Lawyers, Doctors and Everyone Else, Your Input Needed!!!

Parent Cafe
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<p>Theoretically, a physician can choose to join a network or not. However, if a physician does not join a particular network, he will not receive patients from that network. In some markets a single payor dominates the insurance market (for example, Hawaii’s “HMSA” Blue Cross Blue Shield network). In these markets no physician can afford to bypass the dominant network; at the same time, the dominant network uses its market clout to require fee schedules unfavorable to physicians.</p>

<p>Call duties at hospitals require that physicians treat all patients who present emergently. Any physician who attempts to cherry pick patients by selectively signing onto insurance plans will soon receive no referrals or see patients directed to other providers.</p>

<p>Aside from cosmetic surgeons, very few physicians set their own rates. Physicians may accepting “cash pay” patients only find that “cash pay” often means “no pay.”</p>

<p>Terms of participation in any insurance panel prohibit balance billing.</p>

<p>Opie: See my PM</p>

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<p>“Theoretically, a physician can choose to join a network or not. However, if a physician does not join a particular network, he will not receive patients from that network.”</p>

<p>Yes, and it will depend on the area your practice is in. Patients still will see their “doc” in some cases as most network plans also contain a non network provision. Yes, that usually means a little more out of pocket, but some do.
Doctors groups and hospitals aren’t nearly as trapped by networks either. The simple thing they do here is send every patient a letter saying the network is asking for too much and they are dropping their participationl. The folks when they find out, raise holy hell and the mds and hospitals usually get what they want. Most recent was Boeing up here, the network dropped the most expensive doctors from the net. People found out raised hell with HR, HR raised hell with insurance, everything changed back. </p>

<p>" In some markets a single payor dominates the insurance market (for example, Hawaii’s “HMSA” Blue Cross Blue Shield network). In these markets no physician can afford to bypass the dominant network; at the same time, the dominant network uses its market clout to require fee schedules unfavorable to physicians."</p>

<p>Hawaii so far is the exception, or 2% of the market, so far. </p>

<p>“Call duties at hospitals require that physicians treat all patients who present emergently.”</p>

<p>However, if you are at work at a hospital on call, are you not compensated by the hospital? Doesn’t it become the hospital administrator’s job to find the money? </p>

<p>" Any physician who attempts to cherry pick patients by selectively signing onto insurance plans will soon receive no referrals or see patients directed to other providers."</p>

<p>That’s always a possibility even if they don’t cherry pick. Employers can switch health plans and networks at any time. Employers (and individuals for that matter) are always looking for the lowest cost coverage they can find.
It is part of the checks and balances of healthcare costs. </p>

<p>"Aside from cosmetic surgeons, very few physicians set their own rates. "</p>

<p>yup.</p>

<p>“Physicians may accepting “cash pay” patients only find that “cash pay” often means “no pay.””</p>

<p>It’s going to depend on your market. There are some practices that work a cash pay system with the wealthy in the greater Seattle area for example that for a cost (considerable) these patients have exclusive personal care. They pay the doctor not to have many other patients. </p>

<p>“Terms of participation in any insurance panel prohibit balance billing.”</p>

<p>Above U&C or are your refering to network plans? Network, you’ve signed a business agreement to accept x and you can charge more than x, but can’t collect. This usually shows up on an eob as discount or write off. </p>

<p>U&C usual and customary means an average rate for that particular service in that particular area. You can charge more for than that, an insurance carrier will only pay U&C. These were/are known as traditional coverage. As a md, you still could request additional payment above and beyond U&C and have a legal right to do so. But that’s where you make a business decision.</p>

<p>“opie: See my PM”</p>

<p>Yup, I’m in the same circle of life, just at a different point on the circle. Believe me, your life is still better than mine. Your worries, while they worry you, I would trade for in a heartbeat. I encouraged my kids into your profession and not mine. Yours has a better future.</p>

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<p>gooduniforme–
Neat that you are thinking ahead/actively researching these fields before committing to something. So many people don’t–I knew a few people who ‘defaulted’ to law school (didn’t know what else to do – didn’t want to go to med school, weren’t engineers or otherwise possessed of a clear career path, etc.). They generally did not do too well. </p>

