How should a physician turn down a job offer? There’s no sneaky legal or technical way to do this but there’s a right way and a wrong way to do it. And the last thing that a physician wants to do, or at least they shouldn’t do is burn bridges. There’s a professional way to turn down a job offer. And then there’s an unprofessional way to do it as well. Let’s first talk about how a physician is provided with a job offer and then maybe a short difference between an offer letter, letter of intent, and then the actual employment agreement. The process when a physician is finding a job either the physician will reach out to the practice knowing that they have an opening, or a recruiter can reach out to the physician.
Many times, employers will hire physician recruiters to go out and bring them candidates. You could also have word of mouth through other people that the physician trained within residency or fellowship. At some point, if the physician gets hooked up with a job, there’ll be an initial talk. Whoever the point person is, if it’s a smaller practice, it could be the physician who owns the practice. If a physician recruiter is involved, then the point person, at least initially, would be the physician recruiter who would then set up a call with someone with the practice. If it’s a hospital or health network, most of the big ones employ their own physician recruiters then that person would be the point person. At first, it’ll just be cursory, here’s what we need.
And then most likely, they won’t even go through basic things like salary, benefits, compensation structure. There may be a mention of ‘this is the range’ but before they get into the details, what will likely happen is there’ll be a couple of calls with multiple people. If goes well, the physician will then have an onsite visit where they’ll meet everyone involved. Maybe I wouldn’t consider it interviews, but more of a get to know you. You may go to dinner, you’ll kind of tour the facilities and see what they have to offer. After those things have concluded, so they’ve had the calls, they’ve done a site visit. Then if the organization wants to extend an offer, they’ll usually do it verbally. I would say almost always with the big hospitals, they’ll always provide an offer letter first. Other blogs of interest include:
The offer letter will then go over the basics of what’s in the contract. How much will the physician be paid? What are some of the benefits? How long will the contract last? Maybe some of the restrictive covenants like the non-compete and non-solicit. What are bonuses? There could be a signing bonus, relocation assistance, maybe how much they provide for continuing medical education on an annual basis. The offer letter just goes through the quick and dirty details of what the employment terms will be like. At this point, the physician has the decision to make. Some places will not provide an employment agreement until the physician has signed the offer letter and then essentially committed to the job. Now, signing the offer letter is not a binding decision.
Declining the Job Offer Professionally
Many times, the terms in the offer letter will either change slightly once the employment agreement is given, or there will be terms in the employment agreement that make a job that looks great at the beginning, most likely a terrible decision. What are some things that make an offer letter okay and an employment agreement terrible? Well, the details of the non-compete, how long it lasts, what’s the restriction, is it all practice of medicine or just the specialty of the physician? Many physicians can do multiple things. For instance, someone in family practice or internal medicine could do hospitalist, urgent care, and family practice. What are the specific terms of the non-compete? How does the compensation change over time? Obviously, the employer will pay for the underlying medical malpractice insurance, but if it’s a claims-made policy, who pays for the tail insurance usually that’s not in the offer letter.
And depending upon specialty, that can be a huge decision point if tail is not offered. If the physician gets the offer and then they say, you know what, this is not for me. Or even after they do the onsite visit and the interviews and they get a bad vibe and they say, you know what, this isn’t for me. Don’t just ghost the physician recruiter or whoever the director of the practice is, or just cut off communication and be silent. Although some people want to do that because they believe they’ll be conflict when they say I’m not interested in the position, it’s an unprofessional way of acting. Nowadays an email is sufficient just saying, hey, I really appreciate your interest. Currently, I’m going in a different direction.
I’m not going to accept the offer. Just be cordial. Don’t go into here are all the reasons why I don’t think this is the right fit, but just give them a definitive like I’m moving on, appreciate the interest, maybe sometime in the future we can revisit employment and the main reason why you need to be professional when you’re turning a job offer down is circumstances may change. At the time the job wasn’t great but maybe in six months to a year, it looks attractive. If there’s an open position and burning any bridges, or as I said before, just completely not responding to any communications from that employer, we’ll burn that bridge and they most likely would never go forward with the physician. So, if you want to turn a job offer down, you just send an email, say cordially, I appreciate the interest, I’m moving on.
Maybe someday in the future, we can revisit it and then just leave it at that. If the physician has signed an offer letter, and then after reviewing the employment agreement, maybe they say, you know what, I’m not going to sign this. You need to do the same thing, you need to say in writing, I understand I signed the offer letter. This employment agreement is either different or contains some terms I’m simply not comfortable with, therefore I’m going to withdraw my acceptance of the job offer. I appreciate your interest, that type of thing. Now, I can just tell you from experience, a physician has signed an offer letter and then backed out of a job. There usually will be some hurt feelings and it’s unlikely that the physician will have that opportunity available in the future. But just because you’ve signed an offer letter doesn’t mean you have to go through with it. You need to make the best decision for yourself. This is a business. Although I’m a lawyer, it is a business as well and we need to make business decisions, not just for ourselves, but for instance, for my law firm.
