Physician Resources

Webinar recap: How to negotiate a better contract

Physician in contract negotiation discussion

Physicians learn a lot of things during medical school, residency, and fellowships — but how to interpret and negotiate lengthy physician contracts isn’t usually one of them. Physician contracts are notoriously complex, and the agreement you sign affects everything from your earning potential to your work/life balance. So how can you tell an average offer from a great one and make sure your physician contract negotiation experience is a successful one?

In collaboration with Contract Diagnostics Founder & CEO Jon Appino and Dr. Kathryn Sarnoski, our recent webinar Physician Contracts 101: A Practical Approach to Understanding and Negotiating…from a Locums Perspective offers expert tips on reviewing and negotiating your offer, plus important insights on how locums contracts differ from permanent positions. Watch the full webinar below or read on for an overview of the most important material.

The basics of contract review for physicians

The contract you sign can be the difference between a dream job and a waking nightmare. To make sure you end up with a favorable agreement, there are a handful of key areas to consider:

Compensation and benefits: Make sure the salary, bonuses, and other incentives align with your expectations and professional goals. (For more in-depth info on payment structures, check out our previous webinar: Physician’s Guide to Competitive Compensation.) Consider benefits like vacation time, sick leave, health coverage, or retirement planning, and be sure you understand how they’re structured and when they become available.

Work schedule and expectations: Pay close attention to the number of hours you’re expected to work, the call schedule, and any after-hours duties.

Non-compete clause: Don’t risk compromising your future employment prospects — look closely at the length and geographic scope of any non-compete clauses.

Duration and termination: Make sure you understand the terms for renewal, termination, and any repercussions if you decide to move on before a contract is completed.

Malpractice insurance: Ensure any provided policies will adequately cover you in case of a claim.

Intellectual property ownership: If you’ll be involved in research, it’s important to know who owns the rights to any IP you create during the terms of your contract.

Miscellaneous clauses: This is where you’ll encounter things like non-disparagement clauses, non-disclosure agreements, or arbitration agreements. Become familiar with their terms and how they could impact your employment or future prospects.

What’s different about locum tenens contracts?

Locum tenens contracts are work agreements between a physician and a locums agency. The terms of most locums contracts are generally pretty similar, but certain things are negotiable, including:

Compensation rate: This is the most frequently negotiated term. Ensure your hourly or daily rate is satisfactory, and pay attention to reimbursements for things like travel or meal stipends.

Scope of practice: Make sure you’re clear on what’s expected of you during an assignment, and what support staff will be available for patient care or administrative tasks.

Travel and housing: Understand who’s responsible for arranging (and covering the costs of) flights, lodging, and rental vehicles.

Go deeper: How locum tenens travel and housing works

Payment terms: These typically range from 15 to 90 days. Electronic transfers are usually much faster than paper checks.

Termination and cancellation: Review any termination procedures and auto-renew clauses to ensure you have plenty of notice, and that you’re not locked in for longer than anticipated. Make sure you’re clear on any procedures and penalties that apply if you or a healthcare organization decide to cancel an assignment.

Contract buyouts: If you decide to accept a permanent position, you may be responsible for buying out your locums contract — though it’s common for hiring organizations to cover contract buy-out expenses. Some agencies will decrease your buyout if you agree to keep working locums for a certain amount of time before starting your new role.

Malpractice insurance: Know where your coverage is coming from — the facility, your agency, or your own policy — and what the policy limits are. Be sure to ask about tail coverage, especially for short-term assignments.

Explore more: What to know about Weatherby Healthcare’s malpractice coverage

A few of the terms in locums contracts are typically non-negotiable, including terms related to cancellation of assignments, malpractice coverage amounts, and indemnification policies. A reputable locums agency will take the time to explain these terms in detail and make sure you understand the agreement you’re signing.

How to negotiate your offer

Many people find negotiating uncomfortable, but it’s an essential part of securing a contract that meets your needs. Never assume an employer has your best interests in mind. Take your time reviewing an offer, ask lots of questions, and consider the following:

Know your worth: Research compensation packages for physicians in your specialty and geographic area so you have a frame of reference as to what’s fair.

Prioritize your needs: Every individual has their own priorities when it comes to compensation, scheduling, benefits, and other factors.

Consider the entire package: Salary is only part of the equation. Consider health and retirement benefits, paid time off, and your work schedule and scope of responsibilities.

Negotiate from a position of strength: If you have multiple offers or an in-demand specialty, you’ll have the leverage to ask for more. In more competitive job markets, you may have less wiggle room.

Ask for what you want: Be clear, confident, and specific in expressing your needs and expectations. Never be afraid to ask, but be willing to compromise if necessary.

Understand the terms: Don’t sign until you fully understand everything in the contract, including termination clauses, non-compete clauses, or other restrictions.

Consider legal advice: If you’re unsure about any part of the agreement, ask an attorney specializing in physician employment contracts to take a look at your offer.

Always be respectful: Be prompt, professional, and courteous in your responses, even if the negotiation doesn’t go as planned. Don’t compromise future opportunities by burning bridges.

How is negotiating a locums offer different?

Staffing agencies are aiming for a win-win agreement that benefits both the physician and the agency. A relationship with a trusted locums agency is a huge asset when reviewing and negotiating agreements, especially when they’re experienced with your specialty and preferred job markets. Locums agencies can help with:

Negotiating contract terms: Great locums agencies remain proactive in securing fair compensation and reasonable contracts for your services.

Identifying red flags: Locums consultants have seen a lot of contracts, and they can provide support during the review process to point out any abnormalities or areas of concern.

Acting as a liaison: Staffing agencies streamline communication between you and the client organization and ensure contracts and any logistical details are finalized efficiently.

Contract negotiation resources

Below are several resources provided by Contract Diagnostics to accompany the information provided in the webinar:

Choose a locums agency that caters to your needs

Securing the best possible terms for your contract is the key to maximizing your earning potential and job satisfaction. The best locum tenens agencies will help you secure a contract that’s in line with your personal goals and career aspirations while taking the stress and uncertainty out of the review process.

When you work locums with Weatherby, you’ll be paired with a personal consultant who understands your specialty and what to watch for during contract negotiations. We’ll work to deliver contracts that exceed your needs, along with locums assignments that match how, where, and when you like to work. And thanks to our partnerships with leading healthcare organizations throughout the U.S., you’ll have access to more jobs in more of the best facilities.

Connect with a Weatherby consultant today, and learn more about the locums opportunities that are waiting for you. Or get in touch with Contract Diagnostics for more assistance.

Full webinar transcript:

Madison Wood: Hello to everybody joining us so far. We’ll just give it a few more minutes for people to trickle in and then we’ll get started. Alright everybody. We’re going to go ahead and get started.

