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Physician Employment Interview Kit

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The Guide to Successful Interviewing, Negotiating and Evaluating Physician Employment Offers

Overview
Successful employment begins with a good foundation, which begins with the interview process. How do you effectively prepare yourself to enter the professional world? How do you equip yourself with the right questions? How do you evaluate offers to put them on a level playing field and make them directly comparable, considering no two offers are the same? How do you effectively negotiate to obtain exactly what you want in a job offer? The answers to all these questions are right here at your fingertips. In this document, weve compiled the best material from a number of outside sources, and added it to our own experience and knowledge. The result is an interview and negotiation kit that will help prepare you to enter your interviews with confidence, ask the right questions, and review the details of offers side-by-side to determine which is best for you. We hope you will use this material thoughtfully, with the assurance of knowing that, as you use it, you are on your way to finding the best possible job.

Copyright 2010 by Physician Advisors LLC All rights reserved. No portion of this kit may be reproduced, stored in a retrieval system, or transmitted in any form or by any means--electronic, mechanical, photocopy, scanning or other--without written permission from the author, except for the inclusion of brief quotations in a critical review or article. This kit is designed to provide information in regard to the subject matter covered. It is sold with the understanding that, by presenting this information, the publisher and authors and advisers are not rendering legal, accounting or other professional services. Every effort has been made to make this kit as compete and as accurate as possible. However, there might be mistakes, both typographical and in content. Therefore, this text should be used only as a general guide and not as the ultimate source of information. Furthermore, this kit contains information available only up to the printing date. The authors, advisers and publisher shall have neither liability nor responsibility to any person or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly by the information contained in this kit.

Table of Contents

Part 1 | 15 Basic Principles for a First InterviewTM Part 2 | Before Your First Interview

Understanding Contracts 7 Understanding Employment Designations in a Contract 7 Issues for Independent Contractors 8 Issues for Employees 9 Preparing for Negotiation 9 4 Keys to Preparing for Contract Negotiations 9 Figuring out Who to Negotiate With 10 Develop Your Salary Expectations 10 Questions to Ask During the Interview 12 12 Benefits 13 Organizational Structure 14 Scheduling 16 Performance 16 Financial Stability of the Practice 17 Termination or Instance of Death 17

Part 3 | During Your First Interview

Compensation

Starting the Negotiation 18 Salary Negotiation 18 What Kind of Physician/Negotiator are you Dealing With? 20 7 Keys to Successful NegotiationTM 21 7 Things to Avoid in NegotiationTM 22

Part 4 | Evaluating the Interview and Offer Part 5 | Contact Information and End Notes 3

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15 Basic Principles for a First Interview

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When you walk into a first interview, what do you need to be thinking? How should you dress? What should you ask? How should you relate to the interviewer? Below are critical questions you should answer to present yourself in a way that will impress and build rapport with a potential employer. They are the most important things to keep in mind when preparing for a first interview with a hospital or private practice. If you follow these principles, you will be well on your way to finding the perfect career fit. 1) Know what you want in the job. Think ahead about the money, benefits, location,
type of practice, setting, patient load and practice philosophy.1

2) Write down your questions based on what you want. Having questions, even in a
first interview, shows you are prepared and serious about the position.

3) Bring your spouse. If you are married, it is wise to ask the practice if you can bring
your spouse along. If the practice is unwilling, it could be a red flag. One of the major reasons physicians leave jobs is an unhappy spouse. Let your spouse get a feel for the area. Ask to introduce your spouse to employees and partners at the practice and to show him or her the facilities. This is a significant part of the interview process and will greatly affect your decision.

4) Dress for success. Many assumptions will be made about you based on the way you
dress, so this is important. Two key principles should guide your choice of dress professional and conservative. Men should wear charcoal or navy suits. Blue or white shirts are the best option to match the suit. Women should wear conservative business suits as well, and avoid anything tight or revealing. Do not wear anything high fashion. This will quickly be interpreted as unprofessional. Also, do not wear too much cologne or perfume, because this will lead to quick negative judgments as well.

5) Engage the Environment. Show up early, and as soon as you walk in the door begin
carefully observing and engaging. Talk with the office staff warmly and ask them questions to show interest, because you never know when a good word from a member of the office staff will make a difference. Also, take note of honors, plaques, pictures and other items in the interviewers office, then ask about the ones that spark a particular interest for you. This will show you are interested and will encourage the interviewer to be more at ease and comfortable with you. Always watch and match the posture and level of seriousness of the interviewer. The goal in all of this is to be kind and respectful, and these two things go a long way in making an impression in the initial interview.2

6) Bring along new, professional copies of your CV or resume to offer if needed.

