FROM THE AMERICAN COLLEGE OF NUCLEAR MEDICINE
Tips for a Physician in Getting the Right Job, Part XXI Introduction to Contract Negotiations Jay A. Harolds, MD Abstract: Those physicians who have excellent job prospects, and preferably have more than one offer, may wish to try to negotiate better terms for their employment contract than was initially offered. However, any negotiation must be done in a friendly, polite, and professional manner. This article gives many tips regarding contract negotiations. However, the employment contract should be discussed with the job seeker's family and attorney before signing it. Key Words: physician contract negotiations, physician employment negotiations, doctor contract negotiations (Clin Nucl Med 2015;40: 314–316)
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efore entering into a contract negotiation, it is important for the job seeker to carefully analyze whether the job and the area it is located in are right for him/her and the family. Income, fringe benefits, time to partnership (for some positions), time off, how hard and fast one is expected to work, the amount and hours and days of call, whether the job will likely help the individual achieve his/her career goals, whether the type of practice is of high quality and professionally satisfying, the friendliness and likability of the atmosphere and team members, the retirement package, the type of health and malpractice insurance, whether there is mentoring, and whether or not teaching or research is available or required are all important factors. Another factor is whether or not there is a good fit between the qualifications and interests of the job seeker and the practice. Sometimes, there is no sufficient provision made for circumstances of coverage help by other colleagues in the practice if the volume of cases is too high or the case requires subspecialty help, such as on night call. Sometimes, there is inadequate help by other members of the health care team, such as physician assistants, nurse practitioners, or hospitalists. For a private group, other considerations include the reputation, governance, and the stability of the group. The stability and reputation of the hospital(s) and the competition in the area are important factors to consider. Sometimes, there will be micromanagement, which the job seeker will find offensive. Sometimes, the supervisor of the physician is not a doctor, which the candidate may not like. The area must also meet the needs of the family, such as for education, cultural attractions, entertainment, access to a house of worship for a certain denomination, and so on. No matter how good the contract is, if the job seeker or the family is unhappy, eventually the job seeker will probably seek another position. If that occurs, any prospective new employer will want to know the details of why the individual is seeking a new job and, often before a contract is drawn up, will want to speak to one of the members of the current employer's team. Usually, there
Received for publication November 16, 2014; revision accepted November 21, 2014. From the Advanced Radiology Services and the Division of Radiology and Biomedical Imaging, College of Human Services, Michigan State University, Grand Rapids, MI. Disclaimer note: The author is not a lawyer, and this article is not legal advice. Furthermore, laws vary in different states, and laws and court decisions may change with time. An attorney should be consulted before signing an employment contract. Conflicts of interest and sources of funding: none declared. Reprints: Jay A. Harolds, MD, Division of Radiology and Biomedical Imaging, College of Human Medicine, Michigan State University, Advanced Radiology Services, PC, 3264 North Evergreen Dr NE, Grand Rapids, MI 49525. E-mail: [email protected]. Copyright © 2015 American College of Nuclear Medicine ISSN: 0363-9762/15/4004–0314
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will also be a financial loss, at least initially from starting all over again and perhaps having to move.1–6
GENERAL COMMENTS ON EMPLOYMENT NEGOTIATIONS For convenience, one could divide contract negotiations into 2 separate areas. One has to do with the specific terms of the contract such as the initial salary. For example, there could be verbiage such as duties, hours, or call as determined by the employer in the contract rather than having those important details specified. The employer will want to have as much flexibility as possible, and to an extent, this is understandable because circumstances change. However, it would be better from the standpoint of the candidate for employment if the contract gave certain specifics that the job seeker wanted, such as stating that at least half of the duties for a neuroradiologist would be within the subspecialty of neuroradiology or that call would be handled equally among all people within a subspecialty in the group. Nevertheless, such specifics are often not present, and that does not necessarily mean that the contract should not be signed.1,7,8 In some cases, the specifics in the contract may be onerous, such as the individual will see x number of patients per week, where x number is thought by the job seeker to be too many. Similarly, the job seeker needs to be wary if the contract specifies that the individual must be accepted in a certain managed care plan. Better for the job seeker would be a contract clause that specifies the newly hired physician would do his/her best to be accepted. Often, a contract will specify that the individual must be board certified or board certified within a certain period. If the job seeker is not board certified, he/she needs to make sure that the amount of time allowed to achieve certification stated in the contract is adequate, with perhaps the time for 1 or more examination retakes if necessary. It is best for the job candidate that the start date of the contract is when the licensing, credentialing, or other starting qualifications for the contract are met, rather than specifying a time after which the contract is canceled. Sometimes, licensing and hospital privileging take longer than anticipated, and the contract start date should leave plenty of time for this or allow appropriate flexibility rather than provide for automatic contract cancelation if not done by a certain rather close date. Another detail is to be sure to study any documents, such as procedures and policies, referred to in the contract.1 In any negotiation, it is important for the job-seeking