Not Even Medical

THE LAID OFF PHYSICIAN

Part I: How being laid off as a physician is different than being laid off in other industries, and the things you can do now to make your next transition easier.

I had just finished my first patient visit of the morning on that hot July day when my office manager sent me the interoffice text that I would need to meet with our lead physician administrator at 2:30 pm that afternoon. She informed me that my afternoon patients would be cancelled and that they would give me the driving time to get downtown to the administration building. Every physician knows that the impromptu meeting with an administrator is never a good thing, particularly when it’s without prior notice.  My chief concerns were whether I was being named in a lawsuit or whether my employment was in jeopardy. After a few sentences into the meeting it was quite evident that it was the latter. I tried, unsuccessfully, to fight back tears as I was told that I was “wonderful to work with,” but that due to financial losses from the pandemic that my employment at the organization was ended. I was being let go without cause and that I would be expected to work for the next month to month and a half, after which I would receive a short severance.

As I went home that evening, reeling from the news, I wasn’t good for much more than the shedding more tears like those I had expelled earlier. I spent the next twenty-four hours in the uncomfortable emotional amalgam of sadness, disbelief, anger and fear. I actually called in to work the next day but knew I would have to work on pulling myself back together to meet the needs of my patients and my co-workers.  I congratulated myself for maintaining composure the remainder of that first week despite the swirling turmoil of that first week at work after being let go. The following weekend I spent scavenging the internet for anything or anyone that would give me insight about what a good physician should do in a situation like this. Despite some late nights, I really couldn’t find any advice from physicians going through something similar. Perhaps it’s a sign of weakness, a rarity—at least until this point—or we simply are discouraged from discussing such matters. However, in this post-COVID healthcare environment I knew I wasn’t the only one experiencing this. In fact, I later learned I was one of a few dozen physicians from my organization who was actually going through this same process.

LAYOFFS: WHAT’S THE SAME ACROSS INDUSTRIES?

My response above is likely similar to many other individuals after losing their job, whether they’re a barista or a rocket scientist. There are other commonalities aside from the emotional response that employed workers share at a time of layoff. I have tried to delineate these in the following questions that you should be asking yourself or others at this time.

  1. When will your last day be? Will they walk you out immediately or expect you to give a few weeks for transition? Both will carry their benefits and drawbacks. If you’re being walked out immediately, try to ensure that you’re given time to collect any electronic files you may need (for instance your last paycheck statement for tax estimation) and that there’s some grace given to you while removing personal items from your desk. No matter how you’re feeling at the time always try to remember that this is the last impression you’ll leave with your former employer. You are a professional, even if you don’t feel you’re being treated that way at the moment.
  2. Are you eligible for unemployment? If yes, find out who to call and what supporting documentation you’ll need from your HR department to prove this fact. Also check with your state and determine how long you’ll be able to obtain this benefit. This obviously varies from state to state and COVID has undoubtedly made this more complicated.  However, at a time like this you may be eligible for more benefits than in a better economic environment. 
  3. Will you be receiving a severance? If so, for how long? Ask how this will affect unemployment benefits as well. Also ask if benefits will be included in your severance, or if there are any stipulations on your behavior or continued work that will be tied to your severance.
  4. How long will you have access to healthcare benefits? For some this may run out at the end of the day and for others at the end of the month. Ask now if you can you have a letter from HR stating when your coverage ends so you can qualify for another plan either through a family member or the marketplace. Also, ask your HR when can you expect to receive information about COBRA and see if they can provide you with an estimate on cost in your situation (this may help with #14 below).
  5. How do you access information on other benefits? If your workplace uses special software or internal processes for submitting HSA, flexible spending account or dependent care account expenses figure out this process now! If you are not being walked out same day, gather what receipts you can and submit anything and everything possible. This should help with cash flow. If you are being walked out the same day ask for an HR contact who will be able to walk you through this process from outside your organization so you can access the money you have set aside. If you have disability or life insurance through your employer determine if you want these policies and can keep these policies if they’re needed. If keeping them is cost prohibitive work on obtaining replacements as soon as possible—for healthy individuals these can often be found outside your organization for far better rates.
  6. Who do you contact for issues that may arise after you leave? For instance, if you receive patient protected information after you have left the organization or if you have questions regarding benefits, who is your point person? Your HR should have planned for these events and should have a plan in place in case these questions arise. 
  7. Does your former employer help with placement services? This may include someone who gives your CV or cover letter a once over. It may be a practice interview or two. If it’s been a while since you’ve been for a job search in today’s marketplace a free practice session may be enough to help you brush up on skills. Also remember to ask how long these services are offered—the answer may surprise you.
  8. Do they offer an EAP (Employee Assistance Program) to assist with mental health needs? Is this available for family members or only the employee? Having a sounding board outside of a friend or family member may be just what you need to help you make it through and reframe the emotions you’re experiencing.
  9. If you have an employer sponsored retirement program, when will you receive information on transitioning this account? Also ask if you met criteria for being vested—will you be able to keep your employer’s match? Be sure someone from your plan can walk you through the pros and cons of rollovers as well as the tax implications. If your former employer doesn’t offer this assistance, work on finding this help on your own and start now.
  10. Who will your references be? Hopefully you have not been working alone or under a rock and will have at least a few! Contact these references as soon as possible and ask what their preferred methods of contact are. Write down office phone numbers or better yet keep an office phone tree if you work in one so you can reach these individuals more easily. This is also the time that you may reach out to former references from other positions you may have held to see if they can still put a good word in for you. 
  11. Are you being restricted from telling anyone about your layoff? Some employers may require you to sign away your ability to discuss your layoff outside of those in your immediate family. I believe everyone has a right to ask what is going to be said about this to your co-workers and superiors, though you may not always find an answer. If you are being restricted, you may want to seek legal counsel.
  12. If you’re working after your termination, are you permitted to say you’re still employed to prospective new employers? Like it or not, new employers may look more favorably upon someone who’s currently employed rather than not. You’re not misrepresenting yourself if you’re still under a working contract whether or not you’re physically at the job.
  13. What will be said to prospective employers who call to check your references? What will be permitted to be said about your time at your former employer? Many times former employers will be limited to divulging only the dates you were engaged on your job. However, sometimes they will be able to divulge whether or not you are eligible for rehire. That “Yes” or “No” answer could make or break a future job offer, so asking whether this information will be given now is in your best interests. If the answer is going to be “No,” then try to determine why this is the case and prepare yourself to provide an answer to any prospective employers who may question you on this.
  14. What will your new budget be? This is probably the most difficult answer to pin down, but in my experience this is the part where you HOARD CASH. After all, you do not know when or where your new job will be. If it’s a service that’s not absolutely necessary—cancel it! You don’t need cable, HULU, Netflix or Disney+. You don’t need dry cleaning. You can scrub your own floor. If you drink coffee you just learned to love Folger’s. I do hope you have at least a small emergency fund—and if you don’t, for the love of all that’s holy, start one now! If you have student loans and you’re eligible put them in forbearance. If you have a 401k or 403b and can stop contributions in order to put cash in your pocket before you leave your job, do it. If you’re in dire straits and have a mortgage ask if you qualify for delay in payment on that due to the pandemic. Try never to commit the cardinal sin of borrowing from your own retirement funds—it’s an issue you are likely to regret later. Maybe not today, maybe not tomorrow, but soon, and quite literally for the rest of your life. Budgeting is quite hard and you’ll have to talk with your family about this too—preparing spouses or children for a change in groceries, social events or travel doesn’t always go so well. However, sometimes you’ll realize how much money you truly have and what’s really important in life.

