U.S. Moves to Bar Noncompete Agreements in Labor Contracts

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Neuronix

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It's about time!

It's impossible to find a rad onc job in my state without a large area and long-time non-compete. If you never get a pay raise or get abused in your position, you're essentially forced to move a long distance out of the area.

Finally we're making progress to end this anti-competitive practice that only hurts employed physicians.


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Members don't see this ad :)
I’ll believe it when I see it, but when I do see it I’ll celebrate big time.

I’d put my money on it having an exclusion for “high earners” or even specifically physicians… or end up like some states where you have to buy your way out.
 
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Federal law so yes but I expect there to be many legal challenges.
It wouldn't be a law, the executive branch can't just create laws. It would be a FTC regulation that would be subject to legal challenge. Obviously this would be a very pro free market policy. Question would be if FTC has the authority to make such a regulation.


From the WSJ:

WASHINGTON—The Federal Trade Commission on Thursday issued a proposal to ban the use of noncompete clauses, a move that would allow workers to take jobs with rival companies or start competing businesses without the threat of being sued by their employers.

The FTC said noncompete clauses constitute an exploitative practice that undermines a 109-year-old law prohibiting unfair methods of competition. Noncompete clauses, which typically bar employees from joining a competitor for a period after they quit, affect nearly one in five American workers, according to the agency. Long associated with higher-paid managers, the clauses have also been imposed on lower-wage workers who lack access to trade secrets, strategic plans and other reasons that could be cited for hampering job switchers, the agency says.

If the FTC eventually votes to adopt the proposal, companies would have to rescind noncompete requirements they impose on workers and let employees know about the change. FTC officials say noncompetes suppress wages, restrain new business formation and hurt the ability of companies to hire workers they need to grow.

“Noncompetes are basically locking up workers, which means they are not able to match with the best jobs,” Chair Lina Khan said on a call with reporters Wednesday. “This is bad for competition. It is bad for business dynamism. It is bad for innovation.”

The four-member commission voted 3-1 last month to issue the proposal, which is subject to a 60-day period of public comment before it can be adopted as a regulation. Republican Commissioner Christine Wilson voted against the plan, writing in a dissent that the FTC has gathered only scant evidence to support a complete ban on noncompete agreements.

The proposal was expected by business groups, which sometimes say noncompetes have beneficial effects, such as safeguarding confidential customer data and intellectual property. Ms. Khan said in an interview with The Wall Street Journal in June that it was an urgent task for the FTC to rein in the growth of noncompete agreements.

President Biden 18 months ago called on the FTC to ban or limit clauses in employment contracts that restrict workers’ freedom to change jobs. Most states limit noncompete clauses or require the restrictions be reasonable, which leaves them open to judicial interpretations. A handful of states, including California, say the clauses are unenforceable in employment contracts.

The rule proposal is the first time in decades that the FTC has embarked on a rule-making project that seeks to broadly outlaw business conduct on competitive grounds. Some conservatives have argued that the FTC lacks authority to write rules targeting anticompetitive practices.

“The rule proposes to regulate a significant portion of the American economy through a ban on noncompetes,” Ms. Wilson wrote in the dissent. A rule “indisputably will negate millions of private contractual agreements and impact employer/employee relationships in a wide variety of industries across the United States.”

If the FTC eventually adopts the proposal and creates a regulation, the measure could trigger a legal challenge by affected businesses. Federal regulators have faced headwinds from the courts in recent years over policies and enforcement tactics that some judges found to exceed the agencies’ statutory authority.

Last year, the Supreme Court said in an opinion targeting an environmental-protection rule that when federal agencies issue regulations with sweeping economic and political consequences, the measures are presumptively invalid unless Congress specifically authorized the action.

Ms. Khan has argued that the FTC has clear authority to write competition rules and has written that drafting regulations is a more efficient way to inform businesses and consumers about what the law allows. Historically, the agency has used its enforcement cases to show which acts or practices cross the line.

“There is very strong support for us taking this action,” Ms. Khan said.

The FTC has also moved under Ms. Khan to step up how it uses enforcement to go after unfair methods of competition.

On Wednesday, the FTC announced settlements with several companies that it said collectively required thousands of employees to sign noncompete agreements. The companies agreed to drop the provisions and stop enforcing them against any workers they accused of violating the rule.

