A Comprehensive Guide to Onboarding 1099 Clinicians

Do not index

As the healthcare industry continues to evolve, many healthcare groups and practices are turning to independent clinicians to meet their staffing needs.

While you likely have an established playbook for employees, you may not have thought through the process for 1099 Clinicians, who have different needs and requirements.

Hiring 1099 clinicians offers several benefits, including flexibility, specialized expertise, and cost savings. However, onboarding these independent clinicians requires a unique approach to ensure a smooth transition and integration into the healthcare organization.

We like to think of this using the acronym ‘RITA’, which stands for:

Recruitment, Induction, Training, Assessment

In this comprehensive playbook, we explore best practices for HR teams onboarding 1099 Clinicians. We provide you with a step-by-step process to effectively integrate these independent contractors into your healthcare group or practice.

We cover everything from the initial screening and selection of 1099 clinicians to the necessary documentation, orientation, and ongoing support.

The Benefits of Hiring 1099 Clinicians

Before the onboarding process, let’s talk about the benefits of hiring 1099 clinicians.

Flexibility

Hiring 1099 Clinicians provides healthcare organizations with the flexibility to meet fluctuating staffing needs. You can engage 1099 clinicians on a project-by-project basis or for specific time periods, allowing healthcare organizations to efficiently manage their staffing resources.

Specialized Expertise

1099 clinicians often bring specialized expertise and skills to healthcare organizations through experience in niche areas or possess unique qualifications that can enhance the quality of care you can provide to your patients.

Cost Savings

Unlike hiring full-time employees, independent clinicians are responsible for their own benefits, insurance, and taxes. This relieves the healthcare organization of the financial burden associated with providing employee taxes (for example, Workers' Compensation) and other benefits, ultimately reducing overall costs.

Independent Contractors vs. Employees

Before starting any onboarding process, it's important to understand the distinction between independent contractors and employees. Misclassifying workers can have very real legal and financial implications for healthcare organizations. Therefore, it's essential to accurately determine the classification of your 1099 clinicians to ensure you comply with labor laws and regulations in your state.

Whether a clinician should be classified as an independent contractor or an employee, is a common-law test taking into account the following factors:

Control and Supervision

Independent clinicians have more control and autonomy over their work compared to employees. They typically determine their own work hours, methods, and processes. In contrast, employees are subject to the control and supervision of the healthcare organization, with specific guidelines and expectations.

Financial Arrangements

Independent contractors are typically paid based on a predetermined fee or project rate, while employees receive a regular salary or hourly wage. Additionally, independent contractors are responsible for their own taxes and benefits, whereas employees have taxes withheld and may receive benefits from the healthcare organization.

Duration of Engagement

Independent contractors are typically engaged for a specific project or time period, while employees have an ongoing employment relationship with the healthcare organization. The duration and continuity of the engagement can help determine the appropriate classification.

Your legal team will have a very close eye on this - but HR leaders should have a high-level understanding of the issues at play.

Assuming that there is no issue with any of the above.

Legal Considerations and Compliance

Legal compliance is a critical aspect of onboarding 1099 clinicians to ensure you meet your obligations and protect your interests. Here are some key legal considerations to address during the onboarding process:

Independent Contractor Agreement

Healthcare organizations should have a comprehensive independent contractor agreement in place to establish clear expectations and protect the rights of both parties. This legally binding document outlines the terms and conditions of the engagement, including the scope of work, payment terms, confidentiality provisions, and intellectual property rights.

Tax Obligations

1099 clinicians are responsible for their own taxes, including self-employment taxes. However, healthcare organizations must ensure compliance with tax reporting requirements, such as issuing Form 1099-NEC or Form 1099-MISC to independent contractors who meet the applicable thresholds.

Licensing and Credentialing

Healthcare organizations should verify the licensing and credentialing status of 1099 clinicians before engaging their services. Ensuring that independent clinicians have the necessary qualifications and credentials is crucial to maintaining quality standards, compliance with regulatory requirements, and contractual obligations with hospitals and health insurance companies.

HIPAA Compliance

Healthcare organizations must ensure that 1099 clinicians comply with the Health Insurance Portability and Accountability Act (HIPAA) regulations. This includes protecting the privacy and security of patient health information and implementing appropriate safeguards and protocols for data handling and sharing.

Recruitment

Healthcare organizations should carefully evaluate potential independent clinicians to ensure they possess the necessary qualifications, skills, and experience for the engagement. Here are some key considerations:

Define Job Requirements

Before initiating the screening process, clearly define the job requirements and expectations for the 1099 clinician. This includes identifying the specific skills, qualifications, and experience necessary for the engagement.

Source Candidates

To attract qualified 1099 clinicians, healthcare organizations should utilize various sourcing methods, for example, leveraging professional networks, engaging with locum tenens agencies, utilizing online job boards, or collaborating with medical associations and societies.

