Got a contract? Get a lawyer.

[Sushirolls]

For the new grads, or the seasoned docs changing jobs, get a lawyer to review your contracts AND represent you. Most jobs are boiler plate templates, but even then I've combed over one such boiler plate and found few errors. In conjunction with a lawyer better language was drafted, additions added and submitted back. Feedback was positive with intent to use on future contracts by their corporate lawyer. Other changes were begrudgingly obliged because it wasn't worth the effort to push back.

Get your contract as squeaky clean as you can before you sign it. You won't ever get a post hoc revision. Honeymoon over, company store owns you.

Find a lawyer, and let them do the negotiations for you. One past experience I had the lawyer more in the background, a passive reviewer, and ghost writer for language. Things got heated in the negotiations. Never again will I do that. I encourage others to retain counsel, communicate your wants to your lawyer and let the lawyer communicate with their corporate counsel. It will add time, but ultimately it buffers you from process, and sadly, lawyer negotiations I believe are actually handled more favorably.

I don't like paying lawyers any more than the next person, but this is a value added area, even if just peace of mind.

Don't sign a non-compete clause, if they have one, instruct your lawyer to get it removed. If they don't have the lawyer communicate this is a deal breaker and move on to the next opportunity.

No fault notice of termination, get that down to 60 days at the least. 90 days, 120 days, just drags on forever. It can even be a barrier to jumping ship and picking up a new job in your area if a solid opportunity arises.

If your job has a lot of external references to "system wide benefits policy" get that in your contract, and strike the language that it magically updates when they say it updates. Otherwise, the sweet retirement account bonuses, or whatever might be, disappear like that *fingers snap*.

Details of call frequency, and call time need to be clearly written in the contract. You will want that protection when a colleague in the future skimps and dumps call duty on you when it isn't time, or when colleagues leave and now you aren't just understaffed but incredibly understaffed you are expected to magically take on the burden of more call. By having a clearly defined call requirement in your contract, you have the ability negotiate later for extra call pay if things become critically short staffed, or use it as a "for cause" termination to get out of the job almost immediately and not wait for the above 60, 90, 120 day period.

Don't be afraid to put in a clause about determining appointment times set by you. Tomorrow, the mid manager could approach you and say, "Yeah, about those TPS reports.... and um... yeah, you now are doing 15 min follow ups."

Preserve your right of independent practice, that has language about referral protections. You have the right to refer a patient where you please. I.e. your health system has a poor family med department, or OB, or Sleep, or therapists, whatever it might be, or even lab services. You should be able to confidently refer those patients out where you want, and have the language in your contract to support you. This way, if they fire you because they are ticked off that you refer all your lab services across the street, you have it clearly in your contract, and they just exhibited retaliation.

Please add more, or even share things you've learned over the years for contract improvements.

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[splik]

This is good advice for jobs with corporate entities, particularly in the private sector. This is not going to fly in academics, at the VA, state hospitals, or unionized positions (e.g. county jobs). This is also not going to work for much smaller employers (like a small group private practice), where if you have an attorney negotiate for you, you will find your job offer quickly evaporates. It would be a massive faux pas to bring a lawyer into the negotiation process if your directly talking with a physician owner of a small practice where there is no HR and corporate lawyers. For government jobs, the contract, is likely what the union has negotiated and not open to further negotiated beyond the collective bargaining table. some government jobs there may not even be a contract (or you might start work before you get it!!)

I agree that it definitely is worth it to have an attorney who is experienced in reviewing physician contracts, review your contract and make any changes as appropriate.

I would also say, have any discussions over email, or summarize discussions over email so you have written documentation of any agreements they made. This is just as valid and important as what is in the contract.

 

[Crayola227]

I agree with Splik for the most part, but I still think for any job it might still be worth having an attorney look things over. You don't have to let the employer know this, and if you are dealing with a non-corporate entity, they may be more amenable to little changes here and there that you suggest that could help a lot in the future.

 

[Sushirolls]

I have one Psychiatrist friend who was able to negotiate with the VA. Was able to get adjustments I never thought the VA would ever consider. Granted, this is a rural VA that struggled with Psychiatrist staffing levels. This doctor is superb with negotiation skills.

