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.
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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.)
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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!
Am definitely curious to learn more about contract renegotiation, esp involving productivity-based pay and what really goes in “overhead”. Would love to win a copy of this book!
Looks like a great read. Would love to get a copy and share with my other co-residents if possible who are negotiating contracts right now. Thanks for the great post.
This sounds very useful for me as I just finished residency and am in a one year fellowship looking for a job currently. I would love to win a copy!
Please enter me in the drawing. Also – would love to read more about negotiation and contract terms in general, even just a post to allow readers a little further along in their careers to talk about what they would have done differently.
Any takers?
Is that “any takers” on the drawing or on WCI writing more about contracts and job transitions? In any case, sign me up for both!!
And even if there’s no takers for a guest post, I was trying to describe a post similar to “Stupid Doctor Tricks” — one of the best posts on this site for people newbies or people early in training.
We would be happy to write a guest post – been meaning to do this for quite some time. What would people like to see? a ‘what to do’ or a ‘what not to do’ with horror stories (we have many many stories). And WCI, would it be a good idea to have basic questions submitted as we could get very lengthy with a post (obviously, some are writing entire books on the subject).
-Jon
Contract Diagnostics
Yes please, would love to see this post.
Horror stories are fine. If people want to submit questions, that’s fine too.
Entering my final year of residency and would appreciate inclusion for the drawing, thanks.
Here are my two cents from being in the private world 8 yrs:
1. Know what is the notice period for both parties to exit the contract and the reasons for immediate termination. Don’t want to be in a situation the fire you overnight.
2. What is the restrictive covenant and what is the law in your state say regarding validity of restrictive covenants.
3. What is the tail situation, i.e. who covers it and does it matter if you leave or they leave.
4. If a lawsuit occurs who covers the legal fees, i.e. each cover their own. Some employers will plant a phrase saying if you litigate and they win you have to pay BOTH sides.
5. IF there are bonuses what are they based on. Are they easy to measure, i.e. prove in court if your are denied or “multifactorial based on production and quality”.
In the end I disagree contracts are so easy to negotiate. It all matters who needs the other one more. IF it matters to the employer and they can easily fill the spot no matter who you hire will matter. Just like life it all depends on who has the advantage.
The best thing a lawyer can add value is understanding what is the “norm” for the region and explaining the nuances of the contract to a newbie so they know what they are getting themselves into.
As more folks are being hired by corporate medicine there is not much negotiation just like there isn’t much negotiation when you join any multimillion dollar company.
Sounds like a perfect book for me at this moment–I’m about to renegotiate my contract after a year!
Even though there was no real negotiating allowed by my now-employer, the attorney reviewed my contract, explained potential pitfalls, and suggested I write a letter for my file detailing my understanding of clarifications provided by the employer. These provided much peace of mind and were well worth the $400 I paid – a relatively small amount in light of median physician salary.
Thanks for your reviews and the education you’ve provided over the years on your blog!
I have been passing along the WCI to friends in training. I consider those who trained me failures in some at least collegial responsibility to educate me about the realities of medical practice. Some of that stems from training in academic programs where most of those folks didn’t have anything to do with private practice ever in their careers. There are predators galore out there and I learned that contracts are everything. Sounds like a good book.
Sounds like a must read. Would love a copy.
This is something I think my classmates would benefit from and will be increasingly important as so many of us will likely go into employment agreements.
I liked the comment long time lurker and first time poster as it applies to me as well. WCI, would love a copy and I appreciate the $300 you got me from DRB. As you say, win, win, win. Much thanks.
Glad to be of service, and as you know, I got paid too.
Would love a copy as well. Thanks!
Just bought my copy, kind of sounds like something a financial planner should understand to some extent. I think there is only 1 more available on amazon st this time.
Remember that many books such as mine are printed on demand. There are always only a few dozen books available. When more get bought, more are printed. That prevents the issue you see with books like the physician negotiator books where it is no longer in print and the price jumps by hundreds of dollars.
I would love a copy, especially since I will hopefully be making partner at the end of the year.
Also, do you have any general information about buying into specialty hospitals, surgery centers, etc.? Future post?
Thanks for educating us!
Every deal is different, unfortunately, so it’s hard to give general advice other than read everything, consult with a lawyer, and remember that a business partnership is a lot like a marriage- don’t get into one with someone you don’t trust, who can’t manage money etc.
Thanks WCI for all you do! Would love to have a copy as I’m likely about to sign a new contract for a new job.
We had a talk by someone from legal to our residents to discuss “business aspects” of medicine. They made it clear there is not much negotiating in their contracts (big academic university). At the same time we have had attendings leave, and the ones left behind are picking up the work and not getting paid for it. I would think that specifics about getting paid for doing extra work should be in a contract as well.
Are contracts with Veteran Affairs negotiable?
I love that question. “Is this negotiable?” The answer is always “No” because the person asking isn’t sophisticated to know that everything is negotiable. But you must negotiate from a position of strength, or at a minimum, a perception of a position of strength. “Is this negotiable?” is like “Will you pay me more?” In reality, rather than asking, “Is this negotiable?” you should be saying, “My job offer in Reno is for $30K more than you’re offering. I like this area and I really like the people here, but I can’t afford the equivalent of a 10% pay cut to stay here. How close can you get to their offer?” Now you’re negotiating from a position of strength.
So what you need to decide is whether the VA needs you more than you need the VA. There’s nothing that improves your salary and contract like another offer. Same thing when buying or selling a house.
Would love to see another post specifically on this topic of what is negotiable and what is not and hear everyone else’s experiences from both sides of the table.
Generally speaking I’m guessing that salary is usually negotiable. Even with government positions where there may be a set pay scale but they can often start you at different spots on the pay scale depending on how much they want you.
Most benefits are probably not negotiable, especially group benefits like health coverage, 401k plans and so forth. No point trying to negotiate for a different 401k offering, not going to happen.
The rest I’m guessing probably varies.
You’re basically correct. Benefits arent really negotiable as they will be whatever the practice or corporation will have been able to negotiate when set up and the same deal everyone is getting for the most part.
Almost everything else is negotiable. Its not surprising that HRs are out basically giving “lectures” and “teaching” residents about contracts when they are really just planting ideas to their future benefit so no one even thinks to negotiate at all. Of course its done at a time when if a talk is given the resident assumes no disclosures or conflicts of interest and their trust levels are high.
Closing in on the end of residency would love a copy
Just curious how much of this discussion is relevant to employment with HMO groups like Kaiser Permanente? Are the employment terms basically the same for doctors across different provider types or do contracts and employment vary drastically depending on whether one is in a traditional group or HMO-based group?
As a non-physician executive managing a physician division for a health system, I recommend that all of my physicians have their contracts reviewed by a lawyer. The one piece of advice that I would offer to help reduce costs is to have an evergreen clause in your contract so that you do not need to have a lawyer review your contract every year or two!
I am definitely interested in reading this book to gain more insight into what information is being offered to the physician during this process.
Would love to win thereview copy, I am a fellow in the process of starting to look at first “real” job.
Read half of it last night. good info so far, just wish it wasn’t written at a 9th grade reading level 😉 The “book” could be half as long with the same content if the reading level were set for an audience that graduated med school. But, so far, learned so good things, even just learning what I don’t know and how to ask for help.
I am an attorney but I might pick up a copy just so I can help my wife navigate this in a year or two.
I would love to enter the drawing, I’m currently in talks for a new job, and looking over their sample contract and job description. Thanks for all that you do!
this looks like it be a great book to read!