American College of Physicians: Internal Medicine — Doctors for Adults ®

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Job hunting? College guide offers negotiating tips

While you don't want to seem pushy, you need to work out all the details before you sign a contract.

From the March ACP-ASIM Observer, copyright 2003 by the American College of Physicians-American Society of Internal Medicine.

By Phyllis Maguire

Your residency or fellowship is almost over and you've found a group that seems perfect. The senior partners are offering a decent salary, so isn't it time to sign on the dotted line?

Hold on, cautioned Carl B. Cunningham, MBA, Director of the College's Practice Management Center (PMC). That employment contract may determine just how happy you'll be working in the practice, and it could contain several points you want to change.

Whether they're just starting out in practice or veteran clinicians, Mr. Cunningham said, "Physicians need to carefully read any employment contract they're considering. At the same time, they should steer clear of 'hardball' bargaining tactics or unrealistic demands that might offend their future employers, who are also potential colleagues and perhaps eventual partners."

Before you rush to sign or argue one of the finer points of a contract, Mr. Cunningham recommended reading "[M]Physician Employment Contracts," a PMC publication that members can download free of charge. The guide offers the following tips that can save you time and money and make that "perfect" opportunity even better:

  • Do your homework. Before you negotiate, make sure you've found the right group. The PMC guide features a self-assessment tool that can help you zero in on what you're really looking for in a practice.

    What practice structure do you prefer—private practice or hospital-owned, for example—and how many hours do you want to work? What compensation model matches your practice philosophy: equal shares to promote team effort or productivity bonuses to reward individual effort?

    And how financially stable is the group? As part of your evaluation, ask about its accounts receivable and potential growth, and spend a day with one of the practice's physicians.

  • Set priorities. Typically, the group's compensation model isn't negotiable, but just about everything else is. While you don't want to appear pushy, you shouldn't ignore points that are important to you. The trick, according to the PMC guide, is to be forthright without being abrasive.

    A signing bonus and relocation expenses are fair game for negotiations. Young physicians may want to bargain for more family leave, while those who want to do research need to discuss whether nonclinical income accrues to you or the group.

    Another bargaining area: ownership and partnership terms. Does the contract clearly spell them out? If not, will the practice spell out conditions under which ownership will be considered at a later, specific point in time? What's a reasonable restrictive covenant, and who pays tail coverage for claims-made malpractice insurance?

    The PMC guide details more than a dozen contract points you should discuss, starting with salary. And the guide's "Physician Compensation and Benefits Worksheet" helps you compare salary, benefit and incentive packages in detail.

  • Develop a negotiating strategy. The best time to negotiate is right after a group makes an offer. Experts recommend starting with an easy point the practice is likely to concede. That will give you a feel for the process and the people involved. Tackle your toughest point halfway through the discussion, then conclude with lighter issues.

    According to the PMC guide, physicians should return to any unresolved issues after most of the bargaining is done. When a successful conclusion to your discussion hinges on those few remaining points, the pressure is on to find common ground, which only improves your bargaining position.

  • Get changes in writing. Remember to get in writing all contract changes you negotiate. Sharing a verbal agreement and a firm handshake might end your negotiations on a high note. Unless the contract reflects those changes, however, they won't hold up.

    It's probably wise to hire an experienced health law attorney to read the contract, pinpoint potential trouble spots and suggest alternate language.

    Some physicians use third-party negotiators to bargain on their behalf, but beware. While a seasoned consultant can smooth over tough negotiations, introducing a new person may add tension to a budding relationship, particularly if the practice isn't relying on outside parties to represent them.

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