The Length, Complexity & Negotiability of Physician Employment Agreements

In the world of physician Employment Agreements, there are many aspects that are the same or similar across the board – regardless of the Employer’s location or entity type – but there can also be a great deal of variation. The length and complexity the Agreement is one factor, which coincides with how comprehensive it is, but there are also many aspects to consider in terms of which terms and provisions the Agreement contains, what aspects of the employment relationship are assumed or incorporated by reference, and finally – the overarching consideration – of whether the Agreement is “negotiable.” This blog will break down what exists out there, on all points of the spectrum, and what I often observe as a physician contract attorney.

            In a Twitter poll conducted by Joe Wolf, a partner in the healthcare division of Hall Render, physician respondents replied to his poll question regarding the length of their Employment Agreements. That poll found that approximately 40% of physicians have an Employment Agreement that is between 11 – 20 pages long. Another 25% said their Agreement was more than 20 pages, and the remaining respondents had an Agreement of five pages or less. While these responses were similar to what I see in my practice, I would note that a larger majority of my clients (about 60%) have an Agreement in the 15-20 page range. Regardless of the specifics, the point is obvious – physician Employment Agreements are not brief. They are not term sheets with certain aspects of employment relationship bullet-pointed. On the contrary, they are fairly long and long-winded, containing a great deal of complex language and details concerning both parties’ obligations and responsibilities pursuant to the employment relationship. And more, they are of course legally binding documents and must contain certain pieces of language and provisions in order to exist as a valid and enforceable contract.                            

On one end of the spectrum are the most robust of Employment Agreements, often used by large health care systems, which contain almost every provision imaginable and aim to embody every conceivable aspect of the employment relationship. On the other end of the spectrum are Employment Agreements that contain only the most straight-forward and important of employment details, such as the termination provisions and compensation method, while merely referencing other policies and procedures, which are intended to be incorporated by reference. For instance, such an Agreement might make reference to the Employer’s benefits policies, its Intellectual Property Policy, the entities’ Rules, Regulations and Bylaws, and/or the Call Responsibilities and Schedule. In these instances of incorporation by reference, it is important to remember that the entirety of the employment relationship will be made up of all applicable terms and policies, whether or not they are actually contained within the pages of the Employment Agreement.

            In serving physician clients, I often hear, “My Employer already told me that my contract isn’t negotiable.” So, is that case? Are Employment Agreements negotiable and subject to revision based on the physician’s requests? The answer, of course, is that it depends. Very broadly, I will say that in my experience, most Agreements are negotiable in at least some ways. By that I mean that in even the strictest of settings, such as an academic institution, it may be possible or even likely to successfully negotiate a couple aspects of your employment, while leaving the content of the Agreement uniform. For example, clients are often able to successfully negotiate adjustments to items like their Compensation or their Signing Bonus, despite being told the Agreement was “non-negotiable.” In those instances, what the Employer likely really means is that they will not adjust the language of the Agreement itself, or amend the scope of their Non-Compete, for instance.                                                                                                                        

As mentioned above, this strict approach and need to have their Employment Agreements very static and uniform for all physician-employees is most common in the academic setting. This is also frequently the case with large hospital systems that desire uniformity and stand by their efforts to not make any adjustments “for any one employee.” However, as with most rules in life, there are always exceptions. For instance, I recently worked with a physician who was re-negotiating a renewal to his contract with a large health system. He works in a highly specialized field and is revered for his immense experience and long-term success. In that scenario, he was able to dictate a number of adjustments to his contract, to both the content of the contract itself as well as his compensation method, because the hospital was not willing to lose him. In other words, he had very strong bargaining power.                                                                                     

Another frequent question I get relates to who will do the negotiating on a physician Employment Agreement. Most commonly and most appropriately, it is usually the entity’s legal counsel that engages in the negotiating process. However, in some situations it is a practice manager or CEO who negotiates directly with the potential physician-employee. And often, it is a combination of both. In these instances, it may be a practice manager who is the decision-maker regarding a physician’s specific duties and which location(s) they serve, and then it is the attorney who has to make the call regarding whether the Non-Compete or Termination provisions can be adjusted. In either case, it is important for physicians to understand their right - and arguably their duty - to be represented by counsel in the negotiating process. Not only should physicians exercise due diligence in ensuring they are making informed decisions in the process, they should seek representation in order to level the playing field. Employers invariably have more power in the employment relationship, and the fact that they (or their attorneys) are the ones that drafted the Employment Agreement means that the playing field is inequitable from the get go. The only way to make a fair and informed decision about entering into a contractual relationship is to be appropriately represented by legal counsel.

            The attorneys of Lauth O’Neill Physician Agency are experienced and able to guide you through this process.

Healthcare Mergers & Acquisitions: Implications for Physicians, Part I

Small businesses of all kinds have struggled to stay afloat during the COVD-19  pandemic, and healthcare practices are no different. The pandemic has brought about many changes to the healthcare industry, with particular impact on smaller, privately held practices. Larger, more financially sound entities were better equipped to face the fallout from the pandemic – implementing adaptations, offering telehealth, effectuating novel clinical protocols, etc. – and in many cases the larger entities have stepped in to acquire those smaller businesses that were floundering. Therefore, it is not surprising to learn that in 2020 alone there were seven “mega mergers,” which the healthcare industry defines as a merger involving two entities with over one billion in annual revenue (RevCycle Intelligence).                                                                   

While mergers and acquisitions are common – 2019 saw a recent high number of transactions with 94, while 2010’s “low” was 74 – it appears that we are on track for a continued upward trend. Healthcare CFOs were recently surveyed, and 44% agree that the pandemic will cause an increase in partnerships, and 41% expect increased consolidation (BDO). While the average patient may not necessarily even notice a change or disruption to their healthcare, this transactional atmosphere begs the question, what happens to the physician-employees when their employer is bought out?

When a physician is employed, the terms of that employment are governed by an Employment Agreement, aka a contract. The contract will explicitly state the nature of the relationship between the specific provider/physician and the entity that employs them. Because contracts appear to be so specific to the respective parties, many would assume that if the entity changes or is acquired by a completely separate entity, then a new contract would be required. But surprisingly, this is not the case. When mergers or acquisitions take place, essentially changing who the “employer” is, contracts are actually very easily transferred or “assigned” to the new party. It generally all boils down to just one provision of the original contract.

Physician employment agreements are by their nature personal services contracts. Rather than a general contract for the supply of goods, the contract is an agreed-upon bargain for the performance of actions. In other words, the employer has specifically hired the physician for his ability to perform agreed-upon duties. As such, physician employment agreements fall outside of the general business contract rule whereby contracts are freely assignable. Accordingly, physician employment agreements always contain a provision governing “Assignment” in order to make clear the fact that it is not freely assignable. The Assignment provision will state whether, and to what extent, the contract may be assigned by either party. Very commonly, the Assignment provision in a physician employment agreement will read as follows:

This Agreement shall not be assignable by the Physician without the prior written consent of the Employer. The Employer may assign its rights and obligations under this Agreement to an entity under common control or to a successor in interest without the consent of the Physician.

 As you can see, Assignment provisions are more often than not more flexible and favorable to the rights of the employer, ensuring their ability to freely “pass the torch” if and when a merger or acquisition takes place. This is the standard approach and employers generally are not willing to amend this language. One slight exception is that some employers are willing to ensure their employees’ right to advanced notice in the event of an assignment. This is a favorable adjustment to request, being that a physician might find herself working for an entirely new company without any prior knowledge. Further, the right to have advanced notice puts the physician in the position to terminate the Agreement without cause (which usually requires 90 – 180 days’ notice) if they do not wish to be a part of the future organization.                                          

The impacts of an employment agreement’s Assignment provision is only one of numerous items that should be analyzed prior to signing a contract. Physicians are well-advised to seek the counsel of attorneys who are experienced with these terms and the most favorable approaches to pursue.

The COVID Crisis and Its Effects on Our Nation’s Health Care Workers

Physicians have been lauded – rightfully so – since the very beginning of this global pandemic. Working on the frontlines and putting themselves and their families at risk in order to serve others, it is difficult to entirely comprehend the sacrifices made by our nation’s health care workers. It is in some ways only now, a full year after this situation first unfolded, that we are truly able to appreciate and quantify the burden borne by health care professionals (and more will certainly come to light in the future). Both in terms of the impacts on physicians’ employment situations and the impacts on their health (both mental and physical), the COVID-19 pandemic has left a permanent mark on physicians.

