Hospital Sign on Bonus Pay Back | Repay a Bonus When Doctor Leaves?

A sign-on bonus for a physician is a cash payment that is provided as an enticement to accept the position. A physician’s signing bonus can vary dramatically from employer to employer, but a standard range would be from $5,000-$50,000.

When Is the Physician Signing Bonuses Given?

It will be spelled out in the employment contract professional benefits. Typical timing of the payment of the signing bonus includes:

• At the time of execution (when the agreement is signed)
• During the first pay period after the physician starts providing care
• At the end of the initial year of employment

Pay Back the Physician Sign-On Bonus

The employment contract will determine whether the physician must pay back none, all, or a portion of the signing bonus. A forgiveness structure will likely be provided, which dictates how much of the signing bonus is forgiven based upon the length of the physician’s employment. For instance:

• If the initial term is 24 months, 1/24 of the signing bonus is forgiven each month.
• If the initial term is 36 months, each year completed will forgive 1/3 of the signing bonus.
• If the physician does not satisfy the initial term , they must repay all of the signing bonus.
• Is a Sign-On Taxable?

It’s no secret that relocating to a new city is often stressful. But have you ever wondered what, if any, tax implications come with it? Well, the short answer is “yes.” The IRS and state authorities consider signing bonuses paid by an employer as taxable income for employees. These are taxed like any other earnings each year through Form W-2. Employers may also offer additional benefits that help persuade you to relocate!

Bonus Requirements

Some signing bonuses come with requirements the company should explain in your job acceptance or bonus paperwork. For example, one might be a pay increase of 10% after you’ve completed three years on staff within two months of accepting the position. Another could involve participating a certain number of times per year for five hours to stay eligible for incentives.

Some companies offer signing bonuses. They will need their new employee to adhere to if they want it and are deemed worthy by upper management. These often include things like receiving an increased salary incentive package (i.e., a raise) once you complete three consecutive annual evaluations at work. And they were then required to participate part-time from home once every quarter because this is where most people telecommute.

If you are a signing bonus recipient, be aware that the company has set requirements for your stay with them. If you don’t meet these criteria before this time limit is up even by one day or hour, they will have to pay back their end of the bargain. It could mean paying taxes on money that was never theirs to keep it within legal guidelines.

Suppose there’s anything we all know about big business deals like sign bonuses. In that case, contract terms can change over time as situations evolve around us. For example, suppose an employee leaves early due to personal reasons, such as medical leave from stress or illness out of work. But still manages not to break any other rules (no stealing), yet moves at some point.

Other Blogs of Interest

• Does A Physician Have to Repay Relocation Assistance If They Leave?
• Should a Physician Receive Relocation Reimbursement When Moving for a New Job?

Physician Contract Review

Contracts are a pervasive and obligatory part of nearly all business and legal transactions. Well-drafted contracts help to enumerate the responsibilities of the involved parties, divide liabilities, protect legal rights, and ensure future relationship statuses. These touchstones are even more crucial when applying their roles to the case of a provider employed by a hospital, medical group, or other health care provider. While contract drafting and negotiation can be long and arduous, legal representation is a must to protect your rights.

The present-day conclusion is simple: A doctor should not enter into any contract without having a physician’s contract reviewed by legal counsel. 

There is too much risk for doctors to take contract matters into their own hands. In addition to the specific professional implications, contract terms can significantly impact a physician’s family, lifestyle, and future. There are many essential contract terms and clauses which can present complex and diverse issues for any provider, including:

• Non-compete clauses
• Damages
• Indemnification
• Verbal guarantees
• Insurance statements
• Paid Time Off (PTO)

Additionally, frequently, the most effective terms and clauses in any employment contract are the ones that are not present. With the advent of productivity-based employment agreements, any physician must have an employment agreement reviewed before it is executed. Attorney Robert Chelle has practical experience drafting and reviewing physician contracts for nearly every specialty.

Benefits of Physician Contract Reviewed

A thorough contract review can benefit new residents, attending physicians, doctors entering their first employment contract, or established physicians looking for new employment. By employing an experienced attorney for your representation, you can ensure that you will be able to fully understand the extensive and complex wording included in your contract. By having a complete understanding of the contract, you will be in a better position to decide whether you want to enter into the agreement, which will affect your career life for years to come.

