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.

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.

Gender Pay Gap Among Physicians

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If you have not been blasted with reports about the gender pay gap in Hollywood, you may be living under a rock. Recent news articles and headlines have scoured the issue, and just about everyone is weighing in on the disparity between men and women’s incomes. Liam Neeson, for example, thinks the pay gap is “f---ing disgraceful.” While opinions and frustration levels vary, it is pretty much safe to say - nearly everyone is troubled by the pay gap.

Despite all the recent reports, it is important to note that the gender pay gap is not limited to those that grace the silver screen. Rather, the pay gap affects people across all professions and industries in the US. People, however, may be surprised to learn that the gender pay gap is alive and well among one of our country’s oldest and most revered professions: medicine. That’s right – although the year is 2018, reports indicate that female physicians – across all specialties - earn an average of 74 cents for every dollar that male physicians make. This figure translates to an approximate $90,000 per year. Even when the data is broken down based on medical specialty, there is no area where women earn as much as men. Of course, it is not news to anyone that the medical field is one that has historically been dominated by men. While male doctors still greatly outnumber females – approximately 66% of physicians in the US are men – women are entering the medical field at unprecedented rates. The number of women enrolled in medical school recently reached a 10-year high, and in 2015, female medical school graduates outnumbered males in several states.

One of the largest factors affecting compensation among men versus women is geography. The statistics prove that where you live does matter. In several cities, the pay gap is 30% or more (including Charlotte and Durham, North Carolina; Orlando, Florida; and Pittsburgh). Five other cities have pay gaps of at least 29%. It appears that the pay gap was the least significant (relatively speaking) in Sacramento, where female physicians earn 19% less than their male counterparts.

Perhaps the most disturbing aspect of this issue is an examination of when, if ever, the gap will close. Although the gender pay gap has certainly been inching closer and closer together (no one can deny the progress made in women’s education and workforce participation since the 19070s), the rate of change simply is not happening fast enough. Experts estimate that if the rate of change experienced between 1960 and 2016 continues, then women are expected to achieve pay equality in 2059. However, experts also advise that progress has slowed in recent years (since 2001, specifically), such that if the more recent and slower rate of change continues, women will not achieve pay equality until 2119. So, even if we take the more optimistic stance, women will continue to earn less money than their male counterparts for another staggering 41 years.

Having presumably achieved the same level of education and training upon entering the work force, why do female and male physicians get paid so differently? Unfortunately, there truly is not a good answer, but it appears that at least part of the problem is self-doubt and reluctance on behalf of women. Reports indicate that, in general, women feel less comfortable than men when it comes to negotiating their compensation, and therefore simply accept what is offered to them. Therefore, although the problems working professionals in our country face require a systemic response, it is clear that we also need women to stand up for their value and for female voices to be heard.

The physician-agents of Lauth O’Neill work solely on behalf of health care providers, and are experienced in the analysis and negotiation of physician employment contracts. If you have questions about your contract or compensation plan, contact the physician-agents of Lauth O’Neill.

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Hospital Employment vs. Private Practice: What You Need to Know

In a previous blog post, we touched briefly on the issue of hospital-based employment versus private practice. Physician employment trends have seen drastic changes in recent years, with a myriad of factors leading the change. This post will shed some light on exactly what differentiates hospital employment and private practice, and the practical implications on physicians’ lives and careers. Employed vs. Not Employed?

Whether you are an established, working physician or a young doc just finishing training, you have probably either read or heard – physicians are seeking “employed positions” at higher rates than ever before. You may be wondering, what exactly does this mean? What is the alternative to being “employed?” For physicians, there are generally two different routes to take when searching for a job: either as an employee working for a hospital/large organization, or entering private practice (either as a partner in a group or as a solo practitioner). Upon joining a private practice, you will be an employee for a period of time (usually two years), and then you will (hopefully!) be offered the opportunity to “buy in” as a partner. While private practice used to be the gold standard for physicians, the climate has drastically changed.

