First Contract

[HooliganSnail]

I am negotiating my first contract(s) as an attending. I have done a lot of reading on these forums and other places about things to look out for, but I can't help but get this feeling like I am getting taken advantage of.

I am hoping for advice on the following

1. What are some things that made a bad job that you never realized until it was too late?

2. Things that are often overlooked by first time negotiators?

2. What are some successful negotiation tactics you have used in the past.

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[bravotwozero]

I got my employer to reimburse me for moving expenses. Other people have negotiated licensing fees (good to ask for in states where its expensive, like Texas, Utah, or Cali). CMGs tend to be rather inflexible on sign on bonuses, so not too much leeway there.

Honestly though, if you want something just ask for it. So many people just don't ask.

I would stay away from CMGs that have a non compete clause, not as big of a deal if you're joining a SDG. Also, try and see if you can sign a 1 year contract instead of the standard 2 yr contracts that CMGs get you to sign.


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[fahimaz7]

I am negotiating my first contract(s) as an attending. I have done a lot of reading on these forums and other places about things to look out for, but I can't help but get this feeling like I am getting taken advantage of.

I am hoping for advice on the following

1. What are some things that made a bad job that you never realized until it was too late?

2. Things that are often overlooked by first time negotiators?

2. What are some successful negotiation tactics you have used in the past.

I took a 5k moving "bonus" and didn't ask for more money. It all comes down to location and how much you want to be in a certain spot. For me, I was/am willing to give up some money on the front end to hopefully have a long career on the back end at my dream location. Only push if you have room to push. Super competitive venues will be less flexible up front.

 

[namethatsmell]

I can't help but get this feeling like I am getting taken advantage of.

That's because you are.

There are many legitimate reasons why a new grad is more costly to a group than a seasoned doc. You are going to be the least productive, most likely to make a mistake, most likely to have a gaff or two with other medical staff, etc. Over time you'll get better and you'll gain more negotiating power as your worth increases. Accept it and move on.

That said, there are many degrees of getting hosed and there are ways to minimize this. Some ramblings to get you going...

SDGs, regional groups, and CMGs all have their pitfalls and all are happy to pray on you if you let them (I've worked for 2 out of 3). In general, the big three job features are: location, pay, schedule. You have to know your priorities and go after what's the most important to you. Conventional wisdom is that you can pick two, but the reality is that jobs in the most "popular" locations will shortchange your pay and the schedule is less likely to be "fair." So if you're dying to live and work in San Francisco then accept the fact you're going to be paid far less than the guy working inland and move in. But hey, you won the location game.

The simplest way to secure the most negotiating power as a new grad is to find an area you want to work in that also happens to be understaffed. It sounds obvious but it's totally true. This is what I did and I was able to snag very fair pay and a fair schedule.

As far as some generic negotiating tips:

-Get multiple offers so you can leverage them against each other
-Know what your "must-have's" are and be willing to say no to a job if they won't deliver. The next day you may get a call back saying they magically found a way to make things work out.
-If you want something, ask...and then be silent and let the person you're negotiating with fill the void. Silence is a very underrated tactic. The worst they can say is no.
-In general, avoid a multi-year sign-on bonus and negotiate a one-year bonus. Many places will say they don't do this...until you push them to.

 

[OccupyTheED]

I would also ask than any signing bonus be pro-rated. Lots of new grads, myself included, will change jobs within a year and you don't wanna be on the hook for that signing bonus if you can avoid it. Your group may say no, but it doesn't hurt to ask.

 

[GeneralVeers]

I would also ask than any signing bonus be pro-rated. Lots of new grads, myself included, will change jobs within a year and you don't wanna be on the hook for that signing bonus if you can avoid it. Your group may say no, but it doesn't hurt to ask.

Also you will take a huge tax hit from a lump sump. I would have them pro-rate it monthly. That way you don't risk paying taxes on something which you have to pay back if you leave early.

 

[deleted109597]

If you pay it back, you can either get the taxes back if you already paid them on your quarterly, or claim it at your annual. I'm less worried about that part. I would worry about burning through the pile of money just because it's sitting there, but considering how my "bonus" was smaller than any of my actual monthly checks for the first year, it probably wouldn't make any difference.

 

[Venko]

I would factor in a commute as part of your work hours and your hourly wage may look quite different then.

I signed a job with a group that staffed an academic center and assumed that they had occurrence based insurance and they did not. Very expensive assumption on my part.

I was also told that nights and weekends and holidays would be equally distributed but in practice certain junior faculty were doing all the heavy lifting. Get all these things in your contract if they are important to you.

