Editor’s note: This is the first in a new series focusing on issues of interest to early career pediatricians.
Katherine Bline, M.D., FAAP, admits she knew little about employment contracts when she signed her first one in 2020.
“I was told that academic contracts were not negotiable and believed it, but I ended up accidentally negotiating and it made me realize that I had a lot to learn,” said Dr. Bline, who now is an assistant professor in the Division of Pediatric Critical Care Medicine at Nationwide Children’s Hospital in Columbus, Ohio.
That’s not uncommon, said Jesse Hackell, M.D., FAAP, chair of the AAP Committee on Pediatric Workforce. Pediatricians often don’t know what to look for in their first contract or what they should negotiate, which can cause problems down the line, Dr. Hackell said.
“There is essentially no business training as part of a pediatric residency or in medical school,” he said.
To fill that gap, Dr. Hackell and Dr. Bline, a member of the AAP Section on Early Career Physicians, have plenty of advice for those navigating their first contract.
Part of the process
Contract negotiation can be intimidating, but Dr. Bline recommends considering it an “expected part of the process.”
“I think so many people are afraid to engage in negotiation because they don’t want to be seen as greedy … but, collectively, getting pediatricians to be better at this could also help the field and care for patients,” she said.
If an institution isn’t open to negotiation, Dr. Bline considers it a red flag. “They should want to make sure that this opportunity will meet your career goals and aspirations and help you be successful.”
Key considerations
It’s important to become familiar with common characteristics of contracts and ask mentors and peers about their experiences. Following are some key considerations:
Location: Unlike in real estate, location isn’t everything, but it is important. Clinicians, especially those working in private practice, will put down roots in a community, which can make leaving hard, Dr. Hackell said. “… where you are settling in is, with some likelihood, going to be where you stay for many years or even for your entire career.”
Contract length: A one-year contract often is too short for a first contract. “You need to make sure that the contract has enough time in it for you to assess the practice and the practice to assess you before you start talking about renewal,” Dr. Hackell said. In addition, pediatricians should ensure there are opportunities for advancement or change in status when the contract is up. “You need to figure out what your needs are,” Dr. Hackell said. “If your needs are to become a partner or an owner or a manager, that should be an option that’s in your first contract.”
Compensation: It’s critical to understand the pay structure, including the base salary and how bonuses are determined, Dr. Bline said. “It’s a red flag if the compensation formulas are unclear.” It’s also important to determine how pay will change, Dr. Hackell added. Some employers tie productivity goals to pay, which are difficult to meet in the first year.
Clinical expectations: Dr. Bline advises pediatricians to clarify the role, including clinical expectations, call schedule and any other expected duties, such as teaching or administration. Key questions to ask are: How is office time broken down between seeing patients and doing administrative work? How many patients are typically seen in a day? If colleagues leave, who gets their clinical responsibilities? “If something wasn’t determined in the contract or written down anywhere, it’s within the right of the institution to do that, but it can really impact quality of life and job satisfaction,” she said.
Restrictions: Think about leaving a job even before accepting an offer, Dr. Hackell advised. “You need to make sure that if you decide for whatever reason to leave your employment situation, there are not severe restrictions on you.” These include noncompete stipulations limiting a physician from working in the same area for a certain timeframe after leaving a practice.
Retirement: As with all jobs, it’s important to ensure there is a retirement plan that will put you in a position to retire when the time comes, Dr. Hackell said. Pediatricians also need to ensure the contract stipulates what will happen if they or another physician in the practice gets sick or dies unexpectedly.
Malpractice: Standard contracts include malpractice coverage paid by the employer. Most policies cover claims filed during the effective period, according to Dr. Hackell. Physicians also need coverage for claims made after they have left the employer (i.e., tail coverage), which can be expensive. “Any contract should discuss the cost of tail coverage,” Dr. Hackell said. “Ideally it would be the employer’s responsibility, but that is not always the case, especially if an employee moves on after only a short period of time.”
Resources and development: Items such as advancement opportunities, AAP memberships, continuing medical education (CME), time off, mentorship and other details are negotiable. “Never assume anything is standard,” Dr. Hackell said. “If you’re at a current institution and they have a certain amount of CME, don’t assume that a different place will have the same. Ask those questions. Make sure that’s included in the contract.”
Dr. Hackell calls the first contract the “sweet spot” since that’s when an employer is most interested in a candidate.
“It’s not the first contract you need to be wary of. It’s the second contract,” he said. “You need to have at least some guidance as to what will happen after the first contract, and I don’t think that’s too much to ask. A practice that balks on giving you that is one I would worry about.”
Resources
- Information from the AAP on evaluating an employment agreement
- National trends in pediatric salaries
- Information from the American Medical Association on understanding physician employment contracts,
- The following are available through AAP Member Advantage Programs.
- Employee contract review services, negotiation services and pediatrician salary data via Resolve
- Educational content including white papers, videos, podcasts and blog articles
- Physician salary data
- AAP virtual career fair webinar on contract review tips and salary data
- Information on loan consolidation, high yield savings accounts, personal lending and financial education from Laurel Road
- USI insurance program
