After several years serving as a physician for a large health care organization in my city, I recently found myself looking for a new job when my wife and I decided to move out of the area to be closer to family. Before committing to such a major life change, it was important to think about my career goals and my family's future, but I also had to research more immediate issues such as the basic elements of an employment contract. (For an overview, see “Evaluating Employment Agreements,” FPM, July/August 2012.)
In this article, I'll share what I learned about the two issues that proved to be most crucial in the job search and selection process.
Most employers will initially compensate a physician with an agreed salary, often with a productivity component. Productivity is usually based on the work relative value units (RVUs) the physician generates over the year. For example, a 99212 visit has 0.48 work RVUs, while a 99214 visit has 1.5 work RVUs. More work equals more RVUs and more pay.
You'll need to do some research and find out what the salary averages are in your area. Networking with colleagues locally can be helpful, but you may also want to consider joining a physician social networking site such as Doximity. Its career section includes a “Salary Map” that shows salaries reported by members by region.
Once you've done your basic salary research, ask your potential employer the following questions:
How are bonuses decided? Are they based on individual performance or on the organization's performance? What are the metrics (e.g., patient satisfaction scores)?
Is it possible to become a shareholder? If so, what are the factors that decide shareholder status, and is there additional compensation for those in this role?
If the position requires supervising midlevel providers, is there additional compensation for this work?
If you are involved in outside medical activities, such as precepting medical students or providing lectures outside of the organization (such as at medical conferences), will the organization let you retain this compensation?
Is there a signing bonus, relocation allowance, or CME reimbursement? According to search firm Merritt Hawkins, the averages are $26,365 for signing bonuses, $10,292 for relocation allowances, and $3,649 for CME.3 However, be sure to set realistic expectations when discussing these offers as they are highly dependent on geographic region, organizational need, and physician experience.
Will you be reimbursed for medical and Drug Enforcement Administration licenses as well as for board certification exams?
What's included in the benefits package? A retirement plan, health benefits, life insurance, disability leave, and malpractice coverage are all standard. Make sure the employer also provides (or at least covers a portion of) tail coverage, a supplemental policy that protects you from claims made after you leave your current position.
Are there any special perks, such as wellness incentive programs or consumer discount programs (e.g., cell phone service or gym memberships)?
For many job-hunting physicians, work-life balance is just as important as the compensation package. You'll want to find out not only what your daily work schedule would be but also what your call schedule would be. Some important questions are as follows:
Do physicians admit their own patients after hours, or is there an on-call hospitalist group?
Do physicians field all after-hours calls, or is there a nurse triage system?
How do physicians cover for one another when someone is out of the office?
Are physicians expected to work additional urgent care shifts or extended hours?
How much vacation or personal leave is allowed each year? According to the American Academy of Family Physicians, family physicians work an average of 47 weeks per year; that leaves five weeks for vacation, holidays, sick leave, and CME.1
Time away from the office is important for recharging your batteries, spending time with family, and earning CME credits. Make sure you are happy with the employer's work schedule and time-off policies.
Even more important than the work hours, though, are the people you will be working with – not only the physicians and staff but also the physician leadership and management team. As you interview with various individuals, try to get a sense of how everyone works together and whether they share the same vision. If you would like to eventually serve in a leadership role, consider whether this opportunity would be available to you and whether you can picture yourself in this role in this organization.
Just the beginning
Being an employed physician is a very different practice style and can be challenging for those transitioning from private practice or residency/fellowship training. There are rules to follow, polices to adhere to, and expectations to fulfill. However, the advantages of this work setting include income security, a stable benefits package, and the opportunity to influence an organization in the everchanging landscape of healthcare. Once you've signed the contract, the real work begins – to fulfill your obligations to your new employer, your patients, and yourself.