Early Contract

[Cranjis McBasketball]

My home town is writing up a contract for me to sign on with them. Its a very generous offer, but I wanted to get some tips on what to make sure is included in the contract and if a lawyer is definitely needed to look over the contract. CMO says it should be done in the next couple of weeks.

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[VA Hopeful Dr]

My home town is writing up a contract for me to sign on with them. Its a very generous offer, but I wanted to get some tips on what to make sure is included in the contract and if a lawyer is definitely needed to look over the contract. CMO says it should be done in the next couple of weeks.

If you've never dealt with a physician employment contract, a lawyer isn't a bad idea.

That aside, some basic ideas of things to pay attention to:

Non-compete - Many (most?) contracts will have some form of this. In an ideal world you could negotiate those out, but that's not all that common. So look into the terms of the non-compete and make sure you're OK with it. I've had some success getting non-competes reduced so that's an option.

Money - Find out how much you'll be paid and for how long on the initial guarantee. These days you shouldn't take less than 200k/year and at least 1 year of that although 2 is better. Find out how you will be paid after that. Will you always be salaried or will you be production based. If the latter, find out the exact terms of that and if you get busy enough and out-earn your guarantee will they pay you the extra.

Benefits - Almost everywhere will offer the basics like health insurance, some kind of retirement plan, disability benefits, and so on. But you want to ask about days off, CME money (and any restrictions on how you use it). Stuff like that.

Quality measures - Most places are going to some form of quality based payment, its usually part of the bonus structure for physicians. Find out details on that if they do it.

 

[Cranjis McBasketball]

If you've never dealt with a physician employment contract, a lawyer isn't a bad idea.

That aside, some basic ideas of things to pay attention to:

Non-compete - Many (most?) contracts will have some form of this. In an ideal world you could negotiate those out, but that's not all that common. So look into the terms of the non-compete and make sure you're OK with it. I've had some success getting non-competes reduced so that's an option.

Money - Find out how much you'll be paid and for how long on the initial guarantee. These days you shouldn't take less than 200k/year and at least 1 year of that although 2 is better. Find out how you will be paid after that. Will you always be salaried or will you be production based. If the latter, find out the exact terms of that and if you get busy enough and out-earn your guarantee will they pay you the extra.

Benefits - Almost everywhere will offer the basics like health insurance, some kind of retirement plan, disability benefits, and so on. But you want to ask about days off, CME money (and any restrictions on how you use it). Stuff like that.

Quality measures - Most places are going to some form of quality based payment, its usually part of the bonus structure for physicians. Find out details on that if they do it.

This helps a ton! Thanks! So far what I know is

Guaranteed 260k for 2 years base. Not sure yet what itll say for after, but itll be production based and i will definitely keep my eye out for the specific $ per rvu. $1000 stipend during residency. 25k sign on. 25k a year for loan repayment with max 75k. Non compete is 1 year after. 10 weeks PTO. 3500 CME. I definitely need to find out the quality measures. SO seems like theres a lot I dont know but will need to verify in the contract

 

[VA Hopeful Dr]

This helps a ton! Thanks! So far what I know is

Guaranteed 260k for 2 years base. Not sure yet what itll say for after, but itll be production based and i will definitely keep my eye out for the specific $ per rvu. $1000 stipend during residency. 25k sign on. 25k a year for loan repayment with max 75k. Non compete is 1 year after. 10 weeks PTO. 3500 CME. I definitely need to find out the quality measures. SO seems like theres a lot I dont know but will need to verify in the contract

Doesn't sound too bad so far. I'm guessing this place is not super urban based on all the money they'll be giving you up front.

Find out what happens to all that money they fronted you if you leave early, and how long you have to be there to avoid having to repay any of it.

 

[cj_cregg]

Thinking also about quality of life stuff in addition to the above - make sure you're comfortable with the language surrounding your responsibility for working with midlevels, call responsibilities, and work hours (clinic hours vs admin time, allowances for time for other responsibilities you may choose to take on like inpatient rounding, deliveries, etc.).

 

[Cranjis McBasketball]

Doesn't sound too bad so far. I'm guessing this place is not super urban based on all the money they'll be giving you up front.

Find out what happens to all that money they fronted you if you leave early, and how long you have to be there to avoid having to repay any of it.

Yeah its like mid size in the mountain west. I will definitely find that out.

