American Society of Hematology

Negotiating a Contract

Dale Bixby, MD, PhD

Published on: July 20, 2009

As trainees, we dedicate a lot of time and effort to developing the required skill set to be an effective hematologist. When transitioning from fellow to attending, we are often overwhelmed with new responsibilities and do not devote the proper time to understanding our employment contracts. However, as many current attending physicians can tell you, the devil is often in the details. Just as you would want the best advice on managing a difficult medical case, seeking counsel before signing on the dotted line of your new employment contract can potentially save you many headaches as you embark on your new professional career.

Do Ask … Do Tell 

As with your previous academic interviews, you have a finite period of time to decide whether the new employment option is a good fit for your career. It is critical that you openly and honestly discuss your career plans with your new employer, ensuring that you can thrive in the new environment. From an academic perspective, understand your service and clinical responsibilities and ensure they will allow you adequate time for research pursuits. Inquire about details, such as the number of clinics per week, months on ward service, call requirements, and teaching assignments. It is always wise to start slow and build up your clinical responsibilities later if necessary. If you are overloaded with patient care from the start, it may be difficult to pare down your duties later and your academic work will suffer. For those with a laboratory research focus, understand your start-up package including lab space, core facility availability, and charges, as well as access to collaborative faculty. Those wanting to work on clinical trials should clarify protocol review committee and internal review board functionality, as well as data management and regulatory support. For those entering private practice, meet the members of the group to understand their dynamics and planned division of labor.

One Size Doesn’t Fit All 

Because your job responsibilities and needs are very individualized, a generic contract cannot contain enough specifics to ensure your protection. Each physician’s specific assignment, personal priorities, practice area, patient makeup, and compensation scheme will be unique, so the physician and the institution need to work together to ensure that the employment contract reflects the physician’s unique role in the organization. Yet the vernacular of contract law is often beyond the scope of many, including issues of safe harbor provisions, non-compete clauses, multitiered compensation packages, and malpractice coverage including tail insurance. This does not even begin to address time off and reimbursement for professional education, details addressing support staffing and materials, or dispute resolution and termination clauses. Oh yes, and there is also the issue of your salary. Understanding that most of the initial contract terms are subject to negotiation is critical; don’t assume that anything is set in stone until the contract is signed. 

You Can’t Always Get What You Want

While there are clearly some factors that are non-negotiable, others can be surprisingly flexible. How you broach the subject is critical. Taking a bull-headed approach to “winning” your concessions is likely to fail. If you make a legitimate attempt to meet somewhere in the middle, you may find yourself with significantly more bargaining power. Recognize if you have specific parameters that are just too important to you to concede, and realize that at some point you must be willing to walk away from offers that cross these boundaries. Sacrifices that significantly affect your quality of life will not make you a productive hematologist. Consider the impact your decision will have on your significant other and family, and involve them in the decision-making process.

Final Thoughts

Job hunting can be a whirlwind experience. It can be extremely easy to get wrapped up in individual details, while overlooking perhaps the most critical aspects of your new opportunity. For most of you, this will be the first significant employment contract that you sign. Take a moment and seek the advice of former fellows and attendings, and consider hiring a professional who is familiar with medical contract law.

1. Terry K. Look out for employment contract snags. Med Econ. 2008;85:30, 32-34, 38.

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