Ask the ZZLP Docs (or other contract workers)

[CFordUNC]

I know there are several doctors, lawyers, and possibly other contract professionals in this community so I wanted to get some insight from y'all. We're in the contract negotiation stage right now after choosing between two great offers for two different jobs- one was at an academic medical center and one is private practice. We've selected the private practice offer, where I think there may be a little more room for negotiating. Academic medicine seems like the offers for first-time attendings are pretty standard/boilerplate and therefore little to no room for negotiation, but practice practice seems more open to it.

For background info, this private practice offer is for a partnership/ownership track where, after working a certain number of hours (typically ~3 years), you have the opportunity to become a partner. It's a 100% physician-owned practice. The first three years as an associate (pre-partner) are salaried with a transition from straight salary for the first 6 months, to more RVU-based production from month 6 through month 36, at which point as a partner from month 37 onward, it is strictly 100% RVU-based. Once partner, you have the opportunity to also buy into a capital account for profit-sharing.

My questions are:

1. Where are there typically the biggest opportunities for negotiating a first-time attending contract? I don't think we can negotiate starting salary, for multiple reasons, but not the least of which is because the starting base salary of the private practice offer is already more than double that of the academic offer. Once you make partner and participate in profit-sharing, the total compensation is essentially 4x the academic offer. So I don't think there's any room for negotiating compensation.

2. The non-compete clause seems pretty draconian; you can't work for any competitor health system within a certain radius for a minimum of 20 months after separation from this practice (or there are some really steep financial penalties), and you can't moonlight at all at any other practice or with any competitor healthcare system, period. Obviously it's hard to know what we'll want to do 10, 15, 20 years from now, or whatever, but since we don't have any interest in working for any of the competitors or moonlighting at all, is it worth trying to negotiate the non-compete at all?

3. Assuming we can't (wont) try to negotiate anything from a compensatory standpoint, and also assuming we don't really need to negotiate the non-compete clause, is it worth trying to negotiate the size of the signing bonus and/or relocation bonus?

4. Should I pay to have a physician-specific contract review service take a look at this contract? It's not inexpensive by any means to do so, but obviously in the grand scheme it'd be a drop in the bucket compared to being saddled with a contract that I don't fully understand.

Just trying to wrap my head around this kind of stuff for the first time and want to make sure I'm not missing anything or blindly signing what I don't understand. Thanks a ton for any advice or insight anyone is willing to share.

 

[ZenMode]

Am I wrong, or did you say in another thread that you had an opportunity to travel overseas, at some in the future, as part of your job? Was that this job you're talking about or do I have the wrong poster?

I ask because, if traveling internationally part of your job, it's not a bad idea to negotiate that all international travel is Business class or higher. Business class is much better than Coach and you can sometimes get a good last minute deal to upgrade to First at the airport.

 

[BlooVooDoo]

I have nothing to offer with respect to private practice medicine, but the academic physicians I work with have shared strong opinions about how much better they have it (work-life balance, benefits as a university employee, stability) compared to private practice with the exception of salary but the salaries do get more competitive as they climb faculty ranks.
One friend has had 4 children prior to earning tenure. She said that wouldn’t have been possible in private or corporate medicine without major (negative) implications for her career path.
I’d personally be a bit nervous right now entering into revenue focused medicine with so much uncertainty around ACA and potential threats to Medicare and Medicaid. Granted, I’m quite risk averse with things like that and value stability, but I know our healthcare admin have had talks about expansion plans in light of the election results, so I think it’s not an outlandish concern.

 

[farce©]

I thought your wife was in emergency medicine?

 

[CFordUNC]

Am I wrong, or did you say in another thread that you had an opportunity to travel overseas, at some in the future, as part of your job? Was that this job you're talking about or do I have the wrong poster?

I ask because, if traveling internationally part of your job, it's not a bad idea to negotiate that all international travel is Business class or higher. Business class is much better than Coach and you can sometimes get a good last minute deal to upgrade to First at the airport.

Yes sir! You had it correct. I just did an awful job of clarifying in my OP. My wife is the physician, not me. I’m not in medicine. I do potentially have the opportunity to work internationally in the coming years, so that bit of advice in your second paragraph is very helpful. Appreciate you!

