Inderpal Singh, M.D.

Fall 2020 | Snapshot


“PracticeLink also gives details about the job and employer, which helped me screen if I should proceed with contacting the employer or let it go,” says Inderpal Singh, M.D. – Photo by Kris Janovitz

Employer: Self Regional Medical Center in Greenwood, South Carolina

In practice since: July 2018

Singh loves fusion cooking and spending time with his wife and two kids.

What surprised you about your first job search? There are so many jobs available in the market, but it is not easy to find the right fit. There is so much variability: social life, weather, school districts and the potential to grow in your own specialty.

What is your advice to residents looking for jobs? Please start searching for jobs at least six months in advance. Compensation is just one factor of getting attracted toward a job, but make sure this is not your only concern.

Do a background search on the area and the reputation of the workplace. Lots of things are available on the internet and may save you time before actually visiting the site and then getting disappointed by not experiencing what you are actually looking for.

What was most important factor in your job search? I was looking for a hospital-based position in a city with a low cost of living and the ability to enjoy a good social life

Anything unique about your job search? My specialty is interventional pain management, and there is an ongoing opioid epidemic issue, as we all know. So for me, finding a place with a good work ethic and strictly following CDC guidelines were of utmost importance.

How did PracticeLink help you in your job search? The website is simple and very easy to find the latest jobs. It also helps to search for jobs based on a particular state, or search private vs. hospital-based positions. PracticeLink also gives details about the job and employer, which helped me screen if I should proceed with contacting the employer or let it go.



Live & Practice: Sports Towns 2020

By Liz Funk | Fall 2020 | Live & Practice


After finishing undergrad at Harvard, Chris Lewis, M.D., returned to his hometown of Cincinnati—and chose to stay for his career. – Photo by David Stephen Kalonick

In some areas of the country, sports are so embedded in the local culture that they practically become part of day-to-day life. Ask any Dallas resident, and they’ll tell you the Cowboys are widely loved, regardless if they have won or whether one truly follows the sport. In State College, Pennsylvania, Penn State alumni return to campus to see their Big 10 teams compete. In Anaheim, California, locals can root for minor league teams—or join in the Lakers mania in nearby Los Angeles. And Cincinnati’s baseball team, endearingly referred to as “the Reds,” is the only MLB team that, as a rule, has their first game of the season at home, making for a full day (and evening) of team spirit and celebration.

State College, Pennsylvania

State College is nestled in a valley surrounded by beautiful central Pennsylvania mountain ranges. While the scenery is bucolic, State College can be an action-packed place to be. It’s home to the flagship campus of Penn State University, with nearly 50,000 undergraduate and graduate students. The Penn State community is devoted to the university football team, and football season is practically synonymous with fall. Penn State is a “Big 10” school that competes with sports teams at other large universities like the University of Michigan, The Ohio State University and Northwestern University.

Christopher Hester, M.D., heeded an early calling to internal medicine. “I realized that I wanted to be a physician in high school. My family physician was an older provider that had cared for members of my family since my mother was a child. Everyone in my family trusted our physician’s medical judgment. I hoped that patients would trust me some day the way my family trusted our family physician,” he says.

Hester attended Penn State College of Medicine at the Hershey Medical Center, an academic medical center in Hershey, Pennsylvania, near the state capital of Harrisburg. The environment clicked for Hester and he continued at Hershey Medical Center for his internship and then residency training.

“I interviewed with a group in the area and was amazed by the level of talent of the providers in the group and by their strong reputation among my training physicians at the Hershey Medical Center,” Hester says. He’s nearing his 25th year with Mount Nittany Physician Group.

Mount Nittany Health can trace its roots back to 1902 and is now one of the predominant health care providers in central Pennsylvania.

Says Nichole Monica, director of marketing and communications for Mount Nittany Health: “We have more than 18 Mount Nittany Health locations–with 16 Mount Nittany Physician Group locations–in six counties.” Mount Nittany Health employs more than 2,800 people. Mount Nittany Health operates Mount Nittany Medical Center, a 260-bed hospital in State College.

“As the area’s largest multispecialty group [Mount Nittany Physicians Group], our more than 170 providers serve nearly 100,000 patients each year, offering primary and specialty care services at a growing number of offices throughout central Pennsylvania,” says Monica.

Hester’s long tenure at Mount Nittany speaks volumes to its culture. Says Hester, “I still work with many of the same people since my first day nearly 24 years ago. …The providers, nurses, front desk staff and administrators I work with at Mount Nittany Physician Group are excellent and are committed to providing the highest quality care.”

Other opportunities in the area can be found at outpatient clinic Geisinger – Patton Forest and SunPointe Health, a physician-owned internal medicine practice in the area.

Outside of work, “Happy Valley” has lots to offer, particularly when it comes to special events and outdoor activities. Says Edward Stoddard, communications director for the Happy Valley Adventure Bureau, “We have all the excitement, opportunities and culture of a small city, plus small town roots. You can enjoy reasonably priced fine dining with a spectacular valley view or a pleasant drive among rural fields—20 minutes from downtown State College.”

Stoddard emphasizes that State College’s appeal is in its dichotomies. “One of our strengths here is all of the outdoor opportunities located nearby the urban mix of Penn State University. Spend the weekend enjoying nightlife, a concert and shops, or drive 10 minutes, hike for 30 minutes and escape every sound of civilization.”

Hester appreciates the local access to the outdoors and top-notch sports. “I most enjoy the outdoor activities including mountain biking at Tussey Mountain, boating at nearby Raystown Lake and sporting events at Penn State.”

“Whatever one’s definition of adventure is, we believe it can be found here,” says Stoddard.

Cincinnati, Ohio

Cincinnati is a special place. It is a midwestern, medium-sized city with a lot of local pride. And there is a lot of be proud of. The people of Cincinnati played a large role in the abolition of slavery with a number of “stops” on the Underground Railroad. Today, local museums and exhibitions celebrate and preserve Cincinnati’s social justice roots. Another source of great pride is the city’s predominant health care system, UC Health (University of Cincinnati Health). With a diverse patient population and a system-wide focus on community health, UC Health is a place for physicians to marry their medical expertise with a passion for improving the overall health of their city and its residents.

Chris Lewis, M.D., began his medical career at the University of Cincinnati College of Medicine. It was an easy choice: His mother worked at the university, and family members were eligible for full tuition remission. Lewis was a biology and pre-med undergraduate at Harvard University, and he liked living in Boston. “My initial plan was that I would go back to the East Coast after medical school,” says Lewis. “But I fell in love with the health care industry in Cincinnati. We have a plethora of hospitals and doctors. In Cincinnati, we have a fairly sizable equity gap in terms of who gets access to health care. What I love about Cincinnati is that we have a whole bunch of people closing those gaps.”

Solving that challenge and working with passionate people eclipsed the allure of going back to Boston. “It seemed wrong to take my medical education and go back to Boston when there was so much that could be done here,” says Lewis. This decision was spot-on foreshadowing for Lewis’ activism at the intersection of health care and social justice.

Lewis stayed on at UC Health—the health system anchored by the University of Cincinnati Medical Center—for his residency, then joined a family medicine practice and firmly put down roots in Cincinnati. “It’s a fantastic place to live and work,” he says. “We have world-class industry. We have arts, ballet, symphony, soccer, baseball and football. We have a downtown area that is undergoing a real resurgence. My wife and I are foodies, and we can’t keep up with the restaurants on every corner.”

Indeed, food, history and sports are important parts of Cincinnati’s culture. Says Jenell Walton, director of strategic initiatives for the Cincinnati Convention and Visitors Bureau, “We have a sort of big city/small town feel. Here, we have Fortune 500 company headquarters, world-class arts and culture experiences, big league sports, historic architecture and an incredibly unique culinary scene.” The Cincinnati region is home to 2.2 million people, while the city of Cincinnati itself represents just over 300,000.

The Cincinnati Reds is the city’s beloved baseball team. “Reds Opening Day in Cincinnati has been a special tradition, and an unofficial holiday, for a century and a half,” says Walton. “There are several local parties throughout downtown Cincinnati, especially near the Banks Entertainment District near the ballpark, that keep the celebration going all day and night,” says Walton.

Lewis returned to UC Health as a practicing family physician and took on an academic role as the assistant dean of diversity and inclusion. “The College of Medicine puts a huge emphasis on diversity and inclusion. They are great about giving money for scholarships for health care students of diverse backgrounds,” says Lewis.

What Lewis is perhaps most known for at UC Health is his work on the Village Life Outreach Project, a non-profit organization he founded that organizes volunteering in Tanzania and bringing Tanzanian teachings and wisdom back to Cincinnati.

Lewis still sees patients one day a week, but most of his time is devoted to his role as vice provost for undergraduate programs at the University of Cincinnati. “I started as the assistant dean of Diversity and Inclusion. I wouldn’t have made it through medical school without the people who started that office, the Office of Diversity and Inclusion. I needed support and guidance and some handholding as a medical student. When I was given an opportunity to join that same office, it was a no-brainer. Then I got the academic bug.” He pivoted into higher education administration.

