Menu

first contract-what’s realistically negotiable?

Home Practice Management first contract-what’s realistically negotiable?

  •  guitarguy23 
    Participant
    Status: Resident
    Posts: 5
    Joined: 11/29/2018

    Relatively new WCI reader/follower. I have enjoyed learning from collective input of much more financially savvy and clinically experienced providers here. Thank you.

     

    I am a current PGY3 IM resident doing primary care IM reviewing my first contract. Seems straight forward for a hospital owned, large, multi-specialty outpatient only IM program. Guaranteed salary first year followed by productivity from year 2 onward (obviously pending meeting productivity which should not be an issue with this group). Quality bonus is completely provided the first year given <sample size to generate data which is nice. 15k reimbursed moving bonus and 2yr 20k sign on bonus (ie loan, must repay prorated amount if leave within first 2 years). Salary is prorated based on FTE 0.9 (180k). I can keep my earnings if I generate enough prior to end of first year contract ie they can move me to productivity earlier. Malpractice with tail seems appropriate, PTO 33 days, full range of retirement benefits, insurances through hospital program. No noncompete.

    Main question: What is truly negotiable? Obviously I am a new hire but want to be sure I can maximize my value. Not sure what I should target for negotiation I am going to have a formal contract review and did consider Contract Diagnostics recommended here for that, plus a law review or would this be overkill?) Job is in an area we will stay in long term (have spouse and kids).

    For those who have lived through numerous contract negotiations-what would you recommend a new hire to negotiate? Thanks again for all the shared knowledge here.

    #170467 Reply
     treswolf 
    Participant
    Status: Physician
    Posts: 19
    Joined: 02/23/2017

    Congratulations on job offer and finding the WCI.
    First piece of advice: use the WCI to your full advantage.
    Everything is negotiable.
    I would suspect that most employers expect some degree of negotiation- don’t be afraid…As an internist, you are worth it!
    Couple questions:
    -Outpatient IM only (hospital, ALF, NH)?
    -What are parameters for Productivity bonus?
    -RVU based? What is the RVU threshold? What is dollar amount per RVU?
    -Is there a base pay reduction if RVU threshold not met?
    -If PTO not used, can it be cashed out at end of year?

    These are just some random thoughts from one IM to another…Good Luck !!

    LB3

    #170478 Reply
     jhwkr542 
    Participant
    Status: Physician
    Posts: 782
    Joined: 02/15/2016

    Well, not everything is negotiable.  Things like CME money, health insurance, retirement accounts, and the like are often standard across all providers.  Call responsibility, number of rooms, staff/overhead are good things to keep an eye out for.  Always get in writing if you can.  The sign-on bonus and first year base are probably the most negotiable depending on how much they’re looking for peopel.

    #170480 Reply
    Craigy Craigy 
    Participant
    Status: Spouse
    Posts: 1664
    Joined: 09/16/2016

    The whole contract is negotiable.

    You just have to determine what is worth the effort.

    If you have a good attorney familiar with physician contracts, I would skip contract diagnostics.

    LEVEL 1 WCI FORUM MEMBER.

    #170485 Reply
    Liked by guitarguy23
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2011
    Joined: 05/07/2017

    at first I thought someone was trolling us. outpatient internist is like a unicorn.  anyhow, congrats!  it’s an amazing accomplishment.

    as far as negotiation of contract goes, what is your goal?  more time off?  possible but harder for new grad.  I’m not sure I understand your 0.9 FTE.   it should come out to more than 33 days in my opinion.  do you also get holidays off that is not included?  I think that’s reasonable.  you can probably squeeze a day or two extra if you want to.

    money should be more easily negotiated.  possibly moving expenses, although we tend not to offer more there.  definitely signing bonus would be in play.

    benefits are harder to negotiate.  you might negotiate the timing of some of the markers if you think that is to your benefit.

    ultimately however, you will do best by being an awesome physician and your productivity will follow.  it’s just a matter of whether you want to push for it to start earlier, or whether you settle in and learn how to practice, who your lifelines are, how to balance the demands of professional responsibility with personal time.  physicians tend to want to be productive quickly, but that can backfire if they haven’t learned how to function efficiently within the system first.  maximize your emr time.  set up your templates.   learn how to bill properly.  build your order sets properly.  learn what needs to be documented, especially to minimize preauthorization re-dos.  learn how to make your life easy when it is slower.  it will pay off later.  don’t rush to fill the schedule right away.

    good luck!

