Physician’s Attorney Dennis Hursh
If you have received the first draft of an employment agreement, you probably find yourself in a dilemma. You don’t want to make a mistake and accept an unfair agreement that you know was drafted by a lawyer for the employer who is focused on getting the best possible arrangement for the employer. At the same time, you don’t want to alienate your future colleagues. My experience as a physician’s attorney assures that you can get the best deal possible, without unduly upsetting the employer.
I am exclusively devoted to increasing physician career satisfaction by reviewing and negotiating fair physician employment agreements. I am a veteran physicians’ attorney with over 35 years of health-law experience, I am based in Pennsylvania, but I assist physicians in all 50 states.
My extensive experience in physician contracting led me to write the definitive book on physician employment agreements, “The Final Hurdle – a Physician’s Guide to Negotiating a Fair Employment Agreement”.
I believe that the authorship of this book, and my focus and experience in physician agreements, makes me uniquely qualified to get you the best deal possible on your physician agreement.
“I started as a physician’s attorney out of a sense of obligation and wanting to pay back a debt I will never be able to repay.”
In 1989 my wife and I were lawyer DINKS (double income, no kids). It took a while for her to convince me that we should have a family. I think it’s fair to say that I was lukewarm about the idea until the second I held Rachel in my arms. This tiny, perfect little human being that gazed back at me with her mother’s blue eyes and my father’s crooked brow line owned my soul. I never knew how fiercely you can love a person until I looked at her and knew I would do anything to protect her. I told my wife we needed to find a convent/medical school for her to attend – my ambitions for her were as strong as my need to keep her safe always. I knew I would do everything I could to be a good father. She instantly became my whole life.
Within days of her birth, my life was shattered when the nurses noticed that Rachel seemed listless. She left the “well-baby nursery” and was admitted into the NICU (a term I had never heard before). I remember the sense of relief when the local pediatric cardiologist seemed so pleased as he performed the echocardiogram. The relief was short-lived. It turns that, although that physician had seen pictures of echoes performed on a child with truncus arteriosus, the echocardiogram was a newfangled device in his practice, and he had never actually performed an echo on a child with that condition. He was delighted that he could see it so clearly.
Although we are only seven miles away from Hershey Medical Center (a tertiary medical center with a pediatric cardiothoracic surgeon on staff), the local cardiologist referred us to Children’s Hospital of Philadelphia, about a two-hour drive, for Rachel’s surgery. We drove Rachel to CHOP, stopping at my parents’ house on the way. I still choke up remembering my mother crying as she kissed Rachel goodbye – we didn’t know if she would ever see her alive again.
Rachel was operated on by one of the best pediatric cardiothoracic surgeons in the world – the brilliant Dr. William Norwood. We were told that she had about a 70% chance of surviving the operation, but Rachel came through seemingly fine. Although Dr. Norwood had told us that the first 24 hours were critical, we foolishly went out for a celebratory dinner after Rachel came though the surgery alive. That night, she arrested three times. There was discussion as to if it would be a good idea to resuscitate her if she arrested again that night. Calling my mother and telling her that Rachel might not make it through the night was one of the hardest things I have ever had to do.
Relying 100% on the physicians to keep my precious baby alive was maddening for me. I have always been good at learning, and had breezed through all my classes in high school. College, law school, and even a Masters in the Laws of Taxation from Georgetown all came easily for me. I wouldn’t describe myself as a know-it-all (although others might), but suddenly I was forced to depend on strangers in white coats to protect the person that was most important to my life.
I actually got a copy of a pediatric cardiology textbook at a sale in the lobby of CHOP. I read and reread the parts about truncus arteriosus – but I couldn’t understand what was happening, and I was incapable of figuring out how her reconstructed heart worked. Although I was developing more of an appreciation for the expertise of the physicians, I still was forced to completely rely on them.
Twice in the first year of Rachel’s life I had to leave her bedside to get my wife – because the doctors thought there was a good chance Rachel wouldn’t make it through the night. You never forget the look of concern and empathy in the eyes of a physician when they tell you they’ve done all they can.