physician to be polite, professional, and never bitterly adversarial. It is also important for the job seeker to be firm about what is critical to him/her. The job seeker should be realistic about how strong a candidate he/she is for the position and how many other candidates of about equal qualifications are ready to take the position. For clinical positions, this depends largely on the shortage of doctors in the specialty in general and in that area, the clinical qualifications of the individual, how the candidate presents him/herself, and the institutions the individual trained and practiced in.9 It also depends on how much the employer wants the individual for other reasons such as a record of high productivity, outstanding professional and personal recommendations, research accomplishments, excellence in teaching, a personal connection politically in the area, and so on. For positions that are largely or entirely administrative, it will also depend on administrative course work, experience, accomplishments, Clinical Nuclear Medicine • Volume 40, Number 4, April 2015
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people skills, and special skills such as in information technology, marketing, quality and safety, and so on. The stronger the applicant and the more good choices for employment he/she has, the more strongly he/she can negotiate for better terms. If the applicant has few or no other viable choices for a good job and there are many qualified doctors for the job, it is unwise to engage in tough bargaining. Taking an aggressive stance in negotiations could lose for the doctor the chance for the job. If at all possible, the physician should have at least 1 alternative if the employment terms of a contract are not acceptable and cannot be negotiated more favorably. In addition, the job seeker should be sure to leave plenty of time for the negotiation before he/she is close to a deadline, such as the date of leaving a residency or a fellowship or another job. If the job seeker is close to a deadline, he/she may feel obliged to settle for less than optimal terms. Again, this is a good reason to begin the job search about a year in advance, or more if possible.10 The negotiations should be respectful, cordial, and hopefully quite friendly. Negotiations with the employer should never become antagonistic. Even if the job seeker wins a point, the future atmosphere in the relationship with the other individual may be poisoned. The candidate's lawyer should not be in the room during these discussions because that will not leave a positive impression. On the other hand, the applicant's lawyer should be very helpful to explain to his/her client in private not only what is good and not so good about a contract, but what is important and not so important, and what might be negotiable and what is not. Usually, there is no problem with a job seeker having a friendly conversation on reasonable points with the employer shortly after reviewing the contract with an attorney. On the other hand, it is unwise to push hard on points of little significance or to argue forcefully on any point if the candidate does not have alternative attractive job offers. It is also important to be realistic. Furthermore, repeatedly bringing up the same item after it has been rejected in multiple conversations may make the employer turn to another candidate.11 It may be that several items may be negotiated simultaneously so that each party will feel that they are getting a good deal.12 For example, there may be tradeoffs between salary, who pays for malpractice tail coverage, and time off. For a multiple location practice, the location where the candidate will mainly practice may be an issue. For example, the job seeker may be willing to take a lower salary in return for practicing mainly at a certain hospital or getting more vacation time. This type of negotiation allows the job seeker to come across as flexible and also allows him/her to ascertain what items are most important to the prospective employer. If the individual wants to work during hours that are less desirable for most of the members of an organization, such as nights and weekends, that can be very helpful in negotiating a better employment package including salary and time off.
RESEARCH PREPARATION FOR A CONTRACT NEGOTIATION It is wise for the applicant to have a general idea of the total remuneration before starting to interview so that he/she has an idea of what is reasonable. It is important to consult various references about the prevailing compensation for the services the applicant will be providing.13 The total compensation includes not only salary, but all remuneration, including bonuses and various fringe benefits. Journal articles and published surveys from medical organizations and other sources give a general indication of what the likely salary or total compensation might be for different specialties and subspecialties. This may be further broken down by geographic region and given for the mean and the top 25% and lowest 25%. It may also be given for how many years the physician is out in practice.13 The American Association of Medical Colleges has an income survey conducted every year that includes geographic area, academic rank, and department.14 The Medical Group
Tips for a Physician in Getting the Right Job, XXI
Management Association creates a yearly Physician Compensation and Production Survey, a free synopsis of which is on its Web site.13,15 A survey of the initial remuneration of doctors can be viewed without charge.13,16 Another survey of remuneration of doctors is available at www.memag.com.17 A survey of remuneration and output of physicians in large groups is produced by the American Medical Group Association.18 A search company produces a Physician Executive Compensation Survey every other year, and a synopsis of it is available without charge on its Web site.13,19 However, asking various physicians in the field and individuals who are on the interview trail what they think is a fair compensation package is very helpful information.13 The job seeker should also be wary of taking a position mainly because of its high compensation. It may be that the practice is very efficient or has a favorable payor mix. However, it may also be that the members of the practice work longer hours, take less vacation, or have a lower quality practice to get that higher than usual compensation. This may substantially decrease happiness and job satisfaction of the new doctor and his/her family.
