Canadian needing contract negotiation tips

[MethICanDoc]

So I decided to jump ship from Canada to the US and the compensation scheme is very new to me and I want to make sure I don't shortchange myself when I sign a contract. The basic set-up for the gig that I am really interested in is a base salary plus RVU bonuses that apparently end up being 50-60K extra a year for the average physician in the group, a month of paid time off, and then what seems to be the usual fare (malpractice, CME benefits, health benefits, some retirement plan matching, relocation bonus of like 5K). A sign-on bonus "would be considered" and I am expected to see patients 4 days a week and then do admin work for half a day. The RVU bonuses were explained to me in simple terms as basically $50 per patient encounter beyond what's required for my base salary. I'm a single person with no children, so the move itself is not going to be particularly costly or difficult for me. The terms I am alluding to here are just the initial verbal offer, so I expect they are prepared to go up from here. Keep in mind that this is a low cost of living state and a position tending primarily to low income and underserved patients.

I've asked some acquaintances for tips and was told to ensure tail malpractice is paid for, the terms for breaking a contract early are clearly defined, and that a lawyer should review the contract. However, beyond that, I am not sure about the best route to improve my contract. I want to come up with something that the employer can easily accommodate. However, the employer also seems to want me to start as soon as possible. I preferred to start closer to the end of the year but with the right financial incentives, I would be willing to start pretty quickly.

The things most important to me are, in order of significance:

1) time off (including unpaid) e.g. I would actually love to have TWO months off per year even if one is unpaid - there is no paid vacation for physicians where I am, so this is nothing new to me. I am able to maintain some very well-paid part-time work in Canada involving Telehealth and only rare on-site visits if I can get another month off.

2) flexibility (e.g. be able to work some longer and some shorter days, start and finish at different times, etc)

3) earning potential (I love my time off, but I'm also noting the number of patients I'm required to see to get the base salary is VERY manageable and I can certainly go much higher)

4) Sign-on bonus


In your experience, what are employers usually most likely to budge on? Is it the lifestyle factor or the compensation? From a pay point of view, would it be easier to negotiate a high signing/relocation bonus, or a higher base salary, assuming the overall amount added up would still be the same? I would appreciate any personal experiences re: how much more you were able to get out of an initial offer. Thanks!

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[deleted87716]

Signing bonuses are one-time things, and they're taxed at a much higher rate than paychecks, so I'd take a higher salary in lieu of a signing bonus.

 

[deleted480308]

So I decided to jump ship from Canada to the US and the compensation scheme is very new to me and I want to make sure I don't shortchange myself when I sign a contract. The basic set-up for the gig that I am really interested in is a base salary plus RVU bonuses that apparently end up being 50-60K extra a year for the average physician in the group, a month of paid time off, and then what seems to be the usual fare (malpractice, CME benefits, health benefits, some retirement plan matching, relocation bonus of like 5K). A sign-on bonus "would be considered" and I am expected to see patients 4 days a week and then do admin work for half a day. The RVU bonuses were explained to me in simple terms as basically $50 per patient encounter beyond what's required for my base salary. I'm a single person with no children, so the move itself is not going to be particularly costly or difficult for me. The terms I am alluding to here are just the initial verbal offer, so I expect they are prepared to go up from here. Keep in mind that this is a low cost of living state and a position tending primarily to low income and underserved patients.

I've asked some acquaintances for tips and was told to ensure tail malpractice is paid for, the terms for breaking a contract early are clearly defined, and that a lawyer should review the contract. However, beyond that, I am not sure about the best route to improve my contract. I want to come up with something that the employer can easily accommodate. However, the employer also seems to want me to start as soon as possible. I preferred to start closer to the end of the year but with the right financial incentives, I would be willing to start pretty quickly.

The things most important to me are, in order of significance:

1) time off (including unpaid) e.g. I would actually love to have TWO months off per year even if one is unpaid - there is no paid vacation for physicians where I am, so this is nothing new to me. I am able to maintain some very well-paid part-time work in Canada involving Telehealth and only rare on-site visits if I can get another month off.

2) flexibility (e.g. be able to work some longer and some shorter days, start and finish at different times, etc)

3) earning potential (I love my time off, but I'm also noting the number of patients I'm required to see to get the base salary is VERY manageable and I can certainly go much higher)

4) Sign-on bonus


In your experience, what are employers usually most likely to budge on? Is it the lifestyle factor or the compensation? From a pay point of view, would it be easier to negotiate a high signing/relocation bonus, or a higher base salary, assuming the overall amount added up would still be the same? I would appreciate any personal experiences re: how much more you were able to get out of an initial offer. Thanks!

I have friends who always ask how many patients per day they will need to see, call reqs, how long the avg doc has been at that location, do you get to pick your cnas, avg income of all docs who are there more than 3 yrs, ob?, midlevel supervision?

 

[VA Hopeful Dr]

Signing bonuses are one-time things, and they're taxed at a much higher rate than paychecks, so I'd take a higher salary in lieu of a signing bonus.

Depends on the need. If you can get a signing bonus that will pay off a loan or cover moving expenses (assuming that isn't a separate offering) it can be worthwhile.

 

[MethICanDoc]

Good point...that said, I would be moving before the end of the tax year and the first few months, my income would be limited as I build a practice. So I think unless it was some sort of gargantuan bonus like $100K (which isn't gonna happen for this position), it won't really make a difference for me tax-wise.

Any opinions on extra unpaid time off or flexibility?

 

[MethICanDoc]

I have friends who always ask how many patients per day they will need to see, call reqs, how long the avg doc has been at that location, do you get to pick your cnas, avg income of all docs who are there more than 3 yrs, ob?, midlevel supervision?

Yeah, I have a few of these questions already added to my list as we sort out the details. When you supervise midlevels, are they seeing your patients, or is that extra? E.g. if I'm being told I'm expected to see 20-25 pts/day and there are midlevels in the practice, would midlevels generally see some of those patients first, or would I be supervising them for extra patients on top of my own workload (and thus no pay)? Obviously, this is also a question I am asking this specific employer, but I would also like to know what the general standard is so I can compare other opportunities.

Thanks!

 

[deleted480308]

Yeah, I have a few of these questions already added to my list as we sort out the details. When you supervise midlevels, are they seeing your patients, or is that extra? E.g. if I'm being told I'm expected to see 20-25 pts/day and there are midlevels in the practice, would midlevels generally see some of those patients first, or would I be supervising them for extra patients on top of my own workload (and thus no pay)? Obviously, this is also a question I am asking this specific employer, but I would also like to know what the general standard is so I can compare other opportunities.

Thanks!

I would defer that answer to @VA Hopeful Dr

 

[VA Hopeful Dr]

Yeah, I have a few of these questions already added to my list as we sort out the details. When you supervise midlevels, are they seeing your patients, or is that extra? E.g. if I'm being told I'm expected to see 20-25 pts/day and there are midlevels in the practice, would midlevels generally see some of those patients first, or would I be supervising them for extra patients on top of my own workload (and thus no pay)? Obviously, this is also a question I am asking this specific employer, but I would also like to know what the general standard is so I can compare other opportunities.

Thanks!

So first and foremost, never ever supervise midlevels without extra compensation for doing so. Hard stop. There are basically 3 ways this can work. You can get a flat amount for supervising, you can get an hourly rate based on the actual work you do supervising them (chart review, consults, whatever), or you can get a piece of their billing.

With that out of the way, usually the midlevels will be seeing patients separately from you. Whether they have their own patient panel or are there for overflow for your patients varies. You'll be signing off on some number of their charts and being available for questions they may have.