employment contract discussion

[peter90036]

not sure if this is the correct forum

i'm in talks with a place for outpt job, and just got emailed a draft of the contract, and have a couple questions/looking for suggestions if following are reasonable or need change...

- call schedule "similar to schedules of other internists in the Company" <<should this be more specific as discussed (q6)
- "devoting minimum 40 hours a week" for patient care
- tail "premium is shared" equally unless i'm fired or i quit at which point im responsible for all the premium <<?reasonable
- base salary and employment is "guaranteed if Company can bill for 300 pt encounters/mo averaged over 6 months"
- production bonus based on encounters (no mention of how many), calculated by "policy adopted by Company from time to time" << no specifics here...
- clawback provision "refund all recruiting expenses" << uhm what??
- 2 weeks vacation but no mention of CME time (was told 1wk)

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[jdh71]

not sure if this is the correct forum

i'm in talks with a place for outpt job, and just got emailed a draft of the contract, and have a couple questions/looking for suggestions if following are reasonable or need change...

- call schedule "similar to schedules of other internists in the Company" <<should this be more specific as discussed (q6)
- "devoting minimum 40 hours a week" for patient care
- tail "premium is shared" equally unless i'm fired or i quit at which point im responsible for all the premium <<?reasonable
- base salary and employment is "guaranteed if Company can bill for 300 pt encounters/mo averaged over 6 months"
- production bonus based on encounters (no mention of how many), calculated by "policy adopted by Company from time to time" << no specifics here...
- clawback provision "refund all recruiting expenses" << uhm what??
- 2 weeks vacation but no mention of CME time (was told 1wk)

You need to have a LAWYER look these things over but generally, IMHO, yes, you need to get these things spelled out explicitly and they can't be petty douches and expect you to pay back expenses for recruitment. That's bull****. If you take a sign on bonus and don't fufill your contract that is on thing but They choose to recruit you. You didn't force them to spend the money, you simply showed interest. I'm concerned a bit about the operation you are attempting to work for based on some of the language but much of this might just be common "legalese" which is why you need to drop some money to have a lawyer look at it. Also you need to find out if that is a common practice for tail coverage and it kind of doesnt sound like it.

 

[VA Hopeful Dr]

not sure if this is the correct forum

i'm in talks with a place for outpt job, and just got emailed a draft of the contract, and have a couple questions/looking for suggestions if following are reasonable or need change...

- call schedule "similar to schedules of other internists in the Company" <<should this be more specific as discussed (q6)
- "devoting minimum 40 hours a week" for patient care
- tail "premium is shared" equally unless i'm fired or i quit at which point im responsible for all the premium <<?reasonable
- base salary and employment is "guaranteed if Company can bill for 300 pt encounters/mo averaged over 6 months"
- production bonus based on encounters (no mention of how many), calculated by "policy adopted by Company from time to time" << no specifics here...
- clawback provision "refund all recruiting expenses" << uhm what??
- 2 weeks vacation but no mention of CME time (was told 1wk)

Having just gone through this myself (with a lawyer), here's my thoughts in no particular order.

Many contracts do state that if you don't stay for X amount of time, they will require you to pay back your signing bonus. That time should be no more than 1 year.

Base salary should be that - base. It should not be contingent upon you seeing a certain number of patients. Also, and more importantly, your employment should not be contigent on seeing a certain number of patients your first year.

The whole point of tail coverage is that you don't pay it even if you leave. I could see making you pay if they fire you, but not if you quit. That's crap.

The minimum I've seen for days off was 21 days including CME (ie. 2 weeks). Even if you get 3 that's a bit on the low side. Also, make sure the CME part is spelled out.

You can ask for specifics about bonuses but they aren't usually written into contracts as they often change from year to year. That said, you can ask for clarification as to how that works this year.