Hello and welcome to today’s webinar, reviewing your contract and negotiating a better one. We at Weatherby Healthcare are thrilled to have you join us for this informative overview of the physician contract landscape from the eyes of Contract Diagnostics. Contract Diagnostics is the only nationwide consulting company that specializes 100% in physician contract reviews. Since its inception in 2011, they’ve served tens of thousands of physicians in every specialty in every state, including many Weatherby locums physicians. At Weatherby Healthcare we believe in creating win-win situations for healthcare providers and the institutions that they work at, and that we work with, and that means that contracts should reflect that philosophy as well. So, with that, we’re proud to introduce to you today’s experts, founder, John Appino, and Director of Physician Education, Dr. Kathryn Sarnoski. And you guys can just take it away from here.

Jon Appino: Thanks, Madison. And thank you everybody for joining. I’m John and Dr. Katheryn, and we’re happy to join. We were talking before everybody hopped on about our educational division. I was telling Madison that we started this company 10-12 years ago to help people and it’s these kinds of talks that get us back to our core so we appreciate all of you joining. We know your time is valuable, and of course, I’m looking forward to the presentation and answering any questions that you all have afterwards. But to that end, Dr. Kathryn can kind of give a little bit of background on herself, and why she is the best to give this presentation to you all. I’m looking forward to listening in and then helping with any Q&A’s. And definitely do send all your Q&A’s either through the chat or save them until the end, and we’ll do our best to answer every single one. But again, thanks for joining, and we look forward to discussing this tonight.

Dr. Kathryn Sarnoski: Thanks everybody for joining us on a Wednesday night. We appreciate you being here. We hope you find this really useful. Thank you, John and Madison for the intro. Just so you guys, hear again, we are with Contract Diagnostics. I am a practicing OBGYN who also helps out as the Director of Physician Education with Contract Diagnostics. We specialize in physician contract review. That is all we do, all day, every day, and my role is to help educate you on the language and terms behind the contract, give you some ideas for negotiating the contract, and tonight talk about them more in the context of a locum setting as well, and to be a good resource for you. I’m one of your colleagues; I go through this every day as I’m looking for jobs, too, from private practice to academics, to locums, employed and in between. I’ve done it all. So, I am here to be a resource for you as well. So hopefully we’ll answer a lot of questions as we go through this. Of course, it’s comprehensive, but we’re never going to touch on everything so we do leave time for a Q&A at the end. It’ll be about 35 minutes of content, and then that should give us a solid 20 min for the Q&A so feel free to put those in the Q&A chat box and we will get to those at the end, and we’ll answer anything afterwards if we can’t get through them all tonight.

So, to jump right in, tonight we’re going to be going through all of the sections of a contract that we deem to be some of the heavy hitters for you, define some of those terms, understand what they look like in a locums agreement. This applies to any level of training so this is meant to be helpful if you’re a resident still looking for your first job, fellow looking for your first job, or if you are an attending and you’ve been out in practice, maybe you’re thinking about locum tenens, just trying to make this applicable to all. So, from the start process through the contract process, these are all opportunities for clarification, understanding the job better, negotiating some of the terms. So, it starts with the site visit, might have a letter of intent, we’ll certainly be talking about the contract, and then renewal if you’re somebody who is staying at a practice and interested in adjusting terms within a couple of years, or a certain amount of time at that stay.

The site visit, I just want to highlight here what you would expect for a normal job, and then what you might expect for a locum’s job, and how those could differ. So, the site visit is your first opportunity to really get to know the location, the team, the resources, ask as many questions as possible. I have a few photos up here because I have worked all across the world essentially. But I have photos of Guatemala, Steamboat Springs, Colorado where I worked, at a rural site in Washington State that I actually worked with Weatherby. Each of these locations has very different resources, and so going on site is a great opportunity for you to one, bring your family, if you’re traveling, moving with anybody. Get to know the schools, the trails, the community, the gyms, whatever matters to you, the food scene, all that good stuff, where the nearest airport is, whatever you need to know. And then when you are on the job side, look at what your team is like. Who’s going to be part of your team? Do you have an MA? Do you have a nurse? What kind of resources are you used to having? If you work in a procedural or surgical setting, are there certain instruments that you like to have at hand that you know give you your best outcomes? If they’re not available, what does it take to get those? These are all the types of questions that you can ask. Those can be applicable to a standard employed job all the way through a locum’s job, those types of questions. And we do a lot of – I’ll mention this a couple of times just to remind you guys – we have a ton of free resources available on our website. John and I and a couple of others have written a lot of blogs that we have out there, and we put together some great PDF resources all free to you. Whatever you want, let us know. We’re happy to share them. There’s one called Job Diagnostics Q&A that gives you a list of questions that you can ask about a job, because it’s so easy to get to an interview and have them say, what questions do you have? And you just totally freeze up and don’t know what to ask at the moment. So, we put together a pretty dense list for you to work off of so that you have somewhere to go with your questions, and then maybe you’ll think of some that are more specific to you once you see that.

One thing that might be a little bit different for a locum’s job is generally you’re not going to be doing a site visit in person because the need tends to be a little bit more urgent. You are maybe not interviewing at all, or you’re doing a phone or a Zoom interview. I’ve done everything as simple as I had no interview whatsoever, I just showed up, I kind of had an idea from my locums rep of what to expect, to a full on Zoom interviews with the CMO, CEO, department chair, you name it. There can be a variety but most of the time you’re not actually going to be interviewing in person. But it doesn’t mean you don’t want to ask all of those good questions. Sometimes it’s nice when you’re on Zoom or on the phone you can just have your notes app or your Microsoft word open and have all those questions and just drill through those and it seems casual. They have no idea that you’re referencing anything. Still feel free to ask all of those questions because you want to feel comfortable in the position that you’re joining.

The letter of intent on this left side of the screen is generally more applicable to an employed job or an academic job. We’ll see this in about one in five offers for physicians, and it’s generally a one, maybe two page summary of the position, and it’s a preliminary commitment. It may or may not be binding – it should state that on there – but it generally outlines the basics of your job. Compensation, vacation, CME, maybe some signing or relocation bonus. Very, very simplified. This is the time to get your team on board, whether it’s us, whether it’s somebody else. This is the time to have your professional on your side reviewing this with you because you do want to start negotiating these terms. One thing I didn’t mention at the site visit, and this would be applicable to any type of position, is that’s not the time to be negotiating pay just yet, because you want to be looking at the full picture. And so, when you’re looking at the letter of intent, this is your chance if there are any gaps that you’re not sure of. What is the malpractice look like? What are the benefits looking like? What is the CME going to be, or what is the vacation time going to be? That’s your time to determine if the whole picture is looking reasonable. Is this all making sense? Does this all look really fair? And do we need to negotiate these terms? Because once you sign that letter of intent, those terms are going to get translated into your contract, so it can be a little bit harder to renegotiate those on the backside when they think you’re already on board with all of those numbers initially. Not impossible, but it just makes it a little bit harder so you want to start off strong there.