15 Basic Principles for a First Interview


to communicate it in a positive light.3

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7) Always tell the truth. If something you have to tell doesnt sound positive, figure out how

8) Never badmouth your previous employer. This will make you seem like a potential problem employee and damage your credibility. It might take some effort to resist the temptation to do so, but you MUST.

9) Keep your answers short and to the point, but make sure you are answering fully. 10) If the interview is taking place during a meal, make sure you eat lightly, avoid alcohol
and carry mints.

11) Clearly state your interest in the position. If two candidates are equally qualified, the one
who shows more interest in the job will likely receive the offer.

12) Know and emphasize what makes you unique. If you have a story that makes you memorable or a particular skill or quality you believe gives you an edge, find a natural way to share it in the interview. You want your name and qualities to be what the interviewer remembers easily when the practice is making a decision to extend an offer.

13) If you dont know the answer to a question, dont be afraid to admit it. Once you admit
you dont know, you can then offer what you believe, based on what you do know, without coming across as overconfident and uneducated. The interviewer will respect honesty, and often will throw a stumper or trick question at you to see how you respond.

14) The initial interview between the physician and the potential employer might not be the
best time to begin contract negotiations. During the interviewing process, it is generally more appropriate to focus on developing a good working relationship between the prospective employer and the physician candidate, which could carry over into the contract negotiation. During this interview process, it is critical that you keep copious notes of all employment offerings and arrangements made with the potential employer.

15) When the interview is over, make sure to show your gratitude in person, and then obtain
a business card from your contact at the practice or hospital. The business card will be helpful for you later when you send a personalized thank-you note, which is ALWAYS a good idea.

Before Your First Interview

Understanding Contracts
Most Employers Use Standard Contracts
A hospital or physician group generally will use a standard general form of contract for physicians. This is easier for the employer, and the employer generally avoids time-consuming and often undesirable negotiations when it is used. Employers use this type of contract to ensure equity of employment contracts for their physicians. It avoids potential conflicts that might arise among physicians over who has a better contract. Employers also tend to use a standard form because they feel comfortable with their common terms of employment. By including new and unfamiliar contractual provisions in an employment agreement, the employer might have fear of uncertainty as to an employers liability and obligations. It is generally the physicians obligation to offer changes or amendments to the agreement.

Flexible Provisions
Most employers, however, have latitude to amend or revise some of the provisions in a physicians employment agreement. Many employers are willing to amend terms and conditions of a physicians employment agreement to accommodate special circumstances and special needs of a physician. The burden is, however, entirely on the physician to relay those special needs and special circumstances to the potential employer for consideration.

Understanding Employment Designations in a Contract


The terms of the employment agreement should state clearly whether the physician will be considered an employee or an independent contractor. For tax purposes, the status of the physician will be determined by the actual circumstances surrounding the relationship and not necessarily by how the parties identify the physician under the employment agreement.

Independent Contractor
Sometimes physicians are offered the option of becoming a contractor, rather than an employee or partner. That means you sell your services to the practice, but you have no legal connection to the practice other than as a provider of services. There are definitely pros and cons to this kind of arrangement. An independent contracting physician has the freedom to decide things such as when to take vacation, how often to work, and which insurance policy to choose. Contractors can even work a second job IF they have time. However, its not for everyone. Independent contractors do not have insurance and other benefits provided. That makes it cheaper for the practice, but its not good for you. You have to find and provide your own benefits. You might not have say in how the practice is run. You are not allowed to be a shareholder or partner. You might be left out of important decisions that affect your work and you might make less money. Nonetheless, physicians who prefer independence and flexibililty might prefer this type of an arrangement.

Possible Issues for Independent Contractors


Control Adopting an independent contractor relationship reduces the ability of the employer to control the actions and activities of the physician. An employer might attempt to blur the distinction between an employee and independent contractor relationship. This is done by retaining control over the hiring, retention and termination of a physician, yet allowing the physician to exercise independent professional judgment in carrying out his or her duties. Outside Practice The adoption of an independent contractor relationship could allow the physician to practice medicine for entities other than the employer. The employer might attempt to limit the independent contractors right to practice outside of the employer/physician independent contractor agreement through non-compete clauses contained in the contract. Labor and Employment Laws The state where the physician intends to practice might have labor and employment laws intended to govern the relationship and liabilities between employer and employee. For example, anti-discrimination laws can apply to an employer/employee relationship, but the same protections might not apply to an independent contractor relationship. Tax Issues The employer is not obligated to withhold federal and state income taxes or make payments for Social Security, Unemployment Compensation or Workers Compensation for independent contractors. An independent contractor is responsible for his or her own taxes and should pay quarterly estimates. Employee Benefits An independent contractor usually cannot participate in the employers employee retirement plans or employee sick plans. The independent contractor also does not receive vacation pay, disability insurance, malpractice insurance or other fringe benefit plans available to employees.

