For young physicians transitioning to practice or moving on to the next stage in their early careers, interviewing for jobs might seem like a new frontier, but it’s a lot more like medicine than they might think.
Just as physicians are trained to ask patients sometimes awkward or uncomfortable questions to elicit the information they need to make a diagnosis or treatment plan, so too should doctors feel confident in asking hard questions of prospective employers and keep an eye out for potential trouble spots.
An AMA STEPS Forward® toolkit explores how to evaluate a practice environment to match your priorities. It also provides breakdowns of the pros and cons of various practice settings and the steps to take to decide where to practice.
What should give you pause
“Interviewing and negotiating contracts are really big windows into your relationship with a practice,” said AMA member Brandi Ring, MD, an ob-gyn in Houston.
“The biggest red flag is if you're really uncomfortable during the negotiation process—if you’re arguing and not feeling respected and not feeling valued,” Dr. Ring said. “That’s not going to get better once you sign the contract.”
But a healthy relationship also depends on concrete details, including things as fundamental as work schedules and staffing.
“I’ve always felt a red flag was when an employer failed to commit to something around hours, time, responsibilities,” said AMA member Michael Hanak, MD, a family physician in Chicago. "If everything is only discussed in general terms, what do they think your Monday's going to look like when you start working? Are you on 12 hours a day or eight hours a day? You need to know these things.”
You should also look for details on call responsibilities and time off, both noted.
“As a resident, you’re probably tired of being on call,” Dr. Hanak said. “You might enter a practice where they give you a beautiful new office in a beautiful new building and tell you you’re the face of their new operation. But that might also mean that until you bring more people on, you’ll be the only one on call. You definitely want to know what support mechanisms are set up around you.”
Listen to or read highlights from this great “AMA Making the Rounds” podcast episode for tips on what to consider before you begin the contracting process.
Hospitals often act differently
As ever more physicians choose employment by a hospital or a hospital-owned practice over private practice, they need to understand that hospital employment contracts are often quite different from those of private practices, and these differences have implications for their professional satisfaction.
A typical hospital employment contract could run to dozens of pages and include 70 or more provisions, many of which would rarely show up in a private practice employment contract.
“In my experience, almost all doctors in hospital contract negotiations—but particularly those who are just coming out of residency—focus on the money to the exclusion of a lot of other really big issues,” said Elizabeth A. Snelson, president of Legal Counsel for the Medical Staff PLLC, which specializes in working with medical staffs, medical societies and medical staff professionals. “I want physicians to appreciate how much those other issues can be make or break to their personal and professional goals.”
Snelson is the author of the AMA Physicians’ Guide to Hospital Employment Contracts (PDF), which provides expert guidance to physicians contemplating, entering into or working under employment contracts with hospitals or related entities. The guide is free to AMA members.
One example: the assignment clause. Many hospital employment contracts have a clause that says the hospital can assign the contract to a different entity. This is problematic because most physicians do not suspect that they could be traded like professional athletes after they worked so hard to find the right employer.
Another: “Other duties as assigned.” This may be seemingly ordinary boilerplate in contracts, but it can be a real problem for physicians, Snelson said.
“Let’s say you're a neurosurgeon and another duty might be delivering babies,” she said. “This provision makes the contract open-ended on one of the most important questions: What are you going to be doing here?”
And yet another: nondisparagement clauses. These can be depicted in a variety of ways, including as nondisclosure agreements. Essentially, they mean this: You shall not say anything negative about the hospital.
“They are problematic for so many reasons,” Snelson said. “They’ve been used to fire employees who spoke up about shortages of personal protective equipment during the COVID-19 pandemic, and they could even be used to say you can't do peer review.”
Who to ask for help
Fortunately, there are professionals who can help you navigate contracts and even interviews.
“You should absolutely have a lawyer,” Dr. Ring said. “They can find conflicts of interest and other inconsistencies, but they can also speak the language.”
Snelson agrees, and she warns not to go to just any lawyer for help.
“Employment law is a highly specialized area,” she said. “So just as you wouldn't go to a shoulder guy to get your hand operated on, you shouldn't go to, say, a tax attorney to get your physician employment contract evaluated.”
One of the ways an employment lawyer specializing in physician contracts can help is by looking at what happens at the end of your employment.
“They can help you understand how a contract will impact you if you decide to leave in four or five years,” Dr. Ring said. “The most important part of your contract is how you get out of it.”
Which might lead young physicians to wonder how long their contracts ought to run.
“When you’re starting off, you want nothing more than two years,” Dr. Hanak said, adding that having an attorney—he found one through his state medical society, and he recommends going that route—helps facilitate a fleshing out of the pain points in a contract.
“You will usually do better by handling negotiations yourself,” he said. “But if there’s some change you want made to the contract, you can always say, ‘It's weird to me, but my attorney said I should ask about this.’”
Learn more about the AMA Young Physicians Section, which gives voice to and advocates for issues that affect physicians under 40 or within the first eight years of professional practice after their training as residents and fellows.
