With larger regional and national groups, the scenario is different from the smaller groups I discussed last month. Dan Phillips, MD, the medical director of recruiting and the southeast regional director of hospital development for Emergency Medicine Physicians, Ltd. in Canton, OH, admits that they negotiate some limited aspects based on a graduating resident's background, particularly if the physicians is willing to work at a site for which recruiting is difficult.
“This isn't a Saturn lot where the price is posted on the window,” said Dr. Phillips. “As an equal-equity group, the package must be essentially the same for everyone.”
That being the case, EMP is legally bound not to change any of the benefits, although relocation allowances are open for negotiation if merited by the candidate's background. Sign-on bonuses and other unusual incentives for attracting a physician, however, aren't EMP's style. “These days, my first question when I see a sign-on bonus is, ‘Why?’” Dr. Phillips said. “Beware of the offer that sounds too good to be true; it probably is,” he cautions graduates. “We have learned that if you have to pay a doctor to live there, that's a contract we don't want.”
Matthew Rice, MD, JD, the senior vice president and chief medical officer for Northwest Emergency Physicians, an affiliate of TeamHealth, asserted that “what physicians want is to be treated right. That means to be treated fairly. New grads have to get past the old myths and legends about national groups, and establish trust to effectively negotiate a compensation deal,” he said.
Dr. Rice said negotiating in good faith is more important than negotiating a good contract for both parties. He advised graduates to remember that taking a job is a business arrangement, which is why a contract is involved. “You need to be careful what you choose to negotiate, especially trivial items, and not respond emotionally without first researching those individual items. Any company has a right to protect itself, just like any candidate,” he said. “For NEP, the desired result of any negotiation is to create an environment of comfort on both sides, as well as a long-lasting relationship.”
Though he said he strongly believes that incentive models for compensation provide the best opportunity for higher earning, Dr. Rice said “every part of a contract should be negotiable, even if the final decision is that we won't budge on an item.”
California Emergency Physicians, a partnership of 750 physicians based in Emeryville, CA, usually has more candidates than openings. “Once physicians make it through the first year, they almost never leave,” said Mark Spiro, MD, the chief operating officer and vice president of operations for CEP. “They can change locations, but they don't leave the group.”
As for what's negotiable, Dr. Spiro said there's “not a lot that is because everyone gets treated similarly. We have the group so standardized for everyone that partnership is the same for everyone.”
Dr. Spiro said an incoming physician “can negotiate the number of hours they work. They can choose to work more nights or split their time between various sites, but consistency is important, and must fit our shift equity model.”
Though CEP has been in existence for 30 years, the group and Dr. Spiro (eight years in his position) have seen little change in negotiating ability. “We have a good product. When we interview a physician, we are seeking someone who is not dealing with an employee mindset but with an ownership mindset.”
The president and chief medical officer of the Schumacher Group in Lafayette, LA, Randy Pilgrim, MD, expressed concern that certain academic programs are “scaring their grads about particular elements of the jobs available out there.” He said, “A larger group means larger opportunity. A large group has more resources and more ability to distribute its business risk,” and as a result, “everything is negotiable.” “But,” he said, “what's probable to negotiate is a whole different ballgame.”
Larger regional and national contract groups do negotiate, but most packages are standardized for new graduates
With incentive plans in place in most of their facilities, Schumacher provides assistance with establishing a benefit package for independent contractors, and will also negotiate a desired schedule and even length of shift “if there is a way to make it work without disadvantaging anyone else,” Dr. Pilgrim said. “What is the most long-term, sustainable deal is what's best for both parties.”
Schumacher, however, doesn't use signing bonuses. “There are times when it seems like a lure on a fishing rod, and though it may be initially attractive, it does not send the right signal,” Dr. Pilgrim said. On the other hand, reasonable loans for bridging time just before a move or relocation assistance can be a sign of commitment from a group. He said the “perspective of the candidate is essential [in negotiating]. Are we seen as an adversary or as good potential business partners?” He said the best candidate presents a perspective that demonstrates his ability “to be a partner who meets core needs and respects the practice.”
While negotiating potential with larger regional and national contract groups is noticeably higher, it still does not leave a lot of wiggle-room for a graduating resident. Dr. Phillips, for instance, saw a recent candidate lose his offer by over-negotiating. Dr. Spiro agreed. “Whatever you are negotiating, I advise you to develop antennas that detect when you are stretching the envelope from what others have asked for. Understand that whatever you negotiate for yourself, a great deal will be expected from you in return. It's a trade-off.”