The financial benefits gained from having your contract reviewed and negotiated by an experienced healthcare attorney far outweigh the costs associated with a review. You are a valuable resource, and you should be treated and respected as such. Attorney Robert Chelle will personally dedicate his time to ensure that you are fully protected and assist you in the contract process. As a result, your interests are fairly represented.

Every physician’s contract is unique. However, nearly all contracts for health care providers should contain several essential terms. Suppose these crucial terms in the agreement are not spelled out. In that case, disputes can arise when there is a disagreement between the parties regarding the specific term. For instance, if the doctor is expecting to work Monday through Thursday and the employer is expecting the provider to work Monday through Friday. Still, the specific workdays are absent from the Agreement. Who prevails?

Essential Terms that Contracts Should Contain

Spelling out the details of your job is crucial to avoid contract conflicts during the term of your employment.  Below is a checklist of essential terms that contracts should contain (and a brief explanation of each term):

1. Locations: Which facilities will you be scheduled to provide care at (outpatient clinic, surgical sites, in-patient services, etc.)?
2. Outside Activities: Are you permitted to pursue moonlighting or locum tenens opportunities? Do you need permission or have to provide information to the employer before you accept those practice of medicine related positions?
3. Practice Call Schedule: How often are you on call (after hours office call, hospital call (if applicable))?
4. Electronic Medical Records (EMR): What EMR system is used in the practice of medicine? Will you receive training or time to review the system prior to providing care?
5. Base Compensation: What is the annual base salary? What are the pay period rates?  Does the base compensation increase over the term of the Agreement? Is there an annual review or quarterly review of compensation?
6. Productivity Compensation: If there is productivity compensation; how is it calculated (wRVU, net collections, patient encounters, etc.)? Is there an annual review?
7. Practice Benefits Summary: Are standard benefits offered: health, vision, dental, disability, life, retirement, etc.?  Who is the advisor of human resource benefits?
8. Paid Time Off: How much time off does the job offer?  What is the split between vacation, sick days, CME attendance and holidays?  Is there an HR guide?
9. Continuing Medical Education (CME): What is the annual allowance for CME expenses and how much time off is offered? Is it variable?
10. Dues and Fees: Which business financial expenses are covered (board licensing, DEA registration, privileging, AMA membership, Board review)?
11. Relocation Assistance: Is relocation assistance offered?  What are the repayment obligations if the Agreement is terminated prior to the expiration of the initial term?
12. Signing Bonus: Is an employee signing bonus offered When are loans paid?  Do you have to pay it back if you leave before the initial term is completed? Is a loan paid back?  Is there a forgiveness period for a student loan after signing? What are the tax implications of a loan?
13. Professional Liability Insurance: What type of liability insurance (malpractice) is offered: claims made, occurrence, self-insurance?
14. Tail Insurance: If tail insurance is necessary, who is responsible to pay for it when the Agreement is terminated? What are the post-termination responsibilities?
15. Term: What is the length of the initial term? Does the Agreement automatically renew after the initial term?
16. Without Cause Termination: How much notice is required for either party to terminate the Agreement without a case?
17. Non-Compete: How long does the non-compete last and what is the prohibited geographic scope?
18. Non-Solicitation: How long does it last and does it cover employees, patients, and business associates?

Coming into a new organization with a favorable contract can put the doctor in a positive financial situation for years to come. Before you sign the most important contract of your life, turn to Attorney Robert Chelle for assistance.

If you have questions about your current medical malpractice policy or are interested in having your medical employment contract reviewed contact Chelle Law today.

How Much Should an Employer Give a Physician for CME Expenses?

Physicians need to continue their education in the medical field by attending Continuing Medical Education (CME) courses. The cost of these courses can be a burden on an individual physician’s wallet. To reduce this burden, employers will cover the cost of CMEs for their employees as part of the contract benefits package.

Continuing medical education (CME) is a type of continuing professional development that helps physicians stay updated with the latest developments in their field. It can be done online, on-site, or through other means, such as books and journals. It is not just for physicians; it also includes nurses, pharmacists, dentists, physical therapists, and other professionals in healthcare fields. It helps people keep up-to-date on new treatments and technology while keeping them out of trouble regarding ethical issues within their profession. It has many benefits, so read this article to learn more!

Continuing Education for Medical Providers

Continuing Medical Education can help physicians keep up to date on new treatments and technology while keeping them out of trouble regarding ethical issues within their profession. As a doctor, you know the importance of continuing medical education to stay current with the latest advancements in your field. 