At a time when physicians and health care workers have been needed the most, it is a bit counterintuitive to realize that they are being greatly undervalued. Recent studies indicate that nearly half of practicing physicians in the US have either lost their jobs, experienced a reduction in income, or were furloughed. Approximately 16,000 health care practices around the country have closed as a direct result of the pandemic, leaving thousands of health care providers and support staff without employment. Focusing only on physicians who were able to keep their jobs, 72% of them have had a reduction income. This is the result of the drastic decrease in appointments and procedures (more than 40% of adults in the US have skipped medical care due to COVID) as well as the movement to telemedicine. While no one is arguing that physicians who have reduced their income are now in desperate or destitute situations, it is important to remember the circumstances – they are in the most dangerous situation of any professional. Whether they are a hospitalist working the COVID unit or a specialized surgeon who does not necessarily face COVID head on, the fact is across the board they come in contact with so many people each day, making their job inherently risky. For this reason, the loss of employment or reduction in income adds insult to injury – we expect physicians to do the most and risk the most, but we do not recognize or reward that in any way.

In terms of the dangers and sacrifices faced by physicians, there are many factors to be considered that are not entirely obvious. To begin with, physicians (and all levels of health care workers) are of course in the most dangerous situation of all, directly caring for those who are COVID positive. Regardless of PPE and appropriate precautionary measures in place, there is still a great risk in doing this work. Importantly, this risk does not only apply to the physician, but also to the physician’s entire family and/or whomever she shares a home with. Countless physicians and health care workers have knowingly and willingly faced this dilemma with such strength of character, understanding that they are in many ways putting their oath as a doctor ahead of their own personal well-being (and that of their loved ones). Sadly, health care workers have certainly paid the price for this risk. As of December 2020, studies indicate that roughly 3,000 health care professionals have died from COVID (with most agreeing the figure is actually much higher). Among those who have not been afflicted by the disease itself, the majority of health care workers are facing significant effects nonetheless. Exhaustion and burnout are at an all-time high – since the start of the pandemic, the number of physicians who report feelings of burnout has increased almost 20%, and 37% of physicians reported that they would like to retire in the next year. These numbers certainly indicate that the pressures we have placed on health care providers are simply not sustainable under our current system. The effects on the mental health of health care workers should not be overlooked or diminished. For those working in COVID units, most have witnessed events that are deeply troubling, and not just on a few occasions, but rather every single day. Health care workers are trained, and in some ways accustomed to, witnessing death, but one thing is clear – none of them were prepared to witness the type of death that COVID created. Aside from the tragic suffering that those dying from COVID endure is the almost unbearable sadness of those people dying alone. With strict quarantine measures in place preventing the presence of loved ones, even at the very end, it has been all-too common for health care workers to step in, filling the role of “loved one” to someone who is actually a stranger. Often physicians and nurses will gather together in a room during a patient’s final moments, holding her hand through the barrier of PPE, just to be sure that person does not die completely alone. It is also common for health care workers to use their personal cell phones to Facetime with family members so they can see their loved one before they die. No one can be prepared for this level of sorrow in their workplace on a daily basis, and it has led to unprecedented levels of physician depression and suicide. Time will only tell us more about the lasting effects of all of this.                

In a nation where a physician shortage was already the reality, it is daunting to think where the future of health care will lead. Will systemic changes take into account physician insights, and create a national health care system that puts priority on providers and patients, rather than policymakers and executives? One can only hope that with the benefit of hindsight, perhaps real change can be made to adequately care for our population while simultaneously taking care of our providers.

Physician Non-Compete Covenants: Indiana’s Recent Update

While physician employment agreements vary in their form, length, terms and provisions depending on the employer type and which state the agreement is in, one aspect that is a near-certainty in every single physician employment agreement is the Non-Compete Agreement (also called a Restrictive Covenant). Whether a hospital position, an academic appointment or entering into private practice, a physician accepting a job offer can almost certainly expect to be bound by a Non-Compete upon termination. The question of whether a Non-Compete is enforceable and to what extent it can validly restrict a physician’s right to work is a difficult one. Courts in most states require that Non-Competes be examined on a case-by-case basis when challenged, meaning that there often are no “bright-line rules” as to what is allowed. However, some states have recently created relevant statutes with guidelines for how employers can and cannot restrict their physician employees’ behavior. Because Lauth O’Neill is based in Indianapolis, this post will focus on the recent updates to Indiana’s law, which has significant repercussions for physicians and employers in this state.

         Early this year as the new legislative session got under way, healthcare attorneys heard rumors about a supposed ban on Non-Competes for doctors in Indiana. Now, we all know 2020 has been wild, but not that wild. The rumors were not true, but in reality there was a significant update. Effective as of July 1, 2020, a new chapter in the Indiana Code places specific restrictions on physician Non-Compete agreements. The new requirements, outlined in I.C. 25-22.5-5.5, detail language and provisions that each physician employment agreement must contain or else the Non-Compete will be completely unenforceable. Specifically, any physician employment agreement that has a Non-Compete entered into after July 1, 2020 must contain the following:

• a provision that entitles the physician to see any notices about his/her departure that are sent by the former employer to the physician’s patients;

• a provision indicating that the employer must share the physician’s last known or current contact information with any patient who asks for it;

• a provision entitling the physician to copies of patient medical records;

• a “buy-out” provision on the Non-Compete; and

• a provision that prohibits the providing of patient medical records to a requesting physician in a format that materially differs from the format used to originally create or store the medical record.

 Importantly, the new law does not merely dictate that employers adhere to these requirements, but rather it requires that the employment agreement actually contain language guaranteeing each of them. In that sense, employers must be very careful in drafting their employment agreements, as omission of any of these provisions will render the Non-Compete entirely unenforceable. With regard to agreements entered into prior to July 1, 2020, nothing has changed, and the new law only applies to new employment agreements.

One of the most pressing new dilemmas created by the law pertains to the requirement for a buy-out. The code tells us that a physician whose employment has terminated/expired must be given “the option to purchase a complete and final release from the terms of the enforceable physician non-compete agreement at a reasonable price.” In other words, the physician must have the chance to pay their employer a sum of money rather than be bound by the non-compete. This is not surprising, as buy-out provisions are very common in Non-Competes, but what is a “reasonable price”? No one knows. In that sense, this requirement creates more questions than answers. Notably, the statute goes on to clarify that if a physician does not utilize the buy-out, the employer is not restricted in its ability to exercise equitable remedies to enforce it (i.e. injunctive relief). This is an important clarification because the existence of a buy-out option theoretically refutes the argument that an employer would suffer “irreparable harm” if the Non-Compete is violated, a requirement for pursuit of injunctive relief.

         The statute does nothing to identify what constitutes a reasonable geographic restriction for a Non-Compete, and also does not discuss duration. In this sense, there are many factors that remain up for discussion in terms of reasonableness and enforceability. The one thing we do know is that unless employment agreements contain each of the above-described provisions, there will not be a need for a determination of reasonableness, as the Non-Compete will be wholly unenforceable.

         In reality, the new statute is a good thing for physicians in Indiana. It really just amounts to an additional burden on employers if they want their physicians to be bound by a Non-Compete. Physicians should do nothing more than sit back, say nothing, and hope their future employers missed the memo on the new update (and have their employment agreement reviewed by Lauth O’Neill, of course).

2020 Physician Compensation Report and the Impact of COVID

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Each year, Medscape publishes its report on Physician Compensation. Based on the survey responses of over 17,000 physicians in the US, the report details physician compensation trends, looking at variables such as: physician specialty, whether an incentive/productivity bonus is offered, which states are the highest earning, how many patients are seen and whether the assistance of PAs and NPs is utilized, and more. The information is undoubtedly interesting and relevant to physicians everywhere, who are eager to glean some understanding of how their own compensation compares to their peers around the country. In addition to compensation data, the report also takes a look at quality of life issues, aiming to determine how many physicians are actually happy and fulfilled in their roles, and whether they would choose medicine as a career again if given the chance. Suffice to say, the report serves as a spotlight into the lives of our nation’s physicians, bringing to light both the good and the bad.                                                                  

This year, the Medscape report and similar studies performed by other organizations have taken the necessary step of shifting some focus to examining the effect of COVID-19 on health care practices and providers. There is already a great deal of data available about the impact COVID has had on revenues, productivity and much more. Needless to say, the impact has already been considerable, with the future of healthcare as we know it hanging in the balance. Practices throughout the country are reporting a 55% decrease in revenue and a 60% decrease in patient volume, while remote patient engagement has increased 225%. Sadly, our nation saw more than 43,000 layoffs among healthcare workers, and 9% of independent practices have shut down (at least temporarily). Additionally, both hospitals and practices throughout the country are reporting significant pay cuts and furloughs in order to keep the business afloat while operating on drastically decreased revenue. And while all health care providers are being affected in one way or another, it goes without saying that physicians whose primary services consist of elective procedures, which were entirely restricted in most places, are the hardest hit. Included among those who provide predominantly elective procedures are plastic surgeons, ophthalmologists, orthopaedic surgeons, gastroenterologists and vascular surgeons. In some cases, these physicians have lost up to 95% of their average patient volume.