Employee
An employee is an individual who is subject to the supervision, direction and control of the employer. If the employer retains the right to control the services of the physician, the physician will be considered an employee. If the physician is an employee, the payment of wages will be for a period of time rather than on a project-by-project basis. The employer also will provide tools and equipment for the physicians use in practicing medicine.

Possible Issues for Employees


Control
An employer might seek an employment arrangement specially identifying you as an employee to retain control over your practice. Under this relationship, the employer is entitled to enforce all employers policies as they relate to the physician.

Outside Practice
Under an employee-employer arrangement, an employer has a greater opportunity to limit an employees right to practice outside the realm of the employers services, compared to an independent contract arrangement.

Labor and Employment Laws


The status of employee allows you the protections of the labor and employment laws.

Tax Issues
An employer is responsible for withholding taxes from the salary of its employees.

Preparing for Negotiation


The initial interview between the physician and the potential employer might not be the best time to begin contract negotiations. During the interview process, it is generally more appropriate to develop a good working relationship between the prospective employer and the physician. A good relationship will hopefully carry over into the contract negotiation later. During this interview process, it is critical that the physician maintain copious notes of all employment offerings and arrangements made by the potential employer. The comments made by the potential employer during the interview process should eventually be drafted into the actual employment agreement. IT IS IMPORTANT TO UNDERSTAND THAT THE ORAL STATEMENTS MADE BY A POTENTIAL EMPLOYER DURING THE INTERVIEW PROCESS MIGHT NOT BE BINDING, UNLESS THEY ARE INCORPORATED INTO THE PHYSICIANS EMPLOYMENT AGREEMENT. Make sure your notes are organized and thorough. They will form the basis for your contract negotiation which will result in a contract that WILL become a binding agreement.

4 Keys to Preparing for Contract Negotiations


1) Be Prepared with Facts, Data and Research. Before attending an interview with a potential employer, investigate the terms of employment you should expect within the community you are interviewing. You should have a good idea of the salary ranges offered, fringe benefits typically offered, as well as duties expected by a potential employer. (See section below titled Questions to Ask to Prepare for an Interview.)

2) Identify your Personal Priorities and Special Circumstances. Employers are generally willing to
vary from their standard form employment agreement to accommodate the special needs or special circumstances of a physician. It is important for the physician to be able to articulate these things and be able to justify his or her position for purposes of the negotiation.

3) Research Your Potential Employer. It is important to understand the general business and services
offered by the potential employer. This understanding of the type of business of the employer, number of employees, nature of services provided, areas of service provided, etc., will assist you in your understanding of the intentions and goals of the potential employer during the negotiation.

4) Know Where You Can Give. It is helpful before beginning negotiations to understand your range of
acceptable terms and provisions. A successful negotiating skill is having the ability to provide immediate feedback and response to a potential employer when discussing a particular term or provision of the employment agreement. In some circumstances, a response of, Well, I will think about it and get back to you, could slow progress of the negotiation.

Figuring out Who to Negotiate With


It would be disappointing to get yourself into a position in which you agree and make concessions to terms and conditions of an employment agreement, then later find that the agreement is subject to the approval of someone else. At the beginning of any negotiation, it is crucial to determine whether the negotiator has the authority to bind the employer. In other words, does the negotiator have the authority to make offers and accept employment agreements? If not, it might be beneficial to schedule a time with the person who does have authority to negotiate terms and conditions of the agreement.

Develop Your Salary Expectations


1) Ask other doctors in your specialty what the average salary is for a new physician just out of residency or out of fellowship.

2) Ask the going rate for physicians in your community in your specialty. (This is to ensure that you are
comparing apples to apples and not comparing a dermatologist salary to an orthopedic surgeon salary or comparing a salary in Ohio to a salary in Southern California.)

3) Ask how much money doctors in your specialty earn after being in practice X number of years.

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During Your First Interview

Questions to Ask During the Interview


This section is designed to arm you with all the right questions to ask in the contract negotiation process. Once the first couple of interviews have been completed, the focus of the interaction with the group changes. If they like you, the conversation will turn to a job offer and terms that accompany the offer. In your excitement, you might be tempted to take what they offer without asking the right questions. DO NOT give in to this temptation. Your goal should be to ensure that the business is healthy, that the practice environment is conducive to building a long-term working relationship, and that you will be fairly compensated for the work you do for the group. This section of the guide will help you look at all the different aspects of your working relationship with the group to ensure that you find the right fit and that you are treated fairly. If you use these questions well, you will be able to create a working relationship in which you will feel confident about your working environment. You will feel respected, because you are being paid and receiving the benefits you deserve. You will be set up to succeed for the long term in your career. Using these questions as a part of your interview process is one of the most important pieces of advice we can give you.

