The direct causes of physician burnout are no longer a mystery. For some doctors, the big issues are time pressure in the exam room or on the EHR, or a lack of control over their work environment. For others, it’s the chaotic, fast-paced nature of the workplace, or an organizational culture that doesn’t align with their values. Other physicians may be struggling with a combination of these forces.
Yet there’s an indirect cause of burnout that gets little attention but deserves a front-row seat in the discussion: physician employment contract terms.
The problem is that, all too often, the steps physicians take to head off burnout are either precluded or made impractical by one or more contractual obligations, and not all are immediately obvious.
Resolve, a contract review and negotiation firm specializing in physician employment, has identified a number of contract terms that deserve heavy scrutiny vis-à -vis burnout when considering your first employment contract or negotiating a new one.
The AMA has partnered with Resolve to provide AMA members an exclusive discount on custom contract review. Resolve offers personalized legal expertise 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.
The RVU model
Relative value units (RVUs) are used to represent the value of resources needed to perform procedures and services described in the Current Procedural Terminology (CPT®) code set.
One Resolve podcast details in plain terms how chasing RVUs can affect physician well-being.
“One of the main things I work on with a physician who is burned out is really looking at does their self-worth come from their productivity and their identity as a physician, because if they’re just chasing RVUs and more money and that’s how they’re getting their self-worth, they’re going to burnout rapidly,” said Mary Wolf, president of Veritee Partners, an executive coaching and consulting firm focused on promoting well-being.
Wolf advises physicians to focus instead on achieving self-worth from being good with patients, having successful outcomes, and being a good partner and parent at home.
“I always talk about: Is your pace sustainable?” she said. “And if they’re feeling like it’s not, some can get suicidal because they have worked this hard and their identity is wrapped up in being a physician.”
Learn more with the AMA about understanding physician employment contracts. And if you’re seeking your first physician job after residency, get your cheat sheet now from the AMA.
Patient-volume expectations
While RVUs measure the physician’s work, practice expense, and professional liability required for patient care, patient-volume expectations are built solely around encounters. Often, both are used to calculate productivity-based compensation.
“Not taking all the variables into consideration and running the numbers beforehand is what can get physicians into trouble later,” says a Resolve blog post. "If patient volumes are too low, a bonus threshold is too high, or both, you could never reach the productivity numbers needed to receive your bonus. Some of the variables, like billing practices, payer mix or support staff efficiency, are out of your control.”
But bonus rate, threshold and other terms can be modified before signing your employment contract, the post notes.
“Make sure you review the bonus structure offered in any contract, compare the numbers to the norms for your specialty and location, and negotiate when necessary,” says the blog post. “If you do not scrutinize the bonus structure up front, you could discover that you are being grossly underpaid after years of work.”
As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine®.
Vague call requirements
“When it comes to job satisfaction and burnout prevention, proper scheduling and call coverage are some of the largest contributors,” the blog post adds.
Call hours, for example, can directly affect your work-life balance by interrupting plans you have for your personal time.
"Your call schedule may be within expectations when you first start a job, but if other employees leave or something else happens to change how call is shared, you could be stuck picking up the slack,” the post explains.
To head off this issue, make your contract language as specific as possible about call requirements.
“Your contract should explicitly state how call is shared between employees, preferably in an equal fashion. It should also be capped at a certain amount to keep you from covering additional hours when other employees are not available. This sort of contract language will prevent your call responsibilities from spiraling out of control when aspects of your workplace change,” says the Resolve post.
Unfair termination clauses
Few physicians take a job with an exit strategy in place, but you should consider the eventuality of having to change jobs when negotiating an employment contract.
“Leaving a job on your own accord, or terminating without cause, can be more complicated than simply giving notice and counting down the days until your departure,” the post says. “Some contracts require you to jump through at least a few hoops in order to leave, and others fail to include clear termination terms at all.”
The first thing to look at is the amount of notice you must provide and make sure it’s reasonable.
“A 90-day notice period is typical in physician contracts, and you should be compensated for that entire span of time,” the post says.
You also need to consider how termination affects other parts of your contract, such as a signing bonus or stipend.
“These forms of compensation are usually structured like loans—you receive a bonus upfront, but it must be repaid by working for a length of time stipulated in your contract,” the post explains. “Problems arise when you want to leave the job before that repayment period is complete. In this situation, you could be required to repay the remaining amount all at once, which can be a large financial burden depending on the bonus or stipend size.”
You could also be subject to restrictive covenants when you terminate your contract.
“These include non-compete, non-solicitation and non-disparagement clauses, all of which affect your ability to practice medicine after leaving a job. When these clauses are too limiting, you could have difficulty finding work in the same general location as your previous employer. It is always best to negotiate these terms out of a contract or try to make them less restrictive, if possible,” it says.
Noncompete clauses
These deserve a second mention because they may be the most vexing of contract terms.
A noncompete agreement restricts your ability to work in a particular geographic area for a specified amount of time after you leave your contracted job. Imagine, for example, being prohibited from working for a competitor within a 50-mile radius of a former employer for a year or more. You might feel you have no choice but to stay in your present job.
"Since a noncompete has virtually no effect until you want to leave a job, it is easy to ignore when you first sign a contract,” the post says. “This is especially true when you are excited about other aspects of the position and do not think you will be leaving any time soon. However, changes to your workplace or personal life might necessitate a job change as well, and an overly restrictive non-compete can force you out of your present location just to find new work.”
The one clause you need
On the podcast, Wolf noted that when life changes, it’s often hard to predict how you will feel. She recommends one key clause you should always negotiate for: “This contract will be reassessed in one year.”
She has heard physicians say in desperation: I’m so stuck. I can’t re-negotiate. I have to do this.
“I really think it would help if they knew they could reassess,” she 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.
