Can that be a negative if you show up with somebody besides yourself doing your negotiating? We can get pretty creative based on the group story and the physician story and why they want to be in the market, obviously, different from dermatology to OB to ophthalmology, but it's a give and take. There are lots of ways to learn physician personal finance. Jon Appino: It's a great question. The due diligence is very important. In rare instances, we've seen employers willing to say, “I'm not going to sell to private equity. 231 talking about this. But I would never discourage anybody from getting a local attorney to look at a contract for sure. You can learn about all of those if you go to the whitecoatinvestor.com under the recommended tab. But I think that having it, knowing what you're going to get upfront and not having an hourly rate would be important. Now, will they or not? So if it's non-negotiable, that's fine. And I thought that I had it figured out with some recruiting company and then I didn't think that that was a good fit. He is not a licensed accountant, attorney, or financial advisor. When we've helped a physician go through that process, a lot of the employers actually think it's a great idea to have a third party, and a third party who knows a lot about the market, who's asking good questions, who understands what standard language, who understands what contracts are going to be redlined and what contracts are not, a firm who doesn't want to drag out the process. It's not something that I would encourage them to spend a lot of money on. Yeah, working a quarter time and getting full-time benefits from what I know the VA has really good benefits, but that sounds like a nice either part-time gig for anybody out there, or for someone who's doing a 1099 work, or just a good lifestyle to live.”. We talk a lot on the blog about having an investing plan before you begin investing but haven't specifically discussed the importance of having a business plan before you start a new business. “We hear that a lot. It makes little sense to discuss the riskiness of stocks without specifying the ratio of human capital to investment capital....All investors should avoid nonsystematic risk--that is the risks of not being properly diversified. And I think it's always good to have someone look at the contract to at least explain to you your risks and how to get out. We kept it at what was a 1.0 for the department. Those are things that we, of course, don't get involved in here. Jon emphasized in the ending the importance of having your contract looked at by someone who does a lot of contract reviews, that they know what they are doing and understand how physicians are different. I don't know. Investing and Personal Finance Advice for Physicians, Dentists, Their Trainees, and Other Busy Professionals Dr. Jim Dahle: Do you think that happens more often with women or people working part-time? 1 Provide contact information then select turnaround time and add-ons. Dr. Jim Dahle: Yeah, they had a happy ending for me anyway. What is the best approach when you are told a contract is non-negotiable or this is our standard contract? If it's just a disagreement on your schedule, or if it's something bigger when there's a breach of contract, obviously, schedules change and expectations change and program coordinators or directors change, but I think as far as what the percent that there is a contractual issue, I think it's pretty small. There's a lot of other things that you could put metrics around. In the six or seven years since he retired, the company that managed his money was sold or merged with another company two times, but he kept the same advisor whom he had grown to trust. Jon Appino: So the way that we boil it down to is the contract is what sets expectations for what the physician is going to do, which of course is their time and giving their expert opinion, and then what the employer is going to do for the physician, so providing compensation, providing benefits, and then the rest of it is just what happens if we want to go our own ways. And then obviously, follow trends, conferences, and those kinds of things, they'll provide good detail on that stuff. Having an attorney or someone else who understands RVU compensation structures, how compensation trends could change over time, regional differences in pay, and understands the backend of healthcare and not just how the law is applied in the state would be beneficial, too. One year at a partnership, two years at a partnership and maybe having a defined metric in the contract. Jon Appino: But in a smaller market where there's not a lot of OB help, and obviously the call has to be taken for OB, we do see some physicians who can do very well as far as call compensation goes in some specialties, OB being one of them. Jon Appino: So something that just maybe lays out a little more detail that the physician wants to see, that's not necessarily going to be in the contract because to your point they don't modify or they don't negotiate contracts. We'll see you next time on the White Coat Investor Podcast. I think it does depend on the group and what things you could do to show that you are worthy of partnership early. It doesn't mean that there's not questions that the physician should ask as they do the due diligence. That is really concerning, especially with the difficulties in measuring quality, number one, and also the data that suggests more satisfied patients are actually getting worse patient care. Have you ever considered a different way of practicing medicine? Some groups are willing to do that, and some groups aren't. Maybe 20% or 30%, and a lot of them might be the attendings who have just settled into the position and they really haven't revisited it for years. Not sure where to start? I think fortunately for people to learn from, maybe unfortunately because we don't like telling these stories. What percentage of doctors do you think are currently underpaid? I asked Jon this question and he thought 20-30% are underpaid. So it's really worrisome that they're basing physician's compensation on that. Also available on Audible! I think she was fantastic. And so that was an example, not that everybody can do that, but I think it's a good example of what not to do and not just settle into your job and they give you a 2% raise here and a 3% raise here