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Here Are Some Common Sense Tips for Taking Your USMLE Step Exams and Scoring Higher

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Here are some common-sense tips you should be sure you follow that may help you to reduce stress and score higher when you take your United States Medical Licensing Examination (USMLE) Step examinations. You should be doing everything within your control to minimize your stress and the risk of being late for the examination. Again, these are common sense and if you have taken a lot of standardized examinations, you may already be aware of these.

1. Do not plan on driving to the test site from your home the morning of the examination even if you leave in the same city as the testing center.

a. Unexpected car problems could occur.
b. Traffic backups and delays always occur.
c. Accidents always happen.
d. Road problems, construction delays, and detours are common.

Eliminate these unnecessary risks.

2. Find the hotel closest to the testing center and stay there the night before the test. Hopefully, this will be within walking distance of the test site if it is necessary to walk there.

3. Read all of the applicable testing procedures, the applicable USMLE and/or Educational Commission for Foreign Medical Graduates ( ECFMG) Handbook, Guidelines and Procedures again the day before the examination you are taking. You signed an agreement to be bound by these and you are expected to know these for the examination. Be sure you understand how scheduled and unscheduled breaks work, how the time is accounted and what you are allowed to do and prohibited from doing on breaks.

4. Make sure you know ahead of time exactly how much time you will be given for each part of the examination and for breaks, Be sure you have calculated how much time you have for each question on each section of the examination, answer within the times you have calculated and move on through the examination in a timely manner.

5. Do not let other occurrences and disturbances in the testing center upset you or distract you.

6. If some extremely disruptive event occurs, for example, fire alarms and evacuations taking place, other examination takers having seizures and being removed by paramedics, etc., consider leaving and taking an incomplete on this examination. Be sure to ask the test center monitors/proctors to file an incident report on what occurred at the test center, Then, within 24 hours, write to the USMLE and ECFMG and advise the organization of exactly what happened and why you had to leave.

7. Bring your own lunch, snacks, and beverages, including something like energy bars or chocolate bars, to provide needed sustenance. Do not leave the testing center for lunch unless you absolutely have to, and then, stay local and on foot. Do not take the risk of driving someplace and back.

8. If a certain testing center has a bad reputation for being a poor testing site or having frequent computer failures, schedule to take the test at a site in another city or state. Travel there and stay at a hotel within walking distance of the test site, perhaps a few days before the examination date. You can then use the additional time and isolation for additional studying and test preparation.

9. Do not refer to or use any cell phone, tablet or personal device while the test is still underway. Be sure you are familiar with all test-taking procedures.

10. To avoid any risks of misunderstandings, do not write down anything during the examination or about the examination at the testing center. Outside during lunch, may be okay; otherwise, wait till you get back home.

Although common sense, you would be surprised at how many test-takers violate these common-sense tips and then suffer from the consequences.

Plan for and have as stress-free of an examination as you can. Control the controllable.

For more helpful tips and to learn more about examples of “Irregular Behavior,” click here to read my prior blog.

Additionally, click here to view one of our blogs on our experience with the USMLE, ECFMG, and NBME, and Hearings on “Irregular Behavior.”

Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education, and those being challenged by the National Board fo Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat , and the Educational Commission for Foreign Medical Graduates (ECFMG)

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and any other matters. We routinely help those who have disputes with the National Board fo Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat , and the Educational Commission for Foreign Medical Graduates (ECFMG), including on hearings and appeals concerning “Irregular Behavior,” “unprofessionalism,” and “Irregular Conduct.”

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620

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“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

Irregular Behavior and Disruptive Physicians: Nobody Likes a Nuisance

George Indest

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Identifying and eliminating disruptive physicians has become a top concern for many hospitals and healthcare systems. Disruptive physicians hinder the safe and orderly operation of a healthcare facility and are considered a threat to the safety of patients. Disruptive behavior can impact staff morale and can increase the risk of liability to all employers.

Consequences of Disruptive Behavior.

Disruptive behavior from a physician can lead to dire consequences for both the physician and his or her employer. Lawsuits and liabilities, such as those in the New York case discussed above, can detract from a safe, cooperative, and professional healthcare environment.

Disruptive behavior can negatively affect the quality of patient care. Hospitals claim that this happens because of conduct that:

  • Disrupts or impedes the operations of the hospital;
  • Adversely affects the ability of others on the healthcare team to do their jobs;
  • Creates an unprofessional or hostile work environment for hospital employees;
  • Interferes with coworkers’ ability to practice competently;
  • Prevents effective communications among healthcare providers and staff;
  • Disrupts the continuity of care a patient receives; and
  • Adversely affect the community’s confidence in the hospital’s ability to provide quality patient care.

Being accused of being a disruptive physician may lead to adverse action against clinical privileges, action to drop the physician from insurance panels, consequential action by the state medical board or licensing authority, loss of specialty certification, termination of employment contracts and other various consequences.

What Conduct May Cause One to be Labeled a Disruptive Physician?

A hospital’s creed, ethical statement, or code of conduct, as well as Joint Commission Standards, and medical staff bylaws can define what constitutes disruptive behavior. Case reports, hospital policies and actual cases in which we have defended physicians demonstrate the types of acts that can be used to label a person as “disruptive.” Disruptive behavior includes, but is not limited to:

    • Verbal attacks that are personal, irrelevant to hospital operations, or exceed the bounds of professional conduct;
    • Shouting, yelling, or the use of profanity;
    • Verbally demeaning, rude or insulting conduct, including exhibiting signs of disdain or disgust;
    • Inappropriate physical conduct, such as pushing, shoving, grabbing, hitting, making obscene gestures, or throwing objects;
    • Inappropriate comments or illustrations made in patient medical records or other official documents, impugning the quality of care in hospital facilities, or attacking particular medical staff members, personnel, or policies;
    • Belittling remarks about the patient care provided by the hospital or any healthcare provider in the presence or vicinity of patients or their families;
    • Non-constructive criticism that is addressed to the recipient in such a way as to intimidate, undermine confidence, belittle, or imply stupidity or incompetence;
    • Refusal to accept, or disparaging or disgruntled acceptance of, medical staff assignments;
    • Inappropriately noisy or loud behavior in patient areas;
    • Making sexual or racial jokes;
    • Physically touching another professional, nurse or staff member, especially those of the opposite sex;
    • Making sexually suggestive remarks;
    • Commenting on another person’s body parts;
    • Threatening violence to another;
    • Throwing surgical equipment, medical supplies, charts, or anything else at or around anyone else; or Other disruptive, abusive, or unprofessional behavior.

I previously wrote a blog detailing the types of conduct considered disruptive, as well as the consequences associated with disruptive behavior and how you as a physician can avoid such pitfalls. To read part one of the blog series, click here.

 Proactively Educate Yourself.

It’s wise to review your hospital’s or institution’s policies on disruptive behavior. Arming yourself with the knowledge necessary to avoid such accusations is imperative in protecting your reputation and career.

No one lives in a glass house, but pretend you do. Someone can always observe your actions in the office or hospital. Once you have been labeled a disruptive physician, others may be close, at times, scrutinizing you for anything you may do wrong. You will make yourself a target for possible false allegations and accusations. The healthcare industry is a demanding and stressful field. It’s understandable that potential outbursts can occur; control yourself and don’t let them.

Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.

The attorneys of The Health Law Firm provide legal representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in accusations of disruptive behavior, Department of Health (DOH) investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare investigations, Medicaid investigations and other types of investigations of health professionals and providers.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Source:

Burger, Jim. “Doc Threatens Physician’s Assistant During Open Heart Surgery: I’m Going to Put Your Through the Wall.” Outpatient Surgery. (July 14, 2014). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

 

By |2019-06-14T01:23:36+00:00July 15th, 2019|Medical Education Law Blog|0 Comments

Employment Contracts: Tips For New Physicians and Health Professionals

Headshot of attorney George IndestBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

This is intended to provide an introductory review of the basics of contracting for new physicians and health professionals, primarily by discussing employment agreements. We will highlight
many of the common provisions found in employment contracts, along with many of the mistakes and pitfalls that we see in our day-to-day practice.

After reading this, it is our hope that new physicians and other health professionals will understand the common language and terms found in employment contracts. Therefore, they can recognize mistakes commonly made by physicians and health professionals when negotiating them. We hope to help make both employers and employees more knowledgeable about employment contracts so they can avoid potential problem areas and legal entanglements.

Our comments here are meant to provide general rules we have learned from our experience. However, please remember, every situation is different and there are exceptions to every rule.

Tip 1 – There is No Such Thing as a “Standard” or “Routine” Physician Employment Agreement.”
No two employment agreements are identical. Each must be reviewed on its own terms. It is important to consult with a healthcare lawyer experienced in negotiating employment contracts and evaluating health care business transactions.

Tip 2 – Everything is Negotiable.
Even though an employer may have what appears to be a “standard” employment contract for all physician employees, this can have changes, amendments, schedules, exhibits or terms that are varied from physician to physician or professional to professional. Generally, large employers are less likely to change their form to accommodate the physician than small organizations, but they can and often will. Small employers are often willing to make more changes to their written agreements.

If there are any changes, additions or clarifications you need to make to the contract, then put them in writing, sign them, incorporate them into the contract and attach them to the contract.

Tip 3 – Be sure the Wording of the Contract Represents Exactly the Agreements you Made Orally.
If it is different or not specified, the language in the contract will govern in any future dispute.

Tip 4 – Make sure the parties are identified.
In many contracts we review, the correct names of the parties, especially the employer, are not included. Often, the only identification of the employer is a fictitious business name or part of a fictitious business name. Additionally, many business entities are not incorporated in the state in which the job is located. There is a misconception that a corporation or limited liability company, its owners and directors have far greater legal protections in states such as Delaware. Therefore, a disproportionately greater number are incorporated or organized there.

Often, a large institution such as a hospital system or health maintenance organization (HMO) has a business entity to hire and manage its physician and other health professional employees. Sometimes a potential employee may incorrectly believe that he or she is being employed by the larger organization. More often, the business entity that employs the health professional is actually a wholly owned subsidiary corporation or company. Always be sure that the contract includes the complete name of any corporation or company, the state in which it is incorporated (or organized or registered), its address and its fictitious business name (sometimes called a d/b/a or “doing business as” name). We include the complete identities and addresses of each party to the contract in an addendum if they are not included in the main contract.

Tip 5 – Make sure that the employee or contractor is fully and consistently identified and treated as such throughout the contract.
In the case of physicians and many other health professionals, a medical group or business with which that person contracts may seek to treat him or her as an independent contractor instead of an employee. Independent contractors have far fewer rights and protections against the party with which they are contracting and have to incur a number of expenses that a true employer would have to pay otherwise.

It may be legally incorrect for a group or business to attempt to treat someone as an independent contractor instead of an employee. This may be attempted by someone who has received incorrect advice on how to evade taxes or to avoid paying legally required taxes and fees (such as Social Security deductions and workers compensations insurance payments). If the Internal Revenue Service (IRS), Department of Labor or Department of Finance scrutinizes the employing entity, it may result in an assessment of back taxes and penalties, stop work orders and other sanctions being taken against the employer.

In most cases, doctors, nurses, physical therapists, dentists, psychologists, nurse practitioners, physician assistants, mental health counselors, massage therapists, and other health professionals should be treated as employees. The law requires that an employer pay a portion of the taxes, social security and other government assessments for those employees. Being an employee usually requires the employer to include the employee in any health insurance, retirement plans or other employer benefit plans which the employer has. The employer is also required to incur the costs of withholding taxes, unemployment compensation assessments, social security payments and other government-required deductions and forwarding them to the correct government entity. This saves administrative costs an employee might otherwise have to incur.

If the health professional has his or her own professional service corporation (sometimes called a professional association or “P.A.”) or limited liability company (LLC) then this business entity can be contracted by another group or business as an independent contractor. The individually-owned P.A. or LLC is the employer of the health professional. Employees receive an IRS Form W-2 at the end of the year. This recaps the withholdings, Social Security, Medicare, unemployment compensation and other taxes and assessments deducted from their pay. Independent contractors receive an IRS Form 1099 at the end of the year with the total compensation paid to them reflected on it. Employers are vicariously liable for the negligent acts of their employees while they are within the scope and practice of their jobs. The company or group that retains an independent contractor is not liable for the negligent acts of the independent contractor under the same circumstances.

Regardless, it is important that a contract accurately identifies whether the health professional is an employee or an independent contractor. It must also consistently refer to and treat the individual as either an employee or an independent contractor throughout the contract. If the contract is one that an employer has taken and tried to modify without the help of an attorney, it may use the term, incorrectly or include conditions that violate the law or that negate the treatment desired. It is almost always far more advantageous for the individual being hired to be treated as an employee.

Tip 6 – Be Sure That You Receive a Signed, Dated Copy Back Before You First Start Working.
If you are an employee, be sure that you receive a copy of the contract back that has actually been signed and dated by the employer. One of the most common legal problems we encounter when we consult with an employee whose employer has broken the contract is the absence of a signed or dated copy of the contract. Anyone can type up a blank contract. There may be many preliminary drafts of a contract that are not agreed to or executed by the parties. How can you prove that this is the actual agreement between the parties if you do not have a copy that is signed by the parties?

Tip 7 – Make Sure That all Exhibits, Schedules, Addendums and Referenced Documents are Attached to the Contract.
We often see contracts that refer to attached exhibits for job requirements, bonus calculations, benefits, employer handbooks, employer code of ethics or conduct, etc. However, in many cases, these are not completed or not attached to the contract when it is signed. Make sure that any documents that are referred to by the contract are actually attached to it and are completed. These are part of the contract. Your copy is not complete without them.

Tip 8 – Amend the Contract, By Hand if Necessary, to Make It Consistent with the Agreement of the Parties.
A contract is not a sacred document. You may write on it, if necessary, to amend it. You may attach separate handwritten amendments to it. Just make sure any handwritten changes on the contract itself are initialed by each party. Make sure any amendments attached to it are signed and dated by each party to the contract. Remember, also, that the changes must be understandable. If a judge is later called on to read it and interpret it, it must be clear to the judge.

