Questions to Ask Before Taking a Hospice Physician Role
Occasionally, members of our physician communities are approached about hospice roles. If you haven’t been specifically trained in this space, you may have a lot of misconceptions about it, or not know much about it at all. Often, the position is pitched by the hiring company as a relatively simple and light lift - a few hours a month, modest stipend, and an occasional signature if needed by the on site staff. However, physicians on our communities who’ve actually done the work say it’s rarely that simple because of the time-sensitive nature of requests and all the regulations in the space - and of course the fact that everything you do is tied to your name and license. Below, we cover questions that you should ask to fully understand the responsibilities and liabilities of a hospice role prior to saying yes and signing on.
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Why does vetting a hospice role prior to saying yes matter so much?
How much time do you think I’ll need per week, and what kind of call should I expect?
How is the role paid, and is there additional compensation for specific circumstances?
Will I have real authority over care decisions and the people working under me?
Why does vetting a hospice physician role prior to saying yes matter so much, and what questions should I ask?
Hospice medical director work is often framed as entailing an occasional physician signature on orders and prescriptions and approving some protocols, as well as being available for phone calls if needed. As Medicare expectations have grown, though, there’s increasing requirements and oversight in the space. Because of this, from a regulatory perspective, physicians are generally expected to play a more substantive part on the interdisciplinary team. While that’s good news for patients and physicians who want to do meaningful work, it also means the gap between a well-run agency and a poorly run one can result in consequences for the physician whose name is on the paperwork.
Our members relay two sorts of job descriptions that they tend to hear - one from agencies that truly are seeking clinical leaders, and the other that pitches it basically as a way to satisfy a requirement. No matter how anybody pitches it, it’s your role as the physician to ensure that your role is there to augment the patient care experience, and protect your license and reputation. The questions below are drawn from what physicians in our communities say is important to ask to deduce whether an opportunity is a good one.
What will I actually be responsible for as a physician working in the hospice space?
Start by asking this question, because the answer will tell you a lot. The more that they downplay the responsibilities, the more of a red flag it is that they’re either not being realistic or that they only want you as a signature, but don’t actually want your input.
Also, make sure that you get the answers in writing, because they may say one thing, and then ask for another - often without commensurate increase in pay.
You should specifically ask who’s responsible for:
Certifying and re-certifying that patients are eligible for hospice
Signing and reviewing medication orders and care plans
Meeting regularly with the interdisciplinary team
Joining family meetings and answering team and family questions
Taking call, and/or rounding on inpatients or visiting patients at home if applicable
Also ask if you are the sole medical director, or if there’s a team. It's important to understand the patient load and how many patients are typically on the service, as well as how that load is divided, particularly in larger organizations or agencies where there may be a few hundred patients on the service at a time.
How much time do you think I’ll need per week, and what kind of call should I expect?
This is obviously different if this is a full time gig for you and your specific training is in the space. Larger or nonprofit agencies and health systems have full time and part time roles in the space, and the requirements for those roles tend to be much more defined, though you should always also make sure these responsibilities are defined in your contract.
However, for many physicians in our communities, this is a part time position or a side gig. For those doing it as a side gig, reported time commitments can run from roughly 10 to 40 hours a month.
If you’re considering doing it as a side gig, ask:
How often are the team meetings, and are they required?
How many medical directors share call, and how often would I be on?
Is face-to-face work expected, and who handles most of it (nurses, NPs, or me)?
What backup is there for me if I’m unable to drop everything when a time sensitive issue comes up?
One really good way to actually understand the time commitment would be to ask to talk to other medical directors or others in similar roles, and get a sense for what the day to day looks like for them. It may be different than what the recruiters express.
Understand that in this space, many calls are time-sensitive and can arrive in the middle of your workday. If you can’t take interruptions during your main job and there isn’t back up, this may not be the best position for you.
How is the role paid, and is there additional compensation for specific circumstances?
If this is your main gig, review our article on how much hospice and palliative care physicians make.
For side gigs in the space, structures vary, and our members report seeing hourly pay, monthly stipends, and per-visit mileage or driving payments. Community-reported ranges have been roughly $150 to $250 an hour or $2,000 to $4,000 a month, with $100 to $200 per face-to-face visit for travel.
When you’re taking the job, don’t take these numbers at face value. Ask:
What exactly does the rate cover (meetings, documentation, call, calls from families)?
Is call time paid separately?
If there is extra paperwork or regulatory work above and beyond what has been agreed to in a flat fee arrangement, are there separate buckets of compensation or hourly rates that can be charged, and what are those rates? It’s better to negotiate this upfront.
Is mileage compensated?
You’ll also want to ask yourself this question:
How does the compensation compare with the responsibility and liability I’m taking on?
Is the compensation worth being on call 24/7, if that’s the case?
Several members note that pay can feel modest relative to the responsibility, so weigh it honestly.
Can I trust this agency or employer with my license and reputation?
This is where our physicians are most emphatic about doing due diligence, especially because ultimately, you’re putting your name and license on orders and claims. Their advice:
Talk to physicians currently working there, and to those who left.
Be wary of for-profit agencies that minimize your role or mostly want signatures.
Look up any reports of fraud, or things that the agency may be under investigation for.
Ask whether the agency welcomes scrutiny of its eligibility and billing practices.
Look for signs that the agency prefers inexperienced physicians who are easier to persuade.
Will I have real authority over care decisions and the people working under me?
Before accepting, you’ll want to confirm that you’ll be able to practice the way you find the most appropriate, and that you have real authority over anybody whose work you’re signing off on. Ask:
Can I review the medical record myself before certifying a patient, rather than relying on an administrator’s summary?
Can I discharge a patient who no longer qualifies?
Can I review standing orders, and am I comfortable with how much latitude nurses have to titrate doses?
Will I be called about changes with controlled substances such as opioids and benzodiazepines?
How experienced are the nurses and nurse practitioners, and will I have the opportunity to participate in the review and hiring processes for these members of the team? Members say team quality makes the biggest difference, so you’ll ideally have some say in this matter.
Am I prepared for this role in hospice?
This last question is really more of a question for yourself, obviously, but it’s one that you should definitely ask. This is a patient population with unique needs at a critical stage of life, and you are being entrusted with that responsibility.
The fact is that if you haven’t been specifically trained in this area, you’re unlikely to have had much training in this space during medical school or training. While hospice and palliative medicine fellowships exist, many physicians in the role come from family medicine, internal medicine, oncology, or emergency medicine. This means they’re familiar with the patient population for sure, but that doesn’t mean that they’re necessarily comfortable with the nuances of the space. Many physicians on our communities suggest that hospice-specific training helps you stay compliant and understand the job. Options include courses from CAPC and AAHPM, and the Hospice Medical Director Certification Board (HMDCB) offers a certification (HMDC) that members describe as straightforward and valuable.
Also - ask yourself whether you want this work. It can be demanding in both time and emotional energy, and members say you have to care about it to do it well. If you aren’t sure you have the mental bandwidth for the role, it may not be the best time to take it on.
Conclusion
Hospice work is deeply meaningful, but it isn’t an easy side gig, and like most clinical roles, carries real responsibility and comes with real liability. The job description doesn't always match the role, and the compensation doesn’t always match the responsibility. Get a true understanding of the role, pay, call, and other aspects of the position in writing, talk to physicians who’ve worked with the agency, consider certification if you lack formal hospice training, and of course, have an attorney review the contract for any other red flags.
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