LAYOFFS: WHAT’S DIFFERENT FOR PHYSICIANS?

Well, the most obvious answer is that compared to many other occupations, we’re much less likely to experience layoffs in the first place! This can make the entire experience much more devastating. Other than the colleagues my former employer sent out in the e-mail that listed our COVID-related terminations, I have never personally known another physician who was let go; and as a mid-career physician myself, this is really quite telling. The feeling of isolation is profound and as time has passed, I realize that there is a great deal of self-doubt and embarrassment that typically follows as well. As I had mentioned before, internet searches were not entirely fruitful when looking for support from others in similar circumstances. Though I certainly want to explore the emotional ramifications of what being laid off feels like to a doctor, for this article I want to focus on the things you can do to stabilize your lifestyle and focus on finding new work. We’ll talk more about feelings later.

Additionally, unlike other professions, we can very rarely be ready to go start a new job the next day, the next week or sometimes even the next month. The sheer volume of paperwork required for us to be vetted for a new position may take weeks to compile and background checks may take a similar amount of time. Credentialing is yet another hold-up—this months-long process means that a new employer isn’t likely to allow you to start work until they can guarantee you’ll produce revenue. Negotiating out of portions of a contract after layoff can also add more cost and time to beginning a new position.

Though the list of questions to ask about layoff in our previous section is not exhaustive, it’s again a great place to start when you think about what you need to do following job loss. Next we’ll go over a few things a physician will need to do and questions to ask as a physician facing layoff.

