Dennis Hursh, Esq., is a Pennsylvania healthcare attorney who published a book called The Final Hurdle: A Physician's Guide to Negotiating a Fair Employment Agreement. This is one of those niche books that is super useful at a certain stage of life, but really boring to read at any other point in life (such as the point I'm at.) So, despite its brevity and straightforward layout, it took me a while to get through it. But I'm glad I did, so I could recommend it to any of you looking at getting your first “real job” or changing jobs this year. There are other books out there on this subject, but this may be the best one I've seen yet. My favorite on this subject is Contract Issues for Emergency Physicians, but that's obviously specialty-specific. Four years ago I gave a positive review to Thomas Crawford's Physician's Guide: Evaluating Employment Opportunities & Avoiding Contractual Pitfalls. There is a great deal of overlap between the books, but I think I prefer The Final Hurdle (despite the higher price-$70 vs $38) if I had to choose between the two. (Truthfully, your employment contract is such a big deal it wouldn't be a bad idea to read both of them, and then hire a firm such as blog advertiser Contract Diagnostics or the authors' firms for additional assistance.)
Criticism of the Title – The Final Hurdle?
Before I get into all the great stuff I like about the book (which is 99% of it), I just wanted to take a minute to talk about how much I dislike the title. It obviously appeals to residents who have been traveling down this long, dark tunnel of college, med school, and residency and now see “the good life” as just beyond “the final hurdle” of negotiating an employment agreement. Well, as one who's well past that hurdle, I can assure you it isn't the final one! Now, is it more catchy than the boring old “Evaluating Employment Opportunities…?” Sure, but don't kid yourself that you're anywhere near done with this process. You have $300K in student loans, a dramatically negative net worth, and are entering a career fraught with pitfalls. You might not even be out of the blocks yet, much less over the final hurdle. Okay, rant over. Once I got past the title, I loved the rest of the book and if you need this book, I'm sure you will too.
The Final Hurdle Overview
Now, if you've never looked at a physician employment contract and never read a book about it, reading this book is like picking up a pile of gold coins left on your doorstep. It talks about all the important stuff like compensation, restrictive covenants (“non-competes,”) performance requirements, malpractice insurance issues, ownership, and negotiation strategies. Here's an excerpt from the introduction:
The secret all experienced attorneys know is that all contracts are negotiable….When the person you are dealing with tells you that you have been given the “standard” contract, he or she is either misrepresenting the situation or is misinformed. You have developed a massive amount of knowledge about and experience in your specialty, but that specialty is the practice of medicine–not the business of medicine. This book's purpose is most definitely not to encourage you to “do it yourself.” Instead, I want you to understand the basics, so that when you engage an attorney you are fully aware of the importance of the points the attorney is negotiating on your behalf.
In case there is any doubt why an attorney would write a book like this, he wants you to hire him to review your contract, let there be no doubt about that. A niche book like this rarely sells enough copies to really provide any significant income to its author, especially when there is a traditional publisher involved.
However, I can look past that point because I think he's right. While I'm obviously a big time do-it-yourselfer when it comes to most financial stuff, the real bang for your buck there is eliminating high, ongoing investment management fees (thousands per year for decades) not saving a few hundred bucks on a contract review or even hiring an attorney to do your negotiating for you. I certainly had mine reviewed by an attorney. But don't be surprised when you get to the last 5 pages of the book and find they're all an advertisement to hire Mr. Hursh.
The Five Chapters In The Final Hurdle
The book is just over 100 pages and divided into 5 chapters. The first is all about pay and benefits, and provides a very useful warning against productivity based pay and all the ways it might work out against you. The second chapter is all about restrictive covenants, and how having one in your contract, even if its not enforceable, can really hose you. The third chapter is all about call, how you can quit or be fired, and medical record issues. The fourth is all about malpractice insurance (hint-know who pays the tail.) Chapter five, however, is the best one in the book. It is all about what it takes to become an owner of the practice, and even without the rest of the book is worth the price of admission. This is perhaps the best guide I've seen on how to value a practice for buy-in. He talks about the pluses and minuses of fixed dollar amounts (who knew that $1 was such a terrible price), fair market value, and book value (his preferred measure.)