<p>I had a friend (smart–scored in the 99 percentile of the biz school admiss test) who went to law school but just never ‘clicked’ w/it. It wasn’t for him & ultimately he didn’t pass the bar (after 5 attempts!).</p>

<p>The three years in law school can be thrilling/challenging/exhausting (I loved it). But, they are very hard and expensive years–it’s a lot to give of yourself if you are eliminating at least 80 percent of the careers law grads take (practicing law careers).</p>

<p>Ditto the advice—get to know some docs/lawyers and visit their place of work if possible. See these people in action & see what it’s like if you can.</p>

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<p>Not to be contradictory, but I know a lot of people who “defaulted” to law school but like law and have successful careers as lawyers. It may not be the best way to pick a career, but I think most people can be happy in a number of areas. Law school has always been my back up/default if I find myself not knowing what else to do.</p>

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<p>Hello Jolynne, </p>

<p>It’s very interesting that you mentioned people who’ve “defaulted” and have taken the law school route just because they didn’t know what else to do. And I realize now that 3 years is an investment of both time and money that simply isn’t worth it if I don’t plan on actually becoming an attorney. </p>

<p>Maybe my problem is that I don’t know what to do; maybe that’s why I’m automatically telling myself “law school is the way to go.” </p>

<p>You see, whenever people ask what I want to do, I say “um, business/law.” When I say this I don’t necessarily mean “business law” but business and/or law. And it seems to mean that I can merge both business and law into one career by specializing in business/corporate/tax law. Is this a correct assumption? </p>

<p>I guess I should mention that I would like a degree that can give me the most benefit lest I decide to change careers. That’s a highly variable topic since who can decide that? </p>

<p>Ideally, I’d like to work in a corporate setting. Maybe unbeknowest to me, a corporate setting isn’t where most lawyers work. Perhaps I’ve got the wrong idea in my head, and perhaps I should head towards the business route. Who knows … </p>

<p>Oh, did I also mention I’d like to work overseas, preferably for a multinational corporation… something like in-housel counsel maybe?</p>

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<p>“However, if you are at work at a hospital on call, are you not compensated by the hospital? Doesn’t it become the hospital administrator’s job to find the money?”</p>

<p>Hospital privileges require taking call. Most hospitals do not pay for call since doctors will be “compensated” by the patient or third party payors. Unfortunately, many trauma patients that come through the emergency room have no insurance or means to pay.</p>

<p>“There are some practices that work a cash pay system with the wealthy in the greater Seattle area for example that for a cost (considerable) these patients have exclusive personal care. They pay the doctor not to have many other patients.”</p>

<p>Concierge medicine is not a cash pay system that replaces medical insurance. Patients in these practices pay an annual cash retainer to the physician in addition to paying for private health insurance. This cash subsidy, multiplied by 100 patients, allows the doctor to make a decent living not possible on usual insurance fees.</p>

<p>“Above U&C or are your refering to network plans? Network, you’ve signed a business agreement to accept x and you can charge more than x, but can’t collect. This usually shows up on an eob as discount or write off.”</p>

<p>If you can’t collect, then the de facto rate was set by the insurance company.</p>

<p>The fact remains that most lawyers set their own rates and most doctors do not set their own rates.</p>

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<p>gooduniforme,
It’s true that there are many lawyers in corporate settings. There are tax lawyers (I’ve known several) who work on super-high level deals and have all sorts of intellectual challenges in the biz world.</p>

<p>There are numerous in house jobs (I worked in the in house dept of a corp for a few years). The lifestyle (at least a few years ago) was much better than in firms. But, many, many companies also hire firms to do their corp work–so you’d be doing corp law, but not ‘living’ in the corp envi–you’d be in your firm. Which can be a very hard life (billable hour requirements very high, many long hours–although from what I hear firms are getting a bit better about lifestyle flexibility). A lot of lawyers work in firms–that’s, generally, the environment where most are employed (although it’s not where I worked). </p>

<p>To pick a particular area of the law (corporate law in a corporation) that you want to do is not necessarily a problem — however, if you know pretty clearly that you would not at all be interested in any other area of the law–you might be investing a ton of money/time into a slightly limiting career area. There might be something else (business?) in which you’d enjoy a variety of the job choice options. </p>

