ECFMG Certification Requirements | Certification Requirement
Overview
The Educational Commission for Foreign Medical Graduates (“ECFMG”) is an organization that ensures international medical graduates (“IMG”) are qualified to practice in the United States. This article will discuss what Educational Commission for Foreign Medical Graduates (ECFMG) requirements IMGs need to meet to be eligible for residency or fellowship programs, USMLE Step 3, and medical licensure.
What is an IMG?
An international medical graduate is someone who has graduated from a medical school outside of the US. They are required to go through ECFMG certification to practice medicine in the United States. IMGs have already completed their education but need to meet specific requirements before entering residency programs or taking Step III of the three-step series for licensure exams.
Medical School Requirements: What does an IMG Need?
IMGs must: pass both parts of a computer-based examination called Test of English as Foreign Language (TOEFL), complete and successfully submit all four sections of the Medical College Admissions Test (MCAT) with no score lower than 500, which includes writing and verbal reasoning, obtain at least one year’s work experience after
It is a requirement for IMGs to:
- Enter residency or fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME)
- Take Steps of the three-step United States Medical Licensing Examination (USMLE)
- Obtain an unrestricted license to practice medicine in the United States.
Requirement
ECFMG Certificate is needed by IMGs as part of their qualifications for ACGME accreditation, USMLE Steps, and licensure. There are two ways they can get it–through certification through completion of a medical school program or through demonstration proficiency during training at institutions outside North America with teaching methods similar to those found in US medical schools.
Requirements for ECFMG Certification
The requirements for ECFMG Certification include:
- Currently enrolled student or graduate of a medical school that meets ECFMG requirements;
- Primary-source verification of your medical education credentials.
- Completion of the Application for ECFMG Certification, including the notarized Certification of Identification Form (Form 186);
- Satisfying the examination requirements (medical science examination requirement and clinical skills requirement).
Physician Contract Review
Our physician contract review identifies areas we could improve, and an attorney will assist you in negotiating the best contract possible. A physician’s contract should be taken apart and understood fully. Signing contracts before fully understanding each clause and implication could be disastrous. Coming into a new organization with a favorable contract can put the physician 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.
Other Blogs of Interest
What Should be in a J-1 Physician Contract?
Many physicians coming out of training are for medical grads. To assist in their immigration, they must enter a J-1 waiver employment contract with their first work out of medical training. I will go through the basic elements that a J-1 physician employment contract needs to include. Hopefully, maybe make it a little easier to understand. So, what is an employment contract? Simply it’s just an agreement between you and the employer about what the terms of the business relationship will be. Every state has requirements of what needs to be in a J-1 visa contract. Most of them are almost the same.
How to Get Started in the Program
Some states either require or don’t require many things. I’m going through what everyone will have and a few things that vary from state to state. First, the J-1 contract must contain sites where the J-1 physician will be working and the services they’ll be providing. It must state that the J-1 physician must start within 90 days of receiving the J-1 visa waiver. Since I’m in Arizona, I’m going through the Arizona department of health services. The requirements for the contract, and get into what varies from state to state. It must be for three years—that goes for any state. It must express that the J-1 physician will work a minimum of 40 hours on average.
That must be in every contract in every state. Then the employer and J-1 physician must both sign the agreement. Those are just the bare-bones things that must be in every J-1 contract.
Things That Change From State to State
Some of the things that change from state to state. And this might help a J-1 physician who’s looking in multiple states for different opportunities. Arizona, for instance, prohibits any non-compete in the agreement. Arizona does allow and enforce reasonable non-competes for J-1 physicians in the state, but they prohibit them in a J-1 contract. Which can change from state to state whether it needs to be in there or not. If the contract changes in some way, if there’s an amendment, it must still reach those basic amendment requirements. If they amend it, they must run it through the state’s health department or whoever oversees the contract.
Visa Petition Approved Medical Contract
Regarding negotiating a J-1 contract, I mean, every contract negotiation is based upon leverage. A J-1 physician probably has less leverage because they need to be in that position. But different specialties always have different leverages than others. Then if you’re willing to go into certain places. The entire point of the J-1 visitor program is to bring physicians to health service shortage areas or under-served communities. So, you’re likely going somewhere that’s more rural, not in a large city, and is probably harder to recruit to. The visitor program intends to bring good J-1 physicians into these areas where recruiting is harder. Then after three years, they can go through the certification process and get their green card. So that’s the basics of what needs to go into a J-1 employment contract.
J-1 Visa Waiver Program
The J-1 Visa Waiver Program is designed to bring in physicians from abroad for a temporary period. J-1 physicians are required to work full-time at their assigned location and have an employment contract that includes those requirements. J-1 Physician Contract Requirements list all the criteria J-1 Physicians must meet before their application would be approved for the J-1 waiver program. A visitor waiver program granting entry into the United States of America. Here is a breakdown of what you must know about getting your J-1 physician contract application ready for approval!