 

[CFordUNC]

I thought your wife was in emergency medicine?

She is- you’re exactly right. She is emergency medicine and then did specialization fellowships in critical care/trauma and point of care ultrasound. The private practice model is pretty common in emergency medicine; they just contract with big health systems like Atrium, Novant, WakeMed, etc.

 

[CFordUNC]

I have nothing to offer with respect to private practice medicine, but the academic physicians I work with have shared strong opinions about how much better they have it (work-life balance, benefits as a university employee, stability) compared to private practice with the exception of salary but the salaries do get more competitive as they climb faculty ranks.
One friend has had 4 children prior to earning tenure. She said that wouldn’t have been possible in private or corporate medicine without major (negative) implications for her career path.
I’d personally be a bit nervous right now entering into revenue focused medicine with so much uncertainty around ACA and potential threats to Medicare and Medicaid. Granted, I’m quite risk averse with things like that and value stability, but I know our healthcare admin have had talks about expansion plans in light of the election results, so I think it’s not an outlandish concern.

All fantastic points and worthy of consideration! Thanks a ton for your insight. I had initially had the same exact thoughts about the benefits of academic medicine versus private practice. I think my wife had always been set on doing academic medicine but then realized after 7 years of residency and fellowship that she wants to just practice clinically without any of the teaching, research, non-clinical responsibilities, etc. And the private practice offers one fewer shift per month than the academic offer (14 8-hour shifts vs. 15), fewer overnight shifts per month (1-2 vs. 3-5) and no other non-clinical responsibility. The non-salary benefits are roughly equivalent; the PP has an incredibly good retirement match as does the academic option, but the academic offer has it beat on insurance.

 

[farce©]

I ask because, if traveling internationally part of your job, it's not a bad idea to negotiate that all international travel is Business class or higher. Business class is much better than Coach and you can sometimes get a good last minute deal to upgrade to First at the airport.

Most companies of substantial size have pretty strict policies about travel. I’ve worked for companies which wouldn’t allow any travel other than coach. Another employer would permit business class for all flights over 8 hours. Another had rules based on your level in the company, other required prior approval on a case by case basis by the division president. If you’re dealing with a smaller company with more malleable policies, everything is on the table but with most you have to have some rank to negotiate around written policy and not a lot of managers would have the authority to approve it anyway.

 

[CFordUNC]

Most companies of substantial size have pretty strict policies about travel. I’ve worked for companies which wouldn’t allow any travel other than coach. Another employer would permit business class for all flights over 8 hours. Another had rules based on your level in the company, other required prior approval on a case by case basis by the division president. If you’re dealing with a smaller company with more malleable policies, everything is on the table but with most you have to have some rank to negotiate around written policy and not a lot of managers would have the authority to approve it anyway.

Yep. The travel rules for my company are that business class can be booked for any flights 6+ hours, which makes sense but is funny because the longest domestic flight for me is 5 hours 45 minutes. But anything 6–9 hours can be booked business class, and I believe anything longer than 10 hours can book international first class.

 

[CFordUNC]

Went ahead and decided to get the contract review service. I sat here today and twice tried to read that contract word for word and wrap my head around it and my head was swimming. Found a great one called Contract Diagnostics that is entirely physician-owned/operated with an in-house legal team.

 

[ZenMode]

Most companies of substantial size have pretty strict policies about travel. I’ve worked for companies which wouldn’t allow any travel other than coach. Another employer would permit business class for all flights over 8 hours. Another had rules based on your level in the company, other required prior approval on a case by case basis by the division president. If you’re dealing with a smaller company with more malleable policies, everything is on the table but with most you have to have some rank to negotiate around written policy and not a lot of managers would have the authority to approve it anyway.

There are definitely several factors. A larger, publicly traded company will likely have a "corporate policy". Smaller ones may not have a set policy and will negotiate.

It can't hurt to ask.