I hear what you are saying about the small private practices getting skiddish with a lawyer. This can also be ameliorated with good old fashion, forewarning, "Hey, I'm very interested in being your doc, we have mutual goals and an ability to really work well together. I do want to make sure that I walk into this right, with a solid contract that protects us both and gets both of us what we want. I'll be having this contract looked over by my lawyer and I'll let her work out the details with you. Or do you have a lawyer for the group I should have mine reach out to?" But I must say if a small private practice hasn't had lawyer input with their contract development for a partnership or basic employment, or even their business corporate structure, its probably a practice best to avoid. Small practices are a marriage, and like anything that intimate the abuses can also be the worst.

I'm on the cusp of opening a private practice, insurance based. One of the first things I did was make sure I have a lawyer on retainer. In the coming months if my grand business plan comes together I'll need one solid partner. I will indeed use the lawyer to draft the contract, and will be delighted if this candidate utilizes a lawyer. I would interpret that as some one who has their head on straight and/or already been burned in the past and accrued some wisdom. They are part of doing business.

On a side note, one interview with small niche group practice years ago, I didn't even get around to using a lawyer. Initial verbal discussions were started on premise, "yeah, if the offer will be at least X, I'll come interview." After the interviews and trips, and emails, and further follow ups, the offer was for X-50K. That was a quick nope, and walked away.

 

[clausewitz2]

This is good advice for jobs with corporate entities, particularly in the private sector. This is not going to fly in academics, at the VA, state hospitals, or unionized positions (e.g. county jobs). This is also not going to work for much smaller employers (like a small group private practice), where if you have an attorney negotiate for you, you will find your job offer quickly evaporates. It would be a massive faux pas to bring a lawyer into the negotiation process if your directly talking with a physician owner of a small practice where there is no HR and corporate lawyers. For government jobs, the contract, is likely what the union has negotiated and not open to further negotiated beyond the collective bargaining table. some government jobs there may not even be a contract (or you might start work before you get it!!)

I agree that it definitely is worth it to have an attorney who is experienced in reviewing physician contracts, review your contract and make any changes as appropriate.

I would also say, have any discussions over email, or summarize discussions over email so you have written documentation of any agreements they made. This is just as valid and important as what is in the contract.

What are you talking about, my academic center is incredibly flexible with its contract for new attendings: they'll let you sign in blue pen or black pen!

 

[MedMan80]

This is good advice for jobs with corporate entities, particularly in the private sector. This is not going to fly in academics, at the VA, state hospitals, or unionized positions (e.g. county jobs). This is also not going to work for much smaller employers (like a small group private practice), where if you have an attorney negotiate for you, you will find your job offer quickly evaporates. It would be a massive faux pas to bring a lawyer into the negotiation process if your directly talking with a physician owner of a small practice where there is no HR and corporate lawyers. For government jobs, the contract, is likely what the union has negotiated and not open to further negotiated beyond the collective bargaining table. some government jobs there may not even be a contract (or you might start work before you get it!!)

I agree that it definitely is worth it to have an attorney who is experienced in reviewing physician contracts, review your contract and make any changes as appropriate.

I would also say, have any discussions over email, or summarize discussions over email so you have written documentation of any agreements they made. This is just as valid and important as what is in the contract.

Just want to see I've seen both sides, that if its not in the contract it doesn't exist and email communications don't mean much. An employer I was recently looking at was very flexible over scheduling details via email, but was hesitant to put this into writing in the contract meaning that if push came to shove I'd be doing more calls even though it wasn't agreed this way in email communications. If they want you bad enough (and in psych they do), get it in writing in the contract, period.

 

[clausewitz2]

lol in all seriousness, there are quite a few things you can negotiate for academic positions include: when you start, your actual job duties, protected time, your title, the academic series you are in, outside professional activities, your office, moving/relocation expenses, time for professional leave, and for foreign nationals visa and green card sponsorship. for research faculty you will also be able to negotiate your start up package and what that consists of and how much time you have before you have to secure your k-award or other external funding. you are not going to be able to negotiate things like salary, benefits, call schedule, non-competes (if there is one), or prohibitions on working for other entities (if this exists).

Fair point. Our system actually refuses to specify specific job duties in contracts; they will specify service line (so our general Mood and Anxiety, child, substance/dual diagnosis, ED, ID/ASD, psych emergency, psychosis/SMI, C&L, inpatient v. outpatient, etc.) but within those service lines anything that is promised is leaves on the wind. As a rule I reckon they don't try to jerk people around and make them do things they didn't really want to do in the first place, but I definitely know a couple of alums who signed up with very specific expectations of the clinic they would be working in only to be bumped to a totally different clinic within a few months of starting. Thought you were signing up to run an OCD IOP? Too bad, now you just see gen pop OP forever.

