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AHLA's Speaking of Health Law
Leveling the Playing Field: How Attorneys Can Empower Physicians in Employment Negotiations
Sarah Laws, CEO of Physician Prosperity, speaks with Dennis Hursh, a veteran physicians’ lawyer, and Jim Dahle, a practicing emergency physician, about how attorneys can help physicians navigate employment negotiations. They discuss potential misconceptions physicians may have about employment contracts, the connection between legal and financial literacy, potential risks during the negotiation process, how attorneys can better work with physician clients, how financial advisers and attorneys can better collaborate to assist physicians in a holistic way, and what to ask during a contract negotiation. From AHLA’s Labor and Employment Practice Group.
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Learn more about AHLA's Labor and Employment Practice Group: https://www.americanhealthlaw.org/practice-groups/practice-groups/labor-and-employment
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SPEAKER_03:Hi, everyone. I'm Sarah Laws, CEO of Decision Prosperity, and today I'm joined by Dennis Hirsch and Jim Dolley to talk about leveling the playing field. How can attorneys... empower physicians in employment negotiations. Dennis is a veteran physician's lawyer. He's vice chair of the Labor and Employment Practice Group with the AHLA, and he's the author of The Final Hurdle, A Physician's Guide to Negotiating a Fair Employment Agreement. Jim Dolley is a practicing emergency physician and the founder of White Coat Investor, the most widely read physician-specific personal finance and investing website in the world. So guys, thanks for joining me today. We're excited to be here. Before we jump in, I'd love to have each one of you just share why this topic matters to you personally.
SPEAKER_00:Well, I can start first. I mean, what I do is reviewing employment agreements, and I see so many horrible agreements that the physician is renewing and the first agreement is just horrible. So I think it's really important that we get the word out to the lawyers that are representing physicians that there are things you can do and go for it.
SPEAKER_01:Yeah, I'm a firm believer that A physician that is financially comfortable, that is financially stable, that has their financial ducks in a row, however you want to describe it, is a better doctor. They're a better parent. They're a better partner. They're a better doctor. They get better medical care when they're less worried about their finances. And the first thing you got to do to have finances is to make some money. And it's hard to do that without some sort of employment or partnership contract. So if things break down right at the beginning of the process of building some sort of wealth or some sort of financial stability, the rest of it doesn't go very well. And so physician contracts, physician negotiations for employment, it's all an important part of the process.
SPEAKER_03:Absolutely. And I couldn't agree with you more. You can't be giving your best of yourself to your patients, to your family, to everybody if you're worried about your financial things that type directly into contracts. Let's talk about what physicians don't know that can hurt them. Dennis, there's this illusion of the standard contract. When you first read an employment contract, what are you scanning for in the first five minutes? Are you just skimming the documents? Any clauses you consider deal breakers?
SPEAKER_00:Well, no. The way I do it is I prepare a detailed letter on law firm stationery that I send to the physician with the idea that the physician will just take my letter and send it to the employer. So I don't actually skim. I start at section one and start going through and saying, hey, what can we do to make this better for the physician?
SPEAKER_03:What? You don't just skim through like, where's that salary?
SPEAKER_00:Good. They said it was a standard contract. So there's no sense talking about this, I guess.
UNKNOWN:Yeah.
SPEAKER_03:Jim, you have worked alongside thousands of physicians. What feelings do doctors commonly have about their employment contracts? Do they know what they're signing? Is it really just a big question mark?
SPEAKER_01:You know, Dennis might look at these things all day long. But a typical physician only looks at these things once, twice, three times in their career. This is a foreign language to them most of the time. And obviously they speak English. They understand some of the contract, but there's a lot of it they don't understand. And the issue is the contract comes up when things aren't working out. You know, when everything's great, nobody needs a contract, right? But when things are not working out is when people go to the contract and find out what they actually signed. And so it's a lot of times it's the terms about the breakup, how this relationship ends, that is the first thing the physicians notice. And often it's way too late to make any changes to the contract at that point.
SPEAKER_03:Yeah, it's one of those nicely into a mindset where I'm guessing you just don't get a lot of business training and legal training in med school, which is great. I mean, you shouldn't come out with all this debt and all of this.
SPEAKER_01:Yeah, it'd be nice to get a little bit of that training, right? I agree they don't get any, but they do need a little bit. Maybe that shouldn't be the focus of medical school and residency, but is it too much to ask for an hour a year? I don't think so. And doctors are not even getting that.
