Our Questions Answered: A Chat About Physician Contracts with Jon Appino

Let’s face it – you will have to decipher at least one employee or partnership contract in your career, probably several. I turned to the expert with some common issues our physician clients face.

1. What about reviewing locums contracts – are there any issues to be concerned about? Any traps when the locums co. provides med-mal?

They are typically ok – but we would recommend a look by someone who knows what they are doing to make sure risk is minimized and expectations are set.  You’ll want to make sure there are the appropriate clearances and disclosures/conflicts up front should you have another employer or income.

2. Do you review the contracts yourself or do you outsource to attorneys? Do you use attorneys in every state? How do you vet them?

We have our own General Counsel that reviews all contracts.  All are reviewed by legal, we just don’t let them drive the process.  We look at things much differently here – and our expertise around compensation (as well as our data!) and the ‘how’ to discuss/negotiate with the employer has been proven very valuable to our clients.  We want to partner with our clients and help them through the process – in an educational way – not just tell them it’s fine and give them a few points, then send them on their way.

3. What has been your most interesting contract review?

Tough question!  There have been so many wonderful physicians we’ve worked with – some great stories and successes and some very tragic/stressful things we’ve had to help people out of.  Overall, Ophthalmology deals are very ‘interesting’ since they have so many moving pieces.  All private practice contracts are ‘interesting’ since they are so unique and different.  Overall though, we love to hear the stories from our physicians on an individual level – why are they interested in the job – why is the employer hiring?  Why did they call us?  One we know their unique story (and all are interesting!) we can serve them the way they need for the opportunity in front of them.

4. Can you name a couple of reviews that have made a huge difference for your client?

We’ve had physicians be let go for various reasons – and we’ve been there (uncompensated time) for 20+ calls and 50+ emails to help them through it – in a stressful time for their career and family.  These have created not only happy clients, but friends and people we plan on keeping in touch with over the years.

We do take great pride in inspiring those physicians that feel guilty asking for things to ask the right questions at the right time. We take the time to coach them and help them to make sure all expectations are clear prior to signing and starting with an employer.  This gives us great pride in making a difference for them!

5. How many contracts do you usually review in a year?

We don’t disclose numbers, but we run a full-time 5-7 days per week business doing 100% contract reviews.  We’ve done over 5,000 – and truly enjoy each one of them!

6. Are there any specialties that particularly benefit by a contract review?

We feel all agreements should be reviewed by someone who knows what they are doing – there is just too much on the line from a physicians investment to get there (time and money) and what they’ll make (120k or 1M+) over the life of their career.  Believe it or not, some of the lowest paid specialties like Pediatrics really benefit – simply because they are too nice and polite and don’t want to question the potential employer – or ask for more.  Often times more aggressive personality physicians (surgeons) benefit by allowing us to help them formulate HOW to ask…they may know the WHAT they wish to ask but our frame and perspective can be beneficial in that process.

7. Are there any types of contracts that particularly benefit by a contract review? i.e. – small private practice, hospital, large partnership?

Like the previous question we feel all contracts should be reviewed and the physician candidate would benefit by a professional process/review.  Some need more eye and guidance than others – typically private practice – partnerships – and the like.

8. Is it worth it to pay for a review if you’re going to work for a large organization like Kaiser or CEP? Do they care about negotiating or just say “Next!”

They may not need a full negotiation review, but for a few hundred bucks (with us or someone else) we feel all agreements should be reviewed – it may not be about ‘negotiating’ but more of asking the right questions and clarifying.  These are things we can provide in addition to just reviewing the agreement.

9. What are some common areas you find in contracts that should be negotiated?

TONS!  Often times schedule – location – compensation – some benefits (PTO and malpractice) – budgets (CME, relocation, etc)…

10. Anything that is not worth trying to negotiate?

Most standard benefits are non-negotiable (health insurance plans, life/disability plans, etc).

11. I always hear only your name associated with Contract Diagnostics – do you have a succession plan?

We have many great people here!  I have been out of the office more this year, but we are careful to only have highly qualified people doing this – truth is I really enjoy working with the physicians myself, and the vision isn’t to provide a copy-paste service from trained people in cubicles reading scripts – it is to provide a personalized service that is world-class and that meets the needs and demands of our clients.