Questions to Ask Regarding Compensation


1) What is the salary range? (It is not a bad thing to find out right away in the interview process, so you
know up front if it is in an acceptable range.)

2) What is my earnings potential in 1, 3, 5 and 10 years? 3) Whats the signing bonus, if any? 4) Is there an income guarantee? 5) Are there costs the practice will ask me to pay myself, such as malpractice insurance? What are those
costs? What are the specific terms? (For example, some firms will pay for malpractice insurance for doctors, but they wont cover the tail if the doctor is no longer at the practice. Be sure to ask for the details of all terms and make sure they are represented as fully as possible in the contract.)

6) How soon will I be considered for partnership? (Stay away from non-equity partnership.) Will there
be opportunity for a buy-in or work-in? (Work-in means over time you transition from salary to a percentage of profit from your patients or the group as a whole.) Is there a buy-in clause in the contract? What formula determines the buy-in price?

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7) Is there a productivity bonus? (If everyone gets the same salary regardless of how many patients
they see, then wheres the incentive to work harder or see more patients? There is none. But when you know, if you see X number of extra patients each month, youll be guaranteed Y extra dollars, thats an incentive for you. The only way to know if the standard is realistic is to ask other doctors at the group. If that doesnt work, then ask the interviewer outright, Whats the real chance Ill make any bonus from my productivity in year one or year two? If the group has a productivity bonus, is it based on a personal productivity schedule you must meet, or is it a collective productivity schedule that all partners and employees must meet?) 4

8) Can I take more call for more money? 9) Can I moonlight? (Moonlighting is working a second or third job.) 10) If I do outside consulting, am I allowed to keep what I earn, or do I have an obligation under my contract to give the fees to the group? (It is not common for a group to take outside consulting fees of individual doctors.)

11) Are doctors inventions created during the time of employment considered employer property and
therefore belong to the practice, or does the doctor retain ownership of any inventions? (It is possible to write the contract stating that the practice has no claim on any inventions the doctor creates.)

12) Is there an escalation clause in the contract? (There should be an escalation clause in your contract
that says for every year you work, your base salary should increase X dollars per year. If there is no substantial increase between each successive year, ask why not? Certainly, you should ask for a cost of living increase.) 4

13) Is there an annual year-end bonus?

Questions to Ask Regarding Benefits


1) What are the benefits and perks? 2) How much time off would I be offered? How many sick days? What days are considered paid holidays
that will not reduce my vacation time?

3) If the potential employer is a hospital, will they pay for time off to study for and take boards? Will
they pay for and allow time off for a boards review course? Will they pay board certification fees?

4) Is there a pension or profit sharing plan? If so, at what point will I be fully vested? How is the benefit
amount calculated?

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5) What are my hospital privileges? 6) How much time off will I get for maternity or paternity leave? (You must ask for maternity leave in
your contract even if the group has never had a woman before. Ask for the maximum amount. Try three months. If that doesnt work, ask for six to eight weeks. Keep in mind the groups thinking. While youre out on leave, they will have to cover your call, see your patients and handle your surgeries. The group loses money. They might have to try to find a part-timer to fill in. These questions can be answered simply by saying, Im single now and obviously not planning on having kids in the near future. But, just in case things change, Id like to know what options are available. Your group also might decide to mix your maternity leave with vacation time to give you extra time off. You have to negotiate this. Do your research. Find out what other groups in the area do, and use that as leverage.) 4

7) Will the hospital pay annually for continuing education courses? How much? Will these courses be
deducted from my vacation time?

8) Will the organization help my spouse find employment? 9) How does your group deal with malpractice insurance? Is it a claims-made or occurrence policy?
(Occurrence is better, because it covers you long-term, even after you leave the group.) Do you need to buy a tail? Will you be joining another group immediately? Will they provide a nose for my prior employment? How much coverage will I have? (If they say, Get your own policy, and well pay for your premiums, ask why. It is normal to take out a group policy covering the corporation and policies for individual physicians as well. If theres no other way, ask the group to list you as an additional insured on their group policy.) 4

10) What is your medical insurance package? Will you pay for family coverage too? 11) What expenses will the group pay for, and is it with pre-tax money? (Pre-tax means the group pays
for the expenses directly and separately from your pay, so the money isnt taxed as a part of your income. This might include expenses such as board and licensing fees, phone expenses, association memberships and mileage.)

