Me vs. My Employer: Part 2

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At the end of last month, we began our blog series on our Top 10 Reasons Why Physicians Should Seek Legal Review of Their Employment Agreements. Part 2 of the series continues below:

3. Knowledge of What is Fair and Reasonable. As we discussed above, physicians are often eager to sign the employment agreements that they are offered, almost without even a second thought. Coming fresh out of training, young physicians are accustomed to earning a pittance for their hard work and time. So it is no surprise that when they see that first offer and realize they will soon be paid a real and substantial salary, they are ready to dive right in. The only problem is that these physicians are not in a position to gauge whether the offer is fair and reasonable based on current market norms and standards. Obviously the salary offered is a huge part of this, but there are a variety of other aspects to consider as well, including but not limited to the following: fringe benefits; reimbursement for relocation expenses; reimbursement for CME expenses and professional subscriptions and dues; and contribution toward student loan debt. The truth is, the only people who are really capable of offering an objective review of whether a contract’s terms are fair and reasonable are professionals who work with and on behalf of physicians. Such professionals (attorneys and CPAs, mostly) review and analyze a large number and variety of physician employment agreements and as a result, have an objective understanding of what physicians are being offered. Further, such professionals have on objective understanding of what physicians can reasonably and justifiably request of their employers. Additionally, only certain individuals have access to the facts and statistics concerning physician income. The Medical Group Management Association (MGMA) publishes annual data that breaks down physician compensation based on specialty and the geographic region of the country where the physician is employed. The MGMA does not make this information available to the public, but rather is only accessible to members who subscribe and pay a substantial fee

4. Lifestyle Factors You May Not Consider. When a physician receives an employment offer, her eyes are bound to go straight to the Compensation provision, paying little to no attention to the remaining terms. While the compensation offered is certainly important, there are additional provisions of any given contract that are even more likely to affect a physician’s day-to-day life and lifestyle.  For instance, physician employment agreements often lay out a physician’s on-call responsibilities, but do so in a very vague way. Such ambiguous terms often put physicians in a position of agreeing to responsibilities that are completely open-ended and undefined. – basically an “agree now to what we may or may not dictate later” sort of situation. Not good. Physician employment agreements similarly often dictate that a physician will be responsible for certain administrative duties, with the extent of these duties being undefined. Agreeing to such responsibilities without an understanding of what they entail can have serious effects on a physician’s practice and quality of life.  Aside from contract provisions relating to aspects that are analogous to medical practice, there are many that influence your life in more direct and significant ways. Practice locations, for example, are often undefined and may require a physician to serve any and all existing and future locations. You may assume that this is standard, but consider the potential repercussions. If a new practice location is opened an hour drive away from your home and you are subject to serve it, your daily life could be greatly impacted. Consider also if a contract requires your residency within a particular county, zip code or mile radius of a practice. Such fine print is often overlooked and can have enormous effects on your life and the life of your family.

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Physician Employment Benefits – Part 2: What questions should I ask, and are these provisions negotiable?

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In part 2 of this blog series, we are continuing our discussion of the benefits that are generally offered pursuant to physician employment agreements. Last week, we outlined the benefits that are typically provided to physicians, and the manner in which they might be offered. This week, we are examining each category of benefits and guiding you in terms of what questions should be asked, and what you can (or should) expect from your future employer.

 Health Insurance: Because employment contracts are typically devoid of any details or particulars regarding the coverage to be provided, it is important to address this issue before executing an agreement to ensure that you and your family will be adequately covered. Employers usually can provide term sheets and/or explanation of benefits for the policies they offer.

Disability Insurance: In analyzing the disability coverage offered, it is recommended to obtain the following information: What is the definition of “disability”? Does an accident or illness qualify? How long must one be “disabled” in order for coverage to apply? Additionally, a consideration that is especially important for physicians is whether the definition of disability includes “own occupation.” Inclusion of “own occupation” in the definition can ensure that a physician will be covered if he/she is unable to perform the duties of his/her specific medical specialty.

