Doctor Employment Lawyer Blog

You can be the greatest doctor in the world, but it means nothing if patients don't know who you are or where to find you. Medical school and residency programs provide the training necessary to treat patients, but there is very little access to the business and marketing aspects of developing a medical practice.

Many private practices are moving away from guaranteed salary structures and implementing productivity based pay plans. This means that, in addition to treating patients, doctors are expected to market and grow their practice.

Employment agreements often reflect this type of pay plan, but have little information about how the practice will assist you in attracting patients. These types of employment contracts will typically provide a short period of guaranteed pay (anywhere from 6 months to 2 years). After that period, your pay will be solely based on collections resulting from your medical services.

As with any business, it takes time for a doctor to build a reputation and patient base within the practice. Make sure you know how the practice will support you in attracting new patients. And, more importantly, make sure you understand how collections are processed within the practice. It's no longer enough to be a great physician. You have to have great support. The only way to ensure that, is to have an employment contract that provides for that support.

There are certain job requirements and considerations that only a physician might need to contemplate. For example, no other profession ever has to worry about getting hospital privileges or ensuring call coverage or completing CME courses. And for those physicians that do have to worry about those things, it is assumed that their employer will support them.

However, I have repeatedly seen physicians sign a employment agreements that are silent as to the level of support the employer will provide. This provides the employers with an opportunity to terminate you for breach of contract if you are unable to meet your obligations without their support. Since most doctor employment contracts have notice periods, terminating the physician for "cause" can save the employer a substantial sum of money.

Even if your employer orally promises you a certain level of support, that promise may not be enforceable depending on the written terms of your agreement. For this reason, it is imperative that you ask your employer to clearly delineate the level of support it will provide. Will it provide administrative assistance to handle the paperwork? Will call coverage be equally shared? Will it provide financial support for CME courses?

Asking these questions at the start of your employment can establish the trust necessary to create a long term relationship.

Congratulations to all of you who have just completed your residency. Most of you have already signed your employment contract and are preparing to take on your new role as an attending. I hope that you asked for everything you want in your employment arrangement and that your employer gave you what you want in a clear manner.

Just make sure you read your agreement and enjoy what you do.

It is the time of year when physicians are completing their residencies and locating new positions. And, even those that are not moving on, usually find themselves faced with an annual contract negotiation. Yet, surprisingly, most physicians do not take the time to review their agreements and fully understand their obligations.

This is especially true when the physician has been with the employer for many years and complacency has set it. Just because you didn't read the last agreement does not mean you should continue to sign everything your employer places in front of you.

If you get only one thing from this blog, get this: Read your agreement.

Most physician employment contracts allow either party to terminate the agreement at any time by giving a certain amount of written notice. The notice period is typically 90 or 180 days. However, many physicians do not understand that the notice period is not a guarantee that he or she can work through that period.

I recently spoke with a physician who was shocked when her employer exercised the 90 day notice period by providing written notice and asking her to immediately leave the practice. The physician was paid during the notice period, but no notice of her departure was provided to patients or referring doctors. She was understandably upset because her patients were left with the impression that she did not even give them the courtesy of letting them know she was leaving.

This physician had believed that the notice period was a promise that she could continue to work for her employer during the 90 day period and use that time to inform patients and referring doctors of her departure. Instead, she was discovered that, as long as she was paid through the notice period, the employer was not under any obligation to allow her to treat patients during that period. Nor was her employer required to work with her to notify patients or referring doctors of her departure.

Leaving a practice without any notice to your patients or referral relationships is likely to damage relationships that may have taken years to cultivate. Patients don't usually understand that the employer owns patient information and a doctor likely will not have access to such information after leaving a practice.

The lack of notice can be damaging to the employer as well. Patients often impute the conduct of a treating physician to the practice as a whole. Leaving a patient wondering what happened to his or her physician is not likely to create a trusting doctor-patient relationship.

Working out an agreement about how to notify patients and referring physicians regarding a physician's departure at the start of the employment relationship is beneficial to all parties. It allows the doctor and the employer to protect their reputations and minimize patient confusion. It ensures patients are informed about whom they can contact about their treatment issues. And, it ensures that referring doctors know who will be taking over the departing physician's practice.

