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: 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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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 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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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 Negotiations: Don't Miss Out!

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I recently spoke with a group of medical residents and their spouses and we discussed the value in negotiating their physician employment contracts, and whether doing so was really necessary or of benefit to the physicians.  It was suggested that they may have previously been hesitant to negotiate, but they had recently learned of specific instances of physicians employed by one of their training hospitals that changed their minds. In the specific instance they cited, three physicians had recently started jobs at the training hospital, and they were all joining the same departments and with the same salary and employment offer, except one physician was given an additional $10,000 in moving expenses that the other physicians did not receive.  The residents I was speaking with were surprised to learn why the one physician was given the extra $10,000- simply because the physician asked for it!

This is a typical example of the difference that can be made with some simple physician contract negotiations. And I always cringe when I hear stories of this sort from the side of the physicians who didn't ask for any changes to be made to their contract. When you know how to tactfully and respectfully negotiate your physician employment agreement, it is possible to obtain added benefits and even higher salary and other forms of compensation.  An experienced physician agent has knowledge of what perks physicians can expect from their employment offers, and they know how to successfully negotiate to ensure that those added benefits are not left on the table.

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Isn't Job Searching Too Personal To Have An Agent Do It?

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This is a question I sometimes hear mumbled when I discuss what I do with others. They wonder if the job search process might be too personal to have someone else involved in it, let alone take the reigns and head it up. And I always say, "yes, physician job searching is certainly very personal. But that is where our strengths come in." The bottom line is that physicians don't want to embark on their job search all on their own. When done properly, it's too time consuming and burdensome, and involves too many tedious tasks. Not to mention, physicians understand that a physician agent has the experience necessary to put the physician on a level playing field with the employers in terms of getting the benefits, salary, and other forms of compensation they deserve.  After all, physician agents have experience with negotiating contract terms and they understand the various physician compensation models and how to make sure physicians get the best deal out of their next employment arrangement.

So while the job search process is, of course, highly personal, we make it our duty to ensure we know all about what you want out of your next job. We talk with you to find out what sort of practice you envision yourself having, in what part of the country you would like it to be, and what aspects of life outside of work are important to you and your family. Of course we don't stop at that- we gain a thorough understanding of what details you expect from your employment- be that your physician salary, particular benefits, time away from work, and any other special features you would like. While some clients have already been contacted by potential employers or have heard about possible job openings from colleagues, we not only assist you in pursuing those jobs, but we also go a step farther. We help you explore all other potential jobs so that you can rest easy knowing all viable options have been unveiled and you are not missing out on a job that may be a better match for you. In addition to seeking out all potential physician employment options, we follow through on every critical step of the physician job search process- from keeping in touch with potential employers and scheduling your interviews, to providing a detailed legal analysis of all contract offers you receive and suggesting favorable changes.

To learn more about how we can assist you in this very personal, and important process, contact Leigh Ann at 317-989-4833 or loneill@lauthoneill.com.

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Physician Compensation: What are the Various Models?

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When a physician employment contract is offered, often the first thing physicians look for is the compensation section to see how this offer stacks up against others.  What physicians sometimes find, is that rather than a simple 3-sentence paragraph outlining the annual compensation, and the payroll policy, there is a reference to an exhibit at the end of the agreement that sets out, over multiple pages, the compensation methodology according to which they will be paid.  While every individual agreement is different and should be reviewed by your individual lawyer, it is helpful to generally review some possible scenarios in order to gain some understanding of what payment methodologies are commonly used.

100% Straight Salary Guarantee

One of the most common physician compensation methodologies is the 100% straight salary guarantee.  In a time of hospital systems sweeping up private groups left and right, and physicians becoming employed in the majority of instances, the straight salary guarantee is a hugely common payment method.  This type of payment methodology is pretty much exactly how it sounds- the physician is guaranteed an annual salary of a certain amount, and such total salary is paid to the physician in accordance with the employer's regular payroll policy.  With this methodology, there is no incentive or bonus pay tacked on based on productivity.

Salary Guarantee + Incentive Compensation

In a payment methodology that includes a salary guarantee, plus incentive compensation, the physician is guaranteed a minimum annual base salary to be paid in accordance with the employer's payroll policies, and they are also eligible for additional compensation that can be based on a variety of factors.  Such incentive compensation can be paid on a quarterly or end of year basis, and may be based on factors such as wRVUs billed, wRVUs collected, quality incentive measures, or a variety of other factors.  When the incentive compensation is based on production, such as according to wRVUs billed or collected, the incentive compensation only kicks in once the physician has produced enough to cover his or her minimum base salary.  At that point, the methodology often calls for payment to the physician of a bonus in the amount of a certain percentage of his or her collections above the minimum guaranteed salary.  Take, as a basic example, a physician who has a minimum base annual salary of $100,000 per year, and an incentive payment of 30% of the collections the physician brings in over $100,000.  In this instance, if by the end of the fiscal year the physician has brought in collections of $200,000, he or she would have surpassed the base salary threshold, and would be paid a $30,000 bonus.

How the incentive compensation is structured exactly can vary widely depending on the specific agreement, and sometimes is dependent upon a base number of billed or collected RVUs or wRVUs, any excess of which can earn a bonus payment of $xx per RVU or wRVU billed or collected above the base amount.  Again, these are only a limited set of basic examples.

Pure Production Compensation

A third compensation methodology is one based purely on production, sometimes referred to as "eat what you kill."  This methodology is most commonly seen in private practice settings, and within those, it is mostly partners of the private practice who are compensated this way.  Under this methodology, a physician is paid a certain percentage of what he or she brings into the practice.  The remaining collections are typically paid to the practice in order to cover overhead expenses, such as real estate, malpractice insurance, support personnel, equipment, and supplies.

In this scenario, as well as the Salary Guarantee + Incentive Compensation methodology, the details of your employment or partnershipagreement are critical. Differentiation in single words can make an enormous difference in the compensation you end up being paid.  Therefore, it is highly recommended that you obtain a detailed legal review of your physician employment agreement to ensure that you are receiving the terms most favorable to you.

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Physician Employment Contract Negotiation Tip #1: Know What You're Worth

If you're finishing up residency or fellowship, you've spent the last 4, 5, 6, 7, maybe even 8 years being paid about 18 cents per hour. Now you're out there looking for your first "real" job. So when someone comes along and offers you a 6-figure salary, it's tempting to accept it, no matter how unfair the offer actually is. Unfortunately, some employers are anxious to take advantage of young physicians who are desperate to take any job that will help them begin to pay off their enormous student loans. So many times young physicians wind up accepting compensation under their physician employment agreement that is not up to par with market standards. After all, it's hard to know what the market standard is when you don't have access to national physician compensation benchmark data. That is where a physician agent can help you. In providing our Premier Opportunity service to our clients, Lauth O'Neill utilizes our access to the MGMA and other important surveys to ensure that our clients receive the compensation and benefits they deserve. Before you accept a physician employment contract offer, be sure someone is looking out for your financial and legal interests.