As a fellow I discovered that my hourly wage was lower than my colleague fellows. I made the assumption that they were all fixed rates....don't be as stupid as I was.

I didn't realize how important great secretarial support is to my happiness. I would easily take a pay cut if I can have an assigned secretary who is capable and not over worked to help me.

Consider negotiating parking, CME dollars, travel dollars, administrative days or time, office space, etc in addition to traditional salary or wages, retirement, no compete clauses etc.

The book negotiation genius is masterfully written and I wish I had read it before I finished residency. It has helped me negotiating many things though since then.


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[HooliganSnail]

I would factor in a commute as part of your work hours and your hourly wage may look quite different then.

I signed a job with a group that staffed an academic center and assumed that they had occurrence based insurance and they did not. Very expensive assumption on my part.

I was also told that nights and weekends and holidays would be equally distributed but in practice certain junior faculty were doing all the heavy lifting. Get all these things in your contract if they are important to you.

As a fellow I discovered that my hourly wage was lower than my colleague fellows. I made the assumption that they were all fixed rates....don't be as stupid as I was.

I didn't realize how important great secretarial support is to my happiness. I would easily take a pay cut if I can have an assigned secretary who is capable and not over worked to help me.

Consider negotiating parking, CME dollars, travel dollars, administrative days or time, office space, etc in addition to traditional salary or wages, retirement, no compete clauses etc.

The book negotiation genius is masterfully written and I wish I had read it before I finished residency. It has helped me negotiating many things though since then.


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Thank you.

Many of these things I had not even considered.

I actually just bought that book too...

 

[GTP]

That's because you are.

There are many legitimate reasons why a new grad is more costly to a group than a seasoned doc. You are going to be the least productive, most likely to make a mistake, most likely to have a gaff or two with other medical staff, etc. Over time you'll get better and you'll gain more negotiating power as your worth increases. Accept it and move on.

That said, there are many degrees of getting hosed and there are ways to minimize this. Some ramblings to get you going...

SDGs, regional groups, and CMGs all have their pitfalls and all are happy to pray on you if you let them (I've worked for 2 out of 3). In general, the big three job features are: location, pay, schedule. You have to know your priorities and go after what's the most important to you. Conventional wisdom is that you can pick two, but the reality is that jobs in the most "popular" locations will shortchange your pay and the schedule is less likely to be "fair." So if you're dying to live and work in San Francisco then accept the fact you're going to be paid far less than the guy working inland and move in. But hey, you won the location game.

The simplest way to secure the most negotiating power as a new grad is to find an area you want to work in that also happens to be understaffed. It sounds obvious but it's totally true. This is what I did and I was able to snag very fair pay and a fair schedule.

As far as some generic negotiating tips:

-Get multiple offers so you can leverage them against each other
-Know what your "must-have's" are and be willing to say no to a job if they won't deliver. The next day you may get a call back saying they magically found a way to make things work out.
-If you want something, ask...and then be silent and let the person you're negotiating with fill the void. Silence is a very underrated tactic. The worst they can say is no.
-In general, avoid a multi-year sign-on bonus and negotiate a one-year bonus. Many places will say they don't do this...until you push them to.

I second this. I just negotiated a bad ass contract and got a lot of stuff that "Per our policy, we can't do" once I leveraged the second hospital, everything was suddenly possible. But it was understaffed in a cold location. But that's the location I wanted.

 

[da8s0859q]

I second this. I just negotiated a bad ass contract and got a lot of stuff that "Per our policy, we can't do" once I leveraged the second hospital, everything was suddenly possible. But it was understaffed in a cold location. But that's the location I wanted.

I'm curious. What made it badass?

 

[LabMonster]

We (physicians) don't understand our value to a group/hospital/system adequately because we haven't be taught about it. I hired a lawyer for my first contract, which I now regret because while his input was valid, it didn't change the outcome and I signed anyway.

Get multiple offers if you can, then start pushing the envelope with those you like. Like many EM grads I changed in a year because my initial assignment wasn't a good fit. On my second, we asked for the moon, and they gave it to us. Realize that medical centers in particular spent inordinate amounts on physician recruitment and they really do want to make you happy, retain you so they don't have to do it again. It's far more expensive to FIND a good match for one year than retain a good match, AND, in the case of rural EM, the hospital/group/ etc pays less if they're burdened with locums.

SO. Ask about current locums status (how many etc) and ask about retiring EM docs in the group. Assess their need and compare it with other offers, e.g. NC has a fair glut of EM docs (new grads who want to stay in NC) so the market is saturated and your capacity to negotiate is limited by supply. Conversely, rural places may offer significantly higher bonuses and benefits because of location and resources.