SPEAKER_03:Yeah, and I think that's where lawyers can really and attorneys can take some proactive steps with educating. their clients and overcoming the mindset and misconceptions. I'm sure there's quite a few misconceptions about working with attorneys and how that goes. Not
SPEAKER_00:saying- No, physicians love attorneys.
SPEAKER_03:Not saying they're not everyone's favorite, but Dennis, what do you think most physicians underestimate how negotiable their contracts are? Are they negotiable? If somebody's working with you, have you ever seen a contract not be changed when you've asked for something.
SPEAKER_00:Actually, I have. I've done, I don't know, thousands and thousands. I'm guessing around 4,000 maybe contracts. And I can count. I used to say on one hand, but I've been doing it 40 years. So now I could probably count on two hands the times that they've come back and said, no, that's our standard contract. We don't change anything. And many times, even on those contracts, they'll change the compensation. You can say, well, look, it's below median signing bonus. Sometimes they'll at least change the money. But By far, I would guess 99.9% of the contracts that I've looked at, the employers are willing to make changes.
SPEAKER_03:I'm sure that has to put some skepticism in there for physicians of what if I work with an attorney and they don't make any changes and I've spent all this money and all this time and they're not going to change it. Jim, do you think that physicians could avoid legal help because of the cost or they don't see the value? I
SPEAKER_01:do think that is a problem. they become penny wise and pound foolish, right? I mean, a contract review service typically only costs a few hundred dollars, right? You're going to make this back the first morning you're in this job, right? It does not, this is not a huge investment. As financial services go, this is one of the cheaper ones. And so pretty much every doc signing a contract ought to have it reviewed. You know, this has been consistent messaging. I've been given to docs for the last 15 years since the White Coat Investor was founded. But, you know, it's interesting because the first question you often hear from a doctor is, is this negotiable? And the problem is they assume that negotiation is just kind of asking for more, whereas negotiation is a much more in-depth process of knowing what you want and knowing what you're worth, what the going rate is and what a typical contract looks at. And that's where an attorney can help because, you know, at least most of them that are doing this work a lot have seen far more contracts than the physicians have and often have access to data that helps the doctor to know what they're worth. I mean, obviously a doctor that's being underpaid by 30% should negotiate that salary. A physician who's been made a first offer that's actually a very fair offer or even better than a fair offer, maybe they ought to spend their negotiation on other points of that contract rather than purely salary. But the problem is so many docs, they don't have any of the background information they need. And so the employer is far more empowered in the negotiation than the contracting physician is.
SPEAKER_03:Yeah. And they have a whole team behind them and they're trying to get their best deal. And it's, you know, I, I know that you're both like, how can everybody come out with a fair deal? Like everybody should be happy. You don't, you don't want an employer that is going to squeeze the physician to get the most out of them. Like let's, let's create a long-term working relationship here. Dennis, I know that your contract review is, is fixed fee, which kind of alleviates some of that question mark for a physician of how much is this going to cost me? Cause traditionally, you know, our, our attorney's bill by the hour. And it's like, I might be aging myself, but the, the old commercial where it was, we had a baby eats a boy when they were, they're calling, calling on a collect phone call of trying to get through something as fast as possible. And I think when you position yourself like that, it's how can you provide value to the attorney or to your, your clients as the attorney that is authoritative and not, you're just trying to keep them on the phone as long as you can. Cause you you want your billables to be up. Do you ever get any questions about why you don't charge hourly?
SPEAKER_00:Sometimes. It's usually the other side. Mine's simple. It's a six-page contract. I understand if it was a big contract, but I see people getting 20-page. Why are you... Well, if it's six pages, there's a lot of stuff that's not addressed. So sometimes I get the flip side. Well, mine's really simple. And you know, that's maybe a problem, Doc. You know, maybe there should be a little complexity in there. You know, a little bit about what your rights are and some limits on the employer. So, unfortunately, I get it the other way. I mean, a lot of physicians are happy that, oh, I forgot to tell you, you know, this, that, oh, yeah, I got your letter, but, you know, I didn't mention they said I could work four days a week. And that's not, you didn't mention that in the letter. It's like, well, because I didn't know it. So, yeah, I think generally they, they like it, but sometimes I get the opposite. It's like mine short and easy. So no big
SPEAKER_03:deal. Everybody wants a good deal. So you're like, but you don't have to read 27 pages of a contract. Surely I can get, I can get a discount. Yeah. I, I appreciate their, their, you know, tenacity. Let's talk about how financial literacy and legal literacy go hand in hand. Dennis, how would you describe the connection between the two? Do they go hand in hand? I can't imagine signing an employment contract and not being concerned at all with the financial impact.
