Navigating the Job Search and Physician Contracts
Adapted from a presentation by Shania J. Seibles, DO, JD, FACOOG — Maternal Fetal Medicine, Crossroads Medicolegal, LLC.
Timeline
12–18 months prior
- Evaluate personal preferences and available resources
- Begin to look at opportunities
- Initiate contact
6–12 months prior
- Interview by phone and in person — at least two or three; gather info and keep track
- Review offers and conduct return visits
- Negotiate the contract of choice and accept the position
- Begin licensing and credentialing
Under 3 months prior
- Search for housing and complete moving arrangements
- Finalize license, credentials, and insurance acceptance
Readiness
- Curriculum vitae: a PDF in reverse chronological order that accounts for any gaps. Cover residency and fellowship, education, experience, and personal detail.
- Cover letter: personalized — why, your education and qualifications, interest and availability, personal detail, and contact information. Include it with the CV in one PDF file.
- References: have the sheet ready to go, with name, title, and contact information for each individual. At least four or five, of varied types.
- Resources: MGMA and AAMC salary information, national organization websites, job search sites, recruiters, and people you know — previous graduates and peer groups.
- Site visits: time visits within a window and provide a deadline for your decision. Tour the hospitals and offices, the community, and housing. Talk to everyone.
What Is Important When Considering an Offer
Quality of Life
Can I live and work here and be happy? Will my spouse or partner be happy, and can they find a job? Can I raise a family here? Are there good schools and access to events of interest?
Quality of Practice
Practice type and size, ownership, single or multi-specialty. Practice culture — meet and talk to everyone. Financial condition, growth, mobility, referral network, and payers.
Geography
Region, urban versus suburban versus rural, proximity to airports and amenities, cost of living, crime rate, transportation access, and schools.
Compensation
Models vary widely by specialty, location, and experience level: base salary, productivity (RVU), base plus productivity, shared productivity, and other performance variables. Consider the whole package.
If you are asked specifically about what salary you are expecting, do not give a number.
Contract Basics
- Salary: base, productivity (RVUs), sign-on bonus — when do you get it, and are there payback conditions? Relocation, ideally paid by the employer directly to the company. Loan repayment.
- Ownership or partnership: is it a future option, and under what stipulations, timing, method, purchase price, and window? If not offered initially, can it be considered later?
- Job requirements: full or part time, administrative or teaching duties, length of work week, patient volume, call schedule, hiring authority, mid-level providers, who you report to, and the evaluation process.
- Outside activities: research, publications, teaching, consulting, directorships, moonlighting, and telemedicine.
- Restrictive covenants: clauses that prohibit practicing medicine for a specified period in a specific geographic area. Smaller radius in a city, larger in suburban or rural areas; no more than one to two years. Make sure it is waived if they terminate without cause. Watch for non-solicitation clauses, which prohibit a departing physician from actively seeking to attract patients, employees, and health plan contracts away from the former practice.
- Term and termination: start date, end date, and automatic renewal. Termination with cause should be narrowly defined — loss of license or DEA, loss of privileges, felony conviction — and should never include discretionary reasons. Without cause should be reciprocal, with advance notice of 90 or 180 days.
- Assignability: what happens on acquisition, consolidation, or merger. Assignable means your obligations continue as before; non-assignable frees you from them, and staying requires negotiating a new contract that may not carry the same salary or benefits.
Benefits & Insurance
- Insurance: health, dental, and vision; short- and long-term disability; life; and malpractice. If there is a waiting period, ask them to cover it.
- Tail coverage: who pays, and is it 100% immediately?
- Other: PTO including maternity and paternity leave, CME, and retirement.
Gap and Tail Insurance — know the difference
- Claims made provides coverage that is triggered when a claim is made against the insured during the policy period, regardless of when the wrongful act that gave rise to the claim took place.
- Occurrence made covers losses that take place during a specific coverage period, regardless of when the incident is reported. It does not matter whether you have coverage when the lawsuit is brought.
- Nose coverage is additional coverage you purchase when joining a new insurer.
- Tail coverage is purchased when you leave an insurer. It covers events that may have occurred during your period of employment, and is required if your previous insurance was claims made.
Negotiating a Contract
- You do not have to accept any contract as it is written — but everything is not negotiable.
- Understand what is minimally acceptable, and negotiate only what is essential to your job satisfaction.
- Be flexible and willing to accept modifications. Try to create a win-win for all parties.
- Gather information and be as informed as you can. Outline your priorities and strategize.
- Be respectful and professional at all times, coming from a place of mutual benefit and fairness.
- Express significant interest before asking for more. Consider a third-party negotiator.
Obtain all finalized changes in writing, and have a lawyer review everything before signing the contract.
Full Presentation
Physician Contracts: Introduction to the Basics
Shania J. Seibles, DO, JD — crossroadsmedicolegal@gmail.com