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First time job seekers are often timid about asking about what they should be compensated for. You've endured hundreds of hours studying, anatomy lab, scutwork, and bowel disempaction. Time to get paid what you deserve.
Sign on the Dotted Line
When it comes to your first job, reading thru your contract may seem a daunting task. If you’re joining a major physician group or HMO (like Kaiser) your job will probably be easier because they have standard contracts which have likely been reviewed by more experienced people than you. But that doesn’t mean you shouldn’t read your contract very carefully! This document will describe your day to day job duties and your responsibilities and expectations.
It will also detail your salary, your benefits, and reasons you could be fired. Be sure to read this carefully, and strongly consider having an attorney review it. Your contract will probably be skewed towards your employer, protecting the medical practice. Your contract should also stipulate the responsibilities of the medical group or hiring physician so you know what you can expect in return for your services. You’ll want to be sure to find someone who is experienced in physician contracts (ask when you hire your lawyer). A few hundred dollars up front may save you thousands in headaches later on if something goes wrong. Be sure to ask lots of questions.
Money, Money, Money
It may be very tempting to take the first offer presented to you. In some cases you’ll have very little negotiating room depending on the type of job you’re looking at. In others, you’ll have much more flexibility, depending on how badly they want you. Look at market rates, ask your colleagues what they made their first years to get an idea of what you’re worth. Don’t sell yourself short! If you have special talents or skills you should make these clear to your prospective employers. Ask about signing bonuses. You can ask for a salary increase, or a signing bonus. If there is no wiggle room on your salary, you may consider asking for more in benefits, say CME coverage, journals, books, etc… In many cases these are less expensive than adding to your salary and can still get you some additional income.
What’s in it for Me?
In some cases, you may be willing to take a slightly lower salary compared with market value for your services if that job comes with other benefits that offset the lower salary. These include retirement benefits (401K, 403b, or other pension), CME benefits, other educational expenses, books, licensing fees, white coats, and other perks). Make sure you read the section about malpractice insurance, disability insurance, and other forms of insurance. And if it doesn’t specify, make sure to ask about tail malpractice insurance. If you leave, who will pay for the remaining years left for the malpractice after you stop practicing in that area? Patients have a seven year window to sue you, so you’ll want seven years after you see your last patient where you’ll be covered. See if they also offer a good disability insurance plan. If you already have disability insurance, see if your employer can cover your premiums. Make sure your contract defines who is responsible for paying things like hospital staff dues, licensing fees, etc.
Get Out of Town!
With many medical group contracts, you may have a “non-compete” clause which restricts your practice as a physician outside of a certain geographic area, say 15 miles. In some states and locales these may be considered unenforceable, but this varies from state to state. Some employers will say “that’s standard, but don’t worry, it’s not enforceable.” Do not accept this for an answer. If they state that it’s unenforcable, or if the location unfairly restricts your practice of medicine then ask that it be removed from the contract. Even if you don’t think they will take you to court, don’t take that chance. In some areas, a court may rule that a certain number of miles is not realistic. For example a 10 mile area might be ok in the country, but in Manhattan, that would effectively lock one out of the entire island! Be careful what the terms of the non-compete clause are. Some may restrict your association with particular HMOs or insurance companies and the like. When in doubt consult a lawyer!
Batman and Robin
Before you enter into a contract with a medical group, if you have any interest of becoming a partner, be sure to have these details laid out in your contract. Some groups may simply make you a partner after you “pay your dues” after a certain amount of time. Others may ask you to “buy” a portion of the practice (the way this value is determined varies widely, consult a practice management specialist) in order to practice as a partner, sharing in the profits of the overall practice. You don’t want to get into the situation of joining a group, with promises of entering the partnership, only to find out three years down the road that the group is unwilling to make you a partner. Some medical groups are even known to hire new graduates every few years, burning them out and dumping complex or difficult patients on them. Try to have everything in writing before you begin practicing.