Lewis has advice for medical students to feel supported on their path: seek mentors. Says Lewis, “I encourage students to develop a network of mentors, and to pursue a step beyond mentors, which are sponsors. Mentors are people who will give you advice and be sounding boards. A sponsor is someone who is willing to stick their neck out for you. Every amount of career success I’ve experienced has been attributed to a mentor, group of mentors or sponsors.” This ethos of creating an interdependent community of people who give and share seems influenced by the generous culture of Tanzania, and is also highly useful career advice.

Dallas, Texas

With a home base in Dallas, James Pinckney, M.D., started a medical concierge company to provide patients direct physician access and upscale care. – Photo by Kelly Williams

Dallas, Texas, comes with a lot of preconceived notions about what it’s like to live there: There are cowboys (the people), the Cowboys (the team), and everything is “Dallas big.” Dallas is indeed big; it’s the ninth largest American city with a population of 1.4 million people within the city and 6.8 million residents in the greater Dallas metro area. Dallas has a big personality, too, and for good reason: It’s a big city with a high quality of life and a low cost of living (and no state income tax!).

When James Pinckney, M.D., was a small child, he discovered a television channel that showed medical procedures, namely surgeries. He was transfixed. “My mom thought that was a little weird,” says Pinckney. But he knew he wanted to be a doctor as soon as he could operate a remote control. As he got older, he developed a special interest in anatomy and physiology that dovetailed with his passion for playing football.

Pinckney grew up in the suburbs of Dallas and was a star on his high school football team. “High school football is huge here. Like Friday Night Lights. People love coming out to support their high school football teams,” says Pinckney. Alas, he was sidelined by a sports injury; he seriously broke his leg on the field. So he headed off to college at Wake Forest University with full focus on his dual major in pre-med and biology. That focus paid off: Pinckney landed a full scholarship to Baylor College of Medicine in Houston. His goal was to become a surgeon.

Pinckney had what he calls a “quarter-life crisis” during his general surgery residency at Cedars-Sinai Medical Center in Los Angeles. “I love being in the OR, but I’m a people person,” he says. “As a surgeon, most of your time spent with your patients is when they’re half-asleep at 4 a.m. before their surgery or they’re asleep on your operating table.”

After some soul-searching, Pinckney decided to pivot into family medicine. He landed a residency with Methodist Health in Dallas, and became a board-certified family medicine provider. This proved to be a better fit, and he began to think in a bigger way about how to add more depth and meaning to the patient relationship. He wanted to make going to the doctor a better experience.

Today, Pinckney is the founder of Diamond Physicians, a primary care concierge that circumvents insurance companies by having patients pay for a membership that gives them more direct access to their doctor and an upscale patient experience. Pinckney was happy to set up shop in his hometown of Dallas: “It’s a great place to live,” he says.

“Dallas is a very user-friendly city,” says Stephanie Faulk, the director of marketing and communications for VisitDallas. “It’s easy to live here. The weather is great. We can do year-round sports, year-round growing in our gardens. There’s lots of space, and it’s affordable.”

Faulk says that one of the most important aspects of culture in Dallas is its sports teams. “Dallas is definitely a sports city. We are one of the few cities that has a team for every major league sport: hockey, baseball, the NBA, the WNBA, and of course, the Dallas Cowboys. Dallas is synonymous with the Dallas Cowboys.”

In fact, the city’s growing population called for a bigger stadium for the Cowboys. After 10 years of planning and construction, the new stadium was completed in May 2017 and can accommodate a whopping 80,000 people. “Our stadium is new enough and big enough to really make an impression. It’s an experience,” says Faulk.

For those who like to travel, Dallas is an excellent place to call home base. The Dallas-Fort Worth international airport is one of the largest airports in the country and serves as home base for American Airlines and Southwest. “We can fly anywhere direct,” says Faulk. “We can get to either coast in under four hours.”

Pinckney has been doing some traveling himself. He’s working to build out Diamond Physicians as a national brand with franchising opportunities for physicians who are entrepreneurial and passionate about the benefits of concierge medicine: less middlemen and more time with patients.

Says Pinckney, “When I see a patient, I spend, on average, an hour with that patient. The national average is seven minutes. When patients come to see me, I personally come greet them, and we sit in my office and talk. We have nice exam rooms, but they’re just for physical examinations. After I examine a patient, we will go back to my office to talk about options and treatment.”

Outside of work, Pinckney thoroughly enjoys living in Dallas. “If you want to be in the city, you can have a rich city life. If you’d rather have more space, there are many suburban areas that all have a different feel, and excellent schools,” he says. After living and practicing in a handful of other cities— Winston-Salem in North Carolina, Houston and Los Angeles— Pinckney is happy to call Dallas home and happy to call Dallas home base for his business.

Anaheim, California

When most people think of Anaheim, California, they think of Disneyland. But there are ample job opportunities beyond the mouse ears. Anaheim is approximately an hour southeast of Los Angeles, but Anaheim offers culture and industry that makes LA seem like a distant mirage.

“Anaheim is rich in many things including history, culture and activities. The city continues growing, evolving and flourishing as a dynamic destination with its own cultural footprint in the arts, cuisine, entertainment, sports, and recreation. It’s home to activities and attractions that provide residents such a unique living experience,” says Jay Burress, president and CEO of Visit Anaheim.

With a population of 333,000, Anaheim is a large city that has a small-town feel. Says Burress, “No matter where you go, you’re greeted with a smile and a warmth that’s hard to find elsewhere. Neighbors care about you, about your family and about your work.”

Center City Anaheim is a hub of activities, including a yearly Halloween parade. Anaheim’s mild to warm year-round weather is conducive to the weekly outdoor farmer’s market in Anaheim.

For visitors interested in relocating for a health care career, Anaheim has a lot to offer. There are several hospitals and health care systems that may be of interest to physicians considering a move.

Anaheim Regional Medical Center is a 233-bed facility owned by Advanced Healthcare Management Corporation (AHMC), a for-profit health care system based in Southern California.

Kaiser Permanente Orange County-Anaheim Medical Center is the largest health care provider in Anaheim and the largest employer of health care professionals in the area. It is a 484-bed facility with specialists in pulmonology, neurology, oncology and obstetrics.

For Anaheim-based physicians, there is no shortage of things to do during their off time, especially if sports are of interest. Anaheim is the proud home of both the Los Angeles Angels (MLB) and the Anaheim Ducks (NHL). The Angel Stadium of Anaheim and the Honda Center are across the street from each other. Not only can you catch a game all year round, you might even score a doubleheader when the seasons overlap in April, May and October.

Burress has a “pro tip” for those who want to watch the game from the comfort of a restaurant or sports bar: Many of the breweries, bars and restaurants near “Platinum Triangle,” the sports district, will comp your parking during the game, so head out early for a pregame celebration.

“Whether you come for work or play, choose your own sun-soaked Southern California adventure,” says Burress. For a week’s vacation or a long, happy career in health care, you will find plenty to do in Anaheim.



The who, what, when and how of contract negotiation

Approach your next employment contract with flexibility, knowledge and backup support.

By Debbie Swanson | Fall 2020 | Feature Articles


Remember—especially when working with large hospitals or practices— that you may be presented with a standard contract with little wiggle room, says Houtan Chaboki, M.D. – Photo by Arielle Lewis

Your long-awaited dream is finally within sight. You’ve been offered a promising job! You’re just one signature away from a celebratory dinner. But don’t reach for your jacket just yet. No matter how excited you may be to seal the deal, there’s one more crucial step: contract negotiation.

The first contract you receive isn’t necessarily the one you’ll sign. Most employers expect some back-and-forth after they deliver your employment contract. These lengthy documents are written by attorneys paid to protect an employer’s interests first. Before you sign, you should take time to read and understand what you’re agreeing to. That way, you can identify any clauses that are vague, missing or not in line with your best interests.

Step 1: Getting ready

When you’re contemplating a job, it’s important to weigh your priorities. What do you and your family need and want from the arrangement? Your priorities may have shifted throughout your medical journey, so if you haven’t revisited them recently, now is a good time.

Clarify your vision

You probably have some ideas about what you want your career to look like. Now is the time to make sure your job offer lines up with the picture you have in your head. Take these factors into consideration as you do:

Location. Does the job require relocation? Is that feasible for you and your family? Do you plan to stay in the area, even if you don’t stay at this job? If so, review any restrictive covenant carefully as it may limit your future mobility.

Finances. How much debt do you have? Can you afford to move? Consider negotiating for loan forgiveness, a relocation stipend or a signing bonus to help offset these burdens.

Lifestyle. What kind of schedule are you looking for? What other responsibilities do you need to keep in mind? Be sure you understand your expectations in terms of days and hours worked.