WHEN TO NEGOTIATE FOR BETTER CONTRACT TERMS Negotiating for a better salary, bonus, fringe benefits, shifts, and so on is best done after the employer makes an offer to the job seeker. Otherwise, the candidate may seem presumptuous. Typically, for a physician job, the doctor knows in advance of the in-person interview the general terms of the offer, but not all the details. For example, the candidate for a private clinical position may be told on a phone interview the initial salary and vacation time, but not necessarily all the details for increments of salary in future years, how partners are voted in or out, how bonuses are calculated, the type and amount of malpractice coverage, retirement benefits and vesting, the amount of money for courses, the type of medical insurance and the deductible, the terms of a noncompete clause, buy-in costs if any, and so on. For some clinical physician initial job offers, the salary is negotiable, but often the initial dollar figure offered is also the final offer. However, a number of matters such as moving expenses or the amount of time seeing patients in the job seeker's subspecialty or the time or radius of a noncompete clause might be negotiable. Sometimes, especially if the candidate does well on the interview or demonstrates additional value for the group such as with a special background in business, more salary or a shorter time to partnership in a private group may be possible. Sometimes, it is possible to have a greater initial salary in return for more years to partnership or less of an increase in salary in the next few years, if that will help the new doctor—many of whom have huge debts from medical school. The group might well grant a request if it does not cost them more money in the long run, although it is not their routine structured offer. Occasionally, the job seeker can negotiate a shorter time to partnership or a subsidy for a year if a fellowship is done. For executive positions, it may be that both the duties and the salary may be negotiable.13 For those interviewing for departmental chairperson positions, negotiations about many aspects of the support of the institution for the department are routinely done. In business, sometimes the interviewer, on the phone or in an in person interview, will inquire what remuneration the candidate expects. This is less common for physicians, in the author's experience, except for executive positions. If the question occurs early in the interview, some say it is best to put off answering that by saying that it is premature to discuss remuneration until the applicant fully understands the job requirements and expectations. Another response is that because the organization created the position, no doubt it must to have an idea of the salary range, so what is that? The problem with immediately answering the query is that if the candidate mentions a figure that is too high, the interviewer may no longer consider the applicant because the demand cannot be met and/or it shows poor research about the job market. If
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the applicant mentions a figure that is too low, the applicant will be stuck with that as his/her initial salary. If the interviewer persists in asking the question, the job seeker could ask whether he/she is being offered the position, and if so, what does the organization anticipate paying. If the interviewer continues to persist in asking about salary, the applicant could mention a salary range. As a general rule, neither the interviewer nor the candidate should be negotiating salary early in an interview situation. Furthermore, the candidate should research likely salaries in the area before engaging in such a conversation. If the candidate wants a higher than usual salary, he/she should be able to point out what special qualities he/she has that make it reasonable. This could be high productivity for a clinical position, high research output for an academic position, or administratively helping the bottom line for an executive position.20 When offered a position, 1 author recommends that the candidate should play it cagey and indicate that he/she will be looking forward to reviewing the final offer, before committing to a job, to maximize the possibility of negotiation. However, the employer may not like this, and in reality, there is not much of a commitment until a contract is received, reviewed, signed, and sent back. Although it is possible to negotiate for a better deal under some circumstances, this can also backfire and result in the job being offered to someone else or generate bad will. If the job seeker has multiple good offers, he/she will have a much stronger position than if there is only one. In any event, in any negotiation, it is important to be both tactful and diplomatic.21 It is unwise to treat one's future colleagues as adversaries. Even if the applicant is successful in getting certain terms accepted, if it turns off certain members of the practice, it may spell trouble down the road. The interview and negotiation processes are part of building a good relationship with the members of the practice.13
REVIEW BY A LAWYER All employment contracts should be reviewed by the job seeker's personal lawyer before it is signed.9,22,23
CONCLUSIONS This article discusses many general principles of contract negotiations for a physician. There are many circumstances in which the job seeker should not try to negotiate better terms. However, if the individual does wish to enter into negotiations, it should be done with care, and preferably there should be a good backup job offer elsewhere. The job seeker should also be aware that if an employer employs a large number of physicians, there are many items that are set for all for the doctors and are not negotiable. In addition, an employment contract should be discussed with the prospective employee's family and lawyer before he/she considers signing it.
