Post-residency contract while still in medical school?

[ggidgetzz]

Hey guys, so I've been talking with some of the FM residents at my institution, and they've told me that more than half of them have employment contracts already. Ok, that's cool, but some of them said they signed them as 3rd and 4th year medical students! Has anyone else heard of this happening? I can't find any information on this through google, so I'm not sure if it's unique to my corner of the country or if this is normal.

Anyway, it sounds like a pretty sweet gig, they're getting a stipend and their loans paid off all through residency, with a 3-4 year commitment afterwards. It's not through the NHSC, it's through individual hospitals that apparently they just cold-called or emailed and expressed their interest for. Is this normal?? Have any of you done this or know of people who have?

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[Bostonredsox]

Internist not FP here, but I signed with my hospital only 5-6 months into intern year. I'm not aware of anyone who signed prior to graduating from medical school though.

 

[plica]

We have one resident at my program who signed at the end of 4th year (just prior to starting residency). That resident had done a 3 month rotation with the group and they made an offer. We have another who signed a contract 6 months into their intern year.

 

[lakesdoc]

I've already signed an employment contract for a FM job after residency. I was recruited following a 3rd year rotation. I'm receiving pretty excellent financial incentives over the next several years, and a good job with great people after residency. And this is for a job that I'd likely seek out post-residency anyway.You need to have a really good idea of what you want in a job and place to live to do this. But if you already know these things, it makes financial sense to sign on early. It's not everyone, but it worked great for my circumstances.

Also, it's not uncommon in my area (Upper Midwest) for medical students to sign on in their fourth year, especially if they are planning to work in a rural location. I know of 5 other people in my class who have made commitments to jobs post-residency. It's almost always through a rotation experience. I haven't known anyone to make a cold call and get a job out of the deal. But then again, in rural areas, in the right circumstances, that could work.

 

[ggidgetzz]

Thanks guys, this is very interesting. For those who signed during intern year without having done a rotation prior, did you have people offering you a contract or did you have to ask?

 

[cabinbuilder]

Hmm. All the hair on the back of my neck just stood up. Sounds too good to be true. Likely will be a slave with no rights. I would never do this. Be sure you have a lawyer look at the contract. Sounds like big brother preying on the naivete of those who have no idea how the real world works in the area of physician hiring.

 

[VA Hopeful Dr]

Agreed, this sounds like all kinds of bad. You don't even know what type of family medicine you want to do yet, might even end up wanting to change locations.

Leave your options open.

 

[mdmed2012]

I was reading this and thinking "that sounds like a bad idea, I'd never do that". Then I remembered I signed a contract with the Navy in my first year of medical school...

 

[HelloGoodbye]

My wife is a PA and her hospital said I could sign a contract with a stipend (this was between 3rd and 4th year). Like the above posters, it makes me nervous because I don't know for sure what type of family medicine I would be doing. Anyways, this sounds more common than I thought!

 

[JustPlainBill]

Hey guys, so I've been talking with some of the FM residents at my institution, and they've told me that more than half of them have employment contracts already. Ok, that's cool, but some of them said they signed them as 3rd and 4th year medical students! Has anyone else heard of this happening? I can't find any information on this through google, so I'm not sure if it's unique to my corner of the country or if this is normal.

Anyway, it sounds like a pretty sweet gig, they're getting a stipend and their loans paid off all through residency, with a 3-4 year commitment afterwards. It's not through the NHSC, it's through individual hospitals that apparently they just cold-called or emailed and expressed their interest for. Is this normal?? Have any of you done this or know of people who have?

With all due respect -- Are you nuts?

I signed my contract at the start of my PGY3 year, got the nice stipend with faithful promises regarding buildout money, equipment money, operating costs, CME money, etc.....yeah, well when it came time to put up or shut up, it went from "Here's what we're giving you to do this" to "You pay for it first and we'll reimburse".....the situation went downhill from there and I'm leaving ASAP....