<p>You’ve thought a lot about his, which is good. What you might want to consider is sitting in on a few law school classes at a local law school (I did this when trying to decide which law school to attend). If your mind likes the way the classes are conducted (analysis, debate, seeing a bunch of sides to an issue, arguing a point) that might give you a clue that you’d enjoy the law generally (most areas of the law have an adversarial component–you’re trying to make your argument better than someone else’s or convince someone of something. Is that something that get’s you excited? I liked it.)</p>

<p>Good luck!</p>

<p>PS corranged–I’m sure a lot of people have defaulted and done okay, certainly. I just think though, if you are putting a lot of thought/planning into a career, it’s worthwhile to try to find something that you really like and gets you excited (from the get-go) – if at all possible. The odds are just better for your ultimate success/happiness.</p>

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<p>“If you can’t collect”</p>

<p>my.02cents,</p>

<p>This will depend entirely on what type of person you are. I know of some who have no problem sicking collection agencies on folks 60 days after date of service. </p>

<p>Several times in my career I have contacted medical practices whom have sent out collection notices scaring the heck out of insureds only to find they’ve forgotten to bill the insurance carrier for payment. </p>

<p>Not everybody is as nice as you are out there. Several with their first billing send along the collection threat within their paitent letters. </p>

<p>We are far more in agreement than disagreement here, but we have different perspectives of the elephant, that’s all. Some of the unpleasant aspects of your career are basically business decisions you must make in these times. In the situations you bring up, there is a yes or no to the decision in most cases. The yes/no isn’t necessesarily a 50/50 proposition, but it still involves choice. Alot of folks work in situations where they can’t decide because they have only one side of the yes/no grid. </p>

<p>As I’ve explained to my kids when dealing with situations where the outcome is critical to them, "find the person who can say yes or no, and stop dealing with the ones who can only say “no”. " It is kind of nice to have the ability to make a choice. That’s the hidden secret to many career choices that folks should understand before they pick a career as well. Some people are very happy to only say no and will have long careers in many different occupations. Others, don’t like being hemmed in that tight and want the ability to choose good or bad, an outcome.</p>

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<p>Jolynne, thanks for the informative post. You’re right, I should probably sit in on a law class and see how I like it. So far, I can tell you that I enjoy taking large amounts of information and synthesizing it into one compact, concrete argument, debating, researching, etc. In addition, I understand that working with corporations means a lawyer can be confined to working in his/her <em>firm</em> (rather than working as in-house counsel). </p>

<p>I read some of the following from this website, with some of my own comments in parentheses: <a href=“http://www.mergeracquisitionattorney.com/[/url]”>http://www.mergeracquisitionattorney.com/&lt;/a&gt;&lt;/p&gt;

<p>“The new entity must be careful and aware if they are eliminating competition and becoming a monopoly (sounds like knowing some economics would be useful here), then the government may take action with a federal investigation.”</p>

<p>and </p>

<p>“However structured, these transactions require the assistance of a business lawyer.”</p>

<p>and </p>

<p>"During the drafting or reviewing of sales agreements, a merger acquisition attorney makes the buyer aware of any potential hindrance to their financial health. " </p>

<p>Sounds good so far. I understand that such an attorney works mainly with corporations and businesses, and in a way, provides financial “advice” in terms of what’s best for the company. </p>

<p>I took this from a law firm’s website under the section “Practice Areas” and then under “Business Practices”. I find the following to be of interest to me: </p>

<p>Mergers and Acquisitions
Project Finance and Real Estate Development
Corporate Finance and Securities
Estate Planning, Trust & Succession Planning and Administration</p>

<p>Again under “Practice Areas” is listed “Litigation Practices”. I find the following to be appealing, too: </p>

<p>Business Litigation; Financial Litigation; Surety, Fidelity and Construction; </p>

<p>Anyway, all of these sound dandy. It’s the “combination” I wrote of earlier in my very first post (how i wanted a little bit of everything: legal, financial, real estate, etc.).</p>