Between 2000 and 2010, the number of physicians employed by hospitals grew by 34%. A 2016 report by Medscape (Read the Medscape report here). showed that roughly 80% physicians today are employed by hospitals, with 20% of physicians reporting a self-employment position. This shift is further evidenced by examining a breakdown based on age. For physicians 55 years and older, 45% are self-employed and 36% are employed. Conversely, for physicians younger than 40, 23% are employed and only 11% are self-employed. However, although older physicians continue to occupy self-employed positions at higher rates, they too are contributing to the shift to employment. Since 2014, the number of older physicians in employed positions has risen by 8 points.Why the shift?

A variety of factors have caused these changes, with health care market dynamics and physician preferences leading the way. To begin with, health care reform and declining reimbursement in many specialties has meant that physicians feel more uncertain than ever about the future. Together with this uncertainty is the fact that many private practices struggle to manage their overhead costs and in many ways, cannot compete with large organizations. Lastly, there appears to be a change in mentality of physicians leaving training wherein their priorities revolve around patient care and their daily practice, rather than any sort of entrepreneurial endeavors. In fact, physicians surveyed about their employed positions overwhelmingly reported that their favorite thing about being employed is “not having to deal with business of running a practice,” with the second leading response being “not having to deal with insurers, billing and other administrative aspects.”

A Breakdown of the Differences

Where and how you are employed can greatly affect everything from the way in which you are paid, to the benefits you receive, to your ability to strike a work/life balance. Below is a breakdown of some of the most significant aspects of employment and how those aspects might vary based on where you work.

Compensation

Employed Position: Often times, starting salaries offered to physicians in employed positions are higher than those in private practice. Employed physicians are also generally afforded the ability to earn productivity or incentive income in addition to their base salary. As employees of large organizations, employed physicians do not feel financial insecurity and do not fear any possibility of their payroll check bouncing. Lastly, while signing bonuses are typical in both hospital employment and private practice, the bonuses tend to be higher for those in employed positions.

Self-Employment Position: While base salaries may be lower and there may be less opportunity for incentive income, private practice does offer substantial money-making potential. Once a partner in private practice, you are entitled to portions of net profits, and you can also earn additional income from ancillary facilities and services. Although overhead may be high and cash flow might be a concern, private practice certainly has its benefits, not least of which is the many benefits derived from ownership and the equity-stake.

• It is important to note that the 2016 Medscape report indicated that employed and self-employed physicians are satisfied with their incomes at nearly identical rates. 38% of employed physicians reported that they are “satisfied” and 16% reported they are “very satisfied” with their income. Similarly, 36% of self-employed physicians reported they are “satisfied” and 17% reported they are “very satisfied” with their income These satisfaction rates suggest that any perceived differences in compensation are likely either negligible or are off-set by other benefits.

Benefits

Employed Position: Working for a large health system generally means that you will be exposed to less risk in terms of the compensation and benefits that are promised to you. As a hospital employee, you can likely rest assured that the benefits you are offered are comprehensive and that they will not be arbitrarily amended or revoked. Further, employees of large organizations have more certainty that they are being afforded the exact same benefits as their colleagues.

Self-Employment Position: While working for a private practice does not necessarily mean that you will not receive sufficient benefits or that they will be taken away from you, there is generally some more wiggle room for the practice owners to amend benefit plans based on practice needs and improving their bottom line. In some senses, however, the benefits offered may not be as substantial as in an employment setting. For instance, it is normal for physicians to receive reimbursement for their annual CME expenses and expenses associated with professional dues, memberships and subscriptions. A small practice may cap that reimbursement at a lower figure than a large organization. Another important benefit is malpractice insurance coverage. While it is the norm for physicians to have their coverage paid for by the practice or hospital, a private practice may be more inclined to leave the responsibility for tail coverage to the physician.

Restrictive Covenant

Nearly every physician who begins employment, regardless of where, is required to sign some form of restrictive covenant (covenant not to compete) in conjunction with their employment contract and/or partnership agreement. In fact, as attorney agents who specialize in analysis and negotiation of physician employment contracts, we have only ever seen a handful of contracts that did not contain a restrictive covenant.

