Aug 25, 2016
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Hi All,

Any advice on signing letter's of intent? Still awaiting some details on the position.

LOI only has base salary, PTO, CME allowance.

It states "this is a nonbinding letter of intent".

Have you seen these before? What should and shouldn't be in a letter of intent? What are the pitfalls to signing or not signing? Can I continue to look elsewhere once singing this?

(It's an AMC btw)

Thanks!
 

PainDrain

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Seen them and they aren't worth that paper they are printed on. Make sure everything in the LOI is in your final contract and under YOUR terms, if it's not them find another job.
 

RussianJoo

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they are not binding. Just like yours says. You can sign it and keep looking for a job knowing that you will at least have that place to work if you can't find anything better.
 

hypnosMD

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they are not binding. Just like yours says. You can sign it and keep looking for a job knowing that you will at least have that place to work if you can't find anything better.
Given the supposed track record of AMC's in the war on physicians, what is to stop them from changing such a "nonbinding" agreement once you have committed and relocated? They gotcha!! Sounds super shady. Is this their newest tactic??
 

Mman

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Given the supposed track record of AMC's in the war on physicians, what is to stop them from changing such a "nonbinding" agreement once you have committed and relocated? They gotcha!! Sounds super shady. Is this their newest tactic??
There are probably some state to state legal variations on this, but as far as I know LOIs are what they are. Intent. It isn't binding. They can't change it to become binding after you sign it. It also doesn't 100% give you a job with them if you want it as they can change their mind and not offer you a contract.
 

hypnosMD

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There are probably some state to state legal variations on this, but as far as I know LOIs are what they are. Intent. It isn't binding. They can't change it to become binding after you sign it. It also doesn't 100% give you a job with them if you want it as they can change their mind and not offer you a contract.
So basically, they could offer you the world in the LOI, only to later learn they dont need you? Could they instead, upon your relocation/arrival, offer you a contract that was substantially different in compensation and/or workplace obligations? Is there any legal precedent?
 

Planktonmd

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So basically, they could offer you the world in the LOI, only to later learn they dont need you? Could they instead, upon your relocation/arrival, offer you a contract that was substantially different in compensation and/or workplace obligations? Is there any legal precedent?
They definitely can do whatever they want including not hiring you at all.
 

Mman

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So basically, they could offer you the world in the LOI, only to later learn they dont need you? Could they instead, upon your relocation/arrival, offer you a contract that was substantially different in compensation and/or workplace obligations? Is there any legal precedent?
I'm assuming you wouldn't be crazy enough to relocate without an actual contract first. LOI just means they intend to offer you a contract and when you sign it means you intend to sign said contract. You actually need a contract, though. The LOI is just like a love letter, not a wedding.
 

NightNight

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CA3. Recently signed. Interviewed at several places, I have to say I never saw one of these. Sure I got run sheets that summarized the intended offer (faster to get out than a contract) but no request to sign it as a letter of intent. I'm not really sure I see the point, other than what Plankton pointed out? Would strongly echo the above statement, DO NOT relocate without a signed contract. If they ask you to relocate with just a signed LOI I would be extremely wary.


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OP
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Aug 25, 2016
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CA3. Recently signed. Interviewed at several places, I have to say I never saw one of these. Sure I got run sheets that summarized the intended offer (faster to get out than a contract) but no request to sign it as a letter of intent. I'm not really sure I see the point, other than what Plankton pointed out? Would strongly echo the above statement, DO NOT relocate without a signed contract. If they ask you to relocate with just a signed LOI I would be extremely wary.


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Agreed. Relocating without an actual contract signed would be insane in my mind. Just wanted to make sure that it didn't stop me from looking elsewhere since they haven't provided all the details anyways.
 

gasdoc77

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Just curious, but is this letter of intent in a super competitive market (So Cal, etc.?)
 

polar403

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CA3. Recently signed. Interviewed at several places, I have to say I never saw one of these. Sure I got run sheets that summarized the intended offer (faster to get out than a contract) but no request to sign it as a letter of intent. I'm not really sure I see the point, other than what Plankton pointed out? Would strongly echo the above statement, DO NOT relocate without a signed contract. If they ask you to relocate with just a signed LOI I would be extremely wary.


