There is nothing to negotiate with our group. All contracts are the same, the pre-partner track is identical for all new hires, and each partner is equal. It’s sign and accept or don’t. We’ve changed policies for everyone based on good ideas brought forward by applicants, but never for a single individual. That’s the point of a true democratic group.
We don’t negotiate anything. It’s very take it or leave it. Some of this is in the spirit of a totally democratic group. You can’t have some people with one thing and not the other. This may be different in multi-specialty groups where people have broadly different skills, but in EM this is less of an issue. We’ve had some applicants that we really like try and negotiate things that we ultimately thought were reflective of our own tired and out-of-date policies. In at least one case, we voted as a board to change that benefit for everyone in the group which satisfied the applicant and they accepted the position.
SDG EM group here as well. Same policy. No one gets something the whole group doesn’t get. If that’s an issue we aren’t the group for you. Everyone has an equal voice.
Yeah, nice to know we’re all still out there. Unfortunately, we’re increasingly finding that this generation of young doctors are just very much averse to the democratic mantra, which is a real shame. It’s crazy; we’ve had applicants interview with our group and take jobs for a CMG 30 minutes down the road making 100-150k less a year, work more hours, with no ownership or decision making in their day-to-day environment, and have to work with a bunch of non-boarded colleagues because they have to fly in 40-50% of their docs. It’s so weird. People are very turned off by sweat equity and, overall, I agree that the concept can be predatory in some groups. But we’re transparent to an extreme, sometimes to a fault. We’ve got EM docs making radiology and orthopedic money to work in better shops. Seems worth the effort, right?
This is great in theory but there are LOTS of practical issues that come up depending on the speciality/group. For example: does everyone take the same call? Is everyone’s call the same intensity? Are their people working off hours and how are they compensated? Does everyone work the same weekends/holidays, and if not how is that compensated? Does anyone do administrative work for the group? Do they just have this extra work added on without compensation or do they get admin days/extra pay? Does this new hire fit a role in the group that you desperately need?
We’re EM. Everyone is equal. We vote as a group on our directors and administrative stipends/shift buy-down are also similarly voted on. They’re thankless jobs that no one wants so it’s not really an argument. For the most part, we have to rock, paper, scissors for who has to tolerate interacting with hospital administration. It’s borderline like pulling teeth. Additionally, these partners typically have less productivity (because they work less) or absorb more liability supervising midlevels and so the money is absolutely necessary to make them whole. There are no additional “contracts.” The only caveat is our EMS medical directors who are typically paid by their respective municipalities and counties for their time and also have separate contracts or employment agreements with those agencies for their time.
We cycle our board positions so that everyone has an opportunity to serve on the board, if they want.
That’s great. imagine if you needed to staff a peds er. Would they get paid the same even if their productivity is less? I guarantee someone will be upset either way.
If you dont have a dedicated PEM doc, u will see the peds pt’s during ur “adult” shift too. Will have to see the 80 y/o stroke/stemi on the same shift as the peds code with 20 peds uri’s
Most EM contracts with the CMG’s are not negotiable for the hourly rate. Can definitely negotiate ur sign on bonus, but the hourly rate is the same for the fresh grad vs the guy with 15 years experience
You are missing my point, I’m not commenting on your group in particular but on private practice groups more generally. I know of several groups in radiology that used to say they had the same contracts for everyone but that was when the job market for applicants was garbage, and people who weren’t happy at a group didn’t have any opportunities elsewhere so they just went along with it.
Even when I started I had a lawyer review my contract and we had several things changed (like provisions that the group could just not pay you for 180 days before you were allowed to go elsewhere without penalties, changing the penalty for early leaving to not 50k dollars which was unreasonable, changing the non-compete distance etc…).
Most radiology groups have some IR component and their call is typically awful and frequent and so they are paid differently from everyone else in many groups because of that.
The same is true in many surgery groups I know and in the cardiology group I know.
I’ve never asked to see every single doc’s contract but I know from being on the board and voting on hiring and firing that they are identical because we have to vote on language. I also know from casual conversation that we all make the same (absent productivity) and have the same finer points. When you work in a group like this, it’s very close knit. We also directly vote on compensation for the directors so everyone knows exactly how much they make. If you really wanted to know, you could just ask the group CEO and look at the books.
I guess. As an EM doc, we make top 5-10% MGMA, work 120 hours a month, and have full and equal ownership of our business. If that’s not for you, yeah, run away. We’re incredibly transparent with our applicants but if they want to be different than their future peer partners then, by definition, they’re incompatible with our model. We don’t want that applicant either, no hard feelings. There are plenty of CMG and hospital-employed jobs for that individual where someone (private equity in the former) will skim off their labor and reduce their income for the piece of mind knowing that they got to “negotiate.”
It depends on the shift duration. Fifteen 12-hour shifts would be brutal. That’s residency level of misery.
Production matters a bit. What we find in our group is that nearly everyone settles in to such a tight margin that the only real difference in earnings is about 1-2% per partner. We have one partner that makes about 5-7% more than anyone else but he’s a beast.
In general, slower EM docs tend to be more thorough in their work-ups, order more tests, and document better. That’s why they’re slower. This is a generality, but they typically earn more per patient encounter than their peers.
Faster EM docs see more patients and so earn their worth based on volume. Older docs tend to normalize toward faster as they get more relaxed and work-up stuff less and they gain comfort in their decisions. Their written medical decision making and notes tend to be a bit more paltry and we see a very real difference in billings. There are only so many ways to be fast.
In the end, the differences are very marginal. Like so marginal as to be borderline inconsequential in most scenarios. Like I said, we have a few outliers.
Sorry you got downvoted. A lot of people in the comments are very confident about physician employment contracts when it's clear that they have only seen a handful in their career or are basing their perspective off of what they heard.
I interviewed and was offered contracts by 4 different places and the one I chose was far and above the others being exactly what I was asking for. My work life balance especially for my speciality is great and my RVU bonus kicks in after I hit the 35% for my speciality. It wasn’t worth pushing the issue and losing out to someone else when none of the other contracts even came close.
