Employment Agreements

One thing important to me is to make sure everyone, specifically a new graduate resident/fellow going into their first job, understands their contract so they do not encounter any unexpected surprises once starting. One should not sign a contract until it is completely understood, and feel 100% comfortable in what is included. The goal in negotiating is an arrangement acceptable to all parties involved, both for the Employee and Employer.
       
While it is important to have a lawyer review ones Employment Agreement, I also feel having someone in the field to which you practice offers additional value, and podiatry is no different. I can fully admit I had my first contract reviewed by a lawyer and respect their advice. Just look at one of these things (example contract), its long, wordy, words/terms/language phrases I did not understand, and confusing.

​However, there are many contract points specific to a "Podiatry Employment Agreement" that a standard (medical) contract lawyer: 
  1. may not be familiar with;
  2. does not understand;
  3. does not know to look for it (if it is missing);
  4. does not make you aware it is missing;
...all based on their unfamiliarly with the podiatric profession and employment structure "standards." They can offer some great "general" advice, but leaving some podiatry-specific items out of the contract can cost most notably money/revenue/salary.

To that end, I have found value in attendings and professional colleagues within podiatry reviewing my contract. Both reviews (lawyer AND podiatric profession) have proven key in me both understanding my personal contracts, and also negotiate items that benefited me upfront and down the line. The more qualified people who can review the contract, the better.
 
 Remember...
  • Contract lawyer who specializes in medical/physician employment agreements will review the contract so you can understand some of the "legal verbiage" unfamiliar to us doctors.
    • ​REMEMBER - Attorneys are good at explaining the legal wording of the contract and general physician contract points.
    • REMEMBER - The attorney gives you the advice, but YOU make the decisions
  • Podiatric physicians (i.e., attendings, colleagues) have both signed and created own contracts, and likely have reviewed many over their career), 
    • REMEMBER - Podiatrist are good at explaining the points needed in the contract or to be explained specific to working in a podiatry practice.​​
It is because of this second point why we have created this service.
As our motto goes, we offer a "Podiatry Contract Review, by Podiatry, for Podiatry."

Services

  • INITIAL REVIEW - $350 for "Residents/Fellows" / $550 for "Established Doctors"^
    • (1) Draft "Employment Agreement" review; 
      • A line-by-line review of the proposed contract/employment agreement
      • Assistance in formulating a response to the job offer, including questions you should ask.
    • (2) Telephone conference consultation to discuss the contract, negotiating strategies, and any questions you may have, 60-minute maximum; 
    • (3) Follow-up email to our conversation highlighting what was discussed with contract edit / notations.
    • (4) "Contract Review Advice, Hints, and Tips" document (created by Dr. Hood at PodiatryContractReview)
  • SECONDARY REVIEW - $100 for "Residents/Fellows" / $150 for "Established Doctors"^
    • (1) Draft "Employment Agreement - revision" review; this would include a review of the Primary Employment Agreement contracts revision, if required/desired.
    • (2) Telephone conference consultation to discuss the updates and any final questions, 30-minutes.
  • NOTE = These services Initial/Secondary are for the same "Employment Agreement." Any NEW "Employment Agreement" contract reviewed would re-set the fee schedule.
  • (4) "Contract Review Advice, Hints, and Tips" document (created by Dr. Hood at PodiatryContractReview)

Contract Related Items

After 1-2 rounds of interviews, you will be given a contract to review. Below I have provided links to helpful articles to consider as you review your contract, the Employer, and the job opportunity below. In my opinion, the contract should be looked over by both a contract lawyer with medical employment agreement review knowledge / specialty, and someone in the podiatry field. This may seem overboard and can get expensive, but the first contract you sign with a practice sets the tone for the duration of your employment time-frame. Therefore, it behooves you to have everything within that contract as "perfect" as you can get it.

