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Contract Review

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  • Avatar MSooner 
    Participant
    Status: Spouse
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    Joined: 02/25/2016

    My husband will be doing 2 interviews (private practice radiology) ~3 weeks apart in the next month. We have a couple of questions:

    –If he gets an offer at either or both, how long is reasonable to ask for to make a decision? It is definitely very early in the interview season (this is for a July 2020 start date), but that is just how the cards fell and seems to not be all that uncommon right now (and is better for us anyway).

    –I know this has been debated to death here, but any thoughts on contract review? Both jobs are out of state from where we are now. I have the name of an employment attorney specific to one state from a fellow radiologist that was happy with him. No idea where to start for the other state. I’ve looked into Contract Diagnostics, but had a friend that was pretty unhappy with them (they missed stuff, she understood the contract better in the end, they could provide no help in whether the compensation was good for the region, and they ended up refunding her). I think we’d like an attorney familiar with the state laws, but I’m assuming they aren’t going to be helpful in compensation issues?

    #214986 Reply
    Liked by mapplebum
    Avatar Peds 
    Participant
    Status: Physician
    Posts: 3800
    Joined: 01/08/2016

    how long is reasonable to ask for to make a decision?

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    as long as he wants technically. i wouldnt entertain a job where they wanted me to decide in 1 week or something like that.

    but any thoughts on contract review?

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    a good idea. it has to be someone who understands medicine.

    never used contract diagnostics but not good to hear.

    #214987 Reply
    Avatar MSooner 
    Participant
    Status: Spouse
    Posts: 181
    Joined: 02/25/2016

    Also, anything the radiologists have to add about what to ask/look for in a practice…we’re all ears!

    Neither group is corporate/PE. Both have partnership tracks. Both exclusively serve one hospital system and are mid-size groups. Both are in small-mid size cities in the South/Midwest, if that helps.

    #214989 Reply
    Vagabond MD Vagabond MD 
    Participant
    Status: Physician
    Posts: 3245
    Joined: 01/21/2016
    If he gets an offer at either or both, how long is reasonable to ask for to make a decision?

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    Two weeks, as this allows for him to consider terms and have contract reviewed. That said, given the current job market, he might be able to practically have as long as he wants. When I offered contracts, I would give two weeks and say that after that time, the offer still stands, but there is the possibility that it is being shopped to someone else and may not be in effect three weeks or three months from now, if we have filled this job.

    I know this has been debated to death here, but any thoughts on contract review?

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    I think that contract review is both necessary and overrated. When I was a resident, one of my junior resident colleagues, who did an MD/JD program, became an immediate cottage expert on private practice radiology contracts for our large program. I do not remember if he charged people for the service, but I remember that he reviewed mine. My employment attorney wife has reviewed my contracts along the way, too.

    The thing about the contracts is that the group is going to give you the same contract that most/all of them signed, too. So if you do not like this term or the wording of that, they are going to come back and say, “well, we have all signed the same contract here.” Also, if the group is going to screw you, there is virtually nothing in the contract that says that they cannot and won’t, and that’s really what you are trying to ascertain.

    More important than the language are the terms:

    Compensation

    Vacation/time off (ask to see medical/family leave policy)

    What can get you fired? (ask to see code of conduct)

    Retirement plan contribution and vesting

    Med Mal insurance and tail coverage (hint, no one will pay for your tail to leave to join another group)

    Ask about the Hospital contracts and imaging center relationships (if any)

    Ask about non-compete

    What about buy-ins, if any?

    Will you be reviewed? How often and what are the factors that your review will be based on?

     

    Even more important than all of that is that it helps to know an old colleague or two in the new group, so you can get the straight story, the skeletons in the closet, why the last three people really left, etc. If you have friends in the group who are happy there, you have a higher chance of employment bliss than you do going to work with strangers. (That probably applies to any industry.)

    "Wealth is the slave of the wise man and the master of the fool.” -Seneca the Younger

    #214992 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 2263
    Joined: 01/03/2017

    There’s no time frame for which they expect a decision. Have him be honest and tell him that he has a few other interviews/offers and he wants a little time to make the best decision. Any reasonable group will understand because they’re also trying to find a good fit.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #214994 Reply
    Liked by Vagabond MD
    Avatar Tim 
    Participant
    Status: Accountant
    Posts: 2320
    Joined: 09/18/2018

    1) Contract review: Attorneys actually practice healthcare law. I would suggest looking for healthcare certification/specialization first, the physician contracts.
    Most of these will be state specific, but have the MGMA data as well as possibly experience with local contracts. Added benefit is the PP and partnership and Side venue contracts.
    2) What to ask: Basically he needs to know how the business is ran and how he would fit in. Is it democratic (partners have a vote and he is treated equally) or is it more of a hierarchy where preference is given to a select few. The seniors set all the rules and guess who gets the short end of the stick.

    Length of time to partnership, probability of success ( how many new attendings left). What are the requirements ( basically is he going to make partner but simply needs to perform).

    How the partnership expenses and income are allocated, buy ins and buyouts. He would also want to know if some individuals are key to the hospital contract and if they will be staying.

    He is taking the job to become a partner. How good is the opportunity.

    You know enough about the “boiler plate” signing, moving CME etc. Benefits from healthcare to retirement options that are available. I would not focus on benefits until it reaches an offer stage. Because of the long lead time, he should not commit. It’s a big decision and he is evaluating his options. This opportunity was appealing but he doesn’t have a timeframe set. They should be amenable, otherwise they are looking for a qualified body, not your husband as the best candidate as a partner. It’s the partnership opportunity that’s important. Otherwise, you are potentially moving again with partnership further down the line.
    Workwise, he will know if it’s the environment is agreeable. Good luck.