Life Insurance: The most important questions to ask regarding life insurance offered through employment are: 1) What is the amount of coverage? and 2) Who is the designated beneficiary? Employers generally allow physician employees to designate his/her beneficiary, however, this is not always the case. For instance, when working for a private practice, a physician might be required to name the practice as the beneficiary if and when they become a shareholder/partner. In any case, make sure you know exactly who will benefit from the life insurance policy that you have been offered.

Malpractice Insurance: Professional liability insurance will almost certainly be addressed in an employment contract, and the type of coverage offered should be specified. If the malpractice coverage offered is claims-made, it is necessary to clarify whether tail coverage will be provided, and specifically, who will be responsible for obtaining and paying for the tail coverage. If the coverage offered is occurrence-based, then tail coverage is not necessary. Additionally, regardless of which type of coverage is offered, the coverage limits should be at least $1 million per occurrence/$3 million in the aggregate, and may have state-law-specified required limits.  It is important to consult with an attorney to ensure your medical malpractice coverage offered is adequate and compliant with any state-specific requirements.

Vacation and PTO: This is an area of employment agreements where deciding to ask for more should be carefully considered. A physician may not want to come across as lazy or wanting to work less. Further, employers often will simply not amend these provisions, as they are typically set policies applicable to all physicians. However, it is nonetheless important for physicians to be aware of the applicable vacation/PTO policies. Employment agreements will often dictate the number of days a physician can take per year, and also might provide the relevant procedures for scheduling time off.

CME Expenses and Professional Dues: Before executing an employment agreement, it is important to clarify exactly what the employer will provide in this regard, and what expectations the physician needs to fulfill. Will you be required to maintain memberships with professional organizations, or subscribe to professional journals? How many CME events will you attend each year? CME reimbursement rates can often be negotiated, and the physician’s bargaining power is strengthened if he/she can clearly outline the expenses that will be incurred annually. The attorney agents of Lauth O’Neill can offer further guidance as to significant expenses you might incur during your first years of practice, and how to alleviate the burden of those expenses.

Retirement: A physician employee will almost certainly not have a say in the type of retirement plan offered; however, it is still important to be knowledgeable about the plan. One important consideration to keep in mind is when the physician becomes eligible for participation. Sometimes employers require that a physician be employed for a period of time (i.e. up to one year) before becoming eligible. Once you know what type of retirement plan you will be participating in, it is recommended you speak with a financial advisor to ensure you are taking full advantage of any tax savings that may be available.

Relocation Expenses: Relocation expense reimbursement is another issue that can usually be negotiated based on the reasonable and realistic needs of a physician. It is advisable to explore the available vendors and get multiple quotes. Further, physicians should consider whether they need additional funding for one or more house-hunting trips to their future hometown. The attorney agents of Lauth O’Neill can advise you as to the average reimbursement rates offered based on their experience, and give you maximum bargaining power.

Considering an employment contract and all of its implications can be incredibly daunting for a physician. In addition to the often cumbersome language and complexity, employment contracts are also intimidating because physicians have no way of knowing what is “normal” or what provisions should be included in the contract. Only an experienced physician attorney agent can adequately guide you through this process to ensure that your interests are protected. If you have questions or concerns about your employment contract, contact Lauth O’Neill to learn more about how we can help.

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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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@MGMA Publishes 2015 Provider Compensation Data

Every year the Medical Group Management Association ("MGMA") collects survey input from thousands of health care providers across the country resulting in their annual provider compensation data. This information is crucial for physicians looking for their first job, a new job, or in simply renegotiating their current contract. Access to the MGMA survey data allows physicians and other providers to feel comfortable in their worth when reviewing and negotiating an employment contract because this comprehensive data shows physicians where they can expect to land in terms of median total compensation amounts, and other important benchmarks. When we review a client's employment agreement, our full analysis of the relevant MGMA data is an integral part of our process.  Because this data is broken down by geographic region, employer type, and of course physician specialty, we can quickly reference the production and compensation amounts our clients can expect to reach, giving our clients an edge in the negotiation process that comes from having this important information at their finger tips.

For more information on the 2015 MGMA Physician Compensation Data, and how this important tool can help you as your enter your physician contract review and negotiation process, call Leigh Ann O'Neill at 317-989-4833, or email at loneill@lauthoneill.com.