Other endeavors. What else is on your plate, both professionally and personally? Do you have an entrepreneurial nature and want to start a side business? Do you plan to do other medical work on the side? Take note of any restrictions limiting such activities.

Career direction. What do you hope to be doing in five or 10 years? Is this job a good steppingstone toward that goal?

Ongoing learning. What are you interested in learning more about? Education doesn’t end with medical school, so make sure this job supports continued learning through mentors, educational opportunities or other avenues.

These considerations will help you determine whether this job and this contract fit your needs. Just as you planned out your education and residency, you now need to map out your career to reach your professional goals.

“[You] need to be happy with the scope and trajectory of your individual practice,” advises R. Bryan Butler, M.D., a surgeon at Orthopaedic Medical Group of Tampa Bay. “For instance, as a shoulder-and-elbow-trained specialist, when I chose a group or location, I wanted to make sure that the majority of my practice would entail shoulder and elbow patients.”

Ramp up your knowledge

As you were winding down your academic years, you probably received plenty of career guidance to land a residency or fellowship or craft your CV and nail your interviews. However, young physicians don’t always receive much advice about employment contracts. The good news is just a few hours of research can quickly get you up to speed. Search online for sample contracts, ask your medical schools for resources, and reach out to past mentors or professors for help.

Some employment issues—such as insurance costs and regulations—vary greatly by region, so tailor your efforts to your location. Consider your specialty, too. Supply and demand for specific types of physicians play a big role in salary, perks and your overall leverage. Finally, consider your background, skills and education. What do you bring to the table, and do your credentials give you an advantage in negotiations?

Line up supporting resources

Employers have plenty of legal minds on their side. It wouldn’t make sense for you to go without. Before you sign a contract, have a lawyer review it. Choose an attorney who is familiar with physician employment contracts. If you need help finding someone, check with alumni associations, nearby medical schools or colleagues for recommendations.

“M.D.s do not usually have training in business and law,” says Scott Goldsmith, M.D., president of Orthopaedic Medical Group of Tampa Bay. “It’s prudent to have [a lawyer] mark up the document to point out possible areas of concern for you. There are always points of the contract that need to be addressed further, so if the attorney sends back a contract without any red marks, it would be wise to seek alternative legal advice.”

Your lawyer will charge a fee, but it’s money well spent. Legal review can help improve your job satisfaction and prevent conflicts during or after your employment. Plus, you may even recoup the cost directly or indirectly if your lawyer helps you negotiate better terms.

In addition to seeking legal guidance, you should also tap into your medical network for their knowledge.

“Talk with other doctors you trust, others finishing up residency or fellowship proctors [with whom] you established a relationship. You can do this without divulging specifics. Speak in broad strokes,” suggests Goldsmith. “Have an intelligent conversation about what’s reasonable, what they’ve been seeing, without revealing any personal details.”

Step 2: Getting down to the nitty-gritty

It may be the last thing you want to do at the end of the day, but don’t put off reading your employment contract. Whether it’s a page-long letter or a hefty 30-page document, it’s well worth analyzing. Don’t just expect your lawyer to read it for you. This review should be a mutual exercise.

“Remember that [your] attorney is being paid to look after your best interests, but at the end of the day, you alone get to decide if you believe the contract is fair for you,” Goldsmith says.

Even with help, it’s up to you to take the reins in your contract negotiation. “The importance of representing yourself is paramount,” says Scott Goldsmith, M.D. – Photo by Alicia Johnson

What am I looking for?

Gather some sticky notes and highlighters as you prepare to mark up the document. Flag things you don’t understand or don’t agree with. Make note of anything you plan to research or ask colleagues about. Look also for what’s missing. Sometimes, informal agreements you discuss in an interview don’t find their way into the contract, and you’ll need to have them on paper if you want them enforced.

Be on alert for vague language or sparse descriptions, such as “perform duties as required” or “participate in call rotations in compliance with the group.” These open-ended statements put no limit on what can be asked of you, and they don’t provide benchmarks you can use to measure your performance.

“Get the job expectations in writing as much as possible—specifically with certain areas, such as call expectations, weekly clinical work responsibilities and even how add-on cases are handled,” suggests Goldsmith. “As the new hire, will you get access to the same work as the others? Is there a true collaboration among the surgeons, or is it more of a pyramid scheme?”

Don’t skim or give a half-hearted effort. Just as your lawyer’s copy of the contract should come back with notes, your own copy should be marked up when you are finished with it.

What’s off limits?

While you shouldn’t hesitate to voice any and all concerns you identify, be aware that some areas may be out of your employer’s control.

“Everything is potentially negotiable. However, for large hospitals or practices, there may be a standard agreement with little wiggle room,” says Houtan Chaboki, M.D., president of Potomac Plastic Surgery in Washington, D.C. For example, health, dental or vision insurance coverage likely can’t be changed. Similarly, he adds, “The noncompete clause is less likely to be negotiable.”

“[Other] areas, such as scope of practice or schedule management are more likely to be negotiable. For example, the physician may only want to see certain types of patients on specific days,” explains Chaboki.

“Also, [hold off on asking] how many operating rooms you will have,” Butler says. “This takes time to develop, and it is unlikely that a group is going to be able to guarantee high surgical volume and multiple rooms right off the bat.”

One more area to keep quiet about: phone bills and mileage reimbursement. “These are usually reserved for partners,” says Butler.

If you have an impending major life event, such as a wedding or new baby coming up, it’s better to raise questions about it now, rather than request time off right after you come on board.

A word about salary

Salary is always a hot topic in negotiations, but there’s not always much wiggle room. “At my private practice group, all our new hires straight out of fellowship have the same starting salary,” Butler says. “Most groups are not going to want to negotiate much on salary until the new hire has proven him or herself.”

“There are instances, however, where someone might have a unique skill set or has longer experience or serves in area that is in desperate need for someone right away. If these or other factors are present, then there is more room for negotiation,” Butler adds.

There’s a wide range of compensation models. Physicians early in their careers usually receive a fixed salary, possibly with a productivity bonus. More experienced physicians might be offered a more variable salary. It’s generally difficult to negotiate a different compensation model than the standard one your employer offers, but it’s still important to understand it. Make sure your contract fully explains your compensation, how long it is guaranteed and any external factors that may affect your income.

Partnership potential

You might have your eye on becoming a partner, or you might just be happy to have landed a good job. Either way, now is the time to get the details in writing. “What are the criteria necessary to become a partner?” Goldsmith suggests asking. “When are you eligible to start accruing equity? What are the requirements based on: RVU, collections, number of years in the practice?”

Even if you don’t aspire to partnership, be sure your contract supports whatever type of professional growth you have in mind.

Can I streamline this process?

As you’re plodding through your contract, you may begin to wonder: What’s the most important area to focus on? That answer varies greatly from one physician to the next. A doctor with a young family may place a premium on keeping regular hours, while another physician may seek complex clinical cases, and yet another may be focused on benefits.

Think back to whatever goals and aspirations you identified at the outset, then consider how this contract lines up with those. If there’s anything that will influence your future or interfere with your happiness, put it on your list to discuss.

Step 3: Head to the table

You’ve pinpointed areas to discuss, soaked up knowledge from your attorney and trusted colleagues, and done your own research. All that’s left is a few conversations with your future employer. Easier said than done, you may be thinking. But don’t let nerves or the voice in the back of your head deter you.

It’s up to you

Your lawyer is a helpful resource for identifying points of contention and explaining standard terms. But beyond that, it’s up to you to take the reins and make sure you’re satisfied with the contract and the job itself. “Ultimately, your lawyer will not be working with your [colleagues] and future partners. You will. The importance of representing yourself is paramount,” says Goldsmith.

Advocating for yourself might feel less intimidating with a buffer, but direct communication is much more effective. Avoid relying on email or using a go-between. Instead, phone calls, Skype or Zoom sessions and face-to-face meetings are the best methods.

Don’t rely on memory

Don’t hesitate to bring notes along with you to meetings or have them on hand if you’re talking via phone, Skype or Zoom. That way, you can refer to all the points you want to cover—and your ideal outcomes. Make note of any supporting data you’ve found, such as average local starting salaries for your specialty.

Be flexible

Not every issue is of equal magnitude. You’ll have to compromise in some areas to get what you want in others. Organize your requests by priority: 1) factors that affect whether or not you’ll accept the job in the first place, 2) important concerns that you can afford to be more flexible about, and 3) perks that would be nice to have but not necessary. If you’ve prioritized ahead of time, you’ll be ready for the necessary give-and-take.

Remember to be open-minded throughout the discussion. Listen to other ideas, make notes, ask questions and don’t rush to agree or disagree with anything until you’ve had a chance to digest everything.

Don’t be pacified

Ideally, your negotiations will be professional yet friendly. But be careful. Friendliness can be a way of dismissing your concerns. You don’t want empty reassurances, such as: “Oh, don’t worry about that. That’s never been enforced!” or “That’s just our lawyer. She loves her legal language.” It’s tempting to smile agreeably and take this on good faith, but at the end of the day, if something isn’t in writing, it’s not enforceable.