SPEAKER_00:Yeah, well, a lot of times physicians are happy if it says we, the employer, will determine this after consultation. So they say, oh, no, they're going to talk to me. It's like, well, that's fine. You know, hey, we just bought a new hospital 50 miles out of town and you're going there every Thursday. How do you feel about that? I don't like it. Okay, good talk. I'm glad we had this consult, you know, next Thursday. I'm sending you to that hospital. So they tend to think, oh, I have input. So since I have input, the two of us will jointly do it. You know, if it doesn't say mutually agree, if it says after, many times it just says we'll determine. We'll send you wherever. Your hours will be whatever we determine. You know, you're calling us. All coverage will be whatever we determine. But sometimes physicians are tricked that, you know, after input from physicians or after consultation with physicians and they feel they're protected and they're not really.
SPEAKER_03:Yeah. And as these medical networks expand and get bigger and bigger, like it's, it's a real potential risk for a physician to get moved all the way across the state. I know where I am, you can't swing a bat without hitting two big medical industries and that can be really scary. And that goes back to what the doctors don't know and how attorneys can empower them because again, they don't, they just don't teach that stuff in med school.
UNKNOWN:Yeah.
SPEAKER_03:Jim, what's at stake if a physician just blindly signs? They see that number, they're like, no, they have my best intentions. This person is absolutely great. What are the financial potential risks or have you seen any examples of when they don't get a contract, physicians don't get a contract review and they go ahead and sign and then they're in it and it's backfired?
SPEAKER_01:Yeah, absolutely. When this job agreement breaks up, you know, they cannot take another job in the place where they live. And you think about the financial ramifications of that. Not only are you going to have to recredential, maybe get a license in a new state that you're going to be out of work for months doing all that, but you're going to have to pick up your family and move. And maybe your spouse is going to have to change jobs. You're going to lose a bunch of transaction costs on housing. It can be a very expensive mistake to be in any sort of restrictive covenant that's going to cause you to have to change where you live in order to continue to be employed. Another big error we see physicians make is that they don't know how malpractice insurance works. There are claims-made policies. There are occurrence policies. And if the policy provided to you is a claims-made policy, somebody's going to have to buy a tail when you stop working there, when that policy ends. Otherwise, you're exposed to claims that come in after employment stops. And that happens all the time, that a malpractice claim will come in afterward. And physicians have no idea... What tail coverage actually costs. It often costs two or three times the annual premium for the malpractice insurance. So it wouldn't be unusual for a physician to find out that when they leave this employer, they've got to come up with$50,000 to buy their tail coverage. And that can be a lot of money for a lot of doctors. And so those are two common areas where physicians get burned because they didn't read the contract or they never got past the compensation section. Another problem is with the compensation. A will sign a compensation plan that's basically based on production, and yet there aren't enough patients for them to see, even if they can work very hard and very quickly and be available all the time, there aren't enough patients being provided by the employer for them to have high production. So they end up with very low compensation because there just isn't that much business to do. And so getting into the details of those sorts of production-based compensation structures and really finding out how many patients there are to see at this practice already that you're going to be all lined up with already, those sorts of I hear it all the time. I'm
SPEAKER_00:willing to work hard. It's on productivity. I'm willing to work hard. And it's like, well, that's great. You know, if no patients present. You know, it doesn't help. And another thing I see all the time with covenants not to compete is it's so outrageous. I know that the court won't enforce it. So I'm not worried about it. The physician says, well, the problem is if a new employer hires you, that employer can get sued for intentional interference with contractual relations. Very few new employers are willing to say, oh, I talked to my lawyer. They said a couple hundred thousand in litigation and we're going to win. You know, so we're going to hire you. It's the fact that a court wouldn't enforce a restrictive covenant has very little to do with can you get a job in the area of that restrictive covenant.