The FTC said one of the defendants, Prudential Security Inc. and Prudential Command Inc., required low-wage security guards to sign contracts that barred them for two years from working for a competing firm within a 100-mile radius of where they had been stationed for Prudential. The employees typically earned wages close to the minimum wage, but Prudential’s restrictions said they would have to pay a $100,000 fine if they violated the noncompete clause, the FTC said.

Prudential Security and Prudential Command had common ownership and were based in Michigan but operated in several states, the FTC said. The companies’ owners last year sold their security business to another firm that doesn’t subject the employees to noncompete clauses, the FTC said in a legal complaint. The owners of the security companies couldn’t be reached for comment.
 
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It's about time!

It's impossible to find a rad onc job in my state without a large area and long-time non-compete. If you never get a pay raise or get abused in your position, you're essentially forced to move a long distance out of the area.

Finally we're making progress to end this anti-competitive practice that only hurts employed physicians.


This year I helped a lot of new grads review contracts. Some of the non-competes I saw were insane but there has been so much pressure on people to sign.

Seeing how non-competes have hindered new hires to start in a timely manner, you'd think this would be specifically prohibited in human service fields like medicine.
 
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This year I helped a lot of new grads review contracts. Some of the non-competes I saw were insane but there has been so much pressure on people to sign.

Seeing how non-competes have hindered new hires to start in a timely manner, you'd think this would be specifically prohibited in human service fields like medicine.

The American Bar Association says it's unethical for lawyers to have non-competes because they can impact a lawyer's ability to provide impartial counsel for a client.

Where are you American Medical Association? What a joke of a society.
 
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Presumably, if such a measure were adopted, would it help our labor market? My intuition says that it WOULD help... but I am, by no means, an economist.
 
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I have to imagine this would help ANY labor market, no? As Neuronix said, right now non-compete clauses tend to depress salaries because hospitals know they can lowball you and you're forced to take it unless you want to move out of state, take your kids out of school, etc.

Can anyone speak to the likelihood of this holding muster against legal challenges?
 
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The American Bar Association says it's unethical for lawyers to have non-competes because they can impact a lawyer's ability to provide impartial counsel for a client.

Where are you American Medical Association? What a joke of a society.
Here's the AMA policy on non-competes FYI. They have done advocacy work in this area on the state level
 
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What advocacy? This statement is pathetically weak.

"Physicians should not enter into covenants that: (a) unreasonably restrict the right of a physician to practice medicine for a specified period of time or in a specified geographic area on termination of a contractual relationship;
and
(b) do not make reasonable accommodation for patients’ choice of physician."

As if the physician has any choice.
 
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Presumably, if such a measure were adopted, would it help our labor market? My intuition says that it WOULD help... but I am, by no means, an economist.
I would think so but they’ve always been banned in California for example and I’ve never thought of that as a particularly well paying area. Perhaps it would be even worse if they were allowed though.

I believe they’re also banned in Alabama and one of the Dakotas?

I’m about to be in the job market and had this bookmarked on the subject

 
AMA:

Always Making Assumptions?
Avoiding Making Advances?
Altogether Meaningless Association?

Does -anyone- actually know anyone else who is a member of the AMA as a radonc? I mean, I know of only those who are grubbing their way into political power (repping an association like ACRO etc and getting a seat within the AMA) otherwise, not a soul. For decades..
 
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Members don't see this ad :)
I would think so but they’ve always been banned in California for example and I’ve never thought of that as a particularly well paying area. Perhaps it would be even worse if they were allowed though.

I believe they’re also banned in Alabama and one of the Dakotas?

I’m about to be in the job market and had this bookmarked on the subject


purple I guess = reformation
 
Need to ban non-competes ASAP. A lot of talk, no action yet
 
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AMA:

Always Making Assumptions?
Avoiding Making Advances?
Altogether Meaningless Association?