Negotiations require a fine balance of persistence and politeness. Gently push these friendly reassurances a bit further by saying something like, “That’s good to hear. Given that, can we omit it from (or add it to) the document, please?”

Keep it in neutral

You’re likely to experience an array of emotions during negotiations. You may feel intimidated by your prospective employer and their lawyers, worried that you are asking too much, or even offended by a comment someone makes. Regardless what’s going on inside your head, try not to appear ruffled or get heated. Remind yourself that this is just business. Your employer is protecting their own interests, just as you are protecting yours.

Even if you realize mid-negotiations that you won’t be taking this job, don’t do anything you might regret. If you lose your cool, that reputation might precede you elsewhere.

When to walk away

If your employer won’t—or can’t—accommodate one of your key points, you have a decision to make: Do you accept their terms or walk away? “Ask yourself if you can live with that specific term,” suggests Chaboki. You may know the answer right away, or you may need some time to weigh the pros and cons.

If things don’t shake out the way you want, you can always ask to revisit the issue in a few months, once you’ve proven yourself as a valuable employee. But make sure any arrangements to renegotiate terms are added to your contract in writing. Verbal promises are easily forgotten.

Of course, some issues are too important to put on hold. If you’re not comfortable waiting to revisit an issue later, it may be time to part ways. “Something that I learned from my father in regard to negotiations is that if you are going to negotiate hard, you have to be willing to walk away,” says Butler. “What I have added to that over the years is that you should not be willing to walk away unless you have a plan B.”

Negotiations are never easy. Remind yourself that this is just one more step in the process of landing at your dream practice.



Revenue and RVU’s

A physician’s guide to productivity-based compensation.

By Laurie Morgan | Fall 2020 | Feature Articles


“It takes a little legwork to understand [productivity compensation], but it’s worth it,” says Samuel Gerhardt, D.O. – Photo by Jesse and Gena Photographers

Whether you’re fresh out of residency or simply looking for a change, odds are some of the job offers coming your way will include a productivity component. According to the Medical Group Management Association’s (MGMA) 2019 compensation survey, nearly a third of primary care positions and more than 22 percent of specialist positions include some portion of productivity-based compensation.

For many physicians, this prospect is nerve-racking. Productivity-based compensation isn’t guaranteed, which is why a lot of physicians favor straight salaries. But rejecting productivity-based compensation out-of-hand may be costly, especially over the long run. By limiting your search to straight-salaried positions, you could be missing out on great employers or locations, and there’s a good chance you’re also losing money.

“Some docs shy away from productivity incentive compensation because they’re concerned about or don’t understand it, but they’re leaving money on the table,” said Samuel Gerhardt, D.O., chief family medicine resident at Methodist Community Hospital in Henderson, Kentucky. Just like medicine, business and finance are specialized fields with their own terminology, which physicians rarely hear or use in medical school and residency. Then along comes an offer with a multifaceted compensation plan, and he says, “What usually happens is the physician sees the complex pay model and drops it because they don’t understand it.”

Gerhardt points out that physicians are by nature accustomed to basing decisions on their own expertise. Productivity compensation plans can play havoc with that expectation. “When you’re in a situation where you’re no longer the expert, you back off,” he says. “When you only understand the base salary, that’s the only thing you can look at.”

Productivity compensation in context

“It very much is my experience that physicians are nervous about productivity, but I don’t think they should be,” says Seger Stacy Morris, D.O. – Photo by Hunter Hart

Some physicians are also concerned that emphasizing productivity takes the focus off of patient care. Seger Stacy Morris, D.O., internal medicine program director and division chief of Mississippi internal medicine programs at Baptist Memorial Medical Group in Oxford, Mississippi, says, “It very much is my experience that physicians are nervous about productivity, but I don’t think they should be.”

According to Morris, modern medical training doesn’t give physicians a good sense of the workload they’ll be able to handle. These days, residents are assigned fewer patients than in the past. “Physicians coming out of training are not being trained in starting a business,” he explains. “They’re being trained to be employed. Volume is completely deemphasized, even discouraged, in most programs. Throughout your training, there is very little about what the real world will expect in terms of your productivity.”

In some ways, Morris says, productivity expectations have changed more in training than in actual practice. Doctors are in short supply, and patients need care. But the same regulations that seem to deemphasize volume, including the Affordable Care Act, also mandate that access to care be more universal.

“Some physicians get interested in MIPS [merit-based incentive payment system], thinking that it [and other quality programs] will change everything,” Gerhardt says. “But improved quality won’t replace the need for people who can see more patients. Speed and efficiency are still what makes money in any setting.”

In the simplest terms, productivity-based compensation is pay based on the volume of work a physician does. Volume can be calculated in a variety of ways, which complicates things a bit. But a well-designed productivity incentive program can be a much fairer arrangement for both physicians and employers than a one-salary-fits-all contract.

“Some physicians are risk-averse and just want to know what they’ll be paid,” says Satish Prabhu, M.D., pediatrician and owner of Rainbow Kids Clinic in Clarksville, Tennessee. “But their employers want to share risk.”

Prabhu says productivity-based compensation can be a win-win because physicians can earn more pay by allowing their employers to manage risk. It also helps reward clinicians who face unexpected increases in workload—for example, from an unusually stressful flu season or a colleague’s maternity leave or retirement. This can head off resentments and boost morale.

Productivity-based compensation can also provide more flexibility, Prabhu adds. For example, a physician could take on more work to help with buying a home, paying down debt or planning an extended vacation.

How productivity compensation models work: A brief overview

Compensation is typically structured as a mix of salary and incentives, including bonuses. The salary is the guaranteed portion: the amount you get for showing up to work and completing the basic requirements of your job. Additional incentives are a way for your employer to recognize your work and encourage you to create more value.

Incentives are usually based on some productivity measure, typically calculated based on billable services or actual collections. They can make up a tiny percentage of your overall compensation or as much as 100 percent. The American Medical Association reported in 2016 that an average of 32 percent of physician compensation was tied to personal productivity.

In hospitals, HMOs and other large organizations, productivity is often calculated using work RVUs (wRVUs), a standardized measure of physician effort assigned to each CPT billing code. Andrew Hajde, CMPE, assistant director of association content at MGMA, sees an ongoing trend of larger employers moving away from measuring productivity using revenue and toward an RVU-based approach.

Work RVUs are a fairer way to gauge work and effort,” he says. RVUs track the type of work performed instead of revenue. This frees physicians from worrying about how much a patient’s health plan pays or how effective the billers are. Also, most electronic medical records systems make it easy for physicians to track their own RVUs.

Revenue-based productivity measures encourage proper coding and documentation, too. Employers want to be sure physicians give these administrative tasks sufficient attention, since they determine how much and how quickly your employer will get paid.

Before your search: Empower yourself with information

Productivity compensation could be a part of any job packages you’re offered, and you can’t evaluate these offers unless you understand the terms and know what you’re signing up for. Arm yourself with knowledge to help make sure you’re getting a fair deal.

Start by getting familiar with common productivity benchmarks. For example, many organizations use MGMA compensation and cost survey data to set thresholds for incentives. Accessing the complete survey data requires a subscription, but the association publishes select metrics each year through other channels. Older MGMA data is also available online. Specialty societies often do their own surveys, too. Many make some reports available for free—or at a low cost—to members.

If you’re not yet at ease with CPT coding, you should also study up on billing. It will serve you well in your new job, and it’ll also help you make the most of productivity compensation. Since CPT codes provide the RVU data that often determines productivity, it’s crucial to understand coding relevant to your specialty. That way, you can get an idea of how billing patterns will affect your income.

“Your specialty society and other medical organizations are good places to start,” Morris says. He adds that E/M University can also be a great resource and says that without a solid understanding of CPT coding, you could end up seeing more patients than necessary to meet your RVU goal.

Researching supply and demand can help you gauge how hard it will be to build a panel and reach your productivity goals. There are many online databases to help you calculate how many physicians in your specialty are practicing in your target location and compare those numbers with population trends. As Prabhu points out, it’s much easier to build a high-productivity practice if the patient population is growing and new patients are looking for doctors.

Mike Blaney, M.D., a general surgeon and founder of Live Healthy MD in Augusta, Georgia, adds that your employer’s contracted insurers (a.k.a., payer mix) may also affect your earning potential. “In Beverly Hills, you’ll find 80 percent or more of your patients will have good commercial insurance with excellent reimbursement. But in other parts of the country, your practice might be as much as 50 percent Medicaid,” he says.

Payer mix will directly impact productivity pay that’s tied to net collections. It can also affect how much your employer can afford to pay you in salary. Having a basic understanding of reimbursement economics can help you understand the sort of offers you might get and if there’s room to negotiate more pay for higher productivity.

