Let's be honest here. There was once a time when I naively believed that as professionals we would look out for each other and treat each other with respect and kindness. That was until I was offered my first real employment contract. This was about two years ago, after I had decided to leave my fellowship and was floundering about trying to figure out what the heck I was supposed to do with my life. In the process, I had interviewed with a private practice in an affluent community, a community health center in an underserved community, a private practice in a middle class community, a pseudo-academic peds hospitalist group, a community peds hospitalist group, a neonatal hospitalist group and an ethics fellowship. Oh, and I tried to submit an application at Borders but my husband wouldn't let me. I was clearly a bit directionless. That being the case, when I was offered a position with a private practice, I jumped at the chance to settle into a life polar opposite to what I was living as a fellow. After getting the contract (a 20 page monstrosity) I decided to have it looked over by a lawyer simply as a formality. That flip decision ranks as one of the most important in my life to date. Who knew? This blog, my friends, is dedicated to the road not taken and I hope that a little tidbit from here makes a difference to at least one little starfish...
Lessons I Learned About Contract Negotiation, Part 1:
1. Don't treat yourself to a celebratory dinner and bottle of wine until the ink is long dried on the contract that you successfully negotiated to your liking.
2. Spend whatever you have to on a lawyer experienced in physician contracts to look over yours. Just do it. Please.
3. Don't be so enamored with your base salary that you ignore how your raises and bonuses will be determined. "Physician's base salary will be reviewed and adjusted if necessary" does not cut it. If it's not in the contract, it doesn't exist.
4. Tail insurance coverage = big deal. Typically, the tail is about twice the cost of the annual premium. So, if the 1st year premium for you is $6000, the tail is $12000 for that first year. In many practices, until you become partner/shareholder (more on this later) you are responsible for the cost of your tail (or a portion) if you leave for any reason. This is why some say that joining a private practice is like getting married. You better be damn sure that's what you want or else it will come back to bite you in the tail (I couldn't resist). This could potentially be thousands of dollars you will owe the practice when you leave. Ouch!
5. Restrictive covenants are standard nowadays. They are otherwise known as 'non-compete clauses'. Make sure that they don't prohibit you from practicing anywhere else in a reasonable drive from where you live. E.g. a radius of 7.5 miles in Chicago is pretty rough. In Phoenix? Not so bad. Get out a map and use it.
6. Termination. It could happen to you. The following sentence is a red flag "Employer may terminate this agreement immediately if...Physician engages in conduct that, in the sole discretion of Employer, is detrimental to patient care or to the reputation or operations of Employer." Wow. That basically says that they can make up a reason not to like you and fire you immediately. Here's another one, "... the other party shall have no rights to cure or contest the termination of this Agreement." I can't even contest it?? This clause smacks of the "Because I said so" mantra of my mother when I was young.
7. Here's another one of my favorites. "Physician agrees...not to make any disparaging remarks to any third party concerning Employer or any of its officers or directors...throughout the term and at all times thereafter." Really? You mean I can't say anything nasty about the unreasonable and freakishly controlling contract you offered me? I can if I didn't sign it. ;)
8. Clarify your vacation time/CME time/sick leave. Especially if you see a rule like this one. "Excused time for illness extending more than two days requires a consultation with your primary care physician." Ignoring the obvious fact that you are a primary care physician, when was the last time you needed a note from your doctor to prove you were ill? Wait, am I actually reading that application for Borders? Sadly, no.
That wraps up Part 1 of contract negotiation, otherwise known as "Learning from my Almost-Mistakes". The statements quoted above may or may not have a basis in fact. They may or may not have come from a contract I was once offered and still have if only to remind me of how close I came to misery. That lawyer charged me $800 to review my employment contract. Pricey? Sure. Priceless? Absolutely.
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