Whether you are a resident or fellow, or an early-, mid- or late career physician, this course will help you answer questions like:
- What are my key career issues?
- How can I find jobs that might satisfy my key career issues?
- How can I evaluate jobs during interviews and visits?
- What are my duties and schedule?
- Is the compensation fair?
- How can I leave the job?
- How health care market consolidation affects your career
- The decline of the voluntary medical staff model
- Accountable Care Organizations
- Health system employment
- Physician-owned independent private practice
- Career costs of family
- Take charge of your job search
- Recruiters, networking, and other job sources
- Learning about the job and community
- Visiting the practice and community
- Physician-owned practice: Joining, buying (into), and starting
- Physician-owned practice: Hospital loan agreement
- Good and poor employment contracts
- Duties, schedule, location, and workload
- Compensation models
- Term and termination of employment
- Professional liability (malpractice) insurance
- Restrictive covenants
- Path to becoming a shareholder in a physician-owned practice
- Negotiating strategies and techniques
Whether you are evaluating your first employment contract, considering a mid-career change, or approaching retirement, this Introduction explains why this is the course for you.
Knowing yourself is the key to making yourself happy.
Sources of career satisfaction
- The Work Itself
- Culture, Colleagues, Career
- Location, Lifestyle
Take charge of your job search!
In the 1980s, physicians who owned their practices served on hospitals’ voluntary medical staffs.
Since then, continuing changes in reimbursement have driven hospitals to employ physicians.
Employed physicians perform hospital functions formerly performed by the voluntary medical staff.
Before 1985, local health care markets were fragmented.
Changing reimbursement drives market consolidation.
In many markets today, a few health systems employ most physicians.
Accountable Care Organizations promote higher quality and lower costs; and may drive market consolidation.
Management quality influences organizational culture and physician job satisfaction.
Hospital-employed physicians “lose money” due to system upgrades, staff compensation, and management overhead.
Physicians generate significant revenues for hospitals.
Plan your job search 18 months in advance, Start looking 12 months in advance, Start negotiating 6 months in advance.
Practice your elevator pitch.
Make your curriculum vitae an easy-to-read chronology of your experience and qualifications.
Recruiters work for employers.
Recruiters use pressure tactics.
Use word of mouth and networking to find jobs.
Learn about the local health care market
“Tell me about your practice”
Ask followup questions about key issues.
“Tell me about the compensation package.”
“I would like to be fairly paid for my work.”
“I will be happy to consider your offer.”
Plan your visit
Observe organizational culture: Positive? Negative?
Shadow your prospective colleagues
Compensation, benefits, obligations
Employee vs. Independent Contractor
- Financial stability
- Highly functional systems
- Current technology
- Early- mid- and late-career physicians
- Low physician turnover
- New physician success
A hospital loan may be offered to start or join a physician-owned practice
Physician’s hospital loan subsidizes Employer’s expenses
- High loan balance
- Underperforming practice
- Reduced compensation
- Due diligence
- Transparent financial relationship
Before signing a hospital loan agreement, you should insist on a __transparent__ financial relationship and perform __due__ diligence.
Is this job a good fit?
Consider your contract in the context of
- Direct observation
- Experiences of prospective colleagues
- Precise, clear, equitable, concise
- Positive tone
Specialty and scope of practice
Typical office, hospital, and call schedules
Specific office(s), hospital(s), other locations
Anticipated practice development
Shadow your prospective colleagues
Local market conditions strongly influence compensation
Base salary may be reduced/eliminated after 1 - 3 years
Incentive compensation = Work Units above Threshold x Rate
Correlation between work and pay
- strong: wRVUs
- moderate: Collections
- weak: Profits
Each CPT code has 3 Relative Value Units (RVUs)
- Physician’s work effort (wRVU)
- Practice expenses
- Malpractice insurance expenses
wRVU Threshold ~= same percentile as guaranteed compensation
wRVU Rate = Guaranteed compensation/wRVU Threshold ~= median wRVU rate for specialty
Collections Threshold <= 2.5 x Base Salary
Collections Rate >= 25% amount above Collections Threshold
- Fair allocation of fixed, variable, and direct expenses
- Shareholder agreement protects your rights
Obtain realistic projections of your practice’s
- Starting size
- Growth rate
- Goal size
Develop a plausible practice business plan
Consider other physicians’ experiences
More employers offer modest incentives for quality and patient satisfaction.
Some employers offer other bonuses.
Typical recruiting incentives
- Signing/starting bonus
- Relocation expenses
- Student loan repayment
- Immigration expenses
Learn about your employer’s health insurance, retirement plan, and other benefits.
Most employers also offer CME and other professional expense reimbursement.
Physicians can often work a flexible schedule or part-time to help maintain a healthy work-life balance.
- 1-3 years
Termination without cause
- 90-day notice
Malpractice tail insurance premium
Malpractice tail insurance extends the protection of a claims-made policy after employment ends.
The Employer should pay the tail insurance premium because employment creates Physician’s liability which continues after employment ends.
-May not practice in restricted area during restricted period
- Patients, employees, business relationships
Can I live with the restrictions?
Obligations during and after employment
The legal framework describes how and where the Employer and Physician will interpret and enforce their contract.
Legal framework “boilerplate” language typically benign.
Notices to your home address
Get it in writing!
Path to partnership outlines mutual expectations
Goal: Full and equal shareholder
Estimate buy-in price, return on investment
Fair compensation as an associate
Consider group practice compatibility
Consider practice financial stability
Avoid hospital loans
Consider your key career issues
Let sleeping dogs lie
Negotiate with decision maker
Walk away from a bad deal
It’s probably a good idea to have someone advise you on your employment contract before signing.
Here’s what to look for when choosing professional advisors -
Before signing your contract, consider how well the job might satisfy your key career issues.
Since 1979, when he started Jack Valancy Consulting (www.valancy.com), thousands of physicians have participated in Jack's classroom course, The Complete Practice Management Seminar™. His Classroom Farewell Tour continues through 2017.
Jack Valancy's Udemy course, Physicians: Find The Right Job and Negotiate a Better Contract, is adapted from his classroom course.
Jack Valancy has taught at graduate medical education programs around the country, and served on the clinical faculty of Case Western Reserve School of Medicine for more than two decades. He holds an MBA from Case Western Reserve University and a Bachelor of Science in Applied Science (Systems Analysis) from Miami University.