Consider location, compensation and independence when negotiating contracts

One needs to maximize all three areas, but one will most likely increase one at the expense of the other, expert says.

Issue: March 1, 2006

Friday, 2 p.m.: A fellow walks out of an academic chair’s office after a successful final interview.

Monday, 10 a.m.: The applicant opens her e-mail to find a job offer, a contract and a request for response within two weeks.

The clock is ticking.

Manish Bhandari, MD [photo]
Manish Bhandari

Most employers use this tactic to discourage excessive haggling. However, fellows must use that time to ensure the contract satisfies three major considerations: location, compensation and professional independence.

“You need to maximize all three areas, but you will most likely end up increasing one at the expense of the other,” said Hem/Onc Today board member Manish Bhandari, MD, oncologist at Cincinnati Hematology-Oncology Inc. “Look at it like a three-way axis. It’s hard to maximize all three. You can live in San Francisco, for instance, but you might not make as much money.”

It’s best to employ a contract attorney before beginning the interview process. Fellows should negotiate a flat fee for each contract read. Bhandari said that between $400 and $800 per contract is typical. Although most contractual stipulations for compensation and vacation time are straightforward, lawyers can help applicants hammer out the fine points that will directly influence clinical and academic success.

Professional marriage

“The first job you choose is a professional marriage,” Bhandari said. “These are the people you’re going to spend the next five to 10 years of your life with. What are their interests professionally and socially?”

In an academic setting, new hires need a mentor.

What is your mentor’s track record for getting junior doctors promoted to faculty?
How many successful grants has your mentor written?
How much funding has your mentor obtained?

Fellows should use these criteria to identify the top three physicians in a particular disease area.

They should then consult their fellowship mentor about which of those physicians would be the best professional complement. A good mentor can help a new physician learn the finer points of:

successful grant writing;
grant resubmission;
opening protocols;
getting through institutional review boards;
recruiting patients;
getting spots on scientific committees and panels; and
competing for foundational grant money.

Private practice

When applying to a private practice, applicants should carefully evaluate potential employers. Are the physicians in this new group the best individuals to consult with on difficult cases? More importantly, “Would you feel comfortable sending a family member to this practice?” Bhandari asked.

It is useful to find out why the practice is hiring. Is the owner simply looking for a new pair of hands to reduce his own clinical time or is he looking to grow the practice? Additionally, fellows should ask potential employers to provide references.

“You shouldn’t be the only one providing references,” said Bhandari. Applicants should request references from area specialists, according to Bhandari. The primary question is “What is the practice’s professional reputation?” he said. “Your name and reputation will be an extension of that group.”

Contract negotiations

The noncompete clause is an often overlooked area that can have excessively poor adverse effects. If a physician decides to change jobs, a spouse working for a local competitor, even in a completely unrelated specialty, can violate strictly defined noncompetes.

There are ways to soften these contract terms at the negotiating table. “It would not be professional suicide to try to cut down a 50-mile radius noncompete to a 25-mile radius and negotiate a six-month period where you won’t take patients,” Bhandari said. “I would give up $10,000 or $20,000 if I were to have the protection and security that I could stay in town and practice my occupation.”

Interviewers typically bombard fellows with verbal promises. Make sure they are all written into the contract. Academic chairmen are likely to promise that a candidate will receive a research nurse when they receive their first grant or that they will be reduced to only two clinics at that time. Make the facility specify those details in writing. Those promises may not be honored if the chairman leaves.

“Be specific,” Bhandari said. “If you only want to work on breast cancer protocols, or if you want at least 50% protected time for your academic interests, it’s important that those get reflected in the contract.”

Support personnel are a major factor for academic success. They can free up time that would otherwise have been spent refilling prescriptions or returning patient calls. Addressing these issues in the contract is especially useful when applying to smaller academic facilities where resources may be limited.

“While the compensation may be $10,000 less, having a full research or clinical nurse devoted to you is much more valuable because it will set you up for success better than the $10,000 would,” Bhandari said. – by Mark Palacio