There are some physician employment agreement negotiations you just never forget. One of my more memorable negotiations involved representing a new physician, just out of fellowship, who was offered a position at a solo private practice. The practice’s current owner was ready to expand and wanted help with his 24/7 call coverage schedule.
Like most first offers, the draft agreement initially presented wasn’t perfect – but it didn’t seem particularly horrible, either. One of the goals of a good physician employment agreement is that it be crystal clear on the parties’ rights and responsibilities. This offer was a little fuzzy on several points, and I requested that the practice’s attorney clear up the ambiguities. One of the fuzzy points was assignment of call coverage.
The draft agreement simply provided that the employer would assign call coverage. There was no mention of how, exactly, call coverage would be assigned. I requested a specific schedule, or, at a minimum, a provision that call coverage would be equitably allocated.
However, when the other side presented the first revision, the offending language was unchanged. The practice’s attorney rather sheepishly explained that his client wasn’t willing to agree to allocate call coverage equitably. Since the solo physician had been practicing alone for six years, doing 24/7 coverage, he intended to assign 24/7 coverage to the new physician, “at least for the first few years.” The attorney was concerned that “there could be an argument” that the arrangement was not equitable.
Needless to say, more negotiations were in order. Eventually, I convinced the other side that they would never get anybody to help the physician unless he was willing to share call coverage. If we had not straightened that issue out, my client would have been miserable in the new position.
Smaller employers are likely to require much more flexibility in scheduling. If the practice only has three physicians, for example, call coverage is likely to spike several times throughout the year. Each time 1/3 of the physicians (i.e., each physician) takes vacation or CME time off, the call coverage will probably significantly increase for the remaining two physicians, who are temporarily doing the work of three.
Larger employers may provide an expected call coverage schedule (e.g., one night every eight and one weekend per month). These schedules will rarely be firm commitments. However, sometimes the employer will be willing to stipulate that call coverage will not exceed some limit (e.g., one night in four or two weekends per month).
The Medical Group Management Association (MGMA) publishes benchmarks for call coverage in various specialties. These benchmarks provide information on unpaid call coverage hours per week, as well as hourly, daily, and annual compensation for call coverage. Citing the MGMA benchmarks in a physician employment agreement review can be very helpful in negotiating a fair physician employment agreement. If call coverage isn’t specified, or if call coverage appears to be more than the median unpaid weekly hours, I always cite the benchmarks and request additional compensation for call coverage beyond median when I review and negotiate physician employment contracts.
Call coverage requirements in private practices can be complicated. Frequently senior partners will enter a glide path into retirement. That is, at some point the senior partner may stop taking call. In a larger private practice, increased call coverage may be negligible for the remaining physicians. However, in a smaller practice, removing one physician from call coverage can have a material impact. When negotiating a physician employment agreement, you have to balance the desire for a workable call coverage schedule for the new physician with quality-of-life concerns for the senior physicians. Sometimes the new physician simply has to “pay dues” with the understanding that when that physician is nearing retirement there will be payback. MGMA benchmarks can be useful in this scenario – although the new physician may be taking more call coverage than they really want, at least we can try to negotiate additional compensation for the additional burden.
No matter how well we negotiate provisions concerning call coverage assignments, I have found that the newest physician always seems to end up with call coverage on Christmas. Isn’t that a freakish coincidence?