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Negotiating Your Hospital Employment: A Surgeon’s Guide  

Negotiating your hospital employment: A surgeons guide

Today’s post comes to you from a guest anonymous writer who wrote about negotiating employment as the leader of an orthopedic division.

Hope you enjoy it!


Entering hospital employment as a new surgeon offers exciting opportunities and a glimpse into the career path that lies ahead. However, many surgeons quickly accept offers without considering how their employment obligations and conditions could hinder their immediate and long-term growth.

An immediate area of concern for the healthcare community is the high rates of burnout among medical practitioners, with various studies reporting around 40% physician and 53% surgeon burnout rates.


While challenging schedules and back-to-back commitments are a norm for healthcare practitioners, what most surgeons don’t realize is that you could be setting yourself up for burnout by ignoring the details of your hospital employment contracts.



Ignoring the possibility of long-term educational and research commitments, on-call responsibilities, financial offers beyond a base salary, and limited negotiation skills will adversely impact your practice.


In this article, I will cover all the key areas of negotiating your hospital employment that will sustain a healthy and productive career.


However, before signing that contract, consider these key points to ensure a fulfilling and sustainable career.

  • Physician Assistant (PA): A PA can significantly improve efficiency, particularly by handling prior authorizations (as permitted by your state). Hiring one frees your time for more complex surgical procedures.
  • Dedicated Office Space: A secure, private office space is crucial for focused work, research activities, and even occasional breaks. Ideally, this space should be lockable and separate from shared areas like cubicles.
  • Intellectual Property (IP) Considerations: Negotiate a fair share of any intellectual property you develop during your employment. If restrictive IP policies exist, consider advocating for changes.


Protecting Your Interests


It’s crucial to maintain a career trajectory that benefits you and retains your passions and interests, particularly if you’re interested in research and surgical development.

One way to safeguard your interests is to be wary of non-compete clauses. Such limitations on your work – while not illegal – could lead to a stagnant, lackluster career. Negotiate these out of your contract if possible, or work to restrict their scope.

You should also focus on getting adequate malpractice insurance coverage, including tail coverage, in addition to a reasonable notice period should you decide to leave the hospital system.

Sometimes, new surgeons opt for opportunities that appear to be the holy grail, only to be miffed out by constraining contractual obligations.


Financial Considerations


You need to negotiate with your workplace to cover all work-related licensing fees. These may include DEA licenses, state licenses, and even fees associated with research study groups.


Ideally, this should extend to professional society memberships and board fees as well.


Streamlining Your Workflow


One of the many ways to make your life easier is to hire an administrative assistant (AA) and/or a physician assistant (PA). An AA can significantly improve your efficiency by managing your schedule and freeing you to focus on patient care.


Hiring a PA will aid in freeing up your time for complex surgical procedures while they handle prior authorizations, as permitted by your state.


Most hospitals expect you to offer time for committee work. Extensive committee participation can reduce the time you have for clinical activities. Negotiate a lower RVU requirement to reach your base salary if you’re expected to participate in many committees.


It’s also best to work on a flexible schedule. Discuss this possibility with the hospital. This could include later/early hours or spreading out administrative tasks across the day. Greater flexibility can help prevent burnout and offer a dynamic workplace environment.


Another important factor is the space you work in. Secure, private office space is paramount for focused work, research activities, and even occasional breaks.


If possible, this space should be lockable and separate from shared areas like cubicles. Don’t be too shy to ask; hospitals are often more than willing to accommodate your needs.


Building Your Team


It does take a village or an OR, so to speak. Assemble a dedicated OR or Clinic staff to ensure smooth surgical procedures. In the clinic, aim for a dedicated MA, or scribe (if needed), or consider resident coverage for routine follow-up appointments.


However, your team extends beyond the OR; utilize your PA as effectively as possible and keep communication lines open. Enable them to manage non-acute, long-term follow-up clinics, so you may dedicate more time to complex cases.


The Benefits of Planning


While these ideas may not be universally applicable, my experience as a department head has proven them to be the fundamentals of long-term success in hospital employment.


A little proactive planning can go a long way in allowing you to thrive and test the limits of your potential.


Physician Contract Negotiation Strategies for Maximizing Your Employment Terms


Entering the world of physician employment can be both an exciting and daunting time in your medical career. As you approach the climax of your job search—negotiating your contract—it is vital to recognize the significance of this phase.

It isn’t just about agreeing to terms; it’s about asserting your value, understanding the fine print of your role, and setting the stage for your future in the medical field.

Negotiation is an expected part of securing a physician position. Knowing how to approach compensation discussions is a valuable skill, as initial offers may not reflect the highest salary possible, and employers often anticipate some level of bargaining.

