3. NEGOTIATING CONTRACTS

MARCH/APRIL

Prior to your final year of training (i.e., fourth year of a five-year residency or first year of a two-year fellowship) Schedule a few “meet and greet” sessions with colleagues to discuss job opportunities, locations and types of practices during the AUA Annual Meeting in May.

AUGUST/SEPTEMBER

During your final year of training Begin interviews and hospital/practice visits.

JANUARY/FEBRUARY

During your final year of training Complete contract negotiations and finalize employment selection.

Figure 1: It is extremely important to follow this timeline to avoid scrambling for a job. Limited options weaken the ability to negotiate effectively.

Urologists are often in a great position to negotiate their first contract immediately following the completion of training. However, as mentioned elsewhere, the first one to two yea-rs of your position can often be a “money losing” proposition for your prospective employer as you have not yet established yourself as managing a competent and bustling clinical practice. Accordingly, recognize that “overnegotiating” your job offer might put you out of a potential job, especially in a large metropolitan market where there may be many other candidates vying for the same position. Negotiating a contract may vary widely depending on the type of practice one chooses. Joining a multispecialty group or physician-owned practice versus a hospital-employed position versus an academic position will affect the type of variables present in a contract. It is important to understand what variables may change depending on practice type. For example, in a physician-owned practice, you may have the opportunity to “buy into” the practice and become a partner. This option is unlikely to be possible in a hospital-employed or academic position. A more recent trend has been the selling of urology practices to private equity groups. This occurrence can drastically affect a young urologist’s job security, quality of life and income, so consider this in negotiations.

3.1 Needs/Requests

Consider the following and whether or not they should be included in your contract: • Equipment ° Office-based equipment (laptop or desktop computer, flexible cystoscope, ultrasound, etc.) ° Hospital-based equipment (full complement of flexible and rigid endoscopes, surgical instruments, etc.) ° Special equipment (surgical robot, ultrasound equipment, operative microscope, surgical

LASERs, etc., and an appropriate amount of dedicated surgical “block time” for use) • Personnel Requirements ° In your office: nursing and ancillary staff members ° In the hospital: Will they provide appropriately-trained personnel for surgical procedures? It’s especially important to be staffed with a qualified assistant for procedures such as robotic surgery, ESWL and microsurgery.

3.2 Understand Compensation

Typically, a hospital will guarantee your salary for one to two years. A suggested negotiated length of an initial contract is three years with periodic evaluations and/or meetings to track progress toward target productivity endpoints. Key questions to consider include: • Does your contract specify that you’ll be evaluated on a quarterly basis? • Will you be reimbursed based on your work

Relative Value Units (RVUs)? ° NOTE: Though contracts will vary, the RVUs are based on national guidelines with an average RVU production of 9,000-10,000 per year. Academic positions generally have a lower RVU requirement to accommodate research activity.