The Fine Print: Workers' Comp, the 24/7 Trap, and Contract Red Flags for Residents

Q: Can workers' comp visits be bundled into a Direct Primary Care membership fee?

It depends entirely on the state, says Dr. Phil Eskew, who divides states into three categories: states that allow bundling with no billing at all, states that require coding the visit as if it would be billed even when no money changes hands, and states that require full fee-for-service billing through the workers' comp system.

Q: Is it legal to advertise my DPC practice as open 24/7?

Advertising a solo practice as open 24/7 is not accurate, says Dr. Phil Eskew. He warns that marketing language can become contract language, so physicians risk building a breach-of-contract argument into their own website, and recommends advertising after-hours availability by email and text instead.

Q: What contract red flags should residents watch for?

Malpractice tail transfers, clawback signing bonuses owed back in full if they leave before a set number of years, and evergreen renewal terms that quietly extend obligations, according to Dr. Phil Eskew. As non-competes become unenforceable in more states, hospital systems are shifting to these tactics.

Q: How can a resident prepare for Direct Primary Care during training?

Pick a residency that allows generous moonlighting and find a nearby DPC practice to moonlight in before graduation, advises Dr. Phil Eskew. He also recommends telling recruiters upfront that the goal is a part-time or PRN role, since those tend to come with less restrictive terms.

Q: What should I ask about workers' comp before signing an employer contract?

Confirm which of the three workers' comp categories your state falls into, says Dr. Phil Eskew: whether injuries can be bundled into the membership fee, must be coded without billing, or require full fee-for-service billing through the workers' comp system.

Maryal Concepcion

Aug 25

5 min read

Updated: 7 days ago

Dr. Phil Eskew, DO, JD, MBA on the My DPC Story podcast State by State legal Q&A

From the My DPC Story State by State series with Dr. Phil Eskew, DO, JD, MBA, founder of DPC Frontier. This post is for education and community discussion only. It is not legal advice. Consult your own attorney about your practice, your contracts, and your state.

Some of the most valuable moments on our State by State calls are the small questions with big fine print behind them. This round covered three: workers' comp inside a membership, the words "open 24/7," and what residents should demand before signing anything.

Workers' comp: three kinds of states

A North Carolina physician asked whether workers' comp visits can be bundled into the membership fee when an employer contracts with a DPC. Dr. Phil Eskew broke the country into three categories.

Category one: bundle and move on. In some states you can fold minor work injuries into the fee without coding or billing anything.

"The employer should be keeping something called an OSHA 300 log, which the state can still use to track the fact that an injury occurred. They can have injury data apart from billing data."

Category two: ghost claiming. Other states demand the billing data even when no money changes hands.

"You don't have to bill it, but you've got to code it like you were going to bill it, and then you can zero-dollar charge it. It still gives you the burden of having to create this paperwork you didn't want to create."

Category three: fee for service or nothing. The strictest states require full coding and billing through the workers' comp system, which may be state administered, as in Wyoming, or run through one or many private carriers. In these states, the answer to "can I bundle it into the fee" is simply no.

Know your category before you sign an employer agreement that mentions work injuries.

Stop saying you are open 24/7

Asked about practices that market around-the-clock access, Dr. Eskew was blunt about both hospitals and solo DPCs.

"I think it's a lie when the hospital says it, because mostly you get some 1-800 call service that's useless and just tells you to go to their ER. If you are running a solo practice, there's no way you're 24/7. You're going to go to bed, you're going to get on an airplane, you're going to hike a mountain."

The legal problem is that marketing language can become contract language.

"Don't let some contract attorney tell you that you've built a breach of contract argument in your own marketing."

His alternative: emphasize that you are available to contact after hours by email and text. It is honest, it is still a dramatic upgrade over the traditional system, and it does not create a standard you cannot meet.

For residents: build your escape route before you sign

Inspired by Dr. Fania Franklin of Lexington, South Carolina, who shared that she had access to a lawyer during residency, we asked what a DPC-bound resident should actually look for in contracts. Dr. Eskew's answer went well beyond non-competes.

"Most hospital systems that are going to offer you employment will do it in a way that is: I'm going to box you in. One of the classic ways is the non-compete, but that's not the only way."

As more states make non-competes unenforceable, the boxing-in tactics are shifting. Watch for:

Malpractice tail transfers, where you pick up the tail burden if you leave, or leave with insufficient notice, or leave too soon
Clawback signing bonuses you owe back in full if you do not stay all five years
Evergreen renewal terms that quietly extend your obligations

His advice for choosing training in the first place: pick a residency that allows generous moonlighting, and find a nearby DPC practice to moonlight in so you build the skills and relationships before graduation. Inpatient work after residency almost always means signing someone else's agreement, so get that experience while you can.

And when recruiters call, he suggests total transparency.

"I would tell any recruiter, from the jump: I'm going to have my own DPC practice. I'm not interested in a full-time contract. Show me the part-time stuff, show me the PRN stuff, because it's not going to tend to come with all these pieces of red tape."

The takeaway

The membership agreement, the marketing copy, and the employment contract are three documents that quietly define what you legally owe. Write all three as carefully as you write a progress note.

Nothing in this post is legal advice, and every state is different. If you have a legal question about DPC in your state, we want to hear it. Subscribe to My DPC Story on your podcast and youtube feeds and leave us a voicemail with your question at mydpcstory.com/contact. We will bring listener questions to future State by State conversations.

Frequently Asked Questions

Can workers' comp visits be bundled into a Direct Primary Care membership fee?

Whether workers' comp visits can be bundled into a Direct Primary Care membership fee depends entirely on the state, says Dr. Phil Eskew, who divides states into three categories: states that allow bundling with no billing at all, states that require coding the visit as if it would be billed even when no money changes hands, and states that require full fee-for-service billing through the workers' comp system with no bundling allowed.

Is it legal to advertise my DPC practice as open 24/7?

Advertising a solo Direct Primary Care practice as open 24/7 is not accurate, says Dr. Phil Eskew, who calls the claim a lie for hospitals and an impossible standard for solo physicians who sleep, travel, or take time off. He warns that marketing language can become contract language, so physicians risk building a breach-of-contract argument into their own website, and recommends instead advertising after-hours availability by email and text.

What contract red flags should residents watch for before signing with a hospital system?

Residents should watch for malpractice tail transfers, clawback signing bonuses owed back in full if they leave before a set number of years, and evergreen renewal terms that quietly extend their obligations, according to Dr. Phil Eskew. He notes that as non-competes become unenforceable in more states, hospital systems are shifting to these other boxing-in tactics instead.

How can a resident prepare for Direct Primary Care during training?

A resident preparing for Direct Primary Care should pick a residency that allows generous moonlighting and find a nearby DPC practice to moonlight in before graduation, advises Dr. Phil Eskew, since inpatient work after residency almost always means signing someone else's employment agreement. He also recommends telling recruiters upfront that the goal is a part-time or PRN role rather than a full-time contract, since those roles tend to come with less restrictive terms.

What should I ask about workers' comp before signing an employer contract?

Before signing an employer contract that mentions work injuries, a physician should confirm which of the three workers' comp categories their state falls into, says Dr. Phil Eskew: whether injuries can simply be bundled into the membership fee, must be coded even without billing, or require full fee-for-service billing through the workers' comp system, which may be state-administered or run through private carriers.