Continuing medical education can be done online, on-site, or through other means such as books and journals. Some people might take college courses where they can earn credits towards getting a degree if they want one. It is important not just for physicians but also nurses, pharmacists, dentists, physical therapists, and other professionals in healthcare fields. The requirements are variable but typically require 20 hours per year, with many employers requiring more than 40 hours annually.

Virtual Continuing Medical Education (CME) Conferences

A sponsoring organization often provides credit for completed CME activities. For example, a medical association will provide credit for time spent listening to presentations at their annual meeting. And this information can be used on the physician’s CV or in seeking new employment opportunities with other organizations.

At a CME conference, physicians will see many lectures and posters on different topics in their field. CME is an opportunity to hear from experts about a topic that can be difficult to stay up-to-date with without reading extensively.

A conference may also have networking opportunities, sharing experiences, and discussing new developments in one’s practice area with other physicians who specialize in the same type of care.

Most CME Conferences Offers:

• They often include hands-on workshops where participants learn how to apply essential information learned during previous sessions.
• Lunchtime discussion panels provide attendees the chance not only to discuss what has been presented but also to voice their opinions publicly for feedback.
• Social events are another way that some organizations foster lasting relationships.

What Expenses are Paid for?

• Travel
• Meals
• Lodging
• Conference Entrance Fees

Average Cost of CME the Employer Pay 

A recent survey revealed that employers often spend between $1500 to $4,000 per year in reimbursements for expenses that are included in the business expenses reimbursed to the physician.

Due to the recent pandemic, many continuing medical education conferences are being held remotely, negating the need for travel reimbursements. However, most employers still provide relocation assistance for physicians when they move to a new job. 

State Licensing Board Requirements for Physicians

Each state licensing board requires certain Continuing Medical Education credits to be completed yearly for a physician’s license to stay valid. To get these CME credits, physicians might take courses on new medical developments or participate in activities supervised by the board of directors at their place of employment or volunteer work.

CME hours are reported on Continuing Medical Education (CME) certificates that can be printed and shared with employers. It’s typically offered in several formats, including live events, online courses or webinars, journal articles, books, and conference proceedings.

The physicians will need to report their CME credits earned according to the guidelines set forth by their state board. A physician may choose one format for completion, such as attending two lectures at an annual meeting. In contrast, another physician might prefer completing twelve three-minute videos over six months. These options reflect different levels of learning intensity. Still, both would qualify as reporting 12 hours for this example year since they represent equivalent academic value.

What Physician Business Expenses Should an Employer Pay For?

When a physician signs an employment contract, the employer will reimburse the cost of many practice-related expenses and offer professional benefits. The items that the employer will reimburse will be listed in the employment agreement. An employer must also assess Tax implications with any reimbursed business expenses (a CPA can help with this). A signing bonus or relocation reimbursement is customarily evaluated by the employer’s income taxes and standard deductions.  

Accountable Business Expenses

An employer should pay for the following:

Continuing Medical Education: Physicians are expected to keep up with the latest developments in their field. They do this by attending conferences, seminars, and workshops that are relevant to their practice. Sometimes, a physician might need CE hours to renew his license or certification credentialing requirements. An employer should give the physician between  $3,000-$5,000 a year for CME expenses.

DEA Registration: Drug Enforcement Administration registration is required for all physicians who prescribe controlled substances. The costs of this can vary depending on whether a physician will write prescriptions only at his office and how often he plans to prescribe drugs from home to patients in need.

Licensing Board Fees: The employer should cover annual state licensing board fees. It is generally prorated depending upon the time of year you join the employer.

Professional Associations: A physician needs professional associations to maintain his skills and communicate and collaborate with colleagues in other practices or institutions.

Health Care Tax Issues

Every physician’s contract is unique. However, nearly all contracts for health care providers should contain several essential terms. Suppose these crucial terms in the contract are not spelled out in contracts. In that case, disputes can arise when there is a disagreement between the parties regarding the specific term. For instance, if the doctor is expecting to work Monday through Thursday and the employer is expecting the provider to work Monday through Friday. Still, the specific workdays are absent from the Agreement. Who prevails?

Do Physicians Get Signing Bonuses?

Do physicians get signing bonuses? The answer is yes. And we’ll get into who gives signing bonuses. What’s the average value of a signing bonus, and then do you ever have to pay it back? First, who gets signing bonuses? Any physician could give a signing bonus if they’re coming out of training or just switching jobs. Does everyone give a signing bonus? No.