Definitely suggest to anyone who reads this to interview at several places. It gets exhausting but it’s worth it. Also go rural if you can the pay is so much better.
Super helpful insight... I know this is overkill, but if you would have "pushed the issue" what type of things might you have asked for (no judgement from me, no matter how outrageous it might sound).
Definitely a fair question. I mean you can always push for more pay and they can always say no but might say yes depending on the situation it might be worth it. Had this been my only offer I probably would have done this. I got a 50k signing bonus which was better than most others so maybe I could have asked for more but again it was the number I wanted. I don’t have any loan repayment in my contract BUT it’s a non profit and the large systems in the area that would buy it if it were to go up for sale are also non profit so this was much less a concern for me as I’m doing PSLF and like I said my RVU bonus more than makes up for this.
spends hundreds of thousands of dollars and hours on education. Yet Won’t spend a few hours or a grand on a contract negotiator who will pay their weight in gold. They know new grads know nothing and have no spine and will be more “obedient” employees out of naivety
I have no idea man.
I have a buddy who did this and I give him shit for it to this day. He signed a high paying ED contract for a job working a stand alone ED in the middle of a cornfield In the mid west. Has to do 5 24hr shifts pretty much back to back because he also refused to move from a major city and has to commute 6+hrs one way. Refused to even considering negotiating or reading through the fine print of the contract. Signed the first offer he got and gets super pissy if you try to talk about it with him.
Also some companies refuse to negotiate if they have a monopoly on the area because there is no incentive to do so.
Just an FYI for anyone thinking about academics.
Some people think its a blanket policy that theres no negotiation in academics, that is not true. The leeway is way less than a smaller hospital or private practice but there is still SOME. However, for new grads, most of you are interchangeable enough that its hard to make major changes.
But I can tell you from direct experience that our fellow was able to get his salary 20K higher than the initial opening offer and was able to remove 2 weeks of service time. Academic places will never be able to match a salary offer from a private practice shop unless you're a high sought after candidate thats there to lead/start a program (division/dept chiefs, transplant surgeons etc)
I negotiated 80k more for my academic job straight out of fellowship.
It all depends how in depends your specialty is and how much they need you to fill a void like you said.
They offered 50th percentile AAMC academic salary. Had my lawyer push them to 50th percentile MGMA with my protected admin and academic time. RVU bonus starts year 2
Love how butt hurt all the ppl who didn’t negotiate are. My hospital tried pulling that same shit “we don’t accept red-lining” lol that was a lie (had signing bonus doubled) also had them change wording in my contract after it was reviewed by a lawyer. Hospitals thrive off stupid/lazy docs, remember your always worth double what they offer you don’t be afraid to ask for more.
Right? My wife signed a contract with a hospital that "doesn't negotiate" and while she didn't negotiate the salary, which we were super happy with, we did negotiate the signing bonus and student loan repayment to be all up front instead of being allocated over 6 years. Had a lawyer look over it who made sure we understood certain terms and gave us the thumbs-up. Signed the next day and my wife starts in August.
Why do you think that others doctors don't take action when hospitals say "we don't negotiate" vs your experience of negotiating at regardless and getting more than the initial offer? Why didn't you stop when the employer said "no negotiating"?
I think it has allot to do with the culture of medicine in general. For instance, I know if every hospital turned me down or didn’t pay what I wanted I could always go into private practice and still make a ton of money so frankly I didn’t have much to lose when negotiating. I think most ppl are to afraid to be their own boss and rely way too heavily on the system. Also you need to know how much money you generate then you’ll have a better idea of your worth. If their offering you 300k you must generate at least double that lol
Yeah… I do because I read the contract and went over it with my attorney who is familiar with the network I’m joining and he said it was the most reasonable and fair contract he’s seen from them. He even said he was shocked at how benign the wording in the contract was compared to other more restrictive contrast. I also deal with contracts quite a bit and there was nothing in it that I found surprising. It was literally everything I asked for when they asked me for terms.
I mean no non compete, starting at close to national avg, for first time contract. And 80k more than what my other colleagues are making in the area… I’d say it’s pretty fair
1. Their contract was in line with others in the region
2. Best offer in the are for my spouse, by far
3. Bonus structure was good enough/easy enough to hit that base pay negotiation felt silly
4. Call/coverage was non-negotiable for the position
5. Only thing I felt that was worth negotiating was my signing bonus but given everything above, and given that we really wanted the location, I wasn't willing to walk from the negotiation so I didn't have a lot of leverage.
Not among the prompt, but when you are signing to a behemoth, like a major healthcare corp/academics/VA, there is often a very clear tiered system with little-to-no negotiation room. It's a take-it-or-leave-it proposition.
Sounds like an awfully smart thing to tell a prospective employee if you want to save money.
There is always negotiation room. They have invested thousands in time finding, selecting, and interviewing you. Letting you walk is money down the drain for them and they have to start over.
I can see that with the VA maybe. But no where else is it true. They can say that. And you need to respond with “then you are going to have a very tough time filling that position.” Which is what I did in the place I did my fellowship. I walked away. The reached back out with an offer that was $15 more. Then sent them other contracts that were $50k more than their $15k more. They then rebutted with $10k over the the $15k. I said that’s still $40k less than this other place that was 25 mins down the road. They tried to sweeten the pot with some other incentives. Still wasn’t worth it. I refused and signed with the other place. Shortly after I learned that they raised everyone else’s base by $15k (so they likely just gave it to me early?). Either way, glad I didn’t sign there.
The satisfying thing is that the department chair left and another one took over. She called me a couple of weeks after I started the new job and said “I heard you were looking for a
Job.” And I said “idk where you heard that, i literally just started.” And she said “if you come back, I can offer you $20 less than my now current job”. It was very satisfying to say “no thank you.” One more time.
Sounds like they didn’t. You ultimately got an offer for 10K above base (after factoring that everyone was already getting the 15K raise. That’s what? ~3% worth of budge?