Ask about key factors that enable productivity

Your own initiative is essential to hitting volume targets, but it’s unlikely you’ll reach your highest levels of productivity without help. One of the first things you should ask an employer is what kind of resources you’ll have. You’ll want to know if your employer plans to invest in marketing your new practice and how much business development you’ll be expected to do on your own.

For specialists, developing a network of referring primary care physicians takes time. Will you be able to rely on overflow from other physicians in the practice to fill your schedule while you make connections in the local community? Will you receive a higher salary while you build your stream of patients—and if so, for how long?

“Some physicians have the personality to go and sing their own praises,” says Blaney. “Others have more farmer than hunter mentality.” It’s important to know what kind of self-promotion you’ll need to do and how you plan to do it, given your personality and skill set. If you’re building a flow of referrals from scratch, you’ll need to know how long the practice expects that to take and if you’ll receive a higher guaranteed salary during that build-up period.

Primary care physicians should ask how many new patients are joining the practice each month and how they’re assigned. If the local market is not growing, how does the practice plan to attract new patients for your panel? The type of patients makes a difference, too. For example, if you’re in an OB/GYN practice where maternity care is the fastest way to earn productivity compensation, you need to make sure there are enough new patients of childbearing age.

Prabhu suggests pediatricians ask how newborns are assigned. Babies have many more check-ups per year than older children, so infant patients can boost a pediatrician’s numbers. Similarly, he adds that a pediatrician taking over for a retiring physician should ask about that doctor’s patient demographics. If many of those patients are teenagers, they may leave a gap in the panel when they move on to an adult primary care practice.

Physicians should also make sure they’ll have enough support staff. Hajde says physicians should ask questions like, “Will I be able to get an extra medical assistant if I’m a high performer? Will I get a scribe?”

Prabhu agrees. His practice was one of the first in Tennessee to be certified as a patient-centered medical home (PCMH). He explains, “We created our own workflow initiative to help our physicians achieve the standards of PCMH and enable them to focus on patient care.” Prabhu says it’s critical to make sure your employer understands how to support you in ways that increase productivity and reduce stress.

Scheduling is an important factor, too, according to Prabhu. He recommends physicians ask about available time slots and whether they’ll have input in setting them.

If you have any doubts about how realistic the productivity expectations are, don’t hesitate to ask for details. Morris says, “A good recruiter should be able to show you the number of patients you need to see to break even and how much you’ll make if you see two or three more than that.” It’s fair to ask for and expect examples of how the practice’s physicians meet their numbers, along with details about their schedules and staff support.

Test assumptions and look for “gotchas”

Once you’re comfortable with the basics of an offer, it’s time to dig into the math. As you do, challenge your assumptions and watch out for “gotchas” in the contract. It’s important to ask detailed questions to make sure you fully understand how you’ll be paid if you accept the job.

In some settings and some specialties, some of your work may not be legally eligible for bonus pay. For example, hospitals can’t incentivize you to recommend procedures they profit from. So if you take on a role as a cardiologist, reading echocardiograms may be excluded from productivity calculations.

“Different settings have different rules,” explains Morris. “In a large group, where the machine is not owned by the group, those readings can count toward productivity. But if you’re employed by the hospital and the hospital owns the machine, they can’t incentivize doctors to do that work.”

Billing processes can determine what counts toward productivity, too. For example, surgeries or maternity care may be billed as a global package. If your job will include maternity check-ups, surgical assists or follow-ups, those activities may be excluded from your productivity calculations.

If you’re inheriting a panel, the practice’s definition of an active patient is also important. “Some practices may consider a patient who hasn’t been seen in 18 months to be inactive, but others might not until it’s been three years,” Prabhu says. As you can imagine, if the panel you inherit includes a significant number of patients who haven’t returned for two or more years, it may not provide you with the volume you need to reach your productivity goals.

If your productivity is calculated based on your practice’s profitability, you’ll also need to pay attention to how overhead is allocated. In a multispecialty practice, the economics may even differ from physician to physician.

Blaney recalls that early in his career, he was bringing in much more revenue from cash-based bariatric surgeries than some colleagues whose patients were primarily on Medicare or Medicaid. Because the cost allocations were based on revenue, he was charged for more of the overhead than he was actually consuming.

“I was bringing in 70 percent of the revenue but was paid only 25 percent of it after overhead,” he says. Luckily, he was able to work out a fairer arrangement with his practice. But not everyone is so lucky. Once you’ve signed a contract, it can be hard to revise the terms, so it’s important to understand how overhead will work upfront, when there’s still time to negotiate.

Get help if you need it

Studying up on productivity arrangements might feel like delving into the business side of things you hoped to avoid by going into medicine. But as Morris advises, you still need to know enough to make sure you’re not getting taken advantage of.

Instead of throwing up your hands in frustration, get help from experts who can fill in the gaps in your knowledge. For example, you can reach out to consulting businesses like Gerhardt’s MedAnalysis Practice Consultants, which he recently started to help physicians compare compensation offers.

Legal advice is also indispensable. “Get a health care attorney—not just a regular business attorney, but a lawyer with experience with health care and physician contracts—to review any contract you’re considering signing,” Morris recommends.

A salary-only deal might seem simpler and safer in the short term, but it likely means leaving money on the table. Plus, there’s really no such thing as a job where productivity isn’t important. Even if you sign a salary-only contract, your employer will still be evaluating the value you bring to the practice. As Hajde explains, “In most cases, physicians do have to grow their business. If they don’t do it, health systems may have to let them go. It’s the reality of being a physician today, the same as any other business.”



Decoding your employment contract

There are few steps more critical in accepting a job than decoding the offer.

By Chris Hinz | Fall 2020 | Feature Articles


“In assessing a position, consider the opportunity it affords for building a successful career to achieve your goals,” says Alicia Arnold, M.D. That includes both professional and personal goals. – Photo by Christy Janeczko

Before you sign any agreement, you want to be confident that you’ve identified a practice opportunity that meets your professional and financial goals while satisfying your personal style and needs. Truth is, there are any number of factors to consider, especially if you’re weighing multiple options.

But you want to make sure that you make the right choice—even if an offer sounds like a lucrative gem. “You shouldn’t be seduced into accepting a job that may be be financially better than another job, but in the big picture is not going to get you where you want to be,” says Franco Fazzalari, M.D., cardiothoracic surgeon at Beaumont Hospital in Royal Oak, Michigan. “It may be a good solution for two years, but in the long run it’s not going to work out and you’ll have to find another job and move on. You really want to avoid that.”

Whether you’re destined for a staff job in a major health system or a partnership track in a private independent practice, it’s critical that you uncover as many particulars as possible not only about the compensation package, but also any other terms that might affect your tenure. And since decoding is all about getting into the business weeds, let’s begin with those financial and other basics that are paramount to understanding offers—and making choices.

Evaluating the financials

“A contract is only as good as the people behind it,” says Jose Avitia, M.D. – Photo by Sweet William Photos & Films

As a new hire, your initial employment contract likely will include a flat or straight base salary tied to your specialty with a possible bonus topper tied to your productivity. Since various payment structures can drive an offer, you need to focus not only on the dollar amounts, but also how they’re derived, especially if they’re anchored in your performance.

If, for instance, there’s an annual bonus, you want to know more than just what you’ll earn and when you’ll see it. How is the amount set and might those metrics change? Your new employer is likely to use one of two production formulations: Relative value units (RVUs), the Medicare measure of value for individual physician services, or net revenue, the profits calculated from actual dollars coming into the practice. But what expectations are tied to the numbers? How many patients must you see per day? What level of RVUs will you need to generate? And what might be asked of you beyond clinical care? You may not get all of the details in your contract or an addendum, even though having everything in writing is certainly preferable. At a minimum, you want to hear a clear explanation as to what might unfold.

Although practices generally make incentives achievable, it’s up to you to find out if they’re really doable. For instance, if the organization has built in a potential bonus based on the success of the department or larger entity, how often do physicians actually receive one? Likewise, if it’s based on your own productivity, how difficult is that to achieve? (And is there any punitive action for failing to meet goals?) If there’s a 15 percent quality bonus, for instance, is the average capture rate 14.5 percent—or 3 percent?

Keep in mind that the shape of your compensation package may very well depend on where you land. For instance, if you’re soon-to-be employed as a staff physician of a major group or medical system, you’ll likely enjoy an initial benefits package that a small independent private practice usually can’t match. What you probably won’t enjoy is the long-term profit-sharing advantages of being a future partner in that independent group. If you’re looking at options in both camps, you clearly want to study the risks versus rewards, particularly of taking a financial step back initially for a potential ownership stake later. “It may or may not be worth it,” says Jon Appino, principal of Contract Diagnostics. “You need to consider all of those things when you’re doing your due diligence.”

When decoding any opportunity, you want to make sure that you target those aspects of the offer that might affect your ability to build your patient base and make or save money as well as pay off debt. How will the practice market your position? Can you work extra to earn extra income? And will you still be able to develop other interests, not to mention a healthy work-life balance?