Breaking Down Physician Compensation: The Devil is in the Details

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A couple weeks ago we started a new series on breaking down physician compensation, and followed up with our second installment which discussed production compensation models. In the final installment in this series, we are addressing some of the details of your physician production compensation that you must keep in mind, and which can make an enormous difference in how and when you get paid.

When you have your physician employment contract reviewed, certain elements in the compensation language should be at the top of your mind! If you will be paid production compensation, either exclusively or in addition to a base salary, it is critical that the contract outline the method and timing for the payment. For example, it may be well-established that you will be paid 70% of your gross collections, but what does that really mean for your monthly or bi-weekly paycheck? Ideally, you should be able to tell simply by reading the language in your physician employment agreement, how each paycheck will be calculated. Suppose for example that your employer will pay you a "draw" each month, and then your overall compensation will be reconciled later. You must consider on what data the "draw" amount will be based. Perhaps it is based on a one-month look-back period, taking into consideration your previous month's collections, and paying you a set percentage of that total amount.  This method can be problematic, as on a month to month basis, your collections could vary greatly, taking into consideration being away from work at a CME conference or on vacation. So it might be safer to have your "look-back" period be a longer amount of time, providing a more even-keel monthly average collections number on which to base your "draw" amount.

Also pay close attention to when and how the reconciliation will occur. In some physician employment agreements, the reconciliation happens just once a year. This may not be the best case scenario, as if you are over-earning your monthly "draw" amounts, you might not want to wait until the end of the year to be paid the difference you have collected.  Likewise, if you are under-earning your draw amounts, it can be devastating to face an enormous repayment amount that you could owe in one lump sum.

Again, these are only a couple points that must be considered when you hire a physician contract review lawyer to analyze your agreement, and every physician employment contract is different.

For further information, please contact Leigh Ann O'Neill at loneill@lauthoneill.com or 317-989-4833.

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Breaking Down Physician Compensation: Production Compensation

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Last week we began a new blog series on Breaking Down Physician Compensation. After all, there are so many different ways physicians are paid these days, and how does it all really work? In this installment, we are taking a closer look at an increasingly popular form of compensation- production compensation. Production compensation has always been the norm for physicians who are partners in private groups, but it has also gained a lot of traction for employed physicians in all different types of settings.

Production compensation is not to be confused with some type of bonus compensation. Instead, production compensation (often referred to as "incentive compensation") is where a physician is literally paid for what they actually do. Production compensation typically takes 2 forms: collections-based compensation, and wRVU-based compensation. Collections-based compensation is most typically seen in the private practice setting, and wRVU-based compensation is more typically seen in a hospital setting.

With private practices, production compensation is relatively straight forward. As a physician, you bring in a certain amount of money (your collections), and you will have to pay out of those collections certain types of overhead. There are both direct and indirect overhead expenses that must be covered, and sometimes private practices handle these expenses by allocating to each physician their direct overhead expenses, plus a prorated share of the indirect overhead expenses, and deducting that total amount from the physician's "gross collections," which leaves the physician with their "net collections" as their take home pay. All of this hugely depends on whether the physician is a partner or an employee, which can change the math dramatically, but the idea is typically the same. You bring money in, you have to pay your bills, and you keep the rest.

In the hospital setting, wRVU-based compensation is typically favored for various different reasons. A wRVU is a unit assigned to pretty much every medical service a physician can offer (there are some exceptions).  The wRVU value of each service, procedure, surgery, etc. is meant to account for all aspects of the service- not just how much it costs to perform, or how much a payor is willing to pay for it. For instance, if a surgeon performs a surgery that is complex and requires enormous amounts of time, training, and experience in order to complete, the wRVU value will be higher than a surgery that takes less time and is less complicated to perform. wRVU-based compensation is favored in the hospital setting because hospitals have such great overhead, and their payor population may be mixed such that certain types of physicians, depending on their specialty, are not likely to actually collect for most of the services they provide (for instance, an ER physician at a safety-net hospital that has many uninsured patients).  With this type of compensation, the physician is paid a dollar amount for each wRVU they perform. The dollar amounts vary hugely based on specialty, region of the country, the physician's training and background, etc.

While we are only really scraping the surface in this article on production compensation, it is important for each physician who is offered a contract to carefully consider the manner in which they will be paid. Make sure you are comfortable with the way in which the employer spends the money that comes in, and ensure you are fairly compensated as compared to other similar physicians.