SPEAKER_03:Yeah, that's where the market really drives. If you have two candidates, let's take the one with less baggage, that tedious little restrictive covenant. Dennis, we were talking a little bit before about someone who you shared an example with me of someone who was potentially getting ready to lose their job because they weren't working enough. And would you share that story?
SPEAKER_00:Well, yeah, you need to be able to audit calculations of productivity. I actually had a cardiologist, full-time cardiologist at a major health center, very, very busy. And they called him in and they were going to fire him because he wasn't productive. And they showed him the numbers. And according to the numbers, it was very clear in a little report, he was seeing two patients a day. I mean, we had to go in with his schedule and say, no, no, I'm fully booked. That day that i saw too here's my schedule no cancellations i was busy all day so it's so important that they audit i literally am working right now with this swamped plastic surgeon. I mean, just working constantly. And the hospital gave him a WRVU report. And according to the hospital's numbers, he's at like the 25th percentile. I mean, it's just, it's absolutely not right. So a lot of times physicians will agree that you can pay me on productivity and they don't have the ability to audit or, or challenge the calculation and employers get it wrong. So I think that's really important.
SPEAKER_01:Yeah. On that, on that same, on that same topic, I see a lot of docs, um, signing, you know, primarily productivity-based compensation agreements when they have no idea how productive they're going to be. They've never been out of residency kind of situation. They find out they're not the fastest dock out there. And they realize that maybe, you know, even if it had looked like it was going to pay them less, a guarantee, especially in that first year or two out of residency when they're still getting their feet under them, can be pretty valuable. And so I actually encourage people to have the you know, most of their compensation in some sort of a more guaranteed format for a year or two until they get a sense of what their options are and how productive they are. Lots of doctors find out they're more productive than most of their peers. But on the other hand, there's just as many that are less productive than their peers. And obviously, it's less advantageous for them to be in a compensation, a production-based compensation structure.
SPEAKER_00:Yeah. Well, and as I said, if there's no patients presenting, you know, sometimes it's like, well, again, I work hard in residency. I'm doing, you know, all these WRVUs. Well, that's great. But the hospital decided they're making a lot of money on orthopedic surgeons. So they hired three of them, you know, well, you may be willing to work hard, but you're not going to have much to do until eventually we'll build it. So absolutely. I think anytime you're switching positions, you should get a year, or two, if you can, guaranteed salary.
SPEAKER_03:Yeah, you just don't know what you don't know. And going into it blindly is a little bit risky financially, professionally, all of that stuff. Because what happens when it's the opposite and they're trying to work you tooth and nail as long as you think, oh, I can work hard, but then physician burnout comes in to play. And that's not good for anyone. I think this is where attorneys can leverage their business knowledge, right? I'm not going to go to a podiatrist if I have a heart issue. You know, if you have a employment contract, you need to be working with an expert and a healthcare attorney and somebody who does look at these all day, every day, not just dabbles in them occasionally. Dennis, how can you, how can, what can attorneys do better when working with physician clients and to get over all those hurdles that we talked about, to show them that you're not out, you know, it's, it's not about you out to make, you know, bill them by the minute for time and things like that, how it's truly the approach of a win-win situation.
SPEAKER_00:Well, I think, again, fixed fee is very important. But the other thing is, I don't think you should expect the physician to be an interpreter. So you shouldn't get on the phone and say, well, the problem with this is this, this, and this, and you should look at that, and I'm concerned about this. I mean, over the years, I've found that the best way to help physicians is I give them a letter with the idea that they can give that to the employer. So you don't have to say, I was talking to him and he said something about WRVUs. I don't really, I don't know what that was. Or I think he said that the median was this, but I'm not sure. I think it's a lot easier to give them something to give to their employer so that they're not put in the position of becoming a legal interpreter.
SPEAKER_03:Yeah, I love that. And that's a way to conquer the overwhelm. The line by line letter so that they do know what they're signing, you know, even if you don't know the legal language or what might be missing from the contract. Do you see your peers doing this or when they're working with physicians or are they giving them that legal language? I know when I go into a doctor, it's, you know, I'm taking notes on what they're saying. So it's, you know, I can imagine being on the other end of that phone conversation and RVUs and the media and an MGMA says this. And how can you point out or how can attorneys point out different legal things to protect their clients without overwhelming them?