International Medical Graduates
The US Citizen and Immigration Services provides valuable information for those interested in the J-1 waiver process. The J-1 classification is for those who want to participate in and submit an application to an approved program. A program allowing them the opportunity to teach, instruct, lecture, study and observe, consult with others, or demonstrate special skills. You can also receive J-1 training while you are there!
Visa
The United States Department of State has named public and private entities to act as exchange sponsors. These visitor waiver programs are designed to promote the interchange of persons, knowledge, and skills in fields like education, arts, or science.
The US Secretary appoints a designated sponsor for each J-1 Exchange Visitor Waiver program. They have goals set out on behalf of those visiting America from their home country. Those who will bring back new ideas and unique perspectives when they return home at the end of their stay. And attaining this through cultural exchanges that help broaden international understanding of different cultures. Which we can all learn something about during this experience.
Visa Waiver Program Application
The US Department of State plays the primary role in administering the J-1 waiver program. So, you want to get a visa for this J-1 trip. But suppose your sponsoring agency is not helping. Then it’s time to start getting creative. You will need Form DS-2019: Certificate of Eligibility for Exchange Visitor Status (formerly known as an IAP-66). This means working closely with officials at your sponsoring embassy or organization who are assisting through this whole ordeal. But don’t worry, they’re there every step along the way!
A responsible officer has the power to grant a student their Form DS-2019, otherwise known as an I-20. Your RO will be your point of contact for any questions you may have during this process. And can help answer any questions. They’re also in charge of issuing documents like letters or transcripts if needed before we issue them our coveted document!
The US Department of State provides Form DS-2019 to those interested in going abroad for educational purposes. And receiving the J-1 visa after acquiring it through their medical school’s sponsor. Which is typically an American university or college with international programs on an F, M, or Q status. The waiting time for your interview appointment can vary, so submitting as early as possible is strongly encouraged. Though you may not enter the United States more than 30 days before your waiver program starts.
Physicians
J-1 physicians should not enter into a contract without having the agreement reviewed by legal counsel first. You need someone to protect your interests. You need a firm grasp of the key terms and their implications. When we do a thorough review of your J-1 physician employment contract, you will receive:
- Available in any state where that J-1 physician is
- Flat-rate pricing, with no hidden costs needed
- Review of your proposed employment agreement
- Phone consultation with Attorney Robert Chelle reviewing the contract term by term
- Follow up with a review of the needed clarifications
Knowing you have professional and experienced help with an employment contract will enable you to take the stress out of trying to do a vital business transaction. You can then focus on what is important — your patients.
J-1 Waiver Visa Contract Requirements
The employment agreement between the J-1 physicians and their employers must contain a number of terms. Each state where the J-1 physician will practice will have its requirements. But all states require the following in the Employment Agreement:
- The contract must specify the name of the service site(s). And the address where the J-1 physician will provide their services. (A separate service site application must be completed and submitted. Where? For each site where the J-1 physician will perform their required full-time hours per week.)
- J-1 waiver program contract must be for at least full-time (at least 40 hours per week). And specify the approved primary care/specialty services the site will provide.
- The contract must be for at least 3 years.
- J-1 physicians must agree to begin employment at the approved service site(s) within 90 days of receiving J-1 waiver. (must state in the contract)
- Until the J-1 physician completes the three-year commitment, the J-1 physician must provide services:
- At the service site(s) specified in the employment contract,
- To the patients specified in the employment contract, and
- In the manner specified in the employment contract
GME Program and Medical School
Alien physicians must, in order to be eligible for a work permit. J-1 applicants must have completed the appropriate educational requirements and training in their home country before coming to America. Successful candidates will need at least an associate degree in accounting from American universities. Or equivalent experience working as an accountant abroad.
Foreign Medical Graduates
The requirements for an international student vary from program to program. J-1 waiver applicants must be able to adapt to the educational and cultural environment they will experience in their visitor programs. And have the necessary background, needs, and experiences suitable for the fields of study offered at university or college-level institutions. Also, competency with oral communication. Such as speaking English fluently so that one can easily comprehend what is being said without any difficulty whatsoever.
Some universities desire international students because it allows them more diversity on campus, giving intellectual stimulation through new perspectives. Also allowing those who may not especially enjoy interacting with people outside of their own culture might create less stress. Worry-free during medical school days if they had someone close enough culturally similar around them all day.
Looking for the most comprehensive and rigorous medical exam? Look no further than The National Board of Medical Examiners. There are three different ways to pass this examination: Part I & II from either an American or Foreign school. Step 1&2 passing with ECFMG (Educational Commission For Foreign Medical Graduates) and a Visa Qualifying Exam(VQE). One must pass all parts before their education begins, as some US schools require it even after graduation!