 

[Psychotic]

I have one Psychiatrist friend who was able to negotiate with the VA. Was able to get adjustments I never thought the VA would ever consider.

Elaborate, please, on what your friend was able to negotiate with the VA.

 

[Sushirolls]

Elaborate, please, on what your friend was able to negotiate with the VA.

Wish I could sing the praises of the negotiation saga, but I don't have permission to divulge the details.

 

[AD04]

I'm on the cusp of opening a private practice, insurance based. One of the first things I did was make sure I have a lawyer on retainer. In the coming months if my grand business plan comes together I'll need one solid partner. I will indeed use the lawyer to draft the contract, and will be delighted if this candidate utilizes a lawyer. I would interpret that as some one who has their head on straight and/or already been burned in the past and accrued some wisdom. They are part of doing business.

Why will you need a partner (instead of going solo or employing mid-level / psychiatrist)?

 

[Psychotic]

Wish I could sing the praises of the negotiation saga, but I don't have permission to divulge the details.

Then why did you mention it in the prior post if you didn't have permission? You can "divulge" without naming names or revealing your friend's identity or location...whatever...

 

[Mass Effect]

Good advice above. I want to add that I always get a kick out of academic or big box shops giving you 24-48 hours to sign the contract. I always tell people looking for a job that if they see that, that's a good indication they're worried your lawyer will find the red flags. Always push back and tell them you need some time to review the contract even if you don't want to mention having your attorney look it over.

 

[Sushirolls]

Good advice above. I want to add that I always get a kick out of academic or big box shops giving you 24-48 hours to sign the contract. I always tell people looking for a job that if they see that, that's a good indication they're worried your lawyer will find the red flags. Always push back and tell them you need some time to review the contract even if you don't want to mention having your attorney look it over.

Yeah, I experienced that from a Big Box shop in the past, think it was a week. But definitely that was a warning sign. The entire time I worked there they had an unfilled position, and after my exodus they've been a revolving door filling just my vacancy for several years now. Big red flag those pressured time stamps are.

 

[Mass Effect]

Yeah, I experienced that from a Big Box shop in the past, think it was a week. But definitely that was a warning sign. The entire time I worked there they had an unfilled position, and after my exodus they've been a revolving door filling just my vacancy for several years now. Big red flag those pressured time stamps are.

This happened when I was looking at jobs after residency. I think they said it had to be signed within 48 hours. Way too short notice for a lawyer. I asked to extend to a week at least and they reluctantly agreed, but that even that wasn't enough time to get a lawyer and have them make thorough revisions and the place didn't want to extend past that. I ended up passing on the job but one of the other residents took it and lasted about 8 months, the last 4 of which was really because of fears that it would "look bad" to leave before a year.

If I ever see that stupid requirement again, I'm saying I need at least a few weeks to fully look it over and if they don't budge, walk away. There's a reason they want such a quick response and it has nothing to do with the "other candidates" line they'll feed you.

 

[nexus73]

This happened when I was looking at jobs after residency. I think they said it had to be signed within 48 hours. Way too short notice for a lawyer. I asked to extend to a week at least and they reluctantly agreed, but that even that wasn't enough time to get a lawyer and have them make thorough revisions and the place didn't want to extend past that. I ended up passing on the job but one of the other residents took it and lasted about 8 months, the last 4 of which was really because of fears that it would "look bad" to leave before a year.

If I ever see that stupid requirement again, I'm saying I need at least a few weeks to fully look it over and if they don't budge, walk away. There's a reason they want such a quick response and it has nothing to do with the "other candidates" line they'll feed you.

I agree with this. Especially in the current psychiatry job market (which is not good for hospitals). If you're applying in a medium size city or smaller, the likelihood they have other candidates lined up who could accept the job before you is infinitesimally small.

 

[whopper]

Agree with the lawyer thing but emphasis on a good lawyer. There's the type of lawyer that doesn't do $hit just in our own field there's plenty of psychiatrists who don't do $hit and then charge hundreds of dollars for bull$hit.

I won't name names but any colleagues from the Ohio area might know who I'm talking about cause there aren't too many MD/JDs out there. One guy that was an MD/JD every time I asked him for legal advice he never gave me anything worth the time and I wasn't even paying the guy.