You have no idea what will change over the next 3 years, nor do you have any idea how your residency will change YOU. Believe me when I say that it's a world of difference "managing" patients as a student with no legal remification if you upgefucht, just a bad mark on your school transcript and maybe a problem getting into a residency versus being a resident when suddenly all the crap the resident took care of that you never knew about is on you....I loved inpatient medicine as a student -- almost went IM and became a hospitalist -- After residency, I despise inpatient medicine and WILL NOT DO IT EVER AGAIN PERIOD!

You are setting yourself up contractually/legally for a world of hurt -- tell me, what's your non-compete clause? How many RVUs are you expected to work -- do you know what an RVU is? How do you calculate RVUS with respect to whether the visit is a 99213 or 99214? What do you need for a 99213? Are you required to be in a call rotation? If so, do you need to handle nursing homes? if so, are you comfortable diagnosing/treating over the phone? What's required in a Medicare initial physical? Are you required to take medicare? What about doing housecalls? Is there any OB? If there is, are YOU comfortable manging OB cases where you need to decide to cut or not? All of these sorts of questions, you'll learn experientially in residency and have no real basis, no matter how much 'managing' you did as a student, for comparison right now......

Don't do it, bro' (or bro'ette).....

 

[psychMDhopefully]

With all due respect -- Are you nuts?

I signed my contract at the start of my PGY3 year, got the nice stipend with faithful promises regarding buildout money, equipment money, operating costs, CME money, etc.....yeah, well when it came time to put up or shut up, it went from "Here's what we're giving you to do this" to "You pay for it first and we'll reimburse".....the situation went downhill from there and I'm leaving ASAP....

You have no idea what will change over the next 3 years, nor do you have any idea how your residency will change YOU. Believe me when I say that it's a world of difference "managing" patients as a student with no legal remification if you upgefucht, just a bad mark on your school transcript and maybe a problem getting into a residency versus being a resident when suddenly all the crap the resident took care of that you never knew about is on you....I loved inpatient medicine as a student -- almost went IM and became a hospitalist -- After residency, I despise inpatient medicine and WILL NOT DO IT EVER AGAIN PERIOD!

You are setting yourself up contractually/legally for a world of hurt -- tell me, what's your non-compete clause? How many RVUs are you expected to work -- do you know what an RVU is? How do you calculate RVUS with respect to whether the visit is a 99213 or 99214? What do you need for a 99213? Are you required to be in a call rotation? If so, do you need to handle nursing homes? if so, are you comfortable diagnosing/treating over the phone? What's required in a Medicare initial physical? Are you required to take medicare? What about doing housecalls? Is there any OB? If there is, are YOU comfortable manging OB cases where you need to decide to cut or not? All of these sorts of questions, you'll learn experientially in residency and have no real basis, no matter how much 'managing' you did as a student, for comparison right now......

Don't do it, bro' (or bro'ette).....

Sounds like you signed a contract to start a practice. That is stupid. If if a person knows they want to do FM however, and don't mind living in a certain area, I dont see how signing a contract for employment after residency is bad. The person would just have to make sure to have someone look at the contract.

 

[JustPlainBill]

Sounds like you signed a contract to start a practice. That is stupid. If if a person knows they want to do FM however, and don't mind living in a certain area, I dont see how signing a contract for employment after residency is bad. The person would just have to make sure to have someone look at the contract.

Hmmm --- interesting assessment --- Almost as stupid as a medical student thinking they know anything about the real world as most of them have had to practice the phrase, "Would you like fries with that" in the only jobs they've ever held --- but I digress ---

In order to enlighten you -- the "contract" was for an income guarantee in the first year of practice which included the office buildout and other things mentioned with a 4 year payback for the stipend and first year + buildout costs "loan" with no money out of pocket from me --- along with this was facilitation of student loan repayment with $160K over 4 years on a graduated scale increasing to $55K/year at the end of the 4th year --- the CEO was a slimy little piece of bovine excrement and the physician/mentor who encouraged this little excursion turned out to have a major conflict of interest that was not revealed until we were way, way down the pipe.