For more information on production compensation, and all other methods of physician compensation, and help with your physician contract review, please contact us at 317-989-4833 or loneill@lauthoneill.com.

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Physician Contract Review Tips: Intellectual Property

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In this next installment in our 2015 Physician Contract Review Tips series, we are discussing a subject closely related to our last article on Outside Income-Generating Activities. That article discussed physician employment agreement language that dictates whether the employed physician can participate in outside activities and retain the income therefrom.  In this article, we are focusing on intellectual property issues that surround certain work product that physician employees may create.  The range of focus on intellectual property rights in physician employment contracts spans from no mention at all, to sweeping, overly-broad language that leaves the physician employee with no rights or interest in his or her own intellectual property.  For many physicians, intellectual property issues may not be a hot button topic, but for those physicians who foresee participating in invention, innovation, consulting, and research work, any language in your agreement having to do with intellectual property can be hugely impactful.

It is crucial that physicians understand each and every term of their employment agreement to the fullest extent, and it is also of utmost importance that physicians never assume they will not, at some point down the road, become involved in activities that might result in work product that is protectable. For instance, while you may not foresee working with a device manufacturer in the future, you also might not be comfortable signing over to your employer, for free, all of your future ideas, inventions, patents, copyrights, trademarks and other protectable work product. Some physician employment agreements do in fact go so far as to provide that the physician employee is agreeing to hand over to their new employer, at no cost, or at only a very minimal cost, their entire inventory, current and future, of intellectual property.  As one can imagine, agreeing to language of this sort could end up costing the physician employee an enormous amount of money in the instance where a piece of intellectual property becomes valuable in the future.  The moral of this article, as is true with physician contract reviews in general, is to not sell yourself short. Especially if you are just coming out of training, you may be hesitant to negotiate away certain contract terms that will limit your rights and interests down the road, but do not assume that they will always be irrelevant to you. They may in fact one day be more lucrative than your basic compensation you earn from providing medical services.

For more information on physician contract review tips, please contact Leigh Ann at 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 Contract Reviews: Check the Medical Malpractice Coverage Terms

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One of the most important aspects of a physician's employment agreement, and also one of the most frequently overlooked, is the section on medical malpractice coverage. After all, who wants to think about getting sued before they've even started a job? And if you have never been sued, to many, it seems like such an abstract idea that much attention is not often paid to the details. However, as any physician who has been sued will tell you, hardly any provision in your employment agreement is more important than this one. It's one of those things you don't really appreciate until you really need it. And then once you have needed it, you're overly appreciative if the coverage was sufficient.

So what type of coverage is "good enough"? Of course the answer to that question hinges on the specifics of the practice you will have, and sometimes, it depends on what state you're in. For instance, most physicians have heard that some med mal policies are "claims made" policies and others are "occurrence-based" policies. Claims-made policies typically cover any claims brought against the physician during the term of his or her employment. Since this type of policy only covers claims brought during employment, most physicians will want to also have provisions for a tail coverage policy to also be purchased following the end of the employment. On the other hand, occurance-based policies cover any claims brought at any time for acts or omissions occurring during the term of the employment.

Not only is the type of policy offered important, but the amounts of coverage offered are also important. Whether a coverage amount is sufficient will not only depend on the type of physician, but also, sometimes it depends on what state you're practicing in. Some states have patient compensation funds that kick in and cover some amount of the damages awarded to patients in medical malpractice suits. In those states, there are often minimum medical malpractice coverage requirements physicians must meet in order to qualify for participation in the funds. Obviously, whether your medical malpractice coverage terms are sufficient depends on many factors, not to mention how the actual language is written. So it's hugely important to have this part of your physician employment contract (and every other part of it) reviewed by your lawyer.

For more information on physician contract legal reviews, contact Leigh Ann O'Neill at 317-989-4833 or loneill@lauthoneill.com.

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Moving the Money Around: How to Make Your Physician Employment Contract Work for You

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When physicians receive an employment offer, it is common for the physician to wish for increases in certain forms of compensation, or to have additional benefits added into the employment package.  For physicians coming out of training, one very common desire is to have some amount of student loans paid off upfront.  While this may or may not be a real possibility for any given physician, depending on how in-demand he or she is, one thing to think about is creative ways to move the money around.

