Employment Contract for first job offer

[peppy]

Just recently received my first contract from a prospective employer after I graduate in a few months.
I am aware of the advice that a lot of times employers will make promises that end up not meaning anything because it is not spelled out in the contract.

Even though we had discussed these topics when I met with the employer, the contract does not spell out anything about topics such as:
-call frequency
-number of patients I will see on inpatient every day (I am going to be on inpatient part time so I think it is important for me to know just how many patients I will be seeing during that limited time!)
-number of days paid time off
-how much money I will receive for CME

Should I be concerned that the contract is vague about these kinds of things? Is that a red flag that I should be skeptical of their promises? Or is it pretty standard that they will wait to see what you ask for and then revise the contract to be more specific depending on what you ask for?
Does anyone have any advice about how to approach them about wanting these kinds of things spelled out in writing before I agree to their offer?

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[milesed]

Mine was not in the contract, but was spelled out in the policies/procedures. Problems is they can change either the contract or policies down the road. Get what you can in writing.

 

[vistaril]

Just recently received my first contract from a prospective employer after I graduate in a few months.
I am aware of the advice that a lot of times employers will make promises that end up not meaning anything because it is not spelled out in the contract.

Even though we had discussed these topics when I met with the employer, the contract does not spell out anything about topics such as:
-call frequency
-number of patients I will see on inpatient every day (I am going to be on inpatient part time so I think it is important for me to know just how many patients I will be seeing during that limited time!)
-number of days paid time off
-how much money I will receive for CME

Should I be concerned that the contract is vague about these kinds of things? Is that a red flag that I should be skeptical of their promises? Or is it pretty standard that they will wait to see what you ask for and then revise the contract to be more specific depending on what you ask for?
Does anyone have any advice about how to approach them about wanting these kinds of things spelled out in writing before I agree to their offer?

you are going to have to give us more info like that kind of setting this is, how is your salary determined, etc.....that will impact how important it is to get these things hammered out.

 

[wolfvgang22]

Just recently received my first contract from a prospective employer after I graduate in a few months.
I am aware of the advice that a lot of times employers will make promises that end up not meaning anything because it is not spelled out in the contract.

Even though we had discussed these topics when I met with the employer, the contract does not spell out anything about topics such as:
-call frequency
-number of patients I will see on inpatient every day (I am going to be on inpatient part time so I think it is important for me to know just how many patients I will be seeing during that limited time!)
-number of days paid time off
-how much money I will receive for CME

Should I be concerned that the contract is vague about these kinds of things?
Is that a red flag that I should be skeptical of their promises? Or is it pretty standard that they will wait to see what you ask for and then revise the contract to be more specific depending on what you ask for?

Yes.

Does anyone have any advice about how to approach them about wanting these kinds of things spelled out in writing before I agree to their offer?

Just ask politely. You don't need to apologize for asking. If they say "it's in the department policies or procedures", keep in mind they can change those anytime. Then you have to make a judgement call based on what has gone on there in that department in the past.
A lot also depends on how much competition you have for this position. The less, the better you will be able to negotiate, obviously.

 

[michaelrack]

you are going to have to give us more info like that kind of setting this is, how is your salary determined, etc.....that will impact how important it is to get these things hammered out.

agree. If you have a flat salary, you definitely want a limit on your patient load. Not so critical if you have a decent productivity bonus.

 

[F0nzie]

My contract: 90 minute intakes, 30 minute follow up.

Reality: 30 minute intakes, 15 minute follow ups

 

[PistolPete]

My contract: 90 minute intakes, 30 minute follow up.

Reality: 30 minute intakes, 15 minute follow ups

Dang, this is what I have to look forward to once in PP? :/

 

[Shikima]

In my PP I'm booking 45 mins for intakes and 15-30 min for follow-up. I lose revenue by booking 30 mins but some of my geriatric patients need this time to review medications and discuss plans.

