Contract Negotiation: Tips for the New Physician Laurie Scudder, DNP, NP; Terry Lee Mills, MD, MMM, CPE, FAAP
Laurie E. Scudder, DNP, NP: Good afternoon. My name Is Laurie Scudder and I’m the editor of Medscape Family Medicine. I’m here at the American Academy of Family Physicians Family Medicine Experience (FMX) in San Antonio, Texas. I’m joined today by Dr Lee Mills. Dr Mills, could I ask you to introduce yourself?
Terry Lee Mills, MD, MMM, CPE, FAAFP: My name is Lee Mills and I am the medical director at St. John Clinic in Tulsa, Oklahoma.
Dr Scudder: Dr Mills has joined us today to talk about the very important topic of contracting. It’s obviously of critical importance for physicians, particularly physicians newly entering practice. My most foundational question is: Just how much power does a family physician newly entering practice really have in terms of contract negotiation?
Dr Scudder: That can be a tough message. When looking at a contract, whether it’s one you can negotiate or one where you want to be sure you can live with the nonnegotiable critical elements, what are key elements that have the ability to impact one’s work-life balance and one’s ability to practice the way they wish to practice? What are those core elements to which you encourage people to really pay attention?
Dr Mills: There are many, and they start with whether you want to be full-time or part-time. If part-time, how is that structured? Is it so many hours? Is it so many patients? Is it so many days a week? It could be scope of practice. Is it full scope, and is that reflected and supported in the contract? Is it a narrower scope, and are there requirements for whoever you are being employed by?
How on-call is arranged is critical. Are there certain requirements to which you have to agree? If a larger group already has call established, you often won’t be able to negotiate less call.
Expenses are important. Are they expensed to you as an individual? Do you have any control of that? These elements are often ones you cannot negotiate because the group or health system does it a certain way, and you are joining the way that they do it.
Dr Scudder: You have indicated that in big systems you may not have the ability to do a lot of negotiating. Should you always have an attorney or a contract specialist look at your contract? Is it penny-wise and pound foolish to do it on your own?
Dr Mills: That is a great question. Ultimately, I always tell a physician looking at an employment contract to have the contract reviewed by an attorney, but maybe not for the purposes they think. It’s to be sure that the contract covers state laws, that it is reasonable, legal, written in a sound fashion, and that it’s a good contract.
Past that, whether the attorney’s advice allows any negotiation of the contract or not again depends on the situation and on the need you are filling for that employer. Often, a health system has a standard contract which has been used to employ dozens or hundreds of other physicians before you. Often, large employers really are not willing to change or negotiate a standard—almost boilerplate—template that is in a contract. The review is really for your comfort and confidence in knowing that it is a good and a legal contract, but it does not necessarily lead to negotiations. Sometimes it could if the situation is just right.
Dr Scudder: Peace of mind is not a bad outcome either.