Most places will at least give relocation assistance, usually between 5,000 to 15,000. Many will pay it directly to the moving company, but that’s not the same as a signing bonus. Some places will combine it to call it a commencement bonus. Then, it’s up to the physician how they want to use it. They could use it for relocation assistance or down payment, for whatever they want. But let’s talk purely about signing bonuses right now. How does it work? Well, I would say now this is specialty-dependent. Usually, signing bonuses are somewhere between 10,000 to 50,000. When making the payment is necessary, some employers will pay it upon signing the agreement. Most employers won’t pay until the first pay period after the physician starts practicing with that employer.

Doctors Get a Signing Bonus and Relocation Assistance

The timing of that is essential. Sometimes people are just coming out of training, either residency or fellowship, and don’t have much money. You don’t get paid a lot in either of those scenarios. And suppose you must move to a city and put a down payment in a house or security deposit. Having some money upfront can help the physician make things more comfortable. That’s one area we can negotiate. When is the bonus paid? How much do you get? Well, there is no hard and fast rule that this specialty receives this amount. It is employer-dependent. Some are willing to pay a decent amount, and others say, no, you’re not getting one, no matter what. This goes for any contract negotiation. 

If you’re in a specialty that’s in high demand and has few out there, you certainly have more leverage. If you’re going to a town that’s harder to recruit, you certainly have more leverage in that scenario. I would ask classmates and others in your residency what you are looking at regarding your bonuses. You could ask some of the attendings and say, what do you hear about? What’s the average amount? Indeed, an attorney who deals with physician contracts can always give you a decent idea. Still, I’m telling you, it can vary wildly between cities and states and different employers. Another thing to think about is that almost every signing bonus will have a repayment obligation attached to it upon signing the agreement.

Term Length Affects Signing Bonuses

If the physician leaves within a certain period, usually the initial term of an agreement, I mean, how long it lasts, it’s going to be somewhere between one to three years. Many employers will tie whether physicians must pay the signing bonus back to that initial term. Then they’ll have forgiveness associated with it. So, I’ll use a couple of examples. Let’s say a physician joins the practice, its three-year initial term. The employer could say that 1, 30, and 6 of that signing bonus forgives for every month you’re here. So, you stay for those three years. You don’t have to pay anything back. Others can do it quarterly; some will do it yearly. And then maybe it’s only a year; it could be two, but you would rarely get a signing bonus.

Then if you left in the first year, you wouldn’t have to pay anything back. That’s something to think about when doctors are accepting a job. How much am I getting upfront? What will I have to pay back if I decide to leave the job before the initial term ends? In addition to assigning bonuses, some places under 10% could also offer student loan forgiveness. That’s another thing to investigate. A physician-owned practice would be infrequent to provide student loan assistance. It would have to be at the hospital or healthcare network. I would say the vast majority would be through a hospital or healthcare network that would be willing to offer student loan assistance.

Student Loans Repayment

And in that case, there’s usually no repayment obligation. The employer would say, we’ll give you a hundred thousand for student loan forgiveness. Then, we’ll pay a certain amount of that a hundred thousand over three or five years, whatever it is. And then they’ll pay it at the end of the month, and that’s the forgiveness. The physician would never have to pay anything back. It certainly is worth negotiating a signing bonus. It needs to be reasonable. The worst thing a physician can do is ask for something completely unreasonable. It makes them look like they have no idea what’s going on or are greedy. That’s kind of like threading the needle.

This is an average amount to ask for, or it needs to be slightly over what they’re offering. So, do physicians get signing bonuses? Absolutely. The amount depends on the situation. Almost any physician should get at least some signing bonus when coming out, trading or moving.

Physician Employment Agreement Negotiation Tips

How to negotiate a physician contract? In my mind, there are three different scenarios. One, you’re just coming out of training. Two, you’re switching jobs to an area of the country you’ve never been to. Three, you’re moving from somewhere within the place where you already live. So, negotiation depends upon leverage. Do you have it, or do you not? Let’s take coming out of training, for instance. For the most part, the only leverage someone has when they’re coming out of training is, are they in a specialty that’s hard to recruit for? I mean, that’s just the truth.