Under the general rules used to construe contracts, typed changes and amendments to preprinted forms take precedence over the preprinted portions. Handwritten changes and amendments take precedence over typed or preprinted portions, and spelled out numbers and dates supersede numerical ones (if there is a conflict). However, there must be evidence that these were agreed to by both parties (such as initials or signatures prove).

Tip 9 – Restrictive Covenants (Sometimes Referred To As Covenants Not To Compete) Are Enforceable By Law in Florida.
A covenant not to compete is common in most physician contracts. This clause prevents a departing physician from competing with the employer in a specific geographic area for a specific period of time. These restrictive covenants are, as a general rule, enforceable under Florida law. There are exceptions and defenses that can be used to defeat or prevent the enforcement of a restrictive covenant, especially in the case of a physician. However, unless you have money set aside to pay for litigation, expect to honor it if it is in the agreement. As an employee, your negotiation strategy should be to have it removed completely or reduce the period of time and reduce the geographic area as much as possible. Also, it should be worded so as to only apply to the office or location in which you actually work and not to the medical sub-specialty or type of practice in which you will work.

If you decide you are going to leave a group or practice and you may need to work in violation of a restrictive covenant, it is very important to plan ahead for this. Often strategies can be developed that will avoid litigation.

Tip 10 – Avoid Agreeing to Pay the Premium for Tail Coverage For Professional Liability (Medical Malpractice) Insurance, Especially If The Employer Terminates The Employment.
If you are not able to negotiate this away completely: a) reduce the percentage you agree to pay to fifty percent (50 %) or have it reduced to twenty-five percent (25%) for each year you are in the practice, and b) insert a provision that if you maintain the same insurance company or obtain retroactive coverage, this will be substituted for tail coverage. If you maintain your insurance with the same company, in reality, your “tail” is covered and you should need no additional tail coverage policy.

Tip 11 – Carefully Consider Clauses That Allow the Employer to Terminate the Agreement Without Cause on a 30 Day, 60 Day, 90 Day or 180 Day Notice.
Many agreements contain a clause allowing one party or both parties to terminate the agreement “without cause” by giving advance notice of so many days. With such a clause in your contract, you no longer have a one or two-year agreement. Instead, you have a 30 day, 60 days, 90 days or 180-day contract. Termination without cause provisions can work for you or against you. Regardless, the term of employment is shortened if there is one. Think about whether or not you can find another job and relocate in 30 days.

Tip 12 – Include a “Cure” Provision If There Is a “For Cause” Termination Provision in The Contract.
This a provision that requires the employer to provide you written notice of any deficiency or breach and allows you a certain period of time (usually anywhere from 10 to 30 days) to cure it.

Tip 13 – In the Contract Specify All Material Terms in a Promise to Make You a “Partner” or “Shareholder.”
A promise to make you a “partner” or “shareholder” in the practice after a certain period of time will not be enforceable unless all of the terms are specified in order for a court to enforce it (price, timing, percentage of ownership, method of payment of the buy-in, etc.). Think of an option to purchase a house. Unless all of the terms for a binding contract are set forth in writing and agreed to by the parties, it will not be enforceable. Also, remember that a promise to “consider” you as a “partner” or “shareholder” in a contract is just as worded. You may be considered and denied this important opportunity.

Tip 14 – A Good Contract Identifies Typical Schedule, Where the Physician Will Work and Expectations About Call.
A contract that simply states the physician will “perform the usual duties of a physician” does not give either party much information about the expectations of the other party. Attention to this section is particularly important for physicians who wish to work part-time, to work only a specific schedule, to work in a specific clinic; or who have special arrangements concerning call. This section can also be used to answer questions about what level of involvement in administrative duties is anticipated and whether certain community activities are expected.

Tip 15 – A Physician’s Compensation Should Be Set at a “Fair Market Value.”
Physician employment and compensation are subject to anti-kickback laws. Generally, a physician’s compensation must be set at a fair market value demonstrating reasonable compensation. Fair market value is determined by comparing the entire compensation package, including benefits, insurance and signing bonuses to industry standards for the relevant specialty and geographic market. In almost any compensation arrangement, the physician and the employer will be protected from legal scrutiny when the compensation is determined to be fair market value, as long as other requirements are also met (such as a written contract, signed by the parties, at least a year duration, etc.).

Compensation usually has two components: salary and benefits. The typical employment agreement will provide for a guaranteed salary for the first one to two years. After that, the physician is usually compensated based on production. It is important to remember that some medical groups might offer an employed physician an opportunity to buy into the group after a period of time as an employee. This type of agreement in which the physician would be able to purchase shares or options in the group may or may not be part of the initial employment agreement. Such arrangements might be referred to as a “buy-in” clause or “partnership” arrangement. It is very important to understand that if the group is a corporation or professional association (P.A., a type of corporation), then the ownership interest will be “shares” and the physician will become a “shareholder.” If the group is a limited liability company (LLC), then the ownership interest is referred to as a “membership” and the physician will become a “member.” The term “partner” is often incorrectly used to refer to either one.

It is preferable to have these types of arrangements drafted separately from the employment agreement since their duration is likely to be longer than the employment agreement. It is always necessary to have all of the details spelled out, including the buy-in price and how it will be paid. Otherwise, it will not be legally enforceable. Common benefits include: family health insurance, dental insurance, life insurance, an allowance for continuing medical education (CME), paid time off or vacation and sick pay, short-term disability insurance, long-term disability insurance, and retirement plans.

Tip 16 – Determine How Outside Employment and Compensation is Handled.
If outside employment is allowed, it’s imperative you know who is entitled to the income. Some employers prohibit outside employment, while others allow it but require that the income be turned over to the employer. If the physician anticipates “Moonlighting,” the physician should negotiate to minimize the employer’s control over outside employment and income from it. If the physician expects to be involved in significant volunteer activities working as a physician, the contract should say whether the employer has the right to approve or reject such volunteer activities.

Tip 17 – Pay Close Attention to the Termination Clause.
This is the single most important clause of a contract because it can dash the expectations of one or both parties. Close attention should be paid to the terms and the conditions. The termination section usually allows the employer to immediately terminate the physician’s employment if certain events occur, such as the physician losing his or her medical license, being convicted of a felony or dying. Many contracts also permit immediate termination if the employee’s license is restricted, if privileges are significantly restricted, or if the employee becomes disabled. Almost all contracts also permit early termination by either party by simply giving notice. While the notice periods range from 30 to 180 days, most physician employment agreements permit either party to terminate the agreement with 60 to 90 days notice. This type of term essentially leaves the physician with a contract that lasts only for the stated notice period.

Tip 18 – Negotiate Reasonable Access to Patient Records.
Most employment agreements provide that any patient records created by the employee belong to the employer. However, the physician should negotiate for reasonable access to those records even after the physician leaves the employer for the purposes of defending a malpractice action, a credentials committee investigation, or a Florida Department of Health (DOH) inquiry. Access to such records is very helpful, and sometimes necessary, to defend these kinds of actions.

Tip 19 – Intellectual Property Usually Belongs to the Employer.
If an employee performs research or publishes books or papers during work time or even after hours, that intellectual property usually belongs to the employer. That is unless there is a written agreement that gives the physician ownership rights to these materials. An employee may want to negotiate the ownership of that intellectual property before signing the contract.

