Tips and tricks to negotiate a contract?

[cyanide12345678]

Beginning to start job hunting for my first post residency job. Looking for insight on the following:

1) How to get these CMGs to come up on their hourly rates? All CMGs I've talked to have given subpar unimpressive hourly rates initially quoted. The same job through locum websites is paying a lot more. For example hospital A CMG A is offering 185/hr full time (+ 80k bonus for 2 year contract and benefits). Locums company has the same hospital at 275/hr on ED job boards (which eventually comes to a much higher total compensation). If someone quotes me 185, if I start negotiation at 240-250, do I just come across as a greedy bastard? One of my seniors couldn't even negotiate these guys up to 200 from 185 for this particular position and ended up signing with someone else because they didn't budge.

2) If CMG X quotes you guys 200 per hour for a generic 2 pph kind of a job, decent support staff, the usual benefits and lets say a 50k bonus for a 2 year contract. Where would you start your negotiation at when you counter?

3) I see all these places saying they love night docs and people getting 30-50 bucks an hour for night differential. What's the best way to get these companies give such generous night diffs? All places I've unfortunately looked at seem to have nocturnists and their need for nocturnists isn't there. My radius is limited to 50 miles because of a spouse in residency, so I might not have encountered places desperate for night docs yet.

3) What are some must haves in a contract? Non compete would probably be one, what else?

4) What are some other perks one should sneak into a contract that you guys recommend or have done for yourselves?

5) Why not just do locums and not be that sucka who works the same job for less pay? How hard would it be to do locums within a 50 mile radius which has 10 or so hospitals.

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[RustedFox]

1. You can't. Sorry.
2. You can ask for a higher signing bonus, but they'll ask for a longer period of time from you. This is unwise for several reasons. Veers?
3. Others can help you more than I with this answer. CMGs in general are not flexible with these things.
4. Sole rights to any publications generated by yourself.
5. Depends on the region and what you're getting into. Also, locums work isn't steady (you might find yourself with not enough hours to make your budget) and has other reasons for being a bad idea when you're right out of residency.

 

[miacomet]

1. You can't. Sorry.
2. You can ask for a higher signing bonus, but they'll ask for a longer period of time from you. This is unwise for several reasons. Veers?
3. Others can help you more than I with this answer. CMGs in general are not flexible with these things.
4. Sole rights to any publications generated by yourself.
5. Depends on the region and what you're getting into. Also, locums work isn't steady (you might find yourself with not enough hours to make your budget) and has other reasons for being a bad idea when you're right out of residency.

Agreed with all of the above, although I don't know why locums is bad right out of residency. I really enjoyed it, and it gave me a really broad view of EM practice, job types, community standards etc. No kids, mortgage or spouse at that time, so it was a great gig.

 

[link2swim06]

It depends on the market. If they are desperate then maybe they will change a little on the rate...but otherwise probably not. They aren't going to pay you more than everyone else.

Try to negotiate on things like:
CME money
Schedule preferences
Guaranteed number of shifts
Sign on Bonus money
Get them to pay for licensing fees, credentialing fees, etc.

 

[miacomet]

Are there only CMGs in your area? No other options? Any other option, including the VA, Kaiser, employment etc would be preferable.

 

[carbonizedeyesockets]

Walk away if there is an indemnification/hold-harmless clause and they won’t remove it. They are bad and becoming more common.

Medscape: Medscape Access

 

[Brigade4Radiant]

the 185 job with locums is awful. Working fulltime with locum docs suck because they have more control of the schedule. Don't even consider working there.

 

[miacomet]

Walk away if there is an indemnification/hold-harmless clause and they won’t remove it. They are bad and becoming more common.

Medscape: Medscape Access

How common is this?

 

[RustedFox]

the 185 job with locums is awful. Working fulltime with locum docs suck because they have more control of the schedule. Don't even consider working there.

Quoted for truth.

 

[miacomet]

Why not just do locums at said job?

Oh, and avoid arbitration clauses.

 

[namethatsmell]

Tell the CMG you can’t afford to work below market rate and maybe you’ll see them in the future as a locum.


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[RustedFox]

The above described situation (locums outnumbering permanent docs and growing animosity) happened several years ago at my "first job out".

We got a sizable raise (25-35 dollars) as a result, once there were zero full-time docs remaining.

