ADVICE FOR CONTRACT NEGOTIATIONS FROM A HEALTH CARE ADMINISTRATOR TURNED PHYSICIAN - PART 2 By Aaron Kuzel, DO, MBA This is the second part of an article featured in the JanuaryFebruary issue of SAEM Pulse. Part one of this article may be accessed here. Dr. Kuzel: When you are looking at a contract for the first time, whether it’s your own contract or a colleague’s, what are you looking for in the contract to either maximize a physician’s revenue or protect the physician? Dr. Winterton: It depends on what the physician’s goals are. The first thing I look for is the location, whether the employer is a group or hospital, and how aggressive is this organization needing this type of doctor in this area. For example, if you’re wanting to practice in rural America as an ER physician, the ball is already in your court. If I see a contract from a rural hospital where the physician is under compensated with few perks or benefits, then I relay to the resident or physician that this organization is trying to take advantage of them. I show the resident what the data shows where the 75th, 50th, and 25th percentile are in terms of compensation and advise them to counter with a higher offer and more requested benefits. I also look for how the contract affects the physician’s work-life goals. For example, I had a physician who presented me with her contract who wanted to keep the door open to having children in the next few years. However, her contract contained a legal binding clause that she had to work 40 hours per week for three years. This cuts her option if she wanted to cut back to have children or raise her children in a year or two. She didn’t catch that going through the contract on her own because she thought this was a typical contract and because I pointed this out to her, she was able to make a more informed decision. Dr. Kuzel: What power do physicians and residents have when negotiating their contract and what do they not have any control over? Dr. Winterton: Physicians have the most control over their compensation, their benefits, and their hours of obligation to be on duty. You don’t have so much power to control the legality terms such as liability insurance or the requirements to see Medicare patients. However, compensation, benefits, and hours of obligation are often the parts of the contract physicians are most disgruntled with but have the most control over.
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"ALLOW THAT CONTRACT TO BE A TOOL TO HELP YOU ACCOMPLISH YOUR GOALS INSTEAD OF THAT CONTRACT HANDCUFFING YOU TO KEEP YOU FROM WHAT YOU WANT TO ACCOMPLISH." Dr. Kuzel: It seems that in your experience that physicians have more negotiating power than what we seem to think, with that being said, why do you think so many physicians are so disgruntled with their contracts? Dr. Winterton: I think they don’t realize how much power and control they have with their contracts until after they sign it. I have visited with physicians who are 20 to 30 years in practice and they are still learning each contract they sign. On the administration side, however, we know all these options going in and we are not going to hand over all those possible options to the physicians so they can use them to their advantage. When residents speak with colleagues at conferences they find out if they’ve been taken advantage of. With one attending I worked with, when he compared his work with his colleague from fellowship, we found that this attending worked more hours, but received less pay. The reason that separated these two was that the other attending was more aggressive in his contract. I hate seeing that because I know how hard it was to get through medical school and residency; you work too hard as an attending to be taken advantage of. There is definitely some bitterness with the traditional mantra of administration versus physician. It’s hard to trust an administration when you’ve been burned like that starting in. I’ve been on that side [administration] and I hate that us versus them mentality.
