09-12-15ContractPropos... - April 27, 2000


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09-12-15ContractPropos... - April 27, 2000

  1. 1. Medicos para la Familia <br />3030 Covington Pike #100<br />Memphis, TN 38128<br />, MD, MPH February 15, 2009<br />Dear Dr. xxxxxxxxx,<br />Congratulations, you have been selected for the FAMILY MEDICINE-OB Fellowship following your graduation from residency this June.. In recognition of your achievements to date and your special aptitude for the mission, Medicos encourages a partnership and faculty role after the end of the fellowship year. However, this letter formalizes the fellowship plan for 2011.<br />Medicos para la Familia in Memphis will be your home practice location, but there will assigned experiences as described below. You have reviewed materials describing the curriculum, its salary, and expectations. This is a letter of financial and educational commitment. <br />I.Medical Licenses and Hospital Privileges<br />Medicos will assist you with applications for medical license and DEA # in Tennessee. Administrative staff will assist you with your applications for hospital privileges at Baptist, St. Francis, and others as needed.<br />Your participation in the fellowship is contingent upon the ability to obtain and maintain valid medical licenses and hospital privileges. Hospital privileges must include the ability to perform an unsupervised vaginal delivery. The Tennessee licensing board meets May, July, September, November, January, etc. If you accept this proposal, Medicos would assist you in initiating an application for licensing immediately because fellowship activities cannot start without completion of licensing and hospital credentials. We would like to start the licensing process as soon as possible.<br />The fellowship requires 12 months from the time you gain privileges for OB surgery, and this hospital process cannot begin until you have finished residency. I explained the option of moonlighting at Medicos until your hospital privileges cleared. (Your hospital applications will be sent from here after you have reviewed and signed them). Also attached is a general code of expected professional behavior.<br />II.Schedule (Preliminary)<br />A.Your starting date is contingent upon return of a signed copy of this agreement and a Tennessee medical license. You will be given your weekly office and hospital schedule by Drs. Rodney, Yibirin, and Carson while in Memphis. They are posted on the main hall bulletin board monthly 90 d in advance.<br />Important curriculum events 2010-2011 include the following. Specific Courses (Preliminary)<br /> 1.Attend AAFP Maternity Care course. Location TBA. Expenses paid, and keep receipts. <br /> 2.Vanderbilt OB conference December 2010.<br /> 3. Wednesday afternoon Animal Laboratory Surgery Techniques, Memphis. 2010 <br /> 4. OB ultrasound course 2010 in Memphis. Other alternative exist, and we would pay for your registration at other courses. <br /> 5. You have taken the ALSO course. We will support your certification as an Instructor and assign you to participate as faculty at our annual course.<br /> 6. You may participate in the preparation of at least one course as part of our outreach to developing countries. One possibility is the ultrasound curriculum for Cuenca, Ecuador and the other is a colposcopy curriculum for la Univerisidad Central de Este en la Republica Dominicana. These are in development. Others are available. <br />7. ACLS, ATLS, NRP should be taken at least once in your career, but current certification is not necessary. Please send copies of your most recent certificates to me. <br /> 8. AAFP Perinatal Course Los Angeles August 25-29, 2010.<br />9. Others by arrangement<br />Memphis Events<br />1. Regular weekend coverage with the Memphis FAMILY MEDICINE-ob coalition (Drs. Laurence, Rodney, Yibirin,Singh, Pean, Berkenstock, Li, Sharma, Culbreath, et al). My goal is to proctor you for at least 10 deliveries and all your Cesareans and then have other cases by other faculty Call averages every fourth weekend, but interesting Cesareans will be offered to you as they occur. When someone is away or ill call can be every third for one cycle. The night call proposal for 2010-2011 will include Drs Carla Lyn-Boswell, Main, Ike, and Azizi. Drs. Rodney, Yibirin, Singh, and Berkenstock are available as needed.<br />2. Memphis academic conferences assigned monthly per Dr. Rodney. OB Risk Management Conference minutes will be sent. <br />3. You will be responsible for maintaining the OB database and for presenting cases and questions to the Risk Management Group.<br /> 4. You will be expected to cover either New Years Eve/Day or Christmas Eve/Day, but not both. You will cover July 4 or Memorial Day, but not both. Thanksgiving or Labor day, but not both. It is unlikely that fellows will cover more than two major holidays per year. Please indicate your preferences, realizing that approval is subject to discussion with Drs. Rodney and the faculty group. Please notify us in writing of any anticipated needs such as anniversaries, family reunions, or religious holidays. Otherwise approval may be contingent upon coverage. A 90-day notice is requested. Please work with your family to plan out the year in advance.