Negotiations (and your first job)

[splik]

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I’m not going to pretend to be some master negotiator. I kinda suck at it despite having formal training in negotiations and having been involved in contract negotiations both personally, and as part of a collective bargaining unit. Nevertheless I thought I would share my advice based on having explored at and interviewed for a wide variety of position (in academics, state hospitals, prisons, med mx private practice, group private practice, community psychiatry, county etc).

Before:
How can I put myself to be in the best position to be competitive?
While it is very easy to get a job in psychiatry, this does not mean you will be offered every job you apply for, or will be able to get the most desirable jobs. For discussion of making yourself competitive for academic/clinician-educator jobs see: Applying for Fellowships

For “real world” jobs they probably could care less about your publications or academic prowess. One thing that can help a lot is to do a ton of moonlighting in a few different places. This can help you have more recent acute care experience in inpatient/PES settings which you might not otherwise have since you were a junior resident. It will make you more comfortable with stepping out into the real world, get a sense of what is out there, and make you more attractive to employers. It can also help you get an “in” into a job you might like that prefer to hire people they know.

All the “optional extra” trimmings of residency can be very helpful: I would make sure you are Clozapine REMS certified, have your x waiver for suboxone, and, if relevant, certified/trained in ECT and TMS. While none of these things require much input and you can do “on the job” it makes you more desirable if you’ve got these things already.

If you are looking at psychotherapy-based practices (these jobs are few and far between but they exist in some major metropolitan areas) further training in psychoanalytic psychotherapy, DBT, MBT, CBT, ACT, IPT or other alphabet soup therapies may be useful.

During residency try to work in as many different kinds of settings as possible. This will give you a flavor of what is out there and provide you with the experience that they might be searching for.

Job Search
· Sell yourself. While they may need you more than you need them, it always helps to sell yourself. This means not only highlighting what is good about you, but why you are a good fit for the job, and what you like about the position (location counts too).
· Be enthusiastic. Convey as much energy and enthusiasm as you can for the position, even if you aren’t interested in. You can decide later whether it’s something you want.
· Remember people will be more willing to negotiate with you if they think you are invested in the position. No one wants to put effort into you if they think you’re not interested or are going to flake out.
· Be extremely pleasant, courteous, polite, and professional throughout the entire process. This can be difficult to do at times because not everyone will return in kind, and there are some scumbags out there. But ultimately this is a small field and you never know what will happen in the future.
· Follow up afterwards with thank yous and expressing your ongoing interest.

Knowledge is Power
· The more you know about yourself, the job, the institution, and who you’re negotiating with the better
· Yourself: what is it that is most compelling about you? What can you bring than no one else can? How highly sough after are you? What skills do you have?
· The job: does anyone else want it? How long has it been vacant? Is it the kind of job that is harder to fill (psychiatrists don’t want to do inpt or work in corrections for example)? Do they need a psychiatrist? (many places would rather go without, some need a psychiatrist to function)
· The institution: where do your interests align? What is it they are looking for and how do you help them meet these needs? Is there some backstory to the institution/department? Are there any current scandals? Are they losing people to a competitor (if so, you might want to look at the competitor!)
· The negotiator: the biggest difference here is if they are an MD or a non-MD. If they are an MD, they may not be a psychiatrist. Basically you need to know if they “speak” your language, and if they don’t, then you can exploit that to your advantage. You also want to know what concerns they might have.


