Attending Contract as Resident

[HLxDrummer]

Hey guys,

How do you feel about signing a contract to work as an attending somewhere in the future? I'm going to be an intern in July and I'm 99% sure what area we will live in when I'm done. Was considering talking to hospitals in the area about signing a contract ahead of time in return for a stipend during residency. I could put this money straight towards loans which would be nice.

Is this a bad idea?

If not, how much is a reasonable stipend? If I go through with this I was going to try shadowing for a few shifts to talk to current attendings and see what it's like there.

Any other tips or suggestions? I feel like I may be jumping the gun but I've heard other residents say they wish they did it sooner and I'm pretty sure where I'll be working now anyway.... I'm sure there are things I'm not considering, however.

Thanks in advance!

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[filhodeinferno]

Hey guys,

How do you feel about signing a contract to work as an attending somewhere in the future? I'm going to be an intern in July and I'm 99% sure what area we will live in when I'm done. Was considering talking to hospitals in the area about signing a contract ahead of time in return for a stipend during residency. I could put this money straight towards loans which would be nice.

Is this a bad idea?

If not, how much is a reasonable stipend? If I go through with this I was going to try shadowing for a few shifts to talk to current attendings and see what it's like there.

Any other tips or suggestions? I feel like I may be jumping the gun but I've heard other residents say they wish they did it sooner and I'm pretty sure where I'll be working now anyway.... I'm sure there are things I'm not considering, however.

Thanks in advance!

Unless the area you wanna settle in is really crappy, I wouldn't plan on a stipend. If a group was desperate enough for docs that they were paying interns to get 'dibs' on them 3 years later, I'd be worried about what kind of place that is.

That being said, some of the CMGs like EMCare will offer said stipends for a commitment. If they operated in some of the places I was interested in living after residency, I would have given that a lot of consideration.

 

[winkleweizen]

Three years early, definitely not.

 

[goodoldalky]

No

 

[emergentmd]

Geeezzzzz....... Hold your horses. Enjoy residency. Your loans will be paid off when you are done. Do not sell your soul.

No decent job will pay you a stipend for 3 yrs and if they did, your pay will be way subpar when you are done.

 

[HLxDrummer]

Alright, sounds pretty unanimous! What makes it different @filhodeinferno if the stipend is offered by someone like EMCare? Two of the three hospitals I was considering the most work with them.

 

[goodoldalky]

Alright, sounds pretty unanimous! What makes it different @filhodeinferno if the stipend is offered by someone like EMCare? Two of the three hospitals I was considering the most work with them.

No no no

 

[Makati2008]

Hey guys,

How do you feel about signing a contract to work as an attending somewhere in the future? I'm going to be an intern in July and I'm 99% sure what area we will live in when I'm done. Was considering talking to hospitals in the area about signing a contract ahead of time in return for a stipend during residency. I could put this money straight towards loans which would be nice.

Is this a bad idea?

If not, how much is a reasonable stipend? If I go through with this I was going to try shadowing for a few shifts to talk to current attendings and see what it's like there.

Any other tips or suggestions? I feel like I may be jumping the gun but I've heard other residents say they wish they did it sooner and I'm pretty sure where I'll be working now anyway.... I'm sure there are things I'm not considering, however.

Thanks in advance!

As someone going through this now, NO NO NO! I made a big mistake about signing early with a hospital I loved but so much has changed I'm looking at ways to pay them back after residency. IF we can reach a beneficial agreement I might stay but hearing them say 225k, to work m-f, 8-5 as well as cover midlevels it doesn't look good.


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[HLxDrummer]

Alright that seals the deal thanks guys!

 

[deleted77919]

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[filhodeinferno]

Alright, sounds pretty unanimous! What makes it different @filhodeinferno if the stipend is offered by someone like EMCare? Two of the three hospitals I was considering the most work with them.

Actually, the only stipends I've ever heard of were offered by large CMGs. The deal I was pitched is that you got like $2000 a month during residency if you agreed to work at one of the places they had contracts. They assured me that there were no limitations on which facilities would qualify. I think you had to work for them for like 2 years after in order to not have to re-pay the money.

I agree with the other posters that you probably don't really know what you want yet, and a lot can change in 3 years, so committing yourself to something that early on may not be the best thing. However, if you are just absolutely dead set on staying in an area, and most of the hospitals in that area are with EM-Care...well, I would bet you're going to end up working for them in the end anyway, so you may as well get the money. Most people, myself included, would just feel a little uneasy about selling your soul to a CMG so early on.

