The first draft of the (generally mythical) “standard physician employment agreements” is silent on patient contact hour requirements. Often, the first offer provides that the physician will be expected to work “full-time” or as a “1.0 FTE” (a full time equivalent), without defining that term.
Larger physician practices and health systems are often willing to stipulate that the physician is expected to work 40 hours per week (exclusive of call coverage requirements). Many physicians initially view that requirement as eminently reasonable. After all, they reason, a standard work week is 40 hours.
However, it is important to determine how many patient contact hours are required each week. “Patient contact” is time spent in actual contact with a patient. Thus, for example, telehealth would constitute patient contact, but call coverage would not qualify as patient contact. Hours spent charting are not patient contact hours, nor are hours fighting with a managed care company.
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Some employers’ first draft agreement specifically requires 40 patient contact hours per week. Obviously, if a physician is scheduled to see patients for 40 hours each week, that physician will be working significantly more than 40 hours, even excluding call coverage. Calls with patients and managed care companies, administrative meetings, etc. can take up a huge portion of the physician’s time.
If the employer does not utilize hospitalists, a physician may be expected to “round” outside of the 40 patient contact hours. This requirement can be especially onerous if the physician admits patients to multiple hospitals.
And even if rounding is not required of the physician, significant time will be spent on charting and other administrative activities. Health Affairs has estimated that physicians in four common specialties spend an average of 785 hours per physician per year reporting on quality measures alone! These 785 hours do not include all the time spent on “regular” charting.
Physician employment agreements with a private practice (especially smaller practices) often require more flexibility in scheduling. Patient volumes do not decline when a physician is absent because of pregnancy, sickness, vacation, or CME. Patient care may require extended office hours for the remaining physicians during these times, so patients can be seen within a reasonable time of an appointment request.
If an employer is not willing to specify patient contact hour requirements, I have sometimes negotiated a 40 clinical hour requirement. Sometimes, if the employer is fixated on 40 as a magical number, simply specifying 40 clinical hours may satisfy them. Clinical hours encompass much more than patient contact hours, and most employers agree that charting and managed care interaction is clinical, as are phone calls with patients, pharmacies, etc.
My usual goal in negotiating physician employment agreements is to get a requirement of no more than 32 patient contact hours for a full-time clinical physician (i.e., a physician with no administrative or medical director’s duties).
A true 40-hour work week is probably not attainable even if the employer is willing to agree to 32 patient contact hours or 40 clinical hours per week. However, that extra time without direct patient contact should reduce the uncompensated time physicians spend on rounding, charting, medical staff meetings, dealing with managed care companies, and other duties. This could allow physicians to get a little bit closer to having a life outside of the practice of medicine.
Physician burn-out is very real. Obtaining a more reasonable work schedule through limiting patient contact hour requirements will not eliminate burn-out. But this adjustment may move the needle slightly, and reduce the strains on physicians, even if it doesn’t completely address all the issues causing burnout.
About the Author
Dennis Hursh is a veteran physician’s attorney with over 40 years of experience in health law. He is founder of Physician Agreements Health Law, which offers a fixed fee review of physician employment agreements to protect physicians in one of the biggest transactions of their careers. He can also be reached on LinkedIn.
Dennis is a frequent lecturer on physician contracts to residency and fellowship programs and has spoken at events sponsored by numerous health systems and physician organizations, including the American Osteopathic Association, the White Coat Investor, the American Health Law Association, the American College of Rheumatology, and the American Podiatry Association.
Dennis has authored several published articles on physician contractual matters on forums such as KevinMD and Medscape. He is also the author of The Final Hurdle – A Physicians’ Guide to Negotiating a Fair Employment Agreement, the go-to resource for physician contract negotiation.
