1st Contract wants/what else should I ask for?

[lots-o-questions]

Hey all,
I have looked through posts with similar themes so I don't want people to feel they need to rehash things have discussed multiple times. I am in my final year and am likely going to be signing a contract with a private practice and wanted to get a feel for navigating contract. I am planning to be pretty aggressive in my requests with the contract. I'm walking in with the mindset that, I know if I don't get what I want I can always go to a tele psych job and make plenty while I'm looking for the next opportunity. Of note this clinic fits a lot of my clinical interests (Addiction, Gen psych, TMS, and Ketamine), as well as built in mentoring, and far as I can appreciate it's a pretty great working environment so ideally it all works out because I think its a good opportunity.

Wants (too aggressive?):
- I will be W2 and would like 75/25 willing to concede to 70/30 (If I end up having some cash patients would it be reasonable to ask for 80/20 given there is less overhead with cash circumstances- or is this splitting hairs)
- I want full autonomy to accept or deny patients based on fit- as well as size of my panel (within reason... I'm planning on working enough to justify putting me on staff)
- Autonomy on how long my visits last (ex no requirement for 15 min med checks and OK to have a few therapy pts)
- Appreciating the extra baseline costs of a TMS machine/staff should I still request the same split as above or should I offer to take a smaller spit to cover some of the extra costs? I know for a fact they have far less volume than they could on their TMS machine so Im hoping to energize this part of the practice by doing some advertising on my own, by visiting some PCP's and other PP psychiatrists in the area.
- No none compete (I have no intention of starting my own practice in this area and frankly if I was to leave this clinic I would likely move to a different state (closer to my and my wife's parents)- however I don't want to be limited)
- Tail insurance

? The MD who owns the practice (solo) is in her 60's and I don't know if or when she is planning to retire. If I am to hang around long enough it may be that I become the DeFacto "next person in line" (note this is totally theoretical and she may plan to work until she is 80), is there anything in particular that I should ask for in the contract so this kind of transition does not bite me in the Butt? (as of now i don't think she is interested in a partner and frankly at least for the first few years I am happy to be a W2).

Is there anything else big that I should think about or ask for?

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[rjs2131]

Sounds like this would primarily be insurance based? One thing to make sure you know well before joining an insurance-based practice is what each CPT code reimburses (99205, 99213-15 and 90833-38 in particular). If this practice has negotiated rates well, a lower split might be better than a higher split at another practice.

I think autonomy should absolutely be a part of this deal (otherwise what's the point of PP?) but I imagine you need to be working x amount to cover expenses and still be profitable.

Definitely good to negotiate, but if this is a small PP I wouldn't push so hard that it is going to impact your relationship with the owner. Lots of little nuances in PP will come up as you move forward and you'll want a good relationship to navigate some of these challenges.

 

[medhead1990]

Sounds like this would primarily be insurance based? One thing to make sure you know well before joining an insurance-based practice is what each CPT code reimburses (99205, 99213-15 and 90833-38 in particular).

Isnt that against the “rules”, ie. Wont a practice breach contract with the insurance companies by telling others what their negotiated reimbursements are? Or is it considered ok in the setting of potential new hires?

 

[calvnandhobbs68]

Isnt that against the “rules”, ie. Wont a practice breach contract with the insurance companies by telling others what their negotiated reimbursements are? Or is it considered ok in the setting of potential new hires?

I mean maybe or maybe not but who’s gonna tell? The person looking for a job?

If a place is serious, they’ll tell you how much they get per code if you’re being paid on a split, otherwise I wouldn’t even consider them.

 

[forchinet121]

Isnt that against the “rules”, ie. Wont a practice breach contract with the insurance companies by telling others what their negotiated reimbursements are? Or is it considered ok in the setting of potential new hires?

You think it makes sense to get hired at a place without knowing how much you’re going to make per patient when you’re being paid per patient? Does that sound reasonable?

 

[medhead1990]

Oh I don’t disagree I think it’s ridiculous but my impression was That most places don’t/can’t. It’s nice to know that’s not the case

 

[ObsequiousAplomb]

Oh I don’t disagree I think it’s ridiculous but my impression was That most places don’t/can’t. It’s nice to know that’s not the case

It's most often that they don't want to more than can't. The less you know the less leverage you have for negotiating and that's pretty much the only real reason they wouldn't tell you.

 

[splik]

Isnt that against the “rules”, ie. Wont a practice breach contract with the insurance companies by telling others what their negotiated reimbursements are? Or is it considered ok in the setting of potential new hires?

No. they'll be working with the practice (and have to contract with those insurances for the same rate) and thus have to know this information, otherwise how will they know if they are being compensated correctly? Also, all this information is supposed to be public now to comply with federal law.

 

[TheRightMedication]

Do be sure to have a series of pleasant conversations before you start making demands. I bet you can work half of that stuff out by the light negotiation of casual conversation before the "real" negotiations begin.