 

[The White Coat Investor]

I don't know. I'd do it for enough money. But a typical stipend like $20K a year? No way. If they want to give you $200K a year during residency and then pay a fair rate afterwards too and it's where I wanted to work anyway? Sure, I'd do it.

 

[link2swim06]

Alright, sounds pretty unanimous! What makes it different @filhodeinferno if the stipend is offered by someone like EMCare? Two of the three hospitals I was considering the most work with them.

Meaning it's worse?

 

[Janders]

I don't know. I'd do it for enough money. But a typical stipend like $20K a year? No way. If they want to give you $200K a year during residency and then pay a fair rate afterwards too and it's where I wanted to work anyway? Sure, I'd do it.

Bingo. It would have to be one hell of a stipend to get me to limit myself, my locations, my earnings, etc ESPECIALLY 3 years in the future. No way for $20-30k/year that I would sign on 3 years early.

 

[deleted547339]

A lot of things change in residency. Unless you're married, you and your wife are from a small town with only one hospital, that hospital is a decent gig but in a bag location and really needs people, you have never even considered fellowship or academics, and they offer a HUGE stipend. Even this, it's iffy.

Getting into a relationship/married can change everything as can having children. You may fall in love with ultrasound or research or whatever. You may decide to do a fellowship or academics. You may love the city you end up training in and wanting to stay. The hospital may change hands or cut their rates. Your family in the area could move or pass.

 

[Jlaw]

I don't have much first hand knowledge of how the stipends work but my finance background tells me that as a PGY1 you are going to get stiffed a) because they have to pay it for 3 years, and b) because you are a poor medical student up to your eyeballs in debt who probably hasn't had a paycheck in years, if ever, and an extra 20 or 30k seems like big money, so you will be stupid enough to take it.

I would wait until you are at least halfway through 2nd year to start looking, and when you do, engage your attendings, PD, etc and get them to help you. Most of the faculty at places I rotated last summer were very involved in helping the rising PGY3 class get in touch with potential employers, interview, and negotiate contracts. If you play your cards right you can probably negotiate a much better stipend at that time. As a PGY1 anyone willing to negotiate with you knows your options are limited. As a PGY3 they know that you can basically work anywhere you want, so if they want to get you they will need to sweeten the deal.

 

[RustedFox]

I signed a 1000/month stipend contract with EmCare for my first gig out. I signed 7 months prior to graduating residency, so that was an extra 7K minus taxes in my pocket. There was a two-year "payback" clause; with a smaller percentage being "owed back" nearer the end of the two years.

I made it the full two years; and the job wasn't a bad one - but I would not sign anything until my PGY-3 year for all the reasons listed above.

 

[Brahnold Bloodaxe]

I thought you could make a pretty penny moonlighting starting 2nd year, so wouldn't that severely diminish the perceived benefit of a 20k/year stipend?

 

[Makati2008]

I thought you could make a pretty penny moonlighting starting 2nd year, so wouldn't that severely diminish the perceived benefit of a 20k/year stipend?

Some programs won't let you at all or make you wait until pgy 3


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[Jlaw]

I thought you could make a pretty penny moonlighting starting 2nd year, so wouldn't that severely diminish the perceived benefit of a 20k/year stipend?

It depends on the program. We can moonlight starting at the end of 2nd year but you need to be approved by the PD first and I believe there are performance qualifiers to meet as well (in service scores, reviews, etc). I imagine that moonlighting income is fairly limited in a 3 year residency because of work hour restrictions impeding the amount of extra shifts you can pick up, and that's if you even have the motivation to work 80 hours a week. I rotated at 4 programs last fall and none of the residents did much, if any, moonlighting. It seemed as though most of the seniors valued their time off more than the extra bucks so most were just picking up an odd shift here and there.

 

[RustedFox]

It depends on the program. We can moonlight starting at the end of 2nd year but you need to be approved by the PD first and I believe there are performance qualifiers to meet as well (in service scores, reviews, etc). I imagine that moonlighting income is fairly limited in a 3 year residency because of work hour restrictions impeding the amount of extra shifts you can pick up, and that's if you even have the motivation to work 80 hours a week. I rotated at 4 programs last fall and none of the residents did much, if any, moonlighting. It seemed as though most of the seniors valued their time off more than the extra bucks so most were just picking up an odd shift here and there.