Generally, in the locums world, and there might be different terms for different companies, but you’ll receive something like a letter of confirmation, and that is the preliminary commitment or the offer that they give you for your assignment. And this is generally going to – Sorry, I don’t think we updated that language under there. I just noticed that it’s the same as before – but this is generally going to confirm your dates, your location, your schedule, and it might be as specific as exactly which dates you’re going to be there. If you’re taking any time off in there, that might already be in the confirmation letter. They’ll oftentimes already put in what you are going to have reimbursed. So, whether it’s your travel, your flight, your hotel, maybe they’re renting you an Airbnb because you’re doing a long term assignment, they might even have that location. Everything gets spelled out in there. So that’s a really, really, very thorough, very detailed document that you will receive for your locums work. So, the process is a little bit different for a locums assignment than it is for an employed or an academic position in that sense that you’re not getting with your site, you’re not getting a specific contract, you’re getting this letter of confirmation which essentially replicates your contract.

You will have a contract between you and your locums company. That is a contract that will mirror the terms that we’re going to jump into on these next few slides that is going to have more of your standard sections that you might be familiar with, a little bit of a mix and match. So, without getting too into the weeds, I’m always happy to at a later date, I just want to make sure everybody’s familiar with those terms, and then we can kind of talk about the compare and contrast as much as possible. So, a standard contract, I’ve seen them anywhere from 2 pages to 78 pages. They usually run in the 15 to 20 page range for an employed position. A locum’s contract is probably only going to be in that two page range, maybe three. They can fit a lot of legalese into that so it’s really important, I really encourage physicians to make sure you are familiar with and comfortable with the terms in that contract. Whether or not you choose to negotiate any of them or find that many of them are terribly negotiable, it’s very important to know what that language is saying so that you know how that can impact your day to day life both in the office, in the hospital, and at home.

And so, I’m going to focus on five of the main sections that have kind of a heavy hit on the work-life balance and so we’ll talk about each of those. When I find terms that are applicable to locums, I’ll try to highlight that for all of you. So, the position and expectations section is essentially what you are agreeing to provide to the employer. So as an OBGYN, I might be providing clinic or on call coverage. If you’re family medicine, maybe it’s something similar, clinic and call coverage. If you are in orthopedics, if you’re in academics, maybe it’s going to list your research. It should spell all of that out for you, and the goal is to have that as detailed as possible. And by that I mean not just saying full time, but then defining full time. How many days in the clinic? How many hours is a clinic day? How many days in the OR? How many call shifts? Can we cap the number of call shifts so if our group suddenly shrinks from ten down to five, we’re not all taking twice as much call without having any say in it, and/or without having any additional pay. So, trying to set some of those boundaries for yourself in the case that the group might change, the hospital might change, maybe there’s a merger that changes things a little bit, that you have some protection and therefore some say in what happens to you and your schedule in your day to day life. So, the goal is to get that as detailed as possible. This definitely applies to locums, too. I mean, those letter of confirmations can get super, super, super detailed and really, really down to the weeds if you want them to. And so, it’s kind of nice to be able to state exactly when you’re going to be somewhere and what you’re expected to do on that day.

From a compensation perspective, we’re going to talk through the three main areas. So, this is for most people, for most of us, especially if you’re a resident or a fellow and you’re going from that salary to an ascending salary, that is the first page that you turn to. Where did they list my compensation and my offer, because that can be such a huge change? But we still want to make sure that it’s the right number. Going from $50,000 to $250,000 sounds amazing, but if you should be getting paid $350,000, you definitely want to be on that end of things. So, we’re going to talk about a couple of different models, and then a couple of different ways to know if what you were offered is fair. So salaried, RVU based, and collections are what we’ll go through. I’ll spend a little bit more time on the salaried concept just because that is more applicable to locums in most cases. So, the salaried is essentially saying, you get a flat rate for the work that you’re doing. So, if I sign up to be a full time OBGYN with a salaried model, it might just say, you’re going to be a full time OBGYN for $250,000 a year. And that is just they’re going to divide it by 12 and that’ll be my paycheck every month. They might offer a bonus so something like if I produce over a certain amount I might get a bonus. If I meet certain quality metrics I might get a bonus. I might have that $250,000 and if I set my boundaries correctly, and I said, Hey, I’m going to take 50 call shifts a year based on that. If I do 51, each extra call shift is going to be reimbursed at whatever. So, that’s a salaried model. Most new grads will see a salaried model for the first two to three years out of practice so that you have time to build your practice, and then some employers are just continuing with salaried models now. The group that I’m joining next year is all salary so we all get paid the same thing just based on how much time we’re putting in so that’s more common. You’ll see that a lot in an ER department, like a 12 hour shift is going to have an hourly rate, or maybe it has a shift rate. And then this is the most common compensation model that you’ll see for a locum’s physician. So, generally there’s a lot of different ways that they can do this so you want to talk to your rep or talk to other physicians who are practicing in your same field to understand what kind of models they’re seeing. But I’ll just give you an example of what I often see as an OBGYN. I’ll have a flat rate for a shift, so say my clinic day is meant to be eight hours. I get a flat rate for that, and then if I spend nine or ten hours there for whatever reason, I’ll have an additional overtime rate. If I’m on call, I’ll have a flat rate so that would cover my 24 hours. If I get called back in, I’m getting paid an additional hourly callback rate. That’s one of the most common ones that I see. I see a lot of just straight up hourly rate for locums for a number of different fields so you just get paid for your time, and if you go 15 min over you’ll get a quarter of whatever your hourly rate is. So, for those who feel that value for your time, it’s a great model in that sense. That way you can really know what you want or know what you’re going to be earning. Rarely in a locum setting are we using one of the production models, which is the next two that we’re going to be talking about. I’ve never come across a locums contract that offers a production base. I’m not saying they’re not out there, but I’m not aware of any out there as an independent contractor.

So, the RVU model is a work relative value model. So, this is one of the production based models that you might see in more of an employer setting, maybe an academic setting. The relative value units are a points system essentially, designed by the center for Medicare and Medicaid, where they assign a certain point value to each patient encounter that we have as physicians. So, let’s say I do – I’m not using real numbers here – but let’s say I do a level three office visit and that gives me two RVUs versus then I go and do a C section and that gives me ten RVUs. Well, that’s going to be the same regardless of what facility I go to. What changes is the employers conversion factor. So how much your employer chooses to value that RVU. So, maybe employer A is going to give me $45 per for each of these RVUs and Employer B is going to give me $60 for each of those RVUs. We can see a fairly big range there, but that’s of course going to dictate what you’re taking home as your salary in addition to how much you’re producing. So, understanding what to expect from that can be really helpful. We do see some tiered models. Some employers are just already setting those up, so they might say, like any RVUs up to 5,000 are $50 an RVU. And if you then produce from 5,000 to 6,000, it’s $60 an RVU, and 6,000 and above $70 an RVU, so incentivizing you to work more, produce more. So those are some options that you can, if they’re not already in your contract, try to negotiate. Otherwise, I am starting to see those across various systems who are using this RVU model.

