Here are some contract tips and some new things to think about when you’re negotiating an employment contract for a surgeon. In this scenario, let’s just take employment contracts. So, either you’re coming out of training or perhaps you’re thinking of switching jobs and you’re offered an employment contract, what are the areas you should be concerned about? And then maybe some areas in which you have more leverage than others.
Signing Bonus, Relocation Assistance, and other Bonus You Can Get
The first thing you should think about is the bonuses. In almost any contract for a surgeon, there’ll be a signing bonus. And then if you are moving to a new city, town, wherever, they should pay for your relocation as well. We’ll call that relocation assistance.
So, you’ll have a signing bonus, and in addition, you’ll have relocation assistance. Now, how much is the normal signing bonus? Well, it depends. Anywhere between 20,000 to 50,000 would be a normal signing bonus. And then as far as relocation assistance, usually, somewhere between 10,000 to 15,000 would be considered a reasonable amount. If you are not getting that much for either one, that’s something you need to negotiate to improve.
Some employers will try to lump it all into one. So, take that into account, just add them together. But that’s the normal range for a surgeon. Obviously, there can be more. Some places like if you’re maybe entering with a rural hospital network, they might offer some student loan assistance as well. And there are some student loan packages that can reach 150,000. Now, there will be a period that you have to stay with the employer in order to get all of that money or have it forgiven and not have to pay it back.
But there are beyond the signing bonus and the relocation assistance. Some physicians also get student loan repayment as well, and that’s mostly for people just coming out of training. You’re not going to get that if you’ve been out for a while.
Negotiating Compensation Structure
Alright, next, you need to think about the compensation structure. Is it just the base salary? Is it RVU production if you’re in a hospital network? Is it net collections if you’re with maybe a private physician-owned practice? You need to determine what your fair market value is, and there are a couple of ways of doing that.
One, talking to the people that you’re in training with and seeing what their offers are, talking to your mentors and seeing what they’re making out there, trying to find the MGMA data. The medical group management association is kind of the industry standard for compensation amongst different specialties for physicians. It’s difficult to get up-to-date MGMA data unless you have direct access to it and pay for it. You could probably Google and find some year or two old data, but very unlikely you’re going to find the most up-to-date data on your own, but that is helpful even if it’s a year or two old to see, alright, well, what’s in a normal range.
You can also find beyond total compensation, average RVU production per year, per specialty, and average net collections per specialty as well. So, you need to find that out. Now, is one compensation kind of calculation better than another? Not really. If you’re in a hospital network, it’s likely going to be RVU production. If you’re in private practice, it’s likely going to be net collections. If there is a productivity model involved, one is not better than another.
If you’re on net collections, it’s going to be a percentage of what the net collections that you bring into the practice from your personally performed services are. That percentage can certainly change. If you’re on pure net collections, it’ll be somewhere between 35% to 45%. If you’re on maybe a hybrid of like half guaranteed base and then half productivity, it might be somewhere between 15% to 25% of your net collections. Just kind of depends.
And then RVUS, very simple. You just multiply the amount of RVUs that you produce per year, per quarter, per month, then multiply those times a conversion factor. You can find that in the MGMA data as well. That is dependent upon specialties. The different subspecialties of surgery will have different comp factor numbers. A way of negotiating is trying to find what is fair market value and whether you’re getting it or not with your new job.
Strategies in Insurance Negotiation During Contract Negotiation Process
Next, if you have a claims-made policy, are they going to pay for tail insurance? If you are joining a hospital network, it’s likely they’re self-insured or have a policy where you will not have to pay tail insurance. If you’re going into private practice or smaller physician-owned practice, it’s very likely they’re going to have claims-made coverage. And it’s also very likely they’re going to expect you to pay for your tail insurance.
Tail insurance just covers the gap in between when you leave an employer and then the last day somebody can sue you. And as far as cost for tail, it could normally be around twice what your annual premium is. Surgical specialties can really, I guess, vary based upon what you’re doing, but it could be anywhere from 12,000 all the way up to 30,000 a year. So, if you just double that, that’s kind of a good range of what you’d have to pay for tail insurance. Tail is a one-time payment; you don’t pay for it per year. It’s just a one-time payment, then you’re covered for what the length of the tail policy dictates.