Smaller places, esp in the west and midwest, offer better compensation, but sometimes you exchange safety - esp when coming out of residency. If you have ZERO airway support on a nasty angioedema 6 months into being an attending - are you comfortable in managing that patient? Are you OK with limited or no specialty backup?

Anyway - EMPs are highly sought after, demand fair compensation - you'll get it.

 

[GTP]

I'm curious. What made it badass?

Essentially went through the whole contract and ripped everything apart and asked for a lot of things. Got 99% of what I asked for.

 

[PalmTreeDreamer]

in the case of rural EM, the hospital/group/ etc pays less if they're burdened with locums.

Can you explain this a little more? Are you saying if the group has to use a significant number of locums, then they will pay someone signing on full time less? Wouldn't it be cheaper for them to pay a full timer well enough to keep them around?

 

[HooliganSnail]

Essentially went through the whole contract and ripped everything apart and asked for a lot of things. Got 99% of what I asked for.

One of the places I am negotiating with uses a fair amount of locum's to fill their spots, I know what they pay them, because I have known someone who has done that gig as a locum. Their offer is significantly less of an hourly wage than the locum doc.

I was planning on using that as leverage along the lines of "If I am actually working with this group, planning for the long term. I could be your doc for years and years into the future, and good long term stable quality relationship. How do you think I am going to feel if every third day I am working with a guy who is making 60% more than me on that shift. It is gonna make me resentful. I think this wage makes me your guy for years and years to come.

Does that seem like a reasonable approach?

 

[Apollyon]

One of the places I am negotiating with uses a fair amount of locum's to fill their spots, I know what they pay them, because I have known someone who has done that gig as a locum. Their offer is significantly less of an hourly wage than the locum doc.

I was planning on using that as leverage along the lines of "If I am actually working with this group, planning for the long term. I could be your doc for years and years into the future, and good long term stable quality relationship. How do you think I am going to feel if every third day I am working with a guy who is making 60% more than me on that shift. It is gonna make me resentful. I think this wage makes me your guy for years and years to come.

Does that seem like a reasonable approach?

Yes, it does. However, on their side, if they had someone prior that told them the same thing, then bailed out, then they might be wary. Where I am, before my arrival, there was a revolving door of locums to fill in. I did not know this. Now, we have two full time guys, me and another, and no locums, but a bunch of part timers, and one resident that comes over. One guy is "agency", but not locums.

It saves them a BUNCH of money, and I have mentioned it often that they should pay me more. Poco à poco, I say!

 

[emergentmd]

One of the places I am negotiating with uses a fair amount of locum's to fill their spots, I know what they pay them, because I have known someone who has done that gig as a locum. Their offer is significantly less of an hourly wage than the locum doc.

I was planning on using that as leverage along the lines of "If I am actually working with this group, planning for the long term. I could be your doc for years and years into the future, and good long term stable quality relationship. How do you think I am going to feel if every third day I am working with a guy who is making 60% more than me on that shift. It is gonna make me resentful. I think this wage makes me your guy for years and years to come.

Does that seem like a reasonable approach?

If you are going to a ED where there is alot of locums, no matter what you negotiate you will be making less than the locums guy. If you are not ok with this, then don't sign a long term deal. Just do locums.

As you start to work the full time gigs, you will be getting constant emails trying to cover shifts and will start to find out the guy who just filled the shift next to you is making 2x your rate. That guy will be me.

 

[GTP]

Everyone makes good points about what you are making Vs the locum guy. As a first year attending with zero experience, I didn't want to seem too greedy. I think there may be a locums person who will make more than me. But ultimately I don't know any other senior who signed full time anywhere who will be making anything close to what I'm making. After the initial contract and once I have more experience, I'm planning to ask for more. The locums guy also travels and lives out of a suitcase. I'll be living 5 min from the hospital. That's probably worth $30 more per hour.

 

[shookwell]

Just gotta ask yourself why they have to use locums. Places that pay well and are great to work at don't have to hire locums. Ask for more money. Or go work for the locums company.

 

[bravotwozero]

FWIW - please don't waste money on a lawyer when looking at contracts. Send it to your PD and/or faculty mentor and they will only be too happy to look at it for you and make suggestions. The lawyers get into to irrelevant technicalities, and don't really know what to negotiate.


