physician employment interview kit

7/27/2019 Physician Employment Interview Kit

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Physician Employment

Interview Kit

TM

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


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Overview

Successful employment begins with a good foundation, which begins

with the interview process. How do you eectively prepare yourself

to enter the professional world? How do you equip yourself with theright questions? How do you evaluate oers to put them on a levelplaying eld and make them directly comparable, considering notwo oers are the same? How do you eectively negotiate to obtainexactly what you want in a job oer?

The answers to all these questions are right here at your ngertips.

In this document, weve compiled the best material from a number ofoutside 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 condence, ask the right questions,and review the details of oers side-by-side to determine which isbest for you. We hope you will use this material thoughtfully, withthe assurance of knowing that, as you use it, you are on your way tonding the best possible job.

Copyright 2010 by Physician Advisors LLCAll 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, thepublisher and authors and adv isers are not rendering legal, accounting or other professional services. Every effort has been made to make this kit as competeand as accurate as possible. However, there might be mistakes, both t ypographical and in content. Therefore, this text should be used only as a general guideand not as the ultimate source of information. Furthermore, this kit contains information available only up to the printing date. The authors, advisers andpublisher 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 orindirectly by the information contained in this kit.


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Table of ContentsPart 1 | 15 Basic Principles for a First InterviewTM 4Part 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 94 Keys to Preparing for Contract Negotiations 9

Figuring out Who to Negotiate With 10

Develop Your Salary Expectations 10

Part 3 | During Your First Interview

Questions to Ask During the Interview 12

Compensation 12

Benets 13Organizational Structure 14

Scheduling 16

Performance 16

Financial Stability of the Practice 17

Termination or Instance of Death 17

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 Oer 24Part 5 | Contact Information and End Notes 25

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15 Basic Principles for a First Interview

TM

When you walk into a rst 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 youshould answer to present yourself in a way that will impress and build rapport with a potentialemployer. They are the most important things to keep in mind when preparing for a rst interviewwith a hospital or private practice. If you follow these principles, you will be well on your way to

nding the perfect career t.

1) Know what you want in the job. Think ahead about the money, benets, 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 arst 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 bringyour spouse along. If the practice is unwilling, it could be a red ag. 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 signicant part of the interview process and

will greatly aect your decision.

4) Dress for success. Many assumptions will be made about you based on the way youdress, 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 busi-

ness 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 oce sta warmly and ask them

questions to show interest, because you never know when a good word from a mem-

ber of the oce sta will make a dierence. Also, take note of honors, plaques, pic-

tures and other items in the interviewers oce, 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 oer if needed.

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15 Basic Principles for a First Interview

TM

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

to communicate it in a positive light.3

8)Never badmouth your previous employer. This will make you seem like a potential prob-

lem employee and damage your credibility. It might take some eort to resist the tempta-

tion 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 alcoholand carry mints.

11) Clearly state your interest in the position. If two candidates are equally qualied, the one

who shows more interest in the job will likely receive the oer.

12) Know and emphasize what makes you unique. If you have a story that makes you memo-

rable or a particular skill or quality you believe gives you an edge, nd 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 oer.

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 oer what you believe, based on what you do know, without

coming across as overcondent 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 pro-

spective 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 allemployment oerings and arrangements made with the potential employer.

15) When the interview is over, make sure to show your gratitude in person, and then obtaina 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.

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Before Your

First Interview


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Understanding Contracts

Most Employers Use Standard ContractsA 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 ne-

gotiations when it is used. Employers use this type of contract to ensure equity of employment contracts

for their physicians. It avoids potential conicts 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 agree-

ment, the employer might have fear of uncertainty as to an employers liability and obligations. It is

generally the physicians obligation to oer changes or amendments to the agreement.

Flexible ProvisionsMost 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 em-

ployment 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 deter-

mined by the actual circumstances surrounding the relationship and not necessarily by how the parties

identify the physician under the employment agreement.

Independent ContractorSometimes physicians are oered the option of becoming a contractor, rather than an employee or part-

ner. 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 denitely 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

benets provided. That makes it cheaper for the practice, but its not good for you. You have to nd and

provide your own benets. 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 aect your work and you might

make less money. Nonetheless, physicians who prefer independence and exibililty might prefer this

type of an arrangement.

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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 physi-

cian, 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 attemptto limit the independent contractors right to practice outside of the employer/physi-

cian 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 pay-

ments 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.

EmployeeBenefts

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 benet

plans available to employees.

EmployeeAn 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.