Tip 20 – Attorney Fees in Contract Disputes.
Ordinarily, disputes are resolved in the courts, and each party will pay their own litigation costs and attorney fees. Sometimes, however, the parties will agree to use arbitration as an alternative way of resolving disputes. While each process has its advantages and disadvantages, arbitration is generally faster and less expensive than litigation. Unless the parties agree otherwise, each party to a lawsuit, mediation or arbitration ordinarily will pay his or her own attorney’s fees and costs. However, most physician employment agreements include a clause obligating the losing party to an enforcement action to pay for all legal fees of both parties. Most places in the U.S. follow the American Rule with regards to attorney fees. Under the American Rule, each party is responsible for its own attorney fees unless a statute or contract provides otherwise. Employment agreements very often include a provision that provides that the prevailing party is entitled to his/her attorney fees in any dispute under the contract.

Tip 21 – Read the “Boilerplate” Provisions.
Most employment agreements have a series of “boilerplate” provisions that usually come at the end of the agreement. These provisions may include important provisions and should be considered carefully. For example, very often there will be a provision that states the written contract in the final agreement of the parties. If something was negotiated that is not included in the contract it will be precluded by the boilerplate provision. Anyone negotiating a contract should be concerned with any promise to work it out later.

Tip 22 – Be Detailed and Specific on What Income Will Go to Employer and Any That May Be Kept by the Employee.
This tip is an expansion on Tip 16 – Determine How Outside Employment and Compensation is
Handled. Typical physician employment agreements will contain statements such as: “The physician agrees to devote his/her complete time and attention to the business of the employer.” Or they may contain a clause stating: “All income derived from professional services delivered by the employee shall belong to the employer,” or something similar.
This can be problematic if the employee:

A. Moonlights, for example by pulling shifts at a hospital’s emergency department on the weekends;
B. Has a separate medical practice or business on the side such as providing diagnostic studies, testing, counseling, etc.;
C. Works part-time somewhere else, such as at a walk-in or urgent care clinic;
D. Consults as a practice management consultant, a risk management consultant, etc.;
E. Serves as a medical expert reviewing patient records for attorneys and providing expert opinions;
F. Serves as medical director of nursing homes, or home health agencies;
G. Invents new medical inventions or technologies on his/her own time;
H. Teaches; or
I. Lectures or writes and receives honoraria.

I have been involved in several court cases where the physician took employment with a large healthcare system and had an oral understanding, never in writing or included in his/her written contract, that the employee could continue a part-time medical practice and keep all of the income from it. This only became a problem (a big problem) years later when the employer found out about it and decided to sue the employee. The employer wanted all of the extra income that the employee had made and had not turned over to the employer.

Make sure that if there are any activities that you will participate in on your own time, including other part-time employment or moonlighting, this is specifically spelled out in the contract and the party who is entitled to receive the income from it is also specified. Furthermore, in the case of government employees such as military or Veterans Administration (VA) physicians, these types of activities may be illegal without advance written permission from the government.

Tip 23 – Make Sure You Receive a Copy of the Contract Back Signed and Dated by the Other Side.
As we have written before, one of the biggest problems we see again and again is when a dispute arises, the party coming to us (usually the employee) does not have a copy of the contract that is signed or dated by the other party (usually the employer).

Can you imagine buying or selling a house without getting a contract signed by each party? Can you imagine buying a car without getting a copy of the contract signed by the other party? Then how can you enter into a contract covering years of time for something as important as a profession without obtaining a signed and dated copy from the other side? Think of employment contracts as prenuptial agreements. As long as everyone does what he or she is supposed to do and things work out okay, the contract is not needed or referred to in most cases. It is only if things start going wrong, for example, if the employee does not work the hours he is supposed to if the employer does not pay the bonuses it agreed to pay, that the contract gets pulled out for possible enforcement.

In litigation in which I have been involved over physician employment agreements, I have had the following defenses raised by employers when sued for breach of contract by an employee:

A. The employer never agreed with the changes the employee wanted in the contract, so the employer never signed it.
B. The employer and employee were involved in negotiations on a possible contract but could never reach an agreement, so the employee has no contract and is merely an “at will” employee;
C. There was never a signed contract so the employment agreement is unenforceable under the applicable statute of fraud.
D. There was never a signed contract so the employment agreement is illegal and unenforceable under the Stark Act and the Anti-Kickback Statute.

If you are the employer, never let the employee start working before you have a copy of the contract back signed and dated by the employee. If you are the employee, never start working, not even a day, before you have a copy of the contract back signed and dated by the employer.

When we review contracts we often add an addendum or amendment to the contract that states: “This agreement shall not be valid or enforceable unless Employee actually receives a copy signed and dated by the employer on or before (date) and employee shall not be expected to begin work until then.”

Adhering to these types of requirements keeps everyone honest.

Contact a Health Care Attorney Experienced in Negotiating and Evaluating Physician and Health Professional’s Business Transactions.

At the Health Law Firm, we provide legal services for all health care providers and professionals. This includes physicians, nurses, dentists, psychologists, psychiatrists, mental health counselors, durable medical equipment suppliers (DME), medical students and interns, hospitals, ambulatory surgical centers, pain management clinics, nursing homes, and any other health care provider.

The services we provide include reviewing and negotiating contracts, preparing contracts, helping employers and employees enforce contracts, advice on setting aside or voiding contracts, litigation of contracts (in start or federal court), business transactions, professional license defense, opinion letters, representation in investigations, fair hearing defense, representation in peer review and clinical privileges hearings, litigation of restrictive covenant (covenants not to compete), Medicare and Medicaid audits, commercial litigation, and administrative hearings.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: physician employment agreement, physician employment contract, health professional contracting, representation for physician contracts, physician contract attorney, employment contract lawyer, healthcare contract attorney, business law attorney, contract litigation, business litigation, contract terms, physician agreements, business transactions, restrictive covenants, noncompetition agreements, covenants not to compete, representation for restrictive covenants, representation for noncompetition agreements, The Health Law Firm reviews, representation for health care providers

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

By |2019-06-18T00:49:24+00:00June 18th, 2019|Medical Education Law Blog|0 Comments

Contracting 101: Tips For Medical Graduates Entering the Workforce

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

This blog is intended to provide an introductory review of contracting 101 basics for medical graduates entering the workforce as residents and fellows. We will highlight many of the common provisions found in employment contracts, along with many of the mistakes and pitfalls that we see in our day-to-day practice.

By the end of this informational blog, it is our hope that medical graduates will better understand the common language and terms found in employment contracts for health care professionals. The following tips are meant to assist new professionals in recognizing common mistakes made by physicians and health professionals when negotiating contract terms. We hope to help make both employers and employees more knowledgeable about employment contracts so they can avoid potential problem areas and legal entanglements.

Our comments in this blog are meant to provide general rules and recommendations that we have learned from our experiences. However, please remember, every situation is different and there are exceptions to every rule. These tips are not intended to constitute legal advice.

We recommend contacting an experienced health attorney for questions or concerns regarding specific employment contracts or to thoroughly review all of the contract terms prior to acceptance.

Tip 1 -“Standard” or “Routine” Physician Employment Agreements Do Not Exist.