     

    #170529 Reply
     guitarguy23 
    Participant
    Status: Resident
    Posts: 5
    Joined: 11/29/2018

    Congratulations on job offer and finding the WCI.
    First piece of advice: use the WCI to your full advantage.
    Everything is negotiable.
    I would suspect that most employers expect some degree of negotiation- don’t be afraid…As an internist, you are worth it!
    Couple questions:
    -Outpatient IM only (hospital, ALF, NH)?
    -What are parameters for Productivity bonus?
    -RVU based? What is the RVU threshold? What is dollar amount per RVU?
    -Is there a base pay reduction if RVU threshold not met?
    -If PTO not used, can it be cashed out at end of year?

    These are just some random thoughts from one IM to another…Good Luck !!

    Click to expand…

    Thank you! Exciting times.

    I do anticipate negotiating for more definitely!

    It is strictly outpatient IM only in a stand-alone outpatient clinic, no NH/ALF

    The parameters for productivity kicking in state that once my monthly production>guarantee then I move the productivity plan.Per  hiring provider productivity would kick in once I met 50% median MGMA wRVU level (which I am not exactly sure of, believe it is low 5000s/high 4000s).

    Productivity is RVU based. Again, no specifics in contract about RVU threshold. I am going to talk to hiring partner about dollar amount per RVU.

    There would be a base pay reduction if threshold not met.

    Unclear about PTO reimbursement, great question which I will consider negotiating as well.

     

    I should mention that there is a 5k CME allowance as well.

    #170549 Reply
     guitarguy23 
    Participant
    Status: Resident
    Posts: 5
    Joined: 11/29/2018

    at first I thought someone was trolling us. outpatient internist is like a unicorn.  anyhow, congrats!  it’s an amazing accomplishment.

    as far as negotiation of contract goes, what is your goal?  more time off?  possible but harder for new grad.  I’m not sure I understand your 0.9 FTE.   it should come out to more than 33 days in my opinion.  do you also get holidays off that is not included?  I think that’s reasonable.  you can probably squeeze a day or two extra if you want to.

    money should be more easily negotiated.  possibly moving expenses, although we tend not to offer more there.  definitely signing bonus would be in play.

    benefits are harder to negotiate.  you might negotiate the timing of some of the markers if you think that is to your benefit.

    ultimately however, you will do best by being an awesome physician and your productivity will follow.  it’s just a matter of whether you want to push for it to start earlier, or whether you settle in and learn how to practice, who your lifelines are, how to balance the demands of professional responsibility with personal time.  physicians tend to want to be productive quickly, but that can backfire if they haven’t learned how to function efficiently within the system first.  maximize your emr time.  set up your templates.   learn how to bill properly.  build your order sets properly.  learn what needs to be documented, especially to minimize preauthorization re-dos.  learn how to make your life easy when it is slower.  it will pay off later.  don’t rush to fill the schedule right away.

    good luck!

     

    Click to expand…

    I know! I am the only one in my class going strictly outpatient but a regular schedule was top 2-3 reasons for an ambulatory position.

    I want to maximize income if possible, though again, productivity will probably be the key and I’m willing to wait as long as good earning is possible based on hard work.

    the FTE is based on 1/2 day off every week. The days off include holidays. I was going to ask for 2 more days off (seems strange not to just give a full five weeks?)

    The 15k moving allowance should be more than enough, I wouldn’t anticipate a 2 adult 2 kid move being more? Maybe wrong.

    I anticipate asking for a higher sign-on at the expense of additional year “owe back”. We are committed to the region and I believe I could stomach the $$ commitment.

    Bold = great advice. I don’t want to rush anything and definitely want to allow enough time to accommodate the job/workflow transition. It will be a new EMR and I have zero billing/coding experience (though the group has a billing/coding specialist in house who works with new hires.)

     

    Again, thank you everyone-just learning and taking it all in.