The National Board of Medical Exams
The National Board of Medical Exams exists so J-1 physicians can ensure they have the best training available. They do this by offering multiple options for completing your certification process.
The country’s government needed physicians with the skills to provide care. The alien had filed an offer, along with a written assurance that he would return after medical training was complete. And they issued permission for him to train.
The passage begins by stating their need to be physicians who are needed within the area first. Before further assessing any individual’s qualifications or willingness to serve. Alongside providing documentation, ensuring their willingness, educational background, and proficiency must also reflect what’s required. Once they meet these requirements, if approved, it will permit them to enter this new opportunity.
The agreement includes a contract from a US-accredited medical school, an affiliated hospital, or a scientific institution. In order to provide accreditation graduate medical education for the alien physicians. Both parties should sign it:
The United States has strict requirements for granting citizenship status that one can meet with various documents. Documents such as diplomas, transcripts, degrees, etc. One of these additional documents required is one detailing how you will receive your training in medicine. That is, via affiliation agreements between institutions like colleges/universities that offer this type of medical training. And hospitals where physicians train after graduating too, called “accredited” schools. Meaning their credits towards certification are recognized nationally (or internationally). This document must detail what year(s) you plan on studying at the said institution.
How Much are Resident Physician Salaries? | Physicians Salary
One question med students have is the average salary for a resident physician. After a physician graduate from medical school, they move on to an internship or residency within their specialty. Then earn. But for most of them, it’s simply not even remotely enough for the work that they’re doing. So, it’s not uncommon for residents to work 70- or 80-hour weeks. The average salary for residents in the United States is around $63,000. Maybe you’re a resident right now, thinking, I don’t even make close to that, or maybe I make more. This is average across all specialties. Some specialties will make a little bit more than others.
Leverage in Salary Negotiation
Some could be as high as the 60s. Whereas maybe in family medicine, you could be about 50s. Can residents negotiate their salary during medical training? No, they have no leverage. Anytime you’re negotiating a contract, you base it upon leverage. Even those residents coming out of training and moving on to their first employed job don’t have much leverage either. The only leverage they have in those situations is if they’re in a needed medical specialty. Or two, if they’re willing to go to an under-served geographic area and need physicians.
So, around 63,000 is the medical residency salary. If you think of it this way, if they work 70 to 80 hours a week, they’re making about $15 hourly. And providing care as a doctor for $15 an hour. Now, once they move out of training, the salary increases substantially. And for some specialties could be an eight-fold increase, at least just coming out. But that’s what it is. One consideration we make when reviewing and negotiating the resident’s or fellow’s first contract. Most of them don’t have a ton of money coming out of training.
Importance of Relocation Assistance
So, suppose the new employer is offering a signing bonus or relocation assistance. In that case, we want to ensure they’re getting a chunk of that before moving and starting the new job. Wherever, if they are moving from where they’re currently training. Simply most residents, especially if they have family, may be the only breadwinner. At that point, they don’t have $10,000 to $15,000 if they’re making a cross-country move. So, we need to ensure that either the employers pay their moving costs directly to the moving company. Or they’re going to front the money before the physician needs to spend it on the move.
In that way, they don’t have to outlay a ton of cash. Because it certainly is expensive moving from one place to an entirely different one. Medical residents certainly are underpaid. Unfortunately, it’s part of the process they must go through to be fairly compensated for the services they provide. But it’s just tough when you’re making that little. And I think the average physician has about. I think 47% of physicians have student loans over $200,000. It could be a big burden.
How to Negotiate a Physician Contract
How do you negotiate a physician contract? What are the goals to consider during the contract negotiation process to win the terms of the negotiated agreements? So in my mind, there are three different scenarios. One, you’re either just coming out of medical training. Two, you’re switching jobs to an area of the country that you’ve never been to before. Or three, you’re moving from somewhere within the area where you already live. So negotiation is always based upon leverage. Do you have it, or do you not? So let’s just take coming out of training, for instance. Often, negotiating job offers, the only leverage someone from training has, is in a specialty that’s hard to recruit for. That’s just the truth.
What to Negotiate in a Contract
You are not bringing in any established PA patient base. You’re also all relatively new to being out on your own. So, a learning curve will go into moving into any position. Consider this, 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 all to bring in and is super profitable. Those are two things to consider.
When you’re looking into it, how do I negotiate the terms of the contract? 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 kind of a narrow mind. And this will apply to anybody looking for work. There are some other goals to consider during contract negotiations. At least in my mind, things that are more important than just the base compensation. One, what are the terms of the restrictive covenants?
Non-Compete is Important to Most People
My advice if someone lives in an area, they have family in the area, they have kids in it. They absolutely cannot move after the contract ends since they will have to also think about things related to moving. Like the schooling of the kids, or your wife’s job, or if they are also running a business. Sometimes, the non-compete could be the most important thing in a contract. A non-compete says you cannot practice within a specific area for a period.
