The good news for physicians seeking a place of employment is there is a shortage of rheumatologists, urologists, and other specialists in the United States. The bad news is the landscape is dominated by large health systems and, therefore, there is usually little wiggle room in contract negotiations.
“It’s ‘take it or leave it,’ unless you have a track record and a large practice,” says Jay A. Motola, MD, Associate Professor of Urology, Icahn School of Medicine, Mount Sinai Hospital, New York, and Chair, Practice Management Committee, American Urological Association. “For someone coming out of a fellowship, there’s very little you can demand above and beyond what’s initially offered,” he says.
Fortunately, some things are standard: disability insurance, health and life insurance, and malpractice insurance. Often, however, the malpractice insurance policy offered is ‘claims made.’ Dr Motola advises asking for an occurrence policy—especially for those years that you are only an employee of the group. “Additionally, one should ask for relocation expenses, and insist on a CME allowance, an allowance for journals in your specialty, and a minimum of 4 weeks of paid vacation,” he suggests.
High-profile physicians or those with a large preexisting practice, on the other hand, are in a much better position. “They can ask for procedural suites in their offices, new equipment, or more support staff and nurses outside the institution’s normal staffing model. Or if they are a robotic surgeon, they may want their own robot or guaranteed time on one,” said Dr Motola. “And the hospitals often accede to these requests—because they know it’ll be worth it for them, in terms of an expanded patient base and revenue.”
An important fact to know is that large institutions can usually pay higher initial salaries than private practices, but “often these institutions will decrease pay with each subsequent contract negotiation, largely because of supply and demand,” observed Dr Motola. “On the other hand, if you want to work for a private practice your salary may be lower to begin with, but you can negotiate things like a partnership or buy-in. But due to referral patterns that may be controlled by insurers, it’s very difficult to valuate the true worth of a practice.” Multispecialty medical groups tend to have an established buy-in such that once partnership is obtained, the physician will be paid less than a full partner until the preset buy-in amount is reached, he added.
Another decision to make is whether to look for a position through third-party recruiters, or directly through the practices/hospitals, or through listings posted by professional organizations such as www.healthcareers.com. Dr Motola says the latter options can prevent some problems, such as being locked out of opportunities offered by some hospitals when they are bombarded with CVs, including yours, via third-party recruiters.
Laura Screeney, President of the Association of Staff Physician Recruiters (ASPR), explains some of the other benefits of going directly to the institutions. “In-house professionals know the hospital, know the city, the community,” said Ms Screeney. “They also do the full cycle of recruitment—they place the ads, coordinate the interviews, are part of the interview process; they go over the benefits and salary with the candidates. The search firms don’t necessarily understand the benefits [of each position] as well. And they represent a large number of clients, while we’re [each] representing one health system.”
However, Craig Fowler, the Atlanta-based President of the National Association of Physician Recruiters—which represents largely third-party recruiters while roughly one-fifth of their members are in-house recruiters—points out that search firms have many jobs on offer at any given time. “Candidates can get an idea of what’s going on in their specialty [across large swaths of the country],” said Mr Fowler. “They also have an expert to ask about the pros and cons or details of each offer, and how it stands with respect to the whole marketplace.” He said that third-party recruiters can offer objective advice about how to get the best deal in the negotiations.
Experienced recruiters know a lot about each practice, including what each can offer in terms of salary and other incentives and what they are looking for from the physicians they hire. Recruiters also spend time learning about each candidate so they can help guide the candidate to an appropriate practice. The idea is that physicians know medicine while recruiters know negotiation. Recruiters will try to close the gaps between what is being offered and what the candidate wants.
Eight Top Job Search and Negotiation Tips
- Put together a solid CV and list of references.
- Wear a suit to the interview.
- You may be encouraged to bring along your partner, and possibly even your children, to the interview. The interview process also usually includes a meal out with the people you’ll be working with. “It’s very much like dating, including when you go out to dinner,” says the ASPR’s Ms Screeney. “Mind your manners. Don’t have too much to drink. Be personable. They’re trying to get to know you, and vice versa.”
- Check the salary data for your target region using a source such as the Medical Group Management Association (MGMA) Physician Compensation and Production Survey: 2014. But Dr Motola cautions that the MGMA numbers tend to be much higher than many offers. “This comes from the MGMA having a usually very small sample size so it skews their data. It’s best to speak to local people to get a feeling for what [salaries are] being offered.”
- Negotiate a relative value unit (RVU)-based bonus when joining a private practice. For example, agree that if you perform 7000 RVUs you will get a bonus for the next 2000 you perform. “That’s the biggest thing to negotiate—because it’s real money. Otherwise you’ll be working Friday until 6, and nobody else will be in the office,” advises Dr Motola.
- Build in protection so the practice will face a penalty if you are asked to leave even if you’re meeting requirements. Dr Motola suggests that you “protect yourself in the contract by having certain standards and reviews,” which, if met, would force the practice to pay a financial penalty to you if you are let go.
- Avoid a restrictive covenant or have one with a reasonable buy-out option. “The new person looking to join the practice is usually very intimidated by restrictive covenants, which stipulate that you have to leave the geographic region if you leave the practice, and that if you try to work in the region [the practice] can sue you or get a restraining order,” explains Dr Motola. “So if you are signing a contract you should not have a restrictive covenant or you should have an out such as being able to pay to stay in the region.”
- Negotiate a buy-in to the practice’s ancillary equipment, such as a CT scanner, via a set amount taken from your salary over time rather than paying a lump sum up front. Dr Motola says, “When you become a partner, you will probably be able to share in the profits of these ancillaries; however, you will be expected to buy into them. Having an amount come off your paychecks is better than writing a big check.” Dr Motola adds that it might be difficult to get your money back if you decide to leave after buying in with a large sum.