Additionally, it’s important to consider not just the financial aspects, but also how the job will affect your work-life balance, career trajectory, and professional satisfaction.


Key Takeaways

  • Navigating contract negotiations is critical for career advancement.
  • Financial negotiation is expected; it reflects your value.
  • A comprehensive understanding of contract terms can influence job satisfaction.


Understanding Contract Elements


Before entering into negotiations, you should have a thorough understanding of contract elements. This knowledge equips you to make informed decisions that align with your career objectives.


Employment Terms

Your employment terms lay the foundation of your professional relationship with your employer. These terms outline your role and responsibilities, expected work hours, on-call obligations, and work location.

Align your employment terms with your career goals and personal needs to ensure job satisfaction and a healthy work-life balance.


Compensation Structure

Compensation goes beyond just your salary. It includes bonuses, benefits, and incentives.

A well-structured compensation package should reflect your qualifications, experience, and the complexity of your responsibilities.

Understand each component, such as base salary, production bonuses, signing bonuses, and any potential for profit sharing to fully comprehend what’s at stake during negotiations.

For instance:

  • Base Salary: is your fixed income regardless of hours worked.
  • Production Bonuses: are additional pay based on the number of patients seen or procedures performed.
  • Signing Bonuses: are usually offered as an incentive for taking the position.
  • Profit Sharing: refers to potential revenue sharing if the practice does well financially.

Most of all, remember not to underestimate yourself by accepting a lowball offer.


Duration and Renewal

The contract duration, typically outlined in years, determines the length of your commitment. Some key aspects of your contract include the terms regarding renewal and termination.

Know the conditions under which your contract can be renewed or terminated, including notice periods and any causes for early termination. This will help you understand the potential longevity of your job and protect your interests in the event of unforeseen circumstances.


Negotiation Strategies


Effective negotiation strategies can profoundly impact the terms of your physician contract. Understanding both the nuances of the negotiation process and the specifics of what you’re negotiating for is crucial to securing a favorable contract.


Preparation and Research

Begin with comprehensive preparation and research. Know the standard compensation packages and typical benefits for your specialty and region.

Be aware of the market demand for physicians with your qualifications. This knowledge serves as a foundation for realistic and informed negotiations.

Review resources like the American Academy of Family Physicians (AAFP) on how to negotiate a physician employment contract and try to consult with legal or financial advisers who specialize in physician contracts.

You won’t ever lose out on an employment negotiation if you know how to make the first incision count.


Effective Communication Techniques

Next, employ effective communication techniques to advocate for your interests while maintaining a collaborative stance.

It is essential to clearly articulate your goals and be open to compromise. Practice active listening to understand the employer’s perspective and respond thoughtfully. Here are two ways I’ve done this:

  • Use phrases like “I understand your position, but could we also consider…” to maintain a positive tone.
  • Manifest an understanding of the contract’s details by referencing CompHealth’s comprehensive guide to physician contract negotiation.

These negotiations are not only about recognizing your own value but building a positive relationship by being open and amiable.


Avoiding Common Mistakes

Lastly, avoid common mistakes such as accepting the first offer, failing to clarify terms, or neglecting the negotiation of non-salary benefits. Thoroughly review every aspect of the offer, and avoid rushing through the process.

Ensure all negotiated changes are reflected in writing and be aware of the full implications of non-compete clauses and termination provisions, as outlined by resources like the AAFP’s Do’s and Don’ts in interviews and negotiations.


Legal Considerations


When navigating through physician contract negotiations, you must pay close attention to legal clauses that could significantly impact your professional trajectory.


Malpractice Insurance

Pay attention to the type of coverage offered. Ensure your contract specifies whether you’ll have a claims-made or occurrence-based malpractice insurance policy.

A claims-made policy requires you to be covered when both the alleged event and the claim happen, while an occurrence-based policy provides coverage for any incident that happens during the policy period, regardless of when the claim is filed.

If it’s a claims-made policy, verify if your employer provides tail coverage, which protects you from malpractice claims filed after your policy ends or after your employment termination. This is vital as claims can be made years after an incident.


Non-compete Clauses

Next, review the non-compete clauses in your contract, as these clauses can limit your ability to practice within a certain geographic area after leaving your job.

Make sure the specified radius is reasonable and does not overly restrict your future employment opportunities. Also, check that the time period during which you’re restricted from competing is realistic and aligns with your career plans.

Some contracts may have exceptions to non-compete clauses, such as ownership stakes or buy-out options. Identify and understand any available exemptions that can offer you flexibility.