The validity and enforceability of a restrictive covenant depends on state law, and the precise terms and restrictions of covenants vary. Whether a physician goes into employment in a hospital or private practice, it is a near certainty that she will be restricted from certain behaviors if the employment relationship terminates. The only way to ensure that the restrictive covenant is as least restrictive as possible - and therefore most favorable to the physician – is to have it reviewed and negotiated by an attorney experienced in these matters.

Work/Life Balance

Employed Position: One of the benefits of working as an employee is the comfort that comes with having your duties and obligations clearly defined, and therefore limited. In general, employed physicians report that they have a better work/life balance than their self-employed counterparts. Part of this work/life balance is the fact that employed physicians generally enjoy more regular hours than self-employed physicians, and therefore can rely on time away from work. Further, employed physicians generally have less on-call responsibilities than self-employed physicians. Notably, however, despite the favorable regularity in hours, employed physicians report that what they dislike most is that they do not have control over their hours and are completely subject to management’s direction and rules. In other words, they lack autonomy.

Self-Employment Position: For anyone who is self-employed, no matter what the field of work, there is always a certain level of autonomy and freedom. Self-employed physicians report satisfaction with their ability to “practice medicine my way” and have a higher level of control over their schedules. Certainly, this autonomy comes at somewhat of a cost. Self-employed physicians often carry much more personal responsibility and are required to partake in business management aspects that employed physicians never experience. It appears that self-employed physicians are happier and more satisfied than employed physicians, which may be a result of their enjoyment of having control. 63% of self-employed physicians reported that they are satisfied with their work, compared with 55% of employed physicians.

• Interestingly, satisfaction rates among both groups have significantly decreased since 2014, especially for employed physicians. The satisfaction rate for self-employed physicians fell from 74% to 63%, and the satisfaction rate for employed physicians fell from 73% to 55%.

If you are a physician who has received an employment contract offer from a hospital or private practice, and you would like a lawyer to review your contract and assist in negotiating changes to the contract, please call Leigh Ann at 317-989-4833, or email her at loneill@lauthoneill.com.

Don't Stop at Physician Job Posting Websites!

There are so many job posting websites out there today geared specifically to physicians: www.physicianjobboard.com, www.practicelink.com, www.jamacareercenter.com/, www.mdjobsite.com, https://www.practicematch.com. The list goes on and on. And there is one important feature all of these websites have in common- they only list jobs that are actively being advertised! So how do you find the other jobs? You know they're out there. How can you be sure you don't miss an opportunity? We know how to do it, and we do it all the time for our clients - we spend hours and hours searching for every potential employer that meets your ideal job criteria. Job searching this way, albeit painful and extremely time consuming, is the only way to make sure you have identified all viable employment opportunities. In other words, it's the only way to embark on a thorough and comprehensive physician job search. Don't start your next job wondering if you missed a better opportunity- now is the time to be sure.

Call or email us today to learn more about what we do for our physician clients: 317-989-4833, loneill@lauthoneill.com. Also, click here to learn about our Premier Opportunity physician job search service.

Physician Job Search Assistance with No Up-Front Costs

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I'm sure most of you know that on average, physicians in training make about $10 per hour- sometimes it's much less. And for most physicians, a significant chunk of that payment is going to pay off the interest on your student loans. So how on earth can one be expected to pay a professional to assist them in their job search and contract review and negotiation while they're finishing up training? For most people, it simply is not realistic. And of course, we know that.

We kept this fact in the front of our minds when we designed our Premier Opportunity service. This concierge-style service provides our physician clients with the greatest potential of locating and landing their ideal post-training employment arrangement, all while we guard and protect our clients' legal and financial interests. And we don't require you to pay a dime of our fee (not even an initiation fee) until you start getting paid. In other words, we work for you for months, making sure you begin your career in the job that is best for you, and under the legal and financial terms that position you best for success. AND- you don't begin paying us until you receive that first long-awaited paycheck.

