Contracts structure and provider protection

[lotsapain]

I am just curious on some feedback from the rest of the crew. I notice that contracts from large organization ie Envision (more so), TeamHealth, NAPA, etc. have gotten significantly more onerous with no protection for the provider (except maybe in states like California). Most contracts state you can be fired for cause or no cause on the spot, while requiring 90 day separation notices from the provider that if violated carry legal penalties or promises of "blacklisting." I know of some people that indeed were pursued while others seek legal action against large AMOs. I just don't understand how is it fair to have these contracts that you cannot fight as large organizations state "this is our standard contract we are not changing it" regardless of the shortages. How did we get to the point to have zero rights, when a word from a nursing administrator, a CRNA, hell from a medical student (I know a few people who had that happen to) can make a provider disappear..... it is also all relative depending on the location... I am not sure if direct hospital contracts now are any better but it seems physicians are not (and especially anesthesiologists) are the only profession that have such malignant contracts. I would appreciate any feedback if anyone has been able to change that or what contracts are elsewhere. How's the ASA involved in changing this if at all?......

More importantly do the national organizations start blacklisting you if you had a separation from them... for example 2 years down the road you want to do locums in one of their facilities (yes I know the practice suppose to be illegal it does happen).

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[IMGASMD]

ASA changing anything? Not gonna happen. Like I said before, for someone to work of Napa, you need to be a paying member of ASA.

If you leave one of them for any reasons, even if it’s an amicable breakup. They can blacklist you.

 

[ryanjmy]

With this market I wouldn’t worry too much about being fired unjustly or not being able to find work. Most practices are short staffed. It’d take something egregious to get you fired.

With an amc contract I’d be way more worried about being overworked and under compensated.

 

[Dr. Rude]

“I ask you to judge me by the enemies I have made.”​

― Franklin D. Roosevelt

 

[POW16]

I am just curious on some feedback from the rest of the crew. I notice that contracts from large organization ie Envision (more so), TeamHealth, NAPA, etc. have gotten significantly more onerous with no protection for the provider (except maybe in states like California). Most contracts state you can be fired for cause or no cause on the spot, while requiring 90 day separation notices from the provider that if violated carry legal penalties or promises of "blacklisting." I know of some people that indeed were pursued while others seek legal action against large AMOs. I just don't understand how is it fair to have these contracts that you cannot fight as large organizations state "this is our standard contract we are not changing it" regardless of the shortages. How did we get to the point to have zero rights, when a word from a nursing administrator, a CRNA, hell from a medical student (I know a few people who had that happen to) can make a provider disappear..... it is also all relative depending on the location... I am not sure if direct hospital contracts now are any better but it seems physicians are not (and especially anesthesiologists) are the only profession that have such malignant contracts. I would appreciate any feedback if anyone has been able to change that or what contracts are elsewhere. How's the ASA involved in changing this if at all?......

More importantly do the national organizations start blacklisting you if you had a separation from them... for example 2 years down the road you want to do locums in one of their facilities (yes I know the practice suppose to be illegal it does happen).

If you don't like the contract or think it's abusive, don't sign it.

 

[timpview]

100% agree.

I’ve learned to keep active privileges at as many places as you can as well as even cont some Locum gigs (even if just a couple weekends a year) at stable places that like you. Gives at least a temporary bridge if things hit the fan at your primary site.

Otherwise just need to be careful. Don’t complain about anything. Don’t get too social. Realize when internal or external stresses put you on edge. Don’t fight the system. Do your best with patient care.

 

[neutro]

“I just work here”

That’s my line. Lol

 

[IMGASMD]

“I just work here”

That’s my line. Lol

“It’s above my pay grade.”

 

[dannyboy1]

As others have said, They don’t want to fire you, they want to WORK you. Honestly, if for some reason they want you gone, you will be gone. The one physician I know of that was let go was given the choice to resign or be fired for cause.( for cause they don’t have to wait 90 days). You can find cause on anyone. You do not want to be fired for cause, especially as a physician. That kind of thing can follow you around.

 

[Dr. Rude]

As others have said, They don’t want to fire you, they want to WORK you. Honestly, if for some reason they want you gone, you will be gone. The one physician I know of that was let go was given the choice to resign or be fired for cause.( for cause they don’t have to wait 90 days). You can find cause on anyone. You do not want to be fired for cause, especially as a physician. That kind of thing can follow you around.

One caveat, if you resign, you waive a lot of your rights to sue. If they fire you, that does not apply.

 

[aneftp]

Black list/no rehire is just strong will nature. I’ve know companies rehire crna’s and docs out of desperation. Heck I was even “black listed” cough cough. It’s because the company changes the terms of the contract last minute and I didn’t like the terms. That’s what I explain on my email. Aka. Call q5 beeper because call q3 beeper due to staffing shortage without any backup compensation measures. I’m within my rights to back out.

Just need a couple of peeps u know vouch for u and that’s it.

 

[dannyboy1]

One caveat, if you resign, you waive a lot of your rights to sue. If they fire you, that does not apply.

Trying to sue for wrongful termination often turns into a huge “he said/she said”. If you worked at a place for long enough you are bound to have some sort of write up. With the job market as strong as it is you are far better off just signing up for locums. Generally you have to be pretty terrible to be fired by these organizations. The one doc that I referenced earlier was horrible. Literally was shunted from site to site within the practice and there were always problems. We finally ran out of places to hide him…..