​There are many points in the job search process from start to finish that are specific to the podiatric field, with limited podiatric-specific information found on the internet (much of my links below are MD/DO related). ​
  • MISC other reviewer options include family / friends in the medical field, whom are lawyers (specifically contract lawyers), or those who work in the business world with experience in consulting and negotiating where learning some of their skill, strategies, and practices can come in handy later on in the process.
    • Example - Consultant Friend
      • My friend who is a consultant explained to me the concept of wants / needs and bargaining chips. Lay out all your cards (i.e., the wants, needs, changes) but only YOU know the ranking order of importance. You can then start to "give-up" some of these lower priority items for higher ones, making you seem like your willing to bargain and negotiate, and the employer is also getting a "win" by eliminating some of the items you "wanted."
  • Co-residents and colleagues going through the process can be a good resource. Do not be afraid in discussing specifics of your contract from salary (base, collection thresholds, percent bonus, ancillary revenue), vacation days, CME reimbursements, non-compete, etc. By knowing what others are getting (for better or worse), this may help you realize if you are getting a "fair deal" or not, or may help you (or a friend) negotiate to a better contract. Transparency here among peers will only help the profession and hopefully advance salary level for everyone.
    • ​REMEMBER - Each job and location with garner different figures. Do not be embarrassed to discuss these specifics nor feel you need to withhold this information to have a "one-up" on others. We podiatrists (young podiatrists) are all in this together.​
  • ​Remember to look at the job and negotiation from both sides, you as the prospective employee and also the employer who is looking to add a new associate. This may give you insight on how they are thinking (playing "devil's advocate") and what best way 
​

The Contract - Sections

  • Compensation
    • Base (+) Productivity, Bonus, Incentives
    • OVs + Procedures ..+ DME?... + XRs?...+ “Products”?
  • Term and Termination
    • Year, multi-year; renegotiation terms; renewal terms
  • Duties – Office, WCC, NH
  • PTO/Vacation  & Leave Days
    • Vacation (vs.) sick (vs.) CME
  • Benefits
    • Medical & life insurance, 401k
    • Ancillary Bonuses
    • Employee Business Expenses (CME, phone/car)
    • Moving Expenses (?)
    • Sick/Disability
  • ​Clinical Duties (scope; loc.)
  • Professional Liability Insurance
  • Restrictive Covenants
    • Confidentiality (to the organization)
    • Restrictive duration/region/centers, etc.
  • Co-ownership
    • Path to partnership; shares
    • Surgery Center? Real Estate?
  • MISC Provisions
    • Tail Coverage ($?)
    • What goes to your “bottom-line”
  • Intellectual property
  • Consulting (1099-income)

Employment Agreement - Hints/Tips

Below is a synopsis of how I have conducted contract negotiating in the past, with recommendations made by past attorneys.
​
  • Once you received the contract, to go through it yourself and mark what you do not understand. Have someone (i.e., lawyer, podiatric physician / colleague) review it with specific notation to explain items and terminology you do not understand and provide advice and recommendations.
  • Once the professional review is complete on your end, create a list of either questions, changes, and requested that you want in the current (now "revised") contract. Email this to the hiring party (i.e., practice CEO, owner, HR manager, etc) and then set up a time 1-2 weeks later to go over all the highlighted points. This will give the hiring party time to review all of the items and possibly even reply in email/writing.
  • Conduct the phone call/secondary review with the hiring party to review all of the points you wished to discuss, going through your points line by line. Take notes during this period for your own records. At the completion of the call, make it known that you would like all of the agreed-upon points to be written/replied in email form, as well as the contract to be updated accordingly, as appropriate/required.
    • ​It is appropriate to have all items documented in written form. Some items may be worthy of an addendum or updates to the physical Employment Agreement, while other items may be documented/noted in this "Q&A" email form, which may be enforceable at a later date and time if necessary. It is good to have detailed notes like this to refer back to at a later day if required.
  • ​​Once the email from the hiring party is returned as well as an updated contract, save both for your records. At this point, you can decided to have your lawyer re-review the contract, or proceed with signing if you feel comfortable with where things stand.
  • The GOAL is to have a contract that:
    • ​You understand;
    • You have all of the points you negotiated in written format (just like medical records, "if its not written down, it didn't happen.");
    • You are comfortable signing.