A collections model is more specific to a private practice. That’s really the only setting that I’ve seen it in so far, not to say that it’s not elsewhere. This is a little bit more complicated and can get a little bit trickier. We do have a whole a PDF resource on this if you’re looking for something along this line. And basically, what collections is saying, that when you see your patient and do your encounter and you send your billing code out, that level three, well, it’s going to go to either the patient if they’re paying out a pocket, or the bill is going to go to their insurance and have to be processed. Maybe it’s private insurance, maybe it’s state insurance. As you can imagine, you might have different timelines on when you actually get the check back from that patient encounter, and those values might be different. So, the patient that’s paying out of pocket might pay a different amount than the insurance would, might pay a different amount than if it were a private insurer versus Medicare or Medicaid. So, understanding your payor mix can impact what your collections might look like. And things like, whoever’s doing the billing, how on top of it are they? Are they submitting these really quickly? Are they being aggressive to make sure that you get those collections back? Are they turning your things around in 30 days, or is it taking 60, 90, or 6 months, or something like that to get that. So that’s important information to have. The other thing to know is that when you do have a collections model, the check that comes back doesn’t go 100% to you. You’re working as part of a team in a facility and you probably have some sort of overhead, whether it is paying MAs, nurses, maybe you and your colleagues are renting a facility or pay a mortgage to have your office space and the equipment that you have in the office. All of that is part of your overhead. So, if you can get creative and think of ways to decrease your overhead, you might be able to increase how much of that collections you get to take back. Are you taking back 30% of it? Or now can you clean things up enough to take 50% of it back? The other thing to keep in mind is there can be tiered models in this, too, and so that could be something that you negotiate if it’s not already built in. Let’s say if you do more than $400,000 in collections or up to that, you would take 30%. Maybe that 400 to 500 is going to be 40%, 500 and above is 50%. Again, incentivizing you to produce more. So those are some ideas for those of you who might be looking at a private practice with a collections model.

Quality bonuses are pretty common throughout the country and so I want to just touch on those. These are basically a value that they may offer you as a bonus at the end of the year if you meet certain metrics. What’s important to think about for a quality bonus is whether or not these metrics are within your control. So sometimes it’s something you can absolutely control like closing all of your charts within 24 hours, and sometimes it’s something like your patient reviews. Which if any of you have been to the physician recently, might notice that you get your text of, Hey, submit a review, and you have ten questions, and one through nine are things like, how easy was it to schedule your appointment? How clean was the office? How pleasant was the front desk staff? And then finally question ten is, and how was your physician? And so, if you are being judged off of all of those questions, you might have a little bit less control. So, understanding how you’re falling within these metrics, asking questions like, Hey, of the other partners, how much of this bonus are they getting? Do they get the full, say $30,000, or are they bringing home $5,000 or $10,000 at the end of the year? Just primarily so you don’t budget to have an extra $30,000 in the bank at the end of the year, and then find out that you don’t get that whole thing. You don’t want to be put in that position. And also, if they’re trying to use this as leverage and keeping compensation lower, you want it to make sense that it’s actually going to be part of your salary.

Evaluating pay. So, this is where I was talking about the concept of how do you know if this is even fair? Is this $250,000 a good offer? It seems great relative to what I got paid before but is my neighbor making $400,000 and doing the same job. So, there are a few different ways that you can evaluate if pay is fair and one of the best ways, kind of gold standard for that, is one of the survey data sets called MGMA. That is a survey data set, it comes out every year, usually around May, sometime in the spring, and it’s based on the previous year’s compensation data, and they get into the nitty-gritty. They do it by region; now they’re doing it more by state. They’ll narrow it down into specialties and subspecialties and sub subspecialties, you name it. They get really detailed with breaking down compensation through different practice types like multi-specialty, private practice, employed, rural setting, urban setting, really break it down to 10th, 25th percentile, median, 75th, 95th percentile. They’ll talk about collections, they’ll talk about RVU. It’s great. It’s not accessible to an individual physician to just go access the full MGMA data set. So, a company like Contract Diagnostics or somebody who specializes in physician pay will buy access to this. And then, when we do a review with our physicians, we share that information with you, the part that is applicable to you. So that’s how you can access that. If all you’re interested in is the financial aspect and having that MGMA data, we have a product called Compensation Rx and I included it up here because this might be helpful for somebody who’s been in practice for a few years, and has not renegotiated the terms, and now that you kind of don’t know. Like, I’m hearing different numbers out there, is my income – does this still make sense? The model that I’m under, should I be asking for a higher salary? Well, this is where you can call us, we’ll give you this data. We schedule a 30 minute phone call with you to go through the data, make sure that you understand all of that, and then you get that full report so you can kind of decide how you want to negotiate that. Otherwise, if you’re doing a full contract review, we’re going to include that data. We do include – so, another way that you can look at this is interviewing at a bunch of different places. So, if you aren’t exactly sure what you’re looking for, you just want to see what the different offers are that are out there, go interview around. That’s a great way to see what the options are. It might be a great way to find some leverage from one job to another, because you will be shocked to see how one job one block to the west of you will pay maybe $200,000 more than the job two blocks to the east. It’s really outrageous the differences that you’ll see. And maybe they make up for it, maybe there’s a reason. Somebody has a great benefit package on one side, or a huge amount of vacation time, or something like that. But we do realize that interviewing a number of places is a bit of a burden and takes a lot of time, and coordination, and pulls you out of the office or out of your residency program, maybe, to accommodate that. And so, at Contract Diagnostics, we do keep all of our internal data available, and we make it anonymous, of course, to share with you. So, if you say I just interviewed for this one job, and I just want to know if this one job is fair. Well, not only will we give you the MGMA data that we have, but we are also going to provide you with all of the applicable data to anybody else whose contract we’ve reviewed in your field, in your location, and what their signing bonuses are. We want to share that with you as well because that’s going to be real time, and then it saves you from interviewing in all those places, and you’ll get to hear what some of your colleagues are being offered in your neighborhood. And then, just to keep in mind, you know one job, it’s not always going to make sense to get the first offer. You might have a niche, you might be offering something really unique, another language that you’re speaking, maybe you’re building up a research department, maybe you’re starting or growing their global health department, you name it. The story that you’re bringing in really matters to what might make sense from the contractual standpoint. It can matter if you’re looking at a rural place where they’ve been trying to recruit for two years, and you’re the first person who’s been recruited there. So, 250, and 250 and 250, each position is going to have room for negotiation because there is so much more to the picture, to the story, that can help us provide leverage and provide negotiation tactics as we’re looking at all of this. And that’s just a reminder, don’t forget to raise your hand that, like I was saying, if you’ve been in practice for a little while, and it’s been a couple of years since you’ve negotiated, by all means let’s figure out how we can get you a better deal.