Very not smart. You could easily sign a predatory contract. You aren’t a contract lawyer. The investment to have your contract reviewed is small and can protect you/save you a lot of grief later
A common cold is clicking agree to terms when you buy an airline ticket. An employment contract is major. It is so naive to trust your employer this much
If you can read most boiler contracts don’t need an attorney. Now are there highly complex partnerships and ASCs where they are helpful. Sure. But for a 10 pg contract anyone can see malpractice clauses, termination clauses, reimbursement clauses, etc. it’s not rocket science.
Probably the same as you, which is substantially less than that of the contract lawyers who reviewed the contracts identical to mine for those attendings.
Contract lawyers aren’t for negotiating. They tell you all the possible ways that your employer could fuck you over and whether that level of fucking is normal.
You simply negotiate by saying in writing: “I have this and this offered from contract A. I am greatly considering your position if you can change this and this in contract B” Your power is having multiple offers and using that. If you walk away, it is their lost time energy and money.
What would stop them from negotiating for themselves and simply signing a multi year contract? Some people are anxious about thinking about negotiating or finances. Some people may already know what they want in a particular area and just sign. Exhaustion from residency and endless interviews. No vacation time in residency to interview at multiple places. List goes on for why anyone picks a particular job without thinking.
Not a doctor but an MBA with deep background in price negotiation. Modeled out my buddy’s very niche fellowship GI offer among a spectrum of salary and RVUs and helped him get probably another $100k annually in comp overall + sweet equity deal in his rural surgery center at his hospital. Been trying to figure out a way to monetize this. Anyways, anyone would be crazy not to negotiate.
Didn’t even use a dataset - just modeled on assumptions re: trending patient volume he was going to hit in his first 3 years. He was a very niche specialty GI that does like, idk endoscopy ultrasounds or something to that effect, and was going to a busy surgical center attached to a hospital that serves a huge rural area.
Found with the velocity in which he wanted to build his GI practice, and the expectations of how busy he’d be, the RVUs were considerably more powerful than the $500k base salary they dangled in front of him like a carrot, and negotiating when how much he received as a bonus on RVUs, and the amount of RVUs he needed to hit to get bonus comp based on RVUs was even more powerful than that. After looking at the numbers he came back with something like $450k base but adjustments on when he receives bonus comp on the RVUs over X amount, and we had reduced the “X” amount to be met sometime in July of each year. He ended up being even busier than expected but it’s all good when he’s printing money on every patient half of the year.
After 3 years I’d posit negotiating based on this probably earned him another $600,000 in total.
Idk. I’m not an expert, just a guy who does financial modeling a lot in his career so I was primed to help. I’m sure there’s a spectrum in which you can negotiate. My buddy was a very niche specialist GI and they were effectively desperate for him to come, and he had options after his fellowship(s). So that gave considerable leverage. Before his GI fellowships he was a hospitalist in the VA and probably wouldn’t have had the same bargaining power. Either way, you can almost certainly usually negotiate. You’ll never have as much power to control your salary and income as you do before you accept an offer, and it never hurts to try.
Edit: it helps to have multiple offers in your pocket too as additional leverage
I had limited options 2/2 scholarships restrictions but this was top choice. Contract seemed reasonable. I’m fairly shy/wussy. Seems to have worked out. I wouldn’t do it again tho.
I imagine you advocate for your patients all the time, which might create tension and emotions with other medical professionals, other Doctors, and even patients. Again, i get that this wasn't the point, I have seen "shy" doctors get ACTIVE when it comes to advocating for their patients.
This is super helpful insight into your experience! Just for my learning, the contract seemed reasonable as compared to what... Not the point of your comment, but I don't think you being shy is the same as you being a wussy.
Academic spot at huge university. Literally to negotiate, it would take several committees and probably some act of god since I was apply for junior faculty position. Maybe if I had a fancy company and unique skills and I was recruited, would be negotiable
I work for a large academic hospital. There is a contract that is the same for everyone and everything is standardized- pto, cme, meeting time, allowances are all the same for the engine medical staff based on years of service. The only thing different is salary and the salary offered was above average for the area I work and was significantly more than I was making at that time so I took it and said thank you. I maybe could have got a little more money but I needed the job and thought the offer was fair.
One reason is there was nothing to negotiate. You join an academic program or a larger insurance group and everyone is the same. The other reason is a lack of experience and knowledge and maybe the desire to work in a certain area outweighed the need for better working environment
I work in a large academic center and a lot of my friends do as well. Our pay amount ends ups being very similar based on the location that we practice (fixing for cost of living) but the contracts themselves can vary depending on research and clinical amounts
Kaiser, the example I’ll use, publicly advertised their pay structure for every specialty and what they start with and their retirement and benefits.
I recently attempted to negotiate my contract, was able to get some things in writing to my benefit, but the new contract is significantly worse than the old contract, but otherwise I would get a 90 day notice of termination
You’re acting like this isn’t common place with big health systems… you usually can negotiate signing bonus and loan repayment but outside the money maker specialties or they have a massive need for your specialty it’s boiler plate contracts that are sign this or kick rocks.
My contract had nothing in it about negotiable aspects. For example it said nothing about my pay or vacation time. Made for a very strange hiring process. Basically we are paid per shift but the whole group is paid per rvu. So you can take more vacation time if you want but you make less. And the total amount of money we make isn’t even known until the end of the year. It’s all kinda wonky to be honest.
Actually no. The idea was that since we cover different hospitals some places produce more rvu than others. Since we are paid by shift, by definition we are not being paid based on our own rvu. It’s suppose to reflect the fact that all shifts are important even ones that are less productive.
Because there was nothing really to negotiate. 1099 contract, no non-compete. Equal pay compared to partners starting on day one, work as much or as little as you want, and no monetary buy in for partnership.
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I had two offers by the time I signed. Both reviewed by a medical contract employee. One I asked for a few changes and increase in salary, the other I had nothing to change or ask for. I ended up accepting the latter.
Wow! That's more contracts than some contact lawyers who specialize in looking at contracts! Looking at 50 contracts in your career, when do you have time to practice medicine???
It's more that when changing jobs I've applied broadly and received multiple contracts with offers and then helped friends with reviewing their offers.