​What Should You Ask?
  • These items are important to review after the initial contract review. The practice finance items may be important to get along with or before the contract review to see the true viability of the practice to take on a new Employee and not waste your time in going through (and paying for) contract reviews and secondary items if it seems like the practice cannot "afford" you or you "afford" to take the job. Some of these items may require some digging and asking around on your end.
    • What is the plan for the new hire? Is it established regarding location(s), a new location (so starting a new practice within the practice, which will result in initial slower growth), hours, etc. Marketing plan?
    • ​Practice finances (seeing physician office visit counts, growth figures from the last 1-2 hires, physician or practice gross billing, net collections, insurances accepted and ratios of commercial/medicare/medicaid , etc - and establish how these numbers may vary between each employee and/or office location). All of these try to give you a gauge as to how busy you may be in starting, and what kind of growth trajectory to expect and over what time period, understanding each hire is its own specific case. If a practice is withholding this information, proceed with caution. You want to see productivity to see if the compensation/productivity goals are obtainable.
    • Delegation of new patient policies and practices (i.e., trying to get the new person as busy as quickly as possible, versus organic growth)
    • Short/Long Term Goals for the Employee
      • What is the short term / long term plan for the new Employee, and how will the Employer reach these goals with what resources?
      • What are the marketing efforts and funds for the new hire to grow their practice.
    • Practice employee benefits -
      • Insurance (health, dental, vision) and if able to cover family (with/without penalty / extra fee by insurance company), 
      • Retirement funds (401k, 403b if non-profit; employment match/benefits)
      • Malpractice coverage, Tail coverage
      • Relocation benefits, loan repayment options/assistance
    • ​MISC
      • ​Employee turnover? What is the rate with mid-level staff and physicians, historically. If high(er), tactfully find out "why?"
        • ​Try to investigate this point yourself whether through the website, social media posts, local physicians or reps familiar with the practice and territory.
      • Employer Reputation - Google research your new Employer and the physicians that work there and review their reviews on various platforms (Google, HealthGrades, Yelp, etc) to find out what you can that may not be discussed in any formal interviews. Find out (a) how the practice is thought of or its position in the community, (b) who the competition is, (c) etc.
      • Hospital Reputation - Find out what hospital(s) the practice is affiliated with, and review them online as well for the same, aforementioned points. You want to make sure it is a "quality institution" since this will be a reflection on you and may effect patients (i.e., if they do/not want to go that facility for surgery).


MULTIPLE CONTRACTS FROM MULTIPLE EMPLOYERS
  • Negotiate all contracts at the same time if applicable. Do not discount one job or another based on timeline if one is more advanced. Your goal is to seek the best outcome for you the Employee (and the Employer).
  • Reach back out to other jobs or keep other opportunities in the loop about your personal situation to keep things moving or get one job to move quicker if needed.
  • Remember, when you are in the Employment Agreement period, time may be of the essence. Usually you will have a few weeks to a month to go back/forth, hash things out, and sign. Try to feel the job out to see if they have other prospective Employees and contracts out to assess how much time you may have.

Other Online Resources

Helpful websites for understanding and going through a personal contract review:   ​ ​
​
Companies who perform contract (and other physician career documents) review:
  • Podiatry Contract Review (this website) - Podiatric Physician Career Services that I personally provide.
  • Physician Career Adviser - "Offering physician career counseling for a changing medical market. Delivering personalized, one-on-one consultation with our nationally recognized team , covering such topics as: contract review and negotiation; knowing what you're worth; comparing career options; buy-in negotiations; benefits analysis; the right position or practice for you; CV and interview prep; financial planing; practice management." ​
  • Resolve Physician Agency - "Resolve takes the guesswork out of finding the best attorney for your employment contract. Our team includes the leading physician contract review legal team in the nation. Our experience reviewing and negotiating physician contracts from every specialty, in every state and with every major health system creates untold value for our doctors."

Lawyer Related Items

 Some MISC key points:
  • Experience
    • Make sure the lawyer does not only do contract review, but specifically medial contract.
    • Someone that has done podiatry in the past would be even better.
  • Compensation
    • Understand the payment/compensation between you and the lawyer. Some will be a "fee for service" flat rate for review, others will charge hourly. Some will include one "re-review" of the contract, others will charge with every review some rate.
    • KNOW what you are paying for before you agree to a review.
      • You can expect to pay anywhere between $500-1000 for some sort of review plan from a lawyer.
  • The Advice Given
    • The prospective employees' (i.e., you) final justification of the lawyers review -- Decide what you are/are not comfortable with in the contract.
      • REMEMBER - The lawyer gives you advice, YOU make the final decision.
  • Looking For A Lawyer?
    • Many can be found online who do medical contract review.
    • Ask a friend who is a lawyer and does contract review. They can often give a general explanation of the language and concepts held within.
    • Ask a co-resident or past resident who they used? Word of mouth with a good past experience goes a long way in trying to find a lawyer to work with.
​
  • Personal Example:
    • Judith MacKarey, JD (LinkedIn) / (email) - MD-Healthlaw
      • I used Ms. MacKarey who was recommended by a co-resident. I have recommended her to others, and all seem to have had a good experience.
      • Her practice offers a "New Doctor" contract review rate including Employement Agreement review with phone conference discussion.  When contacting, ask for the adjusted rate (if still applies) and that you were referred from my site to confirm the discount. (*NOTE - I have no financial relationship with Judith MacKarey, JD or MD-Healthlaw). 
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