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[goodoldalky]

FWIW - please don't waste money on a lawyer when looking at contracts. Send it to your PD and/or faculty mentor and they will only be too happy to look at it for you and make suggestions. The lawyers get into to irrelevant technicalities, and don't really know what to negotiate.


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My .02 but I disagree. 90+% of physicians including your faculty mentor do not fully understand what they are reading when it comes to contracts. Seen it over and over... "got screwed by my old group"... "can't believe such and such clause let them do that"... "wtf you can't do that (contract says we can)"...

 

[deleted109597]

Agreed. Lawyers are worth their weight in contract negotiations. At least, early on. It's like investing. You want to spend the time learning what you need to do it yourself, good on you. But there's a reason contract law is a subspecialty.

 

[LabMonster]

Can you explain this a little more? Are you saying if the group has to use a significant number of locums, then they will pay someone signing on full time less? Wouldn't it be cheaper for them to pay a full timer well enough to keep them around?

Hehe. So you are logical?

In the hinterlands we use locums to cover missing shifts; sometime they are great, and sometimes they suck. Honestly, I wonder how some of these people passed the boards.

The more locums in a group = less stability IMHO. If a group is staffing with 50% locums, then they've had problems with signing docs and there is likely something wrong with that location.

We've gotten to a point where locums are now at a minimum-but one of my partners is pregnant, and I want to decrease the number of shifts I do and look at locums opportunities.

So - NO, hospital systems won't pay you more, from my experience, they'd rather pay more for a locums and then sign a new grad into a 1-2 year contract with a signing bonus and moving expenses. They win with you. Locums can get expensive. Recruiting is expensive, but if they lock you in with a contract, it's usually cheaper to them than using locums to staff the ER.

I haven't seen a hospital or independent group who gives a **** about the individual EP. I guess they can exist, and I'm maybe someone else can counter my pessimissm.

Get paid well in an environment you are comfortable with and try to negotiate NO signing contract/bonus. The data is actually fairly clear that we DO NOT stay at our first jobs for long (50%.) A woman we signed last year is leaving before her contract is up and she will need to pay back her bonus and moving fee.

Do what's right for YOU. We are NOT a dime a dozen, and you can ask for the moon in some places and be granted with it. You will sacrifice money and time to work with a more prestigious group (i.e. academic) but depending on your desires for your career, you may choose money or family time or academic greatness.

Do what suits you, but don't let a recruiter or the head of a department sway you.

 

[DocEspana]

FWIW - please don't waste money on a lawyer when looking at contracts. Send it to your PD and/or faculty mentor and they will only be too happy to look at it for you and make suggestions. The lawyers get into to irrelevant technicalities, and don't really know what to negotiate.


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Id argue this is pretty bad advice. You can see the dramatic difference in what i got (and one other coworker got) with contract attorneys vs the people who just used whomever they had on hand. I admittedly got blood out of a cmg stone and have to thank my solid attorneys and a bit of help from my future chair who told me he was putting pressure on the cmg staff to get *me*; but my buddy with his Democratic group had a similar contract that everyone said "oh man, i should have addressed that stuff" about too

 

[deleted109597]

One of the things people who are going to sites that have a lot of locums are forgetting is that once you're full time, you're obligated to a number of shifts. But you aren't obligated to a schedule. The locums people have the scheduler by the balls. They're the ones who send in schedules like "I can work _____ days of the month, only days or swings, no Mondays. Also, no holidays." And nights, weekends, and holidays pay a higher rate to locums players if you can get them to work them. Well guess what shifts are left?
Be very cautious of a site that has a large number of locums. And yes, you can always get a better deal doing that than you can working there full time. It's supply and demand.

 

[emergentmd]

Essentially went through the whole contract and ripped everything apart and asked for a lot of things. Got 99% of what I asked for.

And Likely they gave some other guy who pushed harder more money and better terms. But at the end of the day, set high and be happy if they get close. But don't kid yourself that your contract is great as CMGs have much more leeway than you think.

at difficult to cover places, If you want stability and set number of shifts, don't want to travel, then go ahead and sign on for a year with the understanding that the guy next to you will be making more (and even double). Also understand that that guy was not required to do any weekends/holidays/nights if he didn't want to. Also understand that that guy did not have to go to any meetings, was not beholden to any metrics or patient satisfaction.

So if you are ok working next to me making 150-200/hr less, going to monthly meetings, working weekends/holidays, having to put in days off requests, having a flip flopping schedule then go ahead and sign up.

I chose to control my schedule, make more money, not have to put in any schedule requests.