Negotiation Basics
· Always negotiate BEFORE you sign the offer letter/contract. Your bargaining power is significantly reduced afterwards.
· Even if you’re dead set on one job, it always helps to have multiple job offers. These are your best chips for negotiating.
· You are always more desirable when someone else wants you.
· You are never more desirable when they think they might lose you.
· You need to be as likeable as possible. Nobody wants to help a jerk out.
· Take the negotiation process of a sign of how they’ll treat you if you end up working for them. If they are extremely resistant or try to take advantage run.
· Always ask for what you want up front. Adding things later is just going to irritate them. The exception to this is, if later on someone else offers you something that you can use as a chip to get elsewhere.
· Make a list in order of importance of what you want. Then they will know what to prioritize
· You can’t always get what you want. And in fact, you shouldn’t expect to. Negotiations are about compromise and realizing there may be multiple ways to get what you need
· They aren’t going to take the job offer away if you ask for too much. Just don’t be a jerk about it, and be reasonable.
· Always ask for something. It’s good practice if nothing else.
· “Everything is negotiable” – wrong. Some things are clearly not negotiable (on both ends). You need to know what are your deal breakers. Similarly, know what is possible. If you are unionized you are not going to be able to negotiate much of anything as the bargaining is done collectively. Also in larger organizations some things (such as salary, vacation, retirement plan) may be set.
· Don’t be outrageous in your asks. If you ask for waay too much you will come across as out of touch with reality (i.e. it is not reasonable to ask for $450k for 40hrs outpatient med management though you could potentially make that in a high volume practice of your own)
· It is best not to remind people they are weak. Nobody likes to be reminded of that.
· It is much better to make it appear that you are asking them to help you. We like people we do things for because of cognitive dissonance.
· It doesn’t hurt to remind people you are wanted.
· Never accept the first offer. The exception to that is jobs where it’s all set anyway (this is true for many government jobs)
· Never make the first offer. Once you make the first offer (i.e. telling them what you consider a competitive salary) you’ve already lost.
· Don’t tell them what your BATNA (best alternative to a negotiated agreement) is until you’re about to lose.

• Email is your friend. Then you have a written record of what you've been discussing.
  
• Be very careful you know EXACTLY what they are saying/offering - it is very common for misunderstandings to occur, or for you to get vague language that you take to mean one thing that means another. if unsure, clarify.

What can I negotiate?
· It’s not just about salary, you need to consider the total compensation package and what else is important to you
· For government jobs and byzantine organizations you need to work within their framework and what pots they have. In smaller jobs you can create things more easily
· vacation (if vacation is set you might be able to asked for advanced accrual so you don’t have to wait 5 years because you get 4 weeks vacation)
· CME leave
· CME expenses – if you are going to want to go to expensive conferences, buy books, macbooks etc, it is a good idea to put more money in this fund, as it is expenses related and thus untaxed money.
· Title – you might want some fancy title
· Protected time (this might be to have your own specialty clinic, for personal psychotherapy, for QI, supervision/process group, creative projects)
· Start date
· Sign on bonus
· Moving/Relocation expenses (updated 2/18 - this is now taxable, you wont be able to claim moving expenses they will likely give you a taxable sum for moving)
· Call (whether you do it, how often etc)
· Visas/green card (you may have to do significant legwork in providing all the information regarding this as they may not know)
· Restrictive covenant/non-competes – in general never sign a contract with a restrictive covenant. These are illegal in some states (e.g. CA). Basically this says you cant have your own practice in the area if you leave. Not worth it.
· Whether you can have your own private practice (this differs from non-competes as some institutions don’t want you working for others because they see you as theirs, not as competition)
· Will they take a cut from expert witness work, consulting, royalties from book/product development etc?
· The actual work that you do (and don’t do)
· Administrative time
· Time for charting etc
· Model of reimbursement
· Terms for any productivity/satisfaction bonuses
· Boards/MOC/licensing/DEA fees (I see this as separate from CME but of course overlap)
· Notice (when can you leave? What are the penalties)
· Loan forgiveness
· Mortgage loans (some systems will have special loans to buy property with low interest rates; some will basically give you money you don’t have to pay back if you stay there long enough) - Some of this stuff might be “secret menu” stuff
· Flexi-time
· Different schedules (for example 4x 10s, 9x 9s etc)
· Length of appointments; number of new pts/follow ups etc

Limits to negotiations
For the most part (unless its like some tiny group or you're the only psychiatrist) you're constrained by the usual agreements for the most part. They can't give you something wildly different to everyone else and they can keep track of multiple different agreements with everyone. So you want to exist within the different pots of money or other things that you know exist.

However, its usually perfectly okay to ask what is possible. Sometimes it takes someone with ambition or vision to create new terms that could eventually benefit others in the future.

You also should remember that their job is to get the best deal they can for as little as they can. You need to appreciate that by realizing what the least amount you will accept would be and convincing them that more than that is the least they can get away with offering. Sometimes it just isn't going to workout, in which case you need to be prepared to walk away. It's usually best to do so graciously, but if they're really deluded than "lolz no" will suffice.

 

[philosophize]

thank you for taking the time to write this, even tho i'm only a PGY1, this is really helpful and definitely saving it for later!