    #215000 Reply
    Liked by jfoxcpacfp
    Avatar MSooner 
    Participant
    Status: Spouse
    Posts: 181
    Joined: 02/25/2016

    Thanks for the feedback!

    We actually know a lot about the group he is interviewing with first–enough to know they are very shorthanded in his subspecialty, it’s necessary to their hospital contract, and they’ve been having a hard time finding people to fill the spot(s). They originally offered to let him interview at any point during the summer since it was so far out from the start date, so we’re hopeful they wont balk at a little extra time to at least see the other place.

    We don’t know so much about the 2nd group, except that it has a good reputation and long term stability with the hospital.

    Question about tail coverage–what *should* he be looking for in a contract?

    I will say that after paying his way through ~30 med school, residency, and fellowship interviews it feels good to FINALLY be in a spot where the recruiting party shows serious interest/effort instead of, “Hey, maybe we’ll take you. Maybe we wont. Anyone’s guess!”

    #215056 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 2263
    Joined: 01/03/2017
    Question about tail coverage–what *should* he be looking for in a contract?

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    Depends if their malpractice insurance is claims-made or occurrence based. If it’s claims-made, they should provide the tail.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #215057 Reply
    Vagabond MD Vagabond MD 
    Participant
    Status: Physician
    Posts: 3245
    Joined: 01/21/2016

    Question about tail coverage–what *should* he be looking for in a contract?

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    Depends if their malpractice insurance is claims-made or occurrence based. If it’s claims-made, they should provide the tail.

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    But rad groups typically will not pay for the tail. Sometimes you can get them to split it with you, or pay it if you are not leaving on your terms. If they are desperate, maybe you could negotiate that into the deal, but you are probably better off negotiating for compensation.

    "Wealth is the slave of the wise man and the master of the fool.” -Seneca the Younger

    #215058 Reply
    Avatar Tim 
    Participant
    Status: Accountant
    Posts: 2320
    Joined: 09/18/2018
    but you are probably better off negotiating for compensation.

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    Your best negotiating data is another offer that you would accept.

    Also, if the group is going to screw you, there is virtually nothing in the contract that says that they cannot and won’t, and that’s really what you are trying to ascertain.

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    Vagabond MD made a monumental point.

    Have him be honest and tell him that he has a few other interviews/offers and he wants a little time to make the best decision. Any reasonable group will understand because they’re also trying to find a good fit.

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    Your deadline is the time to get licensed and credentialed. At least 6 months. Everything else is variable.

    #215074 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 2263
    Joined: 01/03/2017

    Question about tail coverage–what *should* he be looking for in a contract?

    Click to expand…

    Depends if their malpractice insurance is claims-made or occurrence based. If it’s claims-made, they should provide the tail.

    Click to expand…

    But rad groups typically will not pay for the tail. Sometimes you can get them to split it with you, or pay it if you are not leaving on your terms. If they are desperate, maybe you could negotiate that into the deal, but you are probably better off negotiating for compensation.

    Click to expand…

    I didn’t know that was the norm in Rads. Not having your group pay for your tail seems crazy.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #215083 Reply
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2362
    Joined: 05/07/2017

    Question about tail coverage–what *should* he be looking for in a contract?

    Click to expand…

    Depends if their malpractice insurance is claims-made or occurrence based. If it’s claims-made, they should provide the tail.

    Click to expand…

    But rad groups typically will not pay for the tail. Sometimes you can get them to split it with you, or pay it if you are not leaving on your terms. If they are desperate, maybe you could negotiate that into the deal, but you are probably better off negotiating for compensation.

    Click to expand…

    I didn’t know that was the norm in Rads. Not having your group pay for your tail seems crazy.

    Click to expand…

    none of the private practice groups i were in paid for tail.

    same for wife.

    neither of us in rads

    it seems to be more the norm in employed model that the hospital pays the tail.

     

    #215093 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 2263
    Joined: 01/03/2017
    none of the private practice groups i were in paid for tail. same for wife. neither of us in rads it seems to be more the norm in employed model that the hospital pays the tail.

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    It’s the norm in EM. Whether it’s CMG, SDG, or employed, I don’t think I’ve ever heard of an EM doc that ever had to pay for their own tail.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #215094 Reply
    Vagabond MD Vagabond MD 
    Participant
    Status: Physician
    Posts: 3245
    Joined: 01/21/2016

    Question about tail coverage–what *should* he be looking for in a contract?

    Click to expand…

    Depends if their malpractice insurance is claims-made or occurrence based. If it’s claims-made, they should provide the tail.

    Click to expand…

    But rad groups typically will not pay for the tail. Sometimes you can get them to split it with you, or pay it if you are not leaving on your terms. If they are desperate, maybe you could negotiate that into the deal, but you are probably better off negotiating for compensation.

    Click to expand…

    I didn’t know that was the norm in Rads. Not having your group pay for your tail seems crazy.

    Click to expand…

    Why should my group pay for your out to your next job? What typically happens is that the next employer pays for the “nose”, picking up your history and essentially buying your tail.

    "Wealth is the slave of the wise man and the master of the fool.” -Seneca the Younger

    #215096 Reply
    Liked by Tim
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 2263
    Joined: 01/03/2017

    Why should my group pay for your out to your next job? What typically happens is that the next employer pays for the “nose”, picking up your history and essentially buying your tail.

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    I’m not trying to argue the norm for various specialties but, at least in EM, if you see a patient while working for a particular group, I think it’s reasonable (and so does everyone else in EM) for the group you were working for at the time to cover the risk of that patient encounter in the present and future.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #215111 Reply

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