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What you got sounds like a term sheet. I never saw a letter of intent when I was looking for a job. Doubt it's binding for either side. As others have recommended, be sure to have a contract signed and executed that you're happy with prior to relocating and/or buying a house.
 
OP
G
Aug 25, 2016
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Just curious, but is this letter of intent in a super competitive market (So Cal, etc.?)
Not even close, average Midwest city. Base is under 400 and the benefits are poor.

Talked to the recruiter about it and she said it was to make sure we were in the same page in terms of expectations for salary.

That being said she didn't know the call frequency, work hours, or expected supervision. !?!?!?

When a private group sells to an AMC, do they make a deal about staffing and supervision ratios and put it in the contract to keep the group running the way it did before? OR does the AMC say just trust us and inevitably it ends up being more sites covered, more call, and increased supervision ratios?

Just hard to evaluate a base salary without work expectations.
 

Man o War

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Not even close, average Midwest city. Base is under 400 and the benefits are poor.

Talked to the recruiter about it and she said it was to make sure we were in the same page in terms of expectations for salary.

That being said she didn't know the call frequency, work hours, or expected supervision. !?!?!?

When a private group sells to an AMC, do they make a deal about staffing and supervision ratios and put it in the contract to keep the group running the way it did before? OR does the AMC say just trust us and inevitably it ends up being more sites covered, more call, and increased supervision ratios?

Just hard to evaluate a base salary without work expectations.
That's completely nuts. You should know exactly what your call and supervision ratio is.
It's a HUGE red flag to me that nobody knows that, especially the recruiter. Run fast!
You also need verbiage in your contract for a compensation rate over and above your agreed upon rate in the event the AMC runs short on docs and uses the rest of you to fill in. AMCs are notorious for that move.
 
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OP
G
Aug 25, 2016
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That's completely nuts. You should know exactly what your call and supervision ratio is.
It's a HUGE red flag to me that nobody knows that, especially the recruiter. Run fast!
You also need verbiage in your contract for a compensation rate over and above your agreed upon rate in the event the AMC runs short on docs and uses the rest of you to fill in. AMCs are notorious for that move.
My understanding is that the call the supervision for cardiac is yet to be determined. There has been a request to have a dedicated cardiac call pool. This will increase the call burden, but it's unclear how this will shape up. There is also a question as to wether the docs that typically do cardiac cases will go from 3:1 coverage (one heart and two general rooms), to 4:1.

A few questions:
1. When you said "compensation rate over and above your agreed upon rate", does that imply that you should have it spelled out how many hours you work for X amount of dollars? I feel like the AMC's aren't in the business of doing that for docs. Can I ask them for this?

2. I've seen mainly 1:1 coverage of sick cardiac cases in academics. For those of you out there in pp doing cardiac, what do you feel is the limit of supervision and safety in cardiac? (4 cardiac rooms at once? 3 cardiac rooms at once? 1 cardiac room and 1 general room?). What about for someone fresh out of fellowship? I'm fully willing to admit that some of the more seasoned vets can handle much more in a safer manner. Thoughts and advice?
 

Man o War

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My understanding is that the call the supervision for cardiac is yet to be determined. There has been a request to have a dedicated cardiac call pool. This will increase the call burden, but it's unclear how this will shape up. There is also a question as to wether the docs that typically do cardiac cases will go from 3:1 coverage (one heart and two general rooms), to 4:1.

A few questions:
1. When you said "compensation rate over and above your agreed upon rate", does that imply that you should have it spelled out how many hours you work for X amount of dollars? I feel like the AMC's aren't in the business of doing that for docs. Can I ask them for this?

2. I've seen mainly 1:1 coverage of sick cardiac cases in academics. For those of you out there in pp doing cardiac, what do you feel is the limit of supervision and safety in cardiac? (4 cardiac rooms at once? 3 cardiac rooms at once? 1 cardiac room and 1 general room?). What about for someone fresh out of fellowship? I'm fully willing to admit that some of the more seasoned vets can handle much more in a safer manner. Thoughts and advice?