<ol>
<li><p>Jolynne, what exactly is the difference between “Litigation Practice” and “Business Practice” ?</p></li>
<li><p>Oh, and also, what do you find the overall atmosphere to be like in terms of law firms (i forget whether you said you didn’t work for long in an actual firm, i apologize) and corporations? Is it really hectic, stressful, competitive, nerve-wracking? Yes, I know all jobs have their stress, but for some reason, I think we’re led to think that it’s uber-stressful for attorneys especially. </p></li>
</ol>

<p>Thanks!</p>

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<p>Remember that you won’t necessarily have the chance to pick and choose jobs, Gooduniforme. I hate to be a downer, but there are a lot of lawyers right now, and many of them are having trouble getting jobs. If you limit yourself to a particular area of legal practice and are choosy about the type of firm, you may find yourself very unhappy in a number of years if all of this doesn’t fall into place. The only reason I’m warning you about this is because you seem unusually devoted to one area of law–to the extent that you don’t really seem to have a desire to practice law in general, beyond its relation to business. You may not have the luxury to be so picky once you’ve passed the bar and are looking for a job. Do you think you would be happy practicing in some other law specialty in a different type of firm than you are currently envisioning, should you have to?</p>

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<p>Corranged, thanks for your opinion. I really appreciate it (and you’re being totally honest which is what I need, so thank you for that). You’re right: going to law school should mean I enjoy practicing law in general, not just one field. I totally agree. But … when I say financial/real estate/trusts/tax law… what I’m trying to say is that I’m more inclined toward <em>that</em> sort of law than say, criminal law, workers comp., personal injury, medical malpractice, constitutional law, etc. </p>

<p>Or, is that still limiting myself? </p>

<p>And ya, I’m sure finding a job after law school isn’t so easy. That’s one of the things my parents warn me about. As my father says: many lawyers, not many jobs for them to fill.</p>

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<p>If you think that you’re reasonably flexible and can be happy in several areas, then I’m sure it will work out fine for you, I just got worried because it seemed as if there was a particular type of law and a particular environment that you seemed almost exclusively interested in. If that’s not the case and your interests are wider than I understood them to be, then ignore what I said before. If you’re interested in financial, real estate, trust, and tax law then you have a good number of areas (that will probably expand and change somewhat during law school; my initial impression was that you had a pretty specialized and limiting interest in certain types of business law in a non-conventional setting, but your most recent post says something a little different. The fact that you’re thinking this through means it should all work out for you. You really don’t need to think about all this now, though, so don’t get too worked up over it yet. Your interests are likely to change.</p>

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<p>Thank you corranged!</p>

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<p>Um, I just read my post through. Sorry about the strange/incorrect/missing punctuation… That post was kind of start + stop, and it apparently got kind of jumbled somewhere along the way. But I’m sure it will work out fine for you.</p>

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<p>O, no problem, I understood it perfectly!</p>

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<p>Gooduniforme, when I graduated from law school over 30 years ago, I set up a law practice with a classmate. The plan was that I would do transactional law (setting up corporations and partnerships for small businesses, drafting contracts, etc.) as I had shown a talent for that in law school. He was going to do trial work. Within 18 months we both realized we had it exactly backwards. I love trial work, and eventually added appeals; he hated appearing in court, and now is busy writing wills and trusts and helping small businesses and non-profits with their legal document needs. My niece passed the bar last year and joined a firm doing tax work, which she had specifically trained for. She quit the firm last month after she realized she hated the work (and didn’t care for the lawyers in the firm much, either.) She’s now happy doing family law - divorce, custody disputes, etc., with a lawyer she had clerked for while in law school. I’ve got an ex-DA in my office now doing probate work. The father of one of my kids’ friends made a bundle as a financial advisor – and quit last year so he could go back to school and become a teacher. There’s also a poster here on CC whose husband was a doctor and left medicine to become a teacher (IIRC)</p>

<p>Moral: It’s really hard to predict what you’ll like and be good at. My advice is the same as it was before: stay flexible, find what it is that works for you, and do that, whether it’s in law, medicine, teaching, business, or any of the other things you may stumble into and fall in love with in the coming years.</p>

