physician employment agreements with a private practice
Physicians who receive physicians employment agreements from a private practice have all the concerns with their employment agreement that any other physician receiving an employment agreement has. I’ve previously written about how private practice employers react when MGMA benchmarks are cited in a physician employment review. In addition to compensation and physician benefits, physicians in private practice, like all other physicians, are concerned about physician covenants not to compete, call coverage requirements, patient contact hours, term and termination provisions, medical records provisions, and malpractice insurance concerns.
Smaller private practices may require more from a physician
than large health systems, especially in call coverage – if two physicians are
required to cover all the patients of the practice, it makes sense that call
coverage requirements (unless the practice has a call coverage arrangement in
place with other practices) will be more onerous than if 15 physicians are
sharing coverage. In general, private
practitioners tend to work harder than their colleagues in health systems.
So why even consider private practice? There are many
possible reasons – a desire for greater control of your professional life, the
ability to go back home, etc. For many physicians, though, a major lure of
private practice is the ability to earn significantly more money over the
course of your career.
Not only can
private practice physicians participate in “side ventures” like ASC ownership,
etc., but the overhead in most private practices is less than that of a health
system. Perhaps most importantly, owners
of a private practice can profit from the excess of revenue earned over the
salary and benefits of employed physicians.
So, while you are lining the pockets of the current owners, you are hopefully
moving toward ownership yourself. Someday that new physician just out of
training will be working for you!
If one of the biggest reasons to join a private practice is to eventually become an owner, it follows that one of the biggest (unique) concerns in reviewing a physician employment agreement from a private practice is ensuring that potential ownership is addressed. Since potential ownership is probably one of the major reasons you’re interested in this opportunity, you need to know if ownership is in the cards, even though you may be just starting your career with this practice.
Many physicians are upset that typical provisions in private
practice physician employment agreements don’t promise ownership, but instead have
language providing for a “review in good faith” – perhaps based on productivity,
relationships with staff and physicians, etc.
Although it would be nice to have your
partnership guaranteed, I think that overall these provisions are fair and ultimately
beneficial to the practice and all the physicians. Although you may be a nice
person, the next physician they hire could be a jerk. You will hopefully spend the rest of your
career at this practice, so maintaining a collegial atmosphere will be
important to you down the road. You may end up grateful that not every
physician hired is guaranteed to become your partner.
I have a whole chapter of my book on physician employment agreements on various methodologies for valuing your buy-in. The method used in various physician employment agreements with a private practice can vary greatly, but it’s vital that whatever the valuation methodology may be, it is clearly set forth in your employment agreement. Again, it’s the methodology that’s important – the actual figure is most likely not going to be provided.
Private practice for those who want control over their destiny is undoubtably challenging. At the same time, it can be financially as well as psychically rewarding. The first employment agreement may not guarantee ownership, but it’s critically important that a path to ownership is discussed.
You may also be interested in my posts about MGMA compensation analysis, physician productivity compensation, negotiating physician employment agreements, letters of intent in physician contracts, the “standard” physician employment contract, without-cause termination in physician employment contracts, and negotiating your first physician contract.
To learn more about the critical issues to be aware of when negotiating a physician employment agreement, you can see my podcast of the 3 most common traps in physician employment agreements, my physician employment agreement checklist or, for the most extensive discussion of the topic, my book on physician employment agreements. For specific information on topics you might be interested in, see my posts about physician productivity compensation, MGMA compensation analysis, medical record provisions in physician employment agreements, letters of intent in physician contracts, physician covenants not to compete, and call coverage requirements.