Does -anyone- actually know anyone else who is a member of the AMA as a radonc? I mean, I know of only those who are grubbing their way into political power (repping an association like ACRO etc and getting a seat within the AMA) otherwise, not a soul. For decades..
Their disability insurance is very reasonably priced
 
Need to ban non-competes ASAP. A lot of talk, no action yet
In an ideal world, sure, and if we are talking metros with 2-3 big hospital systems, absolutely, but if you are private/independent vs hospital, it basically will let the hospital pick off your partners until there is nothing left of your practice. And that's true outside rad onc
 
AMA:

Always Making Assumptions?
Avoiding Making Advances?
Altogether Meaningless Association?

Does -anyone- actually know anyone else who is a member of the AMA as a radonc? I mean, I know of only those who are grubbing their way into political power (repping an association like ACRO etc and getting a seat within the AMA) otherwise, not a soul. For decades..

Me! :rofl: Im probably not renewing.

I had a networking lunch today and ran in to our benign gyn surgeon. We got to discussing pay between fields and she shared that her gripe is that urology makes many multiples more for the analogous procedure in gyn (ex. oopharectomy pays a lot less than an orchiectomy). She even pointed out that within her own scope of practice, an appendectomy pays a lot more than a hysterectomy. We both agreed this is all the result of lobbying.

What is the best way for a physician to be active defending their specialty and patients? Or is there no way?

The one reason I was considering staying active in a society was to give an opportunity for activism. Maybe it is better to be locally active.
 
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In the end..

michael cohen GIF
 
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In an ideal world, sure, and if we are talking metros with 2-3 big hospital systems, absolutely, but if you are private/independent vs hospital, it basically will let the hospital pick off your partners until there is nothing left of your practice. And that's true outside rad onc
If the hospital is picking off your partners doesn't that mean they're paying them better than they can be making in private practice?

In my (limited) experience they are usually only able to poach the lower volume people in the group although admittedly they still contribute to taking call and that can become an issue if the group shrinks a lot.
 
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AMA:

Always Making Assumptions?
Avoiding Making Advances?
Altogether Meaningless Association?

Does -anyone- actually know anyone else who is a member of the AMA as a radonc? I mean, I know of only those who are grubbing their way into political power (repping an association like ACRO etc and getting a seat within the AMA) otherwise, not a soul. For decades..
20% of ASTRO members are AMA members for what it is worth.
Not the biggest fan of the AMA but not being part of the AMA seems like a worse idea when the AMA is such a heavyweight when it comes to all things reimbursement (push back on yearly CMS cuts, RUC, etc). I see my membership as nothing more than a positive ROI for rad onc (not as support of everything the AMA does or does not do)
 
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I think you'd get more ROI if you had a really, really nice night out with the gang (including drinks and extras) for your AMA dollars.

To each their own.
 
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Whether this prohibition on restrictive covenants is signed or not, in the end:

Rules are only as good as the lawyers arguing about them, or who your friends are.

There's a reason the Dosoretz crew is still practicing in Florida.

My current gig has a very complicated relationship between a few entities, and we (the institution a layer above me) just agreed to a non-compete because we know it can't be enforced, and it was the final sticking point with the other party.

Lawyers: best friends, mortal enemies.
 
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20% of ASTRO members are AMA members for what it is worth.
Not the biggest fan of the AMA but not being part of the AMA seems like a worse idea when the AMA is such a heavyweight when it comes to all things reimbursement (push back on yearly CMS cuts, RUC, etc). I see my membership as nothing more than a positive ROI for rad onc (not as support of everything the AMA does or does not do)
Admittedly, very rough maths:

5500 physician members of ASTRO x 20% = 1100 ASTRO/AMA members - 750 residents = 350 attending ASTRO/AMA members
 
Sure thing. And after the salary guarantee expires?
Hop to the next hospital

EDIT: The inflated two year guarantee thing is only effective with a harsh restrictive covenant in place on the back end.
 
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Sure thing. And after the salary guarantee expires?
Then they go back to your practice I guess? I mean isn’t that the same issue as taking a partnership track job in the first place? You are generally taking lower pay up front knowing that in the long run being in private practice will be better.

If this change actually pushes a hospital into paying people more than they’re making in private practice then that’s a feature, not a bug.
 
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Then they go back to your practice I guess? I mean isn’t that the same issue as taking a partnership track job in the first place? You are generally taking lower pay up front knowing that in the long run being in private practice will be better.

If this change actually pushes a hospital into paying people more than they’re making in private practice then that’s a feature, not a bug.
I for one, welcome my generous, new corporate overlords.
 