Negotiate Tail Insurance
Another important 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. You have to pay for your own tail; your underlying premium is $40,000 yearly. Your tail insurance cost will be higher compared to other specialties. Probably going to be around 80,000. Who pays for tail insurance certainly could be the most important thing in an employment agreement during a contract negotiation.
Employer Practice Negotiations
My advice if you’re being paid on production. Let’s just say you’re in a contract that’s just pure net collection. An average range for a physician is 35 to 40% of collections. Is there language in the contract stating that when the contract terminates, you will be able to collect for a 60 to the 90-day window after the contract terminates? If you don’t have that, then you worked for free for two or three months, which nobody wants to do.
Going back to what is important, it depends upon the person what his goals are. Having the numbers is important when you’re looking at base compensation. They’re not always easy to obtain. Most places, or the majority of the places, use MGMA numbers. It’s a medical group management association. Most of the time, you have to 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 Google around on the internet, sometimes you can find the average RVU production and average compensation. It is broken down into areas of the country. I honestly don’t think those are accurate when determining exactly how much in what part of the country. There’s a feel for what someone is getting in this area, but also consider all the other things I said. If someone has a base that’s $10,000 less, but employers will not make you pay for tail insurance. Or the non-compete is extraordinarily small. That’s worth way more than $10,000 in some instances. That is kind of a few factors during contract negotiation to think about.
Physician Employment Contracts
If you’re just coming out of training, let’s say you’re established in the community. Either you’re a primary care PE, it’s cardiology, you have an established space, and just moving into a new practice. Well, this is the highest leverage you can have during contract negotiation. There’s gonna 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, your net-collections, the RVUs you produced, or the weekly patient encounters. Those are absolute hard numbers that you can use to negotiate compensation terms, moving to a different practice.
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, out of training. You’ve been in medical practice for a while, and you’re moving from one city to another. You don’t have an established patient base. That takes away some leverage. There are two factors that kind of work for you for your contract negotiation strategies.
One, are you moving to an area of the country that’s difficult to recruit to? Very rural communities certainly pay more. Simply because it’s harder to find physicians in certain specialties and make them move and live in those areas. Or two, if you’re in a specialty that is just simply hard to recruit to or extremely profitable. So obviously, surgeons are difficult to find, or some of the other GI subspecialties are always difficult as well.
Doctors Can Negotiate Effectively
If you’re moving to a different part of the country, then the same analysis applies to some kinds of training. However, you benefit from having some numbers of what you produced in your previous position. You can tell them during your contract negotiation, this was the net collection that I generated in my last position. Now, it doesn’t always translate from one state to another or one situation to another. And maybe you’re going from private practice into an employed group.
But having any kind of data to back up what your production was is essential during contract negotiation. Especially in determining your new total compensation in a new position. So, those are some tips on things to think about. I mean, honestly, just doing this blog, I can think this could be broken down into ten different articles. But this is just kind of an overview on negotiating.
How to Negotiate a Physician’s Salary
How to negotiate a physician’s salary? Initially, I don’t personally believe that the salary shall be the driving factor in a decision for a physician. Now, clearly, if there’s an enormous gap, a hundred thousand dollars, maybe 50. But if it’s $10,000 just going with the job that offers the most when maybe the benefits are different. The work environment is different, the ability to learn, have a good mentor, a good teacher, and a good team.
I think all those things are probably more important than just the absolute base salary amount. But it certainly is important. And so, when someone asks me, all right, well, what do I do? How do I get a better salary during contract negotiation? How can I make them offer terms that are my goals in the hiring process? There are a couple of ways of doing it during contract negotiations.
Know Your Worth
One, you need to know your worth. How does a physician find out what’s a reasonable salary? Well, there’s data. The MGMA medical group management association is, I would say, probably the industry standard as far as compensation numbers go. But it is not the be-all and end-all of whether something is fair or not. They break it down into regions: West, East, Midwest, and Southwest. Those kinds of quadrants have different salary numbers associated with them.
Potential For A Partnership
But just the base salary could be great or not depending if there’s productivity compensation in the agreement as well. Or there’s potential they can offer partnership. So, there are many scenarios where a physician is out of training, and they’ve given a two-year, three-year agreement. That’s probably below what’s a reasonable or average amount for someone just coming out of training. Kind of with the carrot on the stick if you take below market for these two or three years. Then you’ll get away above-market. Once you become a partner, be careful of the situation. Do you need to find out how many people are partners? How many people have they not offered partnership to? And then what will you make once you’ve become a partner? That’s certainly important.