The repercussions of COVID on the delivery of health care in our country brings to light many questions about the future. Will people engage in elective procedures at drastically lower rates due to the general fear surrounding hospitals and surgery centers as potential infection hot spots? Another important question is whether remote doctors visits will become more common even after the pandemic ends. Will people realize that it is not actually necessary to visit a doctor’s office in order to get the general health care they require? Or will people just avoid regular health care altogether? A scary thought when one considers the importance of regular check-ups for the long-term health of our population.                                                                         

Time will tell what the future holds for the delivery of health care in our country. Encouragingly, as states start to open up, many health care providers are starting to see the light at the end of the tunnel, with many patients resuming their former health care habits. But whether we will ever return to “normal” is anyone’s guess at this point.

4 Secret Weapons for Negotiating the Salary You Deserve

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Of the many things you’ve been taught in medical school, how to negotiate a salary is not one of them. In fact, during your residency and fellowship, your compensation was likely based on your postgraduate year level (or PGY) with some geographic considerations, so you probably haven’t had any need to know how to negotiate a salary for at least the last three to six years. Between understanding wRVUs and productivity bonuses to deciphering whether the CME allowance, relocation reimbursement and sign-on bonus are all adequate, it can be a bit intimidating even for more experienced physicians. How do you know if what you’re being offered is fair and equitable?

 Understanding physician compensation structures doesn’t generally have to be as complicated as the wording contract makes it out to seem, and negotiating the compensation terms for a job you’re really vying for are much easier when you have these three secret weapons under your lab coat. 

 Do your research

You can’t possibly know whether or not what you’re being offered is fair if you don’t do any research on your own first. Utilize online resources such as PayScale and Doximity to see what the average salary is for physicians in your specialty and in the city the position is located in. Likewise, be sure to investigate what the cost of living is for the area, as this is an important factor to consider.

 If you happen to know another physician who works for this employer, depending on the nature of your relationship, it’s acceptable to consult with them on their thoughts about the compensation plan and other benefits. Even talking to former classmates about what offers they’re receiving for your specialty can be a good way to gauge your offer.

 Likewise, if you’ve received an offer and are having difficulty understanding how certain productivity bonuses are paid out by the employer, you can also ask to see a sample pay stub from other physicians in the group with the names removed. Researching the salary data on your own is a must as it empowers you to advocate for yourself and further ensure you’ll be fairly compensated.

 Be confident in your worth

Consider your strengths, accomplishments, professional interests and what clinical skills you have honed in on; then as you interview for positions, take notice of how these facilities and practices are lacking in areas that you could easily fill. You must be confident in the value that you will bring to a team so that it will in turn be easy to convince potential employers of why they should offer you a salary that matches your worth. 

 Consult an attorney

A contract is the framework for your working relationship with your employer. It’s especially important to consult an attorney who is experienced in negotiating physician contracts, and not just for the compensation aspects. Physician attorneys, such as Lauth O’Neill, are not only versed in concepts like non-compete clauses, partnerships, buy-ins, etc., but we’re also specifically adept in salary data and other forms of compensation. In our Analyze and Shape services, we are able to do just that- analyze and shape your contract to fit your individual needs so that the contract is fair and balanced. Our contract review services include a phone consultation and a thorough review of your contract with a formal comment letter that includes our easy to understand recommendations for various aspects of the contract, including a compensation breakdown. We take the guesswork out of compensation data by informing you of what’s standard and fair, and by comparing your offer to the MGMA DataDrive Provider Compensation (a service which provides a unique and accurate analysis based on your exact region of employment, specialty and experience). From there, we’ll also help you formulate follow-up emails to your potential employer, negotiate on your behalf and provide a final review of all contract revisions.

 Remember, everything is negotiable

Some employers may not be willing to budge on certain aspects of their compensation plans; in some cases, the employer may offer standard rates across the board for every physician just starting out in the practice. That said, remember that everything is negotiable; there are still many alternatives to ask for in addition to increases to your base salary like more PTO, a sign-on bonus or relocation expenses, the ability to hire your own NP or PA, and much more. Furthermore, if your base salary is less than what you feel you deserve, but the employer isn’t willing to budge just yet, you can also ask for the contract to provide the opportunity to renegotiate your base or incentive pay after one or two years of employment. When it comes to negotiating, it never hurts to ask as you may be pleasantly surprised by what the employer says yes to.

 Remember to be pleasant in your negotiations. This will build the right environment for a constructive discussion and a positive working relationship once the offer is signed.

The Dos and Don'ts of Physician Contract Negotiation

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After months of searching and traveling across the country for interviews, the time has come; an employer has finally presented you with a formal offer and employment contract for you to sign. As you read through the numerous pages, however, you begin to feel a bit of anxiety. “Is this offer fair?” “What exactly does my non-compete entail?” “Is it okay to ask for more money or will I scare them off by doing so?” These are all normal questions every physician finds themselves asking. Afterall, a contract is the framework for your working relationship with your future employer so it’s important that before you sign it, you feel confident that the agreement is mutually beneficial. Understand that negotiating is an important part of the employment process. Before you dive in however, there are a few dos and don’ts you’ll want to be aware of so that you can negotiate confidently, respectfully and effectively.

 Don’t: Assume a contract is non-negotiable

Some employers may not be willing to budge on certain aspects of the contract but remember, even in the most boiler-plate contracts, everything is still negotiable. There are a plethora of things you can ask for in your contract so that it suits your professional goals and aspirations such as extra PTO days, a sign-on bonus, the ability to hire your own NP or PA, and much more. When it comes to negotiating, it never hurts to ask for what you want! You may be pleasantly surprised by what the employer says yes to.

 Don’t: Forget to do your own research

You can’t possibly know whether the compensation is fair if you don’t do any research on your own first. Try to gain a general idea of what the compensation is for your specialty in this specific region by utilizing online resources such as PayScale and Doximity. In our Analyze and Shape service, we thoroughly examine the compensation data and inform you of what your contract may be lacking that’s standard such as a relocation reimbursement or a CME allowance. We also compare your proposed salary to the MGMA DataDrive Provider Compensation (a service which provides a unique and accurate analysis based on your exact region of employment, specialty and experience) to ensure that an employer isn’t completely off base with their compensation plan.

 Don’t: Ignore red flags

Contract negotiation can be a nerve-wracking experience and it’s normal to feel a little anxious over it. However, it’s imperative that you trust your instincts and don’t ignore any red flags that make you feel uneasy about accepting the position. Red flags to be aware of include an employer pressuring you to make a decision that feels rushed, being discouraged from using your own attorney, an employer who is completely unwilling to negotiate or takes great offense to your asking. Always trust your instincts if things feel “off”. It’s much easier to walk away before signing than to try to get out of a contract after the fact.

 Do: Be flexible but consider your nonnegotiables

Understand that you may not be able to get everything you want in your contract; employers may have standard language in their contracts that they’re unwilling to budge on and what they’re offering you in terms of benefits and salary may be standard across the board for every physician new to the practice. Though you do need to be flexible on some items, you don’t want to compromise so much so that you feel you’re the one getting the raw end of the deal. Spend some time considering what your nonnegotiables are by making a list of what’s important to you in your employment agreement; is it a flexible schedule, the ability to hire your own NP or PA, loan repayment, etc.? By preparing yourself on what you are and aren’t willing to sacrifice, the better you’ll be able to negotiate and advocate for yourself.

 Do: Use an attorney to review your contract

It’s especially important to consult an attorney who is experienced in negotiating the various aspects of the physician contract. Physician attorneys, such as Lauth O’Neill, are experienced in reviewing non-compete clauses, partnerships, buy-ins, etc., and we ensure that your offer is fair based on the location, the specialty and your level of experience. Our contract review services include a thorough phone consultation and an in depth review of your contract with a formal comment letter that includes our easy to understand recommendations. We’ll also help you formulate follow-up emails to your potential employer, negotiate on your behalf and provide a final review of all contract revisions.

