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 found on YouTube and LinkedIn.
Dennis is a frequent lecturer on physician contracts to residency and fellowship programs and has spoken at events sponsored by numerous health systems and physician organizations, including the American Osteopathic Association, the White Coat Investor, the American College of Rheumatology, the American Health Law Association, and the American Podiatry Association.
Dennis has authored several published articles on physician contractual matters on forums such as KevinMD and Medscape. He is also the author of The Final Hurdle – A Physician's Guide to Negotiating a Fair Employment Agreement, which is considered the go-to resource on physician contract negotiation.
Many physicians do not seem to grasp the risks inherent in physician employment agreements that impose a minimum threshold of wRVU production. However, there can be many pitfalls in these agreements.
What is the effect of the threshold?
The first pitfall is determining the effect of a threshold. Some agreements provide a salary “assuming a minimum threshold of” some number of wRVUs. I have reviewed many agreements with a provision like that …
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wRVU threshold risks in physician contracts
I have been representing physicians for over 30 years, and I am still amazed by the attitude of most young physicians going into their first attending position. These are smart, accomplished, fully qualified physicians who have received some of the best clinical training in the world. And yet, many of these highly trained individuals in a field with massive shortages seem reluctant to acknowledge even the slightest modicum of self-worth.
Bear …
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First physician employment agreement mistakes
Physicians joining private practices have a relatively new issue they should be aware of. As more practices are taken over by private equity, the traditional concerns of a physician joining a practice as an employee with the hope of becoming an owner are heightened.
Traditionally, the physician would join the practice as an employee, work for a few years, and get the “golden ring” of ownership after a few years. Often …
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Private practice employment agreements: What happens if private equity swoops in?
Lately, I have seen a few instances where physicians have been tricked by a term in their physician employment agreement that clearly does not mean what the physician thinks it means.
The most recent example came when I was negotiating a physician employment agreement, and the physician suggested verbiage concerning her scheduling. The physician suggested that we ask for language that the employer would develop a clinical schedule “after consultation with …
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A physician employment agreement term that often tricks physicians
Are 10 percent (or 25 percent) of all the physicians in your specialty breaking the law?
Of course not! Who would think such a thing?
Your friendly neighborhood “nonprofit” hospital, that’s who!
I have been reviewing physician employment agreements for almost 40 years, and in the last few years I have noticed a spike in the number of agreements that “cap” physician salary. A shocking number of hospital employment agreements provide that the …
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Why hospitals are quietly capping top doctors’ pay
If you are working as an independent or locum tenens physician, there’s a good chance you’ve found yourself wondering: Am I being paid fairly for my time and expertise? Unlike employed physicians, whose compensation is often shaped by established benchmarks and internal HR formulas, independent and locum tenens doctors are frequently left to navigate negotiations on their own—often with limited information.
Understanding what constitutes “fair market value” in this context is …
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What independent and locum tenens doctors need to know about fair market value
If you have been offered the opportunity to buy into a medical practice, congratulations! For most physicians, this will be a tremendous opportunity. Being offered an ownership interest indicates that the current owners recognize your worth and are inviting you to “join the club.” It is hard to imagine a greater validation from your peers.
At the same time, physicians do need to protect themselves from a bad deal. In my …
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What every physician should know before buying into a medical practice
“Crappy doc” terminations. First, let me apologize for the use of legalese. Of late, I have been hearing concerning stories about physicians who were terminated from employment on the grounds of supposedly poor-quality care. These are not what you would call slam dunks—I’m not talking about leaving a scalpel in the patient or showing up drunk for rounds.
The stories I hear (admittedly, I’m only hearing the physician’s side) have been …
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Doctors beware: How vague contracts put your job at risk
Are hospitals crazy?
I suspect many physicians would answer “yes” to that question without much contemplation. I have always assumed that, although hospitals are profit-driven and therefore likely to have very different priorities than physicians who care about patients, the institutions can be relied upon to have some semblance of reasonableness.
Lately, however, I have been forced to reconsider my position. For decades, I have represented physicians in their various interactions with …
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The legal trap every doctor needs to know before signing a contract
When you have been reviewing physician employment agreements for nearly four decades, you tend to get a little jaded about the possibility of ever seeing reasonable compensation for physicians. Although I am continually preaching to the choir about the need for reasonable physician compensation, I rarely see something that gives me encouragement that physicians may someday be paid appropriately for everything they do.
However, recently I have reviewed several agreements titled …
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The tiniest ray of hope for reasonable physician compensation?
As somebody who has reviewed physician employment agreements for 40 years or so, I have to admit I am more than a little jaundiced when it comes to the subject of hospital executive compensation. I’m not altogether convinced that one health system CEO really “earned” the $35.5 million he was reported to have been paid in 2021. I’m sure the pandemic was hard on him. Seeing all those physicians exposing …
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Are hospital CEOs overpaid? One lawyer’s skeptical take on executive compensation.
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 …
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Very rarely, a physician can ask for too much
I have been representing physicians for over 40 years, and the vast majority of the people I work with are genuinely nice. Overworked, stressed, sometimes distracted – yes, but most physicians entered the profession because they were sincerely concerned about people and wanted to help. Medicine can be a truly thankless job, and the vast majority of physicians don’t pursue it solely for the money.
Unfortunately, this characterization of physicians is …
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Not all physicians are nice
Locum tenens agreements can be useful to physicians in many circumstances. In addition to serving as a way to supplement your income during vacations, physicians often enter locum tenens agreements between jobs, to provide income while waiting for interviews or for credentialing to be completed at a new position.
In many ways, reviewing a locum tenens agreement is similar to reviewing a physician employment agreement, but there are unique aspects to …
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Locum tenens agreements for physicians
At least one commentator has opined that “physicians aren’t burned out. They’re abused.” That is an extremely accurate diagnosis. No matter how many mandatory meditation sessions physicians are required to attend during their lunch hours, they remain overworked, overstressed, and unhappy with their careers.
Although there is no easy fix, there are issues that can be addressed in the physician employment agreement that can ameliorate the horrible working conditions foisted …
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A tiny step to reduce physician burnout
It will come as no surprise to anyone reading my articles that hospitals can be extremely condescending to physicians. As a physician’s lawyer who spends his days reviewing and negotiating physician employment agreements, I am also frequently “treated” to this phenomenon.
My firm has coined the phrase “hospitalsplaining” to describe how hospitals routinely talk down to physicians and their lawyers. A recent example illustrates the problem nicely.
We were reviewing a …
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Hospitalsplaining: a lawyer’s perspective on condescension in the medical field
Physicians receiving a new employment contract need to be aware of issues that can arise related to their compensation and benefits. These are some of the things that should be carefully reviewed before signing the agreement.
Compensation
The agreement should clearly provide what productivity is expected. You can frequently gauge expected productivity by the salary level. If one employer is paying significantly more than another, it is a safe bet that the …
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New employment contracts: What physicians need to know about compensation and benefits
If you are considering accepting an academic appointment, you need to be cognizant of the special issues involved in contracts in academia. You must know these things before signing an academic physician employment agreement.
An academic physician employment agreement is usually light on provisions.
Unlike most hospital physician employment agreements, an academic physician employment agreement tends to be very sparse on contractual provisions. Typically an academic physician employment agreement will just be …
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Things to know before signing an academic physician employment agreement
