Know the market and be reasonable when requesting changes.
It’s always scary when a physician gets that first job offer. Is it fair and reasonable? Will the physician look like a jerk if he or she fights back or creates a host of red edits? Often there is pressure to sign quickly, or the group or hospital tells a physician that “there is no use editing it.” This can be demoralizing and difficult for providers to manage. But not all hope is lost. Physician contracts are being adjusted and edited every day, especially in the post-COVID-19 market where staffing shortages and physician burnout abound. As a health lawyer, I do this every day. But here’s the real kicker: Trying to ask for everything and the kitchen sink, or using the outdated methods of “aim high and settle low,” simply don’t work in this context. A doctor has to know the market and be reasonable in the changes requested.
Here are three ways physicians can actually get traction when negotiating their employment agreement.
Doctors are an integral part of any community, but if your sub-specialty is unique, or you are in a rural area with limited providers who specialize in your field, this can give you leverage. Know your value before you start the negotiation process, so if the letter of intent or terms come back woefully low, you can stop things before they go too far.
A provider should be encouraged to push for market value. Doing so isn’t greedy or overreaching. But if the Medical Group Management Association’s values are showing that the offer to you is extremely low, you should push back. Also, think like the employer. Do you offer something they need? Do you have any special skills others do not, or can you add some value to a potential employer that pushes you ahead of the pack? Point this out first, then follow that with a salary demand that’s within market value. And don’t forget to ask for a sign-on bonus.
This isn’t personal, and it’s not a reflection on you as a human being. It’s a business discussion, so talking to a potential employer about compensation and noncompetes isn’t rude or disrespectful. It’s necessary and expected. If a potential employer says they cannot budge on a certain business term, that doesn’t mean they don’t like you or see your value. They simply may not be in a position to give you what you need.
Don’t get wrapped up in the fancy dinners, interviews, and the feel of the clinic, which can make you forget the basic premise that this is a business transaction. At a minimum, this contract is going to be important to the next few years of your life. That being said, you are always free to show positive emotion. Show a practice how excited you are about the job, how anxious you are to get started, and how much you enjoy the people who work there. Just don’t let it cloud your judgment and end up clinging to promises that a potential employer may not enforce certain provisions down the road. If it’s not in the contract, it doesn’t exist.
Your lawyer may find seven things to fight for, but at the end of the day you may need to only push for four. Sit down with your attorney or adviser and advocate for the things that are most valuable to you. If you have multiple job offers presented and are highly sought after, you may push for more. But the standard physician is looking at one job offer after a round of various interviews and very much wants to make things work. Focus on what could be most impactful. Is the salary fair? Can you get out of this agreement unscathed? Are there provisions that will bind you after you leave that you can narrow?
In this tight market, it’s important to know your value, but also be reasonable when trying to get what you want. Keep your eye on the prize and push for things that matter. If you go through this process and your potential employer won’t compromise, consider if this business deal is one you’re willing to take. Walking away is a perfectly acceptable choice.
Amanda Hill is an Austin, Texas-based health care attorney and founder of Guard My Practice, an online video platform for doctors in 15-minute weekly sessions guiding them through complicated subjects with ease, such as contract negotiations, fraud and abuse issues, employment conflicts, the basics of setting up a practice, and more.