Finishing residency and passing boards are like the final pages of the prologue to a career in medicine. In the same way, receiving a formal offer and the accompanying medical employment contract from a practice or health system opens the first chapter of what every new physician hopes will be a fairytale career. Knowing the steps new physicians should take before they ever see their first patient is key to a happy beginning.
A medical employment contract isn’t something to be skimmed before passing it off to a friend who is an attorney to see if anything jumps out. What was promised in the interview and negotiation process doesn’t mean anything unless it is in the contract.
Every medical employment contract should clearly define three core elements: how to get in, how to get out, and how to get paid.
That means a contract should address the expenses the practice will cover and what you will be responsible for, as well as any expectations surrounding your performance, patient volumes and call schedule availability. It may or may not contain a non-compete agreement. The bonus or profit-sharing plan should be spelled out in detail. If the practice situation involves a net-income guarantee, the exact structure should be clear. Any medical employment contract should address malpractice coverage and how settlements are determined/handled. For private practices, there should be a section dealing with the path to partnership, if possible.
Should an attorney review your medical employment contract before you sign? Not necessarily, but in most cases, yes. Regardless of the size of the organization offering the contract and whether it’s a "standard" contract or not, if there is anything you do not understand or have concerns about, ask an attorney who specializes in healthcare contracts to look at it.
Having it reviewed by a friend who is an attorney - but who doesn’t focus on medical employment law - is not sufficient. He or she likely doesn’t have the knowledge base needed to point out something that is off or that can be better negotiated in your favor.
Typically, an experienced health care attorney will cost at least $250 to $350 per hour. A contract review, depending on the complexity, may cost $2,000 or more (for reference, Afferent offers a flat rate of $750 for a contract review by a healthcare attorney). Reading the contract and noting any of your concerns - known as "redlining" - before giving it to an attorney can expedite the process and save money.
Before hiring an attorney to review the contract, ask about their process. Beware that organizations offering a cut-rate price for legal review of a medical employment contract may be outsourcing the review to another country, like India or the Philippines. Or they may only have a paralegal look at it before an attorney signs off without so much as thumbing through it.
Obtaining a medical license from a state licensing board can take anywhere from 30 days to 9 months depending on the state.
Any issues surrounding medical licensing should have come up during the interview process, but there’s always a chance that something was missed.
Consider using the Federation Credentials Verification Service (FCVS) from the Federation of State Medical Boards when applying for a state license, which creates a permanent, lifetime portfolio of credentials you can use to speed up the process if you ever need to apply for another state license.
Rather than buying a house in a new city, consider renting for at least six months in the area where you and your family may eventually want to settle. By renting, you will be able to save for a larger down payment and determine if an area is the right location for work and play.
Additionally, more than 25 percent of new physicians leave their first practice within the first two years. Not being tied up in a mortgage increases flexibility and is one less thing to stress about if there’s an early separation from the practice.
Don’t wait until your first day to start marketing yourself. Ask the organization if someone can introduce you to potential referral sources before you even begin. Draft a biography and ask the practice’s marketing person to post it online. Volunteer to write an article or blog post for the website or any publication with which the practice may have a relationship.
By following these steps, you can limit the number of unknowns as you find a career and transition into practice.