Now, being a new grad and trying to cough up the finances to start your own practice, unless you name is Kennedy, Rockefeller,Rothschild, can be a bit out of reach for most and while most physicians are a good risk, banks tend to be a bit leery, no matter how much they tell you it's soooo easy to borrow, Dr. psychMDhopefully ---- to loan money to sparkly new just graduating from residency physicians ---

So, let's learn to think before we speak and gain wisdom by learning from the mistakes of others who are trying to be helpful....

 

[psychMDhopefully]

Hmmm --- interesting assessment --- Almost as stupid as a medical student thinking they know anything about the real world as most of them have had to practice the phrase, "Would you like fries with that" in the only jobs they've ever held --- but I digress ---

In order to enlighten you -- the "contract" was for an income guarantee in the first year of practice which included the office buildout and other things mentioned with a 4 year payback for the stipend and first year + buildout costs "loan" with no money out of pocket from me --- along with this was facilitation of student loan repayment with $160K over 4 years on a graduated scale increasing to $55K/year at the end of the 4th year --- the CEO was a slimy little piece of bovine excrement and the physician/mentor who encouraged this little excursion turned out to have a major conflict of interest that was not revealed until we were way, way down the pipe.

Now, being a new grad and trying to cough up the finances to start your own practice, unless you name is Kennedy, Rockefeller,Rothschild, can be a bit out of reach for most and while most physicians are a good risk, banks tend to be a bit leery, no matter how much they tell you it's soooo easy to borrow, Dr. psychMDhopefully ---- to loan money to sparkly new just graduating from residency physicians ---

So, let's learn to think before we speak and gain wisdom by learning from the mistakes of others who are trying to be helpful....

Cool, I always think before I speak. And like I said before just because the deal you signed was crap, doesn't mean all of them are. You got screwed, 4 years payback for 1 year stipend, just sounds like crap upfront and there are med students who are smart enough to investigate further and seek the help of legal council before they sign.

 

[JustPlainBill]

Cool, I always think before I speak. And like I said before just because the deal you signed was crap, doesn't mean all of them are. You got screwed, 4 years payback for 1 year stipend, just sounds like crap upfront and there are med students who are smart enough to investigate further and seek the help of legal council before they sign.

Wow --- I was being nice and you just won't let it go --- So let's be a little more direct --- I do not appreciate, nor will I tolerate, anyone calling me stupid in any way, shape or form. I was working on projects that would have ended human life on the planet before you were a gleam in your daddy's eye --- I'm no one's fool and was lied to by a person I trusted and yes, for your general fund of information, I had legal counsel (competent of course), look over the contract -- again, when someone you trust lies to you, it tends to end relationships rather quickly.

 

[BlackDynamite]

How does someone go from mad scientist ending life on earth to physician? Just curious.


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[JustPlainBill]

How does someone go from mad scientist ending life on earth to physician? Just curious.


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via electrical engineering from Reagan-Bush to Bush 43 and the telecom bubble bursting....

 

[psychMDhopefully]

Wow --- I was being nice and you just won't let it go --- So let's be a little more direct --- I do not appreciate, nor will I tolerate, anyone calling me stupid in any way, shape or form. I was working on projects that would have ended human life on the planet before you were a gleam in your daddy's eye

Wow dude chill, someone on an internet forum disagrees with you and you threaten to end human life on earth, I know you mean to come across as threatening but its actually hilarious.

 

[cabinbuilder]

Sounds like you signed a contract to start a practice. That is stupid. If if a person knows they want to do FM however, and don't mind living in a certain area, I dont see how signing a contract for employment after residency is bad. The person would just have to make sure to have someone look at the contract.

Oh my, The details are too impossible to go into here and I don't wish to rehash my own bad memories. My two cents is that even though you have a lawyer to look over a contract, even though you think landing a job before residency is over is great, even though it may sound like the best job in the world, etc.............. Be afraid, be very afraid. I have been burned at least 4 times in the past 7 years on a permanent job. I just now bit the bullet and took another one after doing locums for almost 5 years because I just couldn't put myself at the mercy of hateful staff and overbearing administration again after 4 failed attempts. The only reason I took this job now is that I travelled here multiple times over the past 4 years and knew it was probably the best fit for me. I have now surpassed the 3 month mark and think I actually might make it as an employee this time.