One particular night set the trajectory of my career. My baby’s heart was failing fast. She had received two open-heart surgeries by this time, but her recovery wasn’t good. Water retention had her bloated to the point that her skin was shiny. My 6 pound baby weighed over 9 pounds. We were at CHOP again. Claudio was the young Fellow from cardiology, and Maria was the young Fellow from critical care. Those two physicians barely left Rachel’s bedside all night (although the CHOP cardiac ICU was full of patients of Dr. Norwood).
I remember how Claudio apologized when he had to run out and get “sustenance” (his word). He came back with a small salad – I think it was all he could grab in a hurry from the cafeteria downstairs. I remember the worried looks exchanged between the Fellows as each test came back. I remember the multiple calls Claudio made to the attending, Dr. James Huhta. I overheard Claudio tell Maria that nobody had ever tried the multiple drugs being infused in Rachel together before, and that none of them were approved for pediatrics.
Mostly I remember Claudio and Maria huddling after yet another addition to the drug cocktail didn’t seem to have any effect. I remember Claudio calling Dr. Huhta, and I remember the look in Claudio’s eyes as he told me “perhaps your wife should come over”. I raced across the street to the hotel where we were staying and woke up my recovering postpartum wife. She had lots of questions that I couldn’t answer. We both felt completely hopeless – it’s never easy to put your baby’s life in another professional’s hands, no matter how confident you are in their abilities. Yvonne hurriedly got dressed and we raced back. I was apparently slightly less dazed than Yvonne was, so I was able to pull her back when she stepped into traffic while walking back across the street to CHOP.
Rachel is one of the toughest people I ever met, and she pulled through that night. I said “thank you so much” to Claudio and Maria. That hardly seemed sufficient, so I wrote a glowing letter to the president of CHOP and the department heads of Maria and Claudio. All my gestures seemed woefully inadequate as thanks for saving the life of my child.
It wasn’t an instantaneous decision, but the idea that I should help physicians began to take root. Over the years, my practice has evolved to the point where I spend my professional life as a physician’s attorney helping physicians get better physician employment agreements.
I understand the worry that physicians have when they trust me to give them the information they need to make good decisions on their career choices. Trusting a professional in an area where you have no expertise is never easy. I hope that I can ease the anxiety that physicians face when they receive an employment agreement. It will never repay the debt I owe the medical profession, but it’s all I can do.
Rachel is 30 now, and is happy in her group home and day program. She may not appreciate what the medical profession has done for her, but her loving family certainly does.
– Dennis G. Hursh
Education and Experience
- Georgetown University Law Center, Washington, District of Columbia, 1985 M.L.T., Master of Laws in Taxation
- The Dickinson School of Law, Carlisle, Pennsylvania, 1982 J.D. Doctor of Jurisprudence
- Dickinson College, Carlisle, Pennsylvania, 1977, B.A., Bachelor of Arts
Classes and Seminars Taught
- Physician Leadership Seminar on Clinical Integration, Pennsylvania Medical Society, 1998 – 2001
- Business Law, Wilson College, 1988-1989
- The Final Hurdle – a Physicians Guide to Negotiating a Fair Employment Agreement
- A primer on “silent PPOs”
- Hiring a certified registered nurse practitioner
- Considerations when becoming a partner
- Fraud and abuse issues for ambulatory surgery centers
- Negotiating a managed care contract
- Hiring a physician assistant in Pennsylva
- Peer review committee member protections
- Organized Medical Event Discussions
- Choosing Your Medical Practice Entity
- Are Independent Physician Associations Still Viable?
- Letters of Intent Can be a Trap for Unwary Physicians
- How “Defensive Medicine” Compromises Doctor – Patient Relationships & Care
- The Affordable Care Act’s Next Step
- The Affordable Care Act and Retina – What does Obamacare mean for retinal physicians?