We know that medical training is exhausting, both mentally and physically. And the job search service can be too. We pride ourselves on giving our clients their free time back while handling this time-intensive process for them, with no up-front fees or costs. And for those of you entering your final year of training, now is the time to get started! Call or email Leigh Ann to find out more about Lauth O'Neill Physician Agency's Premier Opportunity service: 317-989-4833 or loneill@lauthoneill.com.

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Physician Job Searching: Interviewing & Dating Share Many Similarities

As the end of the fiscal year draws near, many physicians who will be entering their final year of training will also begin the world of job searching! While this process is exciting and hopeful, it can also be intimidating, burdensome, and very time consuming. So in looking ahead to this next big step that many of our clients face, I was delighted to come across this fun and helpful article about how job interviews are very similar to first dates. I hadn't considered this exact comparison, but it is spot-on. This article, found on PracticeLink.com, is not only insightful for physicians embarking on their job search, but also adds a bit of a comedic light that might shave a bit of the edge off this otherwise intense process. If you're beginning your physician job search, and you are interested in learning how a physician agent can make this process not only more fruitful, but also nearly stress-free, please give us a call at 317-989-4833 or email Leigh Ann O'Neill at loneill@lauthoneill.com.

Lauth O'Neill is Proud to Annouce Our New Physician Licensing Service!

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If you have ever completed a physician's state medical license application, you know that it can be downright painful! Plus, it's enormously time-consuming! It's something that most practicing physicians and physicians in training simply don't have time to deal with. And if you're about to start your first job out of training or a new job in a different state, chances are that now is the time you need to start your licensing process. That is why we are proud to announce our state medical licensing service!

Rather than putting you through the hassle of tasks such as looking up the addresses and phone numbers of everywhere you have ever worked, we conduct a short phone call to capture all of your relevant information, and then we go to work for you! For a flat fee, we take care of the busy work and leave you with what limited free time you have left in your schedule. Once we have completed the tedious application work, we send it off to you for your review and signature, along with an addressed and stamped envelope. All you have to do is sign, and drop it in the mail! It's not rocket science, but it saves you hours of precious time!

Contact us today to find out more about our new physician state medical licensing service- 317-989-4833 or loneill@lauthoneill.com.

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Physician Contract Review Tips: Outside Activities Income

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In this installment in our Physician Contract Review Tips Series, we are addressing a type of provision that is included in nearly all physician employment contracts: the ability of the physician employee to participate in income-generating activities outside of the employment arrangement. This type of provision is important to those physicians who may wish to engage in activities such as, but not limited to, consulting, research, teaching, speaking, and even expert testimony outside of their employment agreement (hereinafter, "Outside Activities").  In the minority of physician employment agreements, this issue will go unmentioned, which may leave the physician employee open to participating in such Outside Activities.  However, in the majority of physician employment contracts, there will be a provision that limits the physician employee in one way or another.  In some cases, the agreement will stipulate that the physician cannot participate in any Outside Activities without the prior written consent of the employer.  Additionally, the provision may state that any income earned from Outside Activities, unless otherwise prior agreed to, will become the property of the employer.  In other instances, physician employment agreements will flatly prohibit the physician employee from participating in any Outside Activities whatsoever. Finally, in a third of various other possible scenarios, the physician employment contract might state that the physician employee may participate in certain Outside Activities, but all income earned by the Physician must be turned over to the employer.

As with nearly all physician employment contract provisions, the language addressing participation in and income earned from Outside Activities is typically negotiable. In some cases, we are able to narrow the restrictions initially set out in the agreement, or can carve out certain activities our client is interested in pursuing. Of course we always aim to amend agreements such that our clients can keep for themselves any income they earn.

For more information on how we can assist you with your physician job search or contract review, please call Leigh Ann at 317-989-4833 or email at loneill@lauthoneill.com.