1. Nuland CL. Physician Employment Contracts and Negotiations. American Association of Clinical Endocrinologists. Available at: https://www.aace.com/files/ pm101_nuland_physiciancontracts.pdf. Accessed November 15, 2014.
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3. Harolds JA. Tips for a physician in getting the right job, part XII: general questions for the applicant to ask. Clin Nucl Med. 2014:39:616–618. 4. Harolds JA. Tips for a physician in getting the right job, part XIII: applicant questions about remuneration, call and time off. Clin Nucl Med. 2014;39:698–700. 5. Harolds JA. Tips for a physician in getting the right job, part XIV: assessing some of the business and governance aspects of the practice. Clin Nucl Med. 2014;39: 799–800. 6. Harolds JA. Tips for a physician in getting the right job, part XVI: assessing the relationship between the group and the hospital(s). Clin Nucl Med. 2014;39: 966–967. 7. Harolds JA. Tips for a physician in getting the right job, part XIX: introduction to employment contracts. Clin Nucl Med. 2015;40:128–130. 8. Harolds JA. Tips for a physician in getting the right job, part XX: more comments on employment contracts. Clin Nucl Med. 9. Plantes PJ. The ins and outs of negotiating an employment contract. Am Coll Physicians Obs. 1987;7:25. 10. Karrass CL. In Business As In Life—You Don't Get What You Deserve, You Get What You Negotiate. Los Angeles, CA: Stanford Street Press; 1996. 11. Albin R. Knowing How Hard to Negotiate in Physician Employment Contracts. Physician Advisors Blog. Available at: http://blog.physicianadvisorsllc.com/knowinghow-hard-to-negotiate-in-physician-employment-contracts. Accessed November 15, 2014. 12. Heller RE. Negotiating for more: the multiple equivalent simultaneous offer. J Am Coll Radiol. 2014;11:153–155. 13. Shaw KK, Raj JK. The Ultimate Guide to Finding the Right Job After Residency. New York, NY: McGraw Hill Medical Publishing Division; 2006. 14. AAMC Faculty Survey Study. Available at: https://services.aamc.org/dsportal2/ index.cfm?fuseaction=login.login&thread=jump. FSSREPORTS&appname=FSSREPORTS&frompermissionscheck=true. Accessed November 15, 2014. 15. Medical Group Management Association. Physician Compensation and Productivity Reports. Available at: http://www.mgma.com/industry-data/survey-reports/ physician-compensation-and-production-survey. Accessed November 15, 2014. 16. The Health Care Group. Physician Starting Salary Survey. Available at: https:// www.thehealthcaregroup.com/p-19-physician-starting-salary-survey.aspx. Accessed November 15, 2014. 17. Medical Economics. Primary Care Earnings. Available at: http://medicaleconomics. modernmedicine.com/search/solr_search/salaries%20of%20doctors?f[0] =sm_field_article_source%3ASource-484&f[1]=im_taxonomy_vid_107% 3A494. Accessed November 15, 2014. 18. American Medical Group Association. AMGA's 2014 Medical Group Compensation and Financial Survey. Available at: http://www.amga.org/wcm/AboutAMGA/ News/2014/082014.aspx. Accessed November 15, 2014. 19. Cejka Executive Search. Physician Executive Compensation Survey. Available at: http://www.cejkaexecutivesearch.com/leadership-insights/surveys/physician-executivecompensation-survey/. Accessed November 15, 2014. 20. Boles RN. What Color Is Your Parachute? A Practical Manual for Job-Hunters and Job Changers. New York, NY: Ten Speed Press; 2012. 21. Mumford C. The Medical Job Interview. Secrets for Success. Malden, MA: Blackwell Publishing; 2005.
REFERENCES
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2. Harolds JA. Tips for a physician in getting the right job, part I: self-assessment: where and what kind of a job is best? Clin Nucl Med. 2013;38:636–638.
22. Terry K. Look out for employment contract snags. Med Econ. 2008;85:30–38. 23. Brooks C. What physicians should know about employment contracts. Tenn Med. 1998;91:384–385.