 

[cyanide12345678]

2. You can ask for a higher signing bonus, but they'll ask for a longer period of time from you. This is unwise for several reasons. Veers?
.

Yes, they already were offering 150k bonus for 3 years from the get go. I asked them for a 2 year contract instead and they came back to me with the 80k bonus for 2 years instead stating in the email that it's an initial offer. I'm pretty sure they will atleast come up to 100k over 2 years for bonus. But the way they had the bonus money worded into the contract just made me nervous. If I leave even a day before the 2 year contract is up, I will be responsible for paying back all of that money. Needless to say I'm going to try to get that out of the contract.

Also, I doubt I'm signing with CMG A with what they've offered. I just want to use their contract to leverage other companies and keep theirs as a back up.

 

[cyanide12345678]

Are there only CMGs in your area? No other options? Any other option, including the VA, Kaiser, employment etc would be preferable.

2 large CMG that has 50% of the hospitals in the area. One of them sent the sent the 185/hr + 80k sign on bonus for 2 years. The other is putting in an offer in the next couple of days, I know this other company has some wiggle room to negotiate.

2 SDGs. One of them is drowning and losing contracts left and right. Their doctors are jumping ship and joining the CMGs in the area. The group is down to two hospitals in the area with a combined volume of around 35k. They are offering 185/hr, no bonus, 2 year partnership track. Will they even have any contracts left in 2 years? Also, I'm moving after 2 years back to the glorious state of texas after my wife's residency is done That's where family is, that's where I did college and med school. The second SDG is a big group. Partnership track even lower rates. Non partnership track something like 200/hr. No where near the same bonus as the CMGs. But this is the only company I haven't talked to much, apparently they were supposed to contact me (past grad told me that their CEO will give me a call), but they never got to it.

But yea...otherwise options are pretty limited. I know which job I want, I've visited 5 hospitals in the area now, I just want to bring up the price and negotiate up as much as possible.

 

[cyanide12345678]

the 185 job with locums is awful. Working fulltime with locum docs suck because they have more control of the schedule. Don't even consider working there.

Actually this particular job isn't all that awful. 70-80% of the patients are seen by mid levels. The docs there are mostly working in a supervisory role. Before CMG A took over, the SDG group had really experienced MLPs whom they trained to take care of critical patients. The SDG group that staffed the hospital prior to CMG A taking over was started by a family friend who is now employed by the CMG, he has worked at that hospital for 25-30 years. He still is a strong advocate for this job and says that I won't find a better gig. He also said that the rate is pretty much non negotiable as everyone is paid the same, but right now due to shortage they are giving generous bonuses. I've looked at the track board of this hospital multiple days, the MLPs literally do all the heavy lifting, seeing a majority of patients regardless of acuity and the docs are in the supervisory role mostly.

 

[namethatsmell]

Actually this particular job isn't all that awful. 70-80% of the patients are seen by mid levels. The docs there are mostly working in a supervisory role. Before CMG A took over, the SDG group had really experienced MLPs whom they trained to take care of critical patients. The SDG group that staffed the hospital prior to CMG A taking over was started by a family friend who is now employed by the CMG, he has worked at that hospital for 25-30 years. He still is a strong advocate for this job and says that I won't find a better gig. He also said that the rate is pretty much non negotiable as everyone is paid the same, but right now due to shortage they are giving generous bonuses. I've looked at the track board of this hospital multiple days, the MLPs literally do all the heavy lifting, seeing a majority of patients regardless of acuity and the docs are in the supervisory role mostly.

Not to be a debbie downer, but now this job sounds even worse. 80% of patients staffed by PAs/NPs?? Unless 70% of visits are 4s and 5s this sounds like a miserable setup. Who do you think is going to be signing all of those midlevel charts?? That will likely be you Mr/Mrs Attending.* Do you think all of that liability is worth a low wage? Moreover, when you're a new attending you want time to refine your style and continue to grow...it's pretty challenging to do that when most of your time is being air traffic control for PAs/NPs. And don't think that supervising PA/NPs will be like supervising residents. Completely different. Steer clear of this gig.



* Unless this shop is part of a small but hopefully growing group of places where the pit docs have banded together and requested that the regional or local medical director sign the charts of the PA/NP patients you don't see. If your family friend is such an advocate as you suggest, demand this before you ever sign here. This is not as unreasonable request and something all ED docs should lobby for.