Alicia Arnold, M.D., and her husband, both radiologists, considered various practice types and parts of the country before making Eau Claire, Wisconsin, home because of the excellent practice environment and reasonable cost of living. The two settled on Medical X-Ray Consultants, a small radiology private practice where her husband is now a partner and she’s been both a full-time and per diem provider. Besides meeting their professional requirements to provide personalized, high quality care, the choice gave her flexibility not only to care for a growing family, but also to convert her interest in public speaking and community health education into a part-time role as a local medical correspondent. Arnold’s advice to others: “Most of us were called to medicine as a lifelong career, not merely a job. In assessing a position, consider the opportunity it affords for building a successful career to achieve your goals.”

Weighing benefits and future plans

When it comes to benefits, you’ll likely see a standard mix including health insurance, vacation time, personal days, a retirement plan, annual raises with cost-of-living adjustments and possibly even parental leave. Even though the package may be cut and dried, make sure that you review the provisions. For instance, depending on how professional liability coverage is structured, you may or may not like the ramifications should you leave the place. So if it’s the one item holding you back from taking the job, see if it’s grist for discussion. “Be prepared to negotiate for what you think is fair and appropriate for your long-term career success,” Arnold says, noting that it may be difficult to renegotiate in the future. “You’re not being a bad team player by asking for a more advantageous contract.”

Continuing Medical Education

Do they value continuing medical education enough that they encourage such pursuits and even include the specifics in your contract? Do they pay for and give you separate time off to pursue it? And what about other efforts that could put a cherry atop your competence—for instance, are there regular patient case conferences? “If there isn’t that kind of teaming and learning going on,” says Brigitta Glick, founder and CEO of San Antonio-based Provenir HealthCare, “then it’s going to be a far less attractive model than others if that’s important to you.”

Restrictive Covenants

Whether you’re employed by a health system or independent practice, your position isn’t guaranteed forever. Besides sporting a typical shelf life of two to five years, initial employment contracts have a standard out clause that says usually within 30, 60 or 90 days either side can call it quits. (In some cases, 180 days, if you’re terminating the relationship.) Your focus, however, should be on the restrictive covenant or non-compete clause. You’ll want to drill down on any parameters—time, distance or other conditions—that might cramp your ability to practice and live should you decide or have to move on. Assume that the practice intends to impose it, especially if administrators don’t want to lose a high-producer to a local entity. “So many folks think, ‘There’s no way they can keep me from practicing in the area,’” says Patrick D. Souter, JD, of Gray Reed Attorneys & Counselors. “Well yes, there is. The employer can be protected just as much as the employee.”

In addition to understanding the clause, you want your own attorney to take a look. He or she may be able to restructure it so that you can practice in the area, perhaps in another direction. “It’s a big consideration if you’re looking at a practice and the restrictive covenant says 50 miles and five years,” says Wanda Parker, physician recruiter at The HealthField Alliance. “That basically means that you’ll be out of business.”

After completing his interventional pain management fellowship in 2017, Travis Bailey, D.O., had two goals in mind. First, unlike many colleagues in his specialty who gravitate toward hospital settings, he wanted to be in private practice. Second, it had to be in or near his hometown of Valdosta, Georgia. When his solo practice merged with another group to form VOA: Spine and Musculoskeletal Institute, Bailey insisted on removing the non-compete clause from an agreement that was otherwise very fair in its salary, bonus potential and benefits that would help him stay ahead of the professional curve.

Today, he’s not only on a path to partnership, but he’s carved out a career that fits him to a “T,” combining clinic hours and pain procedures with general anesthesia stints at two hospital locations. His advice to other physicians? Be assertive. “There are always going to be some changes,” Bailey says. “That’s to be expected. But you shouldn’t be nervous or even scared about asking for them.”

The next phase

Even before signing your employment contracts, you want to make sure that the transition from this package to the next phase is clear. For instance, if you’re getting a base salary with a productivity bonus, does it automatically renew, or will you transition into a different structure? And what does that look like? You need assurances in writing that at a given point, you and your bosses will have a heart-to-heart as to how your compensation and working relationship will change.

As to partnership, although there are far fewer opportunities than in years past, ownerships still exist. If that’s in your future, it merits the same kind of due diligence you’d undertake in buying into any business. Granted, your future employer may not let you review the books or pick apart the financials this early in the game. “That’s a very touchy discussion,” says Parker. Nor will you likely see what Appino calls “granular specifics”—“on this day for this dollar you will be a partner”—in your employment contract. But you have a right to ask for information that will help you (and your accountant or attorney) learn if the practice is financially solid and both capable and serious about offering you a stake.

Also, make sure that they’re willing to commit in writing what you’ve both agreed to verbally. At the very least, you should have a framework as to the formula and track—what will the process look like and what will the buy-in actually entail? Will your participation involve a direct payment, sweat equity, or a lower paycheck over time? Moreover, will you have access to all, some or none of the practice’s long-term investments?

In any case, you don’t want to be blindsided down the road by the price or how it might work. As Fred Horton, president of AMGA Consulting, notes: “Somebody should be able to sit down with you, and say, ‘Here’s an example of how it’s worked in the past.’”

When Jose W. Avitia, M.D., joined Albuquerque-based New Mexico Cancer Center in 2012, he liked what he saw in his initial employment contract. It not only included a reasonable base salary and bonus potential for a beginning oncologist/hematologist, but also a very specific two-year track to partnership. Besides meeting a minimum productivity standard, he’d have to demonstrate that he was a good citizen of the group, treating patients well and fostering strong relationships with referring physicians and the staff. As to the numbers, the buy-in wasn’t a lump sum dollar payment upfront. Instead, his share would be built with time and “sweat equity.”

More importantly, Avitia had a good sense that if he’d meet the benchmarks, senior physicians would follow through on their promises. The group had a structured evaluation process to let him know well in advance that he was on track and, if not, what he needed to do to get there. He also had a sense, from potential colleagues, how the process and ownership track actually worked. “They weren’t going to find some obscure thing that would keep me from being a partner,” he says. “They were very transparent and that was very helpful.”

Assessing your chance of success

Before you accept any offer, you want a sign that the owners or administrators actually have backup to show that you’re a necessary cog in their wheel, whatever your specialty, and that you have a reasonable chance for success. For starters, what’s the basis for the position? Has the organization included it in the business plan or done a recent proforma to calculate the needs and financial benefits of adding someone with your skills?

You have a vested interest in learning if the community is saturated with too many stellar providers or ripe with a real opportunity for you to make a dent by marketing your services and developing referral relationships. Jesse Hackell, M.D., vice president and chief operating officer of Pomona (NY) Pediatrics, notes: “You should be asking, ‘Is there enough business here to support me?’”

Practice support

Indeed, besides learning if the environment is conducive to your brand of medicine, you want a sense that it will be a good incubator for your business. Whether you want a long lifespan or see this as a steppingstone, it’s critical to find out if this is a dynamic workplace or a revolving door. Pay close attention if you’re filling a vacancy created by an exit that’s seemingly part of a trend. You not only want to know how your future colleagues have done in meeting expectations, but that the numbers are attainable for you. “You want to make sure that you’re not stepping into a practice where they recruited five physicians,” says Horton, “and they’re all gone because they didn’t build a practice in time.”

Avitia was confident that he was dealing with a solidly established practice that not only included potential mentors who had been there for 10 or 20 years, but also younger physicians who were experiencing what he hoped to experience. As a partner since 2014, he’s been more than satisfied with his choice. “A contract is only as good as the people behind it,” Avitia says. “If they treat their patients with respect and dignity, then they’re going to treat their employees, partnerships and other relationships in the same manner.”

Final thoughts

In decoding any offer, make sure to keep a perspective. Just because you’re looking at a lot of money doesn’t mean it’s a good job any more than it’s a bad job just because it’s not a lot of money. Likewise, a perfectly written contract with little risk to you still might mask what could be a nightmare working situation. You may have to walk away even after negotiating everything you wanted.

Conversely, if the first draft of the agreement puts all of the risk in your court, that doesn’t mean the employer is unwilling to work out the kinks. Maybe an otherwise great practice just hasn’t been in the business of hiring recently and needs a friendly reminder as to what’s fair.

Whatever the case, when in doubt, tap your common sense. For most physicians, it’s a pretty solid GPS. Whether your antenna is telling you that this a great place with honest physicians just like you or you’re feeling an entirely different vibe, listen to your heart and act with your head. “Physicians have good gut instincts,” Appino says. “They should trust them.”



How tight is the job market in your specialty? Fall 2020

The PracticeLink Physician Recruitment Index can help you gauge the relative ease or difficulty of your job search.

Fall 2020 | Vital Stats


What’s your competition like? For job-seekers of all kinds, it can be hard to know. A simple search for opportunities in your specialty will give you an indication of the demand for physicians like you, but without knowing who else is vying for those jobs, it’s hard to get an accurate picture of supply.