12) Do I have input in nurse selection?

Questions to Ask Regarding Organizational Structure


1) How does the organization rank within its field? 2) What is the reputation of the department (or facility) to which I am applying? (Its a good idea to
check this with other knowledgeable people in the area who are not connected with this facility.)

3) What have been its goals in the last year, and did the department meet them?

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4) What are the goals of the department (or facility) in the coming year? 5) What problems or difficulties are present in the department (or facility) now? 6) What are the most important problems to solve first? 7) What will be the greatest challenge in the job? 8) What are the greatest strengths of this department and company? 9) How many people have held this job in the last five years? Where are they now? 10) Whats your practice philosophy? What will the group do--or refuse to do--for patients. (An OBGYN,
for instance, might want to know whether his colleagues perform abortions and sterilizations or use epidural anesthesia.)

11) Who is the competition? How many health organizations are in the community? How is this practice
perceived in the community? Does the practice have enemies?

12) What are the referral patterns? Are the hospitals that refer to you financially stable? How are the
emergency departments staffed? What resources are in the community to assist patients?

13) How long do physicians stay in this practice? Why did the last physician leave? What is the turnover
in employees?

14) How many doctors work in the group? How many are partners? How many full partners? How many
partial or non-equity partners? (A non-equity partner is someone who is held out to the public as a partner, but does not share in the profits of a true partner. A non-equity partner usually will be paid a higher salary than when he was simply an employee. The downside is that, as a non-equity partner, you have no right to, and cannot claim any portion of, the profits.) 4

15) How many staff members do you employ? What is the staff-to-physician ratio? 16) What procedures are performed at the clinic? Who performs these procedures? 17) How does the practice assign patients? What percentage of my patients will be managed care? Medicaid? Medicare? Whats the typical age, education and socio-economic level of the patients Ill see?

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Questions to Ask Regarding Scheduling


1) What is the call schedule? Do partners take or share call equally? How many call days per month?
How often will I have weekend call? What is the holiday call schedule? (Ask for equal call. The group might have a doctor who is retiring or close to retiring. Do you really expect him to take equal call with someone just out of their residency? Unlikely. Youve got to figure that into your equation of how badly you want this job.) 4

2) How many hours per week will I be expected to spend seeing patients in the office and in the hospital? How many patients will I be expected to see in a week?

3) Will I work in one office, or will I split my time between multiple offices, perhaps as part of a regular
rotation? What are the terms of the rotation?

4) What is the policy for assigning patients to doctors, and is it equitable? Which doctors get patients
first? Are all doctors in the group allowed to take new patients? Does a patients insured status determine which doctors can take them? Are uninsured and underinsured patients split equally among doctors? What are other criteria that determine which doctors get which patients?

5) Are there any hospital obligations in addition to office hours that I need to know about? (Being Attending of the month, giving teaching rounds to the residents, clinic coverage, supervising residents, service call, covering the ER, etc.) 4

6) How many hours am I expected to work at a time, and how many consecutive days at a time? 7) Does the group provide online services? Who handles e-mail from patients? Are physicians asked to
spend time online? How much time? What are the offices online medicine policies?

8) How many patients per hour will I be expected to see now? As a partner?

Questions to Ask Regarding Performance


1) How will my leadership responsibilities and performance be measured? By whom? How often? 2) Will there be opportunities for advancement, and how long before I might be considered for promotion? 3) What are the traits and skills of people who are the most successful in the practice? 4) Do you use an individual productivity scale or a group productivity scale? (Individual is better.) 5) How often and from whom will I receive feedback on my job performance?

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6) What would you expect me to accomplish in this job? 7) What qualifications are you looking for in the person who fills this job? 8) Are doctors here expected to socialize for business purposes outside of work? (For example, a practice
might require you to put in 12-hour days and then attend administrative meetings held informally on Saturdays at the golf course.)

Questions to Ask Regarding the Financial Stability of the Practice


1) How many managed care contracts does the practice have? 2) What is the patient insurance mix? 3) What is the groups gross collection rate? What were the groups gross charges last year? What were
the groups collections last year? What are physician mean gross charges and collections?

4) What is the operating overhead rate? 5) How are overdue bills collected? 6) How often are fee schedules reviewed? 7) How many new patients are seen per day or per week? 8) What is the practices medical record system? Hand-written notes? Dictated notes? Electronic medical
records?

9) What is the billing and accounting system?