Since going full locums, I make more $$$ doing less hours. I have not worked a holiday/weekend, no monthly meetings, no vacation requests, no metrics. I just show up and do a good job. A better job than the full time guys to show my worth.

I give up security which is big for alot of people. I may only work 10 shifts one month, but other will work 15.

 

[GeneralVeers]

I would never sign full time with anyone unless the benefits are spectacular. At both of my "part time" jobs I could easily request a full time number of hours and get it. One of my "part time" jobs I have been working ~ 100 hours/month for 3 years. I'm essentially full time, but get all the benefits of locums, including paid travel, flexible schedule, and shift bonuses. For example, this year I did not request any shifts from July 1-July 5. I know that they have hard time getting people to work over those days because of families. Typically the incentive bonus will be $1500-$2000 per shift to work those if I pick them up later, because I know they are going to go unfilled. The same goes for Thanksgiving, Christmas, and New Years.

 

[emergentmd]

I would never sign full time with anyone unless the benefits are spectacular. At both of my "part time" jobs I could easily request a full time number of hours and get it. One of my "part time" jobs I have been working ~ 100 hours/month for 3 years. I'm essentially full time, but get all the benefits of locums, including paid travel, flexible schedule, and shift bonuses. For example, this year I did not request any shifts from July 1-July 5. I know that they have hard time getting people to work over those days because of families. Typically the incentive bonus will be $1500-$2000 per shift to work those if I pick them up later, because I know they are going to go unfilled. The same goes for Thanksgiving, Christmas, and New Years.

Great minds think alike. I did forget about the side benefits of free hotel as I only drive an hr to my locums. I could literally work 30 days a month right now.

I have never worked a locums shift without a bonus.

 

[Status Sciaticus]

How did your home deny your application? That's slightly concerning, no?

And Likely they gave some other guy who pushed harder more money and better terms. But at the end of the day, set high and be happy if they get close. But don't kid yourself that your contract is great as CMGs have much more leeway than you think.

at difficult to cover places, If you want stability and set number of shifts, don't want to travel, then go ahead and sign on for a year with the understanding that the guy next to you will be making more (and even double). Also understand that that guy was not required to do any weekends/holidays/nights if he didn't want to. Also understand that that guy did not have to go to any meetings, was not beholden to any metrics or patient satisfaction.

So if you are ok working next to me making 150-200/hr less, going to monthly meetings, working weekends/holidays, having to put in days off requests, having a flip flopping schedule then go ahead and sign up.

I chose to control my schedule, make more money, not have to put in any schedule requests.

Since going full locums, I make more $$$ doing less hours. I have not worked a holiday/weekend, no monthly meetings, no vacation requests, no metrics. I just show up and do a good job. A better job than the full time guys to show my worth.

I give up security which is big for alot of people. I may only work 10 shifts one month, but other will work 15.

I would never sign full time with anyone unless the benefits are spectacular. At both of my "part time" jobs I could easily request a full time number of hours and get it. One of my "part time" jobs I have been working ~ 100 hours/month for 3 years. I'm essentially full time, but get all the benefits of locums, including paid travel, flexible schedule, and shift bonuses. For example, this year I did not request any shifts from July 1-July 5. I know that they have hard time getting people to work over those days because of families. Typically the incentive bonus will be $1500-$2000 per shift to work those if I pick them up later, because I know they are going to go unfilled. The same goes for Thanksgiving, Christmas, and New Years.

Do yall recommend this for new physicians as well vs. getting a few years experience as an attending with a group?

 

[The White Coat Investor]

It's all money to the employer whether it is signing bonus, moving expenses, CME account, benefits, or salary. It's all money that comes out of the same pot unless you're looking at some cooky university job where they have different pots. Bear that in mind. If you want your compensation in a different form, that's relatively easy. If you want more compensation, better negotiate from a position of strength (i.e. be willing to walk away if they don't give you what you want.)

 

[GTP]

And Likely they gave some other guy who pushed harder more money and better terms. But at the end of the day, set high and be happy if they get close. But don't kid yourself that your contract is great as CMGs have much more leeway than you think.


at difficult to cover places, If you want stability and set number of shifts, don't want to travel, then go ahead and sign on for a year with the understanding that the guy next to you will be making more (and even double). Also understand that that guy was not required to do any weekends/holidays/nights if he didn't want to. Also understand that that guy did not have to go to any meetings, was not beholden to any metrics or patient satisfaction.

So if you are ok working next to me making 150-200/hr less, going to monthly meetings, working weekends/holidays, having to put in days off requests, having a flip flopping schedule then go ahead and sign up.