 

[Dr. Rude]

Not a lawyer, but I do know that employment law is funny and often gives advantages to the employee if things become adversarial. The intent behind this is to level the playing field with an employer who has a relatively huge power differential.
E.g, it is not a defense to say in a court “I wasn’t the only one speeding so why should I get charged” to dispute a ticket. It is sometimes a defense to say “the practices for which I was written up and terminated were and still are widespread and this selective enforcement is not fair”. Also damages in wrongful terminations are often brutal.

 

[lotsapain]

100% agree.

I’ve learned to keep active privileges at as many places as you can as well as even cont some Locum gigs (even if just a couple weekends a year) at stable places that like you. Gives at least a temporary bridge if things hit the fan at your primary site.

Otherwise just need to be careful. Don’t complain about anything. Don’t get too social. Realize when internal or external stresses put you on edge. Don’t fight the system. Do your best with patient care.

Don't fight the system.... this is the type of attitude that has gotten us here......

 

[lotsapain]

As others have said, They don’t want to fire you, they want to WORK you. Honestly, if for some reason they want you gone, you will be gone. The one physician I know of that was let go was given the choice to resign or be fired for cause.( for cause they don’t have to wait 90 days). You can find cause on anyone. You do not want to be fired for cause, especially as a physician. That kind of thing can follow you around.

The contracts have now changed to a point that for cause or no cause do not have 90 days... that is my point the contracts have become unilateral and we as a society of anesthesiologists do nothing to fend for ourselves

 

[kidthor]

Not a lawyer, but I do know that employment law is funny and often gives advantages to the employee if things become adversarial. The intent behind this is to level the playing field with an employer who has a relatively huge power differential.
E.g, it is not a defense to say in a court “I wasn’t the only one speeding so why should I get charged” to dispute a ticket. It is sometimes a defense to say “the practices for which I was written up and terminated were and still are widespread and this selective enforcement is not fair”. Also damages in wrongful terminations are often brutal.

It’s hardly ever worth it for an individual physician to go down the road of litigation. Unless you have several years and 100Ks of cash sitting that you want to burn ti see what happens. Sadly the employers know this so you as an individual are often best off just leaving and taking what ever tied sandwich they’ve thrown at you.

Which is why it’s be nice if something like the ASA would stand up for us. But sadly they’re so captive by cooperate practiced that they don’t do anything. Alas.

 

[Dr. Rude]

It’s hardly ever worth it for an individual physician to go down the road of litigation. Unless you have several years and 100Ks of cash sitting that you want to burn ti see what happens. Sadly the employers know this so you as an individual are often best off just leaving and taking what ever tied sandwich they’ve thrown at you.

Which is why it’s be nice if something like the ASA would stand up for us. But sadly they’re so captive by cooperate practiced that they don’t do anything. Alas.

Actually there is not much ASA can do except say “please don’t be evil and play nice with one another.”

 

[Angus Avagadro]

It’s hardly ever worth it for an individual physician to go down the road of litigation. Unless you have several years and 100Ks of cash sitting that you want to burn ti see what happens. Sadly the employers know this so you as an individual are often best off just leaving and taking what ever tied sandwich they’ve thrown at you.

Which is why it’s be nice if something like the ASA would stand up for us. But sadly they’re so captive by cooperate practiced that they don’t do anything.

I agree. A local predatory group wrestled the hospital contract from friends of mine. They needed the CRNA's who were employed by my friends to cover the large uni affiliate hospital. The CRNA's had signed a restrictive covenant, and were paid a large cash "Consideration" to make it legally binding. My friends went to court thinking their case was solid, and ran up 7 figure legal bill, only to be told by the judge, "It will be a hardship for the community if the restrictive covenant stands, so I'll allow the new contract and you can get it overturned on appeal". When the Docs surrendered and dropped their suit, the hospital working with the predatory group thanked them for dropping their suit, but they maintained their countersuit against them.
TLDR: Don't fight the machine. Cut your losses and move on. Forces with more money and political influence are against you. I would only sign a restrictive covenant that went into effect if I left the practice and not be in effect if the company made a business decision to release me.

 

[GravelRider]

There’s a lot of the wrong attitude on this thread. Just because the job market is good doesn’t change the fact that these contracts are onerous and one-sided. The job market can change (7 years ago it was awful) and we are still left with these unfavorable contracts.

I agree that we are pretty powerless since the ASA is just a puppet organization for these companies, but that doesn’t mean we should sign these contracts. Obviously if you have alternatives then you shouldn’t sign these contracts and make it known why you aren’t. I think it’s also time we hold the ASA accountable for neglecting their duty of representing the best interests of their members. Instead of having another mental masturbation session on how much fluids to give during an ex-lap at the annual ASA conference, maybe there should be a session on how to approach these unfavorable employment contracts…either via direct negotiation or state/federal legislation.

At the end of the day, the single most important thing you can do is to always have an exit plan. Do not sign contracts that have restrictive covenants that prevent you from leaving at a moment’s notice. Your ability to walk away from a crummy situation will always be your most important asset (taking a few people with you to pull the plug on a failing practice helps too).