 

[JustPlainBill]

Wow dude chill, someone on an internet forum disagrees with you and you threaten to end human life on earth, I know you mean to come across as threatening but its actually hilarious.

Your lack of ability to read/comprehend written English is so appalling that it obviates any need for a response to this inane comment of yours --

 

[psychMDhopefully]

Oh my, The details are too impossible to go into here and I don't wish to rehash my own bad memories. My two cents is that even though you have a lawyer to look over a contract, even though you think landing a job before residency is over is great, even though it may sound like the best job in the world, etc.............. Be afraid, be very afraid. I have been burned at least 4 times in the past 7 years on a permanent job. I just now bit the bullet and took another one after doing locums for almost 5 years because I just couldn't put myself at the mercy of hateful staff and overbearing administration again after 4 failed attempts. The only reason I took this job now is that I travelled here multiple times over the past 4 years and knew it was probably the best fit for me. I have now surpassed the 3 month mark and think I actually might make it as an employee this time.

Thanks for the mature informative response, interesting, I would think if a hospital or clinic needs a physician bad enough to offer stipends and other incentives they would be smart enough to not treat the physician badly and cause them to leave.

 

[cabinbuilder]

Thanks for the mature informative response, interesting, I would think if a hospital or clinic needs a physician bad enough to offer stipends and other incentives they would be smart enough to not treat the physician badly and cause them to leave.

Yes, this is certainly the case in many places. My advice is to ask what the turnover rate is and how many doctors have they put in that position you are applying for in the past 5 years. I found out after the fact at the last fiasco that I was the 7th doctor in 18 month. They fired the doctor across the hall from me the day I started and all the 1000's of medical charts she never signed or checked labs on where promptly transferred over to my office. It took me weeks to go through them all.

You would be surprised has how much the nursing staff dictates your happiness and how much the administration dictates what you can and cannot do. It is emotionally frustrating and can be just plain miserable being in that situation. I had nurses conspire against me because I was admitting patients and they didn't like to have to work that much. Admin got on board with their complaints and forced me to leave. Beware of very small town politics because outsiders with new ideas, etc. are not embraced very well.

 

[psychMDhopefully]

Yes, this is certainly the case in many places. My advice is to ask what the turnover rate is and how many doctors have they put in that position you are applying for in the past 5 years. I found out after the fact at the last fiasco that I was the 7th doctor in 18 month. They fired the doctor across the hall from me the day I started and all the 1000's of medical charts she never signed or checked labs on where promptly transferred over to my office. It took me weeks to go through them all.

You would be surprised has how much the nursing staff dictates your happiness and how much the administration dictates what you can and cannot do. It is emotionally frustrating and can be just plain miserable being in that situation. I had nurses conspire against me because I was admitting patients and they didn't like to have to work that much. Admin got on board with their complaints and forced me to leave. Beware of very small town politics because outsiders with new ideas, etc. are not embraced very well.

So if they are making all the doctors quit, where are they getting the money to pay all these horrific nurses and administrators. They have to be bringing in money somehow right?

 

[cabinbuilder]

So if they are making all the doctors quit, where are they getting the money to pay all these horrific nurses and administrators. They have to be bringing in money somehow right?

Again, small town politics dictate much and can be very corrupt. If you are not on the "good list" your days are numbered - always. Seen in more than once. Been in the middle of it more than once.

 

[Bacchus]

Let's behave like the professionals we are. Also, be careful when quoting posts as they may be very old (2 years in the case) and people's viewpoints may have changed.

 

[drcrispmd]

Thanks for the mature informative response, interesting, I would think if a hospital or clinic needs a physician bad enough to offer stipends and other incentives they would be smart enough to not treat the physician badly and cause them to leave.