Thinking also about quality of life stuff in addition to the above - make sure you're comfortable with the language surrounding your responsibility for working with midlevels, call responsibilities, and work hours (clinic hours vs admin time, allowances for time for other responsibilities you may choose to take on like inpatient rounding, deliveries, etc.).

Thank you. I will definitely verify this

 

[hallowmann]

Yeah its like mid size in the mountain west. I will definitely find that out.

Thank you. I will definitely verify this

I would be very cautious with a non-compete in a smaller area.

A friend of mine out of training moved back to their rural hometown and got what seemed like a great job offer (promised the world, rural full scope w/o OB, paid well, gave stipend in last year of training, told him they'd "ease" him into the practice, reportedly good access to specialty care or at least as good as you'd expect, etc.), but it had a 50 mi non-compete for 2 yrs.

When he got there turnover was insane, within 6 mos 2 physicians and a midlevel left leaving him alone there, clinic managers left, tons of trouble keeping any staff, so he was rooming his own patients. Instead of "easing" him into it, he was suddenly full, getting constant pressure to take on more patients in the name "access". It was hard to actually use PTO because even then they still called him on vacation and even to schedule it they gave him a hard time for cancelling (he was booked out months ahead). They kept saying they were hiring new people/locums, but didn't for over a year saying it was hard to recruit. From the beginning he refused to supervise midlevels, but that didn't stop them from constantly asking and pressuring him to supervise NPs without any admin time or additional pay, even though its a FPA state.

He started hating medicine, spending 12 hrs+/day there but paid the same (guaranteed salary). His wife had found a secure job (also physician), they had kids, family was nearby, had a house, and he was stuck, but left anyway at 18 mos for his sanity, and he only lasted that long because of the guilt of leaving his patients. He had to pay back a ton of the money in bonuses/stipends during residency (upper 5-figures). Magically when he left they hired locums immediately and within 6 mos had a fresh grad signed up. Because of the non-compete, he couldn't work for >8 mos anywhere, and it wasn't until he got a ton of medical licenses in other states that he could actually find a telemed place that would take him with <2 yrs experience.

This was in a midwest state desperate for physicians with huge demand for any healthcare, but no lawyer thought it was worth fighting the non-compete and the system was notorious for pursuing 6-figure payouts for physicians to get out of it. This guy is genuinely one of the best FM physicians I know, very efficient, very motivated, studied constantly, was amazing on inpatient, dedicated to rural full-scope FM (without OB) and not shy about taking on tough cases, and despite this the place chewed him up in less than two years.

Work as hard as you can on the non-compete. If they want and need you, they'll at least agree to shorten the distance or shorten the term. These places are not your friend, this is a business relationship, and they will look for every opportunity to squeeze more out of you without compensation. For my job I took a 10-15% pay cut compared to other offers to be at a place without a non-compete so I could have an out if things went bad.

 

[Cranjis McBasketball]

I would be very cautious with a non-compete in a smaller area.

A friend of mine out of training moved back to their rural hometown and got what seemed like a great job offer (promised the world, rural full scope w/o OB, paid well, gave stipend in last year of training, told him they'd "ease" him into the practice, reportedly good access to specialty care or at least as good as you'd expect, etc.), but it had a 50 mi non-compete for 2 yrs.

When he got there turnover was insane, within 6 mos 2 physicians and a midlevel left leaving him alone there, clinic managers left, tons of trouble keeping any staff, so he was rooming his own patients. Instead of "easing" him into it, he was suddenly full, getting constant pressure to take on more patients in the name "access". It was hard to actually use PTO because even then they still called him on vacation and even to schedule it they gave him a hard time for cancelling (he was booked out months ahead). They kept saying they were hiring new people/locums, but didn't for over a year saying it was hard to recruit. From the beginning he refused to supervise midlevels, but that didn't stop them from constantly asking and pressuring him to supervise NPs without any admin time or additional pay, even though its a FPA state.

He started hating medicine, spending 12 hrs+/day there but paid the same (guaranteed salary). His wife had found a secure job (also physician), they had kids, family was nearby, had a house, and he was stuck, but left anyway at 18 mos for his sanity, and he only lasted that long because of the guilt of leaving his patients. He had to pay back a ton of the money in bonuses/stipends during residency (upper 5-figures). Magically when he left they hired locums immediately and within 6 mos had a fresh grad signed up. Because of the non-compete, he couldn't work for >8 mos anywhere, and it wasn't until he got a ton of medical licenses in other states that he could actually find a telemed place that would take him with <2 yrs experience.