 

[TexasPhysician]

Most contracts are written to benefit the person paying the lawyer. It is up to you to adapt the wording to your liking. Some companies agree to changes more easily. I've had them agree to all changes, and I've had to walk away as well.

 

[TexasPhysician]

My contract: 90 minute intakes, 30 minute follow up.

Reality: 30 minute intakes, 15 minute follow ups

Why put up with that? It is in your contract. Tell staff that they will have to reschedule patients to accommodate your patients. I'd refuse to comply.

 

[F0nzie]

Dang, this is what I have to look forward to once in PP? :/

Community MH

 

[F0nzie]

Why put up with that? It is in your contract. Tell staff that they will have to reschedule patients to accommodate your patients. I'd refuse to comply.

Well my patients decompensate and I would rather see them for 15 min than push them out to my next available in 3 months.

I am cutting back by 1 day and probably resigning in a year.

 

[F0nzie]

In my PP I'm booking 45 mins for intakes and 15-30 min for follow-up. I lose revenue by booking 30 mins but some of my geriatric patients need this time to review medications and discuss plans.

Are you contracted with insurance or out of pocket?

 

[Shikima]

Are you contracted with insurance or out of pocket?

I do both. There is a large need in my area and some prefer my services and will pay cash while others rely on insurance.

 

[F0nzie]

I do both. There is a large need in my area and some prefer my services and will pay cash while others rely on insurance.

I take a huge hit with no shows and cancellations in my pp. The bigger the time allotment the bigger the hit. One day I had 4 weekly therapy visits cancel for legitimate reasons. No income that AM.

 

[Shikima]

I take a huge hit with no shows and cancellations in my pp. The bigger the time allotment the bigger the hit. One day I had 4 weekly therapy visits cancel for legitimate reasons. No income that AM.

I take a hit too if they cancel relatively reasonably through the reason and leaving the appropriate notice. Those that do not incur a $40 charge.

 

[F0nzie]

I take a hit too if they cancel relatively reasonably through the reason and leaving the appropriate notice. Those that do not incur a $40 charge.

Thats generous. I warn them during the intake that I charge the full amount if they forget their appointment. I also sign them up for text, voicemail, and email reminders. I waive the first missed visit and charge the full amount for subsequent missed appointments.

 

[clusterF]

My contract: 90 minute intakes, 30 minute follow up.

Reality: 30 minute intakes, 15 minute follow ups

If you see that in CMH then I would send a letter in writing to the (probably non physician in charge) every time and only see the most acute patients. Reschedule everyone else. You are doing the patient's a disservice by your actions. They should hire more psychiatrists and if they need to raise the pay, they should do that. Perhaps they can do so by cutting the useless admins.

 

[Bartelby]

Should I be concerned that the contract is vague about these kinds of things? Is that a red flag that I should be skeptical of their promises?

I'm not sure that it is a red flag, but from what I understand if changes are written into a contract (which can literally be just you writing something in pen on the contract) and both parties initial then it is legally binding. Personally I would write in the terms just as I was told they should be and ask for them to initial it. If they begin to backpedal and say that they can't put anything like that in the contract I would get nervous. Whether I would take such an offer would depend on how badly I needed it.

 

[Information Underload]

In my PP I'm booking 45 mins for intakes and 15-30 min for follow-up. I lose revenue by booking 30 mins but some of my geriatric patients need this time to review medications and discuss plans.

Do you find you lose revenue this way for patients with insurance? If you're doing psychotherapy and med management, a single 99213/4 + 90833 is better than 2 x 99213 and just a bit less than 2 x 99214s, at least in my region.

 

[peppy]

you are going to have to give us more info like that kind of setting this is, how is your salary determined, etc.....that will impact how important it is to get these things hammered out.

It is a large private hospital system with numerous locations - I will be splitting my time between two of their hospital locations probably. They are offering me a salary guarantee for 2 years then RVU based. Does the fact that it is RVU based mean that I really can't expect them to guarantee anything about how many people I will carry on inpatient and such?