There are some other sources of income that are out there, so nurse practitioner and PA supervision, if you’re doing research, teaching, academics, maybe you have some side gigs. So those should all, if they’re going to be additional time, if they’re going to be additional administrative or clinical burden for you, you should be compensated additionally. So please do make sure if you’re seeing those in your contract or anticipating these to be part of your job description, confirm that you have these also supported for income. From a locums perspective, you should not be restricted from other positions. So that’s really important to confirm when you’re looking at a contract with a locums company. Generally, they’re fairly straightforward, fairly simplified, and fairly nonrestrictive in that sense. But you do want to make sure that they are not restricting you from working with another locums company, from working another site at the same time. You should be able to work multiple locums positions at the same time, you can work with different locums organizations at the same time, you could have your employed job plus your locums job, you could do something like I do, working as a physician educator. That should all be available to you in a locum’s contract situation. And if that’s something you want available to you in an employed situation, do make sure that you have that protection in your contract because sometimes they will restrict.

Benefits have a huge dollar value to them. If there is a strong benefits package, you’re probably looking between $30,000 and $60,000 worth of value between your health insurance, your life and disability insurance, vacation, CME funds, retirement plan, retirement matches. These are fantastic, but make sure they’re there and make sure you understand how they work. So, I always recommend when you are interviewing with an organization to ask to meet with or just call their HR Department and ask for one of them to spend 45 minutes or an hour just reviewing all of these benefits with you in detail. And get as many questions answered as you can so that you understand what the employer is going to be providing for you, what kind of premiums you might have to pay to achieve the coverage that you want, if there’s any delay like when you can start investing in the retirement plan, can you do it day one or do you have to wait a year for some reason. Those are all things to be aware of. If they’re prorated, if you are doing a partial year, or if you’re on a maternity leave or an FMLA, otherwise, how is that going to impact all of it. When it comes to locums, you’re pretty much going to need all of this on your own. So, I have done almost exclusively locum tenens for the last three and a half years, and it’s a bit of a learning curve to figure out how to achieve all of this. But yes, you do have to buy your own health insurance, whether it’s going through a partner or going on the marketplace or going into a private plan. Your own life and disability insurance, which we do always recommend that physicians carry their own life and disability insurance. You’ve probably heard that before. Your employer is most likely going to, hopefully, going to provide that for you, but it doesn’t guarantee that they are offering a particularly robust policy, and it doesn’t continue with you. So, when you switch employers, you’re going to lose that disability policy. If you carry your own, then you know you’re going to have that no matter what. Retirement plans; as an independent contractor, you’re going to be looking at an individual 401k or a SEP IRA, and that those are going to have different limits than what your standard 401k might have. Vacation time is going to be when you pick it, and it’s not paid. So, if you’re not working, you’re not getting paid. Those are things to keep in mind. Your CME, that’s all coming out of your back pocket. But we’ll talk a little bit about how you can recoup some of those costs.

In terms of – now this is going back to anybody who is still employed. If you have been in practice for a few years and nothing has changed in your contract, that is a good time to make sure that you are reviewing it, and maybe negotiating terms to update them. Your salary should go up on a yearly or every other year basis and if you’ve gone more than that, without a change in salary, it is time to have that conversation and figure out, Hey, where should it be? How can I get it there? Why haven’t we touched it yet? And what do we need to do to make sure that it’s back to where it needs to be? And we can help you with that. I mean, looking at what kind of production you’ve been on, what kind of departmental roles you’ve been holding, maybe directorship positions, you name it. We can put together that whole picture with you to help make sure that you feel like you have a strong package going into that conversation with your team, because we know everybody tends to feel a little bit anxious about that conversation. We want to highlight how wonderful you are and make you feel like you’re ready to share that.

And then when it comes to compensation. Sometimes you look at the number, and the first question doesn’t have to be, Hey, I want to take this 200 to 250. It can just be asking for more information. So, this is another PDF resource that we have for physicians. It has a bunch of questions that you can ask about. How did we get to this number? How often is it going to be evaluated? What does it look like for other partners? What happened during Covid? What changes if I do additional call? Questions like that. And when you get those answers, that’s your opportunity to decide, I think that was a really well thought out offer and I think this seems fair and I’m happy with this, or you know what, I think, based on that I should be asking for an additional, however much.

A couple of other areas I really want to spend a moment on to highlighting malpractice insurance, is one of those. So, two main types of malpractice insurance. The gold standard is occurrence based, and that is basically saying that as long as you are working for your employer, as long as you are under this policy, you are protected for any patient that you saw under this care, under this policy. So, if you see them today, and in a month you get a claim from a patient, well then, you are covered. If you see them today, you leave the job in a year and you get a claim in two years, you are still covered. On the other hand, with a claims based policy, you are only protected when you are working for the employer under that policy. So, if you see the patient today and you hear back from them in a month, and you’re still employed, and you’re still under their policy, you are covered. If you leave in a year, and you hear from them in two years, you are not. And that is where your tail insurance comes in, and you do need to have tail insurance, and that helps protect it and essentially turns it into what appears more like an occurrence based policy. Most locums companies, as I understand it, and you always ask about malpractice, make sure that is included. That should be provided by your locums company. Most of them will include claims with tail and they should be able to give you proof of that coverage. If you’re working with an employer and they list that they have a claims based policy, then you need to ask about the tail coverage. Who’s paying for that? If they’re expecting you to pay for that, what can you do to negotiate it? So, can you say, no, no, let’s have you cover that; let’s negotiate that one in. That might be possible. If they say absolutely not, you can do a few things. One, I always recommend getting a quote so that you know what to anticipate for that tail insurance and then ideally throw that amount in a high yield savings account or something you can access in the case of leaving, so that you’re not scrambling to put together a five or six figure check when you’re not expecting it and you’re already going through a change. You can also get a little creative saying things like, Hey, let’s do a retention bonus. If I’m here for three years, why don’t you give me a $60,000 bonus? And then you can take that money and put it in that account so that you’re prepared for paying your tail when you leave. Or maybe in three years they’ll pay half of your malpractice insurance, and if you stay for five years they’ll cover all of your tail insurance. And so those are a couple of different ideas, but do make sure you understand what kind of malpractice insurance is provided, and if it is claims only, have a good clear plan for yourself as to what to do about tail.