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Physician Contract Review Tips - 2015: The Fine Print

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The next entry in this latest series of blog posts is dedicated to the physicians who have been negotiating their contract terms for months already, and are finally about to receive the written agreement in its full form for the first time. Often physicians receive, in advance of the actual employment contract, a letter of intent or some other type of term sheet that outlines the "big ticket" items in their physician employment arrangement.  Such a document might spell out the base salary, mention some additional type of production compensation, list a signing bonus, moving expenses reimbursement, and maybe the number of vacation days promised.  And many times, clients I work with ask if they should just get these "major terms" hammered out first, and then ask for the full written agreement once they are ready to sign it.  I never agree with this suggestion, because reviewing the full contract in its entirety is the only way to be even remotely sure that you are in agreement with the job as it is offered.  Of course, the salary, bonuses, and other benefits offered are important in any physician job search, but one can imagine the surprise of finally receiving their contract only to find out it is written severely, or even unfairly, in favor of the employer, and fails to ensure any sort of protection for the physician employee.

This possibility also brings to mind the scenario that often occurs between employers and physician employees, where the two parties have been talking over the details of the physician's job for months, and then the physician finally receives the written employment agreement to find that many of the specific terms are no where to be found in writing.  If you look carefully at the contract, you are more than likely to find a provision that states something to the effect of "The terms of this Agreement represent the full understanding and agreement between the parties, and all other previous agreements, whether written or verbal, are of no force or effect."  In other words- all of those times the employer may have assured you that they will buy you the equipment you need to do you job, and will make sure you have appropriate nursing and administrative support, really mean nothing at all if they are not clearly set forth in the agreement.  Of course, it may turn out that all of the verbal promises are met at the end of the day, but you only have legal rights to the terms spelled out in the written agreement.

It cannot be overstated- the importance of carefully, and thoroughly reviewing your physician employment contract in its entirety is of utmost importance!

For more information on how we can help make sure your interests are protected, and your next physician employment arrangement is truly as it has been advertised, contact Leigh Ann O'Neill at 317-989-4833 or loneill@lauthoneill.com.

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It's Physician Contract Review Season!

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For physicians who are in their last year of training, you have made it past the half-year point, and the light is clearly at the end of the tunnel! So a sigh of relief is in order; and if you're in the midst of considering which job to take, then so is a legal review of your offered employment contracts.

In order to kick off the contract review season, we wanted to pass along a few helpful thoughts and pointers in this series of blog articles: Physician Contract Review Tips - 2015.

Our first tip: Look out for unfavorable termination provisions.  When it comes to the termination section of a physician employment agreement, there are many ways the contract can be more or less favorable and fair to the physician employee.  As part of our comprehensive legal review, we like to tear these sections apart to make every suggestion possible so that the terms end up more favorable to our client.  In some instances, the termination provisions are very one-sided and allow the employer to terminate with and without cause, while leaving the employed physician with only very limited termination rights.  Additionally, some agreements provide the employer with huge discretion in terms of reasons for which they can terminate the physician's employment.  In relation to non-compete covenants, tail coverage, and bonus repayment provisions, any termination event can lead to negative consequences for the physician if the agreement as a whole is not drafted properly. While it is sometimes hard to think about your potential employment arrangement ending even before it has begun, the termination provisions are among the most important in any physician employment agreement.

Stay tuned for our upcoming articles on our next physician contract review tips! And for information about how Lauth O'Neill can help you in your job search and contract review process, please call or email Leigh Ann O'Neill at 317-989-4833 or loneill@lauthoneill.com.

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Physician Job Searching: Licensing Time Is Here!

