Physician employment contracts

Physician contracting is becoming extremely important today, as more physicians are working for hospitals, large health systems and multiphysician practices in nonownership roles.

Medical Economics® recently sat down with Richard Roberts, M.D., J.D., a professor emeritus of family medicine at the University of Wisconsin School of Medicine and Public Health. Roberts was an attorney and has counseled numerous young doctors on employment matters and contracts. He believes it is very important for doctors to investigate the core culture of a potential employer before signing a contract with them. The below transcript of this interview was edited for length and clarity.

Medical Economics®: Why is it important for doctors to learn about the culture of a particular institution or practice before going to work for them?

Roberts: The typical physician will spend more awake hours at work than with his or her family and friends. …The sense of your feeling welcomed and supported, and the sense of professional growth, those are all the things that make a workplace a good or bad place for you to be. And so, if you don’t get that, it really doesn’t matter what the contract says because you’re going to be miserable.

ME: How can adoctor investigate a potential employer to learn about their culture?

Roberts: Usually it’s about just asking the physician recruiter, that’s typically the first person you’ll be talking with about the job; talking with other physicians, especially in your department; the staff that are there, even those employees sitting out in the reception area; and watching how the receptionist and patients interact. Do the nurses seem to enjoy working with each other? Is there a sense of teamwork and camaraderie? These are all key.

And then you can step away from the practice and ask the community. Ask doctors in the community, ‘What do you think of this group? I’m thinking about joining them.’ The nurses are often, in many ways, the better people to ask because they typically have more interaction with the physicians from the group you’re looking to join. So, it’s that kind of reaching out.

ME: Are there areas of flexibility where doctors can negotiate in a contract, and what are some typical examples?

Roberts: Absolutely, there are all kinds of areas to negotiate. But when hospital people say to me or to a young doc, ‘Well, we try to treat everybody the same,’ my immediate answer is, ‘Does that mean the custodial staff is getting paid the same and has the same benefits as a CEO?’

The reality is, nobody is exactly the same as anybody else, because people have unique needs. You may have a young mom who’s got scheduling needs that don’t match what the typical young male physician may feel is a good schedule for him. If the contract doesn’t reflect that, it has not done a good job of really identifying and addressing the priorities of the individual. It’s in the organization’s best interest to try to make you happy. Yeah, you do take up more of their time. Yeah, you do generate more legal fees for them as these things have to be reviewed by their lawyers. But hey, it’s your life.

In an ideal world, at the end of the day, when both you and the organization are prepared to sign, you can both look at that set of papers and say, ‘This is pretty good. This meets our needs but isn’t perfect.’

ME: Can you talk about the
concepts of must-haves and
deal breakers?

Roberts: The example that I’ll often turn to is …the group at Harvard called the Harvard Negotiation Project (cofounded) by professors Roger D. Fisher and William L. Ury. Their book called Getting to Yes lays out some basic ideas on what they call “principled negotiation,” because their view is that if a contract …or an agreement unfairly gives one the advantage over the other party, it’s in the end not going to succeed.

I usually say to people to identify two to three things. One thing might be having the ability to do certain kinds of procedures. And if that’s something that’s really, really important to you, put it in the agreement. On the other hand, there may be certain things that you’re being asked to perform, a certain task or service, and you absolutely cannot deal with that or don’t want to do that. So, it should say, basically, in the agreement that you don’t have to do them. But it’s not an infinite list, because then you’ll never manage to get through the contracting process. It’s a list that really highlights the few things both that you must have and that are deal breakers.

Now, the thing to be careful about in all of this is that language is important and the tone that we set is important. I think, as a physician, you always want to be professional, you want to be polite. You want to assume good intentions on the other party’s part. But you also need to ask good, hard questions and not be afraid to push gently but persistently.

ME: Can you provide a stepy-by-step guide for thinking through a job offer?

Roberts: Well, just like planning for a procedure or visit with a patient in the office, I think the first step is (that) you want to think ahead. And that means planning and prioritizing and developing an overall game plan with a pretty clear sense of the things that you really need to have to be a happy, successful physician and the things that you really must avoid or must not have. Now, you may only be able to identify one or two, that’s fine, or you may identify 10. That’s not so good. But you want to make sure that whatever you’ve identified as key issues for you and for those who are important to you in your life are reflected in the document.

Don’t ever be afraid to speak up for yourself. I think many times, we physicians are so used to deferring gratification and putting the needs of others before ourselves that we feel a little embarrassed asking for this or asking for that, especially when you go from kind of minimum wage jobs as a college student to pretty substantial salary offers. When the recruiter or whomever you’re talking with from the organization says to you, ‘Well, this is the same agreement that everybody signs,’ my advice is that your first response should be, ‘I’m not everybody.’ And I tell people, when you get the first draft of the contract –– because it’s always written by the system’s lawyer not by your lawyer –– change something, even if it’s the date, because under the law, the two bargaining parties have equal rights until you sign on the bottom line. Because what you do when you sign a contract is you give away certain rights to the employer. So, you want to be sure that your rights are protected sufficiently around the things that you care the most about.

And the third thing that I would say is you need to always be thinking ahead and reflecting on this whole process as your career plays out, because what you find is that most people today, especially professional people, usually have several careers. And not only in terms of where we might work, but the particular kinds of duties or jobs. And so, as a young physician, I’m going to find myself constantly going through this prioritization and identifying what I must and must not have, in terms of my list, the standard of living that I’m trying to fund, the investments I’m trying to make for my children’s future — all the things that we all have to think about. And always doing that on a regular basis puts you in a better position when something comes up that feels more pressured or all of a sudden.

It’s the planning ahead that keeps you out of trouble.