Negotiating a Post Residency/Fellowship Contract

negotiate your post-residency employment contract 1

One of the most important points in  every physician’s job search comes right at the end of residency or fellowship – when it’s time to negotiate your first physician employment  contract. However, this is the part many physicians are most uncomfortable with. Many young physicians mistakenly believe that they should not try to negotiate their contracts. Often they fear that negotiation could jeopardize the job offer. However, it is virtually unheard of for a hospital or practice group to revoke an offer because a physician asks to negotiate the terms of the contract. Indeed, total passivity about the terms of the contract will only lead the hospital or practice to conclude that the physician doesn’t care about contract terms of importance to the hospital or practice, or alternatively doesn’t care about securing contract terms, not found in the initial contract, which would be favorable to the physician. The secret known to all experienced physician contract lawyers is that all physician contracts are negotiable.

Once you understand that it is important to actually review and negotiate the contract terms, the next question is whether you should review and negotiate the contract terms yourself or hire a lawyer to represent your interests. There may be a temptation to go it alone. This would be a mistake. What may appear to be straightforward text, most assuredly is not. Physician employment contracts are complex, have hidden landmines, cover detailed and often confusing subjects such as professional liability insurance and “tail” coverage,” have “claw-back” provisions that take back compensation and benefits under certain circumstances, and may or may not cover all  the subjects that need to be covered from the physician’s perspective (e.g., signing bonus, relocation expenses, student loan repayment, etc.). In other words, you cannot just react to what is set forth in the proposed contract, but rather need to be proactive in insuring that your needs and wants are covered in the contract.

What type of attorney should you hire?

Once you decide to hire a lawyer, not all lawyers are created equal. A general business lawyer, such as an attorney who handles real estate transactions for your family, may not be the right lawyer to review your physician employment contracts or letter of intent. Just as there are physicians who specialize in different aspects of the practice of medicine, there are lawyers who specialize in healthcare law and more particularly in reviewing and negotiating physician employment contracts.

The lawyer should take seriously the need to work strategically and collegially with you, and not only review the contract presented to you by the hospital or practice, but rather start with an in depth discussion of the physician’s current situation, short and long-term goals, and what he/she should  want to see in the contract. The contract review lawyer should then review the proffered contract and prepare a written memorandum offering  written comments and suggestions  addressing the terms of  the proposed contract. The contract review should be thorough, covering all the most important terms, not the least of which are the compensation provisions. The most experienced physician contract review lawyers will examine the reasonableness of the compensation, and not leave anything on the table. There should be a comparison of the compensation offered with MGMA benchmarks for the physician’s specialty, including an analysis of vacation, CME, guaranteed compensation, sign-on bonus, and relocation allowance. The benefits being offered should be reviewed with the physician, as well as call coverage requirements, and professional liability insurance coverage, including “tail” coverage. The contract review lawyer should then “redline” edit the proposed contract to delete noxious provisions and add favorable terms.  Finally, the contract review lawyer should stand with you every step of the way, and either directly or indirectly negotiate multiple iterations of the contract terms until you are fully satisfied with the contract.

Not all contract review lawyers provide this kind of thorough contract review physician representation. Of course you get what you pay for! Concierge Healthcare Attorneys, LLC offers flat fee (no hourly billing) physician contract (and letter of intent) review and negotiation services for graduating medical residents and fellows in all 50 U.S. States. This service includes unlimited text, email and telephone communications with my clients. I am the ultimate healthcare law insider, having held general counsel positions with two academic healthcare systems, and a senior counsel position with the American Medical Association, before opening my concierge healthcare law practice. Having held these insider positions, I am well versed in negotiating post residency and fellowship physician employment contracts on behalf of both hospitals and physicians.

For a more detailed discussion of physician contract review and negotiation, see: https://conciergehealthcareattorneysllc.com/physician-contract-attorney/.