Of course, trying to work out those details at the end of an employment relationship is usually an exercise in futility.

Physician Employment Contracts have unique issues, but most doctors look at the compensation provision and sign. It's understandable that a physician might think that his/her pay is the most important aspect of the employment agreement, but in fact there are issues that might make it difficult to ever move on to a new employer or start your own practice. While there are a number of concerns a doctor should address before signing an employment contract, below are the top five issues:

1. Malpractice insurance: Occurrence based or claims based? If the coverage is claims based, you will likely be responsible for purchasing tail coverage to continue coverage after termination of your employment. This can be extremely costly.

2. Duties: You may think that your duties are obvious or self explanatory, but every practice has its own way of divvying up responsibilities. You may have administrative duties for which you are responsible that require a large investment of time. If you don't address this before signing, you are agreeing to those responsibilities without question.

3. Non-Compete Agreements: Many doctors don't understand how far their non-compete agreement really covers. By signing your employment agreement, you may be restricting yourself from working in the same metropolitan area for some time after your employment ends. At the very least you should be cognizant of where you can and can't work in the future.

4. Non-Solicitation Agreements: You may have already spent years building your reputation and patient base, but most physician employment agreements explicitly state that all patients that visit the practice belong to the employer. If you are bringing a significant number of patients to your new employer, you should at least protect your future relationship with those patients.

5. Marketing: Many physicians have the mindset that patients will just show up. In today's environment, doctors have to market just like everyone else. If your compensation is dependent at all on productivity, you need to be certain that your practice is going to be marketed to the public. This isn't an exhaustive list, but being aware of these issues can help a physician negotiate a contract that he/she is happy with throughout the employment relationship and beyond.

I recently heard a story about a General Surgeon who signed her private practice employment contract without reading anything other than the compensation section. It turns out that the agreement she signed states that she was hired as a Primary Care Physician.

While this may not affect her employment at first, it could be an issue is things between her and her employer ever turn sour. Just like any other career, when a doctor starts a new job everything is exciting and positive. However, after the honeymoon phase ends and both sides reveals their flaws, things may not be so rosy. Errors like this one in your Physician Employment Contract could give your employer an opportunity to terminate your employment without any of the benefits for which you may have contracted.

Furthermore, if the employment contract is so inapplicable that even your specialty is incorrect, what else may be wrong? Are call duties clearly spelled out? Is the non-compete limited in scope? These are all important issues that can affect your employment and your future career. Make sure you know what you are getting into before you sign.

When a physician signs an employment agreement that includes a non-competition provision, the doctor should be aware that such an agreement will limit his/her opportunity to practice medicine in the future. Even when a radius seems small on paper (i.e. five miles or ten miles), the actual area covered by the agreement may encompass the majority of hospitals or employers in an urban area. Furthermore, many of these provisions exclude you from working for a competitor even when your employment is terminated by the employer without cause.

A non-solicitation provision can have a similar effect. Employers often draft these provisions in a way that makes it difficult to promote yourself when you are forced to secure new employment. If you are restricted from sending announcements or initiating any contact whatsoever with former patients, can you really build a new practice?

If you are negotiating an employment contract with a large institution, it will likely be difficult to negotiate a narrower application of the restrictive covenants. However, this should not deter you from making some effort. At a minimum, you should request that the restrictive covenants be nullified if your employment is terminated without "cause." In addition, you should be careful that "cause" is clearly defined in the agreement so that there is no question as to whether you may promote yourself.

Although there has been some debate about whether there is a public policy interest in prohibiting physician non-compete agreements, Illinois still enforces these contract provisions so long as they are reasonable in scope and duration.

Physicians should pay close attention to these terms when they sign an employment agreement with a practice or hospital because they could inadvertently remove themselves from the marketplace or exponentially increase their work commute.

A physician entering into an employment agreement should request that the employer eliminate the non-compete provision. Although an employer has a vested interest in protecting its patient base, it may be willing to negotiate terms of a restrictive covenant so taht all parties are pleased with the outcome.

A physician should have an attorney review the entire employment agreement before assenting so that he/she is aware of all rights and obligations conferred by the agreement.