Questions to Ask Regarding Termination or Instance of Death


1) If I die during the time Im employed with this group, how is outstanding income accounted for? Does
it become a part of my estate? Can I designate who it should go to? (Tell family members to contact the group right away after your death, if that happens, and ask them to provide documentation of the income that hasnt been paid yet.)

2) In the event that Im working with only one other doctor, what happens if the other doctor dies or
otherwise leaves the business? What happens to the physical assets? How will outstanding income be allocated? Do I have a right to take the patients, along with their files? Is there a practice continuity plan for surviving physicians?

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3) If I get sick or injured and have to miss work, will the practice hold my job and patients for me? Will
others care for my patients temporarily? What would have to happen in order for me to lose my job? Is this written into the contract?

4) If I get fired, will there be an agreed-upon time (45 - 90 days) required as notice? 5) If the group fires me, will I receive severance pay? If so, how much? 6) If I leave, how will my patients be informed? 7) Is there a non-compete clause in my contract? If so, for how long is the clause in effect after termination? If I were to violate this, what would be the penalty? (You may find a clause in your contract that says, If you violate this non-compete clause and we have to take you to court to force you to stop, you will be liable to the group for your entire years salary, or some other outrageously offensive arbitrary number like $250,000 or $500,000. NEVER, EVER, SIGN A CONTRACT THAT HAS THIS CLAUSE IN IT. Ask the group exactly how they arrived at the number they believe they would be entitled to if you open an office next door.) 4

8) What restrictive covenants will I be subject to? (A restrictive covenant is simply a promise from you that
if you leave the group for any reason, then you will not be able to practice medicine for a specific time within a specific location. YOU SHOULD NEVER voluntarily give up your hospital privileges as part of any restrictive covenant. How do you negotiate your restrictive covenant? By telling the group the geographic restriction is unreasonable, and not the standard in the community for the specialty youre in.) 4

Starting the Negotiation


Knowing the starting point for each party is important to successful negotiation. The starting point of either party can set the parameters for all future negotiations. If the starting point for either of the parties is not realistic, this could lead the negotiation down a dead-end road. Each party to a contract negotiation usually determines the expectations and attitudes of the other party based on their opening position. Successful negotiation of any employment contract begins with coming to agreement on the easy issues first, then working toward the difficult issues. By beginning with terms that are agreeable to both parties, the parties generally develop a favorable relationship that is beneficial to solving any issues in dispute.

Salary Negotiation
In addition to the terms of employment, you will negotiate with your potential employer specifically on the amount of salary or contract fees. Salary negotiations often come after you have been identified as a serious candidate for the job.

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1) What are you looking for? This is a question that needs some thought before you talk to the group
about money. If you offer the amount you want, you will have locked in the starting point for negotiation at your desired salary. This means you will not end up getting anything close to what you want, because they will reply with a much lower number and proceed to try to meet somewhere in between. Try this response instead: Im looking to join a well-respected group with people who truly love what they do. Im eager, aggressive and looking to build a practice and generate lots of profit. I know what the going rate is here, and Id like to know what youre offering. By saying this, the burden has shifted subtly to the group to make the first opening bid. This puts you in the power position to respond high and take the negotiation from there.

2) The line in the sand. At some point in the back and forth, the group will make a final take it or leave
it offer. This is the line in the sand, and it might be at a salary level less than you had hoped. If your negotiation reaches this point, you have two options. Either you take their offer immediately, knowing its less than what you wanted, or you tell them politely that youd like some time to think it over and discuss it with your spouse and/or family. If you choose this second option, which is what we suggest, you must weigh the benefits and compare it to the negatives. Assuming this is your first job offer while youre a resident or a fellow, youll likely be very excited to grab the offer for fear of losing it. You might be afraid to lose what seems to you, after residency, to be a wonderful starting salary. Certainly the salary will be significantly higher than anything youre earning as a lowly resident. But, you must not jump the gun and agree to everything thats offered yet, or you will be stuck with a salary that is less than what you deserve and less than the local going rate. Youve got to stop and think. You also should compare it to any other offer you have.

3) Value added. Once you have the final salary offer, make sure you take time to consider value added
benefits. Why? Because, when comparing offers, you need to compare apples to apples. Here is a basic example: Practice A Offers $250,000 per year, 401(k) with no match, basic health insurance coverage, exceptional occurrence malpractice insurance, three weeks vacation, equal call every 4th weekend and full paid holidays. Practice B Offers $225,000 per year, matching a 401(k) up to 7 percent, premium health insurance coverage, exceptional occurrence malpractice insurance, four weeks vacation, equal call every 3rd weekend and full paid holidays. You must take all of these benefits into account in accepting or not accepting the salary offer. The matching 401(k) alone is worth almost $16,000 after taxes, and how much do better health insurance and more paid vacation matter to you? The bottom line is that benefits are money, so make sure you make the best decision based on your values.

