When negotiating your physician employment contract, you might hear the employer say something to the effect of, “We use one standard contract for all of our doctors.” You might be reluctant, then, to try to negotiate anything other than the top-level items, such as your salary and starting date. The truth is that while their willingness to negotiate will vary, many health care employers can and will negotiate most contract terms—even down to what will happen at the end of your employment.
That having been said, how do you know what to ask for in a physician contract? And, just as important, how do you go about asking for it?
To help physician jobseekers navigate the uncomfortable and high-stakes contract-negotiation process to get the salary, the compensation—and the lifestyle—they deserve, the AMA has teamed up with Resolve, a contract review and negotiation firm specializing in physician employment, to provide custom contract review to AMA members at a discount.
Resolve offers personalized legal experience to help physicians secure the best employment contract terms, no matter where they are in their careers. Ready to access your AMA-member Resolve discount? Learn more now.
Look way beyond physician salary
Physicians often look first at the compensation sections of their employment contracts, but there are many other contract terms that deserve attention during negotiations.
Here are just a few that are often negotiable.
Call schedule. In Resolve’s consultations with clients, call comes up “almost every single time,” said Bryce Krieger, an attorney with Resolve.
Still, there is a wide range in how much call physicians take. It differs not just by specialty but also by employer, and even the location. Some doctors only have to deal with after-hours call for clinic patients, while others might take call in inpatient settings or the emergency department. Some may even be required to do all three.
The key when considering a job offer, then, is arriving at specifics around call expectations, Krieger noted.
“Physicians want some sort of cap” on hours, he said, although employers often are reluctant to go into much detail in the employment contract. “It's usually quite open-ended. They are looking for as much flexibility as possible—and that's typically to the downfall of the physician, unfortunately.”
Being specific about compensation for call is vital, too.
“A lot of employers will try to bake it in and just say it's part of the base compensation,” Krieger said, adding that while some may pay more for call performed on weekends and holidays, many try to include this in the base too.
Call is shared by physicians in a call group, which means one’s share of the call responsibility can fluctuate with staffing changes. “We see that a lot in renegotiations,” where a physician expected call to be at a certain level], “but there was a mass exodus of physicians” in the group and suddenly they were taking double the call they expected when they signed their contract, Krieger said.
“It's important to maybe search in the area—in terms of locums work—as to what would it take for them to pay another [physician] to come in,” Krieger said. “That's really helpful in terms of negotiations if call is a lot more frequent than what you expected.”
Tail insurance. Two important forms of malpractice insurance are nose and tail coverage. The new employer pays for nose coverage , which covers claims made against the physician while they were in their previous job. Tail coverage is paid by the prior employer for claims against the physician for the same period, as claims can sometimes lag.
“You want to talk to your new employer about tail insurance and, most importantly, who pays the cost of tail insurance, which can be very high,” said Richard Levenstein, a health care attorney at Nason Yeager, in Palm Beach Gardens, Florida.
“Ideally, you want the new employer to pay both the nose insurance, if the old employer is not paying it, and the tail insurance on the way out,” he said. “Oftentimes, you can only get one, and anything you can get towards payment of those costs from your employer is a gain and a win.”
Termination clauses. “A termination clause is usually the last thing that a prospective employee is looking at when she's signing a contract—because she wants the job,” said Elizabeth A. Snelson, president of Legal Counsel for the Medical Staff PLLC, which specializes in working with medical staffs, medical societies and medical staff professionals. “She’s not thinking: How will I get out of this?”
One reason to pay particular attention to this clause when negotiating with hospitals iis that hospitals are required to report to the federal government’s National Practitioner Data Bank if a physician’s hospital privileges or medical staff membership is terminated while the physician is under investigation.
The physician might not even know they are under investigation—or that the record is permanent.
But physicians have countless reasons for resigning from a job or going on a leave of absence, including getting another job, having an emergency surgery, taking a bucket-list vacation, having a baby and caring for a parent.
“If a physician terminates her employment or has her employment terminated by the hospital during the time that she is under investigation—even if the investigation hasn't concluded anything—the fact that there's this coincidence of investigation and termination of employment means she's going to be reported to the feds,” Snelson said.
“Given the ramifications of National Practitioner Data Bank and other government reports, physicians should affirmatively ensure they are given review and consensus rights” regarding the filing and wording of any report to the National Practitioner Data Bank, Snelson’s resource, the AMA Physicians’ Guide to Hospital Employment Contracts (PDF), free for AMA members, notes. It also includes a sample provision for due process.
If you’re seeking your first physician job postresidency, get your cheat sheet now from the AMA.
Don’t try to do this alone
“I think that the money that is spent on a health care lawyer negotiating these contracts is the best money that a physician spends, because it can alter … not only their career path, but their lives and lifestyle,” Levenstein said.
He stressed that hiring a health care lawyer—not just any lawyer with experience reviewing contracts—is essential.
“There are lawyers who negotiate contracts all the time that are not health care contracts. I can tell you that employee physicians’ contracts are far different than any other employee contracts,” he said.
AMA members receive a 20% discount on all Resolve services. With Resolve, you get:
- Custom contract review for any type of employment contract.
- Access to experienced attorneys who can negotiate on your behalf.
- Real-time, comprehensive compensation data and benchmarks to help you understand your worth.
- An instant contract-review option, powered by Resolve’s attorney-trained AI model.
- Free tools such as a contract scorecard to give a quick overview of where your contract stands.
Ready to access your AMA-member Resolve discount? Learn more now.
