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A Last Look at the Contract

by Patrick C. Alguire, MD, FACP
Director, Education and Career Development

Once you have found a group to join, and you have reached an understanding regarding the conditions of your employment, take a final, hard look at the contract. (This is an area where professional help from a lawyer is absolutely essential, and if you haven't already consulted a lawyer, get one now.) Your best bet is one who specializes in physician employment contracts. The following is a list of areas that are generally covered in an employment contract and need a final review:

  1. Term: Most initial contracts are for 12 to 24 months, and often are accompanied by language that allows early cancellation by either party. Some contracts will allow the employer to cancel with "just cause," which covers situations like failing to perform your duties, loss of medical license, or conviction of a felony. Other contracts allow early cancellation by either side with no cause, following a 30- to 60-day notification of intent to cancel. What is most important in this section of the contract is language about becoming a partner in the practice. Read this carefully, because in most contracts what is actually included is the "intent" of offering partnership, but "intent" is not binding. If you are interested in becoming a partner, include in the contract as many details as possible about the conditions that make you eligible for partnership. This "preventive strike" can save you unmeasured anguish two or three years from now.
  2. Duties: This will specify what is expected of you. Be absolutely clear what is allowed and what is forbidden. If you are interested in moonlighting, or working as a teacher, make sure the contract enumerates these activities, along with your other responsibilities. This section often includes the responsibility of doing call. Try to pin down, if not exactly, at least a range of call frequency. Avoid vague language like "reasonable call responsibilities." You may not agree with what the most senior partner considers reasonable call for you, the most junior employee.
  3. Salary and Benefits: This is the part of the contact that gets the attention of most physicians. It will outline the base salary, incentives and bonuses. The following chart details other possible benefits and what might be offered:
    Benefit Expectation
    Sick Leave Usually 2 to 3 weeks
    Disability insurance Usually provides for salary continuation until the disability insurance begins
    Group Term Life Insurance $100,000 to $250,000
    Death Benefit One year's salary to beneficiary
    Health Insurance Self and dependents
    Professional Dues and Subscriptions Usually limited to a finite amount ($500)
    Moving Expenses Either added to your salary, or reimbursed
    Vacation Usually 2 to 4 weeks
    CME 1 to 2 weeks with a stipend of $2000 to $3000
    Pension Plan Usually eligible after one year
    Malpractice Paid by employer. Discuss who will pay the tail if you leave the practice
  4. Final Issues: Many contracts will include a covenant not to compete with your former group if you should leave the practice, usually written in terms of length of time, and distance from the original office. A requirement that you become board certified within a specified period of time is commonly included in contracts, as is a clause about binding arbitration should major disagreements arise during the course of employment or upon leaving the practice.

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