Voyage of Discovery

January 15, 2001

What to consider before you sign a contract

Whether you are entering the work force for the first time, or simply changing jobs, finding your way to the right practice can be a daunting experience. There are many important factors to consider before signing a contract -- not the least of which are salary and benefits. But the more subtle aspects of employment, such as compatibility, location, and culture, can combine to make this voyage of discovery a rewarding one.

There's a simple rule to job-hunting, say the experts, one that will take the edge off your search and make it more productive (and one that should be familiar to all former med students): Do your homework. Before you arrive for the first interview, be sure you have researched as much about the potential practice as you can, and be sure you know what you can offer them, as well.

Get the 'going rate'

When it comes to defining priorities for a job, compensation would likely top anyone's list. And it is no secret that most physicians want their salary to reflect the "going rate." Nowadays that may take the form of either a fixed salary or a productivity component, where the amount paid to physicians depends on how much business they bring to the practice. In either case, some amount of negotiating may be needed.

Jack Valancy, president of Jack Valancy Consulting, says that it is common for practices to pay their physicians on a productivity basis, but he adds that for physicians to be paid fairly, the terms of the agreement should be clearly stated ahead of time. Physicians, especially new ones, should verify all of their expenses and find out how much control they will have over the costs that may be attributed to them.

Valancy explains that some practices pay on the amount that the physicians collect, minus expenses. The problem is that the physicians often find themselves unclear on how much has actually been collected and what their take-home pay is.

That's why Gray Tuttle, principal of Rehmann Robson PC, advocates an "openness" policy. Tuttle feels that when discussing salary, candidates should ask prospective employers to share financial information about the practice. "Find out if the practice is financially average, below average, or above average," he suggests. "Ask about the profit levels and the collectible changes. They should have nothing to hide."

It is also important to find out if there are any productivity bonuses, adds Judy Capko, senior consultant with The Sage Group. "This could help the overall motivation of the practice," she says.

Capko also suggests that, before agreeing upon a salary, physicians should consider their economic comfort zone. "Figure out if you are looking at salary as a short-term investment for a long-term benefit, or if you really want to work at that practice," she says.

Valancy agrees. "Salary is always a major factor to consider, yet you may need to weigh earning a couple more thousand dollars a year against having a better job environment with less pay," he says. "If you ask me, the choice is cut and dry. Life is too short to be miserable."

Weigh the benefits

Along with salary, benefits are an important factor in the decision-making process. Physicians should be sure that they are being offered a reputable health plan, and find out if that plan allows for family coverage. They should be clear on preferences for vacation and personal time, too, and find out if they will be reimbursed for Continuing Medical Education (CME) classes.

It is also important for physicians to fully understand the malpractice insurance the practice carries. According to Valancy, a practice normally pays for the malpractice premium, unless it is "claims made" insurance. Such a policy must be in effect not only when the incident occurs, but also when the claim is made. This is important to consider when changing jobs, he says. In such a case, one should also take out a "tail policy." A tail policy can cost thousands of dollars so, when signing with a practice, make sure it is clear who will pay the tail premium.

Tuttle agrees that a tail policy is important to have and is worth fighting for. "Make sure that the practice is willing to negotiate," he says. "That says a lot about the practice and their willingness to want to have you on board."

Will you get along?

Beyond the money and other financial considerations, what counts most in a new job is how you and your employer (and coworkers) get along. Determining your compatibility, on a personal and professional level, with a prospective practice can play a key role in the success of the decision-making process. Although it may be tempting to just show up to the interview (and get it over with), it is a good idea to take the time to write out your expectations of what constitutes a compatible colleague and a productive work environment. Then, find out the mission of the practice and see if your beliefs complement each other.

"It will save you time and aggravation if you write out your thoughts before you begin to interview," says Capko. "If you are a physician who practices on the conservative side, you may want to avoid joining a practice that follows non-conservative guidelines."

Valancy adds that knowing your clinical compatibility ahead of time can help you with further research. "Once you know what your expectations are, set aside some private time and talk with new physicians as well as physicians who have been at the particular practice for several years," he says. "Take notes and ask questions -- lots of questions."

Physicians also should take the time to look beyond the clinical opportunities at hand. For instance, if a position is available out of state, relocating may be a possibility. However, say the experts, physicians need to consider the needs of everyone affected by such a decision.

"Talk with your family and decide as a group if the move is a good move," says Capko. "Consider elderly parents and family obligations, in addition to personal responsibilities, the cost of living, and the climate and culture of the area."

Valancy adds that it is important to investigate the community that surrounds the practice and how the local school system is rated.

Be on the lookout

One of the most important (and most overlooked) factors to consider when interviewing with a practice is to be on the lookout for obvious signs of concern. For instance, what's the turnover rate of physicians in the practice? Does the practice have a revolving door? Valancy suggests asking the interviewer why the practice is looking for physicians. You might want to reconsider the position if the practice is turning over physicians on a yearly basis.

Tuttle suggests researching the level of customer satisfaction, as well. "See how long the patient's waiting period is and if there is an overall good feeling from the other patients who are waiting to be seen," he says.


A final aspect to consider before joining a practice, says Valancy, is the contract clause concerning restrictive covenant, or the restrictions on practicing in a certain geographic area for a given period of time after leaving a practice.

"If the practice has a very detailed restrictive covenant laid out for physicians, try to negotiate it," Tuttle says. "When it comes to signing the contract, make sure that you can live with it before you even pick up the pen."

Joining a new practice doesn't have to be an intimidating experience. In fact, if handled properly, and with patience and care, your new job could be the start of a lifelong, memorable odyssey.

Rebecca E. Jones can be reached at editor@physicianspractice.com.

This article originally appeared in the January/February 2001 issue of Physicians Practice.