MGMA Numbers
Now, as far as the MGMA numbers go, they are kind of hard to find. I mean, you can Google around and find, I would say, data from maybe a year or two old. I found that people are relying on 2020 numbers. They’re completely screwed up due to COVID. Some of the RVU compensation factor numbers are way out of whack. Some of the comps are just way out of whack.
I would not use 2020 data to compare the contract offer. 2019 is probably the safest and most reliable number that we have right now. 2021 hasn’t been released, at least at this point while I’m making this video yet. So, Google and read around. You can try and find some numbers to help you with negotiations. I’d say the best tactic is to go out, find multiple job offers and see what you’re being offered initially.
Colleagues in Training
And then also, anyone in training has other people in their specialty that are also looking for jobs. Reach out to your colleagues, and talk to the people you’re in training with. What have you been offered? Where have you been offered this?
Cost of Living in the Area
One difficult thing is that some people automatically think that they’re in a high-cost city and that they’ll make more. But have not considered other factors, like a higher cost of living. And that’s just not the case. It’s almost the opposite. If you’re looking for a job in a city, that’s kind of a desirable location. Usually, the salaries, or at least sometimes the salaries will be depressed. I live in Scottsdale, Arizona, which is a great place to live.
And when I speak to physicians who are moving into the area, they’re surprised sometimes. Because the salaries may not be adjusted to the cost of living in the area. California as well. If you’re in San Diego or LA or even in San Francisco, the cost of living is very high. And the housing is very high, but the salaries are not commensurate with that. Be aware that just because you’re in a bigger city with higher living costs doesn’t mean you’ll be making more. It’s the opposite, really.
If you’re in a rural location that’s hard to recruit, you will almost always make more money in those scenarios. So, if money is the bottom line you’re looking for. Then you need to look in the smaller cities that are simply difficult to recruit to. You will make more money on average if you’re going to go to a small rural community. That’s a fact.
Negotiating Numbers
Once you have a number in mind, what do you do with the employer? You ask them for more.
If you’re being offered 300 and you want 325, you don’t ask for 325. You ask for more than that. So, if they offer 300 and you want 325, then ask for 350. Just kind of easy arithmetic, try to meet in the middle. Now there is a point where you will look either greedy or potentially just kind of dumb. If you’re offered 300, and you’re asked for 450, they’re going to say, well, that’s ridiculous. They may even yank the offer.
You need to know your value. Specialty is also a big part of what kind of leverage you have. Any kind of contract negotiation is based on leverage. Do you have it, or do you not? You simply have more leverage if you’re in a specialty that’s hard to recruit to or is in high demand. If you’re in a specialty that’s plentiful or saturated in the market that you’re looking in, your leverage is less.
So, you need to take that into account as well. If you’re switching jobs in the community and bringing your patients with you. Then you’re worth more than someone coming into the community. Like peds or primary care, that must build up a patient base that takes time.
When Should a Physician Resident Start Looking for a Job? | Job Search
When should resident physicians start looking for medical jobs? This is a complicated question. First, I do contract reviews daily for physicians. Many are individuals getting their first jobs who’ve never had an employment contract before. They’re either in their last year of residency or fellowship and have an offer they want me to review. There are occasions where there’s a multiple-year fellowship, maybe a PGY-2 or something like that. Wherein residents already have an offer that won’t begin for two years and want me to look at, as well.
Researching a Residency Physician Job
Let me give some words of wisdom, just from doing this for a couple of decades now. One, if you are a resident or a fellow. You know where you need to be, geographically. Maybe you have to move home, or you have a significant other completing trading themselves elsewhere. Want to move close to your family, whatever it is. If you have a pinpoint location in mind, getting started sooner than later is probably a good idea. Start looking for work when you still have two years left in training. Think of it from an employer’s perspective. Some employers don’t have immediate needs for physicians, right? So, if they are well run, they’ll have financial forecasts.
Forecasts as far as the patient load will be, perhaps the practice is expanding and opening a new office. But they’re not going to open it for a year. I guess I’m saying that employers know that they’d have a need for a physician. But sometimes, it’s not for a couple of years. That’s why an employer will start looking immediately for a position that’s not immediately available. Once they get out there and see some candidates, even if that candidate has two years left in training. It’s not uncommon for them to offer them a position and make them sign an employment contract. One benefit of looking early is simply getting in before someone else takes the part. So the earlier you look at the job, the more likely you’ll have a chance to get it. If that makes sense.
If You Take a Medical Practice Early
Next, the downsides of going early. What’s the negative part of finding a position far out from when medical residents have completed training? Suppose you sign an employment agreement that doesn’t commence for two years. And then you have some change in the family. Maybe the significant other that was supposed to move to one city is now moving to another. Or there’s a sickness in the family. There are a million reasons why a location is perfect at one point, and two years later, it’s not. The downside of signing early is that things may change in your life, but you have signed the employment agreement. Then it gets into: how can I terminate this agreement even before I’ve started? Are there any penalties associated with it? Some contracts have built in that if the physician doesn’t start, they will owe some penalty.