<br />5. Please use the medical record system of Medicos. This system emphasizes a written global analysis of the patients diseases and issues prior to ordering lab and giving treatment. The Past Medical history should be noted on the temp record and the EMR MUST contain an up-to-date problem list and medication list. For children vaccines, growth, and development are part of each visit no matter what.<br />6. Follow the Medicos system of information management by displaying all 3 key pieces of paper at the moment of presentation for children. Adults require display of two pieces of paper. This act signifies your understanding of the need to integrate the art and science of medicine with the business of collecting fair reimbursement from uninsured and insured patients.<br />7. All electrocardiograms. radiographs and ultrasound REQUIRE A COMPLETE WRITTEN REPORT as part of the presentation.<br />8. Arrange and manage the risk management conference in the upstairs clinic Thursdays and Fridays.<br />9. Attend the Baptist Hospital and St. Francis Hospital Department meetings. These occur every two months at 0700 for Baptist and 1730 for St. Francis.<br />10. Upon completion of the fellowship, your expense will be paid for the board certification process as offered by the American Board of Family Medicine obstetrics.<br />11. Other conferences by arrangement.<br />III.Malpractice Insurance Requires a Tennessee Medical License<br />Malpractice insurance will be obtained via State Volunteer Medical Insurance Corporation (SVMIC). This policy will be for $1 million per occurrence or $3 million annual aggregate. This insurance will specify that you are doing some practice in the Memphis Hospitals and others as needed in the region. Medical liability insurance will cover you for normal OB and surgical assisting (this level covers you for GI endoscopy, vasectomy, and other minimally invasive surgeries in the office.), Your tail coverage will be provided as needed.<br />IV.Letter of Completion Standards<br />You will be gathering documents describing your surgical experiences stratified by the following categories involvement.<br />A.Assisted;<br />B.Did major parts of the surgery; or did all with supervision immediate. These are equivalent for purposes of future credentialing. Cutting and/or sewing are considered to be major.<br />Pending attainment of independent operative OB privileges, Cesarean sections in the hospital record will be attributed to your supervising faculty. You will document your participation by writing a note in the medical record and keeping a copy of the surgical dictation. You are required to maintain records of your activity as described in the attached clinical inventory. This is your responsibility and quarterly reports must be provided to DR Rodney and/or his designee in writing in the format suggested. You will receive two written progress reports and a formal written Letter of Completion. Your written Letter of Completion is based on your documented experience during 12 calendar months following your start date.<br />V.Time Away/Selectives<br />Under this curriculum proposal, you have four weeks (20 work days with four contiguous weekends) for vacation/CME/selective time. This curriculum provides OB-intensive experiences as part of the Memphis annual delivery volume, and by previously approved external rotations. <br />If you have not participated in at least 50 cesarean sections with a minimum of 25 as the primary/major physician, you have a right to request additional OB experience. For the last five years, fellows have almost always doubled this amount. Time away for additional educational or mission experiences will be prorated. Fellows cannot be released earlier than 52 weeks in Year 1.<br />V.Who Pays What?<br />Your medical licenses, hospital privileges, CME registration, travel allowance, progress reports, Letter of Completion, medical society memberships, and subscriptions to the medical literature will be paid. You are required to submit valid receipts for all reimbursement. <br />Salary costs, health care benefits, and malpractice insurance are paid by Medicos PC. Health insurance is paid to the first $200 per monthly premium and there is a $1500 deductible. Out of pocket costs to the first $1000 paid 50% by Medicos contingent upon valid receipts. All services, imaging, and labs available on site at Medicos are free to you and your family, but all health care personnel receiving services on site at Medicos, must agree to registration, vital signs and a medical record. Hallway health care is bad medicine, and an occupational hazard for physicians.<br /> Friday is payday with biweekly pay periods of 26/year. The fellowship salary is $78,000 per year regardless of any portion of time spent during a given month in the educational curriculum. <br /> Federal and state taxes are withheld. If you select one of our overseas mission options, your travel to and from is paid and usually there is a salary stipend. You will be responsible for your living expenses in the mission hospital, but usually these are covered by the hosting hospital.