Physician Relocation (How MUCH Reimbursement Should You Get?)

Relocation assistance is customarily provided to a physician when the employer assists new hires with relocating from one location to another as a part of the benefits package.  Relocation assistance for a physician can range from $5000-$15000.  It is a benefit designed to help ease the financial burden of moving and get the employee started in their new position as quickly as possible.

New Job Moving Expenses

Relocation-associated costs can include:

• House-hunting trip: Relocation assistance can include house-hunting trips of short duration to give the transferee and family opportunities to find new homes. 
• Transportation:  Relocation assistance can include repayment for transporting the doctor and their family to the new location. If the doctor can travel by automobile, mileage reimbursement is common. Plane flights and vehicle transfers can also be included.
• Temporary housing:  Some employers allow to reimburse the costs of up to 30 days of temporary housing for transferees after moving to the new job.
• Packing/Unpacking: Household goods are packed by a moving company, saving the doctor time and stress.  Additionally, the company, after arriving at the new destination, can unpack the household goods too after moving is complete.

Are Job Relocation Reimbursement Expenses 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 all consider relocation expenses paid by an employer as taxable income for employees – including household goods transportation, temporary living expenses, miscellaneous allowances lump sum payments and more.

These days, most people don’t have the time to pack up their entire lives and move across town. Fortunately, there are ways for them to get reimbursed by their employer – or even pay less in taxes! Just remember that moving expense deductions were eliminated as of January 1st 2018 so if you’re looking at a big change soon it’s worth getting out ahead of the game with your tax planning today.

The Tax Cuts and Jobs Act took effect on Jan 1st 2018 which means all those who want to take advantage of any potential deductions need act quickly before they expire.

When a company’s employees move to new locations, the tax impact on their wallets can be significant. The specific tax implications depend largely on an income and place of residence before they moved; but in general, employers will pay for relocation expenses such as moving costs or temporary housing while waiting for permanent arrangements after arriving at destination—and 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!

Other Blogs of Interest

• How Much Should an Employer Give a Physician for CME Expenses?
• Does A Physician Have to Repay Relocation Assistance If They Leave?

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
• Paid Time Off (PTO)
• Indemnification
• Verbal guarantees
• Insurance statements

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?

Employment Agreement Checklist Including Signing Bonuses

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

1. Practice Services Offered: What is the clinical patient care duties? Are you given time to review administrative tasks? How many patients are you expected to see (like in pediatrics)?
2. Patient Care Schedule: What days and hours per week are you expected to provide patient care? What is the surgery schedule? Are you involved in the planning of your schedule?
3. Locations: Which facilities will you be scheduled to provide care at (outpatient clinic, surgical sites, in-patient services, etc.)?
4. Outside Activities: Are you permitted to pursue moonlighting or locum tenens opportunities? Do you need the employer’s permission before accepting those practicing medicine-related positions?
5. Disability Insurance: Is disability insurance provided (short-term and long-term)?
6. Medical License: Will the practice offer reimbursement for your license? Will an advisor be provided?
7. Practice Call Schedule: How often are you on call (after-hours office call, hospital call (if applicable))?
8. Electronic Medical Records (EMR): What EMR system is used in the practice of medicine? Will you receive training or time to review the system before providing care?
9. Base Compensation: What is the annual base salary? What is the pay period frequency? Does the base compensation increase over the term of the Agreement? Is there a yearly review or quarterly review of compensation?
10. Productivity Compensation: If there is productivity compensation, how is it calculated (wRVU, net collections, patient encounters, etc.)? Is there an annual review?
11. Practice Benefits Summary: Are standard benefits offered: health, vision, dental, life, retirement, etc.? Who is the advisor of human resource benefits?
12. 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?
13. Continuing Medical Education (CME): What is the annual allowance for CME expenses, and how much time off is offered?
14. Dues and Fees: Which business financial expenses are covered (board licensing, DEA registration, privileging, AMA membership, Board review)?
15. Relocation Assistance: Is relocation assistance offered? What are the repayment obligations if the Agreement is terminated prior to the expiration of the initial term?
16. Signing Bonus: Is an employee signing bonus offered? When is it paid? Do you have to pay it back if you leave before the initial term is completed? Are student loans paid back? Is there a forgiveness period for student loans?
17. Professional Liability Insurance: What type of liability insurance (malpractice) is offered: claims made, occurrence, self-insurance?
18. Tail Insurance: If tail insurance is necessary, who is responsible for paying for it when the Agreement is terminated?
19. Term: What is the length of the initial term? Does the Agreement automatically renew after the initial term?
20. For Cause Termination: What are the grounds for immediate termination for cause? Is a review provided to dispute the termination?
21. Without Cause Termination: How much notice is required for either party to terminate the Agreement without cause?
22. Practice Post Termination Payment Obligations: Will you receive production bonuses after the Agreement is terminated?
23. Non-Compete: How long does the non-compete last, and what is the prohibited geographic scope?
24. Financial Retirement: Is a financial retirement plan offered?
25. Non-Solicitation: How long does it last, and does it cover employees, patients, and business associates?
26. Notice: How is a notice given? Via hand delivery, email, US mail, etc.? Does it have to be provided to the employer’s attorney?
27. Practice Assignment: Can the employer assign the Agreement?
28. Alternative Dispute Resolution: If there is a conflict regarding the contract, will mediation or arbitration process be utilized? What is the standard attorney review process for conflict? Who decides which attorney oversees the process?

Suppose you have concerns about signing bonuses and claims-made or occurrence coverage, as well as your current malpractice insurance. Contact Chelle Law today if you want to have your employment agreement reviewed.

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?

Does a Physician Have to Repay a Sign-On Bonus When They Leave?

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 Signing Bonus 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

When Does a Physician Have to Pay Back the 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.

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.

Contract 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.

Negotiations of Medical Practice Specialty 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.

Consultation with Chelle Law

When your Physician Assistant agreement is reviewed by a contract review attorney, you will find financial benefits which end up outweighing the cost of the review. Leave it to the experts. If you are in need of assistance with an employment agreement or contract review schedule a Physician Assistant Contract Lawyer with Chelle Law today!