Here is what will possibly happen....the AMC will give the guy/gal in charge of that site enough money for say 8.5 doc FTEs. So, when you take the job they will quote you a salary and call burden based on that number. When they can't recruit 8.5 docs because the job sucks so bad, they will just shunt the workload and calls off on the rest of you for the same yearly salary you signed a contract for. They may also offer you some vague "quarterly bonus" that either isn't defined at all or very loosely defined. You may never see that unless your contract has very specific language about it (i.e., the date it gets paid out and VERY specific, measurable metrics that it's based on). You need to have very specific language about call burden; so if you're contracted for $400k for q8 call, any additional call you take must be paid out at X rate on a monthly basis (you need to decide what your rate is for that).
I knew a guy with similar circumstances as what you describe- they told him there were going to be 10 docs total. The hospital had cardiac cases. Turns out they could only manage to hire 2 docs that could do cardiac (my buddy and one other guy), so he was on Q2 call until he realized what was happening and got another job. They had promised the hospital a dedicated heart call team.
As far as cardiac, that's all I do these days and I wouldn't do cardiac for an AMC unless I was in a room by myself.
I also wouldn't do a cardiac supervision job unless the docs had hiring/firing power to get rid of any bad eggs. That could mean the group is owned by the docs, or the hospital agrees to let the docs have the final say over which CRNAs do heart cases.
I think your suspicion is right that the AMC will balk at your demands, in which case I would stop talks with them immediately. I've heard too many stories to trust them to not have every single detail spelled out to the letter. When dealing with these AMCs, I would highly recommend hiring an attorney to help you with your contract. It's a good idea for any contract you receive, AMC or not.
As a side note, if you have a cardiac fellowship (I think you do based on your questions), you can be picky about where you work (at least for the time being), and I wouldn't waste my time with an AMC.
 
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OP
G
Aug 25, 2016
18
1
Here is what will possibly happen....the AMC will give the guy/gal in charge of that site enough money for say 8.5 doc FTEs. So, when you take the job they will quote you a salary and call burden based on that number. When they can't recruit 8.5 docs because the job sucks so bad, they will just shunt the workload and calls off on the rest of you for the same yearly salary you signed a contract for. They may also offer you some vague "quarterly bonus" that either isn't defined at all or very loosely defined. You may never see that unless your contract has very specific language about it (i.e., the date it gets paid out and VERY specific, measurable metrics that it's based on). You need to have very specific language about call burden; so if you're contracted for $400k for q8 call, any additional call you take must be paid out at X rate on a monthly basis (you need to decide what your rate is for that).
I knew a guy with similar circumstances as what you describe- they told him there were going to be 10 docs total. The hospital had cardiac cases. Turns out they could only manage to hire 2 docs that could do cardiac (my buddy and one other guy), so he was on Q2 call until he realized what was happening and got another job. They had promised the hospital a dedicated heart call team.
As far as cardiac, that's all I do these days and I wouldn't do cardiac for an AMC unless I was in a room by myself.
I also wouldn't do a cardiac supervision job unless the docs had hiring/firing power to get rid of any bad eggs. That could mean the group is owned by the docs, or the hospital agrees to let the docs have the final say over which CRNAs do heart cases.
I think your suspicion is right that the AMC will balk at your demands, in which case I would stop talks with them immediately. I've heard too many stories to trust them to not have every single detail spelled out to the letter. When dealing with these AMCs, I would highly recommend hiring an attorney to help you with your contract. It's a good idea for any contract you receive, AMC or not.
As a side note, if you have a cardiac fellowship (I think you do based on your questions), you can be picky about where you work (at least for the time being), and I wouldn't waste my time with an AMC.
Man thanks for the advice!

You make a great point about some control over which CRNA you are going to be supervising in the heart room. I could foresee the veteran crnas up and leaving and the AMC hiring a bunch of fresh grads or people with little experience and expect you to cover 3:1 and "bring them along". That'd be scary bouncing back and forth without someone you trust in a room that can go south quickly.

