contract in howntown, stipend good idea?

[tiedyeddog]

Hey all,

I am from a small, rural town that has an academic medical center. They currently have a small surgery subspecialty group(don't want to name it to help with anonymity) but don't have a fellowship trained pediatric person in my field. The hospital has been growing the pediatric side tremendously over the past 5 years and seem to be dedicated to the pediatric side, rebuilding the facilities and also getting more fellowship trained pediatric subspecialty people in other fields to sign on. The people there tell me they would give me all the pediatric patients of theirs and in the future as they have no desire to do it. The job market for pediatrics in my subspecialty sucks and the prospect of building up this practice from scratch is really exciting to me.

I would love to return back to this town and practice here. Their recruiter and head of the specialty in the hospital there contacted me and they are really talking me up, setting up meetings with the hospital president, really pulling out the red carpet if you can believe it....

My question is how common is this set up? I have 2+ years of training left and also a fellowship to complete. Fellowship is not hard to match into in my field. The small town group is talking about a stipend and signing me on now. Is it fool hardy to sign this early? Anyone have experience with stipends during residency in surgery or surgery subspecialty fields?

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[doc05]

Foolish to sign now, you don't know what to look for. You're not even in fellowship!
Also keep in mind that programs in rural areas are often desperate for specialists, you'll get a much better deal if you wait

 

[cpants]

A stipend is great if you can get it. They are paying to lock you down though, so obviously you won't be able to consider any other opportunities. Likely you will also be expected to commit to staying for a few years.

Things can change in 2 years of residency and a fellowship---goals, relationships, clinical interests, etc. Also, you still have to get into fellowship--so what happens if you don't match? Are you certain you want to settle down in this town no matter what? Married? Have a family? Spouse on board?

Make sure you consider all the angles. If you are thinking about signing on now, I would also encourage you to seek out other opportunities in other similar communities at this time. Even if the place you are at is your first choice, it will help you to educate yourself on what competitive compensation and benefits should be and will also allow you to negotiate from a position of strength with other offers on the table when the time comes.

 

[HighPriest]

I’ve known of a couple of these situations. A group I used to moonlight for while in the Army did this with a resident because it was very difficult to attract surgeons and she was from the town where they were based. It makes sense to incentivize someone to come home rather than to attract someone from somewhere else when you’re in BFE. Because that person has roots and they know what it’s like to live there. They’re not going to show up, work for two years, develop an alcohol problem and then leave.

One of my now-senior partners was attracted in the same way many years ago.

There are very few contracts that you can’t get out of if things change between now and then, especially if you don’t take any money up front. If you do take money up front, and you changed your mind, then you e put yourself in a financial hardship because you’ll certainly have to pay it back, possibly with interest. If this seems like a good match, and it’s a good offer, and it aligns with your goals, I think you have little risk here other than a financial one. The size of that risk will depend upon how much money you take from them. You could always try to negotiate a bonus after you start rather than a stipend.

If you jump ship next year, it’ll be disappointing but they’ll get over it. If you jump ship 2 weeks before you’re supposed to start working you’ll risk having the start of a reputation, and they’ll never hire you again, but they’ll get over it.

Just have someone review any potential contract and make sure you’re not being asked to do anything unreasonable.

There is some truth in that you might find a better offer later. That’ll always be true. They might also hire someone in the interim. Who knows? Biggest risk here is you don’t know what other offers you’ll get. If you’re set on moving back home either way, that may not matter. If I had an offer for twice what I’m making now, I still wouldn’t have taken a job in Nebraska. It would make sense to try to find out what other places might offer, which could be hard considering how long you have left in training.

So far as things changing in 2 years: absolutely true. Anything could happen. And that will also be true 2 years after you finish fellowship, which is why most people change jobs within 3 years of completing training.

 

[tiedyeddog]

Thank you all for the responses. A lot to think about. My spouse is on board with moving back to this town, if it makes a difference.

 

[Comfortably_Dumb]

You will be giving up some future cash to sign on now, which you certainly know.

But the value of that cash right now might be worth much more to your change in lifestyle than the marginal amount it will be in just a few years. If I make another $50,000 from one year to the next I literally don't realize it until I pay taxes. If I would have had an extra $50,000 as a resident...my life would have been much, much, much less stressful and more pleasant.

In general, I think it's not wise to tie your hands so far in the future...but in certain cases I think the pros can outweigh the cons.

 

[wholeheartedly]

another thing to consider is that small town hospitals can be pretty volatile from a management standpoint. I did my clinicals for my profession at my hometown hospital. It was not bad for a rural place and we had good staff and docs for the most part. I moved back 8 yrs (and 3 CEO, 2 hospital system changes) later and things were pretty crappy. All the good nursing and other allied health staff headed for the hills. Then the good docs bailed and now it's a revolving door of locums people. They've gone on diversion regularly because they don't have staff to care for more patients. It's really sad. It only took a few years to get this way.

You should be able to get a good contract on the job when you're nearing the end of fellowship. In addition to a lot happening in your own life, a lot can happen at the hospital. I just wouldn't feel comfortable locking myself in that early.

 

[DoctwoB]

Like with all things job/contract related, the devil is in the details. There are pros to this set up, namely the job is held for you, the extra cash during residency, etc. The cons are the lost flexibility, less bargaining power given that you’re not entertaining competing offers, and the fact that this money is coming from somewhere meaning it could have otherwise been salary, signing bonus, etc. TANSTAAFL. I interviewed with one job that flat out told me we have this pot of money allocated to this position, how you want it (stipend, signing bonus, salary, moving allowance, etc) is up to you.

The details to keep in mind are how is it structured? If you change your mind do you repay the money? With interest or penalty? Over what time period? Is it a loan that gets forgiven (with associated tax implications). Is there a non-compete that comes with taking the money? How onerous/enforceable? If you have to repay it immediately will you have the financial flexibility to do so or will you have to take a loan or convince another job to “buy you out”. Long story short it can make sense for the right person in the right situation, but if you can afford to keep your flexibility it’s probably worthwhile to do so.