I didn't do a single moonlighting shift as a resident. I'll have my day off, please.

 

[fahimaz7]

It depends on the program. We can moonlight starting at the end of 2nd year but you need to be approved by the PD first and I believe there are performance qualifiers to meet as well (in service scores, reviews, etc). I imagine that moonlighting income is fairly limited in a 3 year residency because of work hour restrictions impeding the amount of extra shifts you can pick up, and that's if you even have the motivation to work 80 hours a week. I rotated at 4 programs last fall and none of the residents did much, if any, moonlighting. It seemed as though most of the seniors valued their time off more than the extra bucks so most were just picking up an odd shift here and there.

I moonlight about 2 shifts a month which is an extra 4k after taxes. Some residents are getting per diem gigs that are double what we get in my area. Most I've done in a mo was 5.

 

[da8s0859q]

I moonlight about 2 shifts a month which is an extra 4k after taxes. Some residents are getting per diem gigs that are double what we get in my area. Most I've done in a mo was 5.

Just curious - whereabout is this, and what kind of shift exactly?

 

[fahimaz7]

Just curious - whereabout is this, and what kind of shift exactly?

Essentially any state. I'm in the NE. I work 12's single provider.

 

[da8s0859q]

Essentially any state. I'm in the NE. I work 12's single provider.

Not every state. I moonlight too, and it's not like that. Was where I came from and several other places though.

Surprised the NE is treating you that well.

 

[Tenk]

I would have done it for one hospital in a heart beat, but I already knew the docs, the area, the population, etc. because I worked there before medical school.

If you know:
1. This is the #1 city you want to work in far above any other.
2. You have been to this hospital and worked/been around the ED long enough to get a feel for the support staff of the hospital.
3. You have met your future co-workers and seen their work ethic (also if they have high turnover this would be a red flag).
4. How much the pay will be and how much you will gain by signing early versus waiting and maybe looking at other hospitals nearby.
5. The benefit package.
6. You could see yourself working there for at least a few years.

If you know all of the above, I could see the benefits of doing it. If you are just being offered a check and know nothing else, run!

 

[Old_Mil]

Alright, sounds pretty unanimous! What makes it different @filhodeinferno if the stipend is offered by someone like EMCare? Two of the three hospitals I was considering the most work with them.

No. The proper time to sign a contract is sometime between Dec 1st of your 2nd year and Dec 1st of your third year so you pay taxes on your signing bonus at your lower residency bracket.

Also, hospitals/CMGs know that most residents don't know the true market value of their work and try to screw you.

 

[TeamZissou]

I don't know. I'd do it for enough money. But a typical stipend like $20K a year? No way. If they want to give you $200K a year during residency and then pay a fair rate afterwards too and it's where I wanted to work anyway? Sure, I'd do it.

Some of the CMG's are offering $2k/mo for the last two years of residency. TeamHealth categorizes you as "special ops", you choose a region to work in, not totally sure about the specifics of length of time spent at one hospital vs filling their needs.

 

[Birdstrike]

Hey guys,

How do you feel about signing a contract to work as an attending somewhere in the future? I'm going to be an intern in July and I'm 99% sure what area we will live in when I'm done. Was considering talking to hospitals in the area about signing a contract ahead of time in return for a stipend during residency. I could put this money straight towards loans which would be nice.

Is this a bad idea?

If not, how much is a reasonable stipend? If I go through with this I was going to try shadowing for a few shifts to talk to current attendings and see what it's like there.

Any other tips or suggestions? I feel like I may be jumping the gun but I've heard other residents say they wish they did it sooner and I'm pretty sure where I'll be working now anyway.... I'm sure there are things I'm not considering, however.

Thanks in advance!

Signing as an intern is way to early, in my opinion. In fact, any job that would sign someone on as an intern, without knowing what type of resident and doctor the person turns out to be is a ridiculously alarming red flag. Why any hospital would sign someone that's just staring residency has to be only out of shear desperation. You don't want to work at a clown-show this third world. Signing a contract with 6 months to go in your residency, wouldn't be "late." Anything early in 3rd year, would be early. Anything before that, is very early. Signing as an intern would be like a sports team signing a draft pick that's in 5th grade.

Dont limit your options. You'll find a job, no problem. Plus, any place that short staffed that they're dipping into intern-year to get people under contract, will still need help in 2 years. Trust me.