<br />VI.Moving Expenses<br />Please give us two estimates of your moving expenses, which will be repaid to a maximum of $3500. In cases of need, the fellow may petition for advance payment on moving expenses. Any unused portion of the moving expenses will be paid as a signing bonus.<br /> <br />VII.Summary<br />This Letter of Agreement proposes substantial detail. This is good faith representation, and it is understood that emergencies and planned vacation may require flexibility as we progress through the year.<br />Attachments should be initialed and returned. In attachment are the standard expectations for conduct and behavior. Your initials and date should be placed on each page and returned to me. A copy will be returned for your records. Please forgive the detail and formal tone. We want to extend to you a warm welcome in recognition of your outstanding achievements. All of us look forward to working with you in the year ahead.<br />Respectfully submitted,<br />Wm. MacMillan Rodney, M.D., FAAFP, FACEPDate<br />Professor and Chair Academic Affairs <br />Medicos para la Familia<br />________________________________________<br />xxxxxxxxxxMD, MPHDate12/17/09<br />Attachments---Generic Expectations<br />Expectations and Performance Standards <br />Medicos para la Familia and affiliated practices -- 2009<br />I. Access <br />A. The phone will be answered. Fellows receive an additional $40 per month phone subsidy with the expectation that they will carry a cell phone with coverage in Memphis and during away rotations in the continental US.<br />B. At night and on weekends a physician will be available. We will not use an answering service. We are performing a night call study to determine the # of calls received per night on call. So far it is averaging less than 2 with most before midnight.<br />C. Physicians and staff will be financially literate to understand that there are limits to our service if bills cannot be paid. <br />D. Others. <br />II. Affordability<br />A. Information will be tabulated daily and summarized weekly, monthly, and quarterly such that a full-service practice can be maintained. <br />B. Charges will be compared to local, regional, and national norms. We will not be the most expensive practice, but we will establish and collect reasonable charges. <br />C. When in doubt, the physician has the right to engage in charity care. <br />D. Medicaid and Medicare systems in Tennessee are currently in flux. Physicians may choose to participate or not participate depending on the circumstance of state and federal budgets. <br />E. The practice cannot afford to send expensive lab requests that may not be paid. TennCare patients must have their labs done at a TennCare facility or the payment must be collected in advance. <br />III. Affability <br />A. Affability will be the general spirit of the practice. <br />B. There will be a quiet joy connected with the spiritual values of practice. <br />C. Work-in patients are always welcome. <br />D. Patients who arrive just as we are ready to close should be welcomed. We are scheduled to work one hour after the last patient arrives. <br />IV. High Touch is Most Effective When Coupled with High Tech and Vice Versa <br />A. The educational mission will be understood and supported. <br />B. Professional development will be a group responsibility. <br />C. Health services research will be discussed and implemented. <br />D. Spiritual fellowship among staff, students, residents, fellows, faculty, colleagues, and community is expected. <br />RIGHTS, RESPONSIBILITIES & EXPECTATIONS<br />Expectations & Responsibilities<br />Be honest<br />Do not interfere with the responsibilities of others<br />Support each other when those around you are critical<br />Be trustworthy and trusting<br />Recognize that the others you work with are human<br />Remember the purpose for being in your position<br />Keep focused on the goals and mission of the practice<br />Try to mix a little humor into each day<br />Manage resources effectively<br />Help determine, monitor and strengthen the services of the practice<br />Enhance the public standing<br />Ensure legal and ethical behavior<br />Maintain accountability<br />Listen carefully to co-workers<br />Respect the opinion of co-workers<br />Respect and support decisions of the practice<br />Participate in meetings of the practice<br />Bring to the attention of the physicians or manager any issues you believe will have an adverse effect on the practice<br />Work to learn how to do your job better<br />Do not discuss practice matters outside of the practice<br />Do not use your position for personal advantage<br /> Be a team member<br />Rights<br />Work in an environment that is free of discrimination and harassment<br />Be treated with respect by your co-workers<br />Have your opinion about your work listened to<br />Receive regular feedback on your performance<br />Have your work valued by your co-workers<br />Unreasonable Behavior<br />Discusses practice matters outside the practice<br />Uses position for personal advantage<br />Fails to comply with practice standards<br />Shames others for negative outcomes<br />Uses foul, abusive language<br />SidestepS policies<br />Acts in ways that could be perceived as sexual harassment<br />Threatens co-workers with retribution, litigation or violence<br />Criticizes staff in front of others<br />Is disrespectful or discourteous routinely<br />Relies on intimidation to get his or her way<br />INAPPROPRIATE AND DANGEROUS MEDICAL CARE<br />Seeks medical care from Medicos physicians without creating a formal medical record which includes vital signs, a past medical history, and a history of presenting complaint for the visit.