For over 40 years, I have been harping on the fact that physicians rarely understand their true value when they are looking for a new position. I always advise physicians that they get 0 percent of what they don’t ask for.
In my practice, I review physician agreements and provide a letter on my law firm stationery requesting changes. I frequently need to convince physicians that they should send my letter “as is” without removing requests they feel are asking too much or are not important to them. Asking for what is fair is not unreasonable, and I always explain that the issues that they may not feel are important can come back to bite them in the posterior in the future and can be used as bargaining chips in negotiating for what they feel is important.
In 40 years, I had only ever seen one offer withdrawn after sending my letter, and that withdrawal was based on a credentialing issue.
Recently, however, an offer to a physician was withdrawn based on the physician’s requests. I have learned that there is one area where you can overreach. The physician in question had been in practice for several years and had been approached to join a private practice. He was adamant that he should immediately be made a partner and should not have to pay anything to buy into the partnership.
I explained to him that I had very rarely seen partnership offered immediately, and that a thriving private practice was extremely valuable. Nevertheless, the physician was convinced that he was in a strong negotiating posture (which is almost always the case given the physician shortage in this country) and that the practice would be desperate to sign him.
He also insisted on compensation significantly above median and for two weeks more PTO than was offered. The PTO offered represented the MGMA median. I frequently see first offers below median compensation or median PTO. Whether the physician feels happy with the first offer or not, requesting the median amount hardly seems unreasonable.
Of course, it is impossible to say which straw broke the camel’s back for this particular physician group, but I feel that the demand for immediate ownership at no cost was the “bridge too far.”
A group of physicians that have spent their professional careers building a valuable practice are unlikely to be willing to give a share of the practice away without receiving any compensation. Moreover, a professional practice should be a collegial affair. A given physician may be superbly clinically qualified, but how that physician will react to the day-to-day stresses of practicing medicine is largely unknown. A brief interview (or any interview process) is unlikely to provide the partners with reassurance that a given physician will be an asset to the practice in the long run.
Physician partners never know if the group will be able to keep staff and continue to receive referrals until a given physician is practicing “under fire.” Although I have spent my life advocating for physicians, I find it hard to argue that a physician should not have to prove his or her mettle before being admitted to “the club.”
Physicians are entitled to a fair contract, with fair compensation and fair benefits. But asking to become a partner with people who have had little personal interaction with you is probably too much. Partnership is a rare privilege, and it is fair to have to earn that privilege.
Dennis Hursh is a veteran attorney with over 40 years of experience in health law. He is founder, Physician Agreements Health Law, which offers a fixed fee review of physician employment agreements to protect physicians in one of the biggest transactions of their careers. He can also be reached on Facebook and LinkedIn.