Make sure to have a thorough review by a qualified healthcare attorney to navigate these challenging legal considerations.


Financial Aspects


When entering contract negotiations, understanding the financial package is crucial. It’s not just about the salary; it’s about knowing the full suite of financial benefits and liabilities, like the ones mentioned below.


Understanding Total Compensation

Your total compensation extends beyond your base salary. It includes bonuses, benefit packages, and more. Typical elements of a total compensation package include:

  • Base Salary: the fixed income you’ll earn annually.
  • Incentive Bonuses: additional earnings that may depend on performance, organizational achievements, or patient satisfaction.
  • Benefits: this can range from health insurance to retirement plans, and can contribute significantly to your overall compensation.
  • Malpractice Insurance: determine whether it’s provided and the extent of the coverage.
  • Paid Time Off (PTO): look at how much vacation and sick leave is offered.

Remember, your salary should reflect your experience, specialty, and the location where you’ll practice.


Loan Repayment and Forgiveness

Many physicians carry significant educational debt upon entering the workforce. Contracts often address loan repayment in two ways:

  1. Loan Repayment Programs: some employers offer direct repayment as a part of their compensation package. This could be an annual contribution to your loan balance.
  2. Loan Forgiveness Options: Public Service Loan Forgiveness (PSLF) may be available if you’re employed by a government or not-for-profit organization.

Review the terms of these programs carefully to understand eligibility and the long-term financial impact on your earnings.


Work-Life Balance


When negotiating your physician contract, it’s crucial to consider how the terms will impact your work-life balance.

You want to ensure that your professional responsibilities allow time for personal pursuits and rest. Consider the following:

  • Schedule Flexibility: Look for options that allow for flexible working hours or part-time opportunities. This can accommodate personal commitments, such as family time or continuing education.
  • Call Coverage: Be clear on expectations concerning on-call duties. Excessive on-call responsibilities can lead to burnout and should be addressed proactively.
  • Vacation Time: Ensure that the contract specifies adequate vacation time. Time away from work is essential for maintaining your well-being.
  • Professional Growth: Opportunities for professional development can enhance job satisfaction, important for overall balance.

Ask Questions:

  • How many hours will you be expected to work weekly?
  • What is the policy on weekend and holiday work?
  • Is there support for attending conferences or further training?


Career Development


When negotiating your physician employment contract, your long-term career growth should be a primary concern.

Pay attention to clauses such as the ones listed below that address continuing medical education (CME) allowances, opportunities for advancement, and support for specialty certifications:

  • CME Allowances: ensure that your contract provides sufficient time and financial resources for continued education to maintain licensure and stay current with medical advancements.
  • Professional Growth: look for language that shows a clear path to leadership roles or partnership opportunities. Secure commitments for mentorship programs that can steer your career progression.
  • Specialty Certifications: If you’re aiming to further specialize, confirm that your employer will support this. Your contract should clarify if there are any stipulations or support for additional training.

Frequently Asked Questions


Navigating through physician contract negotiations involves understanding critical elements that affect your career and well-being. Each question below targets key areas to help you make informed decisions.


What factors should be considered when reviewing a physician employment contract?

When reviewing your physician employment contract, you should examine the salary, benefits, work schedule, call duties, and termination provisions.

It’s essential to assess the expectations for patient care and any administrative responsibilities outlined.


How can a physician effectively negotiate higher salary and benefits?

To negotiate a higher salary and benefits, focus on your unique qualifications and the value you bring.

Be prepared to discuss market compensation rates and consider non-salary compensation that can improve your overall package, such as signing bonuses or additional vacation time.


What are common pitfalls to avoid during physician contract negotiations?

During negotiations, avoid accepting the first offer too quickly and failing to clarify vague contract terms.

Be wary of not recognizing the importance of non-salary benefits and restrictively broad non-compete clauses that may limit your future employment opportunities.


How does malpractice insurance factor into a physician contract discussion?

Malpractice insurance is crucial in a physician’s contract.

You must know whether the employer provides malpractice insurance or if you’re expected to procure it yourself.

Understand the type of coverage offered, its limits, and tail coverage responsibilities upon contract termination.


What role do non-compete clauses play in physician employment agreements?

Non-compete clauses define where and how soon you can practice after leaving an employer.

These clauses can significantly impact your career mobility; therefore, it’s imperative to negotiate terms that are fair and do not unduly restrict your ability to work.


Why is it important to involve a lawyer in the physician contract negotiation process?

Having a lawyer with experience in physician contract negotiation is important. They can identify potential legal issues, negotiate more favorable terms on your behalf, and ensure that your rights are protected throughout the negotiation process.



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