Who should call the shots when doling out wage increases, Practicing Internet medicine: the risks vs the rewards, Your responsibilities to patients when you leave a health plan, Can a signing bonus create resentment?
Q I always ask my office manager for input in deciding on staff raises, even though we don't always see eye to eye. However, I feel uncomfortable when I overrule her. Because she works more closely with staff than I do, perhaps her opinions should carry more weight. Would it be a good idea simply to make her solely responsible for salary decisions?
A No. You'd be delegating too much authority, and the rest of the staff will pick up on that.
Your office manager's written performance review of a staffer is important, but you also need to consider other things when doling out pay increases, such as your interaction with the staffer, current and projected office overhead, and the prevailing wages in your community.
Q I'm an internist who's had it with managed care. I've thought about retiring, but I'm not yet ready to give up. Instead, I'm thinking of getting involved with a virtual medical practice. Working with one of these Web sites, I'd consult with patients online, then diagnose, recommend treatment, and prescribe. Is this feasible?
A Although the idea may seem attractive, it may be more "virtual" than "reality." Since you'd be practicing across bordersboth state and nationalit's possible you'd have to be licensed in every jurisdiction in which you dispense advice. Another consideration is the malpractice risk. Your professional liability carrier won't cover you if you run afoul of license restrictions or practice medicine outside your jurisdiction. And without a hands-on exam, how would you make a diagnosis or know whether the information the patient provides is accurate or just a ruse to obtain drugs?
Q I recently resigned from a capitated HMO. But some plan members continue to call for prescription refills. What are my obligations?
A Because of the legal and malpractice issues involved, our consultants advise you not to refuse to refill a prescription. Instead, explain that although you are no longer affiliated with the HMO, you'll order enough medication to allow the patient time to choose another plan physician. Be sure he understands that the HMO's prescription coverage may not apply, since you're no longer with the plan. Explain, too, that you can't extend the prescription again without reassessing his condition. And make it clear that any future visits wouldn't be covered by his health plan. Be sure to document your discussion.
QOur six-doctor multispecialty group is having trouble attracting an ob/gyn to staff our new satellite office. So we're considering offering a signing bonus to lure the right one. But we didn't offer a bonus to any other new associate. Do your consultants foresee problems with this?
A Hurt feelings are possible, but you need to do whatever's necessary to assemble the staff you planned for. If anyone complains, simply explain that you've been having difficulty finding a good ob/gyn to join your practice.
Do you have a practice management question that may be stumping other doctors, too? Write: PMQA Editor, Medical Economics magazine, 5 Paragon Drive, Montvale, NJ 07645-1742, or send an e-mail to firstname.lastname@example.org (please include your regular postal address). Sorry, but we're not able to answer readers individually.
Kristie Perry. Practice Management. Medical Economics 2001;20:87.