 

[heysexylady]

I’m not going to pretend to be some master negotiator. I kinda suck at it despite having formal training in negotiations and having been involved in contract negotiations both personally, and as part of a collective bargaining unit. Nevertheless I thought I would share my advice based on having explored at and interviewed for a wide variety of position (in academics, state hospitals, prisons, med mx private practice, group private practice, community psychiatry, county etc).

Before:
How can I put myself to be in the best position to be competitive?
While it is very easy to get a job in psychiatry, this does not mean you will be offered every job you apply for, or will be able to get the most desirable jobs. For discussion of making yourself competitive for academic/clinician-educator jobs see:

For “real world” jobs they probably could care less about your publications or academic prowess. One thing that can help a lot is to do a ton of moonlighting in a few different places. This can help you have more recent acute care experience in inpatient/PES settings which you might not otherwise have since you were a junior resident. It will make you more comfortable with stepping out into the real world, get a sense of what is out there, and make you more attractive to employers. It can also help you get an “in” into a job you might like that prefer to hire people they know.

All the “optional extra” trimmings of residency can be very helpful: I would make sure you are Clozapine REMS certified, have your x waiver for suboxone, and, if relevant, certified/trained in ECT and TMS. While none of these things require much input and you can do “on the job” it makes you more desirable if you’ve got these things already.

If you are looking at psychotherapy-based practices (these jobs are few and far between but they exist in some major metropolitan areas) further training in psychoanalytic psychotherapy, DBT, MBT, CBT, ACT, IPT or other alphabet soup therapies may be useful.

During residency try to work in as many different kinds of settings as possible. This will give you a flavor of what is out there and provide you with the experience that they might be searching for.

Job Search
· Sell yourself. While they may need you more than you need them, it always helps to sell yourself. This means not only highlighting what is good about you, but why you are a good fit for the job, and what you like about the position (location counts too).
· Be enthusiastic. Convey as much energy and enthusiasm as you can for the position, even if you aren’t interested in. You can decide later whether it’s something you want.
· Remember people will be more willing to negotiate with you if they think you are invested in the position. No one wants to put effort into you if they think you’re not interested or are going to flake out.
· Be extremely pleasant, courteous, polite, and professional throughout the entire process. This can be difficult to do at times because not everyone will return in kind, and there are some scumbags out there. But ultimately this is a small field and you never know what will happen in the future.
· Follow up afterwards with thank yous and expressing your ongoing interest.

Knowledge is Power
· The more you know about yourself, the job, the institution, and who you’re negotiating with the better
· Yourself: what is it that is most compelling about you? What can you bring than no one else can? How highly sough after are you? What skills do you have?
· The job: does anyone else want it? How long has it been vacant? Is it the kind of job that is harder to fill (psychiatrists don’t want to do inpt or work in corrections for example)? Do they need a psychiatrist? (many places would rather go without, some need a psychiatrist to function)
· The institution: where do your interests align? What is it they are looking for and how do you help them meet these needs? Is there some backstory to the institution/department? Are there any current scandals? Are they losing people to a competitor (if so, you might want to look at the competitor!)
· The negotiator: the biggest difference here is if they are an MD or a non-MD. If they are an MD, they may not be a psychiatrist. Basically you need to know if they “speak” your language, and if they don’t, then you can exploit that to your advantage. You also want to know what concerns they might have.


Negotiation Basics
· Always negotiate BEFORE you sign the offer letter/contract. Your bargaining power is significantly reduced afterwards.
· Even if you’re dead set on one job, it always helps to have multiple job offers. These are your best chips for negotiating.
· You are always more desirable when someone else wants you.
· You are never more desirable when they think they might lose you.
· You need to be as likeable as possible. Nobody wants to help a jerk out.
· Take the negotiation process of a sign of how they’ll treat you if you end up working for them. If they are extremely resistant or try to take advantage run.
· Always ask for what you want up front. Adding things later is just going to irritate them. The exception to this is, if later on someone else offers you something that you can use as a chip to get elsewhere.
· Make a list in order of importance of what you want. Then they will know what to prioritize
· You can’t always get what you want. And in fact, you shouldn’t expect to. Negotiations are about compromise and realizing there may be multiple ways to get what you need
· They aren’t going to take the job offer away if you ask for too much. Just don’t be a jerk about it, and be reasonable.
· Always ask for something. It’s good practice if nothing else.
· “Everything is negotiable” – wrong. Some things are clearly not negotiable (on both ends). You need to know what are your deal breakers. Similarly, know what is possible. If you are unionized you are not going to be able to negotiate much of anything as the bargaining is done collectively. Also in larger organizations some things (such as salary, vacation, retirement plan) may be set.
· Don’t be outrageous in your asks. If you ask for waay too much you will come across as out of touch with reality (i.e. it is not reasonable to ask for $450k for 40hrs outpatient med management though you could potentially make that in a high volume practice of your own)
· It is best not to remind people they are weak. Nobody likes to be reminded of that.
· It is much better to make it appear that you are asking them to help you. We like people we do things for because of cognitive dissonance.
· It doesn’t hurt to remind people you are wanted.
· Never accept the first offer. The exception to that is jobs where it’s all set anyway (this is true for many government jobs)
· Never make the first offer. Once you make the first offer (i.e. telling them what you consider a competitive salary) you’ve already lost.
· Don’t tell them what your BATNA (best alternative to a negotiated agreement) is until you’re about to lose.