This was in a midwest state desperate for physicians with huge demand for any healthcare, but no lawyer thought it was worth fighting the non-compete and the system was notorious for pursuing 6-figure payouts for physicians to get out of it. This guy is genuinely one of the best FM physicians I know, very efficient, very motivated, studied constantly, was amazing on inpatient, dedicated to rural full-scope FM (without OB) and not shy about taking on tough cases, and despite this the place chewed him up in less than two years.

Work as hard as you can on the non-compete. If they want and need you, they'll at least agree to shorten the distance or shorten the term. These places are not your friend, this is a business relationship, and they will look for every opportunity to squeeze more out of you without compensation. For my job I took a 10-15% pay cut compared to other offers to be at a place without a non-compete so I could have an out if things went bad.

Thanks for your input. Ill make sure to put the non-compete at the top of my list of things to try and negotiate. This initial contract i know is anywhere nearby (the city, suburbs, etc) for 1 year after. So I basically would have to move away if I got out after 2 years.

 

[hallowmann]

Thanks for your input. Ill make sure to put the non-compete at the top of my list of things to try and negotiate. This initial contract i know is anywhere nearby (the city, suburbs, etc) for 1 year after. So I basically would have to move away if I got out after 2 years.

I would work hard to shrink the radius honestly. That sounds like a big area. Also pay very close attention to the wording and absolutely use a lawyer, ideally one well-versed in medical contracts in that area. If they indicate that the radius is from any clinics affiliated with the institution the radius can be way bigger than you'd think it is. Its also typically as the crow flies and not driving distance, which again probably covers a bigger area.

 

[Cranjis McBasketball]

Coming back for more info: productivity bonus is $46.75 and starts after I hit 5561 wRVUs.. This seems like a lower reimbursement and a higher threshold, but am I wrong? My research has led me to see the average being closer to $50-51 and average wRVU in family medicine to be closer to 4800ish. Thoughts?

 

[Ironheme]

I would work hard to shrink the radius honestly. That sounds like a big area. Also pay very close attention to the wording and absolutely use a lawyer, ideally one well-versed in medical contracts in that area. If they indicate that the radius is from any clinics affiliated with the institution the radius can be way bigger than you'd think it is. Its also typically as the crow flies and not driving distance, which again probably covers a bigger area.

My favorite contract was one that said non-compete within 50 miles of any potential *future* location of the institution.

 

[B1GM0N3Y86]

So basically you are being paid $46.75/wRVU generated while working through your base. This is your conversion factor.
- $260,000 base ÷ 5561 wRVU needed produce prior to getting into productivity bonus gives this number. Your productivity bonus conversion factor will be the same as when your working through your base.

You can attempt to negotiate a higher conversion factor, but I don't think that's too bad already at $46.75. Don't hurt to ask to see if they'll come up. Most places I saw, prior to me signing on to a collection based payment model, was the employer will want to skim 10% off this median conversion factor of $51/wRVU.

Now, the higher wRVU needed for you is likely due to 2 things: you having slightly lower conversion factor but also def a higher base pay than the median base pay in FM. Due to this, you'll need to crank more wRVU out to get thru your base before you get into productivity bonus land.

Of note, MGMA data shows that the Median TOTAL Compensation
for FM outpatient is around ~$250,000. Now looking over your offer, you are starting at 260k base pay and you still have other things that'll go into your total comp like any signing bonuses, relocation bonuses, etc... so at least while you are on your guarantee, the total comp is above the reported median.

 

[SLC]

You won’t have any luck negotiating much, I think this is the same company I work for. Huge standardized contract company wide. Good news is it’s a more than fair contract.

You might get the non-compete changed, but it’s not a bad one. You’re usually geographically limited for a while if you’re rural (I couldn’t practice in the county for 3years if I left early when I was rural). If not rural, the non compete may pertain to your ability to be empaneled on the company’s insurance plan (which is the major insurer in the area I’m in now) for a few years, it is otherwise non-restricting geographically.


I just had an office partner in my current suburban location (for the same company) switch to work for a competitor; she is literally just down the road now, tons of her patients followed her to the new location.
She can’t take the company’s insurance plan, which means several of her patients couldn’t follow her, but several could and she is doing just fine there.