The employer may be offering a handsome base salary, but no signing bonus. Or the employer may be offering a signing bonus outright, with no obligation to repay the bonus under any circumstances. When looking at negotiating your physician employment contract, it is important to consider what you are willing to "give" and what you think the employer might be most interested in getting. For instance, some physician employment offers include a free-and-clear signing bonus, with no strings attached. For physicians who want to the signing bonus amount increased in order to put toward student loan repayment, sometime employers will agree to increase the amount of the bonus, in exchange for having the bonus constructed as a forgivable loan. Forgivable loans make the employers happy because they ensure the physician stays in the position for a certain length of time in order to "pay off" the signing bonus. This is merely one possible example of how money can be moved around in an agreement. Another example is adjusting the base compensation over the year downward and getting a free-and-clear signing bonus up front. The employer may be better able to offer this capital amount up front, which can help  young physicians who may have high-interest rate student loans which are better paid off as soon as possible.

For more information about a legal review of your physician employment contract and assistance with negotiating the various terms, contact Leigh Ann O'Neill at 317-989-4833 or loneill@lauthoneill.com.

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Physician Employment Contracts: What Really is in the Contract?

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One of the things we often hear in law school is that the terms of an agreement are dictated by the "four corners" of the contract. In other words, only what is literally contained within the four corners of the pages of a contract are included in the actual binding agreement. To many clients I work with, this news is somewhat surprising. In many cases, clients have been working with potential employers for months, going over the details of their physician employment contract, only to finally get a copy of the actual agreement and find that everything discussed has not been included.

This can be a very frustrating part of the contract negotiation process. By the time an agreement comes around, physicians are often very excited to be done with the process, and want to sign the agreement and be done with it. I always caution physicians to not be hasty in signing their employment agreements, and instead, be completely confident that any term they cannot live without is in writing, as part of the agreement. This can mean bonus compensation, special equipment or support staff promised, or even your family's health insurance benefits. If it's not set out in the agreement, the employer has no obligation to provide you with it.

Likewise, I often talk with physicians who have requirements in their contract they may not be readily willing to adhere to. For instance, the possibility of traveling to any office location the employer maintains. Often the employer will assure the physician employee that such language is merely standard, and they won't be required to actually follow through with many of these requirements. This may be true in some cases, but as long as the terms are included in the agreement, the employer will be in a position to enforce these duties and responsibilities.

Therefore, it is very important that physicians have a thorough understanding of what their employment agreements are offering them, and what they're requiring them to do. Only then can the physician make a truly informed decision in accepting an employment agreement.

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

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Physician Contract Review Tip: Termination Language and Finding the Sweet Spot

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When you go to negotiate your physician employment contract, finding that sweet spot on various issues can be challenging, and especially when you consider contract termination language found in your agreement. The termination provisions in your contract can end up being the most crucial, and often times are drafted quite unfavorably to the physician employee. For instance, is there a non-compete covenant and will it apply to you even if the contract terminates because of something that was outside  your control? What about a "without-cause" termination provision? Is there one, and is the time period provided the right length for you? Additionally, consider instances where there may be a pay-back provision; requiring that you return some or all of your signing bonus or salary if you terminate the physician employment contract before a certain date?

All of these scenarios are commonly found in physician employment contracts, and they can often be negotiated to be made more favorable to the employee. But is it really a good idea to start off your new employment relationship by trying to adjust the terms of your contract that will allow you to end it more easily? On the other hand, accepting unfavorable termination provisions from the get-go can be detrimental down the road. It's certainly a delicate balance, and a negotiation topic that must be carefully considered and artfully approached.

For more information about physician contract reviews and how a physician agent and attorney can add value in this crucial process, please contact Leigh Ann O'Neill at 317-989-4833 or loneill@lauthoneill.com.

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Questions about Lauth O'Neill Physician Agency?

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If you have heard of a physician agent, but are curious about how Lauth O'Neill provides their concierge-style physician job search and physician contract review services, please check out our new FAQ page.  Here we have outlined various questions we often receive and have provided detailed answers. If you have further questions, please do not hesitate to contact Leigh Ann O'Neill at 317-989-4833 or loneill@lauthoneill.com.