<br />Provides medical care to staff without creating a formal medical record and placing a written note into the Electronic Medical Record[EMR] within 24 hours of the care given.<br />Removes medical equipment, dressings, or medication from the Medicos office without permission. Unregistered health care is grounds for immediate dismissal.<br />DOCUMENTATION OF EXPERIENCE<br />Family Medicine Progress Report and Letter of Completion<br />Wm. MacMillan Rodney, M.D. Updated 1/27/04<br />Name:__________i______________________Date:_________12/17/09_______________<br />ProcedureResidency ExperiencePractice Experi-enceFellowship Experi-enceVaginal deliveriesLabor induction/augmentationRepair of peripartum lacerationsEpisiotomy/simple laceration repairs. b. 3rd or 4th degree lacerations.Shoulder Dystocia CasesVacuum /low forceps deliveriesCesarean section assistsCesarean section surgeon or did substantial part Tubal ligationsRetained Placenta or Inverted uterusTwin deliveries[Vaginal or Cesarean]Miscellaneous other surgical assistingOB/GYN ultrasoundPelvic ultrasoundDilation/curettageColposcopy (including cryo or LEEP)Esophagogastroduodenoscopy EGDFlexible sigmoidoscopy/colonoscopyHospital cases (number of) a. ICU b. Non-ICU adult c. Non-ICU children d. NewbornsCircumcisionsEmergency Department shifts [8-12 hours]<br />In summary, please provide information describing your training, education, experience and proven abilities. This will help us in the training of OB-capable family for rural underserved communities. It has been a privilege to work with you. Thank you for your previous and continuing contributions.<br />FP/OB Fellowship of xxxxxxxxx, MD, MPH<br /> at Medicos para la Familia, 2009-10<br />Wm. MacMillan Rodney, M.D., FAAFP, FACEP<br />LEARNING OBJECTIVES<br />Minimum of 91 nights per year on-call expectation as first call for operative OB experience. Call is usually taken from home, but physicians stay in hospital if the situation is unstable. This is rare. Complete at least 50 Cesarean sections. There will be additional call in Memphis and moonlighting outside the program is not permitted. Fellows are expected to carry and answer their cell phone 24/7 when in Memphis. A cell phone allowance is provided. Fellows are expected to review and answer their email daily.<br />Specifically, you will be requested to assist with Drs. Laurence,Pean, Yibirin, Berkenstock Rodney, and others for tutorials. This will be contingent upon successful acquisition of Tennessee medical license. Hospital privileges must clear for St Francis and Baptist hospitals in Memphis.<br />2. The fellow will be required to participate in didactic experiences such as the Surgery Lab, AAFP Perinatal Courses, ALSO, the Vanderbilt High Risk OB Seminars, and others. See Dr. Rodney.<br />3. When the fellow arrives, he or she will have one chance to make one first impression. Technique in knowing the names of surgical instruments and knot tying must be demonstrated. <br />4. Scheduling will generally, but not always, follow this pattern. Ninety-days-in-advance notice is required for personal requests in regard to vacation time. Requests for time off will be considered for family emergencies or important family events (high school graduation, starting college, etc). At least four weeks is required and protected time for the curriculum will be built in. Total personal time will be 20 working days which includes the CME/Required didactic time. Financial support is provided for travel, housing, meals, and registration.<br />Harvest of operative experience is the priority, but independent vaginal delivery privileges are the rule. The fellow will take call every third or fourth weekend- 17/year. This will vary, but other exceptions are noted above. This call will be at home unless there is an unstable patient in the hospital. Otherwise, physicians are expected to come to the hospital when a multiparous patient is 6 cm dilated or a primiparous patient is 8 cm dilated. <br />5. Pending approved licensure, the fellow will be paid a salary for each month with benefits additional. At Medicos, the pay periods consist of 26 intervals of two weeks each. Accounting closes at 8:00 pm on Wednesday, and checks are distributed by 5:00 pm on Fridays. <br />The fellow will receive malpractice insurance coverage of a $1/$3 million policy claims made which can only be applied for when the fellow receives his license, privileges, and DEA number in Tennessee. Until then, all care must be cosigned. There are additional vagaries associated with each health care insurance company. Part of the curriculum teaches you the ups and downs associated with the real world of private practice.