SPEAKER_00:Well, again, I think giving them a letter rather than requiring them to interpret. You know, I'm talking to you and I talked to my attorney and he said something about consultations and it should be mutual. You know, I think it's a lot better to say the attorney would like you to say shall be mutually agreed upon. You know, I think that helps rather than, again, throwing a lot, impressing them. Oh, I know all this legal stuff. Let me tell you. And then good luck. You can try and maybe interpret that to your boss.
SPEAKER_03:Yeah, nothing. I'm sure nothing gets lost in translation that way. Jim, how can financial advisors and attorneys elaborate better to help physicians?
UNKNOWN:Yeah.
SPEAKER_01:Yeah, I think the key is if you're going to do this, do this work, right? This should be, you know, most of your practice. This isn't something that you do one or two of these contracts a year and expect to be good at it. If you're really doing this well, you've got the compensation data available. You can tell the physician what their services are worth with current up-to-date, you know, as much data as is available out there. You can look at the contract and go, you know, the last three of these that I reviewed for a in the last few months, you know, we're different in this way and I think yours should be that way as well. And I think that experience of doing this and seeing, you know, relationships go bad and having to go back to the contract and sort out, you know, what do we do now, I think is really valuable. So I think the first thing to do is, you know, I tell the doctors, you need to see somebody that's doing this work. It needs to be, you know, a healthcare attorney in your state or Thank you. Yeah, absolutely. The legal services may add up to$100,000 or something. We're talking a few hundred dollars. And so I think that's the key is go hire somebody that does this all the time and can do it well.
SPEAKER_03:Absolutely. It's like getting the handyman to come over and do a house inspection before you buy a home. It's like, yeah, I mean, it looks good. You knock on the wall. I've seen a contract before. I couldn't agree with you more. How do you see when a physician's going to get their contract reviewed and maybe they're already working with a financial advisor or they have somebody and instead of siloed approaches, how can we holistically work with financial advisors? How can attorneys work with financial advisors to provide more value to physicians?
SPEAKER_01:I mean, everything downstream, as I mentioned at the beginning of the podcast, everything downstream is, It depends on the compensation, right? So if that financial advisor wants to have a much easier time with the financial planning, wants to have a much easier time helping them get to their goals as far as their asset management goes, it will help a great deal if they are fairly compensated. That's definitely step one. And the truth is the cost of a financial advisor is generally dramatically higher than a contract review attorney. And so I think it's another place that a financial advisor can provide value to their client to point out that, no, you really do need to get this reviewed by somebody experienced in doing this. And of course, that upfront work will make what a financial advisor has to do later dramatically easier. It's just far easier to build wealth and get rid of debt and reach your financial goals when you're being paid fairly for your services. And it's appalling to realize how wide the range is for physician compensation for docs doing basically the same work. It is pretty impressive just how wide that compensation range is. And part of that is just docs not getting their contracts reviewed, signing contracts that really aren't treating them fairly.
SPEAKER_03:Yeah, and you go in and you realize the doctor you're next to is making a lot more than you and they negotiated or they took that effort and worked with an attorney and were able to do that. Dennis, do you find that you work with a lot of financial advisors to sort of proactively get ahead of that for education for physicians?
SPEAKER_00:No, most of the time, just like Jim says, they say, look, This is important. You should get somebody that has the data. Very few financial advisors are going to have MGMA benchmarks, for instance. So most of them do say, look, give it to the attorney. I'll look at it, see if there's anything that I saw. But very rarely do I have a financial advisor come back and say, hey, this is a financial issue which you should discuss.
SPEAKER_01:Yeah, it might be nice to have the advisor weigh in on the quality of the retirement accounts or the health insurance plan and the HSA being offered by the employer. That might be some useful information to have them point out, hey, your retirement account's kind of stinky compared to most of my clients. That might be a useful collaboration that could take place as part of that. But I think for the most part, the role of the financial advisor is getting the client into the hands of the client. contract review attorney.
SPEAKER_03:Yeah, I love that. It's one of the things if you're working with somebody who dabbles, they don't have their own benchmark data to see what industry standards are. If they're just doing and dabbling here and there, they just don't have that information and knowledge. I would love to hear what, if someone was listening right now, and Dennis, I'll let you take it from the perspective attorney side of what is the first step that you should take when exploring the possibility of, of maybe working exclusively with physicians?
SPEAKER_00:Are you talking about an attorney?