Which Year to Start the Job Search?
I would suggest. Before signing an agreement with that kind of language, probably get it reviewed by someone to review the ramifications. What happens if I sign the agreement, I either can’t start or don’t want to start. And then need to get out of the contract? Another possibility is you sign early and get a better offer. So maybe it’s just a better opportunity for you. The compensation is more. The benefits are better. The concern is that if you sign a contractor early, you’re foregoing any potential opportunities down the road. Now, some employers are okay with letting someone out with enough notice.
The contract will have a notice requirement, but if you haven’t even started, most employers are understanding. If there is some actual change in family circumstances. They’re not as forgiving if it’s simply that this person is paying me more than you. I don’t want to complete the terms of this agreement. Once the contract is signed, the employer relies upon you to start, so they will stop recruiting anyone else. They’re going to make plans to either bring in more patient volume. Or maybe the office they’re opening up is contingent upon you being there.
Residents Should Start Looking at Multiple Offers
So, I guess there are problems for both sides if the physician doesn’t want to start. The employer could have some damages associated with the physician not completing the terms of the agreement. Overall, I’d say the sooner, the better to start looking. However, taking the first offer and signing an employment agreement without comparing different bids is a bad idea. There are almost always multiple opportunities for somebody just starting their career. Just to accept the first one just because they are the first doesn’t make a lot of sense to me. So I’d suggest you look at multiple offers, gauge the compensation structure amongst them, and then go from there.
How Should a Resident Physician Look for a Job? | Medical Residency
How should resident physicians look for a job? Literally what steps should they take to find a position they’ll be satisfied with. The timing certainly is important. Most physicians generally start looking for positions early in their PGY-3 year. Some specialties will even sign contracts in their PGY-2 year if they’re not going into fellowship. If a physician is moving from residency into fellowship, they usually won’t start looking until the end of their last year of residency, or maybe it’s a multiple-year fellowship. Maybe at the beginning of the last year of their fellowship as well. There are several ways physicians can find jobs.
How Physicians In Residency Can Look For A Job
The easiest way I’ve found is through colleagues. If you’ve trained with somebody, usually, they’ll know of, a place that’s recruiting, or maybe they joined a practice. And they say, it’s a great environment that we’re looking to add another physician in a specialty. Maybe you should look at it. Now, that can vary wildly in location, and location is very important to some, while not important to others. So, it can go all over the place if you’re getting some leads from fellow residents or fellows. One way is to talk to colleagues, mentors, or other people you’ve met in training. And that’s also a great way of determining the market value at the time. The MGMA data is like an annual physician compensation survey across the nations broken up into geography, specialty, and physician-owned versus hospital-based physicians. In some specialties, the sample size is so tiny.
I don’t think it’s a great tool. Other specialties can usually be a pretty good gauge if there are hundreds and hundreds of responses. I don’t think any physician should base a job search solely on compensation. I think that’s shortsighted. Anyone coming out of training needs to be in an environment where they can learn. Or they’re going to have mentors where they’ll feel safe, where they’ll have an opportunity to grow.
I often see it, especially in rural environments, where they need a specialty. They’re willing to throw a bunch of cash at somebody. But they’ll be the only ones in their specialty out there. Like there’ll be no others, no one to learn from, to train with, to pick someone’s brain, at least locally. Those scenarios are tough. Some physicians can thrive in that environment, but it’s more complicated for others. So, I think they need to consider that.
Physician Employment Recruiters
Any physician contract is going to have without-cause termination. If a physician is unhappy in their practice, they just provide usually, 60- or 90-days’ notice. And they can move on. Even if you’re in a job at the beginning, you’re not stuck there forever. You can find something better. I mean, I find a lot of physicians coming out of residency or fellowship will take the first job. And then they’d say, alright, now I know what I don’t want. So, they can look for work more appropriate to the practice they’re looking for.
Another way is through physician recruiters. There are two types of them. You have in-house recruiters. Many big hospital networks employ physician recruiters who go out to different residency programs. Maybe there’s a job fair, something like that. Or they’ll specifically reach out to people in training, saying, hey, I have this opportunity in this place. Would you be interested? They’re free to physicians. You do not have to pay the recruiter or anything. The employer is the one that pays the recruitment fees.
So, physician recruiters. Both in-house and those that are just a private group where they just go out and broker these deals. Typically, they would get a percentage of the first-year salary of the physician, or maybe a flat fee. Something like that. But there’s absolutely no harm in discussing positions with recruiters. It’s a usual way of doing business nowadays. They usually have their ear to the ground and know many different opportunities that could be exciting for physicians.