 

[TexasPhysician]

It is a large private hospital system with numerous locations - I will be splitting my time between two of their hospital locations probably. They are offering me a salary guarantee for 2 years then RVU based. Does the fact that it is RVU based mean that I really can't expect them to guarantee anything about how many people I will carry on inpatient and such?

The contract is for how long before you could get out? If possible, after 1.5 years calculate what your rvu pay would be had it always have been rvu based. Rvu could be higher risk with higher reward. If it looks bad, negotiate a salary with rvu bonus or keep straight salary or leave.

 

[Information Underload]

Find out what the holiday schedule is. If people cover on certain holiday for others, make sure your contract specifies that major holidays (e.g., Christmas, Thanksgiving) in which you would naturally have off and on which you are not covering are not included in your vacation allotment.

 

[peppy]

Find out what the holiday schedule is. If people cover on certain holiday for others, make sure your contract specifies that major holidays (e.g., Christmas, Thanksgiving) in which you would naturally have off and on which you are not covering are not included in your vacation allotment.

Thanks for the idea. My contract doesn't say anything about that issue, so I am going to ask about if they will give me that info in writing.

I am now thinking I really do need to get a lawyer involved because I don't feel comfortable that I know enough about this stuff to make sure I get a good deal.

 

[Shikima]

I had investigated a gig where it was InPt, ER and C&L combined offering 240k/yr. Sounded pretty sweet with the numbers but when I began to dig further, it appeared that I would be on call 24/7, holiday's and weekends. This particular health organization did believe in paying physicians for call time and I heard nothing but the wind blowing when I asked who would cover the InPt unit on weekends, holidays and vacations. The response was, "Oh, don't worry, we'll find someone to cover."

Don't believe them. Get it in writing. And be sure all your time is appropriately compensated.

 

[F0nzie]

I had investigated a gig where it was InPt, ER and C&L combined offering 240k/yr. Sounded pretty sweet with the numbers but when I began to dig further, it appeared that I would be on call 24/7, holiday's and weekends. This particular health organization did believe in paying physicians for call time and I heard nothing but the wind blowing when I asked who would cover the InPt unit on weekends, holidays and vacations. The response was, "Oh, don't worry, we'll find someone to cover."

Don't believe them. Get it in writing. And be sure all your time is appropriately compensated.

You gotta work hard for those high figures. Sometimes you actually get less for the number of hours worked. That's why I think negotiating part-time contracts is the way to go to max your hourly rate.

 

[thepoopologist]

You gotta work hard for those high figures. Sometimes you actually get less for the number of hours worked. That's why I think negotiating part-time contracts is the way to go to max your hourly rate.

I'll keep this in mind in a year or two

 

[Thruster]

I'm really confused as to why 240K qualifies as a "high number" in terms of salary. It seems as if psychiatrists on average are undervaluing their worth quite a bit. I know a few psychiatrists that earn 350K working about 30-35 hrs a week because of how they've negotiated their contracts. I've been hearing a lot of concerning statements from other senior residents who also aren't aware of how much they are worth. They seem content with earning 150-180k working in some cases, pretty crappy jobs. When psych averages 210k (likely including a lot of part-time workers), I don't see how we are content with not negotiating for better wages.

What am I missing?

 

[TexasPhysician]

I'm really confused as to why 240K qualifies as a "high number" in terms of salary. It seems as if psychiatrists on average are undervaluing their worth quite a bit. I know a few psychiatrists that earn 350K working about 30-35 hrs a week because of how they've negotiated their contracts. I've been hearing a lot of concerning statements from other senior residents who also aren't aware of how much they are worth. They seem content with earning 150-180k working in some cases, pretty crappy jobs. When psych averages 210k (likely including a lot of part-time workers), I don't see how we are content with not negotiating for better wages.

What am I missing?

You have no idea how awful many psychiatrists are at negotiating. One of my past senior residents was told about the salary of his first job, and the admin specifically said they would negotiate to get him there as there was a big need. He said "No worries, I'll take it". No negotiation by him at all.