The exact call burden in the AMC contract seems like a no brainier, as their motive is to get as much work out of you for as little as possible. I'd imagine it's hard to get them to spell out your call responsibility in a contract though. Anyone out there successful in getting the AMC to put exactly how much call and how many hours are expected? Just in case they go a doc or two short for a year or so and make you pick up the slack for the same pay.
 
OP
G
Aug 25, 2016
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As a side note, if you have a cardiac fellowship (I think you do based on your questions), you can be picky about where you work (at least for the time being), and I wouldn't waste my time with an AMC.
I'm currently in fellowship, but still have the rest of the year to go. Unfortunately, where I'd like to live the place that does the most hearts is an AMC and the pp places do very little. Rather live elsewhere than take something that doesn't feel right though.
 

RussianJoo

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I had two letters of intent given to me in the midwest when I was looking for jobs, one was for an AMC the other for a hospital employee. As for things being spelled out in contracts the AMC I work for did not want to do that, and they asked me to trust them. I did and so far they haven't lied to me yet, but at the same time I didn't have to relocate, and I knew everyone in the old group that got taken over. Also yes it's important to find out how many calls you're expected to take and what they will pay you if you take extra calls, not only that but find out if your calls are 24hrs or 16hrs or 30hrs, and how you will be compensated if you're asked to stay and work post call, usually it's per hour bases. If it's cardiac call it might be from home, and there might be extra money if you actually have to come in to do a case. Lastly some places might pay you per hour if you stay past a certain time as well, like staying past 7pm on a non-call day or something. These things might not be written in the contract, they weren't for me but I have it in an email and so far my AMC has been keeping their word.

Lastly interms of how many rooms you'll cover, if it's upto the AMC the answer will be 4 rooms all the time, in order to maximize profits. However, a lot of times the recruiter or AMC big wigs will think one thing but in reality something else will be happening at the hospital level, so ask the people who actually work at the hospital not the management or recruiters about typical case load and how many rooms you'll run. Unless people are complete dicks if you have a tough case or a sick patient your other rooms will be lighter easier rooms. Chances are you'll probably start out with 3 rooms and as the day progresses and people start going home pick up a 4th room to get others out.
 
OP
G
Aug 25, 2016
18
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I had two letters of intent given to me in the midwest when I was looking for jobs, one was for an AMC the other for a hospital employee. As for things being spelled out in contracts the AMC I work for did not want to do that, and they asked me to trust them. I did and so far they haven't lied to me yet, but at the same time I didn't have to relocate, and I knew everyone in the old group that got taken over. Also yes it's important to find out how many calls you're expected to take and what they will pay you if you take extra calls, not only that but find out if your calls are 24hrs or 16hrs or 30hrs, and how you will be compensated if you're asked to stay and work post call, usually it's per hour bases. If it's cardiac call it might be from home, and there might be extra money if you actually have to come in to do a case. Lastly some places might pay you per hour if you stay past a certain time as well, like staying past 7pm on a non-call day or something. These things might not be written in the contract, they weren't for me but I have it in an email and so far my AMC has been keeping their word.

Lastly in terms of how many rooms you'll cover, if it's up to the AMC the answer will be 4 rooms all the time, in order to maximize profits. However, a lot of times the recruiter or AMC big wigs will think one thing but in reality something else will be happening at the hospital level, so ask the people who actually work at the hospital not the management or recruiters about typical case load and how many rooms you'll run. Unless people are complete dicks if you have a tough case or a sick patient your other rooms will be lighter easier rooms. Chances are you'll probably start out with 3 rooms and as the day progresses and people start going home pick up a 4th room to get others out.
What I'm getting from the replies is that it's important to know the call expectations and pay that goes along with extra call or staying late, BUT that stuff will not get written into the contract. Is that accurate? If so, it comes down to how much I trust them? I trust the former group president and the people in the group, but who do I talk to from the AMC side of things since the recruiter seems to know nothing? Is there typically a point person or regional manger that has the ultimate decision making power? I just don't see why they would pay me for staying late or coming in post call or picking up extra calls when a doc quits or retires if it's not in my contract.