Physician Job Search
Another way if you have a specific region in mind. Is just doing job searches for practices in your specialty in one specific area. Most places will have job posts on regular job sites if they’re looking. Then you can search for those in the city you want, find that and contact them from their work listing.
That’s another way. So, those are the three biggest ways. Word of mouth through colleagues, doing it through a physician recruiter, or searching in specific cities through job search websites. Now, for those who are maybe J-1 or something like that, that’s like an entirely different kind of job search. And I can do a separate video about that. But this is more geared towards those looking for the normal position just coming out of training.
Term Length | How Long Should a Physician Contract Be?
The term of the employment agreement refers to how long the contract lasts. Most physician employment agreements are between 1 to 3 years, with automatic renewal after the initial term ends.
Contract duration clauses are often found in employment contracts to outline how long the contract will last. This is typically done for an indefinite amount of time, but if there was a specific date stated on when it would end then that could be included as well. An example of this might include someone being hired with no specified term length and them coming back after they have completed their degree or reached some other goal set by both parties so that work can resume again more easily without having to start from scratch every time something happens outside their control like graduating college in four years instead of six because you were able to go part-time while working during your first two years before going full-time once classes stopped for summer break.
Use a Duration Clause
You will be wise to use a duration clause when defining an agreement’s effective period. This can help you protect your interests should the contract need early termination and also helps clarify what type of early termination is possible for both parties involved. It includes things like whether or not it will end on its own accord at some point, if any specific events trigger an automatic expiration date (such as a breach), and more!
When creating a contract, both parties should know what the terms are. If there is a duration clause in place, it’s common for either party to be able to renew with one another if they desire. And as long as you spell out your conditions within the duration clause, this can also prevent confusion about when their time will expire and how much notice must be given before termination of service takes effect.
Not every contract has an exact end date, but those that do usually allow flexibility on behalf of both parties who may have desires to continue after expiration or wish not to terminate prior to its conclusion. You could always include these personal clauses into the main document, explaining them clearly, so everyone knows where they stand at all times- including yourself!
Without Cause Termination for Physicians
Nearly every physician employment contract contains a provision that allows either party to terminate the agreement for any reason with a certain amount of notice to the other party. The typical amount of notice is either 60 or 90 days. Therefore, the initial term of the agreement is meaningless if either party can terminate the agreement for any reason at any time with proper notice.
Terminating employees is an important business decision. There are two types of terminations: with-cause and without-cause. To fire someone for violating company policies or committing unethical acts can be justified as termination with-cause. But firing them for poor performance alone may not be enough to discharge the employee. This type of dismissal should instead fall under “termination without call.” You must understand which kind you’re terminating before deciding whether it would adversely affect other departments within your organization.
Terminating an employee without cause is a common practice among private employers. This type of dismissal can occur for any number of reasons, such as budget problems or operational restructuring and downsizing. The phrase “termination with cause” might be more accurate since the employer has grounds to fire someone who isn’t performing up to expectations or meeting certain criteria laid out in their contract; however, they do have this right under work at-will laws present in some form across all 50 states unless moving forward would violate state or federal employment law.
For Cause Termination
Companies usually have an employee handbook to outline the standards of behavior expected from their employees. A separate code of conduct may also be in place, outlining specific incidents for termination should they happen within a company or on its premises. Common causes that lead to immediate dismissal include violence and drug abuse but theft is not uncommon either as well as sexual harassment depending upon the severity and number of offenses committed by one individual. The more severe cases typically result in automatic termination with lesser violations which might require progressive warnings before finally being terminated if it reaches a point where other options are no longer viable
Term Lengths | When the Contract Length Does Matter
The one instance where the initial term of the agreement matters is if the physician must repay a sign-on or relocation bonus if they leave within the initial term of the agreement. The agreement will dictate how much of the sign-on bonus is forgiven based on the physician’s employment length. For instance:
Term
- If the initial term is 24 months, each month 1/24 of the sign-on bonus is forgiven.
- If the initial term is 36 months, each year completed will forgive 1/3 of the sign-on bonus.
- If the physician does not complete the initial period, they must repay all the sign-on bonuses.
Set Term of the Contract
Simply put, not all employees enjoy the same protections when it comes to employment. This is why it’s so important for individuals negotiating a contract to be fully aware of their options before committing themselves and signing on that dotted line. For example, an at-will employee can get let go with no notice if they don’t do what their employers want them to do—think back from your favorite show where someone gets fired because she didn’t sell enough lemonade in one day! Meanwhile, some contracts specify fixed terms like two years or more; these agreements will detail specific reasons and probation periods (if applicable) for termination without-cause should either party fail to uphold certain obligations set forth by this agreement.
When an employee must quit their job, they are obligated to give notice that the relationship is ending. It’s typical for a physician to give between 60 to 90 days’ notice before terminating employment so both parties can prepare accordingly.