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<p>Good advise Kluge - I said I wanted to be a lawyer from the time I could remember - I think I was a Perry Mason wannabe. My parents would have been happier for me to be Della Street. I got a bit sidetracked in undergrad when I took an education course with a professor I truly admired so I applied for the graduate program that he was pioneering and, the next thing I knew, I was teaching kids with learning disabilities. I still planned to go to law school so I taught for 3 years and went back. I loved law school - and particularly anything relating to litigation. I took a job at the somewhat rare “biglaw” firm that actually figured out a way for associates to get into the courtroom. That is even more rare now. The courtroom was fine; the boxes of paper and pleadings, I hated. So I went to a headhunter and announced that I wanted to go in house - like I was the first person in the world who had ever thought of that. Then I said the magic words - “I’m not sure I even want to be a lawyer.” We really hit it off so she offered me a job with her company on the spot. I thought about it for 2 weeks and took it. The partner for whom I worked asked me if that was like going to med school and then deciding to sell Ginsu knives. He, on the other hand, is still practicing law and I’m told is as miserable now as he was 20 years ago. I never looked back. This is my third career and it may not be my last. When my daughter goes to college, I’d like to sell my house and start a horse rescue. So stay open to new opportunities - a little whimsy can be good for the career too.</p>

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<p>gooduniforme,</p>

<p>I think based on your most recent posts, you have a pretty broad spectrum of interests in the law (biz, estates, etc.). That seems sufficiently extensive enough so that going to law school would provide you w/a variety of acceptable options.</p>

<p>kluge has a great point too–what you think you like might not be what you turn out to do. But, the good thing about the law–it is possible to change mid-stream or mid-career (although you might not make exactly the same $$ as a person who started at high-$ track at a firm & just kept at it). At most law schools there are no ‘majors’ within which you have to lock yourself (although my law school had a transactional track & a litigation/advocacy track).</p>

<p>Re: the difference between “Litigation Practice” and “Business Practice” – biz practice is often transactional–you are helping firms to do deals, arrange mergers & acquisitions, tax stuff, etc. Litigation is trial oriented–you are preparing for a court trial, w/all the preliminary documentation, depositions, interrogatories, actual trial work in front of judge/jury, etc. Litigation is viewed as one of the more stressful/long hour areas of the law. But, some people love it. I loved argument, but not the litigation lifestyle so I did appeals (writing briefs & arguing before the appellate court…very fun!).</p>

<p>Re: the overall atmosphere in terms of law firms and corporations. Firms are known to be high pressure, competitive & have very high hourly requirements (that’s why I didn’t work for one out of law school–I had a young son & it wasn’t worth the big starting salary, to me). From what I’ve heard though, things have changed a bit in the past 6-7 years. Firms are more amenable to people working fewer in-office hours (perhaps due in part to the advent of virtual commuting, whatever). You’d probably do well to talk to several, currently practicing attorneys. It’s good not to take the word of one person. I know a lot of lawyers who love their work – others who aren’t so happy…it’s good to get varied perspectives. Many times there seems to be a correlation between/the congeniality of the person & the job satisfaction (happy people who get along very well w/others seem to do well, it seems to me-- but this is purely anecdotal!)</p>

<p>When I worked in-house in a corp (during law school) the attorneys had very good hours (8-5:30–almost unheard of in the legal world, then). The salaries were not as high as at firms (but not bad at all, either). The lifestyle was excellent. That was one corp., though.</p>

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<p>PS gooduniforme–I’m assuming that you are a guy?(just by the screen-name…!). If you are not, it’s good to know that there are lot more options for women in the law (esp in private firms) in the area of combining work/family more effectively. From what I’ve heard, firms are doing a much better job of providing non-partnership tracks (w/fewer hours req’d) and generally not demanding as many hours from associates. Of course–the better attorney you are, the more employers are motiviated to be flexible. If you have any friends who are girls considering the legal field, this might be of interest to them.</p>

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<p>In regards to firm atmospheres, keep in mind that there are many different sizes of law firms. There are very small firms with a couple of lawyers as well as many small-medium and medium sized firms. These places likely have different overall atmospheres than what you think of when you think of very large urban law firms. </p>

<p>(Just so you know, my parents are both lawyers and partners in their firm. My brother is a lawyer who works in the DA office in his town. My cousins are all lawyers, my parents’ friends are all lawyers, etc. I’ve seen a range of experiences.)</p>