- Avoiding Pitfalls in Physician Employment Contracts
- Phi Epsilon Pi
Past Employment Positions
- Gettysburg Insurance Services, Inc., CEO, 1992
- Buchanan Ingersoll, P.C., Senior Attorney, 1990-1992
- Bailey, Hardy & Hursh, P.C., Principal, 1989-1990
- Hursh Associates, Partner, 1988-1989
- Coopers & Lybrand, Tax Manager, 1985-1988
- Hedger & Hedger, Associate, 1982-1985
- United States Marine Corps, Infantry Officer, 1977-1979
Pro Bono Activities
- Member, Board of Trustees, Unitarian Church of Harrisburg, 2011-2020
- Co-chair, Patient and Family Centered Care Advisory Council of the Penn State Hershey Medical Center, 2010-2013
- Member, PBA Ad Hoc Committee to Develop Pro Bono Projects for Health Lawyers, 2003-16
- Secretary, Darul Uloom Sidiqua, 2000-present
- Assist. Den Leader, Cub Scout Pack 113, Middletown, PA, 2009 – 2012
- Den Leader, Cub Scout Pack 113, Middletown PA, 2008 – 2009
- Co-Chair, Family Advisory Council, Penn State Children’s Hospital, 2006-2008
- Member, Family Advisory Council of the Penn State Children’s Hospital, 2005-2008
- Chair, Local Right to Education Task Force, 1997-1998
- Treasurer, Aldersgate United Methodist Church of Mechanicsburg, PA, 1987-1989
|3/14/2020||Traps To Avoid In Physician Employment Agrrements||Las Vegas, NV||White Coat Investor|
|2/5/2019||Anatomy of a State-Wide Physician - Only CIN||San Antonio, Texas,||American Health Lawyers Association|
|2/7/2018||Medical Practice Acquisitions - Insider Tips from Both Sides of the Table||New Orleans, LA||American Health Lawyers Association|
|9/10/2015||Physician Employment Agreements||Harrisburg, PA||Pinnacle Health|
|5/8/2015||Physician Contract Evaluation and Negotiation||Lancaster, PA||PA Academy of Family Physicians|
|10/14/2011||Physician Employment Agreements||Hershey, PA||Pennsylvania Medical Society|
|10/14/2011||Financial Planning Basics for Young Physicians||Hershey, PA||Pennsylvania Medical Society|
|9/24/2009||Physician Employment Agreements||Hershey, PA||Hershey Medical Center|
|9/24/2008||Physician Employment Contracts||Webinar||Pennsylvania Medical Society|
|3/21/2007||Physician Employment Contracts||Harrisburg, PA||Pinnacle Health|
|2/26/2007||HIPAA||Pottsville, PA||Pinnacle Health|
|10/21/2006||Silent PPOs||Baltimore, MD||American Podiatry Association|
|10/15/2004||Physician Employment Contracts||Hershey, PA||PA Medical Society|
|1/8/2004||Cardiology Contracting Parameters||Danville, PA||Geisinger Medical Center|
|2/27/2003||Physician Employment Contracts||Hershey, PA||Hershey Medical Center|
|8/14/2002||Physician Employment Agreements||Philadelphia, PA||U of Penn Health System|
|10/10/2001||Physician Employment Contracts||York, PA||York Hospital|
|9/5/2001||HIPAA||York, PA||Central PA Association for Healthcare Quality|
|5/5/2001||Managed Care Highlights||York, PA||YCPO, P.C.|
|7/26/1999||Physician Employment Agreements||Philadelphia, PA||PA Chapter of the American College of Cardiology|
The Final Hurdle
Dennis Hursh, a physician’s contract attorney since 1992, pulls back the curtain and tells physicians what they need to know before they sign a physician employment agreement. Dennis will help you understand the pitfalls in common compensation models, and will also warn you about aspects of physician employment agreements that can devastate the unwary.
He also gives valuable advice on how to deal with letters of intent (sometimes called term sheets). You will learn the key components in potential ownership of a private practice, and potential traps in recruitment agreements.Finally, Dennis will give you sound advice on negotiation of your physician employment agreement, to assure that you get a fair and equitable agreement. The first employment agreement can set the stage for the rest of your career, so make sure it’s reasonable!