The Conclusion Review of The Final Hurdle
Finally, the conclusion sums up the book and serves as a soft sell for his firm and one would expect. It also includes a great list of 10 Key Questions you need to ask about your contract. Finally, Mr. Hursh tells one of his favorite lawyer/doctor jokes:
There's a story about a physician who is traveling on a train. He slips off his shoes to get more comfortable on the long trip and discovers that the folks seated on his right and left are both lawyers. After a time, the physician decides to get up and get something to drink in the cafe car. He asks the lawyer sitting by the aisle if he'd like anything. The lawyer says he'd love a Coke.
While the physician is gone, the lawyer picks up one of the physician's shoes and spits in it. The physician comes back and hands the lawyer his drink and the lawyer on his other side then asks if he also could have a Coke. The physician doesn't want to be rude, so he goes to get that lawyer a drink, too. While he is off on this mission, the second lawyer picks up the physician's other shoe and spits in it.
The physician comes back, and they all make small talk until the train pulls into the station. The doctor then slips into his shoes and instantly knows what happened. “When will the antagonism end between our professions?” he says in exasperation. “The spitting in the shoes, the urinating in the Cokes–when will it end?”
The Final Hurdle is a fantastic guide to employment contracts that every new physician and every physician changing jobs should read. By following its guidance, you may save thousands of dollars and endless hassles. Buy your copy today on Amazon, or, if you're too cheap to do that (and I can't blame you since it's currently listed at $70,) post a comment below and hope you win one of the two free review copies he sent me for faithful WCI readers.
What do you think? Did you have your contract reviewed by an attorney? Why or why not? Was it worth the money? Comment below!
A comment
Greatly relevant for those of us facing this next hurdle/opportunity. I’m curious what the difference between lawyer representation and a review service, like Contract Diagnostics, is going to be. Also, where are the opportunities for doing some of the work for the DIYers among us? Would love to put a copy of this in my resident library.
Contract Diagnostics does have an attorney. At any rate, the key is to have someone who does this all the time, and that’s where I think a firm like Contract Diagnostics is great.
Hi All – we here at Contract Diagnostics 100% hyper focus on physician contracts – its our specialty. We really enjoy working with so many WCI readers. We utilize numerous professionals for a full 360 degree review. A legal review (of course, with experienced attorney’s) is always part of our process but we take it a step further and fully analyze the benefits (401k, disability, life, medical, dental, CME, malpractice insurance, etc) AND compensation (collections, wRVU’s, conversion factors, overhead allocations, etc) and create a fun (as fun as it can be for you!) process to understand it. Our internal database of compensation can be very valuable as you negotiate your contract. We do not just do a ‘legal check’ like many firms that do not 100% focus on physician contract reviews.
We never try to sell you investments or disability insurance, our goal is to just have the best contract possible for you.
Any of you can reach out to me directly anytime for information or just a free consultation. I think the book WCI reviewed sounds like a great idea as well, but we do feel that with the time and money you’ve invested to get to a contract, it’s well worth a few hundred bucks to have someone look at it (someone that has done many, many, many reviews).
-Jon
816-288-3312
[email protected]
Maybe to clarify the original question, what does the “legal review” enatail?
I might have already replied to this, but this is one of those areas where I think DIY doesn’t make much sense. It’s a one time (or a few times) event, like a mortgage or buying disability insurance, rather than an ongoing, increasing expense like asset management where I think learning to DIY has a real economic benefit.
Sounds like a useful book!
What are your thoughts on allowing a financial advisor (Larsen Financial, physician only advising) to be trusted to evaluate a contract? Not sure if they have an attorney evaluate the contracts.
Larson does offer that service. I think the key is having someone experienced do it, generally that means an attorney. Although an experienced advisor who has been doing this for a long time may be just fine.
Sounds like a good book. I hope I win a copy!
Great review. Now I wished i had looked at it prior to starting.