How many other candidates in your specialty are actively looking for jobs at the same time? And how does that number correspond to the number of opportunities available?

That’s where the PracticeLink Physician Recruitment Index comes in. The Index is a relative indication of the ease or difficulty of job searches in various specialties based on supply and demand information gathered by the PracticeLink system quarterly. The larger the “jobs per candidate” number for your specialty, the better your potential standing in the market.

The change in rank reflects the specialty’s movement since last quarter.

The Most-Challenging-to-Recruit Specialties are those specialties with the highest demand-to-supply ratio in the PracticeLink system. The specialties on this list likely won’t come as a surprise to candidates; they’re often narrow fields.

The Most-In-Demand Specialties represent the specialties that have the most jobs overall posted on PracticeLink—specialties for which the demand for physicians is highest. For the Index, we then rank those in-demand specialties according to the supply. Those at the top represent specialties with the most jobs available and the fewest candidates per job.

After reading these Indexes, ask yourself: Do these Indexes match my experience of searching for a job in my specialty? Do I need to widen or narrow my job-search parameters as a result?

This PracticeLink Physician Recruitment Index was pulled July, 2020. Candidate ratios include physicians who have registered with within the past 24 months.



Federal action to help providers deal with COVID-19

Programs to help providers include expansion of telehealth, payments for coronavirus testing and the Paycheck Protection Program.

By Jeff Atkinson | Fall 2020 | Reform Recap


In response to the COVID-19 pandemic, Congress and the Centers for Medicare & Medicaid Services (CMS) have enacted multiple programs to help health care providers and their patients.

Expansion of telehealth

Telehealth services have been significantly expanded. CMS said the reason for the new rule is to not require beneficiaries “to travel to a health care facility and risk exposure to COVID-19.”

The reimbursement rates for telehealth services now are comparable to office visits—increasing from a range of $14 to $41 to approximately $46 to $110.

The types of providers eligible to receive payments have expanded. Prior to the new regulations, reimbursement for telehealth primarily was available to doctors, nurse practitioners and physician assistants. Now reimbursement also is available to physical therapists, occupational therapists, and speech and language pathologists.

The types of services covered have expanded to allow billing for services rendered by hospital-based practitioners to Medicare patients registered as outpatients, including when the patient is at home.

Use of technology also has become more flexible. CMS explained: “[S]ome Medicare beneficiaries don’t have access to interactive audio-visual technology…or choose not to use it even if offered by their practitioner.” Thus, audio-only telephone services (rather than audio and video) generally are now permissible.

Payments for coronavirus testing

The Families First Coronavirus Response Act covers the cost of diagnostic testing for uninsured individuals regardless of income or assets. (The program does not pay for testing for people already covered by Medicare, the Veterans Administration or private insurance, or cover treatment or vaccines.) Diagnostic tests include tests for the virus as well as serological tests for antibodies.

The Families First Act also authorized a 6.2 percent increase in Medicaid matching funds. The funds are designed to compensate for added services to Medicaid beneficiaries during the COVID-19 emergency. The added funds will stop on expiration of the program or if the Secretary of Health and Human Services declares the emergency to be over.

The Kaiser Family Foundation, a nonpartisan organization that studies health issues, said the increase in the matching funds “leverages Medicaid’s existing financing structure, which allows federal funds to be provided to states more quickly and efficiently than establishing a new program or allocating money from a new funding stream.”

Specific cash allocations

Another federal law passed in spring—the Coronavirus Aid, Relief, and Economic Security (CARES) Act—allocated billions of dollars to health care providers. Initially, $100 billion was allocated, and that was followed by another $75 billion. A review by the Kaiser Foundation highlighted the following allocations:

Provider payments through Medicare. $50 billion was paid to providers based on income the providers had received from Medicare and from other sources in 2018. Under the law, the payments could be used for “health care related expenses or lost revenues that are attributable to coronavirus.”

High-impact areas. $10 billion was allocated for high-impact areas, particularly hospitals that see a high proportion of low-income patients. New York was the largest beneficiary of this portion of the funds.

Rural providers. $10 billion has been allocated to rural hospitals and health clinics.

Indian Health Services. A minimum of $400 million has been allocated to tribes, tribal organizations and urban Indian health organizations in coordination with Indian Health Services.

A condition of receiving these funds is that providers may not “surprise bill” patients. Payments to providers must be at in-network rates. For example, if a patient goes to an in-network hospital, but receives care from an out-of-network provider, the bill for the out-of-network provider’s services must be at in-network rates.

Congress has allocated at least $5.5 billion for research related to the coronavirus and to treat COVID-19. Funding passes through multiple organizations, including the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the Defense Department Health Program.

Paycheck Protection Program

Congress allocated more than $650 billion for the Paycheck Protection Program (PPP). Physicians’ practices were among the beneficiaries. Under the program, businesses with 500 or fewer employees could apply for loans that would be forgiven if the businesses maintained payrolls for a period of eight weeks.

The amount of the loan could be up to 2.5 times the average monthly payroll for the preceding calendar year, up to a maximum amount of $10 million per loan. For the purpose of calculating the amount of the loan, salaries were capped at $100,000 per employee per year.

Thus, for example, if an office employed 10 physicians earning more than $300,000 each year, only the first $100,000 per physician would count for the purpose of calculating the loan. The full salaries of nurses and office personnel earning less than $100,000 per year would count for the loan and forgiveness program. If a practice employed 10 physicians and five others who earned $60,000 per year, the practice could have received a forgivable loan of $270,833.

An alternative program is a 50 percent tax credit on wages up to $10,000 per year per employee for wages paid from March 13 through December 31, 2020. Cash savings will be up to $5,000 per employee.

To be eligible for the program, the business needs to have suspended or ceased operations due to COVID-19, or gross receipts of the business need to have declined by more than 50 percent compared to the same quarter of the prior year. This program cannot be used if the business already has received a payment through the Paycheck Protection Program.

COVID-19 has imposed extraordinary challenges on health care providers. The actions taken by Congress and CMS have eased some of the burden, but struggles will continue.

Jeff Atkinson is a professor for the Illinois Judicial Conference and has taught health care law at DePaul University College of Law in Chicago.



Are you evaluating the right things?

Finding your next job is about more than the money; it’s about finding a great place to live, too.

By Chris Scites | Fall 2020 | PracticeLink Tips


When considering new opportunities, I can’t stress it enough: You have to be able to live in the community in which you’re hoping to work.

This is a difficult thing to discover in even the best of times. A day or two in the community you and your family could potentially be living in for the next several years will give you some idea of what the place is like, but there are often things you only find out after being there for an extended period of time.

But sometimes events happen that make it impossible to travel to a location to even get a minimal feel for it. For example: a global pandemic that makes traveling both inadvisable and, in many cases, counter to state and federal guidelines. So how do you get a feel for a neighborhood when you can’t even go there in person, or are limited in how you can interact with the community?

Fortunately, there are many tools that can help you, including many from PracticeLink.

Ask your in-house recruiter

One of the best resources for finding out about a community is the very same recruiter you’ve been working with throughout your interview process. In-house recruiters are almost always very well acquainted with the communities their opportunities are in. Through PracticeLink, you can send messages directly to that recruiter with any questions you have not only about the opportunity, but also about the community in which it’s located. They will also often be able to put you in contact with other physicians and employees who work and live in the community and who can give you perspectives on various neighborhoods.

Attend a PracticeLink Live! Physician Career Fair

If you haven’t contacted a recruiter yet, a good place to do that is through a PracticeLink Live! Career Fair. Recruiters at these events are more than happy to speak with candidates and answer questions about their communities. These virtual events are easy to attend and a valuable way to spend your time.

Chat with a recruiter

PracticeLink’s recently added Chat tool allows you to message with a recruiter in real time on If the recruiter isn’t online at the time, you can still send them a chat message to which they can reply later. So if it’s 1 a.m. and you’re wondering what the trout fishing is like near the town where the opportunity is located, log into PracticeLink and send that message.

Study the profiles on PracticeLink

PracticeLink offers in-depth profiles not only about jobs, but also about each facility and organization that use the system to recruit physicians and advanced practice providers. Look for detailed descriptions of the communities, as well as community links that will help you get a better feel for each area. Even if this is just a high-level description, it can be very useful in helping you decide what other questions you need to ask.

Spend some time on Google Maps

Remember, the internet is your friend when you are trying to find out information about a place that you may have never been. Go to Street View on Google Maps and virtually drive around the community. See what businesses and amenities there are and what people have to say about them. Remember that these apps show traffic data too, as well as public transit data, so you can easily determine travel time between where you will be working and where you are considering living. Don’t forget to do this for your significant other’s workplace and children’s schools, if that applies. Look online for everything from walkability scores to crime statistics.

Like many things, the data you can gather virtually is not a substitute for being there and seeing it in person. However, until that time arrives, keep these tips in mind when scouting out the places where your next opportunity will be located.

