American Academy of Emergency Medicine

At the recent Society for Academic Emergency Medicine (SAEM) Annual Meeting in Chicago, AAEM and the Emergency Medicine Residents' Association (EMRA) co-sponsored a workshop entitled Contract Issues for Emergency Medicine Residents. Designed as an overview of key contract issues graduating residents should be aware of as they enter the job market, the workshop was well attended by more than 40 concerned residents.

AAEM board member Joseph P. Wood, MD JD FAAEM, began the workshop by reviewing the clauses and phraseology common to EM contracts. "There's nothing inherently wrong with contracts," he said. "A well written contract gives both the employer and the employee a clear understanding of the job requirements, duties, and compensation offered."

The thing to watch out for, according to Dr. Wood, is ambiguous language which is either unclear or subject to multiple interpretations. "Many ambiguities found in contracts are unintentional," he said, "and are simply the result of poor wordsmithing. Others are placed in contracts deliberately, and are used by employers to give them greater freedom in the hiring and firing of employees."

Dr. Wood also spoke about the differences between employee and independent contractor status in Emergency Medicine. "Employee status is simple and carries the least amount of risk," he said. "There is less paperwork involved and all your benefits are provided by the employer. As an independent contractor, you do have the advantage of being able to set up your own benefit plan, however, under this scenario both you and the contract holder run some increased risks-primarily with the IRS."

In many cases, physicians who believe they are operating as independent contractors are really, in the eyes of the IRS, employees of the contract holder. "Should the IRS audit you under such circumstances," Dr. Wood said, "whatever retirement plan you might have set up for yourself would suddenly be declared ineligible, and you would be liable for the back taxes, interest, and penalties on the money you had been putting away."

Following this overview, AAEM President Robert McNamara, MD FAAEM, addressed the residents with AAEM's perspective on the issues. He cited that more than 50% of the country's EDs were run by contract management groups, many of whom excessively siphoned the fees of their physicians, included restrictive covenants in their contracts, and denied them rights of due process.

"These are all contractual issues that can potentially be avoided," Dr. McNamara said, "if you understand what to look for in contracts and how to strip out those clauses you find offensive. Democratic employment opportunities do exist, but they are not as widespread as we would like. In some states, in fact, they are non-existent."

Dr. McNamara also described what AAEM views as the "ideal" employment arrangement for the practicing emergency physician. Inclusion of due process rights and the absence of restrictive covenants are obvious ideal conditions, but so are short tracks to full partnership and profit-sharing, and an "open books" policy towards all medical billing and payments.

"All these factors are summarized in the most recent contract guidelines passed by the board," Dr. McNamara said (see page ???). "We believe that after a reasonable trial period, incoming physicians should have the same rights and entitlements as every other physician working in the group."

Dr. McNamara is available to speak at your residency program about the history and current state of Emergency Medicine, and what AAEM is doing to change the status quo. For more information about bringing Dr. McNamara to your institution, call his office at (215) 842-6548 or e-mail him at mcnamara@auhs.edu