 

[miacomet]

You sound like you are living in some post-apocalyptic hellscape of Emergency Medicine. God I hope the pendulum swings soon and that it's not like this everywhere in a few years (or months). I would LOVE to know what part of the country you are in- presumably it's desirable or they would be paying more than $185 an hour, which is less than the VA, the IHS, Kaiser, or even my fancy resort town job, although there is no "signing bonus", which is the worst way to get paid EVER.

I realize that your wife is busy with residency, but have you considered locums, or per diem for these CMGs? I don't see anything here worth signing up for. I imagine you have loans etc, but you can do so much better than $185 that it just doesn't seem worth it, especially for the caliber of these jobs.

 

[emergentmd]

Nothing about any of these jobs sounds very good. Look.... you are out in 2 yrs when your SO is done. Why even sign a 2 yr? Why even join any SDG when you are out in 2 yrs?

You are going back to Texas in 2 yrs.

DO it now. Get a Tx license ASAP. Do locums. Make more $$$. You are going to go through this process anyways.

Unless you have kids, your SO is busy anyways. Fly off, do 5 in 7, do this twice a month. Have 2 wks off. Bank money......

You will thank me in 2 yrs.

 

[cyanide12345678]

Not to be a debbie downer, but now this job sounds even worse. 80% of patients staffed by PAs/NPs?? Unless 70% of visits are 4s and 5s this sounds like a miserable setup. Who do you think is going to be signing all of those midlevel charts??

Point duly noted. I believe the attendings do sign all mid level charts. You're right it's a lot of liability.

 

[cyanide12345678]

I would LOVE to know what part of the country you are in- presumably it's desirable or they would be paying more than $185 an hour, which is less than the VA, the IHS, Kaiser, or even my fancy resort town job, although there is no "signing bonus", which is the worst way to get paid EVER.

I realize that your wife is busy with residency, but have you considered locums, or per diem for these CMGs? I don't see anything here worth signing up for. I imagine you have loans etc, but you can do so much better than $185 that it just doesn't seem worth it, especially for the caliber of these jobs.

Sorry to break it to you, it's not a very desirable part of the country either. The supply of ED docs is abundant in this area however. Medium sized metropolitan with 500k population. 3 ED residencies within 30 miles, quite a few people end up close in the area.

I have considered locums. Infact, planning on calling D&Y and Smart locums soon. My loans aren't that terrible, I went to a texas state school with 17k tuition, plus my wife has 0 loans. The more I've talked to these companies about jobs the more they've made me want to consider locums. Like I said, I don't quite plan on signing up with CMG A who has this 185/hr job offer. I plan to use their offer as leverage against the other CMG.

 

[cyanide12345678]

Nothing about any of these jobs sounds very good. Look.... you are out in 2 yrs when your SO is done. Why even sign a 2 yr? Why even join any SDG when you are out in 2 yrs?

You are going back to Texas in 2 yrs.

DO it now. Get a Tx license ASAP. Do locums. Make more $$$. You are going to go through this process anyways.

Unless you have kids, your SO is busy anyways. Fly off, do 5 in 7, do this twice a month. Have 2 wks off. Bank money......

You will thank me in 2 yrs.

The fact that I was moving in 2 years which is why I've been discrediting the SDGs because their partnership tracks are >2 years. My spouse unfortunately has put her foot down on being a travel doc. I've considered it, the family situation just allows for local work for now.

CMG B which has quoted 190/hr initially is a company that actually is willing to negotiate. A senior of mine who signed 1 year ago with them is happy as ever. He was able to negotiate up to 215/hr. Their benefits include matching 401k in addition to the usual stuff, with a 100% immediate vesting scheduling. Their staffing is significantly better than CMG A. Both hospitals are 41-44k annual volume.

CMG A: 36 hrs doc coverage. 24-36 hrs MLP coverage (M,T,W 36 hours).
CMG B: 42 hrs doc coverage, 24 hrs MLP, and 60 ish hours of resident coverage.

Needless to say, CMG B sounds like a better job to me. I just want to really leverage my CMG A contract and squeeze CMG B because my options are fairly limited

 

[miacomet]

This depresses me for the future of EM. Ugh.

 

[jiffywerk]

Walk away if there is an indemnification/hold-harmless clause and they won’t remove it. They are bad and becoming more common.

