The healthcare workplace is undergoing profound changes.  Where once a letter and a handshake were enough to create a life-long working relationship between colleagues, now the multiple work settings and relationships create many possibilities.  Understanding not only how to get into the relationship, but also what might happen when you need to leave or are forced out of a relationship is critical.

True case report:

A woman internist arrives at work one Monday morning and before she starts her schedule, one of her “partners” asks to speak to her.  The conversation begins: “Patty, we really have had a great relationship, but I am afraid we have to let you go.  We have rescheduled your patients today for Dr.  Burns.”  Stunned, she responds, “How can you do this to me?  I have been working here for 17 years.  I am really liked by my patients and I get along with everyone well.”  He says, “Well, I am sorry.  We are doing some re-organization and what with retirements coming up, we just don’t need you anymore.  Please remember that you have a non-compete clause for 18 months and a 5 mile radius.”

Unbelievable?  It happens more often than you would like to think.  Dr. Smith came to work for this group right out of residency.  She liked and trusted this group.  She felt really lucky that she had a job.  She felt even luckier that she was able to “negotiate” that she would work 4 days a week for a salary reduced by 25% but with no chance at becoming a “partner.”  She didn’t think she cared and didn’t want the hassles of “partnership.”

She just signed her contract.   She never even read her contract.  She didn’t know she was an employee “at will.”  She didn’t understand that all her hard work and investment in the practice could disappear in a moment.  She thought she would work with these physicians until she retired.

Physicians are notoriously naive and incredibly cavalier about contracts and negotiations … until they are hit with a crisis that forces them to actually read their contract, that is if they even had one.  What’s a woman to do?

More women than ever are entering the medical profession during a time a physicians shortage is predicted.  Our knowledge, skills and training carries more value than ever before.  We have the opportunity to get the “benefit” of a bargain–one of the definitions of a contract.  But in order to do this, we have to understand the power and protection a contract gives us,  if properly negotiated.

Physician contracts are different because of the many regulations in healthcare law.  Stark Laws, anti-kickback regulations, non-compete clauses, non-solicitation clauses, buy-ins, buy-outs, sharing of alternative revenue streams, and limited liability are but a few of the many issues that find their way into physician contracts.  And then for physicians employed by hospitals, the important question, “Whose patient is this anyway?”

For women, we also think about flexible scheduling, maternity benefits, career trajectory consideration, resource allocation, pay equity, and much, much more.  These  issues that have to be discussed up front, before signing on the dotted line.

Not every doctor can diagnose a rash properly, not every attorney can decipher a contract properly or complete a complex negotiation successfully.  Physician contracts are special and it is important to get the right help.  Look for a contract attorney who has extensive experience in physician contracts.

After speaking with this doctor, she was emboldened to negotiate continuing her benefits for the next 4 months while she looked for another position.  She also got an excellent letter of reference.  She was able to stay in the same city, but traveled much further to work.  Some of her patients found her, but mostly she had to start over with new patients.  This time she negotiated a contract that suited her and created a long term career with her new group.  She now understood the value of a contract.

A few critical points:

1. Protect yourself for a separation no matter how much you like or are liked by the group.  Spell it out first.
2. Never accept the contract that is “non-negotiable” or “standard” — everything is negotiable and nothing is standard.
3. Understand your own value in the geographic location you are in — this will drive the negotiations.
4. Do your homework and think about everything that you want and need and then some.

So, if you have a contract, look at it and understand it.  If you don’t understand it (and they are convoluted), get someone qualified to help.  And when the time comes to renegotiate, think what it is you want and then go into it with a positive sense that you have value that can be leveraged.  Get the right help.  More often than not, you will come out ahead.  It’s worth the investment many times over.

Linda Brodsky is a pediatric surgeon who blogs at Women MD Resources.