If you're in your last year of training in residency or fellowship, and you'll be starting your first job this summer, it's time to get started on your licensing application for the state in which you'll begin your practice. Yes, the end of most training programs is still 6 or 7 months away, and maybe you're not starting your job until August or even later, but the various state's Boards of Medical Examiners may not be on the fast track pace you might hope for. In some states, just the processing time alone can take up to 4 months or more. This amount of time doesn't account for the additional lead time you need for gathering up all of the necessary documentation you'll be required to submit, or have submitted, to your state's Medical Board. For example, most states require items such as the following:

1. Your USMLE or NBME, FLEX, or SPEX transcripts (Go to the Federation of State Medical Boards website for more info on your transcript);
2. Your medical school transcript;
3. Verification from all post-medical school training programs;
4. Letters of good moral character from other physician colleagues;
5. Documentation of your licensure in any other state you have been licensed.

…..and other items too, depending on the specific state- all states applications are different, and you must check with the Board of Medical examiners in your state to understand their specific process. There will also, of course, be a full application you must complete and submit to your state's Medical Board.

In addition to applying for your new state license, you may also need to apply for your own personal Federal Drug Enforcement Agency number if you have been using an institutional DEA number which is common through certain training programs. Visit the DEA website for application information.

Finally, don't forget about state controlled substances registrations which some states require in addition to your Federal DEA number.

Happy applying!

Physician Job Searching: Should I Work With a Recruiter?

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Many physicians who are in training receive countless emails and phone calls from physician recruiters, letting them know about job openings that are available, and advertising the services the recruiter offers. Having a recruiter work for you can be a great match in certain instances, as they are able to streamline the job search process, and in most cases, come to you with actual job openings right from the get-go. So why would a physician not want to work with a recruiter?

Depending on where you would like to practice, many physicians will benefit from working with a recruiter. For instance, if you are interested in working in a more rural community, or anywhere that may generally pose more of a challenge from the perspective of recruiting physicians, working with a recruiter might be the right thing for you. Recruiters are hired by or employed by health systems or other employers who are trying to fill an open position. The employer then pays a fee to the recruiter who is able to find a match for the job opening.

On the flip side of this coin are the jobs that are not difficult to fill, and are highly or even only somewhat competitive. This could be due to their geographic location, reputation of the employer, or other general popularity of the job. If you anticipate desiring a job that will meet these criteria, working with a recruiter may not be for you.

I have actually worked with clients who have been told by employers that if they plan to apply for a specific job, they must not allow a recruiter to contact the employer on their behalf. In many cases, doing so will obligate the employer to pay a fee to the recruiter. In situations where a job is more easily filled, employers have no interest in, and actually refuse to, pay a recruiter's fee. If you are working with a recruiter and they contact employers on your behalf, you run the risk of actually being passed over by certain employers who will not pay a recruiter's fee. This is due to the fact that hiring a physician who is working with a recruiter will be significantly more expensive for the employer, and therefore, they will easily find a different candidate they can hire less expensively.

Before you begin working with a recruiter, carefully consider the type of job you are looking for, and be sure that working with a recruiter will be beneficial to your physician job search.

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Reference Letters: Good to Have On Tap in your Physician Job Search

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A recent article published by Adventures in Medicine reinforced the notion of being prepared in your physician job search. When you delve into this process, it often can seem fast paced with many moving parts. Being prepared up front can help make everything go more smoothly, and help you feel more in control. One thing that is helpful is having reference letters ready to go in case potential employers ask for them. While many employers choose to make a few phone calls to colleagues in order find out more about you, some will ask to see formal letters of reference. Having these letters written and ready to go can help the job search and contract negotiations process move along more quickly, and more efficiently. Check out the Adventures in Medicine article for helpful tips on how to ask for these letters, and what they should include.

For more information about physician job searching and contract review, please contact Leigh Ann O'Neill at 317-989-4833 or loneill@lauthoneill.com.

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Interviewing for Physician Jobs? Be Sure to Follow Up.

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In my work I often talk to physicians who have begun their job search process, and have interviewed with multiple potential employers. One thing I love to hear from these doctors is that they're being sure to follow through with the employers once an interview is complete. Having an interview not only  gives you the opportunity to make your best first impression with a potential employer, but it also allows you the opportunity to stay at the front of the employer's mind once the interview is over. Never miss an opportunity to follow up!