 

[uncjhodges]

I’m in Primary Care and have been out of residency for about 8 years. I’ve had 3 jobs now due to moving etc and have worked in physician owned private (originally when i signed and then wasn’t when i worked), private big umbrella, and working for Duke.
I’ll try to answer most of the questions
1. the easiest place to negotiate is sign on bonus, moving stipends, loan repayment, etc. Ive been able to increase my sign on bonus each time.
2. Non competes are stupid, particularly for emergency medicine. I can see the pt in primary care as I had patients that were willing to follow me from job 1 to 2, even though it was an hour and a half drive. I’m not sure how enforceable they are and no one ever asked me where I was going to work when i put in my notice. Usually they care far more about giving them time to recruit your replacement- had to give 5 months notice at each place
3. For me, I much prefer the salary as compared to rvu based pay. I made more at the latter but the burn out was real and made me feel gross as they were constantly pushing billing higher
4. there’s a high likelihood that she won’t like the first job anyway- that’s pretty classic and as you get more aware of how you want to work, your style, what you like, etc you’re able to match that better. Just make sure you have outs. I would have someone review the contract but they are typically fairly standard

 

[Callatoroy]

Sounds like there is some good advice / points for consideration in this thread so far. I have nothing to offer other than you didn't mention cost of living or whether one location is preferable to another.

Congratulations to you and your wife. Sounds like you are in a win / win situation.

 

[superrific]

I know there are several doctors, lawyers, and possibly other contract professionals in this community so I wanted to get some insight from y'all. We're in the contract negotiation stage right now after choosing between two great offers for two different jobs- one was at an academic medical center and one is private practice. We've selected the private practice offer, where I think there may be a little more room for negotiating. Academic medicine seems like the offers for first-time attendings are pretty standard/boilerplate and therefore little to no room for negotiation, but practice practice seems more open to it.

For background info, this private practice offer is for a partnership/ownership track where, after working a certain number of hours (typically ~3 years), you have the opportunity to become a partner. It's a 100% physician-owned practice. The first three years as an associate (pre-partner) are salaried with a transition from straight salary for the first 6 months, to more RVU-based production from month 6 through month 36, at which point as a partner from month 37 onward, it is strictly 100% RVU-based. Once partner, you have the opportunity to also buy into a capital account for profit-sharing.

My questions are:

1. Where are there typically the biggest opportunities for negotiating a first-time attending contract? I don't think we can negotiate starting salary, for multiple reasons, but not the least of which is because the starting base salary of the private practice offer is already more than double that of the academic offer. Once you make partner and participate in profit-sharing, the total compensation is essentially 4x the academic offer. So I don't think there's any room for negotiating compensation.

2. The non-compete clause seems pretty draconian; you can't work for any competitor health system within a certain radius for a minimum of 20 months after separation from this practice (or there are some really steep financial penalties), and you can't moonlight at all at any other practice or with any competitor healthcare system, period. Obviously it's hard to know what we'll want to do 10, 15, 20 years from now, or whatever, but since we don't have any interest in working for any of the competitors or moonlighting at all, is it worth trying to negotiate the non-compete at all?

3. Assuming we can't (wont) try to negotiate anything from a compensatory standpoint, and also assuming we don't really need to negotiate the non-compete clause, is it worth trying to negotiate the size of the signing bonus and/or relocation bonus?

4. Should I pay to have a physician-specific contract review service take a look at this contract? It's not inexpensive by any means to do so, but obviously in the grand scheme it'd be a drop in the bucket compared to being saddled with a contract that I don't fully understand.

Just trying to wrap my head around this kind of stuff for the first time and want to make sure I'm not missing anything or blindly signing what I don't understand. Thanks a ton for any advice or insight anyone is willing to share.

1. You should be able to negotiate the non-compete. My wife did. Take it down to a year. If Kamala had won, we might not have to worry about this because non-competes would go away, but alas. You're not going to get moonlighting and you shouldn't want it.

If the non-compete is limited to "competitor health systems," as opposed to any competitive practice, that's pretty good honestly. But this is where the devil is in the details. Does it say "competitor health system"? What is the exact language?

2. Hire the attorney if she's going to buy into the practice. Not yet. Not worth it.

3. What is the specialty? And what state?

4. How did she get an academic offer without a PhD? Usually PhDs are required, as far as I know. Maybe not.