5 Keys to a Successful Physician Job Search

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Whether you’re a resident with program completion in sight or an established physician looking to make a career change, searching for a physician job can be overwhelming. Unlike a typical job search, the process for physicians is much more complex and can feel a bit like taking on a few extra shifts at the hospital in addition to working a full time job. Landing a position that fits both your personal and professional desires can feel like searching for a needle in a haystack. Follow these five keys for a successful physician job search.

1.     Consider your top “must have” priorities

Spend some time creating a list of what your top priorities are and ranking these from least to most important. Salary and other incentives are certainly important considerations to include but go deeper as well; consider which is more important to you- working in a specific region of the country or working in your ideal practice setting regardless of location? What does your ideal work week look like and is there a particular patient population you hope to avoid or focus on? Furthermore, what factors are important for you on a personal level such as for your family or personal life? Once you have prioritized your “must haves”, you can better weed out which jobs fit your professional satisfaction goals and which do not; ultimately leading you to a more productive job search in less time. 

2.     Fine tune your cover letter and CV

A well written cover letter and CV are the first things an employer will see about you; it’s easily a make it or break it aspect in whether you’ll be invited for an interview or passed up for another candidate. 

Writing a cover letter can feel awkward and intimidating; some find it difficult to summarize in enough words whereas others find it challenging not to become too wordy. Format your cover letter similarly to a professional business letter with no more than a few paragraphs, not to exceed more than one page. Remember that a cover letter is a compliment to your resume, so it should be simple and easy to read. While it is okay to use one letter as a template for multiple positions, you should still take the time to tailor certain aspects so that it’s applicable to each individual position you’re applying for; such as addressing the letter to a specific hiring manager or department head, mentioning the practice by name throughout the letter and giving specifics as to why the location is appealing to you. This will show the employer that you’re serious about the opportunity and help you get noticed right away.

Ensure that your CV is accurate, up to date, and professionally presents the skills and credentials you currently possess. Remember that your focus is on physician employment; thus, in most cases, listing previous positions that do not relate to healthcare should not be a part of your CV.

3.     Start as early as possible

If you’re a resident, you should begin searching for a position within ten to fourteen months prior to graduation. Established physicians looking for a career change should consider how long the hiring and credentialing processes are and base the timing of their searches accordingly. The physician hiring process generally takes between three to six months and, depending on the medical board, the time it will take for you to obtain your state medical license can vary greatly; whereas some states will issue a license within thirty days of application completion, others can take even longer.

4.     Stay organized

Keeping track of what facilities you’ve reached out to can get out of hand quickly if you’re not organized. Plus, it’s not a good look to send your materials to a hiring manager more than once by accident. Consider keeping a spreadsheet with a log of which facilities you’ve applied to and when, who you communicated with, and what the response was. You should also include information within the spreadsheet about what is appealing to you about this facility; is it the location or are there aspects of the site that you are interested in such as their stature in the community?

5.     Consult a physician agency

Utilizing the services of a physician agency such as Lauth O’Neill can help streamline the entire job search process from start to finish. As the physician job market continues to evolve, physician agencies are experts on various medical specialties. In our company, we pay close attention to employment trends nationwide and understand the various job markets around the country. Unlike a recruiter, Lauth O’Neill Physician Agency works for you, not the employer. We take the time to first get to know you personally and professionally. In doing so, we are able to gain insight into your individual career aspirations so that we can successfully help you find your dream job by taking a proactive approach to the process. And, as licensed attorneys, we can even help you with contract review and negotiation so that not only are you able to land a job, but it will be fair in compensation and terms of employment.

 Searching for a physician position takes time. Be patient with the process and remember, the right opportunity for you is out there waiting to be found.

Healthcare Practices Amidst the Coronavirus

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For what already seems like an interminable amount of time, our lives have been turned upside down by the coronavirus. While the lives of some are drastically more affected than others, the fact is that we are all experiencing the vast repercussions in one way or another. For some physicians, the effects of the coronavirus have been life altering, and in some cases, life shattering. Those on the frontlines treating coronavirus patients are dealing with circumstances previously unknown, and taking incomprehensible risks every day just to do their jobs. The sacrifices being made by these individuals cannot be adequately described or revered, and we all owe them respect and gratitude unlike any other time in history.

But what about other health care workers, those not directly facing the coronavirus? Surgeons, ophthalmologists, pediatricians, OBGYNs – the list goes on and on. There are hundreds of thousands of physicians in the US of various specialties who are not necessarily being called upon to treat patients of the virus, but their lives are being drastically affected nonetheless. Shelter-in-place orders and restrictions on health care visits to only those that are absolutely essential, means that physicians (and APs and NPs) across the country are in many cases facing a near standstill in their practices. The reduction in office visits, procedures and surgeries of course means that revenue is down – way down – for health care practices of all types. Just like any other business, practices need revenue to survive; they have bills to pay and employees who depend on their salaries. And on top of that is the unique incongruity wherein doctors’ offices have the obligation to remain open and available for patients, despite the drastic reduction in services. Whereas many businesses currently facing a decrease in business are closing their doors temporarily and stymieing some of their ongoing expenses and overhead, conversely, most health care practices don’t have the ability to push the pause button, but rather are required to continue operating with a fraction of the resources they typically utilize. Although Congress has approved the provision of billions in federal aid to assist small businesses through the Payroll Protection Program, it is already clear that the available aid will not be sufficient to help everyone. The resulting financial impacts are very real, with many practices having no choice but to lay off both administrative staff and providers, maintaining only a barebones team to keep their offices afloat. Other practices are taking the approach of drastically reducing provider compensation in order to offset the decline in revenue. In both cases, health care workers are dealing with very real financial effects and are trying to figure out how to support their families until any semblance of normalcy returns.                                                   

Huge unknowns obviously lie in the future. Will the practices that reduced their staff be able to resume their previous level of services? Will there be a giant influx in illness and disease (and therefore medical visits) as a result of the prolonged period without regular check-ups and basic healthcare? Will we have a nationwide shortage of physicians, NPs and PAs, either as a result of cultural changes or as a result of necessitated periods of self-isolation for those who did work on the frontlines? Only time will tell what lies ahead for the health care industry. For the time-being, the best we can do is take responsibility for our health and the health of those around us, taking whatever steps necessary to lessen the burden for our frontline providers.

The Lauth O’Neill team would like to express our deepest gratitude and respect for our clients and all health care providers who are sacrificing so much at this time for the greater good. We continue to provide dedicated services to our physician, PA and NP clients who seek guidance with respect to their employment contacts.

Access to Healthcare in Rural Areas: Particular Challenges and the Providers Who Serve Them- Part 2

Our last post highlighted the particular challenges that rural residents face in obtaining basic, essential healthcare. In many cases, the problem lies in the very simple fact that healthcare providers are too far and few between, making it a logistical nightmare for people to see a doctor. While the problems are well-documented and on the radar of many, what – if anything – is being done to alleviate these struggles? Who will fill the gaping holes that exist in the availability of healthcare? 

To be clear, it is not just highly-trained specialists that are lacking in rural communities. Rather, providers of all kinds and backgrounds are under-represented in rural areas. All areas of care – from dentists to psychiatrists – are grossly under-represented, which is not surprising considering that rural physicians comprise only about 9% of all practicing physicians. Filling these gaps is not only an issue of initial hiring, but also of retention. 

Healthcare organizations and experts tend to focus on monetary incentives when considering ways to induce providers to rural areas. These incentives include not only significant regular pay, but also things like loan payoff arrangements and sizeable bonus payments. Essentially, relying on the lure of flashing dollar signs to get providers to even consider joining the hospital or group in the first place. For many physicians with crippling student loan debt and young families to look after, this is a legitimate inducement, even if it means relocating to an area they may have never considered before. However, these beneficial financial arrangements solve only the first conundrum of hiring, and do not generally solve the issue of long-term retention. So how to get providers to not only moveto rural communities, but also to stayput?              It appears that the most effective strategy lies in pursuing candidates who will appreciate the lifestyle advantages offered by practicing in a rural setting, of which there are many. To begin with, there are many lifestyle factors that simply are not available in urban settings. For individuals who value the activities and opportunities presented by the great outdoors, many of our country’s rural communities offer enticing advantages. Hiking, horseback riding, boating, mountain biking, rafting and countless other activities are typical pastimes available any day of the week in many rural areas. Whereas for most of us, participating in such activities would require a special excursion – likely requiring a flight, a hotel stay and at least a full weekend away from home at minimum – residents of rural areas can partake in those activities any day of the week. A rural setting also might offer an attractive lure for parents of growing children. Children raised in a rural setting may have a completely different outlook on life, community, the importance of spending time outdoors being active, and the comfort, safety and reliability of a close-knit community – all of which are life lessons that cannot necessarily be taught, but rather must be experienced first-hand.         