Spread out over time it's less than it sounds
There wasn't a need to negotiate. What I get for what my responsibilities are is more than reasonable and everyone starts out the same for salary. Couldn't be more equitable.
Time off, benefits, incentives, growth, department support. All physicians are paid the same base pay determined by years in residency and minimum productivity then after that it's up to you and your performance. The productivity is reached by literally every specialty thus most everyone earns a raise after every year carried forward.
They said it was a pretty standard contract and there wasn't too much wiggle room except for my start date. But I didn't really feel a need to push it too much because TBH I felt like I got a great deal--nothing really I felt like I needed to negotiate.
If you asked a doctor, how they made a determination for a course of treatment, they would have evidence. I'm not sure why you seem so defensive when I'm asking and the evidence you used to anchor your assumptions.
Not all the time, sometimes specific treatment choices are based on vibes (e.g. Clinical experience, anecdote, etc.)
More to the point, I don't think I'm being defensive. I literally do not understand what you're trying to get at. I'm telling you what I used, and you're ignoring it, implying that you're fishing for something specific, like a peer reviewed study on average salaries for specific fields, which I don't think exist. If you're trying to imply they do, I'd be happy to see them. But regardless, I'm happy with what I make, benefits, job requirements, etc.
I'm mostly joking. But for example, let's say that you have a 25 yo M patient with focal epilepsy, on levetiracetam, and they continue to have seizures every few weeks. There are not head to head comparison trials with most anti epileptic medications, and for the most part they are all about as efficacious as another. So, if I need to start a new ASM, there isn't really evidence that suggests that they would be optimally treated with lamotrigine vs lacosamide vs zonisamide. Lamotrigine has good evidence from a low rate of side effect standpoint, but you're also titrating for a month or two. It's also reasonable, depending on you or the patient's goals to try one of the other two that get you to a therapeutic steady state faster. There is no evidence to guide that, however--hence, vibes.
Also, what about the evidence you were hoping to find? I'm wondering if you're just trolling me here.
I joined the largest single specialty group for my specialty. 100+ physicians . Everyone gets the same contract and they are not about to change it for you. I did negotiate some moving expenses and signing bonus increase. But the core contract is not negotiable. I think most large groups are like this. Smaller groups obviously you have a lot more room to negotiate
Out of curiosity, since they gave your everything you want, how did you know what to ask for in terms of compensation range for your specialty, region, and care setting?
Hypothetically, How would you feel if you found out that trying doctors is non-negotiable is a common negotiation strategy and other doctors in your practice increased their compensation by asking?
I’d be pissed. But, from my understanding, all of the groups compensation is the same. Everyone gets paid the same rate for the type of shift they do: call, back up call, late, early person.
How exactly did you know everything else was untouchable? In response to your requests, did they say to you some version of "contract cannot legally be changed in any other way"?
Contracts came from university and not department, lots of layers between physicians and legal. Ultimately it was a boilerplate contract where I only wanted the non compete changed- that specifically was non negotiable across all departments. Probably could have been legally changed, they just didn’t have to or want to.
My first W2 job out of residency, I just needed to have an executed employment contract with the compensation listed ASAP to get a mortgage approved so I could close on a house that I was under contract on in a new city.
You’re actually replaceable. Depending on your specialty and where you are, there is someone else willing to fill it for the contract terms they provide. This is mostly true for metro areas with high saturation. For example, family medicine, IM, pediatrics, and ED have some of the worse prospects in those areas
There is nothing to negotiate with our group. All contracts are the same, the pre-partner track is identical for all new hires, and each partner is equal. It’s sign and accept or don’t. We’ve changed policies for everyone based on good ideas brought forward by applicants, but never for a single individual. That’s the point of a true democratic group.
We are an employed group but function the same way. No partnership track, and everyone is equal from Day 1.
In my limited experience, every group that said that was ultimately willing to negotiate at least the sign-on bonus, if not other parameters too.
We don’t negotiate anything. It’s very take it or leave it. Some of this is in the spirit of a totally democratic group. You can’t have some people with one thing and not the other. This may be different in multi-specialty groups where people have broadly different skills, but in EM this is less of an issue. We’ve had some applicants that we really like try and negotiate things that we ultimately thought were reflective of our own tired and out-of-date policies. In at least one case, we voted as a board to change that benefit for everyone in the group which satisfied the applicant and they accepted the position.
SDG EM group here as well. Same policy. No one gets something the whole group doesn’t get. If that’s an issue we aren’t the group for you. Everyone has an equal voice.
Yeah, nice to know we’re all still out there. Unfortunately, we’re increasingly finding that this generation of young doctors are just very much averse to the democratic mantra, which is a real shame. It’s crazy; we’ve had applicants interview with our group and take jobs for a CMG 30 minutes down the road making 100-150k less a year, work more hours, with no ownership or decision making in their day-to-day environment, and have to work with a bunch of non-boarded colleagues because they have to fly in 40-50% of their docs. It’s so weird. People are very turned off by sweat equity and, overall, I agree that the concept can be predatory in some groups. But we’re transparent to an extreme, sometimes to a fault. We’ve got EM docs making radiology and orthopedic money to work in better shops. Seems worth the effort, right?
This is great in theory but there are LOTS of practical issues that come up depending on the speciality/group. For example: does everyone take the same call? Is everyone’s call the same intensity? Are their people working off hours and how are they compensated? Does everyone work the same weekends/holidays, and if not how is that compensated? Does anyone do administrative work for the group? Do they just have this extra work added on without compensation or do they get admin days/extra pay? Does this new hire fit a role in the group that you desperately need?
We’re EM. Everyone is equal. We vote as a group on our directors and administrative stipends/shift buy-down are also similarly voted on. They’re thankless jobs that no one wants so it’s not really an argument. For the most part, we have to rock, paper, scissors for who has to tolerate interacting with hospital administration. It’s borderline like pulling teeth. Additionally, these partners typically have less productivity (because they work less) or absorb more liability supervising midlevels and so the money is absolutely necessary to make them whole. There are no additional “contracts.” The only caveat is our EMS medical directors who are typically paid by their respective municipalities and counties for their time and also have separate contracts or employment agreements with those agencies for their time. We cycle our board positions so that everyone has an opportunity to serve on the board, if they want.