Application and Credential Review

Once potential candidates have been identified, healthcare organizations should review their applications and credentials. This includes assessing their medical licenses, certifications, education, training, and relevant professional experience. Thoroughly reviewing these documents ensures that candidates meet the necessary qualifications.

Interviews and Assessments

Initial interviews can be conducted in person, over the phone, or via video conferencing platforms. Additionally, assessments, such as skills tests or case studies, can provide valuable insights into the candidates' abilities and expertise. Ultimately, in a patient-facing role, there is no substitute for in-person meetings to assess ‘bedside manner.’ This matters.

Reference Checks

Performing reference checks is an important step in verifying the candidates' qualifications, reputation, and past performance. Contacting previous employers, colleagues, or professional references can provide valuable insights into the candidates' work ethic, professionalism, and interpersonal skills. This step is often ignored, but it shouldn’t be - avoiding ‘false positives’ saves time and money in the medium term.

Contract and Agreement

Once the screening and selection process is complete, you will need to establish a formal contract and agreement with the selected 1099 clinician. The contract serves as a legally binding document that outlines the terms and conditions of the engagement. Here are some key elements you might expect to see in the contract:

Scope of Work

Clearly define the scope of work, specifying the specific tasks, responsibilities, and deliverables expected from the 1099 clinician. Both parties have a clear understanding of the engagement and can align their expectations accordingly.

Compensation and Payment Terms

Outline the compensation structure and payment terms in the contract. This includes specifying the agreed-upon fee or rate, payment schedule, and any additional expenses or reimbursements. It's essential to be transparent and clear about the financial arrangements to avoid any misunderstandings or disputes.

Duration and Termination

Specify the duration of the engagement, whether it's for a specific project, a set time period, or until the completion of certain milestones. Additionally, include termination provisions, outlining the conditions under which either party can terminate the contract.

Confidentiality and Non-Disclosure

Include confidentiality and non-disclosure provisions, protecting the healthcare organization's sensitive information and trade secrets. This ensures that the 1099 clinician understands their obligations in safeguarding confidential information and prevents unauthorized disclosure.

Intellectual Property Rights

Address intellectual property rights in the contract, clarifying ownership and usage rights of any intellectual property created during the engagement. This includes any inventions, discoveries, or innovations that may arise from the work performed by the 1099 clinician.

Indemnification and Liability

Include provisions for indemnification and liability, outlining the responsibilities and liabilities of both parties in the event of any claims, damages, or disputes arising from the engagement.

Your legal team will have very tightly defined contracts covering all these points.

Induction

Once the contract is in place, you’ll need to gather the necessary documentation from the 1099 clinician to formalize the onboarding process. This documentation ensures compliance with legal requirements and establishes a record of the engagement. Here are some essential documents you should consider collecting during the onboarding process:

Independent Contractor Agreement

As discussed above. Both parties must sign the independent contractor agreement, indicating their acceptance of the terms and conditions outlined in the contract.

Proof of Licensing and Credentials

Collect copies of the 1099 clinician's medical licenses, certifications, and relevant credentials to verify their qualifications and compliance with regulatory requirements.

Tax Forms

Request the completion of appropriate tax forms, such as Form W-9 for US-based contractors or the equivalent form for contractors in other jurisdictions. These forms provide the necessary tax information for reporting purposes so you can issue a Form 1099.

Proof of Insurance

Confirm that the 1099 clinician has appropriate professional liability (medical malpractice) insurance coverage. This protects both parties in the event of any claims or disputes arising from the engagement.

HIPAA Compliance Agreement

Require the 1099 clinician to sign a HIPAA compliance agreement, acknowledging their obligations in safeguarding patient health information and complying with HIPAA regulations.

Integration into the Healthcare Team

Successful integration into the healthcare team is crucial for the long-term success of 1099 clinicians. Healthcare organizations should facilitate collaboration, communication, and relationship-building to ensure effective teamwork. Here are some strategies for integrating 1099 clinicians into the healthcare team:

Introduce the 1099 clinician to Team Members

Facilitate introductions between the 1099 clinician and other team members, including clinicians, nurses, administrative staff, and other healthcare professionals. Encourage open communication and collaboration to foster a sense of belonging and teamwork.

Assign a Mentor or Buddy

Assign a mentor or buddy to the 1099 clinician to provide guidance, support, and assistance during the onboarding process. This mentor can help the independent contractor navigate the organization, answer questions, and provide insights into the team dynamics.

Foster Communication Channels

Establish clear communication channels, such as email, instant messaging platforms, or virtual collaboration tools, to facilitate ongoing communication between the 1099 clinician and the healthcare team. Encourage regular check-ins, updates, and collaboration to ensure effective teamwork and information sharing.

Team Building Activities

Organize team-building activities or social events to foster camaraderie and relationship-building among team members, including the 1099 clinician. These activities can improve team dynamics, boost morale, and enhance collaboration.

