The role of the Senior Dentist: Ethical and Risk Management considerations

The case: Shortly after graduation from dental school, Dr. A was offered a job in the office of general dentist Dr. B. During the interview process, Dr. A had been candid about the fact that her husband was completing a medical residency and that her family would likely be leaving the state within the next 18 months. Dr. B was willing to accept a short-term employee, and both parties agreed to the arrangement.

While confirming the job offer, Dr. B had stated that he would pay for Dr. A’s professional liability insurance. He assured her that he would purchase a policy from the same insurance carrier that he used. Subsequently, Dr. A inquired about the status of the insurance policy and was told that it had been taken care of.

At the end of her husband’s residency, Dr. A resigned from Dr. B’s practice, and she and her family moved to another state. Six months

later, Dr. B was sued by an angry patient. Dr. A was also named as a defendant. Dr. A contacted her previous employer’s office and requested a copy of her insurance policy, but no one responded to her requests.

During this same time period, Dr. A was in negotiations for an associateship. Her potential employer asked her for a copy of her proof of insurance from her previous employer.

In order to deal with both issues, Dr. A was forced to hire an attorney who contacted Dr. B’s office on her behalf and

demanded information about her malpractice insurance policy. At this point, Dr. B admitted that he had never purchased any insurance for Dr. A. Relative to the lawsuit, this meant that she had no insurance coverage. This lack of insurance also made her a less attractive job candidate since professional practices may be unwilling to hire individuals who have gaps in their professional liability coverage.

men – but always cut the deck.” A variety of topics may be discussed during the pre-employment interview process – but unless the results are formalized, at some point down the road neither party may be able to remember “who said what.” As such, the employment agreement should be documented in writing and signed by both parties.

Inexperienced job seekers may think it rude to ask questions about the inner workings of a potential employer’s practice. But just as it would be foolish to buy a car without having any knowledge about its engine, mileage, or warranties, it is also foolish to blindly accept casual comments as contractual commitments. Over time, one or both parties may forget the details of the agreements or be unable or unwilling to comply with them.

The attorney representing Dr. A demanded a copy of the patient’s records and was able to determine that Dr. A had never seen or treated the patient. As a result, he succeeded in having her dismissed from the case.

At one point, Dr. B stated that he had never promised to purchase insurance on behalf of Dr. A. However, he was unable to verify this statement because no formal employment agreement had been signed by the two parties. Fortunately, Dr. A had retained a copy of an email from Dr. B’s office manager, in which the office manager responded to a question about the policy purchase, assuring Dr. A that Dr. B had “taken care of it.” On the basis of that document, Dr. A’s attorney threatened to sue Dr. B for reimbursement of Dr. A’s legal fees and inconvenience. Eventually, Dr. B did reimburse Dr. A for her expenses.

In Dr. A’s case, she should have requested a written employment offer. Among other things, it should have specified her clinical duties; coverage schedules; production requirements, compensation and bonus plan. In addition, it should cover her supervisory role with respect to support staff and her participation in the development of practice policies and procedures.

Offers to purchase professional liability insurance for clinical employees are fairly standard in the dental profession. Potential employees need to know what kind of coverage will be purchased, generally either occurrence or claims-made. There are significant cost, coverage and termination differences between the two types of coverage, and job candidates need to understand that the price differences between the two are often dictated by the terms associated with each.

Dr. A was lucky that she had never seen or treated the patient involved in the lawsuit against Dr. B. Had she been involved with the patient’s care, and depending on the severity of the case, Dr. A might have faced significant out-of-pocket expenses for legal fees and patient compensation.

Prevention: It was Benjamin Franklin who said, “Only play cards with gentle-

For example, an employer may offer to buy a claims-made policy for a job candidate – and that may be acceptable to the candidate. However, looking into the differences between the two policy types, some dentists might prefer to have occurrence coverage. Even though it is almost always more expensive, an occurrence policy generally provides broader coverage protection and eliminates the need for the future purchase of tail coverage. In this case, the candidate might want to pay the difference between the claims-made coverage the employer would have purchased and the occurrence coverage. But, the candidate who knows nothing about the different policy types won’t understand the variances and may lose the opportunity to negotiate a more satisfactory arrangement.

practice.

information, including copies of any insurance policies. Doctors should keep these policies in a safe place and should not dispose of them if they change employers. In fact, insurance policies should be retained for the lifetime of the dentist.

In addition to a written employment agreement, associate dentists/employees should always have access to their insurance

The hiring/senior dentist has an ethical duty to his or her younger colleagues,

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including the duty to educate them regarding business processes, in addition to the clinical elements of dental practice. Poor business skills and disorganization more often are the cause of professional dispute than intentional dishonesty, but the amount of grief generated is generally indistinguishable, regardless of the type of poor leadership that caused it.

Inexperienced job seekers may think

it rude to ask questions about the

inner workings of a potential employer’s

Open communication, honesty and good documentation are essential to the beginnings and maintenance of a positive and respectful working relationship. ■

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