SPEAKER_03:Yes. You take the attorney perspective. We'll give Jim.
SPEAKER_00:It's a little hard, but I mean, the way I did it was at some point I just decided this is what I want to do. You know, it's, it's a long story, but my, my kid, my, was life and death for quite a while. And that's when I really got to work with physicians other than transactionally, sitting by the bedside one night in particular. So I think part of it is you have to really believe in what they're doing. I mean, if you think these guys in the white coats are just high paid technicians that come in and slap a prescription at you, then you might be a really good contract attorney, but maybe this isn't the area for you. So I think, first of all, you have to have an empathy for the physicians. And it certainly helps if you've dealt with them a lot and you have some sense of what their life is.
SPEAKER_03:Yeah, I love that. And now, Jim, for you, from the physician perspective, how do you... Sorry, go ahead.
SPEAKER_01:I mean, step one is... If you're getting a new job or you're joining a partnership, get the stupid contract reviewed, right? I mean, it really is that simple. You just got to go do this. You got to do a few things in your financial life. You know, you got to go buy some disability insurance. You just have to do it. You have to figure out how your retirement plan works and you have to put some money in there and you have to get your contract reviewed. It really is that simple. But what often happens is somebody listening to a podcast like this, they realize, oh, I didn't get my contract reviewed. Maybe I'm not being paid fairly. And they start looking around and asking questions. Well, it would still be worthwhile to spend some time to go over what your contract says so you understand, you know, what will happen if, you know, you'd have to go to the contract and follow its terms because the relationship is breaking up or something. But oftentimes there can be renegotiations, you know, after a year or two or three or five. And, you know, they want you to keep working there and it's worth getting an improved contract. So getting it reviewed, even after you've signed it, can still be worthwhile, even if it's obviously much harder to change after you've signed it than it was beforehand. But there's usually some sort of an out and you're not completely out of options just because you've already signed the contract. So I think the key is no matter where you're at in your career, in your employment process, it's worth knowing how these work and doing everything you can to make sure that it's working out for you. as well as it can. And the truth is, this is not necessarily an antagonistic process, right? The employer, if they're smart, Wants you happy because they don't want to have to hire another doc. It's expensive to go find another doc. It's not unusual for them to spend$50,000 recruiting a new doctor to a position and paying a headhunter and those sorts of things. They don't want you to leave either. They'd rather pay you less and have you be happy and work hard for them, but they don't want you to leave. And so it really makes sense to turn any negotiation like this into a win-win where it's going to be a fruitful, profitable, happy, long-term relationship. And so that's what you're working with in a physician contract negotiation situation. And I think it's important to realize that up front, that it's to the employer's benefit as well for the physician to be happy. It's not going to do you any good to have a bunch of docs that are not happy with you. It's going to create far more problems than it's going to save you money.
SPEAKER_03:Yeah, I couldn't agree more. Everybody wants that win-win. Everybody wants to be happy. They don't want to go find their new doctor. Dennis, that brings me to something that I know you see a lot of somebody just gets a contract and they want to sign on the dotted line as soon as possible, especially residents and fellows coming out of training because they have a job offer. They've done all this work and now they have to sign and the recruiter might have said, I can't negotiate. This is their standard contract. and I can't change it. What do you say to those physicians?
SPEAKER_00:The recruiter's probably telling the truth. The recruiter probably can't change it. What the recruiter didn't mention is for it to get changed, I'd have to send it to legal. So, you know, probably not lying when I say this is the contract and I can't change it, but that works. And anecdotally, I'm guessing 40% of all physicians just sign what's handed to them. Again, I've never seen a survey, but that's my sense that, well, they said it was a standard contract. And I talked to one of the people, you know, in my graduating class and they were getting paid the same I was. So, you know, I think everything's fine. But that's probably the biggest issue that I see is not, again, the recruiter's not lying, but it may not be the whole story.