Admittedly, very rough maths:

5500 physician members of ASTRO x 20% = 1100 ASTRO/AMA members - 750 residents = 350 attending ASTRO/AMA members
I don't believe residents can be members of astro from what I recall.
 
I for one, welcome my generous, new corporate overlords.
There are states in which non-competes have always been banned and private practice still exists and does just as fine as anywhere else… although I will admit I don’t know as much about Rad Onc specifically.

IMO the real nail in the coffin for PP will be the fact that McMegaHospital can get paid some multiplier of the reimbursement the local PP can make from the same treatment but that has nothing to do with non-competes.
 
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I don't believe residents can be members of astro from what I recall.
I was an ASTRO member as a resident. My residency paid for it. I think that's pretty uniform everywhere. You're called a "member in training".

I'm pretty sure literally anyone can be an ASTRO member if they're willing to pay.
 
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And pay you will. Until one day, maybe 15 years in, you say.. "why am I paying 700...800.. dollars a year.. for what? What exactly does ASTRO actually do for me, particularly when I don't even go to the meeting any more and scihub is free?"
 
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Another practice that harms competition and sustains monopoly power is Certificate of Need laws, which prevent new linacs, MRI, PET and other large ticket items from being installed in an area unless your competitors agree you can, or you can demonstrate severe unmet need. Even when challenged successfully, CON means it takes years to get a new center built.

If your old hospital fires you, a CON means you can't build across the street or even one county over sometimes.
 
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If your old hospital fires you, a CON means you can't build across the street or even one county over sometimes.
Big money talking here.

The fact is, most of us are not at a high risk of being fired and are at a much higher risk of our center or hospital being subsumed into a larger system, where we are in turn valued less.

CON keeps me relatively secure. A large system could easily overwhelm our community hospital without it.

There was a time where CON could have been seen as a real impediment to a doc starting their own place, but in today's environment, other barriers to this are so enormous that I view CON as a net plus. CON likely prevents monopolization of care in my state.
 
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Another practice that harms competition and sustains monopoly power is Certificate of Need laws, which prevent new linacs, MRI, PET and other large ticket items from being installed in an area unless your competitors agree you can, or you can demonstrate severe unmet need. Even when challenged successfully, CON means it takes years to get a new center built.

If your old hospital fires you, a CON means you can't build across the street or even one county over sometimes.
Two sides to every coin. Do you want a proton center on every block, similar to the cyberknife craze a decade or two ago?

Waste of societal capital. Protons a great example of why we need CON laws vs Nancy Lee telling us she will use them regardless of the data because they have to pay off the machines
 
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If we… the rad oncs… would realize WE are the “certificate of need” as to whether or not a new center can be built, it would be a day of rejoicing indeed. I’m probably talking about a level of cooperation, collegiality, and long term loyalty that is beyond human nature however.
 
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If we… the rad oncs… would realize WE are the “certificate of need” as to whether or not a new center can be built, it would be a day of rejoicing indeed. I’m probably talking about a level of cooperation, collegiality, and long term loyalty that is beyond human nature however.
Our leadership has spoken soundly regarding that
 
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Big money talking here.

The fact is, most of us are not at a high risk of being fired and are at a much higher risk of our center or hospital being subsumed into a larger system, where we are in turn valued less.

CON keeps me relatively secure. A large system could easily overwhelm our community hospital without it.

There was a time where CON could have been seen as a real impediment to a doc starting their own place, but in today's environment, other barriers to this are so enormous that I view CON as a net plus. CON likely prevents monopolization of care in my state.
I've definitely circled back around to this opinion as well.

It played a large part in taking my current job. It's in a (relatively) rural location in a state that appears to adhere to the true spirit of CON (not arbitrarily blocking everything, but not rubber stamping everything, either).

In this era of healthcare rollups, PE, VC, and academic health systems, I took the long view and erred on the side of perceived stability at the cost of theoretical salary (from this revenue stream, at least - never forget that you're not limited to only making money through laboring as a doctor).
 

The rule falls under Section 5 of the FTC Act, which bans unfair methods of competition. So, not-for-profit healthcare systems would not be covered by the rule, said Amezcua.

