By Dr. Margaret Curtis, WCI Columnist
Finding your first attending physician position is a milestone, both exhilarating and a little bit frightening. You will be pleasantly surprised by how many people want to hire you, and how much they want to pay you. You will have plenty to consider in your job search: academic vs private practice, employment vs partnership track, and location. You will also have to find the right culture.
Many of the elements of a physician contract are straightforward. You probably feel pretty prepared to evaluate job offers based on salary and benefits. But there are other contract clauses that you may not have considered—or even heard of—that can be just as important.
6 Things to Ask For in a Physician Contract
Below is a list of six common contract items that can have an outsized effect on your happiness and financial success as a physician. (You will notice this list doesn’t include compensation. The topic of how physicians are paid—salaried vs productivity or some combination—deserves its own post, or maybe several.) You may be able to negotiate some or all of them, but at the very least you should be aware of what you are signing on for. Obviously, nothing here replaces the advice of a good contract lawyer who is familiar with physician employment agreements.
#1 Non-Compete Agreements
These limit your ability to practice medicine within a certain distance from your current job, and for a certain period of time. Non-Compete Agreements (NCAs) also deserve their own blog post (or you can read more about Physician Non-Compete Agreements) but the gist is: you might be able to get out of your NCA but you shouldn’t count on it. Consider asking your new employer to reduce the distance or the duration of your non-compete. This is especially important if you are tied to your geographic area for family or other reasons.
#2 Restrictions on Other Work
Moonlighting might be explicitly disallowed or may be included in your non-compete. If the ability to moonlight is important to you, ask for this clause to be removed. Your contract may also include language stating that any work you create while employed—even if you did it on your own time—is the property of your employer. If you plan on writing the Great American Novel on the side, you need a clause explicitly stating that any intellectual property you create is yours alone—and that anything you earn from it belongs to you, not the practice.
#3 Sign-On Bonuses and Student Loan Repayment
These may make you giddy, especially if they come as a lump sum that is more than your annual fellowship stipend, but look closely because they often have strings attached. A “bonus” might actually be a loan that is forgiven over a period of time (say, two or three years). If you leave before the full amount is forgiven you will have to repay the remainder. Student loan repayment might work the same way. If you are offered a bonus or loan structured this way, make sure you have enough cash reserves to pay back what you owe should you leave before the specified term is up.
#4 “Tail” Malpractice Coverage
Tail malpractice insurance covers you for malpractice claims brought after you leave your job, for events that happened while you were employed. You have to have it. Some employers cover tail insurance only after you have been employed for a certain number of years—this is similar to a sign-on loan and is meant to keep you at your job. It’s worth asking your employer to cover 100% of your tail insurance from day one as it can become quite expensive. Or, you can get “occurrence” malpractice insurance which will cover you for claims that arise even after you have left a job. If you can’t negotiate this, again you should keep cash on hand to pay for your tail insurance if need be.
#5 On-Call Commitment
Of course, you know how call works: everybody does it, no one likes it, but at least it comes out even, right? Nope. In the not-so-egalitarian world of private practice, physicians within the same group can take different amounts of call or have different weekend and holiday schedules. If someone leaves the practice or suddenly can’t take call, your call burden will increase.
In addition, employers can define “call” however they see fit: I once had a job in which call included weekend clinic hours and covering the NP clinic if one of them called out. I had to (almost literally) kick and scream to have my weekend clinic hours limited to acutes only—I was seeing check-ups on Sundays and holidays. I hope that other practices aren’t this exploitative/daft, but just in case: ask what call entails, how it is divvied up, and what will happen if there are changes in the call pool (will everyone get a “call bonus”? Will locums be used?).
No one wants to think about how the job they are starting will end, but sooner or later it will. Some questions to ask: can you be let go without cause? If so, your job might be vulnerable, especially in the era of COVID and hospital budget deficits. Do you have to give advance notice if you leave, and if so how much? 4-6 months is typical, shorter is obviously better for you. Does the hospital have to give you notice if you are being let go? Under what circumstances will you get severance, and how is severance calculated? If you are paid based on productivity, your contract should specify if severance is based on most recent productivity, an agreed-upon benchmark such as MGMA, or some other metric.
All of us want to find that perfect job right out of the gate. Most of us won’t: the majority of physicians don’t stay in their first attending job. This isn’t necessarily a bad thing, but changing jobs is stressful and can be expensive—especially if it involves a move, loss of partnership buy-in, etc.—so you should at least maximize your chances of success. When you have the right contract in hand, you can focus on your real job: becoming the attending you always wanted to be.
What tips do you have for a physician contract negotiation? Comment below!