• Email is your friend. Then you have a written record of what you've been discussing.
  
• Be very careful you know EXACTLY what they are saying/offering - it is very common for misunderstandings to occur, or for you to get vague language that you take to mean one thing that means another. if unsure, clarify.

What can I negotiate?
· It’s not just about salary, you need to consider the total compensation package and what else is important to you
· For government jobs and byzantine organizations you need to work within their framework and what pots they have. In smaller jobs you can create things more easily
· vacation (if vacation is set you might be able to asked for advanced accrual so you don’t have to wait 5 years because you get 4 weeks vacation)
· CME leave
· CME expenses – if you are going to want to go to expensive conferences, buy books, macbooks etc, it is a good idea to put more money in this fund, as it is expenses related and thus untaxed money.
· Title – you might want some fancy title
· Protected time (this might be to have your own specialty clinic, for personal psychotherapy, for QI, supervision/process group, creative projects)
· Start date
· Sign on bonus
· Moving/Relocation expenses (again as this is untaxed you might wish to negotiate being able to claim furniture and other things you need to buy when you move as part of this which they might not ordinarily do)
· Call (whether you do it, how often etc)
· Visas/green card (you may have to do significant legwork in providing all the information regarding this as they may not know)
· Restrictive covenant/non-competes – in general never sign a contract with a restrictive covenant. These are illegal in some states (e.g. CA). Basically this says you cant have your own practice in the area if you leave. Not worth it.
· Whether you can have your own private practice (this differs from non-competes as some institutions don’t want you working for others because they see you as theirs, not as competition)
· Will they take a cut from expert witness work, consulting, royalties from book/product development etc?
· The actual work that you do (and don’t do)
· Administrative time
· Time for charting etc
· Model of reimbursement
· Terms for any productivity/satisfaction bonuses
· Boards/MOC/licensing/DEA fees (I see this as separate from CME but of course overlap)
· Notice (when can you leave? What are the penalties)
· Loan forgiveness
· Mortgage loans (some systems will have special loans to buy property with low interest rates; some will basically give you money you don’t have to pay back if you stay there long enough) - Some of this stuff might be “secret menu” stuff
· Flexi-time
· Different schedules (for example 4x 10s, 9x 9s etc)
· Length of appointments; number of new pts/follow ups etc

Limits to negotiations
For the most part (unless its like some tiny group or you're the only psychiatrist) you're constrained by the usual agreements for the most part. They can't give you something wildly different to everyone else and they can keep track of multiple different agreements with everyone. So you want to exist within the different pots of money or other things that you know exist.

However, its usually perfectly okay to ask what is possible. Sometimes it takes someone with ambition or vision to create new terms that could eventually benefit others in the future.

You also should remember that their job is to get the best deal they can for as little as they can. You need to appreciate that by realizing what the least amount you will accept would be and convincing them that more than that is the least they can get away with offering. Sometimes it just isn't going to workout, in which case you need to be prepared to walk away. It's usually best to do so graciously, but if they're really deluded than "lolz no" will suffice.

How do you say no to a contract without burning an bridges?

 

[Jules A]

Thank you, this should be a sticky!

The best advice I can give is to network, as corny as it sounds, knowing people will get you the inside tract on opportunities and arm you with a knowledge of the salary ranges. Please consider discussing salary openly with colleagues as an important tool that protects all our wages rather than a social fax pas.