© 2015 American College of Nuclear Medicine Copyright © 2015 American College of Nuclear Medicine
Tips for a Physician in Getting the Right Job, Part XXI Introduction to Contract Negotiations Jay A. Harolds, MD Abstract: Those physicians who have excellent job prospects, and preferably have more than one offer, may wish to try to negotiate better terms for their employment contract than was initially offered. However, any negotiation must be done in a friendly, polite, and professional manner. This article gives many tips regarding contract negotiations. However, the employment contract should be discussed with the job seeker's family and attorney before signing it. Key Words: physician contract negotiations, physician employment negotiations, doctor contract negotiations (Clin Nucl Med 2015;40: 314–316)
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efore entering into a contract negotiation, it is important for the job seeker to carefully analyze whether the job and the area it is located in are right for him/her and the family. Income, fringe benefits, time to partnership (for some positions), time off, how hard and fast one is expected to work, the amount and hours and days of call, whether the job will likely help the individual achieve his/her career goals, whether the type of practice is of high quality and professionally satisfying, the friendliness and likability of the atmosphere and team members, the retirement package, the type of health and malpractice insurance, whether there is mentoring, and whether or not teaching or research is available or required are all important factors. Another factor is whether or not there is a good fit between the qualifications and interests of the job seeker and the practice. Sometimes, there is no sufficient provision made for circumstances of coverage help by other colleagues in the practice if the volume of cases is too high or the case requires subspecialty help, such as on night call. Sometimes, there is inadequate help by other members of the health care team, such as physician assistants, nurse practitioners, or hospitalists. For a private group, other considerations include the reputation, governance, and the stability of the group. The stability and reputation of the hospital(s) and the competition in the area are important factors to consider. Sometimes, there will be micromanagement, which the job seeker will find offensive. Sometimes, the supervisor of the physician is not a doctor, which the candidate may not like. The area must also meet the needs of the family, such as for education, cultural attractions, entertainment, access to a house of worship for a certain denomination, and so on. No matter how good the contract is, if the job seeker or the family is unhappy, eventually the job seeker will probably seek another position. If that occurs, any prospective new employer will want to know the details of why the individual is seeking a new job and, often before a contract is drawn up, will want to speak to one of the members of the current employer's team. Usually, there
Received for publication November 16, 2014; revision accepted November 21, 2014. From the Advanced Radiology Services and the Division of Radiology and Biomedical Imaging, College of Human Services, Michigan State University, Grand Rapids, MI. Disclaimer note: The author is not a lawyer, and this article is not legal advice. Furthermore, laws vary in different states, and laws and court decisions may change with time. An attorney should be consulted before signing an employment contract. Conflicts of interest and sources of funding: none declared. Reprints: Jay A. Harolds, MD, Division of Radiology and Biomedical Imaging, College of Human Medicine, Michigan State University, Advanced Radiology Services, PC, 3264 North Evergreen Dr NE, Grand Rapids, MI 49525. E-mail: [email protected]. Copyright © 2015 American College of Nuclear Medicine ISSN: 0363-9762/15/4004–0314
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will also be a financial loss, at least initially from starting all over again and perhaps having to move.1–6
GENERAL COMMENTS ON EMPLOYMENT NEGOTIATIONS For convenience, one could divide contract negotiations into 2 separate areas. One has to do with the specific terms of the contract such as the initial salary. For example, there could be verbiage such as duties, hours, or call as determined by the employer in the contract rather than having those important details specified. The employer will want to have as much flexibility as possible, and to an extent, this is understandable because circumstances change. However, it would be better from the standpoint of the candidate for employment if the contract gave certain specifics that the job seeker wanted, such as stating that at least half of the duties for a neuroradiologist would be within the subspecialty of neuroradiology or that call would be handled equally among all people within a subspecialty in the group. Nevertheless, such specifics are often not present, and that does not necessarily mean that the contract should not be signed.1,7,8 In some cases, the specifics in the contract may be onerous, such as the individual will see x number of patients per week, where x number is thought by the job seeker to be too many. Similarly, the job seeker needs to be wary if the contract specifies that the individual must be accepted in a certain managed care plan. Better for the job seeker would be a contract clause that specifies the newly hired physician would do his/her best to be accepted. Often, a contract will specify that the individual must be board certified or board certified within a certain period. If the job seeker is not board certified, he/she needs to make sure that the amount of time allowed to achieve certification stated in the contract is adequate, with perhaps the time for 1 or more examination retakes if necessary. It is best for the job candidate that the start date of the contract is when the licensing, credentialing, or other starting qualifications for the contract are met, rather than specifying a time after which the contract is canceled. Sometimes, licensing and hospital privileging take longer than anticipated, and the contract start date should leave plenty of time for this or allow appropriate flexibility rather than provide for automatic contract cancelation if not done by a certain rather close date. Another detail is to be sure to study any documents, such as procedures and policies, referred to in the contract.1 In any negotiation, it is important for the job-seeking