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What Kind of Physician/Negotiator are you Dealing With?


(Entire section adapted from Oginski, 2005.) 4 Different personalities will handle negotiations differently. Dont go into the negotiation thinking every physician thinks and acts with as much consideration and integrity as you do. Below are a few examples of personalities to watch out for.

The Arrogant Doctor


Dr. Arrogant has just finished performing his sixth surgery of the day. He comes into your interview wearing his scrubs, puts his feet on his desk, and grabs a cigar he wants to light very badly. So tell mehow are you going to make me money? he inquires of you. You know your answer is irrelevant unless it relates to making him tons of money in profit and very little for you. Dr. Arrogant has a significant attitude problem. Guess what? Youre not going to change him, and you shouldnt even try during your interview. Instead, explain to him what youve done recently, and how well you are regarded at your hospital.

The Group
You walk into an office where youve been introduced to the three partners. It turns out they are all interviewing you at the same time. It would appear they do everything together (which is not bad in and of itself). They make decisions on a group basis. Majority vote wins the day. You might not know who carries the most weight in the group. The one who talks most might simply be the one with the biggest mouth, who is the spokesperson for the group. Look for the quiet one, and ask questions of the quiet one.

The Reimbursements are down Negotiator


I can only offer you $100,000 because reimbursements are down. Medicine isnt what it used to be. This speech is given whether reimbursements are down or not. Dont buy it and feel bad for them. Stick to your guns and fight for a contract that will meet your needs and create a healthy working relationship for the future.

The Pressure Negotiator


We have seven other doctors vying for this position. If you dont snap it up now, itll be gone by next week. Either hes telling the truth about the number of doctors trying to get into the practice, or hes pulling your leg. No matter what the truth is, its important not to allow yourself to be pressured into a decision. You might reply by saying, I appreciate that, Dr. Anxiety, but I cant rush my decision. This contract will guide my life for the next few years. If you have to make your decision before Ive had a chance to properly evaluate your offer, then I thank you for your time. Im hopeful that, rather than rush the process, you would hire me based on my qualifications, and not just try to fill the position because of an arbitrary fill date.

The Friendly Negotiator


Be careful of this one. Your instincts might tell you that you can trust him, but the fact is that you dont know yet if you can. Make sure what you discuss is confirmed in your written contract.

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The Deceiver
He will deceive youpromise you one thing and claim he said another. It happens all the time. Regardless of whether its intentional or unintentional, the deceiver cannot be trusted. Listen to your instincts. Do you really want to work for someone who cannot be trusted?

The Promiser
This person makes lots of promises. Some are kept, some are not. Sure, sure, well put it in the contract. Ill have the lawyer add it to the contract. Buyer beware. The promiser tends to puff up his or her claims and promises. If you choose to join the promiser, make sure you hold him or her to those promises by getting them in writing.

The Weak Negotiator


This one cannot make a decision. He or she spends endless amounts of time thinking and performing mental gymnastics before coming to some type of inconclusive decision. You might never hear the end of the issues you bring to him or her.

7 Keys to Successful Negotiation

TM

1) Have clear objectives during negotiation. If you do not have clear objectives when discussing your
agreement with your employer, you could be signing an agreement that will cause uncertainty and unhappiness in the future. You should understand your own objectives and express them to your potential employer during negotiation to achieve an agreeable compromise.

2) Give immediate, continuous feedback to the employer. You should advise a potential employer which
terms of the agreement you agree with, and which terms are not currently agreeable. Terms that are not currently agreeable to you should be based on reasonable justification that can be clearly expressed to the potential employer.

3) Examine the agreement carefully and be prepared. Have your goals, objectives, facts and options
ready for presentation and consideration at the time that the physicians employment agreement will be negotiated. If there has not been sufficient time to prepare, admit it and arrange for additional time to review the employment agreement. Never sign an employment agreement without having a full and complete understanding of its terms and provisions.

4) Maintain a clear, distinct and factual theme throughout the negotiation. This all begins with a clear
understanding of your objectives before becoming employed with the potential employer. Clearly defined intentions and goals of employment, along with a reasonable basis and justification for these goals and intentions, give you a better chance to amend standard form provisions to satisfy your own special needs and special circumstances.

