negotiating

[anthroguy]

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Hey all,

So I'm out interviewing for my first job in the NE region. The jobs are plentiful. For better or worse almost all of them are being offered by Large Hospital systems looking to add a physician to an already established office or a newly bought office.

Clinical hours are usually 34-36 hours/week. Some outliers have 40.

I come here asking basically: What should I be looking for? What should I be asking?Is a signing bonus expected? Are productivity bonuses realistic the first year out? Whats a reasonable base salary? From what I've seen, base salary for this market is 170 (meaning the first number they'll throw out). I think there's definite room for negotiation here considering the number of jobs and the comparative dearth of applicants.

I have some interviews set up with PP groups, so I'm excited for that as that could be a change of pace. Any opinions/tips for negotiating will be appreciated. Thanks for any advice.

 

[brats800]

1) Hours vary. If you are working more hours, you better be getting paid more. "Full time" for me is 27 hours of clinic + paperwork, meetings, etc.
2) Signing bonus: maybe not universal but I'd expect one. The amount and timing of this vary. In larger groups, I found these numbers to be non-negotiable but I was able to get the $$ when I signed rather than on the 1st paycheck.
3) Productivity bonus: you should expect this but probably not realistic your first (or maybe even 2nd) year out. From what I've seen, the bonus starts kicking in when you get off of the guarantee. Longer guarantee = "safer" but longer before you start getting a productivity bonus.
4) Base salary varies by region. $170k sounds like an OK ballpark. I saw from the $130k's (Chicago suburbs / downtown Chicago) to the low/mid $200k's (very rural Wisconsin).

Get the contract. Have a lawyer look it over. Find out what the requirements are for call, inpatient, outpatient, Nursing Home care, OB, etc. If something isn't in writing, it didn't happen. Find out if there is a non-compete clause and, if so, what the details are (distance from where, for how long, etc).

When I got my contract, there wasn't a whole lot of room to negotiate. I was, however, informed that I would have the same contract + requirements as any senior member of my clinic. Your ability to negotiate will somewhat depend on what the current job market in your area looks like. Several years ago, there were lots of openings in my area and few applicants = clinics were hiring anyone Board Certified with a pulse. This led to some problems and some turnover in people who weren't a "good fit." Nowadays, there are about 4-6 openings across the entire city + surrounding suburbs (an area of ~500k population) so clinics can be much more selective and people applying for the jobs have very little room to negotiate.

 

[cabinbuilder]

A few things:

If the jobs are plentiful then that means you are the hot commodity. I wouldn't work for anything less than 190K + production
Is there student loan repayment option? And I don't mean applying for NHSC and maybe getting it. I mean as part of the package.
Look at your out clause. If they make your life miserable you want to be able to get out quickly. Not 4 months notice. Like 30 days notice or immediately with mutual agreement. You don't want to pay back any sign on either.
Make sure that tail coverage is paid by the employer NOT YOU in the case you leave early, or leave EVER.

just remember that ALL NUMBERS ARE NEGOTIABLE and they expect you to come back with a counter offer. No one every signs with the original numbers.

Be sure you have a lawyer look it over before you sign.

 

[DocBlin]

Yes you can negotiate... In my son's experiences with post residency opportunities he saw offers from $140K's to $210K's; from Miami top NYC, NJ. In Urgent Care and FM clinics. You must set a goal of location first, salary amount second. He was fortunate to get the perfect location for the high salary to start. Always have legal advise in any contract, is the final thought...

 

[styphon]

Make sure that the "out clause" has a time frame you are comfortable with (usually 30 days) - and that it is unconditional (you can leave for any reason). I would also look to see if there is a "non-compete" clause - you can bargain to remove this or reduce the distance.

You can bargain Health insurance - I had my last job pay for my family's insurance (important if you have a kid/wife and adds up). You can also do this with other benefits (401k, educational loan payback)

You can bargain sign on bonus, how much you get and what the time before you "work it off" is.

Since it is a hospital system, I am guessing there is no partnership - but you can bargain a "productivity bonus" yearly based on RVUs or numbers of patients or amount billed.

 

[deleted87716]

Make sure that the "out clause" has a time frame you are comfortable with (usually 30 days) - and that it is unconditional (you can leave for any reason). I would also look to see if there is a "non-compete" clause - you can bargain to remove this or reduce the distance.