 

[gutonc]

You need to have a LAWYER look these things over but generally, IMHO, yes, you need to get these things spelled out explicitly and they can't be petty douches and expect you to pay back expenses for recruitment. That's bull****. If you take a sign on bonus and don't fufill your contract that is on thing but They choose to recruit you. You didn't force them to spend the money, you simply showed interest. I'm concerned a bit about the operation you are attempting to work for based on some of the language but much of this might just be common "legalese" which is why you need to drop some money to have a lawyer look at it. Also you need to find out if that is a common practice for tail coverage and it kind of doesnt sound like it.

Agree. What you've excerpted here is kind of a horror show. Pony up a few Benjamins to have a contract/employment lawyer look at it, preferably one with experience in physician contracts (ask around at your program).

 

[peter90036]

I will use a lawyer(if I have something worthwhile) however the excerpted points were quite dubious...

The wording has been shortened for space.
I'm fine with payback of bonus its why i didnt include it.
Tail coverage: A large hospital system i talked with have me pay full if i leave after 1st year, then something like 40% 2nd year
Vac: here in Dallas so far has been 2 wks for outpt. A large hospital system they offer 2 wks that included CME (per inhouse recruiter) ...

I am asking here because some colleagues have told me that for example nowadays its common to have a no-cause provision that wont be taken out(and they work in nice settings). So I'm not sure how many of these crap provisions one should accept, and how negotiable things like vacation are

 

[VA Hopeful Dr]

I will use a lawyer(if I have something worthwhile) however the excerpted points were quite dubious...

The wording has been shortened for space.
I'm fine with payback of bonus its why i didnt include it.
Tail coverage: A large hospital system i talked with have me pay full if i leave after 1st year, then something like 40% 2nd year
Vac: here in Dallas so far has been 2 wks for outpt. A large hospital system they offer 2 wks that included CME (per inhouse recruiter) ...

I am asking here because some colleagues have told me that for example nowadays its common to have a no-cause provision that wont be taken out(and they work in nice settings). So I'm not sure how many of these crap provisions one should accept, and how negotiable things like vacation are

I'll be honest, unless this is the only job offer you're going to get in a location that you can't move from.... I wouldn't sign that contract without some pretty big changes.

Most contracts are negotiable. Usually very much so.

 

[gutonc]

I will use a lawyer(if I have something worthwhile) however the excerpted points were quite dubious...

The wording has been shortened for space.
I'm fine with payback of bonus its why i didnt include it.
Tail coverage: A large hospital system i talked with have me pay full if i leave after 1st year, then something like 40% 2nd year
Vac: here in Dallas so far has been 2 wks for outpt. A large hospital system they offer 2 wks that included CME (per inhouse recruiter) ...

I am asking here because some colleagues have told me that for example nowadays its common to have a no-cause provision that wont be taken out(and they work in nice settings). So I'm not sure how many of these crap provisions one should accept, and how negotiable things like vacation are

- Tail coverage that you have to pay for is a non-starter unless they're paying you well north of $300K for this job.
- A bonus is a bonus. The end. If they want to call it a loan that is forgiven after X # of years, that's fine. But don't let them straight up lie on the contract.
- 2 weeks vacation is complete bull***t. I work a 0.75 FTE job (on purpose) and I get 4 weeks of vacation.
- Salary is just that...a salary. If you're required to have a certain production in order to get it, it's not a salary. Salary + production based bonus is a pretty typical pay mechanism these days but it needs to be outlined in advance. It's OK for it to change but if it's not in the contract...f**k that.

 

[USCguy]

should you ask for something based on wRVU production rather than set number of encounters? A new patient level 4 should give you more credit than a follow up level 3. If you are keen on coding/documentation, the vast majority of patients are level 4. All the physicians in private practice I have worked with who happen to be over the age of 45 seem to bill everything as level 3 despite managing multiple medical conditions each visit and working up new problems.

Also, are they giving a grace period to ramp up? Do they expect you to see 270 patients your first month out?

 

[peter90036]

this is a 3rd place i'm considering and so far nobody "likes" RVUs, this place said encounters, other 2 places said it would be based on total collections (one would give in second year +40% of collections and next year all collections minus overhead, the other place would split over certain $ collected)

break-in period was discussed verbally but not mentioned in this draft.

vacation thing bothers me... wtf is 2 wks ... thats less than residency... do i really have to go thru every word in these contracts and request lots of changes... its lame.

