Contract Negotiation for Emergency Medicine Physicians: 7 Factors to Consider

Contract negotiation is a fact of life in your career as an emergency medicine (EM) physician, and the details can be overwhelming, particularly if this will be your first job out of residency.

It’s a sound investment to have an employment lawyer review your contract before signing so you can be certain you understand it fully. However, it’s also up to you to try to make sense of the salary and benefit packages being offered. Here are seven factors to consider during your next EM physician contract negotiation.

1. The Facility’s Payer Mix and Whether It Affects Your Income

The hiring manager should be able to tell you whether the facility has either an unusually high or low proportion of Medicaid, Medicare, or self-pay patients. It’s also important to learn whether the payer mix will affect your income. Be aware that in some states it can take months to get provider approval by a commercial insurance company. This may mean you see more Medicaid and self-pay patients in the beginning of your job.

2. Whether the Facility Is or Will Become an ACO

Accountable Care Organizations (ACOs) are required to meet quality benchmarks, keep costs down and focus on prevention. The ones that succeed get more money from Medicare, while those that fall short can lose money. The existence of ACOs is partly influenced by Congress and the president, so it’s hard to predict any facility’s status five years down the road. However, you should at least get a feel for what the organization is expecting.

3. Presence of Any Restrictive Covenants

These may include things like geographic or hospital non-compete clauses and chart ownership. While not uncommon, restrictive covenants should be reasonable and realistic for the EM doctor. A lawyer experienced in medical employment law may be able to guide you on what is reasonable and what isn’t.

4. Whether You Will Be Privately Employed or Hospital Employed

There are advantages and disadvantages to being either hospital employed or privately employed. Reimbursement is generally better for hospital-employed doctors, though this isn’t always the case. It’s also important to understand the governing structure, such as whether the organization has a CEO and board of trustees. Knowing exactly to whom you report and who makes decisions that affect your day-to-day work is also critical.

5. Benefits and Intangible Incentives

Some benefits are tangible, like insurance and retirement accounts, while others are less so, like a great location or the possibility of research and publication. Ask about both kinds of benefits, and find out whether the hospital pays for your malpractice insurance. Find out what “on call” really means at this organization and who is in charge of making the schedule. Find out if there is a shift differential for less desirable shifts.

6. The Moonlighting Policy

Many new physicians have unexpected expenses the first few years, and being able to take extra hospital shifts can make financial survival easier. Find out the moonlighting policy and ascertain whether income from moonlighting belongs to the practice or to the individual physician. Learn if certain types of moonlighting are discouraged or encouraged.

7. Salary and the Possibility of Buy-In

Know what is meant by “salary,” because there can be hidden costs as well as hidden benefits. Looking at helpful resources like ACEP’s latest Emergency Physician Compensation Report can give you some guidance on what salary to expect. Buy-in is less common than it used to be, though there are some things that are appropriate for buy-in, such as equipment that is depreciated. Buy-ins for charts and referral base are less common and should probably be looked into by your employment attorney before you sign.

In addition to getting answers to your questions when you’re interviewing for EM physician jobs, it’s also a good idea to research both the hospital and its senior members online in case there are problems like HIPAA violations, civil suits or Medicare fraud allegations they didn’t mention.

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