With regard to interviewing if I'm not familiar with the operation I ask their philosophy on benzos and stimulants which can be a deal breaker for me. Its better to know going in if you are going to be supported rather than get the sticky notes from the social worker running the practice asking why you aren't giving the 70yo patient on opiates their Xanax and Adderall.

 

[splik]

How do you say no to a contract without burning an bridges?

Well if you say no to an offer then they are supposed to make a counter-offer and it's on them!

If you mean you turn down a position to go elsewhere I would just be up front and end on a positive note i.e. "I was thrilled to receive this offer and enjoyed meeting with everyone but I have decided to take x position which is more in line with my interests/the town I want to live in/made me an offer I can't refuse" there's no point being negative if you're not giving them the chance to negotiate further.

If you're open to further negotiations then it's fine to negative about the offer as long as your positive about the job e.g. "I'd really love to accept this position but this is not a competitive offer/too much call/I wouldn't be happy with this/this isn't the right time" etc.

What I have found is that if you're professional during the process they will respect you and in fact they may still keep trying to recruit you (either in a ******ed way where they don't make a good faith effort or where they do tell you they'll do whatever it takes). Even if you're a jerk, some places are so desperate they will still come after you with crappy offers lol. I wouldn't advise being a jerk but it is sometimes hard to be professional when some people are anything but

 

[northernpsy]

Some good advice here! Thanks for bringing this up.
I think those of us who have already graduated do need to try to help the new grads with this because it helps all of us out if we all realize what we are worth and negotiate for what we deserve. I think a lot of times new docs sell themselves short because they don't realize how valuable they are.

Personally, I wouldn't say to never sign a contract with a restrictive covenant/non compete clause but to definitely pay attention to what the terms are and decide if the terms of it are reasonable to you.

If the restriction is so long in duration or covers such a wide area that you would have no choice but to move out of the area if you don't like the job then I would definitely refuse to sign it. I don't think it is necessarily unreasonable for an employer to ask you to not open up shop right next door to the hospital right after you leave though. 😉

 

[Trismegistus4]

Personally, I wouldn't say to never sign a contract with a restrictive covenant/non compete clause but to definitely pay attention to what the terms are and decide if the terms of it are reasonable to you.

If the restriction is so long in duration or covers such a wide area that you would have no choice but to move out of the area if you don't like the job then I would definitely refuse to sign it. I don't think it is necessarily unreasonable for an employer to ask you to not open up shop right next door to the hospital right after you leave though. 😉

Yes, I don't think it's realistic to never sign a contract with a restrictive covenant/non compete clause either. My experience isn't that extensive, but my impression is that, if you're dealing with a private organization in a location that's not a completely undesirable place to live, such clauses are standard. Unless you're willing to relocate to some small town in the middle of North Dakota where they're so desperate they'll do anything for you, your contract is going to include one. Just make sure it's something you can live with. One job offer I walked away from mentioned their noncompete clause barred you from working at all in the county or the neighboring county. If you signed that and then took out a mortgage and got your kids entrenched in the local schools, they'd have you by the balls. On the other hand, the clause in my current contract only prevents me from going and taking an employed position at one of the competing large hospitals in town. I'm entirely free to start my own private practice or join a group practice.

Also, regarding the ECT thing, since there's no central certifying body for doing ECT, some places have a specific ECT training course they want all their docs to have done. So no matter how extensive your ECT experience in residency, they would still send you on that course. I'm sure it would look good if you wanted to do ECT there, but they wouldn't say "oh, great, you can start doing ECT on day 1!" They'd still make you go to the particular course they use.

 

[st2205]

I ended up signing a contract with a non-compete. Originally it was worded as 1 year period after leaving position that I couldn't work for a facility that "directly competes with them." Geographic area was the county. I originally asked for that to be removed. They ended up changing it from the county to 10 mile radius. We're living on the boarder of two counties and that language really only will exclude me from one for-profit facility (which I previously had a relationship with and had tried to recruit me). At the time (a year ago) I needed to quickly accept an offer and get a contract in hand for other reasons (purchasing a lot to build a house on) and they were offering a pretty incredible package (clearly the best in the area) and more flexibility than any other position (can work as much as little as you want as long as you're hitting minimum RVU quota which is small enough that you could knock it out part time, really). Anyhow, big health system that covers an entire state (and a couple others), so there was often a big distance between me and the centralized policy-makers at their corporate facilities.