<br />The fellow will receive evaluations at the end of one, three, six, and twelve months. Continuation in the program is contingent upon adequate medical knowledge, reliability, technical skills, professional behavior, ability to keep the schedule, and interactions with staff. Failure to achieve these expectations as outlined by Dr. Rodney, and other Medicos staff will lead to probationary status. An inability to correct these deficiencies will be grounds for dismissal.<br />Without valid medical licenses and hospital privileges, the operative OB curriculum is not be possible. <br />IN THE AREA OF EDUCATION<br />The physician can select specific clinical skills for professional development. Generally applicants have specified operative skills in obstetrics but other options exist. Other common choices include practice management with a network management track including the technical aspects of supporting a medical record system or gastrointestinal endoscopy with additional time schedule for endoscopy procedures such as colonoscopy, EGD, polypectomy, and endoscopic biopsy. Candidates with an interest in global missions can select from several options in this area as well, but these must be approved 90 days in advance.<br />The fellow will be required to have the ability to perform an average-risk delivery at St. Francis and Baptist hospital in Memphis. Hospital training cannot start until appointment and credentialing has been approved.<br /> <br />The fellow will be expected to actively supervise medical students, medical assistants, and residents as they perform vital signs, take medical histories, and note abnormal physical findings on examination. Although this is an educational environment that requires greater supervision, the licensed physician bears the ethical, medical, and legal responsibility for signing all documents related to the medical care of each patient.<br />Specifically, patients are not to physically leave the premises or be discharged from the hospital until such time as licensed medical physician can fulfill this responsibility. In the event that a patient signs outs AMA or leaves the premise for whatever reason without oversight by a licensed physician, this medical record and all billing information will be set aside for presentation at the practice risk management committee which meets every Thursday and/or Friday with the exception of scheduled holidays.<br />If an emergency and/or any situation merits urgent consultation, consultation resources are available 24-hours per day, 7 days a week. It is the responsibility of the Fellow to familiarize themselves with the cell phone #’s of the consultant group. These are posted on the prenatal database.<br />The fellow cannot independently perform hospital duties or medical care in the hospital until valid medical licenses have been submitted and the credentials committee of the hospital grants temporary privileges as a minimum. During this time, the fellow may function as an observer. Dependent upon training, education, and experience, this may involve a great deal of useful experience, but it will be with on site supervision by a licensed faculty. <br />Fellows are required to provide a written description of all deliveries and miscarriages by entry into the delivery database [the deliveries outcomes research project]. This requires familiarization with the database and required information.<br />Specifically the fellows are responsible for learning and maintaining these databases with posting of problems and unanswered questions to the faculty email This requires a working knowledge of computer keyboard skills and basic Microsoft software such as Word, Excel, Access, and Power Point. Fellows are expected to learn to use the electronic medical record system. Emails should be reviewed daily.<br /> Fellows are expected to learn to be able to see 20-30 patients per 8 hour workday while comfortably working in patients who need minor surgical procedures and OB ultrasounds. Records are to be entered before the close of the work day. Paper records are kept on prenatal charts and selected surgical procedures. Fellows are expected to study performance based learning and competency based testing modules on basic skills such as ECG interpretation, chest radiograph interpretation, instrument assisted delivery, and others. <br />Sorry for the many details, but this an ambitious curriculum. We are optimistic that each fellow can attain all of the above. If unforeseen circumstances arise, we want the fellow to understand that care for our patients is the first priority. Schedules are created 90 days in advance, but when emergencies arise any physician available is expected to respond. In turn we will respond to your emergencies should they arise. Your consideration is appreciated. Welcome!<br />Wm. MacMillan Rodney M.D., <br />Adjunct Professor of Family Medicine<br /> Meharry Medical College<br /> Medicos para la Familia<br /> Memphis and Nashville, Tennessee<br />I have received a copy of these objectives and the contract<br />xxxxxxxxx, MD, MPH.. __________ Date:____12/17/09_____________<br />My preferred starting date is ________End of August 2010_____________________________<br />