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Physician Contract Review & Negotiation: Make the Money Useful

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If you're rounding out your physician job search and have been offered a physician employment contract, congratulations! At this time of year, many physicians are signing their physician employment agreements and looking forward to beginning work. Maybe you've had your physician contract reviewed by a physician lawyer, and you're confident that it's just the way you want it. Maybe you haven't taken the step of having a physician lawyer review your contract, but you'd still like some helpful tips anyway. One particular dilemma that especially comes to light this time of year is the "payment gap". You're finishing up your residency or fellowship, and you'll start your new job maybe sometime in August or September- maybe you're taking a few well-deserved weeks off before you begin. Well-deserved, they may be, but we all know they come at a price. Where is your income going to come from during your time off before you start your job?

If you enlist the help of a physician contract lawyer, they will likely readily assist you with this dilemma. While each and every physician employment contract is different and all circumstances and possible outcomes are unique, it may be possible to maneuver the salary offered to you to help you out as you finish up training. Even if you were not offered a signing bonus or moving expenses reimbursement, it may be possible to adjust your salary in such a way to offer you some initial compensation up front.

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Value Added by a Physician Agent and Attorney

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In this series of articles, we are outlining examples of how Lauth O’Neill’s physician contract review and agent services have added value to our physician clients. While every physician job search is unique and has its own unique outcome, all of the examples in this series are based on actual client experiences.

Value-Added Example #4: Creating favorable and achievable bonus compensation terms. Often times when a physician receives an employment offer, the contract will include a guaranteed salary amount which will be paid to the physician each year of the contract term. In certain specialties and in certain regions of the country, physicians may be very likely to collect payments for their employer that far exceed the minimum salary offered to the physician employee. While many employers do not first offer any bonus or incentive compensation to young physicians who are straight out of residency, it certainly may be an option to you if the legal terms are crafted carefully and so that the employer feels comfortable agreeing to them. If you have access to the MGMA physician compensation survey, you will be able to determine what your potential collections will be, on average, in your first years of training. With this information, it is possible for a physician contract review attorney to create a bonus payment structure that will allow you to achieve compensation beyond what your salary guarantee will pay you.

For more information on ways to increase your physician salary and overall physician compensation, please contact Leigh Ann O'Neill at 317-989-4833 or loneill@lauthoneill.com.

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How a Physician Agent and Attorney Adds Value

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In this series of articles, we are outlining examples of ways Lauth O’Neill’s physician contract review and agent services have added value to our physician clients. While every physician job search is unique and has its own unique outcome, all of the examples in this series are based on actual client experiences.

Lauth O'Neill Value-Added Example #3: Crafting favorable non-competition language.  When you receive your physician employment contract, it may include a non-competition covenant. In general, this type of covenant restricts you from practicing medicine within a certain mile radius of your employer's office, for a set amount of time following your employment. As an experienced health care attorney, Leigh Ann is able to craft legal language within the physician employment contract to ensure her clients are not held to non-compete covenants in certain instances. While we generally disagree with physician non-competes for a variety of reasons, there are particular instances in which physicians absolutely should not be held to complying with these terms, and it is our job to nail down those instances, and put our legal skills to work in amending the employment contract language to ensure our clients receive the most favorable legal terms. This is merely one additional example of the value a physician lawyer can provide when providing physician contract legal review services. If the non-competition covenant ends up being enforced, the result can be that the physician employee is required to uproot not only his or her practice, but his or her family as well, in order to move to a different city or state. This is an extraordinary cost that can be avoided if the proper legal attention is paid to your physician employment contract terms.

For more information on how Leigh Ann can assist in your physician contract review, please contact her at 317-989-4833 or loneill@lauthoneill.com.

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How do you Gain from Lauth O'Neill Physician Agency?

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The answer is simple: We make our clients money, and we save our clients money. The physician job search process is certainly not a short or simple one. It takes months, and more typically, years to complete, and involves innumerable moving parts. The job search process requires extensive outreach efforts and marketing of a physician's credentials and qualifications. And once job offers are received, the physician employment contracts must be legally reviewed for costly and detrimental legal terms, and also negotiated to ensure the best offer is accepted. After all, the point of a physician job search is not to just find a job. The point of your physician job search is to find the best job for you- and the one that is most advantageous to you legally and financially.

