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In this episode, our guest Amanda Hill, a health care attorney, shares insights on navigating career transitions in the medical profession. Whether you’re burned out, seeking new challenges, or dealing with personal or health issues, leaving a job or position can be challenging. Amanda highlights the importance of planning ahead and carefully reviewing legal agreements, such as non-compete clauses and buy-out agreements. She also shares tips on how to notify patients and take time for inner work and self-reflection before jumping into the next thing. Join us for a valuable discussion on transitioning well and setting yourself up for success.

Amanda Hill is a health care attorney.

She shares her story and discusses her KevinMD article, “Mastering the art of transition: essential tips for leaving your medical career behind and pursuing a new path.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Amanda Hill. She is a health care attorney. Her KevinMD article is titled “Mastering the art of transition: essential tips for leaving your medical career behind and pursuing a new path.” Amanda, welcome back to the show.

Amanda Hill: Thank you. Happy to be back.

Kevin Pho: So for those who want to hear Amanda’s story, she’s been on the show multiple times. Go to KevinMD.com/podcast. In the upper right-hand corner there’s a search bar; search for Amanda’s name to listen to her story. But let’s go straight into today’s article. How did it come together?

Amanda Hill: Well, you know, Kevin, I’ve had a lot of questions from doctors who want to turn into something new. I mean, obviously they want me to look at their contracts, but there’s a lot more that goes into transitions. In fact, I had a doctor the other day who said, “I just want you to talk to me for a half an hour about how I’m going to make this transition.” There are a lot of moving parts. So I thought, well, let’s just tackle that head-on and talk about some of the most common things that pop up when you’re making a big shift, whether it’s to a different job or whether you’re leaving medicine altogether. You really have to think about these things.

Kevin Pho: All right. So just before we get into that, in your experience, what are the most common reasons why physicians want to make that career transition?

Amanda Hill: You know, Kevin, burnout is huge, right? I mean, a lot of it is, “I’m tired of working for the system. I’m on call all the time.” These are the most common things: “I don’t put enough time in with my kids. I feel like I’m running on a hamster wheel.” Sometimes it’s more like, “My partners don’t respect me. I’m not getting the recognition that I deserve, or the pay that I deserve, and I just need to go elsewhere where I can make a better living.”

And then I think there’s been a real shift after COVID, right? People are more determined to have a work-life balance. It was sort of hypothetical before, like, “Wouldn’t that be great, to have more time?” Yeah, yeah. Now it’s not negotiable. And so people are really, and I think that’s a good thing, right? People are really examining their life and saying, “Why am I here on Earth? What can I do to make a difference? But also, I have people that I need to tend to, and I have a lot of other passions.” And so that’s been a real difference, and I think we should embrace that and figure out a way to make that transition so that you do feel whole in your next job.

Kevin Pho: So a physician is interested in making that transition, for whatever reason. It’s not as easy as just packing up and leaving. So what are some considerations that physicians should make?

Amanda Hill: Well, of course they call their lawyer. That’s me, because they want me to talk about contracts. So the first question we talk about is just: Get your dusty contract out, whether it’s new or old, and look at it and see what all the requirements are to leave. Sometimes, Kevin, they don’t really understand what they’re bound to, and sometimes I just go over their current agreement. You need to look at it and say, “All right, if I leave, is there a tail policy I have to pay? How much notice do I have to give? Is there,” I always call them a scorpion tail, “something that whips you on the back end? Is there a payback you have to pay your employer if you leave within a certain period of time?” So that’s the first criterion: Where are we, in the present state? What does your contract say? What’s the damage that’s going to happen from bailing on this job?

So the next thing you look at is, OK, you’re going into a new job. Let’s not make the same mistakes. I hear so many times, “I’m so tired of this place. I want out, I want out, I want out.” And then they go to something that’s almost exactly the same. So it’s like, wait a minute, you need to really process the type of job that you’re looking for, because it might look like it has fewer call expectations, or maybe it looks like it’s smaller, but a lot of the pressures are just going to be repeated.

So before you just take a huge leap, I would really advise you to sit down and think about what you really want. What type of lifestyle, what type of environment or town? Take a minute to think that through, because otherwise you’re just going to call me four years later wanting to get out of that bad situation. And then you’re going to take it personally and obviously think, “This is me. I’m the problem.” Just like Taylor Swift: “It’s me, I’m the problem, it’s me.” So let’s not make it your problem. Let’s really analyze the right next step. And so if you take the time to do that well, and of course they call us attorneys and counselors because we counsel them through all this, it’s not just about the contracts. It’s that the next thing that you’re doing is the right emotional and physical fit for you.

Kevin Pho: So commonly, how many days’ notice do physicians need to give before leaving?

Amanda Hill: Ninety days is the most common. You give your notice, you wrap it up, you’re talking about your new position. Usually you’re getting credentialed and interviewing, and that’s good transition time. Some contracts say 120 days, and I feel like in that last month, everyone’s done. The employer’s done, you’re done. Four months is too long. I really think 90 days is the sweet spot.

