Job Search and Contract Negotiation

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Job Search and Contract Negotiation

Business of Medicine
Author Credentials 

Lawrence M. Simon, MD
Clinical Assistant Professor of Otolaryngology
LSU School of Medicine
New Orleans, LA
CPT Advisor, AAO/HNS
Past Chair, Young Physicians Section

Module Learning Objectives 
  1. Demonstrate an understanding the basic principles and content of a physician contract.
  2. Define the different considerations for academic vs private practice vs employed contracts.
  3. Cite the commonalities between these three general physician work models.
  4. Analyze a given contract for its strengths and weaknesses and identify items for negotiation.

References:

  1. Grimshaw H.  Flipping the Power Switch on Contract Negotiations.  February 12, 2014.  http://www.mgma.com/practice-resources/mgma-connection-plus/online-only/....
  2. Harris SM.  Employment Contracts Need to Ensure Physicians are Free Agents. ENTtoday. December 1, 2012.
  3. Parshall M. Negotiating Your First Contract: What to Say and How to Say It.  March 1, 2008.  https://www.aao.org/young-ophthalmologists/yo-info/article/negotiating-y....
  4. Ramey J, Sublett J, Holzhauer R.  Contract Negotiation: Partnership, Employment Agreements, and More.  https://education.aaaai.org/sites/education.aaaai.org/files/contract_neg...
  5. Sakran J.  The Art of Negotiation: Gathering Critical Information. ACS Surgery News. November 12, 2015.  http://www.mdedge.com/acssurgerynews/article/104338/practice-management/art-negotiation-gathering-critical-information.
  6. Quinn R. Landing your first Otolaryngology Job.  ENTtoday. Wiley:September 2014.  http://www.enttoday.org/article/landing-your-first-otolaryngology-job/.
  7. Zaretsky LS, Fried MP, Glazer RA, et al. Negotiating Physician Employment Contracts: What you need to know now and for the future. Miniseminar presentation at the American Academy of Otolaryngology/Head and Neck Surgery. Los Angeles, September 2005.
General Considerations: What Type of Practice Do You Want?
  1. Private practice vs. academia vs employed
  2. Location—city/suburbs.
  3. Subspecialty.
  4. Always retain the services of an attorney who specializes in health care transactions.
  5. Know and understand your value- consult AAMC and/or MGMA data beforehand to get an idea of the average compensation in your area. 
Typical Contract Components
  1. Base salary.
  2. Bonus—how is it calculated?
  3. Duration.
  4. Partnership track—is there a buy in? If so, how is that calculated? Over what period of time do you need to pay it?
  5. What are official leave policies (paternity/maternity/disability/military)? How does leave utilization effect partnership track position?  Are there different policies for partners vs employees?
  6. What are the perks?
    • Time and money for CME?
    • Phone?
    • Car?
    • Licensing? Malpractice?
    • Dues and periodicals?
  7. What is the pension or other retirement plan?
  8. What are the health and dental benefits? Disability insurance? Life and long-term care insurance?
  9. How much vacation time is allowed?
  10. On call schedule
    • How is it made and determined?
    • Is practice call equitable?
    • Are practice and ER call taken separately?
    • Is thre any compensation for call?
    • Do all physicians take the same amount of call and ER coverage?
  11. Malpractice Insurance: who pays? Is it an occurrence policy (if you were covered at the time of the incident then you are covered by that policy regardless of when a suit is filed) or a claims made policy? (With this latter type of insurance you are only covered while that policy is active. If you are sued a year after you leave a practice that covered you with a claims-made policy, you are not covered.)  In this latter incidence,  you would need a ‘tail’ policy to maintain coverage for any events that occurred during the time you had a claims-made policy. If this is the type of insurance being offered, you need to ask who pays the tail.
  12. Which hospitals will you have privileges at? (It can take 6 months to get those privileges!)
  13. What is this payor mix? Managed care/equity/Medicare mix? (Again, credentialing takes time.)
  14. Is there a restrictive covenant? This is a clause that protects the practice you are joining from having you practice with them for a while, then having you leave and set up practice across the street, taking your patients with you away from the original practice. A restrictive covenant generally prevents you from leaving and setting up practice within a certain distance for a certain number of years.
  15. What is the buyout? That is, if someone retires, what happens financially?
Considerations for an Academic Position
  1. What is the Chairperson like?
  2. What are the Research opportunities?
    1. Lab space and protected time should be clearly defined.
  3. What Mentors are available within the department? In the school?
  4. Is Otolaryngology a Department or Division?
  5. What is the compensation package?
    1. Is clinical income based on an incentive or productivity scale?
    2. How is salary for research supported?
    3. How is salary for education and administration supported/determined? (i.e. how does academic productivity factor into your payscale?)
    4. How are you paid- RVUs vs collections vs other (MACRA)
  6. What is the opportunity to travel to meetings? (funded?  In the contract)
  7. How long is the contract for?  How easily can it be changed (i.e. things taken away?)
  8. What are the teaching responsibilities?
  9. Is there protected time for academic roles?  If so, how is that time figured into the compensation model?
  10. Are there specific presentation or publication requirements?
  11. What internal grants are available?
  12.  Is there administrative support for applications for research grants?
  13. What are the requirements/criteria for promotion to higher academic rank? For receiving tenure? Is there an ‘up or out’ policy?
  14. What time is available in the operating room (this is not necessarily a contract negotiation item, but it is worth investigating before making a commitment)?
Considerations for Private Practice
  1. How long has the practice been around?
  2. Have previous associates stayed or is there a high turnover?  Be direct, but respectful.
  3. What are the collections over the last 3 years?
  4. Is the practice working with updated computer management programs?
  5. Does the practice have the latest equipment?
  6. Is there a real estate component to the practice (does the practice own the building in which it is located)?
  7. Does the practice provide and receive income from ancillary services such as audiology/sleep/allergy?
    • What is your business structure/stratey for remaining compliant with Stark/ self-referral regulations?
  8. As an employee do you receive bonus payments/compensation from patients you refer for the ancillary services?
  9. Who does the practice administration with regards to billing/collections/accounting?
  10. Does the practice have a compliance program for coding, billing, government payer systems (which may include bonuses or penalties), Stark/self-referral compliance for anciallary servies, etc.?
  11. What is your vacation policy?
  12. What are your policies/programs for retirement, disability, and life insurance?
Considerations for Employed Contract
  1. How am I compensated- RVU?  Collections?  Fixed Salary?
  2. Is there a bonus structure?
  3. Vacation policy?  How much and how is it calculated/accumulated?
  4. Leave policy for meetings/CME?  (how much time and is it separate from vacation).
  5. How am I evaluated?  (what metrics are you monitoring to determine my value/productivity).
  6. Opportunities for advancement within the practice?
  7. Opportunities for advancement within hospital administration.
  8. Any opportunities for ancillary income?
  9. Non-compete structure in the event of termination?
  10. Non-compete while employed? (i.e. can you maintain a private practice on the side; can you invest in a surgery center that may compete with the hospital)
  11. Have previous employees statyed or is there a high turnover?
  12. What happens to my salary after my initial contract?
  13. Who is my direct boss/supervisor?
  14. Will I have authority over my clinic and office staff, or are they hired/supervised by someone else?
  15. Will I have authority over my clinic and OR schedule, or will those be set by someone else?
Resources 

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  1. Annual Meeting Webcast (AMW):

Other Resources:

  1. Medical Group Management Association: www.mgma.com
  2. Association of American Medical Colleges: www.aamc.org