  1. Find your contract. Unless we’re self-employed, we all have one. Review it with a fine-toothed comb and make sure you’re receiving all the benefits you should be. If the legalese is daunting find a lawyer to help. The expense may be difficult to swallow, but if it gets you out of a non-compete or gets you out of a student loan or sign-on bonus repayment, it may very well be worth it. That being said, make sure you are not still beholden to your former employer for any of the aforementioned expenses and that you’re not ignoring an iron-clad non-compete agreement. Also review what your contract says about soliciting other staff or patients from your facility—avoid being accused of saying anything that could be construed as violating this portion of your contract.
  2. Contact your employer’s credentialing department now and see if they are kind enough to supply you with your credentialing packet. This was one of the first things I did after learning about my layoff. Do you remember how time consuming it was to track down dates of tests, employment, licenses, certifications and contact information? All of that information is still in one place—your former credentialing department! Along with copies of all of your paperwork ask for copies of proof of malpractice and tail coverage, you will often need these to prove eligibility for future jobs and it will make any future credentialing department love you for having all the data in one place.
  3. Change your e-mail and physical addresses on any licenses, certifications, professional organization registration or state substance monitoring websites. If you’re like me, most of these accounts were attached to my work address and e-mail. It’s difficult to change this information without access to work e-mail, so do your diligence and change it now. If you have concerns about your personal home address or private e-mail being used for notification about these services consider a P.O. Box or establishing a separate e-mail account now. 
  4. Do not forget to obtain your CAQH username, password and ID number if this was maintained by your previous employer. Likewise, many of us know our NPI number, but be sure to obtain your online username and password for this number as well so your contact information can be changed.
  5. Make sure that if you work with mid-levels that no further patient care is taking place under your license—you are no longer their supervising physician! If you’re not certain this is being done, please contact your employer before you leave to protect yourself and reduce your risk for litigation. Likewise, if you have proxies that are signed up to check state substance monitoring websites on your behalf, disable their access. You do not want to be accused of misuse. 
  6. Unless you work in the Emergency Room, Anesthesia, Urgent Care or as a Hospitalist, you likely have a patient panel. Determine how your patients are being notified about your layoff—typically it will be written and it will be best to see the notification letter. If you feel it is derogatory you may again ask for a change in verbiage or of course contact a lawyer in this regard. You will also need to make sure that your layoff avoids any obligation you may have to prevent abandonment of your patients. For any patients suffering from immediate needs do your best to make a plan for follow-up with a colleague or another office that can offer similar care.
  7. Review your malpractice policy! If you need to pay for your own tail prepare for this in your budget. Regardless of whether you have a traditional or occurrence based policy, know what your limits are and keep the contact information available.
  8. Another thing you may want to do is look at your Press Ganey scores. The vast majority of us have been subject to these—whether we like it or not—in recent years. If you are fortunate and your patient reviews are good, keeping a copy of these reports to show to a future employer may make you more marketable. Likewise, if your previous employer provided you with quarterly reviews on your productivity, clinical knowledge and colleague engagement, providing this may be similarly helpful if your numbers and scores are good. Knowing they’re hiring a physician who patients and co-workers loved is reassuring for a prospective employer and may put you more in demand.
  9. Check your online presence. Let’s face it, rarely do waitresses or retail workers get called out by name for doing a bad or good job on Yelp—usually these reviews are left for an employer or organization in general. Physicians and other high-level professionals, on the other hand, are more directly at risk for defamation by online reviews. Whether or not you agree with what has been said about you online, you do need to be prepared to answer (in a HIPAA compliant manner) to some of these negative reviews. If you feel any of these are truly false, threatening or border on illegal, contact the site to see if they can be taken down. If you have time left to work at your former employer and your patients ask if there is anything they can do to help, tell them to leave positive online reviews if they feel comfortable doing so. Don’t be ashamed to ask those who have appreciated your care to let others know! Similarly, police any social media presence you have. What is placed online is never truly private, and you will want to make sure you’re only sharing the parts of your life that an employer would be proud to advertise.
  10. Consider obtaining a list of your billed codes and procedures. This of course will vary by specialty, but this is something that can also highlight your skills other than just what is listed on your CV. It can also demonstrate to a future employer how profitable you may be. Your billing department or office manager may be able to provide this information for you.
  11. Determine how your layoff may affect any hospital appointments or affiliations you may have. Many times your employment and hospital privileges may be tied together. If your layoff puts this relationship in jeopardy contact your hospital credentialing department to see what must be done to maintain privileges if you still need them.
  12. Similarly, if you work in an academic setting determine how your layoff affects your academic appointment. The vast majority of these positions are of course tied to a job, but be sure to complete any outstanding reviews on colleagues, residents or students you are overseeing in order to facilitate the next steps for them as well. Remember, your layoff isn’t only affecting you! 
  13. If you perform research, work hard to solidify any ownership you have over a project. Even if your work is being passed off to a colleague, determine any legal right you have for work you have done before now. This may require the help of a lawyer, but intellectual property deserves to be protected.

This list of considerations and things to do is again certainly not exhaustive. While it will certainly take time to become adjusted to this unexpected change, I hope these lists make the process less daunting for you. I also hope that this provides you with some focus on the next steps you’ll need to perform. In the next part of this series we’re going to explore the emotional side of physician job loss and work on ways to cope with the stress—both internal and external—that you’re experiencing.

ABOUT THE AUTHOR:

Dr. Ray is a Family Medicine physician in the Midwest. She is looking forward to using the same skills and empathy she honed while helping her patients to help her fellow physicians during their most difficult times.

Original Article: mdobvious.com

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