“For physicians, if they are working directly for a hospital, and that hospital is a nonprofit, that hospital is not actually covered by the FTC act. So that hospital is not subject to this rule,” said Amezcua.

____
The rules would not apply to non-profit health systems, thereby excluding a massive swath of the American health care workforce, Fierce Healthcare reported.
 
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The rule falls under Section 5 of the FTC Act, which bans unfair methods of competition. So, not-for-profit healthcare systems would not be covered by the rule, said Amezcua.

“For physicians, if they are working directly for a hospital, and that hospital is a nonprofit, that hospital is not actually covered by the FTC act. So that hospital is not subject to this rule,” said Amezcua.

____
The rules would not apply to non-profit health systems, thereby excluding a massive swath of the American health care workforce, Fierce Healthcare reported.
I continue to be convinced that non profit hospitals are some of the biggest scams around

See: How nonprofit hospitals get away with the biggest rip off in America

 
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I continue to be convinced that non profit hospitals are some of the biggest scams around

See: How nonprofit hospitals get away with the biggest rip off in America


The Greatest Trick the Devil Ever Pulled Was Convincing the World He Didn’t Exist”​


-RadOncDoc21 (George Santos)
 
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The rule falls under Section 5 of the FTC Act, which bans unfair methods of competition. So, not-for-profit healthcare systems would not be covered by the rule, said Amezcua.

“For physicians, if they are working directly for a hospital, and that hospital is a nonprofit, that hospital is not actually covered by the FTC act. So that hospital is not subject to this rule,” said Amezcua.

____
The rules would not apply to non-profit health systems, thereby excluding a massive swath of the American health care workforce, Fierce Healthcare reported.

What if you're employed by a medical group associated with a hospital? I have to admit I'm woefully ignorant about how/why that is such a common set up, but if I'm not directly employed by my hospital could it still apply?
 
What if you're employed by a medical group associated with a hospital? I have to admit I'm woefully ignorant about how/why that is such a common set up, but if I'm not directly employed by my hospital could it still apply?
I'm sure they'll lobby the FTC to keep you in line
 
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What if you're employed by a medical group associated with a hospital? I have to admit I'm woefully ignorant about how/why that is such a common set up, but if I'm not directly employed by my hospital could it still apply?
Would love to hear any insight about this setup.

Why is it such a common structure? What does it do to the economics of billing/physician salary/benefits vs direct hospital employment? Are direct hospital employed set ups a thing?
 
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Would love to hear any insight about this setup.

Why is it such a common structure? What does it do to the economics of billing/physician salary/benefits vs direct hospital employment? Are direct hospital employed set ups a thing?
As always - it appears to be a Stark Law/anti-kickback thing.

All of this is relatively "new", in the grand scheme of things. Mostly a consequence of the 1980s (and the people in charge at the time).

I'm too lazy to Google it, I think Stark was introduced in 1989 and started to be enforced in the early-to-mid 90s.

Over that time frame, we had the "health system" phenomenon, and a trend towards doctors becoming employed as a result (well, and for other reasons of course).

If we think Stark is confusing now, it was doubly so in the beginning. There's articles I read about this once upon a time, and I'm a little fuzzy, but this trend of being employed by "Hospital Medical Group" and working at "Hospital" was how the original lawyers interpreted Stark exceptions. Who knows where it started, but I imagine it was quickly copied, and now it's just "how it is".
 
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Why is it such a common structure?
I like the above answer, and the structure itself bothers me quite a bit. Two sets of admins, at times confusion over who has authority over staffing decisions, one entity (either hospital or medical group) acting in their own interests at the detriment of the other partner in the structure when there really should never be an incentive to do so. Docs employed directly with the hospital or by direct contract not being valued by the dominant medical group and not getting resources.

I really see no advantage to the structure unless there is an absolute legal necessity to it.
 
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It's about time!

It's impossible to find a rad onc job in my state without a large area and long-time non-compete. If you never get a pay raise or get abused in your position, you're essentially forced to move a long distance out of the area.

Finally we're making progress to end this anti-competitive practice that only hurts employed physicians.

It's about time indeed! Happens in numerous specialties, not just rad onc. It's frequently used to abuse physicians and prevent them from getting into a different/better position.
 
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