6 minute read
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.
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.
Dr. Kuzel: Following up on the expertise aspect of contracts, how does a contract consulting firm differ from a contract attorney in seeking legal advice on a contract? Dr. Winterton: That’s a great question. A contracting firm, whether its financial firm or health care administration such as myself, cannot provide any legal advice or consultation. A contract lawyer can help you with things like a non-compete clause or, if you are working in an academic center, proprietary rights to products developed or research. Contract lawyers are really great in helping you adjust the terms of your contract, but in my experience not all attorneys are great in adjusting your compensation and benefits. Attorneys are excellent at negotiations since their livelihood comes down to this in the courtroom, so they can be excellent assets when evaluating your contract. But I’ve visited with multiple attendings who had previously hired contract attorney’s and they received minimal if not any help with the areas of compensation, benefits, and hours of obligation. Someone like myself who has experience in these areas can make all the difference for a physician looking for a better contract. Dr. Kuzel: While all these services seem great and beneficial, this seems pretty expensive especially on a resident salary. Dr. Winterton: It’s expensive to spend $500 for a consultation or with some very successful firms can charge you $1500 to $2000 for a contract consultation. This is a lot of money upfront. I get that as a resident your budget is really tight. However, how much have these residents spent on their training and education to this point? If this individual can help you double your sign on bonus from $10,000 to $20,000 you’ve already increased your compensation by $10000 for a $500 consultation. If this individual can help adjust your compensation by $5,000 each year for a three-year contract, that’s $15,000. For a reasonably priced consultation service of $300-$500 this is a great return. I have had a couple of physicians who had previously spent thousands of dollars for an attorney consultation and received minimal guidance and feedback. I think it is wise to get quotes upfront and ask “how this individual is going to help me?” Dr. Kuzel: Do you think that there is some connection between physician burnout and their contracts? Dr. Winterton: Many physicians are altruistic, their primary motivation to going into medicine is to help people. Physicians don’t like to put others off and really struggle standing up for themselves because of that mentality. I think this is a huge factor of burnout because physicians aren’t taking care of themselves, they’re just putting other people first all the time. While this is virtuous, you can’t help others when you are a mess in terms of mental health and financial health. If you’re worried about your debts all day every day, I guarantee that you are not working at optimum performance for your patients worrying about financial obligations. Dr. Kuzel: Thank you so very much for taking the time to speak with us today and for your work empowering physicians and being a physician advocate. Do you have any departing advice for emergency physicians and residents? Dr. Winterton: My advice, for EM or any specialty, is to make a five-year plan and a list of the five things you want in your life. Is it work-life balance? Is it financial independence? Is it student loan forgiveness? Is it the opportunity to work with medical students or residents? First figure out what you want, and then go after a contract — not the other way around. A contact should be a tool to help you accomplish your goals, not handcuffs to restrain you from reaching your goals.
ABOUT:
Dr. Winterton is the founder and CEO of White Coat Consulting. Dr. Winterton is a graduate of Lincoln Memorial University-DeBusk College of Osteopathic Medicine and is a PGY-2 internal medicine resident at the University of Missouri department of medicine.
Dr. Kuzel is an emergency medicine resident at the University of Louisville School of Medicine. He is the associate editor of the RAMS Section of SAEM Pulse and is a member-at-large on the SAEM RAMS Board.