For practitioners who are more concerned with career-focused inducements to residing in rural areas, those exist as well. Physicians in rural communities have greater autonomy in general. Based simply on the fact that there are fewer providers to go around, physicians are often in the position to practice areas of medicine they wouldn’t otherwise see in an urban setting that is swarming with specialists of all types. Whereas in an urban setting a particular case might be sent immediately to a specialist, a physician in a rural setting would likely take on the case herself. This allows (and requires) the physician to use a much greater amount of the broader knowledge and information she’s been taught throughout her career, versus being pigeon-holed into only working on a very specific type of case. Finally, rural physicians generally have the benefit of getting to exercise a more holistic, patient-centered approach to medicine, as they are allowed more time with each patient, thereby enabled to provide more comprehensive care. 

The benefits are varied and many, and physicians of all ages, experience levels and specialties are well-advised to consider the career opportunities available in our nation’s rural communities.

Access to Healthcare in Rural Areas: Particular Challenges and the Providers Who Serve Them [Part 1]

When examining the big picture of our society, rural America is grossly under-represented in many ways. While areas defined as “rural” comprise 80% of the total US land area, its inhabitants comprise only 20% of the US population. In other words, rural communities span vast stretches of land, but there simply aren’t many people living there. The relative lack of population has very real consequences in terms of the healthcare available, and the effects are somewhat disastrous and certainly worrisome. 

In rural areas, there are estimated to be only 30 specialists per 100,000 residents – this is compared to approximately 263 specialists for every 100,000 people in urban areas. The small number of healthcare providers overall means that they are literally and physically spread very thin, creating logistic impediments for people seeking healthcare. It is not uncommon for rural residents to have zerohealthcare providers within an hour drive of their home. The inevitable result is that people are required to devote significant amounts of time just to visit the doctor. This often means taking off an entire day of work to attend an appointment, or even staying overnight in a different town just to see a specialist. For instance, depending on where you live, you may have to travel over 200 miles to see an OB/GYN (54% of rural counties don’t have a hospital with obstetrics services). These statistics shed some light on why it is that the US has very poor maternal mortality rates, which politicians and healthcare experts have recently qualified as a “crisis.”        

Other specific challenges exist in the rural setting that make the delivery of adequate healthcare even more problematic. Rural residents have lower incomes and there are fewer adults with postsecondary education, resulting in significantly higher rates of uninsured residents. On top of that, rural residents are still smoking cigarettes at the same rates or higher than 10 years ago (whereas the rest of the country has drastically reduced smoking rates), and opioid use and addiction are rampant. Finally, because healthcare is logistically so difficult to receive, individuals are generally only seeking treatment once disease presentation is much farther along and therefore less treatable. Whereas an urban resident would likely seek treatment at the first sign of disease or ailing health, rural residents significantly delay their first doctor visit because they simply cannot get there. 

While the rural healthcare crisis continues to progress – at least 80 rural hospitals have closed since 2010 - healthcare experts are examining ways to combat the situation before it becomes an emergency our nation can no longer ignore. Our next post will examine these efforts and the ways some providers are taking steps to serve those that have historically been neglected.   

Lauth O'Neill Founder Helps Kick-Off New Youth Volunteer Program

Leigh Ann O’Neill celebrates Christmas in July with patients at Peyton Manning Children’s Hospital as part of a new youth volunteer program.

Our Founder and CEO, Leigh Ann O’Neill was asked to join the St. Vincent Foundation’s Young Professionals Board (YPB) last year. Among their first priorities in supporting the St. Vincent Foundation and Ascension St. Vincent Hospital was forming their Helping Hands Series. This important new volunteer series focuses on bringing community youth together to engage in meaningful opportunities to support the Ascension St. Vincent facilities, including Peyton Manning Children’s Hospital and the St. Vincent House.

In their first big event, Leigh Ann and other YPB board members organized a Christmas in July event for the patients at Peyton Manning Children’s Hospital. A great time was had by volunteers and patients alike! Read the full story about the event here.

Q & A with Leigh Ann O'Neill: "How did all of this get started in the first place?"

People often ask, how did you get into this business? Working as an attorney-agent on behalf of health care professionals is a unique profession, both for its narrow focus and somewhat novel endeavor. When people learn about what we do at Lauth O’Neill, they often express two sentiments: 1) I’ve never heard of an attorney-agent for physicians, and 2) That’s a great idea. We believe the origin of our business is quite telling, and may shed some light on why it is so important for health care professionals to be represented in their employment matters. Keep reading to learn more about Leigh Ann O’Neill, and the reasons behind whyshe founded Lauth O’Neill Physician Agency 5 years ago.

A native of Indiana, Leigh Ann graduated from Indiana University School of Law – Indianapolis in 2006. Following graduation, Leigh Ann began her first legal job as an associate attorney with Krieg DeVault, an Indianapolis-based law firm. Leigh Ann worked in the Health Care Practice Group and focused her efforts exclusively on issues related to the health care field, both on behalf of physician-clients and hospitals and practice group employers. Given Leigh Ann’s focus and roots in the health care field, it was quite fitting that she married a physician. Leigh Ann’s husband, Kevin, is an orthopaedic spine surgeon. By his side throughout the (many!) years of grueling training, multiple out-of-state moves, Board examinations, and countless job interviews, Leigh Ann had a front-row seat to everything that physicians go through when pursuing employment. Witnessing all that this entailed, not only for Kevin but also for all his friends and colleagues, Leigh Ann quickly realized that physicians needand deservehelp.

Q & A with Leigh Ann O’Neill:

At what point in your husband’s job search process were you really convinced about the importance and relevancy of attorney-agent services?

I distinctly remember the weeks leading up to my husband’s Boards exam, right after he finished residency and before we moved to St. Louis for fellowship. We, and our two young sons, were crammed into a small apartment, and Kevin often retreated to the balcony to get some quiet space to study. On top of all of that, he was searching for names and contact information for potential employers. He wanted to engage in a thorough job search and be sure he considered all opportunities that were available to him. All of that searching took up a lot of time. It was then that I had the light bulb moment- it’s not that physicians can’t job search on their own, it’s that it’s a completely inappropriate use of their valuable time. Not to mention, once they get to the contracting phase, they really need help. After all, they’re doctors, not lawyers. Having worked on the other side of things representing hospitals and practice groups, I know how physician employment contracts are drafted and what they try to accomplish. I fully appreciated the importance of having a lawyer assist a physician through this process, and that drove me to found this company- to create a comprehensive service for physicians who are entering this important phase of their careers. Now, when I describe to folks what I do, the quickest way to sum it all up is by saying “we’re like Jerry Maguire for doctors.” At the end of the day, if a football player needs a professional agent on his side, then there’s no question that highly trained physicians do as well.

In your opinion, why do physicians need the counsel of an attorney-agent? Shouldn’t physicians be able to trust their future employers?

What we see time and time again with our clients is this disparity that occurs somewhat suddenly and often unexpectedly as physicians finish up their training. Through internship, residency and fellowship, physicians have enjoyed the safety and comfort of being surround by their teachers and mentors- in many situations, those mentors are the same people who offer them a contract. So in quick fashion, the relationship goes from being that of student/teacher, to employee/employer. And that is a nuance that many physicians take for granted. The relationship of employee/employer is inherently adversarial. Not in the sense that you are entering a fight against one another, but from a legal standpoint, your interests are somewhat at odds. Think of it this way- the employer undoubtedly hired a lawyer to draft the employment agreement that is offered to you- that means the agreement is drafted in favor of the employer. Shouldn’t the physician-employee enjoy the same comfort of legal representation? We firmly believe they should!



What services do you offer physicians and other health care providers?

For physicians, we offer a concierge-style job search service as well as contract review/analysis and negotiation. For non-physician providers, we offer a more cost-efficient version of our contract review and analysis service, which is slightly more limited in scope. Lastly, we also are sometimes hired by physicians to handle their state licensing needs, as we’ve found that obtaining a new state medical license is an incredibly time-consuming and burdensome process that most physicians don’t necessarily have time for.

What do you feel is the most valuable aspect of your work on behalf of physicians?