Restrictive covenants I highlight because they can have a big impact on providers. So, I do not mind bouncing around from one city to the next or from one state to the next so a non-compete is not going to have a big impact on me. But this is a restriction that is put on you after you’ve completed your employment. And so, a non-compete will say that for the next two years after you leave the job, you may not practice within a 25 mile radius, maybe every clinic or hospital that you worked at with this employer. As you can imagine, if you had satellite clinics, if you had multiple hospitals you were covering, these could be like huge areas that you’re blacking out. And if you’re not somebody like me who likes to move around, you might have picked your location for a reason. You might be born and raised there and plan to live there forever. Maybe you have a partner who is really committed to that location, and you don’t want to be blacked out of working in your community. Well, it’s really important to think of ways that you can try to minimize that non-compete. Depending on your employer, these can be very challenging to negotiate so sometimes you have to get pretty creative. Sometimes you can shrink the radius, or you might be able to shorten the time. Those tend to be a little bit trickier. But another thing you can do is try to limit the number of locations that they select for your blackout area and just say your one primary location, have that named. Maybe it’s your primary clinic or your primary hospital, and you can’t work within 25 miles of that. Well, at least you know it’s just that one radius and we haven’t created three, four, or five areas. The other thing that we’ve had a lot more success with is as different job roles come up within each of our fields you might be able to create exclusion criteria. So, for example, as an OBGYN we have a role as laborists or hospitalists where we don’t have our own clinical practice anymore; we’re just covering whoever walks through the door. And so, we’ve had success saying, Okay, I’m not going to be a full scope OBGYN but I’m not breaching a contract if I work as a laborist for those two years even within that radius. So that’s been successful. I negotiated something like that with a nephrologist who was able to create an exclusion if she worked as a general internal medicine hospitalist, so she just couldn’t do her nephrology work within that radius. So, if you think a little bit about your field, and maybe there’s an area that you would be comfortable with practicing within that radius, that’s a great way to do it. Some people actually do use locums to ride out their non-compete so they’ll find a job that maybe they’re flying to, maybe you’re driving an hour away, something outside of your radius for those two years, and that can be a great way to get familiar with the locums world and also to ride out your non-compete, and maybe have some additional flexibility and benefits during that time. There are certain states that do not uphold the non-competes, like California is known as that one, so be familiar with your specific state restrictions. Federally, Biden is trying to limit or eliminate non-competes. It stands to be told whether or not physicians are going to be protected under that so we don’t know yet. If that clause is in there, please do take that seriously and determine if that is something that’s going to matter for you. You don’t want to breach the contract and end up with like a humongous fine or something like that. Non-solicitations are saying that you’re not bringing your coworkers or your patients with you so pretty simple for that same amount of time. With locums, generally your non-compete is going to come from the recruitment company that you’re working with. So, if I use a company to present me to a site, I will now – and it depends on your contract, but you will generally have a non-compete with that particular hospital for the next two years. And so, if you try to take a job with that hospital you would either need to do it through the locums company or maybe they have some sort of buy out that they already negotiated with the site where you can. Yes, you can be employed with them but you or the facility might need to pay the recruiter and the locums company kind of like a finder’s fee. The other thing is if you start working with that locum’s company and in six months you’re like, I don’t really like this locums company. I want to work here, I love this site, but I want a different company. Well, you’re going to have that two year restriction so you’re not going to be able to make that switch. So that’s pretty much as extensive as the non-competes get. That is something that you can negotiate if you feel like that is going to be prohibitive for some reason, ahead of time. That is something that you can talk to your recruiter and say, Hey, these are my concerns, how can we clarify and negotiate this language.

Termination. Although most of us are not starting a job already thinking about ending it, unless that was the intention with the job, it’s really important to think about what it takes to terminate and the costs of termination. So, most jobs will offer a without cause termination clause, which basically just means you can have a reason in the back of your head, you don’t have to tell anybody. You just write that note, send it via priority mail or however they want you to get it to them and say, my last day will be December 31st. And what’s important to make sure that you know is one, how to deliver that message, and two, how much notice you need to give. Whether it’s a 60 day notice, a 90 day notice, 120 day notice, that you’re giving the appropriate amount of time. For a locum’s contract, most commonly this is a 30 day notice, which if something isn’t working out and you want a quick change, 30 days might be great. If you were loving the assignment and you got a 30 day notice and didn’t have anything else lined up, 30 days is a very short amount of time to find your next assignment, to get licensed or credentials in a new location if you don’t already have a second spot lined up. So, you can think about that as you’re looking at those termination clauses. We have, with Covid, seen more restrictive language and possessive language in some senses. These employers are starting to put language in like, for the first two to three years of your employment, you can’t give a without cause termination. They would have to breach the contract, and you would have to highlight that and they don’t fix it for you to leave, or catch somebody on a day of weakness where they’re feeling willing to let you go, but otherwise you may be stuck there for that amount of time. Some of them are requiring a six month notice. This is important to know because you want to think about how this is going to impact your life. If something’s not working out, what is it going to take to leave? Six months can be a really long time if you feel like, even though you listed this without cause, this isn’t a good place for you, or you have somewhere else that you need to be to be with family or something along those lines. So do think about those clauses as you’re looking at it. In terms of cost of termination, that’s where the tail insurance that we talked about can come in. That is also where if you get a student loan repayment – we’re seeing that offered a lot of places – a signing or starting bonus, a relocation bonus; a lot of those bonuses may need to be repaid if you terminate before two years, three years. I’ve seen one as long as six years. So that’s important to know as well that you’re prepared to pay back a signing bonus, a starting bonus, whatever, $40,000, $50,000, whatever you got. If there was a student loan repayment that might be $75,000. A lot of those were taxed when you originally received them. So, if you had a $30,000 signing bonus you might have only gotten a check for $15,000 or $18,000, but now, if you have to pay it back in full, you have to come up with an additional $12,000 to 15,000. Ideally, they’re prorating them so if you get closer to that two or three year mark, you’re paying that much less. Most of them will prorate, but some of them are expecting a payment in full, so certainly try to negotiate for that prorate. But being prepared to leave, you know, there’s a lot of change, there can be a lot of stress, try to take that amount out of it by knowing what to expect and how much you’d have to pay, and being prepared for that with that savings account.

When it comes to accepting risk, this is where it’s just important to know your goals for yourself, for this job, where you’re willing to give and take a little bit. Because the employer, they’re always going to have their non-negotiables like, Nope, this is what this means. We will not change it. We don’t budge. We put our foot down. It’s okay for you to have that, too. You can have non-negotiables. It’s just important to know what those are and where you feel comfortable finding some compromise. Like, Hey, I’ll give a little bit on the compensation if they’re going to loosen up this non-compete for me, or maybe I’ll take a bump in my salary for a difference in vacation. Think about some of those different areas and what really matters to you so that you feel comfortable with the contract that you ultimately agree to.