You would be surprised. I would not recommend signing a contract that early. What if you end up not matching and soap into something else? With fan med that usually is not the case but you never know. What if you do 1 year and decide family med is not for you? Does their 1 year guarantee salary include your stipend? By that I means they take what they pay in stipend, subtract from that guarantee and that will be your actual first year salary. There are a lot that can be left out that you may not realize in med school. We went through a practice management rotation during residency and a lawyer who went does physician contracts went over a ton of things to watch for. Some hospitals offer their own loan repayment, which who does not love that. However, a lot of family med jobs start as a guarantee for a couple of years. During those couple of years you do not get bonuses for production. The reason is this is what is paying for your loan repayment money and in some places of your rvu is low and does not cover the loan repayment you may owe more time or owe them. I remember the lawyer discussing a specific contract. Thankfully my contract at my current job is open ended, all I have to do is give a 90 day notice which I did a month ago. My situation had to do with issues with front office staff and absolutely no support from the main office. (Basically my PA, who walked out in October, and I were told since they are only making $10 an hour we should just deal with it). There are other things but that was really the big thing. I was the first physician the clinic had for 5 years. It had been staffed with PA with the supervising doc 45 mins away. On paper and in interview this seem like a good place and group of clinics to work for until I was there. You would not want to sign on for a 5 year contract until you know you love working there. And, who knows what salary will be in 4-5years. You could really screw yourself if that goes up.

Definitely have a lawyer who does physician contracts look over anything (not just any lawyer).


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[VA Hopeful Dr]

Thanks for the mature informative response, interesting, I would think if a hospital or clinic needs a physician bad enough to offer stipends and other incentives they would be smart enough to not treat the physician badly and cause them to leave.

You would be incorrect. I left a job 1 year ago and have still not been replaced (and they started looking 2 months after I started), yet despite that they still treated me like ****.

 

[psychMDhopefully]

You would be incorrect. I left a job 1 year ago and have still not been replaced (and they started looking 2 months after I started), yet despite that they still treated me like ****.

Yeah, thats the part I don't get. If they are recruiting obviously they need someone ( or do they really?), but when they get someone who will bring money into the practice they treat them like crap? Not biting the hand that feeds you seems like a common sense thing.

 

[VA Hopeful Dr]

Yeah, thats the part I don't get. If they are recruiting obviously they need someone ( or do they really?), but when they get someone who will bring money into the practice they treat them like crap? Not biting the hand that feeds you seems like a common sense thing.

Its because most physicians will just put up with bad work situations because the money is pretty good (mine sure was). I'm just lucky to have a) no debt and b) a physician wife who can support us while my solo practice gets off the ground.

That said, I'm SUPER angry because this urgent care that made me work Xmas Eve and Day 2 years ago closed on both of those days this year due to lack of staff.

 

[SXMMD]

Yeah, thats the part I don't get. If they are recruiting obviously they need someone ( or do they really?), but when they get someone who will bring money into the practice they treat them like crap? Not biting the hand that feeds you seems like a common sense thing.

On what planet do you live on that all decision making/interactions with people are done in a polite, objective, rational, mature, professional way?

 

[Makati2008]

With all due respect -- Are you nuts?

I signed my contract at the start of my PGY3 year, got the nice stipend with faithful promises regarding buildout money, equipment money, operating costs, CME money, etc.....yeah, well when it came time to put up or shut up, it went from "Here's what we're giving you to do this" to "You pay for it first and we'll reimburse".....the situation went downhill from there and I'm leaving ASAP....

You have no idea what will change over the next 3 years, nor do you have any idea how your residency will change YOU. Believe me when I say that it's a world of difference "managing" patients as a student with no legal remification if you upgefucht, just a bad mark on your school transcript and maybe a problem getting into a residency versus being a resident when suddenly all the crap the resident took care of that you never knew about is on you....I loved inpatient medicine as a student -- almost went IM and became a hospitalist -- After residency, I despise inpatient medicine and WILL NOT DO IT EVER AGAIN PERIOD!