Different Types of Physician Employment Agreements
An employment contract is a formal agreement between an employee and employer in which the two agree to work together. Fixed-term contracts are one type, but there are other types for jobs with more fluid timelines, such as hourly wages or commissions based on performance. A J-1 contract’s term is set for three years.
Employers can terminate employees early in a fixed service contract if the employer provides valid reasoning and proof. However, employers must provide evidence that an employee was not fulfilling their obligations before termination can occur. For instance: suppose an employee wasn’t providing services agreed upon in a contract but had been given sufficient time for absences due to illness or injury. Then they could cancel it without giving notice; however, if there is no reason provided by either party this will fall under “constructive dismissal.”
An employee who signed a fixed term of employment has certain rights when considering being dismissed from work earlier than expected based on agreement with the company during negotiation stages- one such right relates back to whether or not duties were met as per the original terms set.
Physician Employment Agreement 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 physician employed by a hospital, medical group, or other health care provider. While contract drafting and negotiation can be long and arduous, legal representation is necessary to protect your rights.
The present-day conclusion is simple: A physician should not enter into any contract without having a physician contract reviewed by legal counsel.
There is simply too much at risk for a physician 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 important contract terms and clauses which can present complex and diverse issues for any physician, including:
Terms
- Non-compete clauses
- Damages
- Indemnification
- Verbal guarantees
- Insurance statements
Benefits of Getting an Attorney to Review Contract Terms
Additionally, often the most influential 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 its execution. Attorney Robert Chelle has practical experience drafting and reviewing physician contracts for nearly every specialty.
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 experienced attorneys for your representation, you can ensure that you will be able to fully understand the extensive and complex wording included in your contract. By fully understanding 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. Chelle Law will personally dedicate time to ensure that you are fully protected and assist you in the contract process so that your interests are fairly represented.
Reviewing Contracts Help Avoid Possible Conflicts With the Employer
Every physician’s contract is unique. However, nearly all contracts for health care providers should contain several essential terms. If these essential terms are not spelled out in contracts, disputes can arise when there is a disagreement between the parties regarding the details of 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?
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):
Terms
- Practice Services Offered: What are the clinical patient care duties? Are you given time to review administrative tasks? How many patients are you expected to see (like in pediatrics)?
- 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?
- Locations: Which facilities will you be scheduled to provide care at (outpatient clinic, surgical sites, in-patient services, etc.)?
- Outside Activities: Are you permitted to pursue moonlighting or locum tenens opportunities? Do you need permission from the employer before you accept those practice medicine-related positions?
- Disability Insurance: Is disability insurance provided (short-term and long-term)?
- Medical License: Will the practice offer reimbursement for your license? Will an advisor be provided?
- Practice Call Schedule: How often are you on call (after-hours office call, hospital call (if applicable))?
- 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?
- 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 an annual review or quarterly review of compensation?
- Productivity Compensation: If there is productivity compensation; how is it calculated (wRVU, net collections, patient encounters, etc.)? Is there an annual review?
- Practice Benefits Summary: Are standard benefits offered: health, vision, dental, life, retirement, etc.? Who is the advisor of human resource benefits?
- 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?
- Continuing Medical Education (CME): What is the annual allowance for CME expenses and how much time off is offered?
- Dues and Fees: Which business financial expenses are covered (board licensing, DEA registration, privileging, AMA membership, Board review)?
- Relocation Assistance: Is relocation assistance offered? What are the repayment obligations if the Agreement is terminated prior to the expiration of the initial term?
- 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?
- Professional Liability Insurance: What type of liability insurance (malpractice) is offered: claims made, occurrence, self-insurance?
- Tail Insurance: If tail insurance is necessary, who is responsible to pay for it when the Agreement is terminated?
- Term: What is the length of the initial term? Does the Agreement automatically renew after the initial term?
- For Cause Termination: What are the grounds for immediate termination for-cause? Is a review provided to dispute the termination?
- Without Cause Termination: How much notice is required for either party to terminate the agreement without-cause?
- Practice Post Termination Payment Obligations: Will you receive production bonuses after the Agreement is terminated?
- Non-Compete: How long does the non-compete last and what is the prohibited geographic scope?
- Financial Retirement: Is a financial retirement plan offered?
- Non-Solicitation: How long does it last and does it cover employees, patients, and business associates?
- Notice: How is notice given? Via hand delivery, email, US mail, etc.? Does it have to be provided to the employer’s attorney?
- Practice Assignment: Can the Agreement be assigned by the employer?
- 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?
Coming into a new organization with a favorable contract can put the physician in a positive financial situation for years to come. Before you sign the most important contract of your life, turn to Chelle Law for assistance.
Questions About Contract Terms?
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Physician Contract Questions?
Contract Review, Termination Issues and more!
