As a physician you'll be entering into a number of contracts during your career. The most important one is probably your employment contract. Physicians are poor negotiators in general for a number of reasons outlined in books such as The Successful Physician Negotiator. One of the reasons is that despite knowing an awful lot about medicine, they know very little about law, even those parts that affect them directly, such as contracting law. Just as knowing that everything is negotiable is helpful when entering into a contract, knowing what a good contract looks like (and naturally, a bad one) is invaluable.
There are not many “good guys” in the financial world. When you meet one, you would do well to listen to what he has to say. One of these good guys is Thomas Crawford. He isn't a doctor, a lawyer, a financial planner, or even an accountant. He is a hospital executive. Yep, the enemy. (just joking…kind of.)
He stated in a recent email to me “As a previous Hospital CEO, I am driven to ensure no physician ever signs a lopsided contract.” I didn't really understand why he would say that until I read the book. Many of the examples he uses in it involve physicians he wanted to hire but couldn't because they had signed a contract that prevented them from leaving their previous job for a better one for various reasons. His book was recommended to me by a reader of the blog. He was gracious enough to send me a free copy.
Book Review of Physician's Guide: Evaluating Employment Opportunities & Avoiding Contractual Pitfalls
The book is called Physician's Guide: Evaluating Employment Opportunities & Avoiding Contractual Pitfalls and sells on Amazon for $27.70 with free shipping. (Yes, I get 4% if you buy it through a link on this page.) It has narrow double-spaced columns and is only 88 pages long- to ensure it is an “easy read” even a busy resident can get through in a single sitting. Despite its brevity, it is jam-packed full of useful information that may save you thousands of dollars and years of frustration. I quote from the introduction:
During the course of my 17-year healthcare career, I've been privileged to meet and work with many talented physicians of all specialties. I've witnessed firsthand their unwavering dedication to their medical communities, and I've seen patients benefit from the physicians' years of training. Nevertheless, I've always found it ironic that world-class athletes with considerably less education always sought industry-specific representation when turning professional and, conversely, graduating resident physicians who successfully completed four years of undergraduate studies, four years of medical school, up to six years of residency, and potentially two years of fellowship were diving headlong into the business of realities of employment selection and contracting relatively unassisted.
As a senior healthcare executive in the positions of chief executive officer and chief operating officer, I've interviewed hundreds of physicians and, regrettably, I've seen the aftermath of unfulfilled recruiting promises as a result of situations including bankruptcy due to a lack of volume, unsustainable call, terminations without cause, and questionable business practices….Throughout my career, I've helped a relatively small number of physicians out of their untoward circumstances; however, a vast majority of the physicians were contractually bound to unacceptable covenants they simply did not read or comprehend. Thus, the premise for this guide is to provide resident physicians and early careerists with the basic tools required for evaluating employment opportunities and transforming recruiting promises into contractual covenants.
When I was a resident I was lucky enough to read a book put out by the Emergency Medicine Residents Association called Contract Issues for EM Physicians. It was awesome and enlightened me to many of the unique aspects of contracting in emergency medicine. It armed me against many of the errors frequently made by my colleagues and I referred to it throughout three separate job-hunting experiences. It is far better to learn from the mistakes of others than to make them all yourself. Unfortunately, I don't know of any other specialty-specific contracting books. Mr. Crawford's book is the best primer I've seen about contracting issues for all other specialties. I would have found it useful as well since despite having been through the process several times, and having read a book on it and discussed contracts with attorneys, there were still new pitfalls that I would not have known about without Mr. Crawford's book. I can recommend it to you without hesitation no matter what your specialty (but emergency docs should really get the EMRA book too.)
The Physician's Guide has five chapters that instruct you on how to evaluate employment opportunities followed by ten more chapters about specific contracting pitfalls. Each chapter is brief, is to the point, and contains multiple examples of real-life physician mistakes. Each chapter summarizes the lessons it teaches in a couple bullet points at the end. The bullet points from the entire book would fit on one page. Much like investing, contracting is simple when explained by someone who knows what they're talking about. For example, one point hammered on over and over again in the book is to ensure that all verbal promises and representations need to be written in the contract. Seems so simple, yet I'm sure every week in this country a physician realizes he is screwed over by not ensuring that occurred.
The book goes through the important parts of a contract such as calculating your pay, patient volume issues, malpractice insurance issues, call expectations, the perils of signing bonuses and other free money, termination covenants, and non-compete covenants. He explains rules of thumb for what is standard and fair in the industry and gives suggestions on how to negotiate a fair contract. He also includes a table of median salaries for each specialty in each region of the country. Obviously, as the years go by these figures will be out of date, but the point remains that if you don't know what you're worth, you're unlikely to ensure you're paid what you're worth. He also provides checklists to use when evaluating employment opportunities and looking through a contract.