No two employment agreements are identical. Each must be reviewed on its own terms. It is important to consult with a healthcare lawyer experienced in negotiating employment contracts and evaluating health care business transactions.

Tip 2 – A Negotiation is Always an Option.

Even though an employer may have what appears to be a “standard” employment contract for all physician employees, this can have changes, amendments, schedules, exhibits or terms that are varied from physician to physician or professional to professional. Generally, large employers are less likely to change their form to accommodate the physician than small organizations, but they can and often will. Small employers are often willing to make more changes to their written agreements.

If there are any changes, additions or clarifications you need to make to the contract, then put them in writing, sign them, incorporate them into the contract and attach them to the contract.

Tip 3 – All-Oral Agreements Should be Accurately Reflected in the Wording of the Contract.

If it is different or not specified, the language in the contract will govern in any future dispute.

For more information, please read one of my prior blogs on physician and employment contracts here.

In our future blogs, we will continue to provide tips on various issues to watch for in health care employment contracts.

Contact a Health Care Attorney that is Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in the following areas: in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), discrimination due to race, sex, national origin, sexual orientation and any other matters, reviewing and negotiating contracts, preparing contracts, helping employers and employees enforce contracts, advice on setting aside or voiding contracts, litigation of contracts (in start or federal court), business transactions, professional license defense, opinion letters, representation in investigations, fair hearing defense, representation in peer review and clinical privileges hearings, litigation of restrictive covenant (covenants not to compete).

To contact The Health Law Firm, please call (407) 331-6620 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: physician employment agreement, physician employment contract, health professional contracting, negotiating business transactions, physician contracts, contracting tips for medical graduates, contract attorney, business law attorney, business lawyer, contract lawyer, contract litigation, business litigation, employment contract terms, physician agreements, physicians entering the workforce, business transactions, restrictive covenants, noncompetition agreements, covenants not to compete, business ventures, residency and fellowship, medical graduate attorney, fellowship contract lawyer,Graduate medical education (GME) defense attorney, international medical graduate attorney, graduate medical education defense lawyer, lawyer for medical students, medical resident physician attorney, residency program legal dispute, residency program litigation, medical school litigation, legal representation for medical residents, health care professional representation, health care professional defense lawyer, Florida health care lawyer, The Health Law Firm reviews, reviews of The Health Law Firm Attorneys

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

By |2019-06-12T05:23:51+00:00June 12th, 2019|Medical Education Law Blog|0 Comments

Many Actions Can Result in Allegations of Irregular Behavior or Irregular Conduct

George Indest headshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

I have written many blogs in the past, on allegations of irregular behavior being brought against medical students, foreign medical graduates and others applying to take examinations to qualify for a medical license in the United States. These have previously focused on charges made by the United States Medical Licensing Examination (USMLE) Secretariat (an affiliate of the National Board of Medical Examiners (NBME)) and the Educational Commission for Foreign Medical Graduates (ECFMG). In this blog, I will discuss similar allegations made by the National Osteopathic Board of Medical Examiners (NBOME) and the types of actions that are considered “irregular conduct.”

To read several of my prior blogs on these topics, click here to read one on common mistakes made on the USMLE exam or click here to read one on what to do if you receive an inquiry from the USMLE, ECFMG, or NBME.

Charges of “Irregular Behavior” or “Irregular Conduct” Are Similar No Matter What Organization Made Them.

The NBOME is the organization that confirms credentials, tests and regulates osteopathic physicians applying for licenses in the United States.

Like the other organizations mentioned above, it has certain types of conduct (or misconduct) it prohibits that can result in adverse actions being taken against the applicant. The USMLE and the ECFMG refer to these as “Irregular Behavior.” The NBOME refers to these as “Irregular Conduct.” They include, for example, actions that could be termed “cheating” or attempting to gain an unfair advantage on an examination or providing false information on an application.

Irregular Conduct: Definition.

The NBOME defines the term “Irregular Conduct” to include:

any behavior on the part of any candidate [applicant] that violates the integrity or security of the examination, behavior that is disruptive to administration of the examination, or behavior deemed by the NBOME in its sole discretion to be inappropriate in connection with the application, registration, taking, administration, integrity, and security of any NBOME examination.

The key part to this definition is that the NBOME reserves the right to make such determinations “in its sole discretion,” which is a subjective standard that is usually not subject to being second-guessed by a court or other agency.

Examples of “Irregular Conduct.”

The Bulletin of the NBOME provides the following as examples of Irregular Conduct:

1. Copying, fraud, deceit, or other dishonest conduct.

2. Refusal to provide a proper ID or permit photo documentation or other identification for ID verification at any time. Providing false or forged identification upon presentation for testing at a test center. It should be noted that this is to ensure the test-taker is the correct individual and that a “ringer” is not being used.

3. Communication or attempts to communicate with others during the examination other than authorized test center professional staff.

4. Removal of or attempts to remove any test material, scrap paper, or whiteboard from the assigned test area. These organizations are very serious about protecting the integrity of the examination questions and answers, so they go overboard to protect them.

5. Non-compliance with test center rules and regulations and security requirements, including operating test center equipment without reasonable care. This is self-explanatory.

6. Providing or receiving unauthorized information about the content of an examination. We have seen numerous cases of this occurring (or at least being charged against applicants) as a result in participation in Internet listervs and forums on these examinations. Even asking for “cases,” “questions,” or “subjects” from an examination may result in an allegation of irregular conduct.

7. Violation of the NBOME’s non-disclosure or confidentiality policies or the candidate’s non-disclosure agreement.

8. Communication or attempts to communicate about the content, format, or specific test items with another candidate or with any outside source or party (including use of telephones, personal computers, internet access, test review companies, or any other means) at any time, either before, during, or after an examination. See the comments directly above. Posting, downloading or requesting such materials from others has been charged as irregular conduct.

9. Using or having available or access to any unauthorized device, text, notes, or other material that could assist the candidate in taking the examination. Bringing personal property into the test area is considered by the NBOME to violate the security of the examination. This would include, for example, an iPad, smartphone, smartwatch or other types of electronic devices that can access the Internet or notes, “crib sheets,” outlines, or any other type of written assistance.

10. Providing false admittance information or altering applications, score reports, transcripts, or certificates. We have seen an example where an applicant who passed an examination altered his test report to show a higher grade. He was caught, as is usually the case, and received an adverse finding and this was noted on his permanent record with the testing organization.

11. Disrupting another candidate or candidates. This can include, for example, pulling a fire alarm during an examination, setting a fire in the building where the examination is being administered, talking to someone else or any type of noisy or disruptive conduct.

12. At any time (i.e., before, during, or after any examination) verbally or physically harming or threatening to harm the test center professional staff, other examinees, test center employees, or NBOME personnel, representatives or agents, including telephone and in-person encounters regarding scheduling, scores, or score reporting. Although we have never heard of actual cases of most of these types of conduct, we understand that sometimes angry applicants have threatened staff members and personnel. Therefore, one should always be courteous and respectful in all dealings with test center and NBOME staff and personnel.

13. “Unprofessional Conduct” which we will discuss in Part 2 of this blog.

14. Other behavior deemed by the NBOME to be unethical or unprofessional. This is, of course, a “catch-all” provision that allows the NBOME to charge an applicant with just about anything that it believes is irregular conduct.