I likely won’t buy it since I’ve been in practice so long but it might be a great resource for me when I teach residents. I instruct them all to read every word of their employment contracts and understand it. I also recommend having an attorney review it (predetermined total cost of maybe in the $500-$600 or less range). The attorney shouldn’t be to negotiate the contract or determine acceptance but more for education of what the language and risks mean. I have seen countless physicians get burned or lose hundreds of thousands of dollars over not having tail insurance (and later being too costly, accounts receivable or gross vs. net income or wRVU vs. total RVU misunderstandings, or enforced non-compete clauses. In those cases the MD didn’t read or understand the contract they signed. One doctor couldn’t join our practice due to his insurance coverage issues(claims made without a tail), one left the state in order to practice (restrictive covenant), one got a second mortgage to pay off the non-compete buyout clause (250k) to allow her to practice where she wanted. They were all blindsided. Sad.
We’ve seen ‘tail’ insurance cost a OBGYN physician with 2 years of experience $184k. Talk about changing her financial future (tail insurance is typically not financed).
-Jon
This seems like a really useful book! I have a few years left to go in my training, and I’d love to read it before negotiating for my first post-residency job.
Love this blog, will have to check these books out whether or not I win.
Thanks, John
Could definitely use a copy it seems
I’m going on my first job interview for a “real job” in the next couple of weeks, and I could definitely benefit from a copy of this book. Fingers crossed!
I give a financial presentation to Residents. Will add this information.
Would love a copy. Wonder if the book is applicable for renegotiating a contract
James,
Thank you for the excellent book review. Does the author specifically address the difference(s) between contract negotiating with a private practice group versus a hospital system employment position?
We are well past needing the book, so pass on the copies. I wanted to reiterate the warning about productivity based pay as you are coming out of residency into your first job. I hoped this arrangement was less prevalent than when we started ages ago. We never saw a single dollar of productivity bonus in our first jobs due to practice issues beyond our control. Be wary.
This is true in dental too. Be careful with it starting out because if the owners schedule falls out, guess who gets to see your patients…
There are pros and cons to both ways, but just be sure to know what you are worth.
We had 2 lawyers for 2 contacts over 3 years at a private company. Spent thousands on bad lawyers and still paid out $14k tail, lost tens of thousands in bonuses, only got 40% of the profit share after 3 years and the non compete lost us our dream job in Kaiser because the verbal non compete is nothing compared to the written one. I want to read this book!
I agree with dr mom. In my first job now, had a lawyer review several contracts for a couple thousand dollars, would like to learn more tips as it’s a good chance I’ll be looking for a new job in the next year or so. If I win a book, I will read and pass around to a bunch of friends in this stage too. love your blog!! We use your tips regularly–physician house loan, reconsolidated with your advertiser…thank you!!
In my first job, I had them carve out the noncompete clause where I was able to stay in the area and continue to practice if I worked in public health. I volunteered in the local health department while working for them. When we decided to leave the area, I let my practice believe I might stay and continue to work at the health department. It was fun watching their lawyers rack up fees trying to get ready to fight it! Know the rules so you can use them to your advantage even if only for your amusement!
Thanks for the review, Jim. I was wondering if you could go over, in your site, a little more about productivity based pay and its close cousin, “performance” pay, where a portion of one’s base salary is actually based on things an employed doctor simply has no control over. It seems to me hospitals, especially, try to do this as a “back-door” way of lowering your salary without saying up-front that they’re going to lower your salary. Does the productivity pay portion of the book really go over this sufficiently?
I’d have to go back and look at how much time is spent in the book on this important topic. I agree that lots of docs get burned on performance pay.
Sounds like several of those chapters would make for the outline of an excellent WCI/guest post…
Looks very useful as I begin to look for jobs outside of the military. Given your history of service would this book have been a benefit when you were getting out?
Yes, absolutely.
Love the site! Would get great use out of the book! Thanks for all you do!
I would love to win a copy of this as I am currently a fellow with a contract in hand that I am about to review/negotiate.
Do you have any advice on how to select an attorney to review the contract? Is it better to have someone local that is familiar with the area or are there firms that specialize in contract negotiation on a national level that would be better suited? Is it best to have someone that is familiar with your specialty or are the nuts and bolts of a contract similar across specialties?
Sounds like a great book, I hope to win a copy
Thank you — about to start the first job hunt, could definitely use a copy of the book!
Thank you, would like to be entered to win-finishing residency soon and would be helpful!