I chose to control my schedule, make more money, not have to put in any schedule requests.

Since going full locums, I make more $$$ doing less hours. I have not worked a holiday/weekend, no monthly meetings, no vacation requests, no metrics. I just show up and do a good job. A better job than the full time guys to show my worth.

I give up security which is big for alot of people. I may only work 10 shifts one month, but other will work 15.

Sounds real nice. Except I've been in a long distance relationship for 3 years and after residency I'll finally be able to be normal and not drive or fly anywhere twice a month. The hospital is 5 min drive away. My loans are minimal. Would like to try a somewhat normal life for 2 years before trying out Locums.

 

[holabuster]

Resurrecting this thread, because I'm working on nailing down my first job. I have received two job offers so far from different CMGs, and my difficulty with negotiating with them and weighing the offers is that they will not give me specifics of the contract. Is it common for places to just send you a sample agreement without specifics such as pay/hours/sign on bonus/etc.?

It's like they won't put together a full contract until I say I am all in on the offer, but I don't want to accept if I don't have all the details. What is my move?

 

[GeneralVeers]

Resurrecting this thread, because I'm working on nailing down my first job. I have received two job offers so far from different CMGs, and my difficulty with negotiating with them and weighing the offers is that they will not give me specifics of the contract. Is it common for places to just send you a sample agreement without specifics such as pay/hours/sign on bonus/etc.?

It's like they won't put together a full contract until I say I am all in on the offer, but I don't want to accept if I don't have all the details. What is my move?

There are some basic things they should tell you in writing in advance:
1. Median hourly pay per physician at the group
2. Minimum hours required
3. Patients/hours average for the group
4. Number of night shifts per month
5. Non-compete clause (if any)
6. Termination period not-for-cause. Typically this is 90 days.
7. MLP supervision

If they won't provide you this basic information about the job, then walk.

 

[holabuster]

There are some basic things they should tell you in writing in advance:
1. Median hourly pay per physician at the group
2. Minimum hours required
3. Patients/hours average for the group
4. Number of night shifts per month
5. Non-compete clause (if any)
6. Termination period not-for-cause. Typically this is 90 days.
7. MLP supervision

If they won't provide you this basic information about the job, then walk.

Would you require that this be in the form of the contract, or written in an email is sufficient? Appreciate the advice!

 

[Ridge_Runner]

Resurrecting this thread, because I'm working on nailing down my first job. I have received two job offers so far from different CMGs, and my difficulty with negotiating with them and weighing the offers is that they will not give me specifics of the contract. Is it common for places to just send you a sample agreement without specifics such as pay/hours/sign on bonus/etc.?

It's like they won't put together a full contract until I say I am all in on the offer, but I don't want to accept if I don't have all the details. What is my move?

Tell them you are not willing to move forward without more information to better evaluate the position being offered, then go silent.

 

[GeneralVeers]

Would you require that this be in the form of the contract, or written in an email is sufficient? Appreciate the advice!

I'd at least get it in an e-mail written form. This is why I always like to e-mail recruiters with questions, so they can answer them in writing. I hate how every recruiter wants a "phone conversation" so they can try the hard sell to get you to work there.

 

[namethatsmell]

Another thing to get in writing is how med-mal is covered as blurbs like "malpractice insurance provided" isn't enough info. I've come across some shady setups lately, like a company who wouldn't put that they provide coverage in the actual contract and another who wouldn't clearly state if they provide a tail. I only learned these things after I was in deep negotiations with them and could have saved a lot of wasted time if I'd known this upfront.

If you lack any clarity ask for a copy of their COI.

 

[NYEMMED]

Do you guys actually have luck negotiating with big CMGs?
I find that with Teamhealth, USACS, etc, they say they have one contract for everybody and they don’t change anything

 

[DO3]

I had an ideal list of things I wanted to ask for in a contract when I was looking. However, when the place you are looking at interviews 12-15 people for 1 spot, all highly qualified and BC/BE in EM, the reality is it’s pretty much “here’s the contract. If you don’t want it there are 11 more people behind you who do.” If you want to live in a semi-desirable city and work at a decent shop, it’s becoming very competitive. In my group at least which is at a place where the work environment is good and where the pay good (not outstanding), all but two of the providers are in the first 10 years of their career and no one has any plans on going anywhere b/c the rest of the jobs in the surrounding area that are available are open for a reason. My advice is not to look only at compensation when looking for jobs, but to look for what the best overall jobs are in the areas you are looking at and apply only to them. Make sure your contract has the big things...spells out malpractice coverage and type, has no non-compete clause, spells out compensation, mid-level supervision requirements and compensation for that supervision, etc.. Anything else you can get above that is gravy. Also, most any job that has contracted with a recruiter to try and bring folks in is more than likely a job you do not want, no matter how much it pays.