After talking to a lawyer I heard that this is very hard to take out of locums contracts. Mainly because it is something that the hospital negotiates with the locums company so you have no real say in this.
More importantly though does this really make a difference? Regardless of whether the hospital tries to wash their hands of a locums provider or even one of their own providers who they made sign an indemnification clause, who is sued, the patient can sue and name whoever is wants and I imagine would be most interested in suing the hospital since they have the deepest pockets right?

 

[miacomet]

After talking to a lawyer I heard that this is very hard to take out of locums contracts. Mainly because it is something that the hospital negotiates with the locums company so you have no real say in this.
More importantly though does this really make a difference? Regardless of whether the hospital tries to wash their hands of a locums provider or even one of their own providers who they made sign an indemnification clause, who is sued, the patient can sue and name whoever is wants and I imagine would be most interested in suing the hospital since they have the deepest pockets right?

Wow. More reason to get out of this field ASAP. Why are med students lining up for this again?

 

[GonnaBeADoc2222]

After talking to a lawyer I heard that this is very hard to take out of locums contracts. Mainly because it is something that the hospital negotiates with the locums company so you have no real say in this.
More importantly though does this really make a difference? Regardless of whether the hospital tries to wash their hands of a locums provider or even one of their own providers who they made sign an indemnification clause, who is sued, the patient can sue and name whoever is wants and I imagine would be most interested in suing the hospital since they have the deepest pockets right?

So then walk away.

Would never sign this clause. Someone smarter can correct me if I'm wrong but my reading regarding these clauses leads me to understand that something like a patient slipping on the ground and injuring themselves or a staff member committing a HIPAA violation while you're on shift can open you up to liability.

BTW, those rates quoted above are garbage.

 

[jiffywerk]

So then walk away.

Would never sign this clause. Someone smarter can correct me if I'm wrong but my reading regarding these clauses leads me to understand that something like a patient slipping on the ground and injuring themselves or a staff member committing a HIPAA violation while you're on shift can open you up to liability.

BTW, those rates quoted above are garbage.

But legally is that applicable? Anybody can sue anyone for anything but would a jury or judge really find a physician guilty for a patient slipping on a wet floor with this clause in there vs the same scenario if the clause was not present? Not lawyer but would also like to get clarification on this.

Are others getting locums agencies to remove this from their contracts?

 

[GonnaBeADoc2222]

But legally is that applicable? Anybody can sue anyone for anything but would a jury or judge really find a physician guilty for a patient slipping on a wet floor with this clause in there vs the same scenario if the clause was not present? Not lawyer but would also like to get clarification on this.

Are others getting locums agencies to remove this from their contracts?

As with everything, might not be enforceable, but do you want to have to go through the process to find out?

 

[miacomet]

As with everything, might not be enforceable, but do you want to have to go through the process to find out?

But it sounds like it's pretty universal and not removable. Terrible. EM is so tough these days. I've noticed that locums companies have become much nastier as of late. I think there is still a shortage of EM docs, but hospitals would rather give out poor care and be understaffed rather than spend just a bit more on a doc and locums companies are trying hard to crush salaries.

 

[Vandalia]

So then walk away.

Would never sign this clause. Someone smarter can correct me if I'm wrong but my reading regarding these clauses leads me to understand that something like a patient slipping on the ground and injuring themselves or a staff member committing a HIPAA violation while you're on shift can open you up to liability..

No.

First, keep in mind that lawyers are lawyers, they are trained to see both sides of an issue.

Years ago, when my kids played youth sports, there was a big "slip and fall" lawyer who had a kid on the team. He was worried about the "liability waiver" the bus company had us sign. He worried that if the bus driver raped a kid we would have no recourse. Then, a week later he was in the news for a case where he easily defeated the waiver in somewhat similar circumstances. (To be clear, not an attack on a child, but a similar waiver.)

Lawyers write things into contracts to show whoever is paying the checks that they are doing something, even if it is not legally enforceable. (As an aside, you will probably notice somewhere in your contract that it says it is "severable", that means that the stuff they wrote that is illegal/unenforceable can be ignored rather than the whole contract being thrown out.) However, my guess is that any second year law student would be able to defeat that in a second. The lawyers want the hospital, not you.

They agree to take out language that they know is meaningless and you give up a bit of money. It is great for them.

(But don't listen to me. I am not a lawyer and every state is different.)