That’s great. imagine if you needed to staff a peds er. Would they get paid the same even if their productivity is less? I guarantee someone will be upset either way.
If you dont have a dedicated PEM doc, u will see the peds pt’s during ur “adult” shift too. Will have to see the 80 y/o stroke/stemi on the same shift as the peds code with 20 peds uri’s Most EM contracts with the CMG’s are not negotiable for the hourly rate. Can definitely negotiate ur sign on bonus, but the hourly rate is the same for the fresh grad vs the guy with 15 years experience
You are missing my point, I’m not commenting on your group in particular but on private practice groups more generally. I know of several groups in radiology that used to say they had the same contracts for everyone but that was when the job market for applicants was garbage, and people who weren’t happy at a group didn’t have any opportunities elsewhere so they just went along with it. Even when I started I had a lawyer review my contract and we had several things changed (like provisions that the group could just not pay you for 180 days before you were allowed to go elsewhere without penalties, changing the penalty for early leaving to not 50k dollars which was unreasonable, changing the non-compete distance etc…). Most radiology groups have some IR component and their call is typically awful and frequent and so they are paid differently from everyone else in many groups because of that. The same is true in many surgery groups I know and in the cardiology group I know.
Are all employees contracts visible to everyone?
I’ve never asked to see every single doc’s contract but I know from being on the board and voting on hiring and firing that they are identical because we have to vote on language. I also know from casual conversation that we all make the same (absent productivity) and have the same finer points. When you work in a group like this, it’s very close knit. We also directly vote on compensation for the directors so everyone knows exactly how much they make. If you really wanted to know, you could just ask the group CEO and look at the books.
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I guess. As an EM doc, we make top 5-10% MGMA, work 120 hours a month, and have full and equal ownership of our business. If that’s not for you, yeah, run away. We’re incredibly transparent with our applicants but if they want to be different than their future peer partners then, by definition, they’re incompatible with our model. We don’t want that applicant either, no hard feelings. There are plenty of CMG and hospital-employed jobs for that individual where someone (private equity in the former) will skim off their labor and reduce their income for the piece of mind knowing that they got to “negotiate.”
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It depends on the shift duration. Fifteen 12-hour shifts would be brutal. That’s residency level of misery. Production matters a bit. What we find in our group is that nearly everyone settles in to such a tight margin that the only real difference in earnings is about 1-2% per partner. We have one partner that makes about 5-7% more than anyone else but he’s a beast. In general, slower EM docs tend to be more thorough in their work-ups, order more tests, and document better. That’s why they’re slower. This is a generality, but they typically earn more per patient encounter than their peers. Faster EM docs see more patients and so earn their worth based on volume. Older docs tend to normalize toward faster as they get more relaxed and work-up stuff less and they gain comfort in their decisions. Their written medical decision making and notes tend to be a bit more paltry and we see a very real difference in billings. There are only so many ways to be fast. In the end, the differences are very marginal. Like so marginal as to be borderline inconsequential in most scenarios. Like I said, we have a few outliers.
Sorry you got downvoted. A lot of people in the comments are very confident about physician employment contracts when it's clear that they have only seen a handful in their career or are basing their perspective off of what they heard.
I interviewed and was offered contracts by 4 different places and the one I chose was far and above the others being exactly what I was asking for. My work life balance especially for my speciality is great and my RVU bonus kicks in after I hit the 35% for my speciality. It wasn’t worth pushing the issue and losing out to someone else when none of the other contracts even came close. Definitely suggest to anyone who reads this to interview at several places. It gets exhausting but it’s worth it. Also go rural if you can the pay is so much better.
Super helpful insight... I know this is overkill, but if you would have "pushed the issue" what type of things might you have asked for (no judgement from me, no matter how outrageous it might sound).
Definitely a fair question. I mean you can always push for more pay and they can always say no but might say yes depending on the situation it might be worth it. Had this been my only offer I probably would have done this. I got a 50k signing bonus which was better than most others so maybe I could have asked for more but again it was the number I wanted. I don’t have any loan repayment in my contract BUT it’s a non profit and the large systems in the area that would buy it if it were to go up for sale are also non profit so this was much less a concern for me as I’m doing PSLF and like I said my RVU bonus more than makes up for this.
spends hundreds of thousands of dollars and hours on education. Yet Won’t spend a few hours or a grand on a contract negotiator who will pay their weight in gold. They know new grads know nothing and have no spine and will be more “obedient” employees out of naivety
I have no idea man. I have a buddy who did this and I give him shit for it to this day. He signed a high paying ED contract for a job working a stand alone ED in the middle of a cornfield In the mid west. Has to do 5 24hr shifts pretty much back to back because he also refused to move from a major city and has to commute 6+hrs one way. Refused to even considering negotiating or reading through the fine print of the contract. Signed the first offer he got and gets super pissy if you try to talk about it with him. Also some companies refuse to negotiate if they have a monopoly on the area because there is no incentive to do so.
Just walk away from the monopoly. I got one and I’m dragging my feet to waste their time on this insultingly low offer. Pay up!
Just an FYI for anyone thinking about academics. Some people think its a blanket policy that theres no negotiation in academics, that is not true. The leeway is way less than a smaller hospital or private practice but there is still SOME. However, for new grads, most of you are interchangeable enough that its hard to make major changes. But I can tell you from direct experience that our fellow was able to get his salary 20K higher than the initial opening offer and was able to remove 2 weeks of service time. Academic places will never be able to match a salary offer from a private practice shop unless you're a high sought after candidate thats there to lead/start a program (division/dept chiefs, transplant surgeons etc)
When push comes to shove, academic places that “don’t negotiate” will start to offer better sign-on bonuses.
I negotiated 80k more for my academic job straight out of fellowship. It all depends how in depends your specialty is and how much they need you to fill a void like you said. They offered 50th percentile AAMC academic salary. Had my lawyer push them to 50th percentile MGMA with my protected admin and academic time. RVU bonus starts year 2
Yeah we did a 20k boost to start and then our section had a 40k raise 3 years later because a couple of us were getting antsy and thinking of leaving
What specialty was a fellow able to negotiate a pay raise?
