C. COMMON MISUNDERSTANDINGS 1. “Off Hours” Work ID physicians are often asked to work a full clinical load and handle formally recognized administrative effort and other nonclinical activities in their off hours. This additional effort should be recognized as incremental to the physicians’ FTE and not automatically considered part of the job. For example, finishing EHR documentation at the end of the day may be considered part of the job, but maintaining a full-time clinical load and then performing administrative tasks during off hours (e.g., review of ID staff physician productivity and utilization as a medical director of ID, preparing for medical staff meeting as medical director of infection control) should not be considered part of a physician’s standard clinical expectations.

2. Short-Term Responsibilities Physician leaders are often asked to step into a short-term, non-patient-facing role to assist their employer with a strategic initiative (e.g., EHR planning and implementation, facility planning, COVID‐19 response). In these situations, employers frequently cite a regulatory compliance risk as a reason for not compensating physicians for that effort and, thus, imply the effort is part of the job. However, if the job responsibilities and associated effort are documented and tracked (with tracking generally maintained by the physician), physicians can be compensated for this effort discretely.

3. A Physician’s FTE Cannot Be Greater Than 1.0 There is no CMS guideline that stipulates a physician cannot be more than a 1.0 FTE. Once standard definitions of each component of physician effort are adopted by an organization, physicians can clearly show if or when their total contributions amount to more than a 1.0 FTE. However, administrators may point to regulatory compliance or organizational policy as prohibitive measures in recognizing (i.e., compensating) a physician as more than a 1.0 FTE. Therefore, an ID physician should understand the definitions of fair market value and commercial reasonableness to effectively self-advocate for appropriate recognition of effort (e.g., higher compensation). See section IV.A for more information about the regulatory requirements for physician compensation.

The most common scenario that should lead to a negotiation regarding an accurate recognition of FTEs is when a physician agrees to a nonclinical role but their level of clinical effort remains unchanged.