Chris Scites is PracticeLink’s physician relations director. Reach his team for free job-search help at (800) 776-8383.



Physician contracts in the age of COVID-19

Health care—and job-seeking physicians—didn’t emerge from the pandemic unscathed.

By Therese Karsten | Fall 2020 | Job Doctor


In May 2020, the American Hospital Association released a report estimating that between March 1 and June 30, 2020, hospitals and health systems across the country will experience over $200 billion in losses because of COVID-19 expenses and lost revenue.

How will that impact physician job seekers?

Throughout this time, I’ve been on conference calls with in-house physician recruiters from hospital systems and large medical groups all over the country. We gather in national, regional and specialty professional groups on virtual meeting platforms like WebEx and Zoom to share best practices. Every call starts with a check in to share what is going on in our facilities and groups.

A handful of hospitals in unaffected areas are operating and hiring as usual, with just a pause in onsite interviews due to travel disruptions. Some health care systems in hard-hit areas closed practices and laid off physicians and staff. A lot of recruiters reported furloughs and pay reductions for physicians and staff as well as temporary shutdowns for clinical and administrative offices. Every single recruiter reported that their hospitals revisited their 2020 budget and revised physician recruitment planned expenditures for the remainder of the year and began adjustments to 2021. Even facilities that have not admitted a single COVID patient are preparing for the lost revenue and expenses they would experience if the virus spreads in their community at some point over the next year or so.

That said, we are all confident that physician hiring will recover long before other parts of the economy.

How job searches have been affected

Here are a few of the impacts we saw as our health care systems’ leadership teams wrestled with the pandemic.

COVID Cancel was a quick end to positions tied to new site expansions, new service lines or recruitments requiring major capital investments. Not “never,” just not this year, not early 2021.

Hold was a continuum—hold this one for 60 days. Revisit that one in 90 days. Look at this again at 120 days. Facilities want to fill positions, but they don’t want to start new physicians until they know volumes are rebounding and patient confidence is strong.

Push it Back was the directive for many retirement backfills. Whenever late career physicians’ 401(k)s suffer, they second guess retirement timing, preferring to wait until retirement accounts recover before hanging up the white coat. This was bad news for 2020 residents and fellows who had interviewed and were working on contracts when the pandemic hit the community they hoped to join.

Reduce It was one tactic to move forward within a drastically slashed budget. Full-blown hospital system income guarantee packages were reduced significantly. Large, established private practices helped reduce the burden on the hospital. Practice partners agreed to sacrifice perks like CME travel. Groups deferred bonuses in order to cover their new physician salaries during ramp up. Many graduating residents lost sign-on bonuses to the virus.

Proceed as Planned was the welcome directive to continue with contract development for physicians recruited to practices with volumes unaffected by the pandemic.

The AHA number bears repeating: $200 billion in losses due to lost revenue and COVID expenses between March and June 2020. Going forward, hospitals and private practices are proceeding very, very cautiously. Will a rush to reopen local economies bring about new hotspots, new surges? Will there be another wave in the fall? Will patients return to pre-COVID health care utilization patterns? Will the payer mix recover as Americans return to work and health care coverage?

Some thoughts for physician job seekers in the pandemic physician job market:

If you can, consider another year of fellowship, or stay in the job you have until we are firmly in recovery. Any time employers are experiencing uncertainty, they react by tightening reigns on sign-on bonuses and starting salaries. Your negotiating position will improve when the economic indicators are strong and patients once again feel safe in hospitals and medical offices.

Don’t leave a job without signing a contract for your next job. Pre-COVID, physicians in high-demand specialties were accustomed to leaving a job if they got mad at administration or just were not as happy as they thought they should be. “I’ll do locums or work PRN,” they thought. When locums demand drops off and nobody is hiring PRN, those physicians are unemployed and ineligible for unemployment benefits.

Keep multiple irons in the fire until you have a contract. In this hiring environment, it may not matter how fabulously you interview or how great your references are. If patient volumes are not recovering quickly enough in the market where you interviewed, administration will hit the brakes.

Defer the gratification of buying the biggest house, the nicest car in your price range. There will be a time to stretch, but this is not that time.

A contract might not be what you hoped, heard or thought it would say. In times of financial uncertainty, employers are more conservative. Have a health care attorney review the formal draft so that you thoroughly understand if, when and how the contract could be rescinded or terminated.

Understand that the starting salary, sign-on bonus and education loan repayment deal your senior residents and fellows got pre-COVID is not relevant to what employers will be offering today. Candidates in 2020 are competing with a much larger than normal pool of displaced mid- and later-career physicians who lost jobs or are moving for personal reasons. With some positions pushed out as long as two years into the future, there will be more physician candidates competing for a smaller pool of jobs.

Despite disruption today, our country still needs many more physicians than we have in the pipeline. The challenges and disappointments for this year’s job seekers will eventually be a blip in a successful career. And with all this experience interviewing virtually, I predict that the survivors of the physician candidate pool of 2020/2021 will be our next media stars!

Therese Karsten is the division director for physician recruitment for the Continental Division of HCA Healthcare.



Navigating your noncompete

Popular TV shows can help you understand how to make sure your employment contract is solid.

By Bruce Armon | Fall 2020 | Financial Fitness


One of the most important (and most overlooked) elements of the physician’s employment arrangement is the noncompete clause. A noncompete clause essentially prohibits you from working within a certain radius—blocks, miles, zip codes or counties—for a defined period of time, usually months or years.

Told with the help of TV shows, this overview will help you understand the importance of addressing noncompetition clauses at all stages of your career.


Your career should not only survive as you switch from one job to the next, but thrive. Each employment contract sets you up for—or hinders you from—going from one job to the next. It is very important to be always looking ahead and thinking about your next career opportunity and how best to accomplish your professional goals.

You don’t have to outwit, outlast or outplay a colleague or an employer to be successful. Being a physician is a team endeavor. At the end of the day, however, each physician needs to look out for his or her own individual short-term and long-term goals to be the sole survivor and help ensure appropriate career opportunities can be achieved.

The Apprentice

This long-running TV show addressed many of the same elements more junior physicians may encounter early in their careers or in any new job setting: practicing independently for the first time, working with new colleagues, asserting yourself, confronting difficult patient encounters in the board room … err, M&M conference. And no physician (or any professional) ever wants to hear the dreaded words, “You’re fired.”

If you’re only one or two years into the job with an employer, how damaging will it be for you to become a “competitor” of the soon-to-be former employer and stay in that particular community? You may be well-served by including exceptions to your noncompete clause depending on how long you work for an employer before termination and the reason for the employment separation.

Some physicians are very entrepreneurial. They want to do multiple activities in addition to their full-time employment duties. They have (America’s Got) Talent and want to showcase their professional skills to different audiences in different venues.

Carving out exceptions in your employment agreement to allow you to share these talents—and keep any compensation earned and protection of any intellectual property created—are important considerations that need to be properly and clearly addressed.

The Bachelor and The Bachelorette

Switching from one job to another is never easy, even when it is by your own choice. Depending upon supply and demand, you may have many attractive suitors for your next job.

It is critical to understand as much as you can about your prospective employer before tying the proverbial knot. Before accepting the “rose” from an organization, dig into its leadership strengths, short and long-term institutional goals, challenges confronting the community, and the scope of the noncompete, nonsolicit and noninterference clauses.

Use The Voice you’ve been given to express the most important priorities and deal breakers in an employment agreement before signing. An employer can’t read your mind—so advocate for yourself or hire someone to do so on your behalf to make sure the judge…err, employer, knows why an issue is a priority for you.

American Ninja Warrior

Throughout the course of your career, you may feel like an American Ninja Warrior moving from one challenging impediment to another in pursuit of a better job opportunity.

The obstacles of a very restrictive noncompete clause can mean you have to move entirely out of the community or potentially face expensive and time-consuming litigation. Before making a jump, understand whether your current employer will see that opportunity as a threat and if there are mutually satisfactory outcomes possible, such as staying in the employment for a certain amount of time to ensure a smooth transition for a replacement hire.

Top Chef

Most every physician wants to succeed in their job and potentially become the Top Chef. There is, of course, no guarantee this will occur. A carefully crafted noncompete may void the noncompete if the physician is getting a promotion in the “new” job, even if that job is within the noncompete radius. This exclusion should be negotiated in advance before a disagreement can occur with respect to what qualifies as a promotion.

The goal for each physician, and each employment agreement a physician signs, is to have Happy Days for everyone involved without the need for lawyers in Suits arguing before someone like Judge Judy.

Competition can be healthy. Properly crafting and addressing noncompete issues with specific language in your employment agreement can and should protect you and your employer so that, in the ideal world, everyone can be Friends.

Bruce Armon is a partner and chair of the health care group at Saul Ewing Arnstein & Lehr LLP. He advises physicians, medical practices, hospitals and health care facilities and providers generally on contractual, compliance, regulatory and transactional aspects of health care legal issues.




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