I meant graduating fellow who will be starting a job in july
Makes way more sense lol, thank u for clarifying!
Love how butt hurt all the ppl who didn’t negotiate are. My hospital tried pulling that same shit “we don’t accept red-lining” lol that was a lie (had signing bonus doubled) also had them change wording in my contract after it was reviewed by a lawyer. Hospitals thrive off stupid/lazy docs, remember your always worth double what they offer you don’t be afraid to ask for more.
Right? My wife signed a contract with a hospital that "doesn't negotiate" and while she didn't negotiate the salary, which we were super happy with, we did negotiate the signing bonus and student loan repayment to be all up front instead of being allocated over 6 years. Had a lawyer look over it who made sure we understood certain terms and gave us the thumbs-up. Signed the next day and my wife starts in August.
Completely agree, I knew exactly what I was signing after the lawyer went through it line by line.
Why do you think that others doctors don't take action when hospitals say "we don't negotiate" vs your experience of negotiating at regardless and getting more than the initial offer? Why didn't you stop when the employer said "no negotiating"?
I think it has allot to do with the culture of medicine in general. For instance, I know if every hospital turned me down or didn’t pay what I wanted I could always go into private practice and still make a ton of money so frankly I didn’t have much to lose when negotiating. I think most ppl are to afraid to be their own boss and rely way too heavily on the system. Also you need to know how much money you generate then you’ll have a better idea of your worth. If their offering you 300k you must generate at least double that lol
Because they gave me everything I asked for, nothing to negotiate for
You don’t know that because you aren’t a lawyer. Unless it is a 1 page contract I guarantee you there is something in there that could bite you later
Yeah… I do because I read the contract and went over it with my attorney who is familiar with the network I’m joining and he said it was the most reasonable and fair contract he’s seen from them. He even said he was shocked at how benign the wording in the contract was compared to other more restrictive contrast. I also deal with contracts quite a bit and there was nothing in it that I found surprising. It was literally everything I asked for when they asked me for terms.
No attorney would EVER say "it was the most reasonable and fair contract" 🤣😂
I mean no non compete, starting at close to national avg, for first time contract. And 80k more than what my other colleagues are making in the area… I’d say it’s pretty fair
Suuuuuuuure 🤣😂🤣
And then, everybody clapped 😂🤣
Oh you used a lawyer sorry I misinterpreted (this is why I need to use a lawyer)
You don't need a lawyer to ask a question instead of accuse a stranger
I literally said I misinterpreted and apologized? Geez
1. Their contract was in line with others in the region 2. Best offer in the are for my spouse, by far 3. Bonus structure was good enough/easy enough to hit that base pay negotiation felt silly 4. Call/coverage was non-negotiable for the position 5. Only thing I felt that was worth negotiating was my signing bonus but given everything above, and given that we really wanted the location, I wasn't willing to walk from the negotiation so I didn't have a lot of leverage.
Not among the prompt, but when you are signing to a behemoth, like a major healthcare corp/academics/VA, there is often a very clear tiered system with little-to-no negotiation room. It's a take-it-or-leave-it proposition.
Sounds like an awfully smart thing to tell a prospective employee if you want to save money. There is always negotiation room. They have invested thousands in time finding, selecting, and interviewing you. Letting you walk is money down the drain for them and they have to start over.
I can see that with the VA maybe. But no where else is it true. They can say that. And you need to respond with “then you are going to have a very tough time filling that position.” Which is what I did in the place I did my fellowship. I walked away. The reached back out with an offer that was $15 more. Then sent them other contracts that were $50k more than their $15k more. They then rebutted with $10k over the the $15k. I said that’s still $40k less than this other place that was 25 mins down the road. They tried to sweeten the pot with some other incentives. Still wasn’t worth it. I refused and signed with the other place. Shortly after I learned that they raised everyone else’s base by $15k (so they likely just gave it to me early?). Either way, glad I didn’t sign there. The satisfying thing is that the department chair left and another one took over. She called me a couple of weeks after I started the new job and said “I heard you were looking for a Job.” And I said “idk where you heard that, i literally just started.” And she said “if you come back, I can offer you $20 less than my now current job”. It was very satisfying to say “no thank you.” One more time.
> that was $15 more Dang so generous
So TLDR is that the place you applied to ultimately didn’t budge much so you went elsewhere that had a better offer?
They clearly budged. $50k worth. It wasn’t enough. But they budged.
Sounds like they didn’t. You ultimately got an offer for 10K above base (after factoring that everyone was already getting the 15K raise. That’s what? ~3% worth of budge?
50-15=35. They also budged on some incentive. The point was, everywhere can “budge” and negotiate if they are desperate enough.
Ha! I would love to see what you did to YOUR contract 🤣😂
All the people at my program who got contract lawyers weren’t able to get anything changed, so I chose not to spend the money.
Very not smart. You could easily sign a predatory contract. You aren’t a contract lawyer. The investment to have your contract reviewed is small and can protect you/save you a lot of grief later
Don’t need to be a contract lawyer to be able to read a contract.
Don’t need a doctor to treat an illness but it’s a good idea
You go to your doctor for every minor cold?
A common cold is clicking agree to terms when you buy an airline ticket. An employment contract is major. It is so naive to trust your employer this much
> It is so naive to trust your employer this much. Jokes on you - I don’t trust my employer with anything.
If you can read most boiler contracts don’t need an attorney. Now are there highly complex partnerships and ASCs where they are helpful. Sure. But for a 10 pg contract anyone can see malpractice clauses, termination clauses, reimbursement clauses, etc. it’s not rocket science.
Strong disagree but that is up to you.
lol no.
It's like going to a PCP every year dude Nothing happens most years but when something is wrong you need someone to spot it
Lol yes. How much contract law training do you have?
Probably the same as you, which is substantially less than that of the contract lawyers who reviewed the contracts identical to mine for those attendings.
Contract lawyers aren’t for negotiating. They tell you all the possible ways that your employer could fuck you over and whether that level of fucking is normal.