 

[cyanide12345678]

If you are going to a ED where there is alot of locums, no matter what you negotiate you will be making less than the locums guy. If you are not ok with this, then don't sign a long term deal. Just do locus

Surprisingly, I was able to secure a contract that was only 15/hr less than locums rate with a guarantee of 130 hrs per month. It can be done.

 

[cyanide12345678]

Agreed. Lawyers are worth their weight in contract negotiations. At least, early on. It's like investing. You want to spend the time learning what you need to do it yourself, good on you. But there's a reason contract law is a subspecialty.

100 percent agreed. Had both my faculty and a contract lawyer review my contract. Faculty did not add anything more to the equation. My contract lawyer added provisions that I otherwise would have never thought of. Well worth the few hundred dollars. He changed the contract in many subtle ways that prevent me from getting screwed over.

 

[EctopicFetus]

Surprisingly, I was able to secure a contract that was only 15/hr less than locums rate with a guarantee of 130 hrs per month. It can be done.

HOw much? The Locums rate may be BS or crappy.

 

[cyanide12345678]

HOw much? The Locums rate may be BS or crappy.

There is a degree of crappiness to the locums rate as well as all rates in my area which I'm bound to due to a spouse being in residency. Locums rate for same hospital hospital as signed by a senior resident was 275/hr. It's not the 300+ dollars that some of these guys here have, but this isn't Texas, it's a place with surplus of docs, 3 residencies within a 30 minute radius, and the city is smaller than 500k population.

After having visited every hospital in a 1 hour radius, and discussing offers with 5-6 different groups in the area, and having had these groups compete against each other and beat each others offer, I finally got an offer that I happily signed. It took months of work -_- and negotiations -_- The rates for the area ranged from 185-210/hr otherwise for W2 spots (yes, pretty crappy) and around ~ 220-230 for IC positions.

 

[Hercules]

There is a degree of crappiness to the locums rate as well as all rates in my area which I'm bound to due to a spouse being in residency. Locums rate for same hospital hospital as signed by a senior resident was 275/hr. It's not the 300+ dollars that some of these guys here have, but this isn't Texas, it's a place with surplus of docs, 3 residencies within a 30 minute radius, and the city is smaller than 500k population.

After having visited every hospital in a 1 hour radius, and discussing offers with 5-6 different groups in the area, and having had these groups compete against each other and beat each others offer, I finally got an offer that I happily signed. It took months of work -_- and negotiations -_- The rates for the area ranged from 185-210/hr otherwise for W2 spots (yes, pretty crappy) and around ~ 220-230 for IC positions.

Good job respecting yourself and your earning potential enough to put in the work to make this happen. The willingness to do this puts you ahead of about 95% of your colleagues. It will serve you well throughout your career.


Sent from my iPhone using SDN mobile

 

[cyanide12345678]

Good job respecting yourself and your earning potential enough to put in the work to make this happen. The willingness to do this puts you ahead of about 95% of your colleagues. It will serve you well throughout your career.


Sent from my iPhone using SDN mobile

There was a degree of luck as well honestly. I was going to sign a contract at a w2 positron for 190 per hr days and 215 per hr nights plus a "productivity bonus" . The recruiter kept promising that the docs made 15-25 per hr for that bonus. I kept asking for an equation and minimum rvu/pph levels to qualify for the bonus, and they never delivered. In fact I was so close to signing with them that I sent other groups "thank you but I'm choosing company X" emails. The responses to those emails made me realize my worth. Two other groups beat the offer immediately, these guys weren't budging on their offers previously otherwise saying "everyone is paid the same". That tune quickly changed to "don't discuss your rates with anyone else".


215 nights seemed great honestly when every place seemed to start negotiations at 185-190 per hr which is why I was going to sign. In fact I had an attending review that contract who said "wow you're getting paid a lot. You'll be making more than all the attendings here". But I just couldn't bring myself to sign a black box "productivity incentive" that wasn't explained anywhere. I'm glad I didn't sign then.

 

[EctopicFetus]

There was a degree of luck as well honestly. I was going to sign a contract at a w2 positron for 190 per hr days and 215 per hr nights plus a "productivity bonus" . The recruiter kept promising that the docs made 15-25 per hr for that bonus. I kept asking for an equation and minimum rvu/pph levels to qualify for the bonus, and they never delivered. In fact I was so close to signing with them that I sent other groups "thank you but I'm choosing company X" emails. The responses to those emails made me realize my worth. Two other groups beat the offer immediately, these guys weren't budging on their offers previously otherwise saying "everyone is paid the same". That tune quickly changed to "don't discuss your rates with anyone else".