Unprofessional Conduct and Actions that NBOME can Take.

In Parts 2 and 3 of this blog, I will discuss what the NBOME deems to be “unprofessional conduct” as well as the actions it may take and procedures that apply to an applicant facing such allegations.

Stay tuned for part 2 and part 3!

View Our Other Blogs on Our Experience with the USMLE, ECFMG, and NBME, and Hearings on “Irregular Behavior.”

Our law firm is had a great deal of experience representing students and graduates in disputes with and defending charges of “irregular behavior” against the USMLE, ECFMG and the NBME.

To learn more, read two of my prior helpful blogs here titled, “Medical Students, Interns & Residents Beware: A Finding of “Irregular Behavior” Can Ruin Your Medical Career Before it Starts,” and  “USMLE Hearing? Organization, Timing, and Evidence are Crucial.”

Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and any other matters.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620

KeyWords: Graduate medical education (GME) defense attorney, international medical graduate attorney, graduate medical education defense lawyer, lawyer for medical students, medical resident physician attorney, residency program legal dispute, residency program litigation, medical school litigation, legal representation for medical residents, legal dispute with medical school, medical students legal counsel, disruptive physician attorney, impaired medical student legal counsel, impaired resident legal defense attorney, United States Medical Licensing Examination (USMLE) defense lawyer, USMLE defense attorney, National Board of Medical Examiners (NBME) defense counsel, Educational Commission for Foreign Medical Graduates (ECFMG) defense lawyer, ECFMG defense attorney, legal representation for USMLE investigations, legal representation for NBME investigations, legal representation for irregular behavior, irregular behavior defense attorney, irregular behavior defense counsel, health law attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, Philadelphia attorney for ECFMG hearing, Philadelphia lawyer for NBME hearing, Philadelphia legal counsel for USMLE hearing

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

By |2019-05-23T20:06:41+00:00May 23rd, 2019|Medical Education Law Blog|0 Comments

Cheating, Irregular Behavior and Other Challenges Facing Medical Students and Graduates

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The road to becoming a physician is paved with many unique challenges. The long, exhausting journey begins and students are faced with the first battle: rigorous undergraduate course work, followed by the MCAT and medical school applications. During medical school, and for some, after graduation, the USMLE (United States Medical Licensing Examination) and its STEP 1, STEP 2 and STEP 3 exams provide another hurdle in the uphill battle. At any of these stages, medical students can face a gauntlet of accusations including cheating, misrepresentation, falsification of information, unfair advantages and the many faces under the general label of “irregular behavior.”

Challenges Prior to Entering Medical School.

Prior to medical school, pre-med students must be ambitious, inquisitive and extra cautious about any disciplinary action. A minor blemish on a pre-med student’s academic record (from academic dishonesty or other accusations), will become a major red flag once that student begins applying. Not only will any kind of discipline record hinder a student’s chances of acceptance, an infraction can also ruin that student’s reputation as they apply for residency and beyond.

Because the process of becoming a physician is difficult without having a discipline record, any charge against a pre-med student must be taken with the upmost seriousness. Don’t raise a white flag early on in the uphill battle!

Challenges After Medical School.

The battle continues for medical students; medical school courses and clinical rotations will be rigorous and challenging, calling on every neuron you possess to fire efficiently. You will be tested, in more ways than one. You will forget the term “MCAT” and substitute for it a new acronym–“USMLE” which stands for United States Medical Licensing Examination.

The USMLE is a four stage examination required for medical licensure in the United States. Because the USMLE is the barrier between you and your medical license, it is an extremely important component of your medical education.

One such issue is being accused of “irregular behavior.” This broad label includes anything from cheating to disruptions during testing or soliciting information on actual examination content. In the event that your test score is held up or invalidated due to irregular behavior you will want to correct the situation immediately, or you may be prohibited from taking future exams (meaning you won’t be able to obtain your license or a residency in the U.S.). If you are accused of irregular behavior or if you feel that you were faced with inadequate testing conditions, resolving the issue may be as simple as requesting a rescoring of the examination or a retest. Sometimes, because of problems at a test site or because of technical problems, retesting is an option.

The National Board of Medical Examiners and the USMLE take all such matters concerning the administration and the security of the test contents extremely seriously. In ceratin cases, they have sued those they believe may have compromised actual test contents. Click here to read more about the case.

After years of schooling, don’t allow an allegation of irregular behavior to mark your test transcripts and prevent you from attaining your goals and reaping the benefits of your hard work.

To learn more about USMLE, irregular behavior and how we can help you, click here to read one of my prior blogs.  Check our Medical Education Law Blog Regularly to stay on top of news and tips!

Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and any other matters.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620

KeyWords: Graduate medical education (GME) defense attorney, international medical graduate attorney, graduate medical education defense lawyer, lawyer for medical students, medical resident physician attorney, residency program legal dispute, residency program litigation, medical school litigation, legal representation for medical residents, legal dispute with medical school, medical students legal counsel, disruptive physician attorney, impaired medical student legal counsel, impaired resident legal defense attorney, United States Medical Licensing Examination (USMLE) defense lawyer, USMLE defense attorney, National Board of Medical Examiners (NBME) defense counsel, Educational Commission for Foreign Medical Graduates (ECFMG) defense lawyer, ECFMG defense attorney, legal representation for USMLE investigations, legal representation for NBME investigations, legal representation for irregular behavior, irregular behavior defense attorney, irregular behavior defense counsel, health law attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, Philadelphia attorney for ECFMG hearing, Philadelphia lawyer for NBME hearing, Philadelphia legal counsel for USMLE hearing

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

By |2019-01-28T22:56:06+00:00January 28th, 2019|Medical Education Law Blog|0 Comments

Law School Agrees to Drop Accreditation Suit

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On January 16, 2019, the Summit School of Law in Arizona (Arizona Summit) settled a lawsuit against the American Bar Association (ABA) over the decision to pull the law school’s accreditation. The for-profit law school, which is in the process of closing down, agreed to dismiss the suit with prejudice.

This matter may be of interest to those involved in medical education, because of the accreditation problems faced by some medical schools and recent actions taken to revoke the accreditation of or not accept the graduate from some foreign medical schools. There are lessons to be learned from this case.

“The ABA and the council welcome the end of this dispute. We look forward to continuing to serve the best interests of law students, the public, and the profession through the ABA law school accreditation process, which has consistently been upheld by courts and has been approved by the U.S. Department of Education,” Barry Currier, managing director of the ABA section that accredits and regulates law schools, said in a statement the ABA issued.

ABA Enforcement Actions.

Arizona Summit is one of three schools that filed suit against ABA’s enforcement actions, arguing that due process rights were violated before the decision to be put on probation. All three law schools, owned by InfiLaw Corp., sued the ABA in May 2018, regarding accreditation issues. Click here to view Arizona Summit’s compliant against the ABA in full.

Requirements For Law School Accreditation.

In June 2018, ABA decided to pull accreditation for Arizona Summit, saying it had fallen short of standards on student admissions and bar passage rates. ABA requires schools to see at least 75% of students pass the bar within five years. Additionally, passage rates for first-time bar takers are required to be within 15% of the school’s average in three of five years. You can learn more about ABA’s Standards and Rules of Procedure for Approval of Law Schools here.

