Written about doc's - mostly applies to us as well

[ventana]

http://www.medpagetoday.com/resource-center/Infectious-Diseases/Shifting-Employment-Landscape/a/52410?xid=nl_mpt_DHE_2016-11-04&eun=g1096150d0r&pos=6     A Shifting Employment Landscape Demands New Negotiating Tactics for Docs

By Paul Cerrato

Reviewed by Drex DeFord, Independent Consultant; previously, CEO at Next Wave Connect; CIO at Steward Healthcare (Boston); CIO/Senior VP at Seattle Children's; Chairman, CHIME Board of Trustees

 

Take Note

• According to a recent survey, 61% of residents are looking to take on positions as employees when they finish their training.
• The AMA warns job applicants to be wary of unreasonable demands: “Employed physicians should be free to exercise their personal and professional judgment in… any matter regarding patient care interests, the profession, health care in the community, and the independent exercise of medical judgment.”
• If recruiters speak about a “standard contract” that everyone is signing, think twice about joining the organization.

 

A post on the New England Journal of Medicine Career Center site sums up the shifting job market for physicians succinctly: “With increasing frequency, both practicing physicians and those graduating from training are seeking employed positions.”1 From 2000 to 2010, for example, the number of physicians who worked for hospitals jumped by 34%.1 And a survey sponsored by Merritt Hawkins, a recruiting firm, suggests that 61% of residents are looking to take on positions as employees when they finish their training.1

That outlook is consistent with the fact that a growing number of hospitals and health systems are buying medical practices, which frequently turns independent practitioners into employees. With this shift in employment status come challenges for physicians who once spent much of their time negotiating with insurance companies but now find they have to also start thinking about negotiating contracts with their new employer.

Professional groups like the American Medical Association offer some useful advice on the subject. AMA urges physicians to “obtain the advice of legal counsel experienced in physician employment matters when negotiating employment contracts.”2 The association is also concerned about potential conflicts of interest embedded in employment contracts that may prevent clinicians from offering patients good quality care. As it points out in AMA Principles of Physician Employment, if a contract offers financial incentive to over- or under-treat patients, these issues need to be addressed upfront. Specifically the association says: “Employed physicians should be free to exercise their personal and professional judgment in… any matter regarding patient care interests, the profession, health care in the community, and the independent exercise of medical judgment.”

The freedom to make independent medical judgements is only one of many issues that physicians need to consider before they sign an employment contract. In fact there are so many complexities involved that the AMA’s advice to seek legal counsel before signing on the dotted line makes absolute sense.

Dennis Hursh, a lawyer who is a member of the American Bar Association’s Health Law Section, says that when employers offer a new physician a staff position, they may sometimes use language like: “We’ll send you our standard contract, which we all have signed.”3 In Hursh’s view, if you hear that “standard contract” line, the recruiter “is either misrepresenting the situation or is misinformed… The secret all experienced attorneys know is that all contracts are negotiable.”3

So what needs to be negotiated? Compensation and performance requirements are two obvious issues. But also be aware of any restrictive covenants that the contract may contain. Typically these contract clauses will prohibit you from practicing medicine within a certain distance of the employer if you decide to leave the practice or hospital. And they will typically require you to adhere to this restriction for a specific period of time. Hursh has represented more than one physician who found such restrictions put a major roadblock in their career path when they wanted to move to a new practice a few miles from their former employer. “Sometimes the charming Dr. Jekyll who interviewed you turns into a real Mr. Hyde in day-to-day dealings.”3

Jackie Caynon, a partner at Mirck O’Connell’s Health Law Group, concurs. During a recent email exchange, he said: “Noncompete clauses can be dangerous for the newly-employed physician because if they are enforceable against the physician, it may require the physician to move away from the area where the physician has just settled in with his/her family.” Caynon also warns physicians about a contract between a physician and a hospital that contains a mutual indemnification clause or hold harmless clause. “These kinds of clauses come into play if a patient sues a physician for a medical malpractice case and alleges vicarious liability against the hospital where a physician is working. If a physician agrees to indemnify the hospital and the jury decides the hospital is liable, the physician may be on the hook to pay the judgment rendered against the hospital as well as its attorney fees and court costs,” he added.

When it comes to negotiating salary and benefits, job candidates need to be realistic about the amount of money a practice will have available for compensation. Practice revenue depends on payments from patients and insurance companies, but any agreements with payers require those payments to be well below the amount that the practice lists as charges for its services. Similarly any revenue has to be tapped to pay administrative staff and cover operating expenses.4 Nonetheless, you can reasonably expect any salary offer to be at least close to what your colleagues are getting in the same region and with the same credentials.

When it comes to negotiating an equitable employment contract, the American College of Physicians agrees with Dennis Hursh on at least one major issue: ACP believes it would be a mistake for residents to assume they have no bargaining power and must accept any contract offered “in toto.”4 But on the other hand, ACP takes the position that it would also be a mistake to assume that everything is negotiable.

ACP also discussed the pros and cons of hiring a third party to sit in on contract negotiations: “A skilled negotiator can evaluate terms, re-draft contract language, and bring additional negotiating expertise to the table. The right consultant may also help the negotiations build a win/win agreement without creating discord. However, involvement of a third party lawyer or contract negotiator to help the physician can also introduce some tension in the relationship with the group, especially if the practice itself prefers not to employ such outside professional assistance.”

 

 

Published: 07/26/2016

References:

1. Darves B. NEJM CareerCenter: Understanding the Physician Employment “Movement” July 23, 2014.
2. American Medical Association. AMA Principles for Physician Employment. 2013.
3. Hursh D. The Final Hurdle: A Physician’s Guide to Negotiating a Fair Employment Agreement. Advantage Media Group. Charleston, SC. 2012.
4. American College of Physicians Center for Practice Improvement and Innovation. Physician Employment Contracts.

 

[LKPAC]

very interesting.  thanks for posting.

[FSUnoles]

yep my doc just signed a new contract with hospital system (we are academic) they tried to lock him into 3 years. he obviously made them remove it but he also is seasoned and could demand them to remove it. i suspect a new grad would be suckered in