MedEsthetics magazines offers business education and in-depth coverage of the latest noninvasive cosmetic procedures for physicians and practice managers working in the medical aesthetics industry.
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22 MARCH 2016 | Med Esthetics LEGAL ISSUES control the worker has over the means and methods by which the work is performed. In this sense, control means more than general supervisory powers. If the employer assumes control over the details of the work or some part of it, then the party will likely be considered an employee. In the medical profession, there are other restrictions to consider. Physician extenders have become invaluable team members in aesthetic practices, but nurses and physician assis- tants (PAs) typically cannot operate as independent contrac- tors. One of the central principles guiding a PA is that they can perform medical and/or surgical acts and procedures that have been authorized by state law and the supervising physician. The supervising physician bears both the authority and respon- sibility for the delegated acts. Because a PA can only act pursu- ant to a supervising relationship with an MD, in most cases it is impermissible to treat a PA as an independent contractor. © GETTY IMAGES Nurses and physician assistants typically cannot operate as independent contractors. A nurse uses supplies and equipment belonging to the physician, who supervises and delegates tasks to the nurse. In addition, a nurse must seek guidance and permission f rom a p h y sician f or decisions outside o f the nurse's sco p e of p ractice. Because o f this de p endent relationshi p , a nurse w ill not likel y q uali fy as an inde p endent contractor. A nurse p ractitioner ( NP ) , on the other hand, has more a utonomy in most states. A s a result, it is g enerally permissible t o have an independent contractor arran g ement with an NP. These agreements may also be used with estheticians or othe r a ncillar y p roviders since the y do not p erform medical treatments. W HAT T O IN C L U DE IN THE CO NTRA CT W hen ne g otiatin g an independent contractor a g reement, th ere are severa l cr i t i ca l p rov i s i ons t h at s h ou ld b e i nc l u d e d : 1. Establish a set fee for services. The contractor is t yp icall y paid a fl at amount. The ne g otiated amount can be paid h ourl y , dail y , weekl y , monthl y or annuall y . The fee should not be based upon a percentage of income that the physician derives from the actual p erformance of the inde p endent contractor's work, and the f ee should not refl ect a s p lit o f p ro fi ts between the p h y sician and the inde p endent contractor ( as fee splittin g is prohibited in many states ) . 2 . An outline of services that the inde p endent contracto r i s bein g hired to perform. Do not be afraid to provide detail h ere. Th e more d eta il you i nc l u d e re g ar di n g t h e serv i ces y ou ex p ect the contractor to p rovide, the less likel y y ou are t o experience disagreements down the road. 3 . The term of the agreement. This includes the length of time the agreement will be in e ff ect and whether it ex p ires a f ter a certain p eriod. Be sure to cover whethe r t he a g reement will automatically renew unless one o f the p art i es term i nates i t. 4 . How the a g reement can be terminated and whethe r a dvance notice is re q uired. A lso consider whether there are a n y circumstances in which termination is automatic withou t requiring notice. A prime example o f a circumstance that requires automatic termination is where the independen t contractor loses their license to p er f orm the tasks the y were h ired to p er f orm.