You are not bringing in any established patient base. You’re also relatively new to being out on your own. So, a learning curve will go into moving into any position. If you are either in an area that’s very difficult to recruit that could apply to any specialty, or you’re in a specialty that’s difficult to bring in and is super profitable. Those are two things. When you’re looking into it, how do I negotiate? And when people say negotiate, most of the time, they think about the bottom line, what is my base salary? But I think that’s a narrow mind. And this will apply to anybody. When looking at a job, some things are more important than just base compensation.

Other Considerations Aside from Base Compensation

One, what are the restrictive covenants? Suppose someone lives in an area. They have family and kids in the area. They absolutely cannot move after the contract ends. Sometimes, the non-compete could be the most crucial thing in a contract. A non-compete says you cannot practice for a period within a specific area. Another essential piece is who pays for tail insurance. Depending upon specialty, this could be an enormous part of a contract. If you’re an OB-GYN and must pay for your tail insurance, your underlying premium is $40,000 yearly. Your tail insurance will probably be around 80,000. So, who pays for tail insurance certainly could be the crucial thing in an employment agreement for an OB-GYN. If you’re being paid on production, let’s say you’re in a contract that’s just pure net collection.

Physician Compensation Models

An average range for a physician is 35 to 40% of net-collections is your total comp. Is there language in the contract that states that when the contract terminates, you’ll collect a 60-to-90-day window after the contract terminates? If you don’t have that, you work for free for two or three months, which nobody wants to do. Going back to what is important, it depends upon the person. Having the numbers is essential when you’re looking at base compensation. So first, they’re not always easy to obtain. Most places or most of the places use MGMA numbers. That’s a medical group management association, and most of the time, you must pay for that, and it’s expensive. So, no physician, at least most physicians, will not do that. 

You could find someone with access to those numbers or try to get them. Or if you kind of Google around on the internet, sometimes you can find them the average RVUs production, average compensation. It is distributed into areas of the country. I honestly don’t think those are accurate when determining exactly how much and what part of the country. There’s just a feel for what someone is getting in this area. But then you also have to consider all the other things I just said. If someone has a base that’s $10,000 less, they don’t have to pay for tail insurance. Or the non-compete is extraordinarily small. That’s worth way more than $10,000 in some instances, and those are a few factors to think about.

Prominence as the Highest Leverage

Suppose you’re just coming out of training. Let’s say you’re prominent in the community as a primary care PE or cardiology. You have an established space, and you’re just moving into a new practice. Well, this is the highest leverage you can have. There will be no, or at least, there shouldn’t be much time needed to ramp up the practice. You’re just bringing people with you. Plus, when you have numbers in a community, these were my net-collections, the RVUs I produced, or the weekly patient encounters. Those are absolute complex numbers you can use to negotiate compensation, moving to a different practice.

Specialty Negotiations for Physicians  

And in that case, you have the highest leverage possible. Then obviously, you can negotiate all the ancillary things I’ve already spoken about. The last thing would be, if you’re moving, you’re out of training. You’ve been in practice for a while, and you’re moving from one city to another. You don’t have an established patient base, and that takes away some leverage. There are two factors that kind of work for you. One, are you moving to an area of the country that’s difficult to recruit? Very rural communities certainly pay more. That is because it’s harder to find physicians in certain specialties to come and move and live in those areas. Or two, if you’re in a specialty that is simply hard to recruit or highly profitable. So obviously, surgeons are difficult to find, or some other GI sub-specialties are always difficult.

If you’re moving to a different part of the country, the same analysis applies to coming out of training. However, you benefit from having some numbers of what you produced in your previous position. You can tell them; that this was the net collection I generated in my last position. Now, it doesn’t always translate from one state to another or situation to another. Maybe you’re going from private practice into an employed group. But having any data to back up what your production was is essential in determining your new total compensation in a new position. So hopefully, those are some tips on things to think about. I mean, honestly, just doing this video. I think I can make it into ten different videos, but this is an overview of negotiating.

Reach Out to an Employment Contract Attorney 

Before signing an employment contract, you must know all the contract benefits you are entitled to. It means reading your contract carefully and asking questions where needed. It will help you avoid misunderstanding. It will also enable you to enjoy a long and prosperous medical career. Another consideration is whether the Agreement contains a non-compete agreement.

One way to ensure all contract benefits are offered as they should is by having an employment contract lawyer review your contract or independent contractor agreement. This way, the attorney can guide and advise you accordingly. Attorney Robert Chelle is a professional contract lawyer who can help you review the benefits under your contract. He has helped many healthcare professionals, and he can help you too. Feel free to reach out for assistance today.