Keep in mind that the "out clause" is usually mutual. As for non-competes, don't expect any wiggle room there. If they put it in there, it's there to stay. Just make sure you can live with the terms.

 

[styphon]

Keep in mind that the "out clause" is usually mutual. As for non-competes, don't expect any wiggle room there. If they put it in there, it's there to stay. Just make sure you can live with the terms.

I had negotated mine based on distance. The original contract would've pushed me out of almost half of NY state which was crazy - they lowered it to a much more local radius.

 

[DPCsoon]

Just to echo "get it in writing." When reviewing the contract with the attorney, ensure all the promises are in there.

 

[deleted87716]

I had negotated mine based on distance. The original contract would've pushed me out of almost half of NY state which was crazy - they lowered it to a much more local radius.

If it's too restrictive, it probably won't hold up in court. It would be expensive to find out, though, for both parties.

 

[drcrispmd]

Get a lawyer that is familiar with physician contracts, not just any lawyer. They will look up data on salaries for your experience level (1 year out of residency). They will also do the negotiation too. My lawyer did everything. They didn't offer a sign on bonus but he pushed very hard for one.

 

[peter90036]

how much is that kinda lawyer ?

 

[drcrispmd]

All lawyers will charge differently. Mine was $500 flat for one contract that is paid when he receives a fully signed contract.

 

[anthroguy]

Thank you all.

Here is what I've seen so far in terms of non competes and malpractice.

Non competes - are from 5-10 miles and 2-3 years in the suburban areas I'm looking at it
Malpractice - occurrence based which is supposed to be superior? vs one contract where it was not mentioned at all ( asked them to include their terms for it)
Hours - I've seen them mention clinical hours during the interview, but with nothing in the contract so I will ask for this to be better defined.

Anyone have any experience working for an HMO such as Kaiser?? They are actively recruiting around the country and I've heard through the grapevine their salaries and starting bonus are among the highest (at least for starting salary)

Once I narrow down my options, I plan to have an attorney look at the contract(s).
My timeline is to accept a job by late April/ early May to allow for credentialing so I could start late July/early August.

All of the jobs I'm looking at are traditoinal family medicine with NO OB. Kids + adults + gyn + minor procedures (I&D, joint injections, cyst removal etc).
My friends looking at urgent care are looking at 3 day workweeks and hourly pay at around $110.

 

[VA Hopeful Dr]

Thank you all.

Here is what I've seen so far in terms of non competes and malpractice.

Non competes - are from 5-10 miles and 2-3 years in the suburban areas I'm looking at it
Malpractice - occurrence based which is supposed to be superior? vs one contract where it was not mentioned at all ( asked them to include their terms for it)
Hours - I've seen them mention clinical hours during the interview, but with nothing in the contract so I will ask for this to be better defined.

Anyone have any experience working for an HMO such as Kaiser?? They are actively recruiting around the country and I've heard through the grapevine their salaries and starting bonus are among the highest (at least for starting salary)

Once I narrow down my options, I plan to have an attorney look at the contract(s).
My timeline is to accept a job by late April/ early May to allow for credentialing so I could start late July/early August.

All of the jobs I'm looking at are traditoinal family medicine with NO OB. Kids + adults + gyn + minor procedures (I&D, joint injections, cyst removal etc).
My friends looking at urgent care are looking at 3 day workweeks and hourly pay at around $110.

The most strict I've seen is 5 miles and 2 years. Most others are either more distance (15 miles) but only 1 year, or specify who you can't work for within the next 1 year.

 

[Prncssbuttercup]

Thank you all.

Anyone have any experience working for an HMO such as Kaiser?? They are actively recruiting around the country and I've heard through the grapevine their salaries and starting bonus are among the highest (at least for starting salary)

I don't personally, as I'm a student, but I have friends who work for them and rave about them. That said, I worked for my prior job (before med school) for 10 years and hated it, and other people only worked there 2 months, while others worked there for 30 years and loved it. It's all relative, what others may like, you may not.

As for pay, a friend of mine is an FM hospitalist, and she took in ~305k last year in Minneapolis/St. Paul. She's 2 yrs out of residency, and she got a sign-on bonus + tuition reimbursement which was all upfront. I've seen FM hospitalist jobs in CO (in the mountains) for a similar range (250-300k). While it's not for everyone, she never has call, rarely has to stay late, has a set schedule, and loves her job.