Employment Contract During Residency?

[The Long Way]

Greetings all. I am starting residency this summer, and at this point am considering doing either a C&A or Addiction fellowship after residency. The area I am from is grossly underserved for both adult and especially C&A psychiatrists. One of my C&A attendings told me that he made $300+ in his first year out of fellowship.

In order to try to recruit psychiatrists, most of the hospitals in the area offer signing bonuses and pay stipends to residents who agree to return to the area and practice. These bonuses/stipends are paid in the form of a loan that is generally forgiven over the course of one year for each year that the stipend is received. Most of these contracts also contain a clause that if a person were to not return, then the loan would be repaid to the hospital at a reasonable interest rate.

My long term goal is to open a private practice in my hometown, but I would like to work in a group practice for awhile after residency. By signing such a contract, I would be able to have a guaranteed job in such a setting and would enjoy the benefit of having handsome cash bonus now and a nice stipend during residency. The main downside that I see, is that I am basically committing to a 5 year contract that probably wouldn't begin for 5 years. Because of the exit clause and the serious shortage (hence, competition) for psychiatrists, I doubt that I would get screwed when my actual employment contract is written in 5 years, but I can't be certain.

So...for those with some experience, what is your impression of such an arrangement? Win-win situation or too good to be true? Anything that you would be particularly cautious of or demand in the contract before agreeing to sign?

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[whopper]

This is a tough question to answer because there are so many aspects in life that can weigh in your decision.

It's somewhat like asking is if you should marry Joe Schmoe, and gave us 4 paragraphs of information.

Some tidbits of advice...

1) Most residents aren't fully aware of what they want out of their career and where they will be years down the road. Committing to something that is 5 years long is a long commitment. You have to make sure it's right for you.

2) Several residents and new attendings, when they sign a contract, don't know the full implications of what they're signing. Several contracts have clauses for example that if you want to open a private practice, you can't do it within 50 miles of the place you will work in the contract. Others have other clauses such as you will be open to emergency calls if another doctor calls out sick. You have to know what you're singing onto, and if you are being unfairly manipulated.

3) Several institutions know residents and new attendings don't know these things and may try to exploit you.

4) Residents and new attendings IMHO should not be jumping right into private practice because they are green in several areas. Being in a group practice or hospital is different because if you get a tough case, you can ask several colleagues on their opinions to help you.

5) 300K+ pay? Sounds very good to me, but I've also noticed several people inflating their salaries, or the rumor mill distorting salaries. E.g. I've heard from a lot of people in residency that C&A psychiatry earns 300K pay, yet the data given out by several organizations puts C&A pay at only about $20K more than a general psychiatrist. My advice, make sure you get an accurate figure on the salary.

6) If the area is underserved, expect there to be a lot of commitment and push to make you work very hard. If you are in an underserved area, expect to be on call more, and find it harder to find coverage if you want to go on vacation.

 

[heyjack70]

The best advice I've heard is this:

"The most important thing about a contract is knowing how to get out of it."

I agree with whopper that people will try to take advantage of you knowing that you are not experienced at negotiating contracts such as this. I would definitely get a lawyer to go over the entire thing before signing anything.

 

[whopper]

If I remember correctly, the APA has people who are willing to go over contracts with you so you understand what's going on between the lines.

Also, if the contract is to work in the area where you do residency, by the time you finish that contract, it'll be very very difficult to leave. It's life dynamics. The older you get, the less likely you are to move. Further, you will already be established in the area, with 9 years of experience. Whenever you set up shop in a new area, it's like starting over again in several ways.

I know because where I graduated, I had several offers for jobs, and I would've known patients, other doctors, heads of other practices, among other things very well.

I moved to a new area for fellowship, and it was like starting over again. After being in this area almost 2 years, I've re-established myself, but it's hard work and it takes time.

If you don't want to end up where you are doing training, I'd highly think of NOT signing onto that contract. 9+ years in an area, your friends will be there, several business contacts, and you will be settled in.