As an aside, since this thread is about negotiations, you don't hire a lawyer to negotiate a contract. They are really not any better at negotiation than anyone else. You hire a lawyer so that they can tell you what a contract really means. Some language may be incorporated by state law or court decisions even if it is not written in the contract. Some language written in the contract may have no effect for the same reasons. As an example, a "non-compete" can be unenforceable, or iron-clad, it just depends on the state.

 

[miacomet]

No.

First, keep in mind that lawyers are lawyers.

Years ago, when my kids played youth sports, there was a big "slip and fall" lawyer who had a kid on the team. He was worried about the "liability waiver" the bus company had us sign. He worried that if the bus driver raped a kid we would have no recourse. Then, a week later he was in the news for a case where he easily defeated the waiver in somewhat similar circumstances.

Lawyers write things into contracts to show whoever is paying the checks that they are doing something, even if it is not legally enforceable. (As an aside, you will probably notice somewhere in your contract that it says it is "severable", that means that the stuff they wrote that is illegal/unenforceable can be ignored rather than the whole contract being thrown out.) However, my guess is that any second year law student would be able to defeat that in a second. The lawyers want the hospital, not you.

They agree to take out language that they know is meaningless and you give up a bit of money. It is great for them.

(But don't listen to me. I am not a lawyer and every state is different.)

As an aside, since this thread is about negotiations, you don't hire a lawyer to negotiate a contract. They are really not any better at negotiation than anyone else. You hire a lawyer so that they can tell you what a contract really means. Some language may be implied by state law or court decisions. Some language may have no effect for the same reasons. As an example, a "non-compete" can be unenforceable, or iron-clad, it just depends on the state.

Very wise, Vandalia. So would you sign it?

 

[Vandalia]

Very wise, Vandalia. So would you sign it?

It depends. That is the fundamental point.

I would ask a good lawyer what the provision means, right now, in this particular state, and in this particular area of that state.

If he says it is meaningless, I would get that in writing and sign without hesitation. My lay belief would be that this is the case. Keep in mind that in the US, liability always flows to the person/entity with the deepest pockets. These provisions are either lawyers inflating their billable hours, or there is some tactical advantage they are trying to get over potential plaintiffs. (Perhaps the fact that it passes through a physician, even if the hospital is liable in the end, invokes some of the protections that some states provide in medical malpractice cases, I just do not know.)

If, as suggested previously, you are personally liable for anything that happens in the hospital, there is no way. I think this is incredibly unlikely.

In between? It depends. If there are two identical offers, one with the language and one without, you take the job without the language. If every job has it, you don't have much choice, unless you want to work at McDonalds.

 

[miacomet]

It depends. That is the fundamental point.

I would ask a good lawyer what the provision means, right now, in this particular state, and in this particular area of that state.

If he says it is meaningless, I would get that in writing and sign without hesitation. My lay belief would be that this is the case. Keep in mind that in the US, liability always flows to the person/entity with the deepest pockets. These provisions are either lawyers inflating their billable hours, or there is some tactical advantage they are trying to get over potential plaintiffs. (Perhaps the fact that it passes through a physician, even if the hospital is liable in the end, invokes some of the protections that some states provide in medical malpractice cases, I just do not know.)

If, as suggested previously, you are personally liable for anything that happens in the hospital, there is no way. I think this is incredibly unlikely.

In between? It depends. If there are two identical offers, one with the language and one without, you take the job without the language. If every job has it, you don't have much choice, unless you want to work at McDonalds.

Really insightful and wise, thank you. Or unless you want to be an administrator!

 

[miacomet]

Beginning to start job hunting for my first post residency job. Looking for insight on the following:

1) How to get these CMGs to come up on their hourly rates? All CMGs I've talked to have given subpar unimpressive hourly rates initially quoted. The same job through locum websites is paying a lot more. For example hospital A CMG A is offering 185/hr full time (+ 80k bonus for 2 year contract and benefits). Locums company has the same hospital at 275/hr on ED job boards (which eventually comes to a much higher total compensation). If someone quotes me 185, if I start negotiation at 240-250, do I just come across as a greedy bastard? One of my seniors couldn't even negotiate these guys up to 200 from 185 for this particular position and ended up signing with someone else because they didn't budge.

2) If CMG X quotes you guys 200 per hour for a generic 2 pph kind of a job, decent support staff, the usual benefits and lets say a 50k bonus for a 2 year contract. Where would you start your negotiation at when you counter?