When we provide our Premier Opportunity job search service to clients, we offer a start-to-finish service that covers all bases of the job search. So it is incredibly time-saving for the client. But really the most important part of this service is the fact that it is so comprehensive. Physicians who didn’t hire us to do this service for them have called us, and they find themselves stuck, right near the end of training, and they finally have a job offer in front of them. They may have only interviewed one place, and this is the only job offer they have. Not only are they under immense pressure to accept a job due to financials reasons, like having a family to support, and needing to begin making payments on gigantic student loans, but the pressure to take this job is crushing because it’s the only job offer they have. So they find themselves with zero leverage, because they have no other options, and the worst part is, that once they take that job, they are very likely to not be happy with it. Time and time again, we find that physicians who embark on their job search early, and comprehensively, end up in a happier place, job-wise. The more interviews you have, the more practice models you get to experience, and that allows you to make a much more informed decision about what your dream job really is. If you don’t get out there and see what the full market really has to offer, you are at a high risk of taking a job that undervalues you, and that may not be the right fit for you.

And that’s really only part of the equation. You also have to consider the positive impact of having a legal advocate on your side. I have a special perspective, as the wife of a physician and a mother. I know how a physician’s personal life and lifestyle can be seriously affected by their employment contract and duties, and so I have a particular understanding of what factors are most important to consider and straighten out on the front end of things. For example, take a typical non-compete covenant. If you are looking at a job that is in your end-all, be-all location, you better be sure the non-compete is something you can tolerate if the employment relationship does not work out for some reason. If the non-compete itself isn’t very negotiable, then you will need to weigh that risk against the other benefits that can perhaps be added to the agreement.

Do you work only on behalf of physicians, or do you also represent employers?

We only work on behalf of providers. We made that decision very early on, and it really sets us apart from others who work in this space. If you take a recruiter, for example, you cannot feel that they have your best interests at heart- they cannot be objective the way we can. That is because they are paid by the employer for any job they fill. We are only paid by our clients. We aren’t worried about the employers- they have a team of lawyers on their side looking out for them. We only care about our clients.

What should health care providers be aware of/cognizant of when securing counsel/an attorney-agent?

The first thing to check into is whether the attorney actually has experience in physician employment matters. At Lauth O’Neill, Laura Lauth and I handle every case and client ourselves. We are both licensed attorneys, and we are licensed in four states. When we work for a client taking a job outside of those states, we consult our local counsel partner in the given state to make sure all state-specific considerations have been made. So it’s important to ensure that whomever you choose to work with is well-versed in this type of legal work, and can cover all bases for you. Also, make sure you understand exactly what the attorney is going to do on your behalf. Determine if there are any limits on their review and analysis of the contract, and whether they have access to compensation data. And be aware of how you’ll be billed. We always work on a flat-rate fee basis, and only charge an hourly rate if and when our clients request more specialized representation toward negotiations.  Finally, make sure you are comfortable with the level of communication and responsiveness you will receive. We always communicate directly with our clients and handle things personally, making the process more personal. Be aware of certain “attorney services” advertised online, where you may not be able to actually speak with someone or put a face with a name. Those options may be more cost-efficient, but often times result in a far less-personalize and comprehensive service.

Contact Leigh Ann with any questions about the services offered by Lauth O’Neill. (317) 989-4833; loneill@lauthoneill.com.

Ancillary Services – A Win for Physicians and Their Patients

For physicians, the issue of whether to offer ancillary services to their patients can be a difficult one. The availability of ancillary services boasts many up-sides, including an increase in patient satisfaction and a boost in practice income, but they can also complicate matters. Consideration must be made for the associated legal issues, including Stark Law compliance. We all know that physicians do a lot of good, but they are rarely lauded for their business acumen. Sean Weiss, a consultant with DoctorsManagement, does not hold back on this issue. “Physicians are horrible at business. Physicians make the worst business decisions that you can imagine.” Despite this opinion, many physicians are in fact business-minded and appropriately utilize ancillary services in effective ways. By consulting with the appropriate counsel and receiving guidance from experienced practice administrators and financial professionals, there is no reason why physicians shouldn’t take the opportunity to expand their practice’s offerings.

Not every practice takes advantage of the opportunities correlative with ancillary services. It appears that certain medical specialties are far more likely than others to offer ancillary services, with orthopaedic surgeons taking the lead, and primary care physicians (PCPs) offering the least. However, nearly every specialty has a plethora of ancillary services that couldbe offered to patients: ultrasounds; medication dispensing/in-house pharmacy; diagnostic testing; imaging services; nutrition counseling; cosmetic services; physical therapy; acupuncture – the list goes on and on. Consider each and every service that a physician might recommend and therefore refer out. If the physician/practice offered those services rather than referring out, the result would be more money in the physician’s pocket. Not only would the services translate to increased profits for the practice, it also gives physicians the opportunity to have a higher level of control over patient care, with each aspect of care taking place under one roof. And finally, patients, particularly those who are feeling sick, achieve a great deal of relief from having multiple services available at one location. This one-stop-shop approach is a great way to make patient satisfaction a priority. After all, medical practices are businesses and customer satisfaction is key to long-term success.

Perhaps the most important issue from the perspective of physicians who do not yet have an ownership stake in their practice is whether and how the physician-employee actually realizes any benefit or income from the services. When ancillary services are available as a revenue stream, practices take a variety of approaches to distributing income from the same. As attorney-agents who analyze and negotiate physician employment agreements, we have seen countless approaches to this issue. Some practices take a hardline approach with employees, providing that “all fees and charges related to ancillary services are the property of the Employer.” Others permit their physicians to realize income from the services pursuant to a productivity model that assigns income for “wRVUs generated for Physician that are billed by or on behalf of Employer for professional and ancillary services personally performed by Physician.” In any case, it is imperative that physicians understand the terms of their employment contract in order to accurately determine their potential income from ancillary services.

If you have questions about your employment agreement and compensation plan, contact the attorney-agents of Lauth O’Neill at (317) 989-4833 or loneill@lauthoneill.com.

Announcing: New Contract Review Service for APPs

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Physician Assistants (PAs) fill an ever-expanding role within the healthcare field. In the last five or six years alone, the profession has grown tremendously. Whereas ten years ago it was hit or miss as to whether people knew what PAs were and what role they filled, today the general public is well-aware of the profession and the majority of us have even been treated by a PA at least once. All of this is to say – PAs are essential to the healthcare industry, and their star continues to rise.

Did you know that the PA profession has officially been in existence in the US for 52 years? The first class of PAs – all three of them - graduated from Duke University in 1967. Fast-forward to 2018, and there are presently about 170,000 PAs working in the US, and PAs are responsible for about 8.1 million patient-visits each week. The delivery of healthcare in the US has shifted so much, in fact, by placing so much reliance on PAs and other Advanced Practice Providers (i.e. nurse practitioners), that these roles are undoubtedly indispensable. Further, the looming physician-shortage in the US means that Advanced Practice Providers become more critical every day.

Advanced Practice Providers (APPs) see patients, they write prescriptions, they must be licensed and properly insured before they can practice, and generally, their employment structure is very similar to physicians’. Therefore, it is not surprising that when APPs get a job offer, the terms of that position are usually memorialized in a multi-page, complex, legal contract that dictates each aspect of employment. When faced with a convoluted document that is full of legalese, the situation can be daunting, and rightfully so. Even the aspects of the contract that are free of legal terms, such as compensation, can be equally perplexing for someone who has no barometer/benchmark for what is fair and reasonable. How is someone with no legal education and who has never been advised about employment terms and norms supposed to feel comfortable signing this binding document?

For these reasons, the attorney-agents of Lauth O’Neill are dedicated to bringing legal guidance to APPs who find themselves overwhelmed by employment decisions. We are excited to now offer a contract review and analysis service that is specifically tailored for APPs. Our Contract Review for Advanced Practice Providers allows APPs to obtain the advice and guidance they need from experienced attorneys. Working exclusively on behalf of physicians and APPs, we know how employment contracts work: we know what they say, what they shouldn’t say, and most importantly, we know the ways in which the contract can be made more favorable to our clients, i.e. the providers. And also importantly, we understand that employment contracts are written by attorneys who represent the employer’s best interests. In that sense, the contract is inherently biased and unfair. We aim to level the playing field by ensuring that both parties to the agreement are represented and protected.

Our new service dedicated to APPs offers detailed analysis of the employment contract’s most important terms: compensation, restrictive covenant, and termination provisions. Beyond that, we will also share general tips and advice regarding other provisions commonly found in APP employment contracts, giving the provider the ability to gauge their contract’s reasonableness and fairness with an informed perspective. All of this is done for a flat-rate fee. We can also be engaged beyond that, in order to negotiate and revise our clients’ contracts as needed.

We genuinely feel that no one should sign a binding contract and enter an employment relationship without receiving adequate and fair-minded guidance from an attorney experienced in healthcare employment. If you would like to learn more about Contract Review for Advanced Practice Providers, contact Leigh Ann at (317) 989-4833 or loneill@lauthoneill.com.

