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There are certain benefits every job offer should include. If you don't know what they are, you should.

Fam Pract Manag. 2000;7(5):68-69

If you're currently job hunting or contemplating a move from private practice to salaried employment, assess the benefits package you're offered as carefully as you do the salary and bonus. The first step is knowing what benefits family physicians typically receive.

What you should expect

I've seen descriptions of benefits as simple as a one-page exhibit attached to an employment agreement and as complex as a 202-page, three-ring binder. If you're a family physician, here's what to expect. I hope you are afforded as many of these benefits as possible.

Basic medical and major medical/hospitalization insurance. In the past, employers typically provided indemnity-type coverage for the physician and his or her family at no cost. Now it's increasingly common for employers to provide less flexible and less costly PPO or HMO coverage. You may be required to pay for part of the cost of your premium and the entire cost for your family.

If you go to work for a large organization and are terminated, your employer is required by the Consolidated Omnibus Budget Reconciliation Act (COBRA) to offer you and your family continued health care coverage for a certain period of time (generally limited to 18 months). A private practice with only a few full-time physicians may not be required to offer COBRA benefits.

Prescription and vision coverage. Most employers provide coverage for prescription medications and vision care. Some also offer dental coverage, but you may be required to pay for part of it out of pocket. Most private practices do not provide dental coverage.

Disability insurance. Many employers provide group short-term disability coverage and, sometimes, group long-term coverage, partially at the physician's expense. Private practices typically don't provide either.

If you already have a long-term disability insurance policy, don't cancel it if you start working for an organization that provides group coverage. Most likely, your individual policy will provide you with a much higher monthly benefit for a longer period of time with fewer exclusions and exceptions. If you pay the premium personally, any insurance benefits you receive will be nontaxable. And if your organization ever decides to drop its group coverage, or you decide to leave, you won't have to worry about obtaining broad coverage, which can be difficult — and much more expensive as you get older.

Group-term life insurance. Most organizations and private practices provide some type of life insurance policy to physicians; however, universal or whole-life insurance policies are not common. To save costs, many organizations have begun to provide health insurance, disability insurance, life insurance and other benefits such as dependent care expenses as part of a “cafeteria” plan or flexible spending account plan. These types of plans basically allow you to pick and choose your “menu” of benefits among cash and nontaxable benefits each year. Private practices generally don't provide flex plans because of their complexity and nondiscrimination rules. If you have life insurance coverage above $50,000, a small amount will appear on your W-2 as taxable compensation, regardless of the type of plan.

Paid vacation, holidays and sick leave. These are generally provided by both private practices and larger organizations, but private practices typically won't allow you to carry over unused time and won't pay you for time not taken.

Retirement plans. The typical retirement plan provided by private practices is a profit-sharing or money-purchase pension plan, occasionally combined with a 401(k). These “defined-contribution” plans are usually structured so that the practice contributes a maximum of $30,000 per physician. Generally, the vesting schedule is either 100 percent after a two-year eligibility period or a graduated vesting schedule of 20 percent after two years and an additional 20 percent per year until you become fully vested after six years. The plans are set up so that you are the trustee and may invest the money where you choose.

Retirement plans provided by hospitals or health systems are typically less generous, and you may even have to wait one year before you become eligible.

Many larger organizations have a 403(b) tax-sheltered annuity plan, which is very similar to a 401(k) plan, to which you can contribute up to $10,000 of your salary and are fully vested immediately. Others either have a defined-contribution plan similar to that provided by a private practice or a type of defined-benefit plan, with employer contributions varying based on age and years of service.

The vesting schedule of a defined-contribution or defined-benefit plan varies and may be as onerous as zero vesting until five years of service at which point you're 100 percent vested. Or, it may be graduated, with vesting beginning at 20 percent in the third year, with 100 percent vesting after seven years. Finally, your investment options are typically much more restrictive in a defined-benefit plan because you're not the trustee — your employer is.

Perquisites. Family physicians also receive other types of benefits, commonly referred to as “perqs.” (For a list of what you can expect to receive, see “The 'perqs'.”) Be forewarned: These perqs are typically the first benefits to be eliminated or cut back when a practice or institution experiences financial difficulties. In fact, did you know that most employment contracts stipulate that certain, if not all, benefits are subject to change or elimination at any time? It's unfortunate, but cutting benefits is the easiest way for employers to cut the cost of physician employees.

The ‘perqs’

Many family physicians receive reimbursement for the following as part of the benefits package:

  • Continuing medical education,

  • Travel expenses,

  • Automobile expenses,

  • Cellular telephones, beepers, etc.,

  • Professional society dues,

  • Hospital staff fees,

  • Board recertification fees,

  • License fees,

  • Journal subscriptions.

Going from private practice to salaried employment has typically meant receiving a richer benefits package, but today this isn't always the case. Overly generous compensation packages have contributed to financial hardship for some organizations, and many are now scaling back. Because there can be significant differences between the benefits provided by a private practice and what you can expect to receive as a salaried employee, be sure to carefully assess the benefits package you're offered before you sign on the dotted line.

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