When I work with clients in their job search process, I advise them that an immediate follow-up after an interview is crucial. When you're job searching, and your goal is to obtain as many quality job offers as possible, you cannot afford to let someone forget about you. After you interview with a potential employer, you should send a thank you note to everyone you talked with, preferably within a week following the interview. Thank you notes can take many different forms, and to an extent, the specifics of it will be shaped based on your own personality, but certain aspects, I believe, are non-negotiable:

1. As you would expect, always open with a sentence thanking the individual for taking the time to interview you. This will let the employer know you do not suffer from any entitlement issues, and instead, that you realize their time is as valuable as yours.
2. Try to include a sentence that relates specifically to the conversation you had with the individual- if possible, it is nice to offer a compliment about something you learned of the individual or their practice that you found to be impressive.
3. Finally, you must close with an action request. Do not simply end your note with "thanks again for meeting with me." Be sure to convey the message that you're looking forward to hearing from them soon, and if you genuinely mean it, don't be afraid to come right out and say that you would be thrilled to have the opportunity to work with them.

While thank you notes seem basic, and perhaps very elementary, their value cannot be overstated. Especially when sent in the form of a handwritten note, employers are impressed you took the time and energy to send the note, and chances are, the note will sit on their desk for a few days- bringing you to the front of their mind time and time again.

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Physician Job Searching: What to Expect if You're Going Private

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As physicians finish up their training and begin looking for their first job, or as practicing physicians decide to make a career change, the employment possibilities can seem not only endless and intimidating, but also confusing. In the rapidly changing world of physician entities and employment arrangements, it seems there is no shortage of unique practices that are more and more owned by or affiliated with a hospital system. While an increasing number of private (and I use that term in this blog to merely mean non-hospital owned) groups are purchased by large hospital systems, some groups that started from the ground up have managed to proudly remain standing on their own. For physicians who join such private groups, the pros and cons are many, and often balance themselves out in many ways. Where groups owned by large hospital systems do not benefit from holding onto 100% of the revenue they churn up, they often have streamlined operations, with strong compliance and billing support, a robust EMR, and strong payor and referral relationships, leaving less day-to-day worries for the physicians and administrators.

On the other hand, the smaller private groups that have remained standing on their own tend to be leaner and have a much more focused view on running their practice with a business-minded approach. While they may not benefit from the operations support that a hospital-owned practice may enjoy, they are likely to be more efficient in specific areas, allowing them to take full benefit from their revenue and reinvest that revenue where available and appropriate. In these types of practices, physicians are often given the opportunity to "buy in" to the various different entities that may be affiliated with the private group, such as ambulatory surgery centers ("ASCs"), research entities, etc. When a physician is able to buy into such entities they obviously then reap the reward of the revenue coming into those entities from various different sources- a benefit often not enjoyed by physicians employed by hospital-owned groups. Additionally, physician employees and partners of private groups almost always have more leeway when it comes to the ability to adjust their practice and day-to-day operating procedures in a way that best suits their style and needs; whereas, physicians employed by large hospital systems typically have a harder time getting meaningful changes to take place in a timely fashion.

If you're beginning your physician job search and are interested in exploring private practice opportunities, be sure to flesh out the various issues that have the potential to impact your well-being down the road. While younger physicians are likely to begin as an employee of a private group, eventual partnership is very common and somewhat expected, and before you invest your first couple years as an employee, you will want to make sure you know exactly what you're walking into.

For more information about different employment and partnership structures, and how your physician job search can be tailored to meet your specific needs, call Leigh Ann at 317-989-4833 or email at loneill@lauthoneill.com.

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Negotiating your Physician Employment Salary: It is a Fine Art

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Adventures in Medicine is a great organization that provides medical residents and fellows with important and very helpful information about the job search process, as well as physician contract review and negotiation. I recently came across this previous blog article they wrote, and wanted to pass it along. Check out their other blog articles for additional timely input from professionals who are interested in promoting the lives of physicians who are embarking on their job search.

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