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Physician Job Searching in the Millennial Age

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Our previous post discussed the current playing field for physicians entering the employment arena. For some docs, the healthcare field is in a completely different state than it was when they began training. Now that they are searching for jobs, the various factors coming into play can be overwhelming. However, as we discussed, young physicians are very much in demand and have a great deal of power at their hands to secure very gainful employment.

Although a lot has changed, young physicians are approaching the job search in many of the same ways that their predecessors have relied on for decades. That is, primarily through networking and referrals. In this sense, millennial physicians appear to be relying on these tried and true approaches. This is surprising, considering that millennials are the social media generation and rely on social media in one way or another for a variety of aspects in their lives. Whether it’s posting family vacation photos to Facebook, selling old furniture on LetGo, or meeting a significant other through a dating app, it’s safe to say that millennials are tied to their smart phones and definitely know how to work them. Despite this social media marriage, a recent survey indicated that only one percent of millennial physicians found employment via social media.

How do physicians find jobs?

If a referral opportunity is not available, many people begin first with the job post websites, of which there are many: Practice Match, Practice Link, MD Search, Doc Café…the list goes on and on. While these sites can be helpful for the obvious reason that they quickly identify current openings based on location and specialty, they also have downsides. One of the biggest drawbacks of job sites is that they may give a physician a false sense of assurance that they are conducting a thorough job search, when in fact the opposite is true. By relying on job board sites, a physician is immediately and inherently putting a very narrow scope on her job search. Only some employers and practices utilize job board websites, and therefore they do not in any sense represent the full scale of job opportunities out there.

Another aspect to consider is the fact that job sites are sometimes a last resort for employers who are desperate to fill a position. Accordingly, the jobs represented there are often on the less-appealing end of the spectrum. However, in this regard, it is important to point out one upside. Physician jobs that are located in very rural and underserved locations, while perhaps not the most attractive, often come with the biggest income opportunities. In this sense, focusing on “less desirable” positions actually enables a physician to earn incredible amounts of money, so long as she is willing to live anywhere. You may be wondering, if job sites aren’t the answer, how do I know where to look? The answer to this question is not an easy one because it requires a lot of time and work. Essentially, the best way to go about the job search is to cast a very wide net, exploring employment opportunities in each city/geographic region in which you are willing to live. Exploring those potential opportunities means reaching out to the relevant practices and employers and inquiring about your interest, regardless of whether any positions are advertised (formally or informally) as open. This way, you put your name in front of potential employers and best position yourself in case there is an opening or an impending opening. Researching potential employers takes a great deal of time, as does reaching out to them. It is best to reach out with a formal cover letter that addresses each employer specifically, and a copy of your up-to-date CV. Then, it is imperative to keep track of all correspondence so that you are always on top of who you have already spoken with and who you need to follow-up with. Again, very time-consuming and somewhat tedious work. However, this grassroots, bottom-up approach is well worth the effort. Only by exploring every single potential opportunity can you be certain that you are making the best possible decision for your career, your family’s future, and your well-being.

Who has time for all of this? The short and sad answer is: pretty much no one. Job-seekers are often working crazy hours while completing training, studying for their Boards and are possibly in the midst of a move. In other words, they are likely at the busiest point of their lives. We know this from experience, and for this reason, the attorney-agents of Lauth O’Neill offer a concierge-style job search service specifically tailored to physicians. As your agents, we will conduct and manage each and every aspect of your job search. From fine-tuning your CV and drafting, printing and mailing cover letters, all the way to reviewing and negotiating the employment offers you eventually receive (we are attorneys, after all). We do everything we can along the way. To learn more about the services we offer, please reach out to Leigh Ann at (317) 989-4833 or loneill@lauthoneill.com.

Physician Job Search: The Current Playing Field for Young Docs

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Healthcare in the US is in a strange place. A variety of converging factors have significantly affected healthcare, both in terms of the delivery of medical services and the actual practice of medicine. To be employed as a physician is not what it used to be – not even close. The job itself (regardless of specialty) has transformed so dramatically that the previous generation’s physicians already find it nearly unrecognizable. Where health reform is headed is anyone’s guess, creating a level of uncertainty for healthcare professionals. Reimbursements are declining, and the requirements surrounding electronic health records (EHRs) and other administrative tasks make physicians’ day-to-day lives borderline unbearable.

All of the these factors have very real effects on the healthcare profession. There is a shortage of physicians in the US, with the shortage growing every year. The Association of American Medical Colleges projects a shortage of between 42,600 - 121,300 physicians by 2030. In lieu of pursuing careers in health care, millennials and Gen Z have their sights set on STEM jobs (occupations that require an education in science, technology, engineering or mathematics). In fact, even among those that enter the healthcare field, it appears that many are second-guessing their decision. A recent survey showed that among young doctors, 22% said that they would have chosen another field if given the chance.

Despite it all, there is no doubt that becoming a physician remains a very real dream for many. Approximately 19,000 students graduated from medical school in 2017. Given the physician shortage and negative perceptions surrounding the healthcare field, those who actually do pursue a medical license may find themselves in a very beneficial situation.

All these factors and moving pieces beg many questions: How can the future doctors of America enter professional life in the smartest way possible? How can they find a job that not only pays the bills, but satisfies everything that their personal lives and family lives demand? And finally, how can physicians make the right job decision the first time and avoid going through the job search process twice or multiple times throughout their careers?

Supply and demand is very straightforward. A physician shortage means that young doctors are in high demand. Recently surveyed doctors in their final year of residency reported huge amounts of job solicitations (via phone calls, emails and direct mail from recruiters), with 70% of them receiving 50 or more, and 50% of them receiving 100 or more. Mark Smith, president of Merritt Hawkins, likened the need for newly trained doctors to a “feeding frenzy” and said, “there are simply not enough physicians coming out of training to go around.” Such high demand clearly puts physicians in a unique position of bargaining power, but only if they realize it.

Those entering the workforce owe it to themselves (and their families) to harness this power, and make wise decisions in order to come out on top. Next week’s blog will focus on how physicians go about finding jobs, and the ways in which they can best position themselves for a successful and happy career.

Lauth O’Neill Physician Agency provides employment-related services to physicians and other healthcare providers, including contract review and analysis, and concierge-style job search assistance. Call or email Leigh Ann to learn more: 317-989-4833; loneill@lauthoneill.com.

Physician Job Search Timeline: What You Need to Know

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This time of year is particularly exciting for our Premier Opportunity clients. These are the clients we assist, in a concierge fashion, start to finish, in their job search process. Many of them don't know exactly where they want to land their first job, and some aren't even sure which type of job they want once they finish training. But they know it's crucial to start the process now- during the end of summer. So we are diligently working away to ensure our clients are in the best position to land the best deal in their first job out of fellowship.

When our Premier Opportunity clients come to us, many are not sure exactly what is involved in the physician job search process, and when they need to complete the various components of the search. So we thought we would put together our ideal timeline- what we aim to achieve as we assist our clients through this enormously important process:

First- you have to identify the geographic regions you are interested in. If you don't have particular cities in mind, then make a list of important features of a desirable location to live. Do you want to have various outdoor activities available? Maybe you would like to live somewhere with excellent public schools. Each and every component of daily life should be considered. Once you have a good idea of the important features, you can move on to identifying cities that meet your criteria.

Second- you have to find ALL employers who offer your specialty of medical care. Do not stop at what is posted on job websites. Many times jobs are filled by word of mouth and never make it to a job posting board, so don't miss out on what might be a more desirable job. Research all employers that could employ someone with your training and background. Find the contact information for the person to whom you need to send your information. If you haven't done this yet, get started TODAY!

Third- draft a cover letter that expresses your interest in the particular employer, and explains why you would be a good fit for them. The cover letter should give helpful and insightful information about how your training makes you a valuable asset, and why you are attracted to the potential employer.

Fourth- fine-tune your CV. Make sure it is completely up to date, listing all publications, your residency completion date, where you are currently in fellowship, and your new contact information. Including a permanent email address is a good idea, rather than one associated with your current training program.

Fifth- disperse your cover letter and CV to all potential employers. This step can be extremely time-consuming and tedious, but it is KEY. It is a great idea to make sure you've sent your information to all potential employers at one time. This should happen in August or September. This will help keep you on track for well-timed phone calls and interviews. Having your interviews bunched up into a narrow time frame will help ensure that job offers come in around the same time, which will allow you to use the multiple job offers to negotiate for better terms.