Kevin Pho: So I’ve heard stories online, and you can confirm them or not, that once a physician gives notice, whether 90 or 120 days’ notice, that period can be a little bit awkward, because the group knows that physician is leaving. What are some potential pitfalls or horror stories you’ve heard during that time?

Amanda Hill: What horror stories have I not heard? My whole practice is dealing with this stuff. I always say to doctors, the 90-day notice is like a lame-duck session. They don’t really want you there, trying to interfere with getting patients, and you want to just get out of there and move on. So it’s really awkward. And I always say to doctors, “Put your head down, don’t make waves, and get out.” The last thing you want is to have a big altercation during your last 90 days, right? To have a fight with your current employer where they think you’re stealing patients, even though you’re not, where they think you’re having secret conversations with patients about following you, and then they’re arguing that you’re violating the non-solicit provision of the contract. So put your head down.

That being said, patients do have the right to go to whatever medical professional they want, no matter what your employer says, or even if they try to slam it down your throat that “These are our patients, not yours.” I kind of just shrug and say, “That’s not true.” Patients can follow a doctor anywhere they want. And of course, if you’re going somewhere, you have to go to your medical board rules in that state as to how many days’ notice you give patients. Every state’s slightly different. I will say that on average, you need to give your patients 30 days’ notice. Usually there’s some kind of notification, either in the office or in the newspaper. You write out a letter, and that is a huge fight. There’s always a fight about the letter that goes to patients, right? Because the employer wants to keep them, and you want to take them.

And so what I would advise there is to make it very factual: “I’m leaving. This is where I’m going.” Make sure you don’t solicit them. But also, patients have a right to know where their doctor is, and so the group can’t really hold that information back, because they are patients who might need to reach out to you for care and treatment. So that’s the biggest pitfall, fighting over patients, because the group’s trying to hold on to what they feel is their biggest asset, and the doctor’s like, “Well, they might follow me. I don’t know.”

And then probably the next one would just be that there are a lot of emotions that flare up, because the group is frustrated that they lost the surgeon or this great doctor, and they know there’s nothing they can do to bring them back, and they just want them gone. But yet they have this 90-day provision in their contract, and they have to pay them. So sometimes groups will say, “We don’t want you anymore. Go home. We’ll take care of it, we’ll pay you, you’re out.” And I try to reframe that. Remember, everything is mindset, and I tell my doctors: That is a free vacation for you. If you’re getting paid what your salary dictates and you get to sit at home, then go enjoy that time. Don’t look at it badly. You’re going to get patients in the long run.

I think doctors get mired in the little details: “But I didn’t finish this, and I didn’t finish that.” It’s like, make sure your charting’s done, of course, but don’t sweat it. You’re going to get out, you’re going to make a difference, you’re going to make money, you’re going to be successful. So you just have to put your head down and try to get through that crippling transition period. And trust me, change is hard. Change is hard for everybody. And so it’s something you really want to plan for, and you want to be excited about your next thing. That takes a lot of forethought, because then you can trudge through the transition knowing that you have a rainbow at the end.

Kevin Pho: Now, that letter that goes out to patients: I’ve heard mixed things about this. Is that letter allowed to state where that physician’s going? Is it allowed to explicitly state that physician’s next practice?

Amanda Hill: Well, state law rules are different on this, so clearly you want to check with your state law. But generally speaking, I’ve always been of the mindset that doctors should be able to tell their patients where they’re going. I mean, I think it’s pretty ridiculous when you’re like, “I don’t know where I’m going. I’m just disappearing, and I’m falling off the face of the Earth.” You can say, “I’m going to a different practice.” And if they ask, “Where are you going?” you can say, “I’m going to this oncology center.”

Now, there is probably a line that you don’t want to cross, because most contracts have non-solicit provisions, right? So you don’t want to say, “And this place is a hellhole, and you should follow me.” That might not be the right approach. But in essence, telling them what you’re going to do with the next step of your life is typically OK. Now, employers try to tell you it’s not, very often, right? “You can’t say anything to patients. You can’t tell them where you’re going. We’re going to muzzle you.” I mean, there’s a lot of bark, but not always a lot of bite.

Kevin Pho: Now, what about references? Because new jobs always ask for references, and sometimes, if you’re leaving a job, that could be a little bit awkward. How does one navigate that?

Amanda Hill: So usually, employers will provide neutral references, right? That is to say, “They worked here from 2017 to current,” and they won’t give you much more information. Honestly, if there’s any tension between you at all, this is really the best approach, just to get a neutral reference that says, “We’re sorry, it’s company policy. We just don’t verify or talk through or give interviews to people. These are the dates that they were hired.”

Now, if you happen to leave a job in a bad situation and form a settlement agreement or any kind of severance, then you can weave in language about this. I’ve done this multiple times, right? Where you say, “You will not disparage me. You will not say anything about me other than the dates of employment.” And specifically, I can even write in that these particular people will not be telling anyone about me: “These people that I did not get along with, I don’t want them discussing my future with anyone.” So you can write that in.