3) I see all these places saying they love night docs and people getting 30-50 bucks an hour for night differential. What's the best way to get these companies give such generous night diffs? All places I've unfortunately looked at seem to have nocturnists and their need for nocturnists isn't there. My radius is limited to 50 miles because of a spouse in residency, so I might not have encountered places desperate for night docs yet.

3) What are some must haves in a contract? Non compete would probably be one, what else?

4) What are some other perks one should sneak into a contract that you guys recommend or have done for yourselves?

5) Why not just do locums and not be that sucka who works the same job for less pay? How hard would it be to do locums within a 50 mile radius which has 10 or so hospitals.

For what they are paying you, you could do UC or telehealth, so I don't really see the advantage of taking one of these jobs. I think they are hoping suckers will look at the sign-on bonus and sign up and then be stuck for three years of hell. I should add that I know plenty of NPs and PAs getting $150 an hour, so it's not worth it for a doc to be paid just a tiny bit more.

My suggestions:

-Try and negotiate company B into $200 an hour for a low number of hours a month
-Do locums internally at one of these entities if they will pay more
-Do not sign PA charts for patients you have not seen
-I don't see why you need to do locums so close to home. Why not sign on for a week a month elsewhere?
-The sign-on bonuses are balderdash. Clearly they are trying to entice people to stay longer at a crap job. They are useless and pointless.

 

[RustedFox]

For what they are paying you, you could do UC or telehealth, so I don't really see the advantage of taking one of these jobs. I think they are hoping suckers will look at the sign-on bonus and sign up and then be stuck for three years of hell. I should add that I know plenty of NPs and PAs getting $150 an hour, so it's not worth it for a doc to be paid just a tiny bit more.

My suggestions:

-Try and negotiate company B into $200 an hour for a low number of hours a month
-Do locums internally at one of these entities if they will pay more
-Do not sign PA charts for patients you have not seen
-I don't see why you need to do locums so close to home. Why not sign on for a week a month elsewhere?
-The sign-on bonuses are balderdash. Clearly they are trying to entice people to stay longer at a crap job. They are useless and pointless.

The importance of this bolded/underlined statement cannot be understated. Veers had a post on here that mathed out just how much money that would be over the course of a (say, for example) 2-year contact. Its barely a difference at all in your hourly rate after deductions/etc.

I took a 20K/2 year signing "bonus" fresh out of residency. I made that mistake. The only reason I still can justify it in the slightest is because I had pitifully little savings coming out of residency and needed a nest egg/war chest really quickly. I stayed at that job for 2 years, but it wasn't pretty.

 

[InternistDO]

The importance of this bolded/underlined statement cannot be understated. Veers had a post on here that mathed out just how much money that would be over the course of a (say, for example) 2-year contact. Its barely a difference at all in your hourly rate after deductions/etc.

$20,000 over two years is less than $6.50 more an hour before taxes, assuming you work 1,600 hours a year. If you work more hours it's even less.

 

[VA Hopeful Dr]

The importance of this bolded/underlined statement cannot be understated. Veers had a post on here that mathed out just how much money that would be over the course of a (say, for example) 2-year contact. Its barely a difference at all in your hourly rate after deductions/etc.

I took a 20K/2 year signing "bonus" fresh out of residency. I made that mistake. The only reason I still can justify it in the slightest is because I had pitifully little savings coming out of residency and needed a nest egg/war chest really quickly. I stayed at that job for 2 years, but it wasn't pretty.

I was going to say something similar. I got a decent signing bonus for a new job that helped me pay off a pesky loan that otherwise would've taken several months to manage otherwise (saved me about $5k in interest payments). Spread across the year, a signing bonus isn't much money at all but there can be value to a lump sum depending on your personal financial situation. Just make sure you go in with the right mindset.

 

[miacomet]

Thank you RF!

I should add that even a 100k signing bonus (CEP has offered this for some of their less desirable sites) is mainly a sign that the job is untenable. It's all about making the doc stay in a horrible job.

 

[cyanide12345678]

For what they are paying you, you could do UC or telehealth, so I don't really see the advantage of taking one of these jobs. I think they are hoping suckers will look at the sign-on bonus and sign up and then be stuck for three years of hell. I should add that I know plenty of NPs and PAs getting $150 an hour, so it's not worth it for a doc to be paid just a tiny bit more.