12. What if a client is trying to decide between 2 or 3 contracts – how would an engagement with you work? Would you help them compare side-by-side? Do they pay double or triple?

We have this come up all the time.  It is hard to discount the pricing without discounting the time we spend – but we are able to offer a few discounts if we are able to do multiple reviews at once.

13. What makes you better than the competition? Who is your competition, by the way?

We just want to be the best we can and constantly get better for our clients.  We have a great system that is easy to use (sign up and book time online that takes 1 minute) and efficient.  We provide relevant information to the physician based on their personal story and need and do it in a fun (you read that right) manner.  We have great compensation data here from our proprietary database that is impactful to our clients.  We do provide (based on package) unlimited contact with us through phone or email – so we don’t nickel and dime doctors because they are ‘rich doctors’.

I don’t know who the competitors are.  I do know local attorneys do a fine job, it is just a different type of review (this is why we started this company).  There are other online companies that say they do reviews but most outsource it to a third-party and capture (and sell) the physicians data to other vendors – recruiters – life insurance or disability salespeople – financial advisors – etc.  We do none of that – we just want to do contract reviews – it is our sub-specialty and we don’t do anything else.  I think we are the only firm that just does 100% contract reviews and nothing else.

14. Do you ever run across contracts that are actually illegal? If so, can you give some examples?

There has been a few examples, they are small and usually not a big deal.  We typically feel some of these situations are best handled by local attorneys and advise the physician in that way.

15. Can you describe your typical client?

We work with many residents and fellows but we also have established attendings that want things reviewed.  Most didn’t have things reviewed the first time and they are on to the 2nd job since the first one didn’t work out (mis-set expectations is our typical take away).  We also have recurring clients like hospitalists or EM docs that tend to be more transitory in their job.  We’ve even helped large groups in their deals with the hospital.  We had a 68-year-old FP doc a few weeks ago with his first ever contract!

So it is very unique day-to-day but it represents the overall job seeker market well I think – mostly residents/fellows and a good amount of transitioning attendings.

16. About what % of new attendings would you say get a contract review?

I have no idea! I’d love to know…my best guess is 35%.

17. About what % of reviews that you do for physicians pay for themselves?

Nearly all of them.  Unless the physician requests it, we don’t take money from employers – we don’t want to have any conflicts to disclose in any situation (employers also request to buy data from us, but we politely decline!)

18. What is the average % ROI for a physician who hires you?

Hard to say – it’s not all about money and getting more.  We’ve had zero progress for dollars and over $100k gain…it just depends on the situation.

19. What is the most common uh-oh you find in physician contracts?

No specifics on location/schedule or payouts for bonuses.

20. Are there any other times that a physician should have a contract review? Such as – would it pay before you give notice or leave a practice, just to make sure you’re getting everything that is due you?

We feel all should be reviewed by someone who knows what they are doing and has done many before. If you didn’t get it reviewed going in, you should going out to make sure you don’t forget anything (we saved a doc $20k by reviewing his old agreement he was terminating and another $160k in what would have been lost bonus dollars if he was going to quit when he planned on quitting)

21. Do you ever review for the other side – say, for practice owners who want to make sure they are using a good contract to hire physicians?

We have had situations where the practice owner and a physician have agreed to all terms and they just need help with a few things.  We typically do not take revenue from employers unless the physician is requesting we do.

22. Do you review for what is not in the contract? For example, if a physician is handed a one or two-page contract?

Absolutely.  We feel 2 page is just as bad and challenging as a 70 page one.  Often times the physicians are thinking it is ‘just fine’ because it is so simple or ONLY 2 pages but there are many expectations and details left out that could be catastrophic if not cleared up early.

23. How likely is it that a review & negotiation will lose a physician the job he’s trying to land?

We think we’ve nearly seen it all and it has happened – very rare.  Often it means a red-flag for the practice itself. They should want to have the physician investigate and ask questions.  Providing the HOW to ask is one of the things we love doing here.