and they changed the RVU structure there, just not assuming that you can settle in and everything will be just fine, they'll pay you appropriately. But I wouldn't think that they would need much of a service from anybody else included. It doesn't mean that there's not questions that the physician should ask as they do the due diligence. Because having a physician transition out of an employment, now they've got to hire someone else, it costs $100,000 minimum. But I think overall, the frequency of an issue would be pretty small. So I wouldn't pay an hourly rate to an attorney or to any firm that could charge you more than would be required. What does the retirement plan look like? A lot I just kept coming back to the job process after training and how do you go from a resident or a fellow into a good attending role. So here's your salary and this includes you taking calls. I’m sorry but negotiating a contract constitutes the practice of law. Dr. Jim Dahle: All right, let's switch tactics a little bit and take a question off Twitter. So the most of the material for this podcast is coming from some questions I asked to readers, listeners, etc., on the WCI forum as well as on Twitter and Facebook. And if it's over a certain cap, then it's paid, and I think paid at a healthy rate.”. One year at a partnership, two years at a partnership and maybe having a defined metric in the contract. Jon Appino: We hear that a lot. And this is the only group in town or this is one of 10 groups in town.” So having the backend story I think is also important. Not all contracts are negotiating salaries. But so many employers use that to build our compensation models that we see that physician's salaries are dramatically different than that based on various markets. There is a lot of other language in a physician employment contract, but, as long as those things are clear, the rest of the contract just dictates the relationship. We've had a lot of hospitals or a lot of groups be kind of happy that the physician had a third party participate in it simply because it tends to speed the process up. Jon Appino: Do I think it's intentional by the employer to get a good deal on their labor? We do not take legal cases, spend time in court, nor operate as a law firm. So what's the schedule? And I want to make sure that the physicians understand how valuable their time is, and of course that the employer documents that in the contract. Can you talk a little bit about pay per call coverage? It sounded pretty lucrative to me. Notify me of followup comments via e-mail. We specialize in contract reviews – not legal reviews. Here are the guidelines: https://www.whitecoatinvestor.com/contact/guest-post-policy/, Your email address will not be published. We always want to make sure that the contract is clear on what the call is and we like it when it's capped. We've had conversations with employers where their goal is to go more towards the quality, so we're going to get down to 50% RVUs and 50% quality, and then 40% RVUs and 60% quality. So maybe you'll tell the employer, I will give you a dollar amount to buy my way out. Why not use him/her? But of course, every situation is different, whether there's lots of ancillaries and real estate involved, or whether it's just you're going to sign up and assume your portion of the rent every month. Our guest in this episode... – Lytt til 193: Cure Physician Burnout with Dr. Dike Drummond fra White Coat Investor Podcast direkte på mobilen din, surfetavlen eller nettleseren - ingen nedlastinger nødvendig. They will review an employment or partnership contract and even negotiate it if you want. Start your physician contract review now. The data has changed over the years with how they've broken out your length of employment from new grad to established physicians. Jon said it all depends on what the group is willing to do. “We specialize in contract reviews – not legal reviews. Dr. Jim Dahle: If you're interested in learning more about those sorts of passive income opportunities and real estate investments, make sure you also opt into that newsletter. I asked Jon if he had anything in particular for VA docs? So what are the expectations of the physician from the employer, and then one of the expectations of the employer for the physician. But now, they have all their benefits picked up on the VA. So back to the due diligence process, what are their expectations? Review my articles on DIY Investing and Investing Basics for Professionals. Family Physician. I was in the ER working a shift the other day and I had a lady come in from memory care in her 90s that had fallen ground-level fall and ended up with a type II dens fracture, C2 fracture. So they may be non-negotiable as far as we're not changing the material terms. We got a quote from the malpractice folks and it would have been 50 grand for me as an emergency physician after a couple of years. So those situations when seemingly contracts or non-competes are “non-negotiable,” you have a pediatric endocrinologist going to a market or any high subspecialist physician going to a market, and they've been trying to hire that person for the last three years, and they draw a line in the sand. You can hire them to negotiate for you, or you can just get some ideas on what you're worth and what you should negotiate and how you might do it. Continue to read online about physician salaries. “In general, I would tell all physicians, like we said, have it looked at and have your pricing structure fixed upfront. I thought an interview with him about physician contract reviews would be interesting to readers. If they wanted to ask for local guidance on that from a local attorney, then that will give you a good idea. I want to say it was 10% for years ago. Reading it then would have increased my current net worth by a 6 figure amount. Before I'm recording this, I was out at the Passive Income MD Conference in L.A. ”. And those things maybe like benefits that would be similar to financials, or maybe there are things like giving you more spare time, or more free time, or vesting you in a certain benefit earlier, or providing new equipment in the OR. Dunno. Basic questions like what is locum tenens to more complex questions about pay ranges, taxes, various specialties, and how locum tenens works for PAs and NPs. 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