Regular Team Meetings

Include the 1099 clinician in regular team meetings or huddles to ensure their involvement in team discussions, updates, and decision-making processes. This promotes a sense of inclusivity and involvement in the healthcare team.

By actively integrating 1099 clinicians into the healthcare team, healthcare organizations can foster a collaborative and supportive environment, enhancing the overall effectiveness and productivity of the team.

Training

Effective orientation and training are crucial but underlooked components of the onboarding process for 1099 clinicians. This stage provides an opportunity to familiarize the independent contractor with the healthcare organization's policies, procedures, workflows, and culture. Here are some key considerations for orientation and training:

Welcome Package

Prepare a welcome package for the 1099 clinician, including essential information about the healthcare organization, its mission, values, and organizational structure. This package should also include any relevant policies, procedures, and guidelines that the independent contractor must know.

Orientation Session

Conduct an orientation session to introduce the 1099 clinician to the healthcare organization's team members, key stakeholders, and support staff. This session can be conducted in person or virtually, providing an opportunity for the independent contractor to ask questions and gain a better understanding of the organization.

Technology and Systems Training

Provide training on the healthcare organization's technology systems, including electronic medical record systems, communication platforms, and any other tools or software necessary for the 1099 clinician to perform their duties effectively. This training ensures that the independent contractor can navigate the organization's technology infrastructure efficiently.

Policy and Compliance Training

Educate the 1099 clinician on the healthcare organization's policies, such as HIPAA compliance, patient privacy, and data security. This training ensures that the independent contractor understands their responsibilities and obligations in maintaining compliance with applicable regulations.

Department-Specific Training

If necessary, provide department-specific training to familiarize the 1099 clinician with the specific workflows, protocols, and procedures relevant to their role. This training ensures that the independent contractor can seamlessly integrate into the healthcare team and perform their duties effectively.

By investing time and resources in orientation and training, healthcare organizations can set 1099 clinicians up for success and ensure a smooth transition into their roles.

Assessment

Providing ongoing support and maintaining open lines of communication with 1099 clinicians is essential for their success and satisfaction within the healthcare organization. Here are some strategies to ensure ongoing support and effective communication:

Regular Check-Ins

Schedule regular check-in meetings or calls with the 1099 clinician to address any questions, concerns, or feedback they may have. These check-ins provide an opportunity to assess their progress, address any challenges, and ensure their ongoing satisfaction and engagement.

Performance Feedback

Provide regular performance feedback and evaluations to the 1099 clinician, acknowledging their strengths and providing constructive feedback for improvement. This feedback loop helps maintain performance standards and encourages continuous growth and development.

Development Opportunities

Offer educational and professional development opportunities to 1099 clinicians, such as continuing medical education courses, conferences, and workshops. Supporting their professional growth and development enhances their skills and expertise, benefiting both the independent contractor and the healthcare organization.

Achievements

Recognize and celebrate the achievements and contributions of 1099 clinicians within the healthcare organization. This can be done through public acknowledgments, awards, or other forms of recognition. Celebrating their successes fosters a positive work environment and reinforces their value to the team.

Solicit Feedback

Regularly seek feedback from 1099 clinicians to gather insights into their experience working with the healthcare organization. This feedback can help identify areas for improvement, address any concerns, and enhance the overall onboarding and working experience for future independent contractors.

By providing ongoing support and maintaining effective communication, healthcare organizations can ensure the success and satisfaction of 1099 clinicians within their teams.

Performance Evaluation

Regular performance evaluation and feedback are crucial for assessing the performance, progress, and overall fit of 1099 clinicians within the healthcare organization. Here are some strategies for conducting performance evaluations and providing feedback.

Establish Performance Metrics

Define clear performance metrics and expectations for 1099 clinicians, aligning them with the goals and objectives of the healthcare organization. These metrics can include clinical outcomes, patient satisfaction scores, adherence to protocols, or other relevant performance indicators.

Conduct Regular Evaluations

Schedule regular performance evaluations to assess the 1099 clinician's performance against the established metrics. These evaluations can be conducted through structured assessments, peer reviews, patient feedback, or a combination of methods. Based on the evaluation results, provide constructive feedback and guidance for improvement.

Address Performance Issues Promptly

If performance issues arise, address them promptly and constructively. Openly communicate concerns, provide specific examples, and collaborate with the 1099 clinician to develop an improvement plan. This proactive approach helps maintain performance standards and ensures the delivery of high-quality care.

Recognize and Reward Excellence

Recognize and reward exceptional performance and achievements of 1099 clinicians within the healthcare organization. This can be done through public acknowledgments, awards, or other forms of recognition. Celebrating their successes fosters a positive work environment and reinforces their value to the team.

Foster Growth

Provide ongoing feedback and guidance to support the continuous development and growth of 1099 clinicians. Encourage their participation in professional development activities, offer mentorship opportunities, and provide resources for learning and improvement.

By implementing a robust performance evaluation and feedback system, healthcare organizations can ensure the ongoing success and professional development of 1099 clinicians.