My suggestions:

-Try and negotiate company B into $200 an hour for a low number of hours a month
-Do locums internally at one of these entities if they will pay more
-Do not sign PA charts for patients you have not seen
-I don't see why you need to do locums so close to home. Why not sign on for a week a month elsewhere?
-The sign-on bonuses are balderdash. Clearly they are trying to entice people to stay longer at a crap job. They are useless and pointless.

Like I said, CMG B is actually open to negotiation. A recent grad from my residency brought them up to $215/hr from their initial quoted rate plus a sign on for a minimum contract of 120 averaged monthly hours over 1 year. So instead of the 200 you're suggesting, the lowest number I have in mind is 215 which I know they have signed atleast one other person for. Ofcourse I will try my best to try to do better than that during negotiation.

As a side note, this CMG B job initially didnt offer a sign on. I've asked them for one and told them CMG A is offering 150k for 3 years, so I'm curious as to what they get back to me with. My guess is they will offer something around 30k for 2 years which they gave to my contact who signed previously, which comes to around another 10/hr. Their added 401K matching which CMG A doesn't do upto $15600/yr is another 10/hr.

So eventually if I can bring up these to 215 like my previous co resident, that's the equivalent of $235/hr accounting for the 401k matching and sign on bonus, and then on top of that the usual benefits of health insurance, disability, vision, dental, CME, which is worth around another 15/hr for a minimum 120 hrs a month job for a total contract worth around $250/hr. That's not that terrible I think for a 2 pph gig for a place with resident support.

This doesn't sound that terrible right? Thoughts?

 

[miacomet]

Like I said, CMG B is actually open to negotiation. A recent grad from my residency brought them up to $215/hr from their initial quoted rate plus a sign on for a minimum contract of 120 averaged monthly hours over 1 year. So instead of the 200 you're suggesting, the lowest number I have in mind is 215 which I know they have signed atleast one other person for. Ofcourse I will try my best to try to do better than that during negotiation.

As a side note, this CMG B job initially didnt offer a sign on. I've asked them for one and told them CMG A is offering 150k for 3 years, so I'm curious as to what they get back to me with. My guess is they will offer something around 30k for 2 years which they gave to my contact who signed previously, which comes to around another 10/hr. Their added 401K matching which CMG A doesn't do upto $15600/yr is another 10/hr.

So eventually if I can bring up these to 215 like my previous co resident, that's the equivalent of $235/hr accounting for the 401k matching and sign on bonus, and then on top of that the usual benefits of health insurance, disability, vision, dental, CME, which is worth around another 15/hr for a minimum 120 hrs a month job for a total contract worth around $250/hr. That's not that terrible I think for a 2 pph gig for a place with resident support.

This doesn't sound that terrible right? Thoughts?

Sounds better, but I would absolutely not consider the sign-on bonus in your calculations.

 

[carbonizedeyesockets]

After talking to a lawyer I heard that this is very hard to take out of locums contracts. Mainly because it is something that the hospital negotiates with the locums company so you have no real say in this.
More importantly though does this really make a difference? Regardless of whether the hospital tries to wash their hands of a locums provider or even one of their own providers who they made sign an indemnification clause, who is sued, the patient can sue and name whoever is wants and I imagine would be most interested in suing the hospital since they have the deepest pockets right?

An indemnification clause means YOU are on the hook for the hospitals legal defense cost and any damages they incur.

"Indemnification is a legal concept meaning that one party agrees to pay for all the costs and damages another party sustains. A medical malpractice insurance policy is a form of indemnification where the insurer agrees to pay for all the defense costs and any judgment rendered against a physician."

Do you want to pay the hospitals legal bills if they are named along with you? Didn't think so.

WALK AWAY if it is there.

 

[bravotwozero]

If you're moving, and are anticipating significant moving expenses, see if you can get a relocation allowance or get them to reimburse you for your moving expenses. I was not offered this option with my contract, but got it once I asked for it. In many cases it's a tax write off for the employer anyway, so they may be more inclined to offer this to you.

 

[Cinclus]

An indemnification clause means YOU are on the hook for the hospitals legal defense cost and any damages they incur.

"Indemnification is a legal concept meaning that one party agrees to pay for all the costs and damages another party sustains. A medical malpractice insurance policy is a form of indemnification where the insurer agrees to pay for all the defense costs and any judgment rendered against a physician."