SPEAKER_03:Yeah. Yeah. You
SPEAKER_01:know, there's usually some place where the contract can be improved. Maybe they can't pay you more salary, but maybe you can have some more time off. Right. Or maybe you can have, you know, a larger continuing medical education allowance or, you know, maybe you can have some more assistance. in your clinic, making your life dramatically better because you have an extra medical assistant. Things like that can often be added to a contract, even when for some reason you're negotiating partner slash opponent has their hands tied with one aspect of the contract. Often they don't have their hands tied with many other areas of the contract. So I think absolutely the myth of the standard contract really is out there. And the truth is most contracts can be changed in a lot of ways, maybe not every way, but in a lot of ways they can. For example, let me tell you about a contract I signed 15 years ago. My physician partnership contract had a non-compete in it. And I'm an emergency doctor, right? A non-compete is like the dumbest thing ever for a hospital-based physician like me. Nobody is coming to the hospital because they want to see me individually. When I leave the hospital, I'm not taking any business away from the hospital. I'm not taking any patients with me whatsoever. And so I brought this up during the negotiation process. And I'm like, what exactly are you guys worried about? Well, it turned out what they were worried about was me stealing the contract from the hospital and bringing in a new group of emergency physicians to staff that contract. So we rewrote the non-compete agreement to say that I couldn't do that. Not that I couldn't work in the city should we decide to part ways. And everybody was happy. It's amazing, though, that no physician... Prior to me in this partnership, dozens and dozens of physicians had ever balked at that non-compete agreement in the past. And so it kind of became the new standard way that it was written, was the way that I demanded it to be written when I was hired. So just realize that you have more power than you think. Remember, as you're signing these contracts, it is costing them a lot of money to get you or somebody like you in the door. And so it's not insignificant, the power you have in the negotiation. I
SPEAKER_03:love that you just asked the question, like, what are you worried about? Because I think sometimes it comes down to communication or a lack thereof of like, what is the concern here? Because my concern is that I need to go work at a hospital and I don't want to have to change schools for my kids. But what are you concerned about? And actually getting to the bottom of it is an incredible concern. that most physicians just don't ask for.
SPEAKER_01:Another great question is, is that the best you can do? I'm amazed how much better the deal comes back without anything other than, is that the best you can do?
SPEAKER_03:Definitely step one that I would say. Is that your best? Dennis, when you go into a contract negotiation, are you just asking for one thing?
SPEAKER_00:No, my letter covers everything. I mean, every... every clause that could be better or more balanced or more favorable to the physician I asked for it. I don't expect, you know, probably in my career, I've had about three times where they gave us everything we asked for, but they'll give you some and anything they give you makes it better. And I tell physicians, if you want to negotiate, it's a lot easier to negotiate with a letter that has 35 bullet points and say, okay, I'll give you that. I'll give you that. I'll give you that. Okay. No, this one, no. No, we have to talk about this one. You know, it just makes your posture a lot better than what I always caution my clients not to do is read my letter, decide what's important to them, and then go to the employer with those. Because if you think about it, if we're negotiating and I come to you and say, Sarah, there's four things that's really important to me. Well, if you give me two of them, you're going to say, Dennis, I met you halfway. you know, now you look unreasonable. Whereas if there were 35 and I stand firm on four, you know, it just changes, I think, the ease of the negotiation.
SPEAKER_03:Yeah, it definitely takes out that confrontational element when, well, these are my solid. We can let the other stuff go, but these four have to slide through. This is so awesome. So final thoughts when it comes to physician contracts. Dennis, what is one thing that you or your final thought on just the topic in general?
SPEAKER_00:There's no standard contract generally. Even if the language is standard, as Jim pointed out, a lot of times they can do other things for you to make your life better. So I think the first thing to me, the number one thing is don't accept the standard contract line.
SPEAKER_03:And Jim, I can almost already hear what you're going to say, but can we have your final thoughts when it comes to physician contract, how a physician or how they should approach it or what they should do?
SPEAKER_01:Yeah, first for the physicians, get your stupid contract reviewed. That part's pretty easy. For the attorneys, if you're going to do this, do this right. Make this your entire practice or the majority of your practice so you really are well-versed with the ins and outs and the changes in these contracts over the years. Make sure you have access to MGMA and similar data. You do enough of these, you'll have your own in-house data of what a fair contract contract looks like. And, uh, and you'd be surprised you treat physicians. Well, they will send all their friends to you and you will have, you know, a wonderful practice doing great work. You treat people poorly and, and it'll be amazing how few clients you get ever again.
SPEAKER_03:Yeah. Great lessons, even for life. Uh, I want to thank you both so much for your time today. Thank you to the audience that's listened and stay tuned. And, uh, we appreciate you so much. Thanks so much guys.
UNKNOWN:Thank you.
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