By: Thomas M. Gallo, P.A., J.D.
Overview: All employees play a critical role in the success of a medical practice. As a Physician Assistant (PA), your role in a medical practice is unique. Although employees can often be an asset, they can also be a liability. Physicians, as the owners of the business, are ultimately responsible for the actions of the employees. PA’s can easily become positioned between the Practice and other employees, those who are licensed and others such as medical assistants. In order to ensure that the employees are aware of their obligations, it is imperative that the Practice have policies and procedures governing the employees’ duties and responsibilities. Although some employees may be subject to the terms and conditions of an employment agreement, not all employees have such an agreement. Therefore, having an Employee Manual that is up to date and comprehensive is critical in order to inform the employees—in a positive yet clear manner--what is expected from them and what they can expect from the practice, as well as the consequences of violating any Practice policies. This applies to licensed and unlicensed employees. An Employee Manual may also provide the Practice with legal protection if an employee later files an employment claim against the practice. Some key provisions that should be addressed in all Employee Manuals are addressed below.

Probation and Termination: Prior to hiring an employee, the Practice should do its due diligence with respect to such potential employee, including conducting background checks, ensuring such employee has the appropriate license, as well as checking referrals. It is always better to obtain such information prior to the commencement of employment. Likewise, prospective employees with a history of any background issues, including criminal matters, should be aware of this. It would be very prudent to take all of the necessary steps to minimize the impact of any potentially negative events prior to application for employment.

It is recommended that all employees engage in a “trial period” for a few months prior to officially becoming a member of the team. During this time the newly hired employee and the Practice can have a mutual opportunity to evaluate the appropriateness of the employment. During this probation period employees are generally not afforded benefits. Upon successful completion of the probation period, the Practice can then extend a full-time offer to the employee.
New York State is an “employment-at-will” state, meaning an employer has the right to discharge an employee at any time for any reason. This excludes reasons such as those with respect to race, creed, national origin, age, handicap, gender, sexual orientation or marital status. However, the Employee Manual may state the obvious, i.e., that all employees can be terminated at any time without cause. Upon termination, all employees may have an exit interview, whereby the employer has a discussion with the employee regarding his/her employment. The exit interview can be helpful to the Practice, and to the employee.

Status of Employment/ Hours/ Over-time/ Attendance/ Vacation/ Workers' Compensation/ Benefits: Once an employee is hired, in order to avoid any potential disputes, it is recommended that the Employee Manual specify the types of employment (e.g., full-time, part-time or per diem), as well as the hours all employees are expected to work. Employees should also be made aware as to whom they should inform in the event they are late, as well as the Practice’s policy with respect to taking time off during the day for personal matters. Furthermore, employees should be informed if and when they may be eligible for over-time. The Employee Manual should also specify how many vacation days and sick days employees are entitled to, as well as how employees accumulate such days. The Employee Manual shall also identify the process associated with utilizing such paid time off (e.g., how much notice should be given and if a doctor’s note is required), as well as whether employees can “roll over” unused days to the next year or receive compensation for unused days. In the event an employee is injured on the job, employees should also be made familiar with the Practice’s policies and procedures with respect to Workers’ Compensation.
Furthermore, the Employee Manual will ideally highlight the benefits that are offered to employees (as well as eligibility), including for instance health insurance, retirement benefits, life insurance and/or disability insurance. Although the Practice may retain the right to change any such benefits, the Employee Manual is often a good place to at least address which benefits the Practice offers.

Confidentiality: In order to ensure that the Practice’s trade secrets, including billing, general processes and account receivables for instance, are kept confidential, the Employee Manual may contain a provision indicating all such “proprietary information” should remain confidential during and after the terms of employment. Furthermore, in accordance with HIPAA, the confidentiality section will likely specify that all patient information should remain confidential and should not be disclosed unless permissible under HIPAA. This has become extremely important as the Department of Health and Human Services has indicated that the Office of Civil Rights will be conducting audits of physician practices with respect to HIPAA compliance. As such, in the event protected health information is inappropriately disclosed by an employee, the employee shall be made aware that he/she may be subject to disciplinary action, up to and including the termination of employment.

Rules of Conduct: As healthcare providers, it is imperative that employees comply with certain ethical guidelines. For instance, all non-practitioner employees must be fully briefed that they are not to diagnose or treat patients since they do not have the appropriate license. Furthermore, to ensure an effective and proper working environment, the Practice should require the employees to conduct themselves in an appropriate, courteous and professional manner, or else disciplinary action may be taken. For example, employees should not engage in any actions that disrupt the Practice’s operations, engage in sexual harassment, be uncooperative, engage in substandard work performance, engage in theft, destroy property, be intoxicated or on drugs during working hours, offer, solicit or accept bribes, gifts or gratuities from patients, demonstrate a lack of personal cleanliness, disregard safety regulations, engage in verbal or physical mistreatment of patients, or participate in the falsification of time sheets. Furthermore, all employees should be informed of the Practice’s policies regarding smoking, appropriate dress, personal phone use at the office, visitors and email and internet usage. Obviously, PA’s and Physicians are subject to regulations, and ultimately discipline, from the Office of Professional Medical Conduct as well.

Conclusion: PA’s very often do not have an Employment Contract that governs the terms of their employment relationship. PA’s should seek to obtain clarity as to the expectations of the Practice, and the benefits to be received, as an employee, by reviewing the Employee Manual. Practices that realize that labor law issues in today’s medical practice environment are extremely complex, and that most issues can be addressed in a well drafted Employee Manual, are at an advantage. Those practices that have an Employee Manual and train their employees on the policies contained therein, will have taken an enormous step in avoiding labor law, and other disputes, in the future. This helps to protect all licensed employees, as well as the Practice owner(s), from unnecessary difficulties. This, in turn, benefits all of the employees of the practice, and ultimately, the patient.

Kern Augustine, P.C., Attorneys to Health Professionals,, is solely devoted to the representation of physicians and other health care professionals. The author of this article may be contacted at 1‐800‐445‐0954 or via email at