When it comes to negotiation, a BATNA is the best alternative to a negotiated agreement. So generally, I always recommend when you’re going into a job try not to be desperate for that job. You want to be, even though, you know, especially when we’re working with our physicians, if you want to be there, we want to get you there. We want to make sure that we can negotiate an agreement that you feel great about. But I also want you to feel comfortable walking away if you find that your values and the values of this job are just not aligning as you’re going through this. And it’s important to have a backup plan whether that is backpacking in South America for three months because we didn’t do that when we were 21, or if it’s doing that job a couple of blocks to the east that you looked at and thought, Hey, that’d be a good backup option if this one doesn’t work out, and/or anything in between. Maybe it’s taking your boards, maybe it’s having a baby, whatever it may be for you. And sometimes, when we’re negotiating, we don’t necessarily always need to be asking for something different. Sometimes we just need to be clarifying. These terms look different from one hospital system to the next in the way that they phrase their legalese, and so it’s just important sometimes to understand what point are we trying to make here, and is it clear enough? Is anybody who reads it today still going to read it like that in three years, if we have a full turnover of the Admin team or something like that? Is it still going to be clear? Or do we need to negotiate some new terms to make sure that this is more clear, that this is more protective for you. Your negotiation strategy can be a little bit different between academic group versus hospital employed versus private practice versus maybe locums. And we, as specialists, are very familiar with a lot of those differences. And so, we’re happy to help you navigate where you can negotiate, and where you might just be hitting your head against a wall, and they’re not going to budge, and you’re really trying so hard. But we need to redirect that energy to get you something else that is more in line with what you’re looking for and with where they’re willing to give. Sometimes we can get addendums in our contracts. Oftentimes that’s how we can personalize them. An employer might say, Oh, this is non-negotiable, this contract, this is standard, this is non-negotiable. That doesn’t mean, one, that you shouldn’t have it reviewed because you still want to know. It doesn’t mean that it’s fair, you know, it might still have some clause in there that you’re not comfortable with. But that standard agreement might not be negotiable. You might not be able to change the language in there, but it doesn’t mean that you can’t clarify or personalize in an addendum or an official letterhead that’s included with your contract. So those are areas where we can help you make sure that you’re getting the terms that you feel comfortable with and that you like. And then, once you’re in a group, if everybody has the same contract that they’re working under or wants to get under the same contract, definitely power in numbers, we do group negotiations as well, and that’s a great way to help improve your situation as a team, if you’re willing to go into that together.

I guess I mentioned this a little bit, but with a locums contract I did say, so those are pretty simple contracts generally. They’re not meant to be overly burdensome to the physician. But there are certain areas that physicians may or may not feel comfortable with, or when you’re working specifically with a site and you’re looking at dates, you’re looking at rates, you’re looking at what gets reimbursed and what doesn’t. That’s all negotiable. So, by all means you have an opportunity as an independent contractor working with a locums team to negotiate those terms. Your locums rep should be able to help guide you with all of that. You just have to be able to voice what you’re looking for so that they can help you negotiate those terms. When it comes to locums, just since we’re working with Weatherby here tonight, locums has become increasingly needed over the last few years, especially. It’s always been around. A lot of physicians were using it previously. They do their job, and then they pick up some weekends or holidays here or there for some extra money. Maybe it was to pay a mortgage, or to help put a kid through college, or to go take another vacation or something like that. Now we’re seeing a lot more physicians doing this as their full time gig. That’s the only clinical work they’re doing is all in locums. And that was what I did for the last three and a half years, and absolutely loved it, so there is a significant increase in the use of locums. Just from when I started in 2019, I would say the first time I went around there was something like 25 jobs I could choose from. Now I look at the board, and there’s like 100 some jobs with any one locums facility. If I put all the facilities together, I couldn’t even tell you how many job opportunities I would have. There’s a lot out there. So, there’s a huge need for locums physicians. It generally pays a little bit better than an employee position, however, it is 1099 income, which means you get the full check. You do not have any taxes, anything pulled out, which means you have the responsibility to pay your own Federal taxes, State taxes, your own Medicare, Medicaid, Social Security Tax that’s not being paid by your employer. So, it does come with a little bit more burden, a little bit more of a learning curve for you. It can have pretty significant financial advantages though if you are calculating everything correctly and make sure you’re staying on top of everything. Some people use locums to determine if something’s a good fit for them. So, if they say, Hey, do I really want to move from Wisconsin to California. You know what? I’m going to take a locum’s job first. I’m going to check out the area, I’m going to check out the team. Do I like working for this system relative to the last system I was with? And that could lead to a permanent placement. So, sometimes they are placing physicians there with the intent to hire you. That is an option. It’s a great way for you to kind of try out for the position and let them try out for you as well. It’s also a really fun, flexible way to see different places. Since I used locums as my full time job, I moved essentially to those locations. I had full time housing there, I had a full scope practice, I joined a gym, I found my running trails, I found my community, I hung out with my co-workers. It was such a cool way to see different parts of the country. So, having grown up in Wisconsin to then spend a year in Washington State, and then a mountain town in Colorado, and then a mountain town in Utah. I mean, I spent almost two years at my last assignment, it’s like a home essentially. So, it’s a really, really cool way. Some people like to use it to do like a week on, a week off, or two weeks on and two weeks off so you can vacation, or you can know that you’re home with your kids at a certain time, picking somebody up from school. People have some pretty compelling reasons for doing locums so you can often meet some of those needs that you have for the time away from work in addition to the work that you enjoy doing.

There is a difference. I was talking a little bit about W2, which is employed work versus 1099, or independent contractor work. Just so you’re familiar with some of the basic differences, we do have some blogs and PDF resources on this that I’ll link to at the end as well. But with an employed position, most of you are probably familiar with that. Your employer is pulling your tax money out, they’re covering half of your social Security, Medicare, and Medicaid, they are offering a 401k plan, or 401a, or some sort of retirement, and maybe they’re giving you a three or six percent match. They’re giving you all those benefits like that health, dental, disability, life insurance, paid time off, CME, so you can get a lot of benefits by being a W2. What you do not get are much in the way of write offs. So, they take all of that out. You don’t get to try to find many other ways to reduce your tax burden. On the other hand, as a 1099, you’re an independent contractor; it’s like your own business essentially. So, they’re just giving you, if they said they were paying you $150 an hour, and you worked for 1 hour, you will get a check for $150. Whereas your W2 counterpart might have a check for $75. You still have to pay your taxes. You are now paying your full Social Security and Medicare tax; you’re not having a part of that paid by your employer. You do not get a retirement plan from the employer so you are responsible for setting up your own retirement plan. That could be beneficial because you can oftentimes put more into those than you could into a 401k. So that would be something you would talk to your accountant about. You set up your own health, dental, disability and life insurance. Those can all be write offs. So can your car, so can your mileage, so can maybe your groceries? There could be a lot of write offs that can help reduce your tax burden when you do offer 1099 work. Your accountant would be the one to determine like, yes, this one applies. No, this one doesn’t. What’s the best way to keep track of everything, because it is a lot of like record keeping on your part and keeping track of all those receipts and folders and numbers and all of that. But it can be hugely beneficial to help you drop tax brackets if that’s something that you’re interested in. Because you’re responsible for all of those benefits, generally, your compensation should be higher than a W2 counterpart. So usually I estimate about 30% higher, so I don’t know, I can’t do that math in my head. But maybe if your W2 position was 150, then your independent contractor position should be more like 200 an hour.