RussianJoo, it seems like you work for an AMC that has kept their word and pays for extra work despite it not being in your contract. Who did you talk to and what made you trust them? Good to hear that you took a chance and it has worked out so far.

For those of you out there working for AMCs, what provisions did you have placed in your contract that have given you some peace of mind and have lead to a relatively fair job situation? Any absolute deal breakers I should be aware of?
 

RussianJoo

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What I'm getting from the replies is that it's important to know the call expectations and pay that goes along with extra call or staying late, BUT that stuff will not get written into the contract. Is that accurate? If so, it comes down to how much I trust them? I trust the former group president and the people in the group, but who do I talk to from the AMC side of things since the recruiter seems to know nothing? Is there typically a point person or regional manger that has the ultimate decision making power? I just don't see why they would pay me for staying late or coming in post call or picking up extra calls when a doc quits or retires if it's not in my contract.

RussianJoo, it seems like you work for an AMC that has kept their word and pays for extra work despite it not being in your contract. Who did you talk to and what made you trust them? Good to hear that you took a chance and it has worked out so far.

For those of you out there working for AMCs, what provisions did you have placed in your contract that have given you some peace of mind and have lead to a relatively fair job situation? Any absolute deal breakers I should be aware of?

I would talk to the current chief of anesthesia at that hospital (it's probably the old group's president/chief). In my group the chief of anesthesia signs off on the extra payments and it gets scanned and emailed to corporate to be confirmed and executed. So if you trust the current anesthesiologists in that group and they tell you that they've been paid extra to do x y and z, and that they're expected to take x amount of calls and get paid extra for taking more or staying after a certain hour, then you will get paid extra to do the same. Maybe ask them if they had those things written in their contract and if they didn't eiter than rest assured that it will all be okay.

Also, it's surprizing that an AMC is using a 3rd party recruiter, they usually have their own recruiters which should know more, and if they don't know anything, then you should be talking to the Vice Chief Medical Officer of the AMC, the corporate guy, or someone along those lines. I have the cell phone number of my Vice Chief medical officer and even though he doesn't always answer his phone or text me back right away, I know that he sees my text and eventually does get back to me.

Another thing to ask is how your group counts calls, for example for me to get paid extra, I have to do more than 4 calls a month. However, this is averaged out over a quarter (i.e. 3months) so if I only take 3 calls one month the following month I could take 5 calls and not get paid for that 5th call because it's an average over a quarter.

At the end of the day you're working with the anesthesiologists at that hospital and the Chief and Vice Chief of the anesthesia department at your hospital have some pull with the AMC, and also run things how they want to. So if you trust them, then you shouldn't worry, and everything they tell you will happen no matter if it's written on a paper or not.

My situation is probably pretty unique, I trusted the people because I've known the guys in the group that got taken over for over 5 years and I fully trust what they say. I also have mutual friends with the Vice Chief Medical Officer of the AMC and those people have vouched for him, and lastly I really wanted to be in a certain area, the contract I was offered by the AMC was significantly better than the other offers that I had in that area. I knew I would work hard no matter where I ended up (meaning the same amount of call and hours) so I just cared about salary, benefits and vacation time. The only time I was worried was when I didn't have a contract on hand and only had the letter of intent. I had to make stuff up about my lawyer being out of town or not getting back to me because the deadline to sign my other contract was overdue before I got my AMC contract, and I didn't want to reject that offer before I had a signed contract from the AMC.

Lastly I think everyone starting a new job in a new place no matter who you are should not plant any roots in the area until they know that this job will work out or that there will be another job available in that same area. Meaning don't buy a house right away, rent for a year or so first, don't spend money on expensive toys before you even get the first pay check. If you're willing to walk away if the AMC doesn't live up to their promises then the only thing you have to lose is some time. Worst case that can happen is that they don't pay you for extra call or whatever they promise you, start looking for another job and quit that one once you find a new job.
 
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