 

[VA Hopeful Dr]

this is a 3rd place i'm considering and so far nobody "likes" RVUs, this place said encounters, other 2 places said it would be based on total collections (one would give in second year +40% of collections and next year all collections minus overhead, the other place would split over certain $ collected)

break-in period was discussed verbally but not mentioned in this draft.

vacation thing bothers me... wtf is 2 wks ... thats less than residency... do i really have to go thru every word in these contracts and request lots of changes... its lame.

Not usually. In my current contract I only changed 2 things - more money, and fewer hours per week (from 40 to 36 so I could have a half day off per week).

 

[USCguy]

Is this a private group of hospital owned. I was initially looking for a private group, but I found that the offers from private groups were **** compared to the offers from hospitals. After looking over several offers and reading as much online as I can, I have decided to go with a hospital owned practice. I can't imagine being paid based on collections. What if they stick you with all the patients from lower paying providers (such as medicaid). Do they guarantee that your uninsured won't go above x% of your panel? Do you have control over the billing people/agency they use and/or collection agency they use. If its not under your control, it seems unfair to pay you based on it.

The hospital offers i have seen are base guaranteed for 1-2 years. pay at MGMA median. ability to bonus in year 2 or 3 (different from different places, depending on how long the guarantee was), and production metrics are based on wRVU generation. There is a 10% "grace" surrounding the production metric so if you get 90% or 110% of your goal, the pay is the same. paycheck is reduced the following quarter if your previous quarter wRVU was low (or bonus is paid if you were above). ~4 weeks of PTO (including CME) and 6 holidays.

If they pay you based on encounters, you could bill everything level 3; document accordingly and try to see as many people as possible.

 

[dragonfly99]

this doesn't sound very good.
The thing that is most concerning to me is the lack of mention of any guaranteed base salary. they should guarantee you a salary, at least the first year or two, and then production bonus, etc. goes on top of that, and is changeable.
It sounds bad if they pay you based on collections - as mentioned by someone else in a post above this, you probably will have/would have little control over the people doing the billing, so what if they can't collect or you have 30 or 40% Medicaid patients which reimburse at a crappy rate? That sounds like potential disaster to me.

You should try to get 5 days CME added to your contract.
I'm not sure the 2 weeks vacation is that out of line - I think that is kind of the wave of the future, perhaps, especially in places like big cities where they get multiple job applicants. the billing and production stuff, salary, is more important...they can really screw you over on that, potentially. If you can negotiate for CME days that can become sort of like a vacation, though not as cool as a real vacation. Plus sometimes you need them just to retake ACLS, etc.

 

[jdh71]

Two weeks vacation is bull****.

The place in the OP sounds like a sweatshop.

So many places are looking for out patient internists it is ridiculous. I think I'd keep looking.

 

[jdh71]

Also clinic wRVU should not only be easily estimated but your contract should be based on them. It's the only way to get fair pay for fair work. Otherwise like others have said they just toss you to wolves making peanuts on Medicaid patients and womp womp

 

[peter90036]

maybe i dont know how to look(using recruiters), i'll try a new strategy tomorrow- cold calling.
supposedly the outpt internist should be hot, all the babyboomers, obamacares having insurance, old internists retiring .. etc. but i dont see it here in the big city, in non-ghetto areas.
and i dont see much of the multi-provider IM group either... alot of solo

also- why is the first advice "get a lawyer"? doesnt anybody read their contract first? why would you need a lawyer, initially, if gross changes(deal-breaking) need to be implemented. if they dont want to make the changes i want, lawyer is not needed.

 

[gutonc]

maybe i dont know how to look(using recruiters)

Ah...now it all makes sense. The only jobs that use recruiters suck. And now you've discovered why these particular jobs suck.