Getting the employer to pay for your tail certainly is important for most people that have a claims-made policy. Probably 75% of the physician-owned practices make the employee pay for it. If they’re not willing to pay for your entire tail, one strategy we’ve been successful with is telling them, let’s say a three-year initial term, then you would say, alright, for every year that I’m here, you would then chip in one-third of the cost for tail insurance. And if you finish out the first three years, then the employer would pay for the entire amount of your tail policy. You can also get out of having to pay for your tail insurance if your new employer pays for your old tail, that’s called nose coverage. Or, if you stay with the same insurance company at your new job, they’ll usually just roll over your policy into a new one and you wouldn’t have to pay tail.
And then the last thing I’m going to talk about as far as things to think about when you’re negotiating is the non-compete. This is important, especially for surgeons. There are two components to a non-compete. You have things you can’t do while the contract is going on, that’s usually called either exclusivity or outside activities. And most of the contracts will state you have to get written approval if you want to work or practice medicine at all for anyone else during the term of your agreement.
Now, a lot of surgeons will want to do moonlight, locums, or maybe let’s just say they are plastics, but they’re working for a children’s hospital just doing hands. They may want to do and keep up their skills doing adults or other types of general plastics. And so, they want to make certain that their employment contract will allow them to do that. I mean, you wouldn’t want to be prohibited from keeping up your skills somewhere else. But most employers are strong with requiring approval. So, you want to get that approval in advance and just say, alright, if I do this, and obviously, if it doesn’t interfere with my job duties with you, am I allowed to do some of this outside stuff on my off time? And the employer should say yes in that scenario.
Tips About Non-Compete in Contract Negotiation
Now, as far as the non-compete after the contract ends, you need to think about, alright, well, what is the specialty that’s stopping me from doing? Obviously, if you’re a general surgeon that says you can’t practice general surgery, that’s what it’s going to say. But once again, for other specialties that can do multiple things, you just want it to be specific to the thing that you’re doing for that employer. And then it will be for a period, usually, somewhere between one to two years. Try to get it to one year.
And then lastly, the geographic restriction will vary widely based on where you are. If you’re in an urban environment, it’ll probably be a little bit less. Somewhere between 5 to 10 miles would be considered a reasonable amount. I’ve seen contracts that try to knock a surgeon out of every contiguous county, which could be a huge geographic radius or 10 miles from every facility that their employer owns. And they could own dozens of them in a city. You want to limit it to the places that you’re practicing like your clinic location, surgery center, and hospitals where you’re performing procedures. Try to limit it to the fewest possible. And then try to really squeeze down that mileage radius as well. For some people, a non-compete is the biggest deal.
If you have family in town, kids in school, whatever it is, there’s just no way that you could move after, or if your employment ended. That could be the biggest negotiating point with an employer. Some people who move into a city for a specific job have no ties to the area and do not care because they’re going to move as soon as the contract ends.
You must determine what’s the priority level for you. So, those are just four things to think about. There are obviously dozens of other things that could go into a contract. I don’t have time to go over every one of them today, but I’d say the four that I went over are usually kind of the four highlights that I hit with every physician when we’re talking about their employment contract.
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 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. For the most part, in negotiating job offers, the only leverage someone has when they’re coming out of training is in a specialty that’s hard to recruit for? I mean, that’s just the honest truth.
Negotiating a Contract by Physicians
You are not bringing in any established PA patient base. You’re also all relatively new to being out on your own. So, there is a learning curve that 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 a job. 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?
My advice if someone lives in an area, they have family in the area, they have kids in the area. They absolutely cannot move after the contract ends since they will have to also think about things related to moving – like schooling of the kids, or the job of your wife, of 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 for a period of time within a specific area.
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 and you have to pay for your own tail and your underlying premium is $40,000 a year, your tail insurance cost will be higher compared to other specialties, probably going to be around 80,000. So, who pays for tail insurance certainly could be the most important thing in an employment agreement during contract negotiation for an OB-GYN.