24. I’ve read you worked in pharmaceuticals before starting your business. How did that prepare you for reviewing physician contracts? Did you have to go back to school or was it all OTJ training?

It taught me how to work with physicians and their personalities – it taught me the lingo (we are able to talk the talk our customers do!) and understand healthcare on an entire new level.  Because of this we are familiar with MACRA, ACO’s, Bundled payments, telemedicine changes, market updates and dynamics, payor mixes, etc.

25. What do you recommend if a physician is handed a contract that is due in just a few days or a week? Could you turn it around that fast? Is that a warning sign?

We are usually 3-4 days out most of the year.  When we get 7+ days out (February – May) we usually add a day or two to our week to serve our customers (7 day work weeks are understood by our clients too!).  We do have 24 hour review times for an additional fee if it’s important to the customer we’ll adjust our schedules to accommodate their needs.

26. I noticed you offer contract negotiations. Are there any guarantees? How do employers respond to that? Are the negotiations handled by attorneys with that specific expertise? Or who?

Just like when the physician treats their patients are unable to guarantee results in the process.  We look at it not only as ‘negotiation’ and asking for changes but clarifying vague language or expectations.  We feel that many jobs fall through in the first few years because the right question were not asked up front – so we are able to do that.  Just like the physicians are experts in interrogating their patients on what their symptoms are or how they feel to generate their treatment protocol, we are experts in interrogating the employers – asking the right question of the right person at the right time to have all the expectations in front of us.  It often times means asking for things – but it’s not all about that.  It’s a great process we enjoy helping with if the physician doesn’t want to deal with it, play the ‘middle man’, don’t have the time, or just want it done by experts and done right.

Most employers appreciate our help in the process – they find it more efficient having us reach out directly than the physician asking for things, talking to us, re-asking or discussing, and playing that ‘middle man’.  We frame it that the physician is very excited about the opportunity, so they are investing in the process to make sure it’s the right decision for their family and career – because it’s hopefully a long-term fit, and they want to make sure they do all their due diligence and not repeat the job-search process in a year because they didn’t understand all the expectations of the situation.

27. Can you name a couple of situations when the negotiation package really makes sense?

There are many.  Many private practice jobs are just so vague about what the expectations are for not only initial production but partnership as well.  Since physicians don’t do this every day, they always leave out important questions.  We usually take 4-5 pages of notes for these negotiation deals and the physician has many more details than if they do it themselves – with or without changes to the agreement or compensation structure (although this is a very common request/ask!).  We also see many specialist that are uncomfortable with the discussions or asking for things.  We do see differences in Male/Female pay – differences in how agreements are worded or set up for a physician that is more aggressive and able to ‘ask’ for certain things and those that are ‘just too nice and don’t want to rock the boat.’  If the physician doesn’t feel comfortable asking for things and having that discussion, the Negotiation Review may be their best option.

28. Is there any such thing as a “standard” contract?

We do see standardized agreements from many large organizations.  However, there are still very important questions to bring up – which is why we are here.  The compensation does vary, and can often times change, so even the ‘standard’ deal there are things to know/discuss/etc.

29. Do some physicians come to CD just to get reassurance that they have a good contract or are you always expected to “find” something?

It is really different on a case by case basis.  Some have agreements reviewed that they’ve been working under for 5-10 years, and they want to see if it’s ok with today’s pay standards and set up as the renegotiate.  Others were just told they should have it reviewed so they are looking for a ‘thumbs up’ – which we may or may not give, but we always provide detail on what they need to know and what questions they should ask – there are always clarifications and expectations we want!

30. What is your fee/service structure?

It varies depending on what the physician needs from us.  We have packages as low as $200.  All our packages are flat-priced so the physician knows what they are paying when starting the process – no added fees.  We have continued to do our zero-interest payments for Residents/Fellows on some packages as well – they can pay over many months with zero interest – it was requested by them when we build this model and we continue it today!  They can email us anytime at info@contractdiagnostics.com for package or process information.  The Advanced Review is the most popular by a large margin (or middle package) and is 91% of all the reviews we do!

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