215 nights seemed great honestly when every place seemed to start negotiations at 185-190 per hr which is why I was going to sign. In fact I had an attending review that contract who said "wow you're getting paid a lot. You'll be making more than all the attendings here". But I just couldn't bring myself to sign a black box "productivity incentive" that wasn't explained anywhere. I'm glad I didn't sign then.

Well done young Jedi.

 

[Ridge_Runner]

There was a degree of luck as well honestly. I was going to sign a contract at a w2 positron for 190 per hr days and 215 per hr nights plus a "productivity bonus" . The recruiter kept promising that the docs made 15-25 per hr for that bonus. I kept asking for an equation and minimum rvu/pph levels to qualify for the bonus, and they never delivered. In fact I was so close to signing with them that I sent other groups "thank you but I'm choosing company X" emails. The responses to those emails made me realize my worth. Two other groups beat the offer immediately, these guys weren't budging on their offers previously otherwise saying "everyone is paid the same". That tune quickly changed to "don't discuss your rates with anyone else".


215 nights seemed great honestly when every place seemed to start negotiations at 185-190 per hr which is why I was going to sign. In fact I had an attending review that contract who said "wow you're getting paid a lot. You'll be making more than all the attendings here". But I just couldn't bring myself to sign a black box "productivity incentive" that wasn't explained anywhere. I'm glad I didn't sign then.

I've run into similar recently. If you can't clearly show me the math and current metrics, then I become very suspicious that you're hiring agenda is a race to the bottom.

 

[miacomet]

Sigh. I read this thread as "first contact" initially, and I was way more excited. Beam me up, Scotty....

 

[wamcp]

There is a degree of crappiness to the locums rate as well as all rates in my area which I'm bound to due to a spouse being in residency. Locums rate for same hospital hospital as signed by a senior resident was 275/hr. It's not the 300+ dollars that some of these guys here have, but this isn't Texas, it's a place with surplus of docs, 3 residencies within a 30 minute radius, and the city is smaller than 500k population.

After having visited every hospital in a 1 hour radius, and discussing offers with 5-6 different groups in the area, and having had these groups compete against each other and beat each others offer, I finally got an offer that I happily signed. It took months of work -_- and negotiations -_- The rates for the area ranged from 185-210/hr otherwise for W2 spots (yes, pretty crappy) and around ~ 220-230 for IC positions.

Uh....as a hospitalist I am absolutely SHOCKED the pay for EM in a desirable place is this low??

Dude, I moonlight at a VA hospital in a desirable city (>1 million population) where I live downtown.....and the rate is 175-200/hr....and that is for the VA of all places, with residents doing some grunt work and no malpractice worries...and the shifts are admitter/crosscover meaning I don’t have to worry about discharge liabilities too.

You have to pay me 500 or 600+ per hour to put up with what you guys do. Seriously.

The mental anguish of seeing 2+ undifferentiated whining patients per hour, dealing with discharging people whom you only met for the first time ever in an increasing litigious society, stabilizing patients that can crash hard and having to do procedures (well maybe that is what you folks enjoy the most? But crit care pts will totally wreck your workflow), having to see pediatrics (hated dealing with the parents in med school), press ganey nonsense etc....kudos to you but 185-210 sounds crazy low

 

[QuackaDO]

I have a question or two for the collective...

When is the best time (and who) to try to negotiate. I didn’t really try to negotiate my first 2 contracts and realize I did it all wrong. First contract gave me the, what now appears to be standard, “there really isn’t any negotiating because everyone signs the same boilerplate contract” spiel and second one was in a pretty desirable place so I didn’t think I was operating from a position of power to offer up terms.

I’m considering a move to a less desirable (at least that’s what I’ve traditionally heard, correct me if I’m wrong) market in Las Vegas and feel like trying to negotiate the standard “170/hr + RVUs equaling about 236/hr” quote that the recruiter gave. I’m guessing time to negotiate and who is once they offer the job and with who ever offers, be it recruiter or director that offers. Thoughts?

I guess obvious additional question would be how do you approach asking for more on this. Should have mentioned it is with a CMG so that should be useful and also I don’t “have to” take this job... I could stay where I’m at and be ok but if this offer becomes spectacular it’s something that would be good for me and my family.