physician to be polite, professional, and never bitterly adversarial. It is also important for the job seeker to be firm about what is critical to him/her. The job seeker should be realistic about how strong a candidate he/she is for the position and how many other candidates of about equal qualifications are ready to take the position. For clinical positions, this depends largely on the shortage of doctors in the specialty in general and in that area, the clinical qualifications of the individual, how the candidate presents him/herself, and the institutions the individual trained and practiced in.9 It also depends on how much the employer wants the individual for other reasons such as a record of high productivity, outstanding professional and personal recommendations, research accomplishments, excellence in teaching, a personal connection politically in the area, and so on. For positions that are largely or entirely administrative, it will also depend on administrative course work, experience, accomplishments, Clinical Nuclear Medicine • Volume 40, Number 4, April 2015
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Clinical Nuclear Medicine • Volume 40, Number 4, April 2015
people skills, and special skills such as in information technology, marketing, quality and safety, and so on. The stronger the applicant and the more good choices for employment he/she has, the more strongly he/she can negotiate for better terms. If the applicant has few or no other viable choices for a good job and there are many qualified doctors for the job, it is unwise to engage in tough bargaining. Taking an aggressive stance in negotiations could lose for the doctor the chance for the job. If at all possible, the physician should have at least 1 alternative if the employment terms of a contract are not acceptable and cannot be negotiated more favorably. In addition, the job seeker should be sure to leave plenty of time for the negotiation before he/she is close to a deadline, such as the date of leaving a residency or a fellowship or another job. If the job seeker is close to a deadline, he/she may feel obliged to settle for less than optimal terms. Again, this is a good reason to begin the job search about a year in advance, or more if possible.10 The negotiations should be respectful, cordial, and hopefully quite friendly. Negotiations with the employer should never become antagonistic. Even if the job seeker wins a point, the future atmosphere in the relationship with the other individual may be poisoned. The candidate's lawyer should not be in the room during these discussions because that will not leave a positive impression. On the other hand, the applicant's lawyer should be very helpful to explain to his/her client in private not only what is good and not so good about a contract, but what is important and not so important, and what might be negotiable and what is not. Usually, there is no problem with a job seeker having a friendly conversation on reasonable points with the employer shortly after reviewing the contract with an attorney. On the other hand, it is unwise to push hard on points of little significance or to argue forcefully on any point if the candidate does not have alternative attractive job offers. It is also important to be realistic. Furthermore, repeatedly bringing up the same item after it has been rejected in multiple conversations may make the employer turn to another candidate.11 It may be that several items may be negotiated simultaneously so that each party will feel that they are getting a good deal.12 For example, there may be tradeoffs between salary, who pays for malpractice tail coverage, and time off. For a multiple location practice, the location where the candidate will mainly practice may be an issue. For example, the job seeker may be willing to take a lower salary in return for practicing mainly at a certain hospital or getting more vacation time. This type of negotiation allows the job seeker to come across as flexible and also allows him/her to ascertain what items are most important to the prospective employer. If the individual wants to work during hours that are less desirable for most of the members of an organization, such as nights and weekends, that can be very helpful in negotiating a better employment package including salary and time off.
RESEARCH PREPARATION FOR A CONTRACT NEGOTIATION It is wise for the applicant to have a general idea of the total remuneration before starting to interview so that he/she has an idea of what is reasonable. It is important to consult various references about the prevailing compensation for the services the applicant will be providing.13 The total compensation includes not only salary, but all remuneration, including bonuses and various fringe benefits. Journal articles and published surveys from medical organizations and other sources give a general indication of what the likely salary or total compensation might be for different specialties and subspecialties. This may be further broken down by geographic region and given for the mean and the top 25% and lowest 25%. It may also be given for how many years the physician is out in practice.13 The American Association of Medical Colleges has an income survey conducted every year that includes geographic area, academic rank, and department.14 The Medical Group
Tips for a Physician in Getting the Right Job, XXI
Management Association creates a yearly Physician Compensation and Production Survey, a free synopsis of which is on its Web site.13,15 A survey of the initial remuneration of doctors can be viewed without charge.13,16 Another survey of remuneration of doctors is available at www.memag.com.17 A survey of remuneration and output of physicians in large groups is produced by the American Medical Group Association.18 A search company produces a Physician Executive Compensation Survey every other year, and a synopsis of it is available without charge on its Web site.13,19 However, asking various physicians in the field and individuals who are on the interview trail what they think is a fair compensation package is very helpful information.13 The job seeker should also be wary of taking a position mainly because of its high compensation. It may be that the practice is very efficient or has a favorable payor mix. However, it may also be that the members of the practice work longer hours, take less vacation, or have a lower quality practice to get that higher than usual compensation. This may substantially decrease happiness and job satisfaction of the new doctor and his/her family.