On a couple things I wish maybe I negotiated a bit more, but it would have been about fairly minor things as the salary transitions to production (fairly generous), vacation irrelevant as you can take plenty of time off, and there's plenty of flexibility with how patients are scheduled. I tried to get them to pick up my tail coverage for moonlighting but they didn't bite. Got 43k in sign-on though.

 

[splik]

Personally, I wouldn't say to never sign a contract with a restrictive covenant/non compete clause but to definitely pay attention to what the terms are and decide if the terms of it are reasonable to you.

I get what you're saying and never is often a silly word, but I do think non-competes don't make sense in psychiatry. It's one thing if you have a derm or plastic surgery practice. But if I'm working for an institution, the kinds of patients I am going to be seeing are quite different there than what I would see in private practice. So it really doesn't make any difference. For instance if I'm working on an inpt unit or on a C-L service, I'm not going to competing with my employer when it comes to private pay pts. The exception to this is if you're in a group practice and then set out on your own. But such is the nature of psychiatry, those patients are probably going to want to come with you anyway, and not want to be interchangeable. For the most part, they just don't make sense in psych.

I don't have personal experience of this as they are illegal here, but I know people who have had some success getting non-competes removed or to make them specific enough that they don't matter.

 

[Psychotic]

I tried to get them to pick up my tail coverage for moonlighting but they didn't bite.

I am specifically concerned about this. I am considering doing some locum tenens style work for a while after I finish residency, to give me more time to sort out my interests and options, not to mention to look around the country.

However, I am concerned about having the insurance for s short period of time (say a year) and yet getting stuck with tail coverage costs if i go with employer provided insurance.

How expensive was the tail coverage for you? Any advice?

 

[psychresident14]

Moving/Relocation expenses (again as this is untaxed you might wish to negotiate being able to claim furniture and other things you need to buy when you move as part of this which they might not ordinarily do)

Would it be strange to ask a hospital system to use the maximum $15,000 moving/relocation expenses to actually just buying new furniture, appliances (like washer/dryer), even clothes at wherever one decides to practice, rather than actually taking their current furniture, appliances, etc with them? I'm looking into moving expenses and seems like moving my stuff actually costs more than the stuff themselves across the country, so I think I'd rather get new stuff.

 

[st2205]

I am specifically concerned about this. I am considering doing some locum tenens style work for a while after I finish residency, to give me more time to sort out my interests and options, not to mention to look around the country.

However, I am concerned about having the insurance for s short period of time (say a year) and yet getting stuck with tail coverage costs if i go with employer provided insurance.

How expensive was the tail coverage for you? Any advice?

My tail coverage was like ~$1,200. I think a lot of places would be small enough that they could negotiate this stuff. I think the biggest reason they couldn't is because their policies are a company wide thing (they employ about 40k people) and I'm going to a specific region, but the package for psychiatrists is made company-wide so there's lots of bureaucracy and no understanding of how they would handle covering tail policies as it's not spelled out from headquarters. They've been great about everything else though, throwing lots of money around other places. I think the bottom line is that if you are going to a smaller company or even a stand-alone psych facility, their recruitment packages will be more individualized that a large healthcare system that budges little.

 

[clausewitz2]

Would it be strange to ask a hospital system to use the maximum $15,000 moving/relocation expenses to actually just buying new furniture, appliances (like washer/dryer), even clothes at wherever one decides to practice, rather than actually taking their current furniture, appliances, etc with them? I'm looking into moving expenses and seems like moving my stuff actually costs more than the stuff themselves across the country, so I think I'd rather get new stuff.

Problem is moving expenses (for moves that are undertaken for employment purposes) are tax deductible and buying a bunch of new furniture is not. So it is not going to be fiscally equivalent for your future employer.

 

[deleted343839]

But if I'm working for an institution, the kinds of patients I am going to be seeing are quite different there than what I would see in private practice. So it really doesn't make any difference. For instance if I'm working on an inpt unit or on a C-L service, I'm not going to competing with my employer when it comes to private pay pts.

Would a non-compete even be enforceable in this situation (i.e., leaving an institution under a restrictive covenant to start a practice that is really not "competitive" with the service provided at the institution)? I'm not familiar with any legal cases like this but they must surely exist.