According to Arizona Summit’s Report for 2018, the school awarded 118 degrees that year. A total of 25 graduates took the state bar exam for the first time in July 2018, and their pass rate was 52%. A total of 98 graduates of the law school sat for that exam and the overall pass rate was 20.4%.

Therefore, the ABA pulled its accreditation stating that it had fallen short of standards on student admissions and bar passage rates. The school is scheduled to shut down for good in spring 2020.

Don’t Let Accreditation Issues Slow You Down!

We have often been contacted by medical students, resident physicians, fellows, and foreign medical graduates, when experiencing problems with their medical school or graduate medical education (GME) programs. Don’t wait until it is too late to think of consulting with an experienced healthcare attorney regarding possible solutions. Even when it may appear to be too late, it may not actually be too late to recover. Click here to read one of my prior blogs for more information on accreditation matters in graduate medical education (GME) programs.

Contact Experienced Health Law Attorneys Today.

The attorneys of The Health Law Firm provide legal representation to medical students, resident physicians, and fellows in academic disputes, disciplinary cases, and disputes with their programs, schools, or institutions. These include graduate medical education (GME) hearings, contract negotiations, conduct committee hearings, charges of irregular behavior, issues with the National Board of Medical Examiners (NBME), the United States Medical Licensing Examinations (USMLE) and the Education Commission for Foreign Medical Graduates (ECFMG), license applications, board certification applications and hearings, credential hearings, and civil and administrative litigation.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

Sources:

Cueto, Emma. “For-Profit Ariz. Law School Drops ABA Suit Over Accreditation.” Law360. (January, 16, 2019). Web.

Ward, Stephanie. “Arizona Summit Law School agrees to drop its lawsuit against ABA.” ABA Journal. (Journal 16, 2019). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: legal representation for fair hearings, fair hearings representation, fair hearing defense lawyer, legal representation for administrative hearing, administrative hearing representation, administrative hearing defense attorney, legal representation for due process cases, legal representation for clinical privileges, clinical privileges representation, clinical privileges defense lawyer, legal representation for health care investigations, legal representation for peer review hearings, peer review representation, graduate medical education (GME) hearing legal counsel, medical contract negotiations, conduct committee hearing attorney, defense of charges of irregular behavior, National Board of Medical Examiners (NBME) defense attorney, United States Medical Licensing Examination (USMLE) defense legal counsel, Education Commission for Foreign Medical Graduates (ECFMG) defense lawyer, medial license application lawyer, board certification application attorney and hearings peer review defense lawyer, legal representation for DOH investigations, legal representation for licensure defense, licensure defense attorney, legal representation for health care professionals, health law defense attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

Medical Resident Awarded More Than $400,000 in Hospital Breach of Contract Lawsuit

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On October 9, 2018, a jury in Michigan federal court awarded more than $400,000 to the parents of an international medical school graduate after finding that Pontiac General Hospital breached their son’s residency program contract. The law suit, which has been described as a “pay for play” case, was first filed in 2017 in the U.S. District Court in Detroit, Michigan.

Breach of Contract.

The Canadian family claims the owners of Pontiac General asked for $400,000 in exchange for their son’s acceptance into the facility’s residency program in the fall of 2016. Court records show that the medical graduate received a signed residency contract the same day his father paid the final of three checks. However, it is alleged that soon after paying the fee, the hospital breached the contract by declining to let him start the program, and to add insult to injury, the hospital refused to return the funds.

The eight member jury reached a unanimous verdict and the family was awarded a total of $484,000.

The attorneys of The Health Law Firm routinely represent medical students, resident physicians and fellowship physicians, in legal disputes with their medical schools, residency and fellowship programs, and with the United States Medical Licensing Examination (USMLE), National Board of Medical Examiners (NBME), Educational Commission for Foreign Medical Graduates (ECFMG), and legal representation and defense of charges of irregular behavior. This representation includes internal disciplinary and grievance hearings, administrative hearings, due process complaints, academic and conduct committee hearings, appeals, and civil litigation. Click here to learn more about how we can help you in situations like this.

Contact a Health Care Attorney that is Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and any other matters.

To contact The Health Law Firm please call (407) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

“Pontiac General Hospital ordered to pay over $400K to doctor in pay-to-play lawsuit.” WXYZ News Detroit. (October 9, 2018). Web.

Greene, Jay. “Family wins Pontiac General ‘pay-for-play’ residency case.” Modern Healthcare. (October 15, 2018). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Graduate medical education (GME) defense attorney, international medical graduate attorney, graduate medical education defense lawyer, lawyer for medical students, medical resident physician attorney, residency program legal dispute attorney, residency program litigation, medical school litigation, legal representation for medical residents, legal dispute with medical school, medical students legal counsel, disruptive physician attorney, impaired medical student legal counsel, impaired resident legal defense attorney, United States Medical Licensing Examination (USMLE) defense lawyer, USMLE defense attorney, National Board of Medical Examiners (NBME) defense counsel, Educational Commission for Foreign Medical Graduates (ECFMG) defense lawyer, ECFMG defense attorney, legal representation for USMLE investigations, legal representation for NBME investigations, legal representation for irregular behavior, irregular behavior defense attorney, irregular behavior defense counsel, health law attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, Philadelphia attorney for ECFMG hearing, Philadelphia lawyer for NBME hearing, Philadelphia legal counsel for USMLE hearing, legal representation for resident physicians and fellowship physicians, representation for legal disputes with medical schools, representation for residency and fellowship programs, National Board of Medical Examiners (NBME) attorney, Educational Commission for Foreign Medical Graduates (ECFMG) attorney, legal representation and defense of charges of irregular behavior, representation for internal disciplinary and grievance hearings, representation for administrative hearings, representation for due process complaints, academic and conduct committee hearings attorney, civil litigation attorney

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

By |2018-11-27T19:31:12+00:00November 27th, 2018|Medical Education Law Blog|0 Comments

Have You Received a Letter from the ECFMG or USMLE Accusing You of Irregular Behavior? All Is Not Lost; Legal Advice Is as Close as a Phone Call Away!

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Have you recently received a letter from the Educational Commission for Foreign Medical Graduates (ECFMG) or the United States Medical Licensing Examination (USMLE) Secretariat accusing you of “irregular behavior?” All is not lost. But you should seek advice from an attorney or law firm that has a lot of experience with such matters, before responding or doing anything else.

If You Are Innocent or Have a Believable Explanation to Justify What You Are Being Accused of Doing, You Need to Defend Yourself Against the Accusations of “Irregular Behavior.”

Yes, it is possible to successfully defend yourself against accusations of “irregular behavior.” However, we do not suggest that you should attempt to represent yourself or do this on your own. In any letter you receive on this will be advised of your rights to make a statement explaining your side, to have a hearing committee consider the matter, to appear in person before the hearing committee, and to have legal representation (an attorney) at the hearing with you to represent you. We recommend that you always ask for an exercise all of these rights.

It has been our experience that those individuals who think that they can just write a letter and explain what happened will usually not succeed. A full investigation has already been conducted by the USMLE or ECFMG and it will feel that it has already adequately explored and discovered all of the facts in your case.