WHEN TO NEGOTIATE FOR BETTER CONTRACT TERMS Negotiating for a better salary, bonus, fringe benefits, shifts, and so on is best done after the employer makes an offer to the job seeker. Otherwise, the candidate may seem presumptuous. Typically, for a physician job, the doctor knows in advance of the in-person interview the general terms of the offer, but not all the details. For example, the candidate for a private clinical position may be told on a phone interview the initial salary and vacation time, but not necessarily all the details for increments of salary in future years, how partners are voted in or out, how bonuses are calculated, the type and amount of malpractice coverage, retirement benefits and vesting, the amount of money for courses, the type of medical insurance and the deductible, the terms of a noncompete clause, buy-in costs if any, and so on. For some clinical physician initial job offers, the salary is negotiable, but often the initial dollar figure offered is also the final offer. However, a number of matters such as moving expenses or the amount of time seeing patients in the job seeker's subspecialty or the time or radius of a noncompete clause might be negotiable. Sometimes, especially if the candidate does well on the interview or demonstrates additional value for the group such as with a special background in business, more salary or a shorter time to partnership in a private group may be possible. Sometimes, it is possible to have a greater initial salary in return for more years to partnership or less of an increase in salary in the next few years, if that will help the new doctor—many of whom have huge debts from medical school. The group might well grant a request if it does not cost them more money in the long run, although it is not their routine structured offer. Occasionally, the job seeker can negotiate a shorter time to partnership or a subsidy for a year if a fellowship is done. For executive positions, it may be that both the duties and the salary may be negotiable.13 For those interviewing for departmental chairperson positions, negotiations about many aspects of the support of the institution for the department are routinely done. In business, sometimes the interviewer, on the phone or in an in person interview, will inquire what remuneration the candidate expects. This is less common for physicians, in the author's experience, except for executive positions. If the question occurs early in the interview, some say it is best to put off answering that by saying that it is premature to discuss remuneration until the applicant fully understands the job requirements and expectations. Another response is that because the organization created the position, no doubt it must to have an idea of the salary range, so what is that? The problem with immediately answering the query is that if the candidate mentions a figure that is too high, the interviewer may no longer consider the applicant because the demand cannot be met and/or it shows poor research about the job market. If
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the applicant mentions a figure that is too low, the applicant will be stuck with that as his/her initial salary. If the interviewer persists in asking the question, the job seeker could ask whether he/she is being offered the position, and if so, what does the organization anticipate paying. If the interviewer continues to persist in asking about salary, the applicant could mention a salary range. As a general rule, neither the interviewer nor the candidate should be negotiating salary early in an interview situation. Furthermore, the candidate should research likely salaries in the area before engaging in such a conversation. If the candidate wants a higher than usual salary, he/she should be able to point out what special qualities he/she has that make it reasonable. This could be high productivity for a clinical position, high research output for an academic position, or administratively helping the bottom line for an executive position.20 When offered a position, 1 author recommends that the candidate should play it cagey and indicate that he/she will be looking forward to reviewing the final offer, before committing to a job, to maximize the possibility of negotiation. However, the employer may not like this, and in reality, there is not much of a commitment until a contract is received, reviewed, signed, and sent back. Although it is possible to negotiate for a better deal under some circumstances, this can also backfire and result in the job being offered to someone else or generate bad will. If the job seeker has multiple good offers, he/she will have a much stronger position than if there is only one. In any event, in any negotiation, it is important to be both tactful and diplomatic.21 It is unwise to treat one's future colleagues as adversaries. Even if the applicant is successful in getting certain terms accepted, if it turns off certain members of the practice, it may spell trouble down the road. The interview and negotiation processes are part of building a good relationship with the members of the practice.13
REVIEW BY A LAWYER All employment contracts should be reviewed by the job seeker's personal lawyer before it is signed.9,22,23
CONCLUSIONS This article discusses many general principles of contract negotiations for a physician. There are many circumstances in which the job seeker should not try to negotiate better terms. However, if the individual does wish to enter into negotiations, it should be done with care, and preferably there should be a good backup job offer elsewhere. The job seeker should also be aware that if an employer employs a large number of physicians, there are many items that are set for all for the doctors and are not negotiable. In addition, an employment contract should be discussed with the prospective employee's family and lawyer before he/she considers signing it.