And in a business environment, you need to take care of yourself first. And so, if a job is not a right fit, even if you verbally accept it, even if you sign the offer letter, even if you’ve gone to visit, don’t go through with the job if you’re not comfortable doing it.
Should a Physician Sign a Letter of Intent?
Should a physician sign a letter of intent? A letter of intent is also known as an offer letter. Different employers use a different name for it, but effectively it’s the same thing. Let’s go through the process and then once it gets to the offer letter/letter of intent stage, whether the physician should sign it or not. When a physician is looking for a new job or potentially if an employer reaches out to a physician, they can either do it through word of mouth from other physicians. If it’s a hospital or healthcare network, most of them employ physician recruiters who then actively search for candidates for open physician positions, or there are also independent physician recruiters who are brokers.
They will find candidates for open positions, they’ll bring those candidates to an employer, and then they’ll get fee, either a flat fee or sometimes a percentage of what the first-year compensation for the physician is. In this case, let’s say a physician has an interest in a job. There’ll be an initial discussion with the recruiter or usually the owner of the practice or a director or something just to get an initial feel for whether the physician will be interested or not. And then if that goes well, then it’ll likely end up in some site visit. The physician will travel to wherever the location is, they’ll meet with other physicians, meet with the administration, other facilities, and probably talk about some basic structure of the employment. At that point, if the employer is still interested, one step would be the employer would offer and say, hey, we would like you to sign this offer letter or letter of intent before we move forward with providing you an employment contract.
They do this for a couple of reasons. One, it does take some time to prepare a contract and so most smart physicians and certainly, any big healthcare network or hospital, have their own legal counsel. It takes a little bit of time to draft an employment contract specifically for a physician. Most places don’t want to go through the time and cost of paying an attorney to draft those contracts unless they have at least some kind of commitment from the physician. And that commitment is then effectuated through signing the letter of intent. Now, should a physician sign a letter of intent? If the employer is going to require a signed letter of intent before moving forward with an employment contract, then the answer is yes. If the physician is interested in a job and the employer is requiring them to sign an offer letter, then sign the offer letter.
The next question for most physicians is okay, well, if I sign the offer letter or letter of intent, am I bound to this employer? Can I back out or is it a binding contract? Well, in short, no, you can back out. The terms of the offer letter are very basic. Compensation, length of the contract, some benefits, maybe getting into the restrictive covenants, the non-compete, the non-solicit, basic signing bonus, relocation assistance, compensation productivity. That would be a lot for an offer letter, but those are the basic terms in it, however, once an offer letter is signed and then an employment agreement is reviewed by a physician, some of the terms can change or the basic information in the offer letter can completely change when provided more context in the employment agreement.
If You Decline a Job Offer Will it Hurt Your Career?
If it gets to the point where the physician has signed the letter of intent and they think, and they review the employment agreement and they say, you know what, this isn’t for me, this is substantially different. I don’t want to go through with it. Then don’t go through with it, don’t sign the employment agreement. Cordially, let the employer know, these are substantially different or not what I was expecting. And I’m not going to go through with the contract. In that case, you just wash your hands in the situation to move on. There is almost no scenario that I’ve seen where an offer letter would be binding or enforceable in any way. I mean, I guess if there was language in there that states there would be penalty for backing out the offer letter, sometimes they would want to recoup the costs of employing a physician recruiter, the travel costs of bringing the physician out, to do a site visit.
That’s very rare. For the most part, these are just cursory documents. You’ve come to terms on the big stuff, and then the details are in the employment agreement. I would say it is fine to sign an offer letter or a letter of intent from a physician if they’re really interested in moving forward with the job. A scenario where they absolutely should not, is if they’re just fishing for different offers and they say you know what, I’m just going to sign multiple letters of intent, and then once I review the agreements, I’ll decide. If you sign a letter of intent and then back out, you have burned a bridge. That’s just the reality of the situation. It is very unlikely you will ever have a chance of getting a job with that employer again.
And it frustrates any employer when they’re expecting a physician to come, they’ve stopped recruiting the activities, and then the physician comes back and says, you know what? I’m not interested in this. Therefore, most employers will put deadlines, this is the deadline to sign the letter of intent. And then once the physician is given the employment agreement, this is the deadline where we want you to either negotiate or sign the agreement. If you don’t do it, then we’re basically re-sending the offer moving on. So, it’s fine to sign the offer letter if you are truly interested in a job, if you’re not certain, I would not sign it. But it is not a binding document, and you can move forward and not worry that you’re stuck with the job that you’re not happy with or the terms of a job that you’re not happy with.
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