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Possible Issues for Employees

ControlAn 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 PracticeUnder an employee-employer arrangement, an employer has a greater opportunity to limit an employ-

ees right to practice outside the realm of the employers services, compared to an independent contract

arrangement.

Labor and Employment LawsThe status of employee allows you the protections of the labor and employment laws.

Tax IssuesAn 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 oerings 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 STATE-

MENTS MADE BY A POTENTIAL EMPLOYER DURING THE INTERVIEW PROCESS MIGHT NOT BE BINDING, UN-

LESS 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 employ-er, investigate the terms of employment you should expect within the community you are inter-

viewing. You should have a good idea of the salary ranges oered, fringe benets typically oered,

as well as duties expected by a potential employer. (See section below titled Questions to Ask to

Prepare for an Interview.)


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2)Identify your Personal Priorities and Special Circumstances. Employers are generally willing tovary 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 servicesoered by the potential employer. This understanding of the type of business of the employer, num-

ber 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 imme-

diate 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 nd 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 authorityto make oers and accept employment agreements? If not, it might be benecial 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 resi-dency or out of fellowship.

2)Ask the going rate for physicians in your community in your specialty. (This is to ensure that you arecomparing apples to apples and not comparing a dermatologist salary to an orthopedic surgeon sal-

ary 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


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Questions to Ask During the InterviewThis section is designed to arm you with all the right questions to ask in the contract negotiation process.

Once the rst 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 oer and terms that accompany the oer.

In your excitement, you might be tempted to take what they oer 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 prac-

tice 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 dierent aspects of your working relationship with

the group to ensure that you nd the right t 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 condent about your work-

ing environment. You will feel respected, because you are being paid and receiving the benets 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 nd 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 specic terms? (For example, some rms will pay for malpractice insurance fordoctors, 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 per-

centage of prot 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 patientsthey see, then wheres the incentive to work harder or see more patients? There is none. But whenyou 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 con-tract 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 andtherefore belong to the practice, or does the doctor retain ownership of any inventions? (It is possi -

ble 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 nosubstantial 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?

QuestionstoAskRegardingBenefts

1) What are the benets and perks?

2) How much time o would I be oered? 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 o to study for and take boards? Willthey pay for and allow time o for a boards review course? Will they pay board certication fees?

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

amount calculated?


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5)What are my hospital privileges?

6)How much time o will I get for maternity or paternity leave? (You must ask for maternity leave inyour 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 nd a part-timer to ll 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 o. 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 bededucted from my vacation time?

8)Will the organization help my spouse nd 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 poli-

cies for individual physicians as well. If theres no other way, ask the group to list you as an addition-

al 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 eld?

2) What is the reputation of the department (or facility) to which I am applying? (Its a good idea tocheck 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 diculties are present in the department (or facility) now?

6) What are the most important problems to solve rst?

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 ve 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 practiceperceived in the community? Does the practice have enemies?

12) What are the referral patterns? Are the hospitals that refer to you nancially stable? How are theemergency departments staed? 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 turnoverin employees?

14) How many doctors work in the group? How many are partners? How many full partners? How manypartial 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 prots 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 prots.) 4

15) How many sta members do you employ? What is the sta-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? Med-

icaid? 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 gure 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 oce and in the hospi-tal? How many patients will I be expected to see in a week?

3) Will I work in one oce, or will I split my time between multiple oces, 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 patientsrst? Are all doctors in the group allowed to take new patients? Does a patients insured status de-

termine 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 oce hours that I need to know about? (Being At-

tending 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 tospend time online? How much time? What are the oces 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 qualications are you looking for in the person who lls 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 werethe 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 contactthe 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 les? 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? Isthis written into the contract?

4) If I get red, will there be an agreed-upon time (45 - 90 days) required as notice?

5) If the group res 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 eect after termina-

tion? If I were to violate this, what would be the penalty? (You may nd 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 oensive 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 oce next door.) 4

8) What restrictive covenants will I be subject to? (A restrictive covenant is simply a promise from you thatif you leave the group for any reason, then you will not be able to practice medicine for a specic time

within a specic 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 geo-

graphic 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 agree-

ment on the easy issues rst, then working toward the dicult issues. By beginning with terms that

are agreeable to both parties, the parties generally develop a favorable relationship that is benecial tosolving any issues in dispute.