Now, if you don’t have a severance agreement, you try to encourage them, again, to stick with the neutral reference. You have the opportunity in your interview to explain your past. You have the interview process to go through all of that, and you don’t want them calling and getting one negative side comment from a current employer, which can ruin you. And so if there’s any way to negotiate a neutral reference, that’s really best for everyone.

Kevin Pho: Now, you said that you’ve heard so many horror stories. So tell us some examples of such horror stories of physicians leaving a practice, and how physicians listening to this can avoid that situation.

Amanda Hill: You know, I think the most horrific situation was a doctor who was hired from another state, right? He got his license in our state. He went from his residency program, traveled, moved two small children. His wife had a chronic illness. It was like, “This is where we’re going to be.” They bought a farmhouse. They were all in. And then he got there, and the office wasn’t set up, and they just didn’t have the surgeries. And so within the first 90 days they termed him. No reason, no cause, just, “Oh, it didn’t work out.”

I mean, yes, they have the right to do that in your contract, but it’s horrifying that you invested your whole life into something and then you just get termed, and you didn’t do anything wrong. They just thought, “We overshot this. We don’t have the panel that we thought. This location isn’t really the best.” To the hospital system it was no big deal, but my client was devastated. Now his wife might not have insurance, and she’s got this chronic illness. Their kids had just started school. It was a nightmare. So that is the worst scenario.

I mean, if you’re going to move across the country, you might want to have some kind of guarantee that they can’t terminate you within the first year. I mean, this isn’t like you’re moving from one side of Chicago to the other. This is a massive move. So something like that, just think about it before you sign. I talk about this all the time, but think about the exit before you get into any potential locked-in relationship, because most doctors will be moving every three to five years. Sometimes more, sometimes less, it depends, but every five years you might make a change.

And so if you go into something naive, thinking, “This is it for me. I’m never going to go anywhere,” then you’re not being smart. You need to think, just hypothetically, “If my mother came down with cancer, or something happened and I have to move to take care of people or for a job, then how am I going to get out, and how am I going to transition?” And so build in protections for yourself. Even your employer might not think that’s a big deal: “Oh, sure, yeah, no problem. We won’t terminate you within your first year.” And that would have saved my doctor a lot of headaches, or if they wanted him out, they would have had to settle and pay him quite a bit.

Other times it may be a sexual harassment issue, right? Where they have to stay 90 days in a really toxic situation, because the person they accused of harassing them knows that this was the person who reported them. So it is no fun for anybody, and they go to work every day shaking, thinking, “Oh my gosh, how am I going to get through this?” So those are really bad situations.

But you know what? How many times have I talked to doctors who are in a really negative situation, right? It’s toxic for whatever reason. They want out. They’ve put in their notice. My advice is, please, if you don’t listen to anything else I say: Do not burn bridges. I don’t care if they’re a jerk and a narcissist and they’re awful. Don’t allow yourself the luxury of going off on this person because you think, “I’m never going to see them again.” These things have a way of circling back, especially in certain communities. You’re a subspecialist, there’s only a dozen of you. You just don’t want to start a war.

I’ve counseled a lot of people about that. I know that you want to call your therapist, call me, or call a privileged, confidential person and vent all day, but make sure that you try to remain as professional as possible to get out of that. Because I swear that narcissist probably won’t remember you and will not bad-mouth you in the future, unless you go attack him, and then you’re starting an unnecessary battle that you don’t want.

Kevin Pho: What’s the best way to notify your employer that you’re leaving?

Amanda Hill: So, short and sweet. I’ve had doctors tell me, “I’m going to write this letter explaining all the possible reasons why I didn’t like it here and why I felt like I was underpaid.” Absolutely not. You write about a two- or three-sentence resignation letter saying, “Thank you for the opportunity. I’m putting in my notice. My last day will be X, according to my contract. I look forward to talking to you soon.” It needs to be short and sweet. Do not give a bunch of reasons. This is not a chance to write the great American novel. Just tell them you’re leaving, tell them the date, and get out.

Kevin Pho: We’re talking to Amanda Hill. She’s a health care attorney. Her KevinMD article is titled “Mastering the art of transition: essential tips for leaving your medical career behind and pursuing a new path.” Amanda, tell us some of your take-home messages that you want to leave with the KevinMD audience.

Amanda Hill: Well, I just want to encourage doctors not to jump from one thing directly into the next without really thinking it through. Sit down with your lawyer or your advisor, go through your contract, and think about the next thing and how it’s going to be different. Maybe do some mindfulness or coaching about whether you’re in the right headspace to start this new thing. And really focus, to make sure that you’re doing every step of the transition well, that you’re being professional, and that you’re taking the time that it takes. I’ve had doctors walk through this tenuous transition phase and have such a better life on the other side, because they focused, they were professional, and they took every step as it came. They sort of joyfully got out of something rather than burning it on the way out.

Kevin Pho: Amanda, thanks again for coming back on the show and sharing your time and insight.

Amanda Hill: You’re welcome. Anytime.