It is our advice that you must always find out exactly what evidence or information the organization has against you and you must appear in person and testify under oath at a hearing at which the committee can ask you questions in order to show your honesty and innocence.

As Attorneys Experienced in Such Matters, We Know How to Prepare and Present Cases to Such Hearing Committees and to Successfully Convince Them of Your Position.

Our law firm and our attorneys have had a great deal of experience in dealing with the ECFMG and the USMLE on issues involving grading on the Step examinations, accusations of “irregular behavior,” testing and grading irregularities, and allegations regarding conduct which the organizations contends is “irregular behavior” (including mistakes in completing applications and affidavits). We haven’t represented many medical students and medical graduates in challenges, hearings before the committees, and on appeals.

Although, just as in medicine, in legal matters such as this one, we cannot guarantee any specific outcome or success in a case, we can advise you of our many successful cases. Finding any lawyer in the United States who has a great deal of prior experience with the USMLE or the ECFMG is very difficult. There are very, very few of us. Additionally, once you check out the backgrounds of any attorney whom you are considering, you may find that the particular attorney is not what you expect or would desire to hire. You want to hire attorneys that have a great deal of experience in this area, who know what they are doing, and who will not exaggerate or promise you that which they are not able to deliver.

Experience, Organization, and Knowledge are the Hallmarks of Our Legal Representation of You!

In our case, we tell the truth, we know what the “hot” issues are that are important to the ECFMG he and the USMLE, and we are aggressive advocates of your innocence or your position in the case. We prepare ahead of time and put together a comprehensive, detailed, and well organized presentation, through documents, which we deliver to the committee ahead of time for its consideration at your hearing. We always go to the hearing in Philadelphia, appearing with you in person at the hearing, and making the best presentation possible for you. We are by your side allo the way!

We do our best to prepare you ahead of time, going over potential questions that the committee might ask you and preparing your testimony in advance. We try not to leave anything to chance. If you are subject of a similar type of hearing, or court case, then you really do need experienced legal counsel to help you prepare. You should not try to do this alone.

Severe Consequences of Receiving a Label of “Irregular Behavior.”

There can be some very severe consequences of receiving a label of “irregular behavior,” if you do not adequately defend against such allegations. These can extend all the way from a stamp on the transcript of your Step examination scores stating “irregular behavior,” with a letter attached to it going into great detail about your “irregular behavior,” all the way to a complete ban (forever) from taking any further Step examinations, and everything in between. Even the stamp of “irregular behavior” alone can prevent you from successfully matching with residencies you are seeking or obtaining jobs you desire. This is similar to having a stamp of “Found Guilty of Cheating” on a transcript; the effect may be the same. You may find yourself being excluded from receiving interviews or invitations from residency program for which you apply.

Do not take a chance! Although legal representation may be expensive, you must consider the amount of time and money you have already spent to date to have a medical career and be willing to spend what it takes to continue that career. Don’t jeopardize it by trying to scrimp on legal fees. Remember that you usually get what you pay for.

View Our Other Blogs on Our Experience with the USMLE, ECFMG, and NBME, and Hearings on “Irregular Behavior.”

Our law firm is had a great deal of experience representing students and graduates in disputes with and defending charges of “irregular behavior” against the USMLE, ECFMG and he NBME. To review a few of these please see:
Limits on Number of Attempts and Time for Completion of USMLE Step Exams and
ECFMG Affidavit to Complete? Attending a Caribbean Medical School? Being Investigated for Irregular behavior by the ECFMG or USMLE? You need Legal Advice! Your Residency Matching Might Now Be at Issue, as Well!

Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and any other matters.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620

KeyWords: Graduate medical education (GME) defense attorney, international medical graduate attorney, graduate medical education defense lawyer, lawyer for medical students, medical resident physician attorney, residency program legal dispute, residency program litigation, medical school litigation, legal representation for medical residents, legal dispute with medical school, medical students legal counsel, disruptive physician attorney, impaired medical student legal counsel, impaired resident legal defense attorney, United States Medical Licensing Examination (USMLE) defense lawyer, USMLE defense attorney, National Board of Medical Examiners (NBME) defense counsel, Educational Commission for Foreign Medical Graduates (ECFMG) defense lawyer, ECFMG defense attorney, legal representation for USMLE investigations, legal representation for NBME investigations, legal representation for irregular behavior, irregular behavior defense attorney, irregular behavior defense counsel, health law attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, Philadelphia attorney for ECFMG hearing, Philadelphia lawyer for NBME hearing, Philadelphia legal counsel for USMLE hearing

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

Contracting 101: Medical Graduates Entering the Workforce, Follow These Tips!

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

This is part one, of a blog series that is intended to provide an introductory review of the basics of contracting for medical graduates entering the work force as residents and fellows, primarily by discussing employment agreements. We will highlight many of the common provisions found in employment contracts, along with many of the mistakes and pitfalls that we see in our day-to-day practice.

By the end of this informational blog, it is our hope that medical graduates will better understand the common language and terms found in employment contracts for health care professionals. The following tips are meant to assist new professionals in recognizing common mistakes made by physicians and health professionals when negotiating contract terms. We hope to help make both employers and employees more knowledgeable about employment contracts so they can avoid potential problem areas and legal entanglements.

Our comments here are meant to provide general rules we have learned from our experience. However, please remember, every situation is different and there are exceptions to every rule. These tips are not intended to constitute legal advice. We recommend contacting an experienced health attorney for questions or concerns regarding specific employment contracts, or to thoroughly review all of the contract terms prior to acceptance.

Tip 1 -“Standard” or “Routine” Physician Employment Agreements Do Not Exist.

No two employment agreements are identical. Each must be reviewed on its own terms. It is important to consult with a healthcare lawyer experienced in negotiating employment contracts and evaluating health care business transactions.

Tip 2 – Negotiation is Always an Option.

Even though an employer may have what appears to be a “standard” employment contract for all physician employees, this can have changes, amendments, schedules, exhibits or terms that are varied from physician to physician or professional to professional. Generally, large employers are less likely to change their form to accommodate the physician than small organizations, but they can and often will. Small employers are often willing to make more changes to their written agreements.

If there are any changes, additions or clarifications you need to make to the contract, then put them in writing, sign them, incorporate them into the contract and attach them to the contract.

Tip 3 – All Oral Agreements Should be Accurately Reflected in the Wording of the Contract.

If it is different or not specified, the language in the contract will govern in any future dispute.

For more information, please read one of my prior blogs on physician and employment contracts here.

In our future blogs, we will continue to provide tips on various issues to watch for in health care employment contracts.

Stay tunes for part two of this blog series.

Contact a Health Care Attorney that is Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in the following areas: in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), discrimination due to race, sex, national origin, sexual orientation and any other matters, reviewing and negotiating contracts, preparing contracts, helping employers and employees enforce contracts, advice on setting aside or voiding contracts, litigation of contracts (in start or federal court), business transactions, professional license defense, opinion letters, representation in investigations, fair hearing defense, representation in peer review and clinical privileges hearings, litigation of restrictive covenant (covenants not to compete).

To contact The Health Law Firm, please call (407) 331-6620 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

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“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

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