Salary Negotiation

In addition to the terms of employment, you will negotiate with your potential employer specically on

the amount of salary or contract fees. Salary negotiations often come after you have been identied 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 oer the amount you want, you will have locked in the starting point for negotia-tion 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 prot. I know what

the going rate is here, and Id like to know what youre oering. By saying this, the burden has shifted

subtly to the group to make the rst 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 nal take it or leave

it oer. 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 oer 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 benets and compare it to the negatives.

Assuming this is your rst job oer while youre a resident or a fellow, youll likely be very excited to

grab the oer 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 signicantly higher than anything youre earn-

ing as a lowly resident. But, you must not jump the gun and agree to everything thats oered 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 oer you have.

3)Value added. Once you have the nal salary oer, make sure you take time to consider value added

benets. Why? Because, when comparing oers, you need to compare apples to apples. Here is a basic

example:

Practice A

Oers $250,000 per year, 401(k) with no match, basic health insurance coverage, exceptional oc-

currence malpractice insurance, three weeks vacation, equal call every 4th weekend and full paid

holidays.

Practice BOers $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 benets into account in accepting or not accepting the salary oer. The match-

ing 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 benets 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

Dierent personalities will handle negotiations dierently. 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 DoctorDr. Arrogant has just nished performing his sixth surgery of the day. He comes into your interview wear-

ing 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 prot and very little for you. Dr. Arrogant has a signicant 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 GroupYou walk into an oce where youve been introduced to the three partners. It turns out they are all in-

terviewing 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 NegotiatorI can only oer 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 ght for a contract that will meet your needs and create a healthy working relationship for the

future.

The Pressure NegotiatorWe 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 pull-

ing your leg. No matter what the truth is, its important not to allow yourself to be pressured into a deci-

sion. 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 oer, then I thank you for your time. Im hopeful that, rather than rush the process,

you would hire me based on my qualications, and not just try to ll the position because of an arbitrary

ll date.

The Friendly NegotiatorBe 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 conrmed in your written contract.


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The DeceiverHe 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 PromiserThis 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 pu 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 NegotiatorThis one cannot make a decision. He or she spends endless amounts of time thinking and performing men-

tal 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 NegotiationTM

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 un-

happiness 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 justication 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 sucient time to prepare, admit it and arrange for additional time

to review the employment agreement. Never sign an employment agreement without having a full andcomplete understanding of its terms and provisions.

4)Maintain a clear, distinct and factual theme throughout the negotiation. This all begins with a clearunderstanding of your objectives before becoming employed with the potential employer. Clearly

dened intentions and goals of employment, along with a reasonable basis and justication 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 dierent 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 satised 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 toreach the best solution for both parties. With this in mind, you should begin by guring 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 rst. 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 rst oer, because its almost always lower than they are really willing to oer. 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 eort could bring you

signicant opportunities in the future. 4

7 Things to Avoid in NegotiationTM

1)Do not assume you cannot negotiate.

2)Do not start any negotiation with, This is my rst and nal oer. 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 rmly 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 thetime being and continue discussing other points. This will help you avoid getting o 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 nancial straits, tell them. If you have 12 kids to feed, tell them. If you

dont meet a qualication 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


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Evaluating the Interview and OerOnce the initial interview, or set of interviews, is complete and an oer is made, the real hard work

begins. Evaluating the success of the interview and the merits of the oer will be the next step toward

your goal of practicing medicine. The oer should be documented and presented in the form of a writ-

ten 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 contin-

gencies that might exist from the rst 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 nally executed.

The process of negotiating your employment agreement might set the tone for the eventual relation-

ship between yourself and the employer. It is crucial to have a contract that clearly lays out expec-

tations and the parameters of the working relationship. Oral agreements are hard to prove. If your

relationship with the practice sours, you could nd yourself in great personal and nancial diculty. If

both parties get what will make them happy in the contract, future conict can be avoided and a posi-

tive 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 negotiatingprocess. Both parties must work together to negotiate and create an acceptable contract to prevent

unhappiness, stress and conict on the job.

For assistance with evaluating your employment oer(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 benets. This professional review process will give you the

information and tools you need to accept, negotiate or decline the oer(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 [email protected]

www.PhysicianAdvisorsLLC.com

www.PhysicianContractReview.com

End Notes1How 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

2 Lowe, M. (2008). The Physician Job Interview--Essential Tips for Success.

Retrieved July 20, 2010, from Search Warp:

http://searchwarp.com/?swa313842.htm

3 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/

4Oginski, G., Esq. (2005). The Doctors Employment Contract Bible. GreatNeck, NY : The Law Oce of Gerald M. Oginski, LLC.

physician employment interview kit

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