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5) Assume you and the group have opposite goals. In any negotiation, each person wants different things.
In your case, the group wants to get the services you provide as inexpensively as possible. You want to get as much income as possible. Both you and the group should push to get what they want, but the only way for both to be satisfied with the outcome is for both sides to be willing and able to compromise. If its done well, both sides feel like winners, and the contract is positive for everyone. Thats the ideal way to begin a new job.

6) Learn the art of compromise. When you have opposing goals, it will always require compromise to
reach the best solution for both parties. With this in mind, you should begin by figuring out the three most important things you need in a job. Dont bring these up right away, but work hard to obtain all three. Then look at a number of things you would be willing to give on and present those items first. This will create a collaborative environment that opens the door to obtaining your most important objectives later in the negotiation. When it comes to money, always begin by asking for more than you really need. Never take the groups first offer, because its almost always lower than they are really willing to offer. 4

7) Always show gratitude. Whether your interview went well and you believe you have the job in hand,
or you know it went poorly and you did not get the job, send a short handwritten thank-you note to the doctor who, in spite of being busy, took time to interview you. This little bit of effort could bring you significant opportunities in the future. 4

7 Things to Avoid in Negotiation


1) Do not assume you cannot negotiate.

TM

2) Do not start any negotiation with, This is my first and final offer. Successful negotiation is about
compromise.

3) Do not take a position that compromise means losing for either party. 4) Do not enter into an interview with a potential employer unprepared. 5) Do not allow yourself to be emotional or argumentative. Stay as matter-of-fact and calm as possible.
Its okay to make your point firmly and give reasons for it, but do not dwell on it. If a point is causing stress for either you or the groups negotiator, work to resolve it quickly or agree to set it aside for the time being and continue discussing other points. This will help you avoid getting off on the wrong foot with your new employer.

6) Do not beg for anything at any point. If you have to beg for your job, then you dont deserve it. 4 7) Do not lie. EVER! If you are in financial straits, tell them. If you have 12 kids to feed, tell them. If you
dont meet a qualification and they ask, tell them. Integrity is crucial in negotiation. Without it, you could lose your job later. 4

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Evaluating the Interview and Offer

Evaluating the Interview and Offer


Once the initial interview, or set of interviews, is complete and an offer is made, the real hard work begins. Evaluating the success of the interview and the merits of the offer will be the next step toward your goal of practicing medicine. The offer should be documented and presented in the form of a written contract. The purpose of this contractual agreement between you and your prospective employer is to describe the duties and responsibilities of both parties, your compensation and all of the reasonable contingencies that might exist from the first day of employment until the termination of the employment agreement. The unique needs and goals of both you and the employer should be negotiated into the terms of the relationship before the agreement is finally executed. The process of negotiating your employment agreement might set the tone for the eventual relationship between yourself and the employer. It is crucial to have a contract that clearly lays out expectations and the parameters of the working relationship. Oral agreements are hard to prove. If your relationship with the practice sours, you could find yourself in great personal and financial difficulty. If both parties get what will make them happy in the contract, future conflict can be avoided and a positive long-term working relationship can be forged. Often, contract negotiations can be antagonistic, one-sided and unfair, a situation that can be caused by one or more parties. Many times, this will carry over into the performance of services. Thats why it is so important to be well prepared for the negotiation and to have proper timing in the negotiating process. Both parties must work together to negotiate and create an acceptable contract to prevent unhappiness, stress and conflict on the job. For assistance with evaluating your employment offer(s) please visit our website, www.PhysicianAdvisorsLLC.com, or contact one of our advisors at 877-744-9474 for a professional review of your contract(s) and employment benefits. This professional review process will give you the information and tools you need to accept, negotiate or decline the offer(s) you are considering.

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Contact us
Headquarters 9850 Nicholas Street, Suite 305 Omaha, NE 68114 402-343-9474 877-744-9474 402-391-0608 fax Info@PhysicianAdvisorsLLC.com www.PhysicianAdvisorsLLC.com www.PhysicianContractReview.com

End Notes
1 How

to Ace a Physician Interview. (2010). Retrieved July 19, 2010, from Cejka Search, Medical Economics Company, Inc.: http://www.cejkasearch.com/resources/careerdevelopment/how_to_ ace_interview.htm

Lowe, M. (2008). The Physician Job Interview--Essential Tips for Success. Retrieved July 20, 2010, from Search Warp: http://searchwarp.com/?swa313842.htm

Private Medical Practice Q. (2010). Retrieved July 19, 2010, from Career Medicine, Sample Interview Questions: http://www.careermedicine.com/?physician-job-interview-questions/? private-medical-practice/

4 Oginski,

G., Esq. (2005). The Doctors Employment Contract Bible. Great Neck, NY : The Law Office of Gerald M. Oginski, LLC.

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