Should You Read Physician's Guide: Evaluating Employment Opportunities & Avoiding Contractual Pitfalls?
There are few books on the market that are worth 10 times the cover price to you. This is one of them. Read the book. Have a knowledgeable professional review your contract with you. Many of the pitfalls on the road ahead of you are completely avoidable with a little education.
Hi WCI,
Long time reader, since inception of this blog. What are your thoughts on hiring a contract lawyer to review the terms of the contract. If you or anybody has experience with this, how does one go about hiring one, and what is a fair price for this type of service (specifically related to medical contracts)
thanks
Unfortunately, most lawyers only know contract law, not how the contractual terms will be applied to you. If your lawyer does not request a copy of the medical staff bylaws or he/she doesn’t know the difference between a wRVU and a APC… The amount of help will be hindered by his/her lack of industry expertise.
Thomas Crawford, MBA, FACHE
Past residents from my program have paid $250 to $300 and I’m in Chicago.
I think it is an excellent idea. The main thing is to know what the contract says and understand what happens in various bad situations, such as when they want to fire you, when you want to leave etc. I’ve met a number of people who review contracts for docs, often for free or a nominal charge over my career. Most are attorneys, some (such as the author of the book) are not. An internet search engine will also list a number of people who do this for a fee, such as this group (which I don’t know anything about): http://physicianadvisorsllc.com/employmentcontractreview The going rate seems to be a few hundred dollars, which is probably money well spent.
ill give it a try. ive been trying to remember to come here before purchasing from amazon. i find the links are sort of odd where i dont get a regular amazon screen but a minature picture of the book. Hopefully you are getting credit.
Thanks for your support!
I’m a trifle biased (since I’m a physician’s lawyer who focuses on review and negotiation of physician employment agreements), but I think you would be well-served to find a lawyer with extensive experience in physician employment agreements. Also, in the “shameless plug” category, you might want to look at my book, The Final Hurdle – a Physician’s Guide to Negotiating a Fair Employment Agreement. It’s available at Amazon, Barnes and Noble, and other book sellers.
As long as we’re shamelessly plugging, why don’t you send me three copies of the book. I’ll review it on the blog and give the copies away to readers.
Good deal! Thanks!
WCI,
This book is no longer available based o what I saw on Amazon.com. Do you have any other book recommendations for contract Review?
Ben
Ben
Amazon must have had a hiccup, because it’s still available – I just confirmed it on Amazon. You can get to it from the books’ website at http://www.TheFinalHurdle.com
Sorry for the hassle!
Dennis
Bummer. Seems like I just wrote a review about one recently. It should run soon. For the life of me I can’t remember the title right now. Let me see if I can find it.
Ah yes, it’s called The Final Hurdle. Take a look.
Just looked on Amazon for “Physician’s Guide: Evaluating Employment Opportunities & Avoiding Contractual Pitfalls”. It’s no longer in print and people want $700 for this book.
I’m in the middle of reading “The Final Hurdle” by Dennis Hursh. Do you think that Crawford’s book is worth trying to scour the internet for in order to get a decent price? I’m about to finish residency and am looking at the initial contract offer that a large foundation based medical group in San Francisco sent over to me and I’m trying to figure out if everything is really negotiable like you’ve stated previously, even with big groups like Kaiser. In my experience, they won’t budge on base salary but seem to use the bonus as a way to increase flexibility. Also, I’m in a bind because my wife is also going to work for the same hospital group, and if I sign with them, we’ll have $20,000 in relocation money, but I would rather have that as cash or be able to use that towards rent etc.
Ideally, I’d like someone like Dennis Hursh to look at my contract and discuss with me what I really want out of it, but I feel like Contract Diagnostics has the experience, but not necessarily as good of a feel for the legal language as a contract lawyer would. It’d be great to hear your thoughts on my many questions.
Thank you
No, I wouldn’t pay $700 for that book.
You can use Dennis or Contract Diagnostics or both. Seems a better use of your $700 to me. Let me know what your experience turns out to be.
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Hello! Thank you for this really informative article. I bought Physician’s Guide: Evaluating Employment Opportunities & Avoiding Contractual Pitfalls as a resident, about to sign a contract for my first attending position. I found this book worth every penny. I learned more from this book than I did from my contract review lawyer that cost 4 figures. Quick read, entertaining and applicable anecdotes and stories. I would recommend this book to anyone about to graduate from residency.
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