Do you want to pay the hospitals legal bills if they are named along with you? Didn't think so.

WALK AWAY if it is there.

What about mutual indemnification? I am reviewing a contract that has mutual indemnification for issues related to billing.

 

[zero0]

Just curious, how common it is to get loan repayment options in your first contract out of residency? Any anecdotal figures?

 

[Vandalia]

Just curious, how common it is to get loan repayment options in your first contract out of residency? Any anecdotal figures?

I think you are looking at this in the wrong way. When you agree to sign there is a fixed amount of compensation. Within certain constraints, the employer does not care how that pays out, "You want $50K in loan payments? Fine. We will reduce your base salary by that amount."

There is no magic pot of money. If they agree to add $X in loan payments, that is $X that you could have had as salary (or the amount that they will reduce the previous salary offer by). Makes no difference to them.

 

[zero0]

I think you are looking at this in the wrong way. When you agree to sign there is a fixed amount of compensation. Within certain constraints, the employer does not care how that pays out, "You want $50K in loan payments? Fine. We will reduce your base salary by that amount."

There is no magic pot of money. If they agree to add $X in loan payments, that is $X that you could have had as salary (or the amount that they will reduce the previous salary offer by). Makes no difference to them.

I was under the impression that employers could write off money paid to the federal gov't, so it was at least partially free money for them. That was the incentive for doing loan repayment benefits as far as I understand.

 

[Angry Birds]

I'm late to the party, and I'm sure this point has already been stated, but I'll do it just in case it hasn't: the number one thing you can do to improve your bargaining potential is to interview at many places and have alternative job offers in hand.

I also recommend reading the book "Getting to Yes."

 

[scummie]

I'll throw in the book "Negotiation Genius" as it was recommended by someone else (sorry, don't remember who) on this board awhile back.

Good advice in this thread, can't wait to use it in a year when I can start looking for jobs again! Oh happy day.

 

[Money Moniker]

Actually this particular job isn't all that awful. 70-80% of the patients are seen by mid levels. The docs there are mostly working in a supervisory role. Before CMG A took over, the SDG group had really experienced MLPs whom they trained to take care of critical patients. The SDG group that staffed the hospital prior to CMG A taking over was started by a family friend who is now employed by the CMG, he has worked at that hospital for 25-30 years. He still is a strong advocate for this job and says that I won't find a better gig. He also said that the rate is pretty much non negotiable as everyone is paid the same, but right now due to shortage they are giving generous bonuses. I've looked at the track board of this hospital multiple days, the MLPs literally do all the heavy lifting, seeing a majority of patients regardless of acuity and the docs are in the supervisory role mostly.

You sound like you are living in some post-apocalyptic hellscape of Emergency Medicine. God I hope the pendulum swings soon and that it's not like this everywhere in a few years (or months). I would LOVE to know what part of the country you are in- presumably it's desirable or they would be paying more than $185 an hour, which is less than the VA, the IHS, Kaiser, or even my fancy resort town job, although there is no "signing bonus", which is the worst way to get paid EVER.

I realize that your wife is busy with residency, but have you considered locums, or per diem for these CMGs? I don't see anything here worth signing up for. I imagine you have loans etc, but you can do so much better than $185 that it just doesn't seem worth it, especially for the caliber of these jobs.

Is this really where EM is right now, $185/hr in a less than desirable location soaking up liability for an army of midlevels? I remember threads on this very forum just 2 or 3 years ago boasting of full time gigs at $250/hr + benefits and locums hourly rates north of $300. It's scary how quickly things have deteriorated in less than 3 years, given that as a 3rd year med student I am 5 years away from entering the job market.

 

[Restart13]

I was under the impression that employers could write off money paid to the federal gov't, so it was at least partially free money for them. That was the incentive for doing loan repayment benefits as far as I understand.

I think it costs the same for them, but someone correct me if I'm wrong, it is tax free money for you if they pay $50k to your loans rather than cash bonus to you where it gets taxed at your higher tax bracket.

 

[BoardingDoc]

I think it costs the same for them, but someone correct me if I'm wrong, it is tax free money for you if they pay $50k to your loans rather than cash bonus to you where it gets taxed at your higher tax bracket.

Incorrect. You pay taxes on whatever is repaid in the same way you would be taxed if they simply gave you the money. There is no benefit to taking a "loan repayment" offer as part of a contract as opposed to simply being paid the same amount.

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