1. Nuland CL. Physician Employment Contracts and Negotiations. American Association of Clinical Endocrinologists. Available at: https://www.aace.com/files/ pm101_nuland_physiciancontracts.pdf. Accessed November 15, 2014.
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3. Harolds JA. Tips for a physician in getting the right job, part XII: general questions for the applicant to ask. Clin Nucl Med. 2014:39:616–618. 4. Harolds JA. Tips for a physician in getting the right job, part XIII: applicant questions about remuneration, call and time off. Clin Nucl Med. 2014;39:698–700. 5. Harolds JA. Tips for a physician in getting the right job, part XIV: assessing some of the business and governance aspects of the practice. Clin Nucl Med. 2014;39: 799–800. 6. Harolds JA. Tips for a physician in getting the right job, part XVI: assessing the relationship between the group and the hospital(s). Clin Nucl Med. 2014;39: 966–967. 7. Harolds JA. Tips for a physician in getting the right job, part XIX: introduction to employment contracts. Clin Nucl Med. 2015;40:128–130. 8. Harolds JA. Tips for a physician in getting the right job, part XX: more comments on employment contracts. Clin Nucl Med. 9. Plantes PJ. The ins and outs of negotiating an employment contract. Am Coll Physicians Obs. 1987;7:25. 10. Karrass CL. In Business As In Life—You Don't Get What You Deserve, You Get What You Negotiate. Los Angeles, CA: Stanford Street Press; 1996. 11. Albin R. Knowing How Hard to Negotiate in Physician Employment Contracts. Physician Advisors Blog. Available at: http://blog.physicianadvisorsllc.com/knowinghow-hard-to-negotiate-in-physician-employment-contracts. Accessed November 15, 2014. 12. Heller RE. Negotiating for more: the multiple equivalent simultaneous offer. J Am Coll Radiol. 2014;11:153–155. 13. Shaw KK, Raj JK. The Ultimate Guide to Finding the Right Job After Residency. New York, NY: McGraw Hill Medical Publishing Division; 2006. 14. AAMC Faculty Survey Study. Available at: https://services.aamc.org/dsportal2/ index.cfm?fuseaction=login.login&thread=jump. FSSREPORTS&appname=FSSREPORTS&frompermissionscheck=true. Accessed November 15, 2014. 15. Medical Group Management Association. Physician Compensation and Productivity Reports. Available at: http://www.mgma.com/industry-data/survey-reports/ physician-compensation-and-production-survey. Accessed November 15, 2014. 16. The Health Care Group. Physician Starting Salary Survey. Available at: https:// www.thehealthcaregroup.com/p-19-physician-starting-salary-survey.aspx. Accessed November 15, 2014. 17. Medical Economics. Primary Care Earnings. Available at: http://medicaleconomics. modernmedicine.com/search/solr_search/salaries%20of%20doctors?f[0] =sm_field_article_source%3ASource-484&f[1]=im_taxonomy_vid_107% 3A494. Accessed November 15, 2014. 18. American Medical Group Association. AMGA's 2014 Medical Group Compensation and Financial Survey. Available at: http://www.amga.org/wcm/AboutAMGA/ News/2014/082014.aspx. Accessed November 15, 2014. 19. Cejka Executive Search. Physician Executive Compensation Survey. Available at: http://www.cejkaexecutivesearch.com/leadership-insights/surveys/physician-executivecompensation-survey/. Accessed November 15, 2014. 20. Boles RN. What Color Is Your Parachute? A Practical Manual for Job-Hunters and Job Changers. New York, NY: Ten Speed Press; 2012. 21. Mumford C. The Medical Job Interview. Secrets for Success. Malden, MA: Blackwell Publishing; 2005.
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22. Terry K. Look out for employment contract snags. Med Econ. 2008;85:30–38. 23. Brooks C. What physicians should know about employment contracts. Tenn Med. 1998;91:384–385.
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