In this series of articles, I will outline examples of ways Lauth O'Neill's professional services have added value to our physician clients. While every physician job search is unique and has its own unique outcome, all of the following are based on actual client experiences.

Lauth O'Neill Value-Added Example #1: A $75,000 increase in annual salary, in addition to a $50,000 signing bonus. How did we pull this off? We know how to gain leverage for our clients, and we know how to use it appropriately to negotiate better benefits.

Lauth O'Neill Value-Added Example #2: Amending insufficient medical malpractice coverage terms to avoid unquantifiable expense to our client. When a physician employment contract includes insufficient medical malpractice coverage, the consequence can be detrimental to the physician- not only expensive, but potentially career-ending. We understand the ins and outs of physician employment agreements, and know exactly what to look for to ensure that our clients are not stuck with unfavorable and harmful legal terms.

Check back here often or contact Leigh Ann directly for additional ways Lauth O'Neill Physician Agency provides value to its clients. Contact Leigh Ann at loneill@lauthoneill.com or 317-989-4833.

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Physician Contract Review Tips: Not-so-Obvious Points to Keep in Mind

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When I am hired to do a physician employment contract review, I regularly uncover a multitude of different contract provisions that can be made more favorable to my clients. In some instances the employment contract is relatively balanced with regard to many contract terms, but in other ways the contract is completely lacking in crucial provisions that will make the employment arrangement a good one for the physician to enter. For example, a few not-so-obvious aspects to keep in mind are:

1. Your ability to earn income outside of the employment arrangement- Many times employers attempt to keep for themselves any income earned by the physician for activities performed as a physician. For example, some physician employment contracts stipulate that if a physician consults with device manufacturers or other medical industry companies, any income realized from the physician's work for the company will be the property of the physician's employer.  Other times contracts will require that a certain percentage of this income must be paid over to the employer. It is also not uncommon for physician employment contracts to require that any income earned by the physician for serving as an expert witness in a trial, or in other physician-based capacities will be the property of the employer. Provisions such as these are obviously unfavorable to physicians, as in many cases, especially those in private practice, physicians rely on outside compensation to supplement their annual income.

2. Having assigned OR and procedure room times- This point is often overlooked by younger physicians who are accustomed to being forced to work at all hours of the day and night, whether they want to or not. Of course, starting your own practice is an entirely new ballgame, and one factor that is often overlooked is the assurance that you will in fact have a physical space to practice medicine and surgery. Many times physician employment agreements will simply state that the employer will provide the physician employee with the space and equipment he or she needs to perform the job at hand. However, it is a maddening experience to show up to work on day 1 and find that the optimal OR and procedure room times are filled by senior physicians, or those who made sure to ask for specific time assignments in their physician employment contract. One can only imagine the frustration felt by a physician starting a new job who comes to find out that yes, in fact, they do have two days worth of assigned OR or procedure room time, but it's broken up between afternoons on Tuesdays and Fridays and all day on Saturday. Paying close attention to the terms of a physician employment contract relating to these accommodations can make an enormous difference in the long-term success and satisfaction in an employment arrangement.

3. Ensuring balanced billing responsibilities and liabilities- It is not uncommon, especially in private practice, for physician employment contracts to include a provision placing responsibility on the physician employee for certain billing duties. In some cases, employment agreements state that billing personnel will be responsible for coding the services provided by the physician and submitting the bills for payment, but also that the physician will be liable for any recoupments or other recoveries that occur due to incorrect bills. While it is desirable for physicians to have someone experienced in billing be responsible for submitting their claims, there can be very detrimental consequences to the physician if a mistake is made and care has not been taken to protect the physician from liability. Additionally, this type of arrangement can lead to unforeseen consequences to a physician's incentive or bonus income if billing responsibility is not properly tailored.

It is important that physicians have their employment agreements thoroughly reviewed to ensure that all provisions are carefully considered, and that they negotiate for adjustments to be made in critical terms so that their employment arrangement ends up being as favorable as possible.

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