After Training: Options for FMGs. Connie Berry, Manager Texas Primary Care Office January 13, 2009. Proposed State Legislation. Senate Bill 86
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Connie Berry, Manager
Texas Primary Care Office
January 13, 2009
Senate Bill 86
Filed early, would require any physician who is not a US citizen or Permanent Resident to work in a shortage or underserved area. This mirrors New York law, which also has provisions for the state to designate facilities, such as teaching and charity hospitals as serving the underserved.
Why is this being proposed? To obligate all foreign physicians trained in the US to serving the underserved. Addresses the issue of a service obligation for physicians who enter and train on the H1-B visa.
Going from Residency or Fellowship training, into private practice is a transition. The employment settings, public compared to private practice, are very different.
We have developed these Rights and Responsibilities for the Physicians and their Employers, to help make the transition a success for both.
An offer of employment is a serious commitment, with immediate and long term financial implications. The employer is also committing their personal and professional time and practice support. These obligations have value, both financial and intrinsic. Accepting the offer of employment should recognize and respect the value of the offer.
Contract language can be confusing, even if English is your first language. BEFORE SIGNING a contract, ask about anything you don’t understand or ask to have an opportunity to have someone with contract expertise, review it with you.
Productivity, such as the number of patients seen each day, is one measure of performance. The physician and employer can discuss marketing and scheduling to increase productivity. This is not a 9 to 5 job.
Moonlighting or working for another employer is only OK if the primary employer approves. The outside employment may conflict with the primary job.
Understanding the culture of the patients, peers, co-workers and community is important for success, whether in the obligated position or in developing skills for remaining in the US. Non-discrimination is the law in the US, but it’s also our expectation for respect for diversity.
Expectations for a good work ethic and attention to professional standards, such as charting and documenting services you provide are not negotiable. Meet with your employer and peers regularly and join physician associations to further continuing education and expectations.
Be mindful of how your behavior is viewed by others in your community. Be sure that your family knows they are seen as an extension of you and the practice your are associated with.
Your obligation doesn’t make you an “indentured servant.” Negotiate with your employer about equal treatment as far as taking call, etc. Remember also sometimes the newest doc gets the least choice in schedules or duties.
The contracted salary is part of the agreement that allowed the waiver recommendation. If you sign a new contract, it may not meet the requirements for the waiver. This may also limit your right to ask for a much higher salary.
Ask questions, ask to verify billings submitted under your ID number and license. You can be liable for any errors or unlawful submissions.
Meet regularly with your employer and other key staff (Director of Nursing!) to be sure that any problems are addressed. This will also let you know whether your performance is on track with your employer’s expectations.
If issues with your contract or employment concern you, our office can talk with you and advise you about possible solutions.
Be sure that you have been open with your employer about your future plans. If you successfully complete your obligation and the contract terms, you should be able to practice more independently. Be aware of any non-solicitation clauses in your contract and abide by them, and also be aware of Immigration regulations and opportunities. For example, getting a “green card” or permanent residency will require employment that meets USCIS requirements.
Good Luck!Please let us know if you have any questions. We are open to talking with physicians and employers, whether or not they are in Texas or plan to work in Texas. We know when a lawyer might be a better resource, we are not immigration specialists.
Contact: Clay Daniel, 512.458.7518 or [email protected]
(These slides will be posted on our website: http://www.dshs.state.tx.us/chpr/j1info.shtm)