Qs Negotiating first contract

[thisampgoestoeleven]

I am going out for interviews soon, apologies i'm a bit naieve as this will be my first contract negotiation process post fellowship. Couple of q's, would appreciate advice.

1) What is the going rate for a base salary based on number of clinical sessions. is it fair to say that 4 sessions should buy 220 (e.g, academics), and 6 sessions 350 (e.g., community)? Are there any community hospitals that expect 10 clinical sessions, or this is only private practice?

2) Is it ok to haggle over salary on the first interview day, before you have an offer, or should you wait until you actually know whether they want you to start haggling? e.g., via email, second look, etc.

3) How granular do you get with the contract, (e.g., day starts at 8 versus 9, not seeing patients from 12-1, have 1 hour for new patients and 30 minutes for follow up, etc.). Day starting at 8 or 9 seems a sleeper issue, since that is a 15% increase in the number of patients you are seeing per week.

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[gutonc]

I am going out for interviews soon, apologies i'm a bit naieve as this will be my first contract negotiation process post fellowship. Couple of q's, would appreciate advice.

1) What is the going rate for a base salary based on number of clinical sessions. is it fair to say that 4 sessions should buy 220 (e.g, academics), and 6 sessions 350 (e.g., community)? Are there any community hospitals that expect 10 clinical sessions, or this is only private practice?

What do you mean by a "session"? If you mean a half day of clinic, only academics thinks that way. In community/PP work, you'll be expected to work 4-5 clinic days a week as a "full time" job.

And if you can find a job that will pay you $350K base for 3 days of clinic as a new grad, grab that s*** and don't let go.

2) Is it ok to haggle over salary on the first interview day, before you have an offer, or should you wait until you actually know whether they want you to start haggling? e.g., via email, second look, etc.

After the offer letter comes in. That said, it's totally fine to ask about the salary/compensation plan up front.

3) How granular do you get with the contract, (e.g., day starts at 8 versus 9, not seeing patients from 12-1, have 1 hour for new patients and 30 minutes for follow up, etc.). Day starting at 8 or 9 seems a sleeper issue, since that is a 15% increase in the number of patients you are seeing per week.

As granular as you want. Or you can leave it kind of open so you have flexibility. My contract (and the ones I've offered to recent hires in my group) just outlines the number of clinic days and the compensation. Everything else is negotiable on the back end. Want an hour for new patients and 30 min for follow ups? Sure, but you'll never meet your production goal/bonus and some contracts have claw-backs. Want to start at 9 and be done at 3? See above. OTOH, if you want to do 45 min new patients and have 15 minutes for follow ups, you're going to be slamming down those RVUs and your production bonus will rise accordingly.

 

[thisampgoestoeleven]

Thanks, this is helpful advice. I guess 350 for 3 days is kind of a unicorn, I really have no clue what sort of compensation I should be getting for 5 full days a week.

Gutonc, As someone who interviews candidates, what are some pearls and pitfalls you see candidates doing/saying when they are there for the interview day. Are there any particular questions you see asking that could really make or break an interviewee?

Also, I'm sure others have posted here before, I find more and more academic jobs are unwilling to pay for travel or dinner the night before. It's quite a turn-off. It makes me think of the article, "And Then There Were None: The Consequences of Academia Losing Clinically Excellent Physicians."

 

[gutonc]

Thanks, this is helpful advice. I guess 350 for 3 days is kind of a unicorn, I really have no clue what sort of compensation I should be getting for 5 full days a week.

Any job that wants you to work 5 full clinic days should be a hard no. I mean, for $1.2-1.4M I might kill myself like that for a couple of years. But nobody's paying that these days.

Gutonc, As someone who interviews candidates, what are some pearls and pitfalls you see candidates doing/saying when they are there for the interview day. Are there any particular questions you see asking that could really make or break an interviewee?

I can only comment on community based gigs but I really only have 1 piece of advice...Just be normal. Seriously. When I interview people I'm looking for:
1. Somebody with a focus on good, evidence based, patient care.
2. Someone interested in being in the area/job for at least 5 years. I know that life happens and you may not stay that long, but at least try to commit.
3. Somebody I'd like to have a beer/dinner with.

Also, I'm sure others have posted here before, I find more and more academic jobs are unwilling to pay for travel or dinner the night before. It's quite a turn-off. It makes me think of the article, "And Then There Were None: The Consequences of Academia Losing Clinically Excellent Physicians."

If this were the case for my group, I would honestly just take you out to dinner on my own dime and then work the travel compensation into your signing bonus. But the dinner has been the make/break for more than one candidate for me recently.

Academia is in the process of eating itself. It sucks.

 

[thisampgoestoeleven]

When is a usual timeline to sign a contract by? I'm interested in a job in a bureaucratic place where people say it takes forever to get a contract. Does a letter of intent serve to protect you in any way? Not sure if I should be expecting to sign a contract by Dec 1, or Jan 1, etc.

I'm also not sure if I should be rejecting other job offers before I sign a contract with a place. I don't want to be left in the lurch without *any* offers, but some places that expressed interest in me are being pushy about having me sign or they will take the offer away.

 

[gutonc]

When is a usual timeline to sign a contract by? I'm interested in a job in a bureaucratic place where people say it takes forever to get a contract. Does a letter of intent serve to protect you in any way? Not sure if I should be expecting to sign a contract by Dec 1, or Jan 1, etc.

I'm also not sure if I should be rejecting other job offers before I sign a contract with a place. I don't want to be left in the lurch without *any* offers, but some places that expressed interest in me are being pushy about having me sign or they will take the offer away.

An offer letter signed by whoever needs to sign it is contractually binding (per the terms of the contract which will be spelled out in it.

If you really like that place, follow up with the Chief, or with HR if you have a contact. It's OK to say you need a little more time. Some places may give it to you, some may not. It's a big decision, it's OK to need a little time.

 

[anon1984]

Any job that wants you to work 5 full clinic days should be a hard no. I mean, for $1.2-1.4M I might kill myself like that for a couple of years. But nobody's paying that these days.


I can only comment on community based gigs but I really only have 1 piece of advice...Just be normal. Seriously. When I interview people I'm looking for:
1. Somebody with a focus on good, evidence based, patient care.
2. Someone interested in being in the area/job for at least 5 years. I know that life happens and you may not stay that long, but at least try to commit.
3. Somebody I'd like to have a beer/dinner with.


If this were the case for my group, I would honestly just take you out to dinner on my own dime and then work the travel compensation into your signing bonus. But the dinner has been the make/break for more than one candidate for me recently.

Academia is in the process of eating itself. It sucks.

Don't mean to hijack the thread but could you comment on where in the percentile a first year graduate should make according to the most recent MGMA data? I wouldn't think you'd be making in the 50th percentile straight out of fellowship but I would guess somewhere in between 25th-50th percentile.

 

[gutonc]

Don't mean to hijack the thread but could you comment on where in the percentile a first year graduate should make according to the most recent MGMA data? I wouldn't think you'd be making in the 50th percentile straight out of fellowship but I would guess somewhere in between 25th-50th percentile.

Depends on the job and the market.

If you're picking up a busy clinic from someone who quit/moved/retired/died, and they were making that, then yes, you should make that...within a year or two. If you're being added as an extra doc to expand an already busy site, if you can pull 25ht %ile by year 3, you're doing great.

Realize that to make <50th %ile numbers, you're going to be seeing 20-25 patients a day, with 3-5 of them being new consults. 4-5 days a week.

If you can do that on August 1, good on you.

If you get credit for patients that APPs see for you, you might do better...but somebody has to pay them. And it's going to be "you", one way or another.