You are setting yourself up contractually/legally for a world of hurt -- tell me, what's your non-compete clause? How many RVUs are you expected to work -- do you know what an RVU is? How do you calculate RVUS with respect to whether the visit is a 99213 or 99214? What do you need for a 99213? Are you required to be in a call rotation? If so, do you need to handle nursing homes? if so, are you comfortable diagnosing/treating over the phone? What's required in a Medicare initial physical? Are you required to take medicare? What about doing housecalls? Is there any OB? If there is, are YOU comfortable manging OB cases where you need to decide to cut or not? All of these sorts of questions, you'll learn experientially in residency and have no real basis, no matter how much 'managing' you did as a student, for comparison right now......

Don't do it, bro' (or bro'ette).....

I totally agree with this. All it takes for administration to die/retire/change of mind and your life will be hell. Currently I'm in a similar boat and I'll be staring a bad situation in the face in about 25 months.


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[psychMDhopefully]

On what planet do you live on that all decision making/interactions with people are done in a polite, objective, rational, mature, professional way?

Still no one has answered my question, if they running away all the docs, how are they making money?

 

[SXMMD]

Still no one has answered my question, if they running away all the docs, how are they making money?

The short version- on the margins

the long version- they're probably not. Many of these types of business (in healthcare and outside) give the appearance of making money when all that is happening is "third spacing"- i.e. the money is being shunted to administrators/executives while the company becomes less and less sustainable before eventually shutting down or being bought out and gutted/restructured by new management. Multiple sources of revenue (including grants from government for things like EMR use, etc) keep the ship sinking slow as opposed to sinking instantly (which is what the lay person imagines happens when they hear a business is unprofitable).

 

[VA Hopeful Dr]

Still no one has answered my question, if they running away all the docs, how are they making money?

Because fresh grads from residency take these jobs not knowing any better, leave after a few years and the cycle repeats.

 

[psychmanfreud]

Is there anyone new to the conversation, and civil. That can discuss this further? @

I've already signed an employment contract for a FM job after residency. I was recruited following a 3rd year rotation. I'm receiving pretty excellent financial incentives over the next several years, and a good job with great people after residency. And this is for a job that I'd likely seek out post-residency anyway.You need to have a really good idea of what you want in a job and place to live to do this. But if you already know these things, it makes financial sense to sign on early. It's not everyone, but it worked great for my circumstances.

Also, it's not uncommon in my area (Upper Midwest) for medical students to sign on in their fourth year, especially if they are planning to work in a rural location. I know of 5 other people in my class who have made commitments to jobs post-residency. It's almost always through a rotation experience. I haven't known anyone to make a cold call and get a job out of the deal. But then again, in rural areas, in the right circumstances, that could work.

Any information on how this turned out, if you are still active on here? I have a hunch we may be in the same area.

 

[FrustratedFamDoc]

All of the advice given from the seasoned, well screwed over attendings is still 100% spot on. Just because it got heated and it was not what some wanted to hear does not mean it was wrong. Signing a contract before you've even begun residency WILL NEVER be in your best interest. Any place willing to roll the dice on someone who hasn't even graduated medical school reeks of desperation. The question you need to ask yourself is... why are they that desperate.

 

[Vandalia]

The previous reply in certainly correct.

The correct way to interpret any stipend during residency (or even medical school) is as a loan. I guarantee if you actually analyze it, you will find that you are paying a usurious rate of interest. You in fact may be ahead to simply take a cash-advance on a credit card and pay the 18% interest.

 

[IntheClouds4ever]

I know of peers that signed contracts in their home towns (rural) before medical school and are getting their schooling paid for. Depends on your situation, I guess. If you already have life after planned out (lifestyle and location) it may be beneficial, but you are definitely paying a price by shutting doors you may have not known existed. As a non-traditional with a baby on the way, I’m less interested in exploring the wide world of medicine and more inclined to look for financial security, time with my family, and being located near relatives for the sake of the kid. $2000 monthly stipend for school and residency can be very appealing..