Contracts and Laywers

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.
  • 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 - Lawyers are good at explaining the legal wording of the contract and general physician contract points.
  • 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.​
  • MISC other review 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.
  • 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.​

       I have personally been reviewing resumes, cover letters, and contracts / Employment Agreements for residents and friends in the podiatric field for several years and have also see my fair share of contracts through my multiple practice changes to date. 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). There are also many contract points that are specific for a "Podiatry Employment Agreement" that a lawyer (a) may not be familiar with, (b) do not understand it, (c) do not know to look for it (if it is missing), (d) make you aware it is missing or unclear, and so on, based on their lack of knowledge in the field. To that end, I (Hood CR) provide contract review service as a review "by podiatrist, for podiatrist." This is why I feel it is important to have someone in the profession review the contract. To that end, I perform contract review as a service to licensed podiatrists, residents to established practitioners.
                                                                   
​                            Please check out my BUSINESS PAGE for more information on having a contract reviewed.
     
       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 is 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.
  • Once the professional review is complete on your end, create a list of either questions, changes, etc. that you want to the current 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 worth 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.
  • ​MISC Items​ to Ask For​ -
    • 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.
      • ​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?"
        • 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.

Helpful websites for understanding and going through a personal contract review:
Companies who perform contract (and other physician career documents) review:
  • Sherwood Acres, LLC - 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:
  • Make sure the lawyer does not only contract review, but medial contract. Someone that has done podiatry in the past would be even better.
    • 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 1 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.
  • 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 laywer 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).