     

    #170553 Reply
     DCdoc 
    Participant
    Status: Physician
    Posts: 189
    Joined: 06/14/2016

    Why do you view 33 PTO days as less than 5 weeks vacation? Doesn’t a week only count as 5 PTO days since you don’t work weekends?

    #170557 Reply
    Liked by Zaphod
     SLC OB 
    Participant
    Status: Physician
    Posts: 128
    Joined: 06/23/2018
    Why do you view 33 PTO days as less than 5 weeks vacation? Doesn’t a week only count as 5 PTO days since you don’t work weekends?

    Click to expand…

    I calculated it as 6.5 weeks too… not less than 5.

    One thing to think about… you need the wRVU dollar amount in your contract or a “rolling average of the last two years of Median MGMA for outpatient internal medicine” — Important to have that spelled out.

    I would have a lawyer look over the contract. Even well meaning organizations can put in bad clauses into contracts… what State will you be practicing in? I have a California Lawyer (no financial affiliation!) that I have used and paid a pretty penny but he found a clause that could have cost me $50-70K!!! Got it removed from contract.

     

    #170571 Reply
    Liked by Zaphod
     childay 
    Participant
    Status: Physician
    Posts: 691
    Joined: 01/09/2016
    -RVU based? What is the RVU threshold? What is dollar amount per RVU?

    Click to expand…

    This is the most important $$ item.  You need to be clear on thresholds, the conversion factor and current doc’s numbers.  You should get the MGMA or other survey data for RVUs so you have a frame of reference.

    Negotiating the sign on bonus or some such would probably be easily done, but the RVU conversion factor will matter more in the long run.

    #170609 Reply
     guitarguy23 
    Participant
    Status: Resident
    Posts: 5
    Joined: 11/29/2018

    Believe it or not I looked at the PTO in relation to 7 work days each week (ie still a resident and hard to stop considering weekends as “work days”)  😀

    So yes obviously weekends off so appears to be ~6 weeks leave with 33 days PTO.

    I am discussing wRVU/productivity concerns with the hiring partner today. Hopefully it goes well.

    #170652 Reply
     Tim 
    Participant
    Status: Accountant
    Posts: 600
    Joined: 09/18/2018
    he found a clause that could have cost me $50-70K!!! Got it removed from contract.

    Click to expand…

    Can you share a hint?

    #170678 Reply
     guitarguy23 
    Participant
    Status: Resident
    Posts: 5
    Joined: 11/29/2018

    Also-there was no mention of covering/reimbursing license or DEA fees. I am about to register for my boards next summer and that is a fair amount of money. Is it common to negotiate for board exam costs? In other words, to be reimbursed by the group later after paying now?

     

     

    #170938 Reply
     billy 
    Participant
    Status: Physician
    Posts: 115
    Joined: 04/07/2016

    Reimbursing license fees or getting some CME money reimbursed is offered by most places (if you are working as a W2) but not all.  When reflecting on my bad first job, this was a red flag I decided to ignore (they did not reimburse anything).  You should also try to negotiate a bonus for passing the boards (or tie it to a salary increase).  Unfortunately what you pay for before starting the job I think is fair for the employer not to pay for- I mean whats to stop you from getting reimbursed for your boards but leaving before you take them?

    #170976 Reply
    wonka31 wonka31 
    Participant
    Status: Physician
    Posts: 312
    Joined: 03/24/2018

    Agree with most of the above. Some of this also depends if it is hospital employed/large group versus a smaller group. If it’s a large group/hospital system things like PTO, CME May be standard. These models tend to reimburse for boards, licenses, incidentals, etc better than most other models that I have seen.

    Signing bonus is definitely negotiable, you could even discuss a retention bonus on your employment anniversary date (ie signing bonus at time zero, $X at one year, $X at two years). You could also talk about loan repayment, relocation bonus/expenses, moving expenses, an all expenses paid review course (exclusive of CME) etc. These types of things are sometimes easier to negotiate sometimes than salary.

    #170991 Reply
    Liked by Tim

Reply To: first contract-what’s realistically negotiable?

In case of a glitch or error, please save your text elsewhere, clear browser cache, close browser, open browser and refresh the page.

you're currently offline

Notifications Mark all as read  |  Clear