It actually upsets me some that others in the field aren't more aggressive. It lowers the average pay rate, and it allows admins to believe (rightfully so) that we can be hired cheaply.

 

[F0nzie]

You have no idea how awful many psychiatrists are at negotiating. One of my past senior residents was told about the salary of his first job, and the admin specifically said they would negotiate to get him there as there was a big need. He said "No worries, I'll take it". No negotiation by him at all.

It actually upsets me some that others in the field aren't more aggressive. It lowers the average pay rate, and it allows admins to believe (rightfully so) that we can be hired cheaply.

I feel the issue has more to do with funding. I have thought about negotiating a better contract but it seems like too much of a hassle for an extra 5-10k. I am much more focused on the escape plan.

 

[Baller MD]

I feel the issue has more to do with funding. I have thought about negotiating a better contract but it seems like too much of a hassle for an extra 5-10k. I am much more focused on the escape plan.

Why do you want to leave your current job?

 

[TexasPhysician]

I have thought about negotiating a better contract but it seems like too much of a hassle for an extra 5-10k.

Say you give up the "hassle" of 10k/year. 1 year isn't a big deal but psychiatrists regularly short themselves.

Say you have a 25 year career. A 10k loss is just more than $833/month. At 4% interest over 25 years, you are out >$400,000. That's huge! If you actually return closer to the stock market average of 7-8%, my estimate is low.

 

[F0nzie]

Why do you want to leave your current job?

I feel burned out man. By the time I get home from work I am toast. I realized one day that I was giving more of my time, patience, and attention to patients than to my own son... So I am reprioritizing and making changes. Hopefully cutting my hours down and getting more exercise will help.

Right now I am making a conscious effort to not shut down when I get home. Its weird... its not like I am operating for 16 hours but listening to everyones problems and cramming it in 15 min appointments sucks. Sometimes I wish I could just look at a rash or a sore throat and be done with it.

If I decide to stay another year I will probably re-negotiate my contract. My productivity numbers are good so that should help.

 

[F0nzie]

Say you give up the "hassle" of 10k/year. 1 year isn't a big deal but psychiatrists regularly short themselves.

Say you have a 25 year career. A 10k loss is just more than $833/month. At 4% interest over 25 years, you are out >$400,000. That's huge! If you actually return closer to the stock market average of 7-8%, my estimate is low.

Yea that's definitely huge over the long term. I definitely recommend negotiating and not accepting the first offer. As far as renogotiating... not too sure about that one. How often should one renegotiate? In residency my salary went up every year and matched inflation. I have been with my job for 1.5 years now and my hourly rate has not changed.

 

[Shikima]

I feel burned out man. By the time I get home from work I am toast. I realized one day that I was giving more of my time, patience, and attention to patients than to my own son... So I am reprioritizing and making changes. Hopefully cutting my hours down and getting more exercise will help.

Right now I am making a conscious effort to not shut down when I get home. Its weird... its not like I am operating for 16 hours but listening to everyones problems and cramming it in 15 min appointments sucks. Sometimes I wish I could just look at a rash or a sore throat and be done with it.

If I decide to stay another year I will probably re-negotiate my contract. My productivity numbers are good so that should help.

I feel your discomfort and have metamorphosed out of that arrangement over this past summer. For the last year and half I had been working about 65 hours a week. I found my daughter was having more behavioral problems and had developed terrible skin picking habits at the tender age of 4 because I wasn't around. I had been working 7a-9p 4 days a week. When the weekend came, I was too exhausted and barely could interact with her.

Since then I've reduced the number of hours by going into private practice (minus a 20% OH rate) and what I catch is what I eat. I'm medical director of an IOP program and I supervise a new NP. I've reduced my time to about 35-36 hours a week in clinic and will be working another 5-10 hours per week at the local VA doing sleep medicine (interpreting studies and conducting clinic for an hourly rate).

Keep up the good work and never give up your principles. You're doing a great job!