Sixth- conduct more in-depth research about potential employers who have shown interest in you and with whom you are set to interview. When an interview is coming up, it is best to know more about about the potential employer and use that information to develop a list of thoughtful questions you can ask during your in-person interview. Hopefully your interviews take place somewhere around October-November.

Seventh- once you have completed interviews, and job offers have come in, have them reviewed by a physician employment contract lawyer. Ideally you have at least 2 job offers in hand. Have them reviewed by a lawyer who frequently reviews physician job contracts so that you can be sure you are getting the most relevant feedback. That way, you will know what to ask for when it comes time to negotiate.

Eighth- once you have identified key points in your physician employment agreement, it's time to start negotiating. Physicians commonly tend to shy away from asking for changes to their employment agreements, but do not be bashful! You do not want to find out later that another colleague, hired by your employer, received higher compensation or better legal terms. If you don't feel comfortable doing it yourself, ask your lawyer to do it for you! Trust us- it's very common- we do it all the time!

Ninth- after changes to the contract have been agreed, you need to review any new version of the contract and make sure all is in writing. Do not fall for the 'ol "it's fine, this is our standard contract, we don't need to put any of this in the contract." Once all is as it should be in your physician employment agreement, you can sign it! The contract review/negotiation/re-review/signing step of this process should ideally take place between December-March. Unfortunately, the going back and forth can take months.

Finally- apply for your new license if you're moving to a new state. We always recommend this process begins in March or April as many states can take a LONG time to approve a license application. You will need your new license number in order to begin the credentialing process so that your new employer can begin billing for your services. As you can imagine, it's best for everyone if the credentialing is finished by the time you start your job, which will likely be August or September. And just like that, the year has gone by.

So as you can see, this process takes a long time. Typically a full year if you're going to do it right. The last thing you want is to procrastinate and wind up in April with only one job offer, and then you have zero leverage because you MUST take a job somewhere. So we suggest you start today!!

We know firsthand that this process is extremely time-consuming, can be tedious, and stressful. So if you feel like you'd rather spend your free time with your family and friends, call us today and find out how we can help. We provide our Premier Opportunity physician job search service based on a flat rate, and most of our clients don't start paying us until they get their first paycheck! Call or email Leigh Ann today to find out more- 317-989-4833; loneill@lauthoneill.com.

Physician Employment Trends: What Will My Practice Setting Look Like?

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Physicians entering the workforce are facing a very different playing field than their predecessors. The healthcare industry is constantly evolving, and in recent years, changes are occurring at an especially rapid pace. Medical students and young docs wrapping up their training likely wonder, what will my practice setting look like? Are my employment options broadening, or will I be forced into a particular employment setting?

             Compliance costs are at an all-time high, and physicians are burdened more than ever by everything from EHR requirements to new payment models. Essentially, doctors face more red tape than ever before in their delivery of medical services. As a result of these burdens and their inherent costs, it has become less and less sustainable for physician to own their own practices and work in independent settings. Large hospital systems have taken advantage of this trend, snapping up physician practices like never before. Between 2012-2015, hospitals across the country purchased 31,000 physician practices – causing an 86% increase in the number of practices owned by health systems. Practice acquisitions occurred at such a rapid pace, in fact, that the trend has now significantly stalled due to the simple fact that hospitals have “as many practices as they can handle at this point,” according to a senior economist with the AMA.

In addition to health system acquisitions of practices, hospitals are also hiring physicians as direct employees at higher rates. Accordingly, a record-setting number of physicians today are employed by hospitals, and for the first time ever, less than half of practicing physicians in the US own their own medical practice. Today, only about 47% of physicians have ownership stakes in a medical practice, which is about a 6% decrease since 2012.

Another factor contributing to these trends lies in the physician jobs that are available. For instance, the position of a “hospitalist” is actually a very recent development. The term hospitalist was not even used until 1996, and only a couple hundred physicians occupied that role. Today, over 50,000 physicians work as hospitalists. Hospitals further employ physicians at higher rates than ever due to the availability of locum tenens positions. While there is not one clear or exact cause for the boom in these positions, the data shows that hospitals are hiring physicians for locum tenens positions at the highest rates in history. Filling both part-time and full-time roles, an estimated 48,000 physicians worked in locum tenens positions in 2016, marking a roughly 10% increase since 2014.

For a variety of reasons, it is tougher than ever to work as a physician. Today’s doctors face hurdle upon hurdle in their delivery of medical care, to the point where it can seem nearly impossible to work independently. Therefore, it is not surprising that young physicians are increasingly lured by the prospect of hospital-employed positions. Such a role often gives physicians a greater sense of stability and security, while also giving them the privilege to stay away from the business aspect of medical care, which has become a nightmare for many.

Wherever the employment opportunities lie, the attorney-agents of Lauth O’Neill Physician Agency are experienced in helping physicians secure the jobs of their dreams. Whether you require assistance with your job search or you already have employment offers, we can help! Reach out today to learn more about our services.

Physician Recruitment Agreements: Tax Considerations

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Our previous two posts examined a variety of issues related to Physician Recruitment Agreements. Recruitment agreements are complex, and have very serious implications that make it necessary for physicians to be well-advised before signing. Because recruitment agreements provide for a unique manner of compensation, it is critical that both the hospital and physician manage the payments appropriately.

Loans are often extended to physicians in order to attract them to a certain geographic area for a specified period of time. These “loans” are structured such that they are forgiven over time, allowing a physician’s repayment obligation to completely disappear after he has completed his commitment period. However, if the loans are mismanaged, they could be mischaracterized as income. In this circumstance, the physician would face unexpected taxes on that compensation.

A recent Tax Court examination of one such loan to a newly recruited physician highlights important considerations and portrays one situation where a physician actually aimed to characterize his payment as an advanced payment of his salary rather than a loan. In that case, the Hospital transferred the sum of $146,500 to the Physician pursuant to a recruitment agreement providing that Physician would practice in the area for at least 36 months. The recruitment agreement contained a compensation guarantee with forgiveness agreement and a promissory note. That year, Physician did not report the $146,500 on his 1099. Approximately two years later, Physician terminated his relationship with the hospital and therefore fell short of his 36-month requirement. Accordingly, Physician had to pay the Hospital the sum of $46,884 as repayment of the remaining balance on the Hospital’s loan. Physician then took the position that the $146,500 paid to him was an advance on his salary rather than a loan, thereby allowing him to claim the $46,884 repayment as a deductible expense on his Schedule C, Profit or Loss from a Business.The IRS challenged this deduction, contending that the original payment of $146,500 was in fact a loan.

In determining whether the original payment was a loan, the Tax Court pointed to two factors that must exist for a transfer to be considered a loan for tax purposes: 1) the repayment obligation placed on the transferee must not be subject to a condition precedent; and 2) the transferor must unconditionally intend to secure repayment of the funds. Physician argued that he was not unconditionally obligated to repay the amount transferred to him because he would only be required to repay if he breached the agreement. However, in examining the recruitment agreement and the related promissory note, the Tax Court disagreed. The Court found that all signs pointed to the fact that the payment was a loan, and that Physician had an unconditional obligation to repay the loan, even though the obligation was subject to a condition subsequent(i.e. the loan would be forgiven if the doctor continued to practice in the area and met all other requirements). Further, the Hospital did not report the transfer on Form 1099-MISC and the Physician did not include it in his 2009 gross income. Accordingly, the Tax Court ruled that the payment was in fact a loan and that Physician was not entitled to claim the $46,884 repayment as a deductible expense.

This case highlights a unique scenario in which the physician aimed to mischaracterize his recruitment payment as his salary in order to achieve a tax benefit after he was forced to make repayment on the loan. This should be instructive to physicians for two reasons: first, the repayment obligations pursuant to recruitment agreements are very real and physicians will in fact be held liable to make repayment if they fail to fulfill their obligations. Second, once repayment takes place, a physician will not be able to use creative accounting in order to lessen the blow of that liability.

Conversely, physicians may find themselves in trouble if they fail to acknowledge a loan as income at the appropriate time. In cases of forgivable loans, the amount received by the physician becomes taxable income once it is forgiven. Therefore, as a physician continues working and fulfilling his obligations, the loan becomes taxable income incrementally. This can be confusing, as a physician may realize taxable income even if there was no transfer of funds in that year.

For these reasons and more, it is imperative that physicians consult with a tax adviser immediately upon signing a recruitment agreement so that a clear tax payment plan can be delineated.

To learn more about the potential implications of your physician recruitment agreement, or to have your physician employment agreement analyzed by a physician attorney, call Laura Lauth Andrews at 317-979-0081 or Leigh Ann O'Neill at 317-989-4833.

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