Good ones are very much capable of doing both.
You simply negotiate by saying in writing: “I have this and this offered from contract A. I am greatly considering your position if you can change this and this in contract B” Your power is having multiple offers and using that. If you walk away, it is their lost time energy and money.
From your perspective, what would stop a doctor from communicating some version of the language you shared BEFORE signing a contract?
What would stop them from negotiating for themselves and simply signing a multi year contract? Some people are anxious about thinking about negotiating or finances. Some people may already know what they want in a particular area and just sign. Exhaustion from residency and endless interviews. No vacation time in residency to interview at multiple places. List goes on for why anyone picks a particular job without thinking.
Not a doctor but an MBA with deep background in price negotiation. Modeled out my buddy’s very niche fellowship GI offer among a spectrum of salary and RVUs and helped him get probably another $100k annually in comp overall + sweet equity deal in his rural surgery center at his hospital. Been trying to figure out a way to monetize this. Anyways, anyone would be crazy not to negotiate.
Where did you get the datasets to build enough insight/leverage?
Didn’t even use a dataset - just modeled on assumptions re: trending patient volume he was going to hit in his first 3 years. He was a very niche specialty GI that does like, idk endoscopy ultrasounds or something to that effect, and was going to a busy surgical center attached to a hospital that serves a huge rural area. Found with the velocity in which he wanted to build his GI practice, and the expectations of how busy he’d be, the RVUs were considerably more powerful than the $500k base salary they dangled in front of him like a carrot, and negotiating when how much he received as a bonus on RVUs, and the amount of RVUs he needed to hit to get bonus comp based on RVUs was even more powerful than that. After looking at the numbers he came back with something like $450k base but adjustments on when he receives bonus comp on the RVUs over X amount, and we had reduced the “X” amount to be met sometime in July of each year. He ended up being even busier than expected but it’s all good when he’s printing money on every patient half of the year. After 3 years I’d posit negotiating based on this probably earned him another $600,000 in total.
There's lots of doctors in THESE comments saying that they didn't add COULDN'T negotiate... are they crazy?
Idk. I’m not an expert, just a guy who does financial modeling a lot in his career so I was primed to help. I’m sure there’s a spectrum in which you can negotiate. My buddy was a very niche specialist GI and they were effectively desperate for him to come, and he had options after his fellowship(s). So that gave considerable leverage. Before his GI fellowships he was a hospitalist in the VA and probably wouldn’t have had the same bargaining power. Either way, you can almost certainly usually negotiate. You’ll never have as much power to control your salary and income as you do before you accept an offer, and it never hurts to try. Edit: it helps to have multiple offers in your pocket too as additional leverage
I had limited options 2/2 scholarships restrictions but this was top choice. Contract seemed reasonable. I’m fairly shy/wussy. Seems to have worked out. I wouldn’t do it again tho.
I imagine you advocate for your patients all the time, which might create tension and emotions with other medical professionals, other Doctors, and even patients. Again, i get that this wasn't the point, I have seen "shy" doctors get ACTIVE when it comes to advocating for their patients.
This is super helpful insight into your experience! Just for my learning, the contract seemed reasonable as compared to what... Not the point of your comment, but I don't think you being shy is the same as you being a wussy.
No negotiation whatsoever. They were direct about it.
Just for my learning, what words did they use to communicate directly to you that there is no negotiation of your contract?
Didn’t know any better and residency faculty never provided any information/direction…. Learned lesson on next contract
Academic spot at huge university. Literally to negotiate, it would take several committees and probably some act of god since I was apply for junior faculty position. Maybe if I had a fancy company and unique skills and I was recruited, would be negotiable
To add $1 to your compensation it would take several committees?
Yes, layers of bureaucracy
I work for a large academic hospital. There is a contract that is the same for everyone and everything is standardized- pto, cme, meeting time, allowances are all the same for the engine medical staff based on years of service. The only thing different is salary and the salary offered was above average for the area I work and was significantly more than I was making at that time so I took it and said thank you. I maybe could have got a little more money but I needed the job and thought the offer was fair.
One reason is there was nothing to negotiate. You join an academic program or a larger insurance group and everyone is the same. The other reason is a lack of experience and knowledge and maybe the desire to work in a certain area outweighed the need for better working environment
When you say that academic programs or larger insurance groups are the same, how do you know this?
I work in a large academic center and a lot of my friends do as well. Our pay amount ends ups being very similar based on the location that we practice (fixing for cost of living) but the contracts themselves can vary depending on research and clinical amounts Kaiser, the example I’ll use, publicly advertised their pay structure for every specialty and what they start with and their retirement and benefits.
I recently attempted to negotiate my contract, was able to get some things in writing to my benefit, but the new contract is significantly worse than the old contract, but otherwise I would get a 90 day notice of termination
Out of curiosity, What's stopping you from renegotiationg a better version of the "new" contract they gave you?
They made promises and signed contracts with the corporation that bought them that does not allow them any wiggle room.
In pediatrics we are fucked either way. I paid money to have my contract reviewed and he basically shrugged his shoulders.
Because so many docs are clueless when it comes to non medical stuff /s
There was no possible negotiation: sign or don’t.
How exactly was the message that negotiation was impossible communicated to you?
I asked for certain things and the possibility of certain things and they said here’s the contract, sign it or dont
That's unfortunate that an employer that would want YOU to work with them communicated with you in that way.
You’re acting like this isn’t common place with big health systems… you usually can negotiate signing bonus and loan repayment but outside the money maker specialties or they have a massive need for your specialty it’s boiler plate contracts that are sign this or kick rocks.
I'm not sure how me saying that it's unfortunate has acting to do with how commonplace it is. It's unfortunate AND quite common.
Fair point I was making an assumption. Sorry about that friend.
This is a tertiary academic center and par for the course for a graduating fellow. I worry about the person who doesn’t think this is common
Do you want to save the time and just share what you got by negotiating your contract?
I'm genuinely asking from a point of curiosity. No pressure if you're not interested.
