hospitals. TMA opposed the legislation as it was originally written and expressed concern regarding protections for the independent medical judgment of physicians,” Mr. Mc- Beath said. The organizations worked on the language to come to an


agreed-upon bill. “We’re comfortable with the outcome of SB 894. It allows for the employment of physicians in areas that need that ability. I think the Texas legislation could serve as a model for other states,” Mr. McBeath said.


Clinical autonomy of physicians through medical staff over-


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