Sign contract before starting fellowship?

[HyperionGap Participant Status: Mortgage Lender, Spouse Posts: 5 Joined: 08/02/2017]

Hello all, I am asking this question on behalf of my wife and was hoping to get some advice and bounce ideas off people that perhaps have experience in this situation. She is a PGY-5 in a combined residency/fellowship program and has been accepted to do a subfellowship at a major academic research university/hospital.

Her current residency program (teaching community hospital) has verbally indicated they are going to give her an offer.  This would include a signing bonus (golden handcuffs) for her to return once she finishes fellowship with the idea that she would become the director of a new unit at the hospital based on her training.  From what I can tell this is completely unprecedented, but it seems they like her very very much.  She is very excited about this and quite honored by the offer, but I want to make sure she’s not being taken advantage of financially.

So my question is how should she leverage her current position in salary negotiations?  I have had her talk to any recruiters that e-mail her, but as soon as they hear she is going to do a fellowship they say to contact them in 12-18 months.  I know the general salary ranges of what the previous fellow above her have been offered in nearby positions, but they left straight after PGY-5 without doing any subfellowships.

Specifically here’s what I was wondering:

1) Should she attempt to negotiate a salary comparable to an attending with 2 years experience but no subfellowship is getting?

2) If you were to sign a contract today would you expect to get some sort of cost of living increase for locking in employment 2-3 years out?   I.E. 3-5% increase per year based on what they’re current offering?

Sorry for the longwinded post, but any thoughts or items to think about would be greatly appreciated.

[SerrateAndDominate Participant Status: Physician Posts: 479 Joined: 02/01/2018]

1) You don’t get what you don’t ask for.  I’ve heard of faculty asking for their spouse’s residency (in another specialty) to get funded.

2) It’s worth asking for.  Your sales pitch is they don’t have to go through the time and money to hire someone else.  This may be funneled through a sign-on bonus rather than a “stipend”

 

Best of luck.  I got blown up by a recruiter from my hometown last week (finish fellowship in June 2020) so I understand the uncharted territory aspect.

Earn everything.

[q-school Participant Status: Physician Posts: 2622 Joined: 05/07/2017]

I would be much more concerned with whether they will offer the support she needs to get a new unit started.  Without that, no matter how much they pay her she will likely be unhappy because she has high expectations of herself or because they have specific goals that they expect of her.

the universities i have had dealings with don’t have much flexibility in salary for fresh grads.  So it won’t really matter too much what you ask, they have pretty narrow pay bands.  Their recruiting department is trained to emphasize the other perks.

The only way she would get the money of someone two years out is if there are no significant raises.  Why would she?  She is not two years out.  Her pay would be based on her new subspecialty.   That pay may or may not be very close to her specialty pay.  It would be a surprise to me if they even thought of offering her anything other than the base salary.  The clinical people aren’t thinking about what she can make.  At best, they are thinking she can help grow the department and help the community.  At worst, they are thinking she can see patients with unusual illnesses that others don’t want to see.

i’ve never heard of a contract with an income guarantee subject to COLA.  That’s not to say it doesn’t exist, but i’ve not encountered.

Personally i would never accept these things unless i had to return to the community for family reasons AND the job market is very tight.  I would stay in close contact with them.  I would visit often.  Two to three years is a long time and there may be other jobs that are more appealing.  She may or may not know exactly how she wants her practice structured.  She may or may not be savvy to the business side of running the practice, which will inform how successful she is.

From sitting on the other side, we pay these early signing bonuses not infrequently.  Several have to be undone because people change their mind.   We have people come and leave after one or two years.  They didn’t really like the community but felt attracted to the idea of bird in the hand and a signing bonus perhaps made our offer seem more attractive at the time.   It is very rare for me to offer something like this.  For us, HR would handle any of those COLA negotiations or other things.

good luck.

 

[CordMcNally Participant Status: Physician Posts: 2772 Joined: 01/03/2017]

I probably wouldn’t sign anything at this time. If I was going to be the director of a brand new unit, I would want a lot to say about how that process is built from the ground up. Are they offering her that?

 

A signing bonus isn’t a golden handcuff unless you spend it.

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

[fc95082 Participant Status: Physician Posts: 5 Joined: 05/14/2018]

Get a recruiter of the hospital to provide current MGMA 25th, median, 75th, and 90th percentile data on salaries for new grads and experienced practitioners in the subspecialty.  Keep channels open, but I would be hesitant to lock anything down without a clear view of the job market and reimbursement landscape for that subspecialty.  Beware the low-ball offer.  Consider talking to a health care lawyer who deals with physician contracts as a regular part of their practice to help with negotiations and review of any contract.

[Kamban Participant Status: Physician Posts: 2468 Joined: 08/01/2016]

Two years after the subfellowship she might not want to come back to that hospital. Lots of things can change in that time. I would not sign any contract but keep lines of communication open.

[HyperionGap Participant Status: Mortgage Lender, Spouse Posts: 5 Joined: 08/02/2017]

Thanks all this is very helpful.  It sounds like in addition to looking at just the salary, particular care should be taken to making sure the department will adequately provide whatever support she needs in order to develop a new unit.

 

I also appreciated the comment about the golden handcuffs. If you don’t spend the money you can always just give it back and then be free from any obligations (assuming there aren’t any other hooks).

[q-school Participant Status: Physician Posts: 2622 Joined: 05/07/2017]

HyperionGap wrote:

Thanks all this is very helpful.  It sounds like in addition to looking at just the salary, particular care should be taken to making sure the department will adequately provide whatever support she needs in order to develop a new unit.

 

I also appreciated the comment about the golden handcuffs. If you don’t spend the money you can always just give it back and then be free from any obligations (assuming there aren’t any other hooks).

Click to expand…

I wouldn’t go that far.  it costs the organization money to undo a check that has been written and cashed.  Especially if in a different year.

agree with the comments that a signing bonus is in no ways a golden handcuff.  golden handcuffs are classically long term bonuses designed to encourage retention.

 

 

[SValleyMD Participant Status: Physician Posts: 461 Joined: 05/12/2016]

I wouldn’t let the ego stroking cloud judgement. Chances are they’re looking to take advantage of ya, so due diligence and truly understanding market worth is paramount