 

[peter90036]

well, discussions to change language in the initial messed up one didnt go well - "sorry i didnt understand it like that", "the lawyer said" etc

still on topic: i'm discussing w a big system, and they're using some sort of 3/4/5 year contract, non-renewing, supposedly "with no way out" eg no 90 days. I havent seen it yet, but wondering what is that ?

 

[rokshana]

no

maybe i dont know how to look(using recruiters), i'll try a new strategy tomorrow- cold calling.
supposedly the outpt internist should be hot, all the babyboomers, obamacares having insurance, old internists retiring .. etc. but i dont see it here in the big city, in non-ghetto areas.
and i dont see much of the multi-provider IM group either... alot of solo

also- why is the first advice "get a lawyer"? doesnt anybody read their contract first? why would you need a lawyer, initially, if gross changes(deal-breaking) need to be implemented. if they dont want to make the changes i want, lawyer is not needed.

...contracts are complicated enough and those for a group are always going to favor the group...and it can cost you 10s of thousands to get out of one...not only should you get a lawyer...you should get a healthcare lawyer...someone who specifically works on contracts for physicians...

 

[jdh71]

well, discussions to change language in the initial messed up one didnt go well - "sorry i didnt understand it like that", "the lawyer said" etc

still on topic: i'm discussing w a big system, and they're using some sort of 3/4/5 year contract, non-renewing, supposedly "with no way out" eg no 90 days. I havent seen it yet, but wondering what is that ?

You're a physician. A primary care physician - a hard to find commodity - not a slave.

What part of the country are you looking in anyway??

 

[VA Hopeful Dr]

You're a physician. A primary care physician - a hard to find commodity - not a slave.

What part of the country are you looking in anyway??

No kidding. Unless you are tied to this one location and this is the only opening, I would move on. That deal sucks and if they're not willing to make it better then move on.

Or, you could try a last ditch "I'm looking at other offers, you're going to have to do better than this" and see what happens.

 

[peter90036]

I did move on, they were acting stupid and not trustworthy.

Unless you are tied to this one location and this is the only opening, I would move on

I am tied to location (Dallas). And sure, there are outpatient primary care jobs, except they're mostly 1 hour away.

but my Q: have you seen/heard of "no 90 days" for physician in contracts? and yes yes i will get a lawyer if something good shows up

 

[jdh71]

I did move on, they were acting stupid and not trustworthy.



I am tied to location (Dallas). And sure, there are outpatient primary care jobs, except they're mostly 1 hour away.

but my Q: have you seen/heard of "no 90 days" for physician in contracts? and yes yes i will get a lawyer if something good shows up

I think the time is often variable but now way out of an employed position seems more than a little draconian.

 

[gutonc]

I think the time is often variable but now way out of an employed position seems more than a little draconian.

This. I've seen variable time frames but if there's only a 1 way termination clause, that's bogus.

 

[peter90036]

yeah, dont know why they explained it like that but theres a termination from physician end as well

this is a hospital based system, contract looks better worded, only few things:

1st year is an "advance" (or wRVU whichever is greater), after 1st yr goes full wRVU with no base. there's stipulation saying if term is not finished they calculate how much wRVU was done in 1st year and have me pay back.

malpractice paid if term is finished

-should i let those go or negotiate them out?

 

[jdh71]

yeah, dont know why they explained it like that but theres a termination from physician end as well

this is a hospital based system, contract looks better worded, only few things:

1st year is an "advance" (or wRVU whichever is greater), after 1st yr goes full wRVU with no base. there's stipulation saying if term is not finished they calculate how much wRVU was done in 1st year and have me pay back.

what do you mean if the "term" is not finished? you mean the first year? because this only make sense perhaps in the first year, but they weren't going to pay you the whole chuck up front anyway, and if you leave after the 1st year, how can they make you pay back money you didn't earn and they were not going to pay you because you're already working by wrvu.

malpractice paid if term is finished

If you leave by the agreed upon rules for leaving set out in your contract, they need to cover your malpractice WITH TAIL, no ifs and or buts, even if it means you leave "early"