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 that states, when the contract terminates, you’re going to be able to collect for a 60 to 90-day window after the contract terminates? If you don’t have that, then you literally worked for free for two or three months, which nobody obviously wants to do. Going back to what is important, it depends upon the person what his goals are. When you’re looking just at base compensation, obviously having the numbers is important. So first, they’re not always easy to obtain. Most places or the majority of the places use MGMA numbers. That’s a medical group management association, and most of the time you have to pay for that and it’s expensive. So no physician, at least most physicians are not gonna do that.
You could either find someone who has access to those numbers and try to get them. Or if you kind of Google around on the internet, sometimes you can find them, the average, our view production, average compensation. It is broken down into areas of the country. I honestly don’t think those are accurate when it comes to determining exactly how much in what part of the country. There’s just kind of a feel for what is someone getting in this area, but then you also have to take into account all the other things I just 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, well, 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 you’re just moving into a new practice. Well, this is the highest leverage you can have duing contract negotiation. There’s gonna be no, or at least there shouldn’t be a lot of 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, or these were the RVs I produced, or these were the patient encounters I had on a weekly basis. 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, 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, 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 to come 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 have the benefit of having some numbers of what you produced in your previous position. You can tell them during your contract negotiation, that 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 absolutely essential during contract negotiation in determining what your new total compensation would be in a new position. So, those are some tips on things to think about. I mean, honestly, just doing this video, I can think of this could be broken down into 10 different videos, but this is just kind of an overview on how to negotiate.
How to Negotiate a Physician’s Salary
How to negotiate a physician’s salary? As an initial matter, I don’t personally believe that the salary should 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, 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? In the hiring process, how can I make them offer terms that are in my goals? There are a couple of ways of doing it during contract negotiations. 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, Southwest, and those kinds of quadrants have different salary numbers associated with them. But just the base salary could be great or could not be great depending upon if there’s productivity compensation in the agreement as well, or there’s maybe 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 of, well, 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 are you going to make once you’ve become a partner? That’s certainly something that’s important. Now, as far as the MGMA numbers go, 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 comp is 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, but I’d say the best tactics is just to go out there and try to find multiple job offers and see what you’re being offered initially. And then also, anyone who’s in training, has other people in their specialty that are looking for jobs as well. Reach out to your colleagues, talk to the people you’re in training with. What have you been offered? Where have you been offered this? One kind of difficult thing is that some people automatically think that they’re in a kind of high-cost city that they’ll make more, but have not considered other factors, like 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 kind of surprised sometimes because the salaries may not be kind of adjusted to the cost of living of 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. You need to be aware that just because you’re in a bigger city with a higher cost of living, doesn’t mean that you’ll be making more, it’s the opposite, really.
If you’re in a rural location that’s hard to recruit to, you almost always will make more money in those scenarios. So, if money is the bottom line that you’re looking for, then you need to look in the smaller cities, that are just simply difficult to recruit to. You will absolutely make more money on average if you’re going to go to a small rural community, that’s fact. 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 asking, if you’re offered 300 and you’re asked for 450, they’re going to say, well, that’s ridiculous for, it may even yank the offer.
You need to know your value and then specialty is also a big part in what kind of leverage you have. Any kind of contract negotiation is based on leverage. Do you have it or do you not? If you’re in a specialty that’s hard to recruit to or is in high demand, you simply have more leverage. If you’re in a specialty that is 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 you’re bringing your patients with you, then you’re certainly worth more than someone who’s coming into the community, like peds or primary care that must build up a patient base that takes time. Those are some tips on how to get a better salary and where to start. Contacting an attorney and trying to maybe get a feel for the area certainly might be helpful.
It’s fairly specialized in people that just focus on physician contracts. It’s possible you won’t find somebody in the area you’re looking at, so maybe do a wider search for that. But anyway, the last point, there are some employers that simply will not negotiate. They’ll say it’s a take-it-or-leave-it offer and you’ll then have to be willing to walk if you’re unhappy with salary, but there are just simply people out there that say, no, we’re not negotiating. This is we’re offering what we offer, and I wouldn’t be offended by that. That’s just kind of the tech that they’re taking as far as employing somebody. So, don’t be surprised if you have an employer that says no, but if it’s an offer that you’re unhappy with, you need to be willing to walk as well. It’s never a good feeling to accept a deal that you think is well below what your value is. Don’t just accept that because you need a job. Find the right job.
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