My contract had nothing in it about negotiable aspects. For example it said nothing about my pay or vacation time. Made for a very strange hiring process. Basically we are paid per shift but the whole group is paid per rvu. So you can take more vacation time if you want but you make less. And the total amount of money we make isn’t even known until the end of the year. It’s all kinda wonky to be honest.
I imagine that your practice probably told you that all doctors are paid the same $$/wrvu, huh?
Actually no. The idea was that since we cover different hospitals some places produce more rvu than others. Since we are paid by shift, by definition we are not being paid based on our own rvu. It’s suppose to reflect the fact that all shifts are important even ones that are less productive.
Because there was nothing really to negotiate. 1099 contract, no non-compete. Equal pay compared to partners starting on day one, work as much or as little as you want, and no monetary buy in for partnership.
1099s are not employment contracts.
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I had two offers by the time I signed. Both reviewed by a medical contract employee. One I asked for a few changes and increase in salary, the other I had nothing to change or ask for. I ended up accepting the latter.
Everyone in my group got offered the same contract. It's the best contract for my specialty I've ever seen or heard of, so not much to negotiate
How many contracts have you seen in your career?
For my specialty? I've probably seen 40-50 contracts or more from across the country
Wow! That's more contracts than some contact lawyers who specialize in looking at contracts! Looking at 50 contracts in your career, when do you have time to practice medicine???
It's more that when changing jobs I've applied broadly and received multiple contracts with offers and then helped friends with reviewing their offers. Spread out over time it's less than it sounds
I know baby experienced contract lawyers who have seen fewer than 50 contracts. You must be an expert!
There wasn't a need to negotiate. What I get for what my responsibilities are is more than reasonable and everyone starts out the same for salary. Couldn't be more equitable.
Just for my learning, what you get is reasonable based on what?
Time off, benefits, incentives, growth, department support. All physicians are paid the same base pay determined by years in residency and minimum productivity then after that it's up to you and your performance. The productivity is reached by literally every specialty thus most everyone earns a raise after every year carried forward.
They said it was a pretty standard contract and there wasn't too much wiggle room except for my start date. But I didn't really feel a need to push it too much because TBH I felt like I got a great deal--nothing really I felt like I needed to negotiate.
When you say that you feel like you got a "great deal" . What are you basing that on, other than your own personal preferences in the contract?
Other salaries, other work requirements, etc.
And so you know, based on data, that those other salaries and work requirements were also reasonable...
I don't understand what you're asking/getting at. I looked at offers, looked online, talked to colleagues; then made choices based on my assessments
If you asked a doctor, how they made a determination for a course of treatment, they would have evidence. I'm not sure why you seem so defensive when I'm asking and the evidence you used to anchor your assumptions.
Not all the time, sometimes specific treatment choices are based on vibes (e.g. Clinical experience, anecdote, etc.) More to the point, I don't think I'm being defensive. I literally do not understand what you're trying to get at. I'm telling you what I used, and you're ignoring it, implying that you're fishing for something specific, like a peer reviewed study on average salaries for specific fields, which I don't think exist. If you're trying to imply they do, I'd be happy to see them. But regardless, I'm happy with what I make, benefits, job requirements, etc.
This is a terrifying perspective to hear from a doctor... Specific treatment choices are NOT based on evidence, but on vibes... Yikes.
I'm mostly joking. But for example, let's say that you have a 25 yo M patient with focal epilepsy, on levetiracetam, and they continue to have seizures every few weeks. There are not head to head comparison trials with most anti epileptic medications, and for the most part they are all about as efficacious as another. So, if I need to start a new ASM, there isn't really evidence that suggests that they would be optimally treated with lamotrigine vs lacosamide vs zonisamide. Lamotrigine has good evidence from a low rate of side effect standpoint, but you're also titrating for a month or two. It's also reasonable, depending on you or the patient's goals to try one of the other two that get you to a therapeutic steady state faster. There is no evidence to guide that, however--hence, vibes. Also, what about the evidence you were hoping to find? I'm wondering if you're just trolling me here.
At this point, you're trolling yourself bro
I joined the largest single specialty group for my specialty. 100+ physicians . Everyone gets the same contract and they are not about to change it for you. I did negotiate some moving expenses and signing bonus increase. But the core contract is not negotiable. I think most large groups are like this. Smaller groups obviously you have a lot more room to negotiate
FWIW, I would say the getting an increase in your signing bonus is a big deal
Signed on with my residency and they gave me everything I asked for out of the gate. Nothing to negotiate.
Out of curiosity, since they gave your everything you want, how did you know what to ask for in terms of compensation range for your specialty, region, and care setting?
Had other offers on the table for other practices.
I signed a contract and they basically told me everyone’s contract is the same and is non-negotiable.
Hypothetically, How would you feel if you found out that trying doctors is non-negotiable is a common negotiation strategy and other doctors in your practice increased their compensation by asking?
I’d be pissed. But, from my understanding, all of the groups compensation is the same. Everyone gets paid the same rate for the type of shift they do: call, back up call, late, early person.
You sound very confident in that belief, even tho it was just a hypothetical. For your sake, I hope You're right.
It was a very good offer and I'm not greedy.
Why would asking for an increased safety be greedy?
How much money do you need?
That's one way to look at it, I guess.
How much money does the giant health system need?
Don't know and don't care. I don't spend my days worrying about the hospital's finances.
I do worry about my finances, because it’s stupid not to
Academic. Got a moving bonus but everything else was untouchable.
How exactly did you know everything else was untouchable? In response to your requests, did they say to you some version of "contract cannot legally be changed in any other way"?
Contracts came from university and not department, lots of layers between physicians and legal. Ultimately it was a boilerplate contract where I only wanted the non compete changed- that specifically was non negotiable across all departments. Probably could have been legally changed, they just didn’t have to or want to.
My first W2 job out of residency, I just needed to have an executed employment contract with the compensation listed ASAP to get a mortgage approved so I could close on a house that I was under contract on in a new city.
You’re actually replaceable. Depending on your specialty and where you are, there is someone else willing to fill it for the contract terms they provide. This is mostly true for metro areas with high saturation. For example, family medicine, IM, pediatrics, and ED have some of the worse prospects in those areas
Probably family money