Should You Hire a Lawyer Before You Sign a Work Contract?

One of the keys to medical career satisfaction is something not covered in medical school: How to negotiate an employment contract. That’s why physicians should consult a healthcare contract attorney early in the process, say those who have participated in negotiations. As one early career surgeon put it, “They speak a language we don’t speak.”

‘Early’ Means Before Signing Letter of Intent

Dennis Hursh, founder of Physician Agreements Health Law, which reviews and negotiates physician employment contracts nationally, said consulting a healthcare contracts lawyer should happen at the earliest mention of a contract — “even if you just get an email offer.”

He said he regularly sees physicians who have signed a letter of intent (LOI) before seeking legal help, telling him that “it’s not legally binding.” Hursh said that though you are not legally bound to accept the offer by signing an LOI, the employer can and often does consider that stated salary in the signed LOI the agreed-upon salary amount and may not be willing to negotiate. A healthcare contracts attorney can arm the physician with information before signing the LOI on benchmark numbers for physician pay in the area, for instance.

Among the most common contract land mines, he said, are clauses about productivity requirements. He said he regularly sees young doctors — who are used to the heavy patient volumes in residency — say that working hard won’t be a problem, and they agree to the stated work relative value unit (wRVU) level they must meet to keep their salary.

The problem, he said, is that patient volume is out of physicians’ control, and it can drop for many reasons — along with your pay — if you have agreed to a certain level of wRVUs. “I would push for guaranteed income for a year or two,” Hursh said.

Delayed Credentials Can Stall Pay

Hospital contracts also require getting credentialed before starting work. But Hursh said he has been seeing contracts this July that put the start date at September 1 with the contingency of full credentials. “Most people assume it takes about 90 days to get credentialed everywhere,” Hursh said. If they can’t credential you fast enough, “that means September 1 you may have moved to town, you may have signed a lease or bought a house, but you’re not getting paid.”

“Sometimes terminology gets them,” he said. For instance, a contract may have requirements to be met “after consultation with the physician.” A consultation just means the employer talked to you, Hursh said. He said an employer could say the health system “just bought a hospital 50 miles out of town, and we want you to go every Thursday.” Sometimes a “consultation” can turn into a directive if language isn’t specified in the contract, he said.

Physician: ‘They Speak a Language We Don’t Speak’

Alisha D. Reiss, MD, a general surgeon at Wayne HealthCare in Greenville, Ohio, strongly advises her physician colleagues to seek a lawyer’s help negotiating a contract. She also emphasized it’s important to hire an attorney who specializes in healthcare contracts.

“They speak a language we don’t speak, and we don’t learn in medical school on how to protect ourselves,” she said.

Reiss said she sought legal help after she had her first contract in hand. “I offered my first round of revisions, and then I had my attorney do more of the final stages of negotiation.”

A specialist in healthcare contracts can tell you what’s normal for contracts in your region, she said, “and whether you should expect moving expenses or a signing bonus, for instance.”

Clarifying Time Off, Call Pay

“For me, they really cleaned up the language around [paid time off], holiday, and call pay and call obligations,” she said. They also added language around cell phone reimbursement because she uses hers for a paging device and provisions for continuing medical education expenses.

She said her investment in the legal process was “only $5000 to $6000,” and she hasn’t had to renegotiate much since signing in 2016. “I was very happy with what I did up front.” Costs will vary depending on how involved physicians want attorneys to be, she noted.

Reiss said it’s important to remember that “a contract is what protects you when you go to separate and move to your next job in the future. It’s in everyone’s best interest to know what’s in the contract, and a good attorney will explain that to you and help you negotiate.”

Protections for This Job and the Next

Richard H. Levenstein, an attorney with Nason Yeager in Palm Beach Gardens, Florida, who reviews healthcare contracts nationally, said the protections needed not just for the current job but also for the next one are among the most important, complex, and misunderstood parts of physicians’ contracts.

Aside from the amount of physician pay, specifying how long the contract lasts, whether it renews, grounds for termination, and noncompete clauses that spell out how far from your current patients the next job can be and for how many years that requirement lasts are all essential parts of negotiating, he said.

Noncompetes Are Enforceable in Some States

One common misconception is that the noncompete or restrictive covenant agreements are not enforceable. But “they are definitely enforceable against physicians unless there’s a statute that provides otherwise,” Levenstein said. Some states have prohibited noncompete covenants, but others have set their own laws around the issue, he said.

Additionally, it’s important to state that the noncompete area should be measured only from the office where the physician primarily worked, no matter how many branches the business has, Levenstein said. If that is not specified, the noncompete could apply to the entire broad footprint of a health system with all its locations, which might mean a physician has to move out of state when leaving the current job to comply with the restrictions, he said.

Levenstein said he’s recently seen medical groups declining to negotiate, telling applicants “they like to have a standard contract for all their employees.”

“I don’t take that at face value,” he said. “I will mention to those employers that if you want to have a uniform contract for all your employees, perhaps I’ll discuss unionizing these physicians for you. Of course, they don’t want that. But I think it’s happening. And it’s a new wave in medicine.”

Marcia Frellick is a Chicago-based, independent healthcare journalist and a regular contributor to Medscape Medical News.