Red flags in a contract. I can summarize all these into, if it’s too vague, then it needs to be better clarified. So, something to keep in mind there. Resources, reach out to us. Like I said, we have tons of blogs. We have PDFs that are all free. You can email us, set up a free consultation, and I also love this book by Chris Voss, Never Split the Difference. He’s a former FBI hostage negotiator, and he is really great at applying everything that he’s learned to other areas of life. So, you can take that to your next job. These are a couple of QR codes that I thought you might find helpful that are specific to today’s talk, our independent contractor Q&A. Again, so you can read a little bit more about 1099 versus W2; what to expect. And then a couple of the blogs that I’ve written that are a little bit more specific to different practice types, including locum tenens. We do hear a lot of physicians say that they wish they had talked to us with their last contract a few years ago, so we hope this catches you ahead of the curve. It gives you some extra education. And then we’ll jump into a Q&A. And I realize that went a little bit longer than I anticipated. It looks like the Q&A; we’ve been answering a lot of those in there.

Jon Appino: Dr. Kathryn, I did answer one of them, but I thought you might have more experience with one of them than I know, and it was on nurse practitioner or PA supervision, and how that may differ from a locum’s position from like a standard employed position. If you know, can you comment on locums and their ability or willingness or desire to supervise PAs and MPs knowing that they’re really cranking on. I read a report by A&M Healthcare earlier this year, and it was like the number of searches that they’ve done for APPs has been skyrocketing lately, as well as their salaries. So, if you comment on that? And also then, of course, one of the questions that I would think of is, is there typically additional compensation for a mid-level provider supervision? And does that vary depending on the locums position or a standard employee position?

Dr. Kathryn Sarnoski: Yeah. So, for a standard employment position, what you think about when you’re supervising a mid-level provider is you are going to be having additional time. If you have to do a full read through of their charts and sign off, that’s going to be additional time spent. It’s going to decrease your productivity if this is during your clinic day, it might limit the number of patients that you can see, or the number of surgeries you can do. And it can also increase your liability, especially depending on the state that you’re in, if your name is then on the chart, that is going to increase your liability. So generally, that should be compensated, and if it’s not specifically separate from that, it should be factored into your overall compensation. As a locums provider, you generally should have the option to say, I will or I won’t. It gets pretty detailed on what your job description is going to be when you’re working at a particular site. So, if you don’t want to be supervising mid-level, you don’t have to be. So, for an OBGYN, maybe I worked at a lot of sites with midwives, and I had to make the decision as to whether or not I would be supervising those midwives or not supervising them. You might have that in different situations for different fields that you’re in. But that is a conversation that you can absolutely have ahead of time, and you have a lot of protection if you get there and you didn’t realize you were supposed to be negotiating. You go to your rep right away, and that should be fixed almost immediately if that’s something that you’re not comfortable with or needs further clarification.

Jon Appino: This is out of my curiosity; how often do you keep in contact with your locum’s rep? I don’t know if that varies by organization. I know you worked with Weatherby in the past, and I’m just curious as to how often you reached out to them, they reached out to you, about what that relationship is like.

Dr. Kathryn Sarnoski: Well, once you are interested in a particular site, upfront you’re probably going to be talking to your rep quite a bit trying to hone out the details, the living arrangements, the reimbursements, make sure you get your compensation rates down pat. Once you start there, a few things might show up that you weren’t anticipating so in the first week or month there might be a lot of back and forth. Like, Hey, they didn’t mention this. We need to get this in the contract, or, Hey, I want to make sure – it looks like I’m getting called in afterhours a lot. I think my overtime rate is too low, whatever that is. I would say the last contract that I had where I was there for almost two years, I was in touch with them quite a bit upfront, and then every three months or so I’d get a quick text like, How’s everything going? And then I would renegotiate. So, something for all of you to keep in mind if you are doing locums and you stay somewhere for a longer amount of time, as you get to know the position better, I renegotiated my rate every three months, pretty much. And so, that’s something that you would go through your locums rep additionally. If everything’s going really smoothly, you’re happy with your rate, you’re happy with the location, and nothing needs to change, you’ll probably just get those quick like thumbs up kind of check-ins. If there’s a concern you will be in touch with them regularly. And then, as many of you know, once they have your information, you’ll hear from them all the time, by phone, email, and text.

Jon Appino: I know some physician recruiters, and from what I’ve heard, once they place you in your job, they’re kind of like, okay, I’m onto the next candidate so I can get another placement fee. It sounds like the locum reps, if you will, are a little bit more in contact with you and making sure that you enjoy it. And if you don’t, then finding you a new assignment and everything else.

Dr. Kathryn Sarnoski: Yeah, they are definitely your go-to point person. And you stick with the same person, usually, once you’re in a company. They won’t have you bounce around unless that person leaves for some reason.

Jon Appino: Do you know, I guess this is just a general question if the audience doesn’t have any, I just have one. Is there a standard? You know, we see stats all the time about physicians taking jobs and how many of them leave their first job out of training within a year or two. Are there stats with the average locums assignment? I guess it probably varies by the specialty and by location, but are there stats on like the average assignment is two months, two years, somewhere in between?

Dr. Kathryn Sarnoski: Madison might actually have that data better than I do. From my experience, I see them all across the board. I see things like the same sites coming up just for like holiday coverage because they probably only have one or two docs and somebody wants it off. And I see a ton of sites that are looking for full scope clinic five days a week, and one in three call, so I think there’s everything out there. It’s like something for everyone.

Madison Wood: Yeah, that’s really true. That’s what we see on our side as well. I’ll add a link in the chat for everybody to take a look at. We have a State of Locums report that has a lot of interesting information on things like that about how frequently people are entering the locums market, how long they typically work locum tenens, how early in their career, late in their career. Yeah, I’ll add that information as well.

Well, I know we’re over time so I just want to thank our experts just one more time. Thank you so much, John, and thank you so much. Dr. Kathryn. You are wonderful. We just really appreciate all the information that you guys shared here today. Everybody who attended will be getting an email to allow them to re-watch the webinar. We’ll also have some additional resources there that Contract Diagnostics shared with us today so please look out for that by end of week. And if you want to have more conversations with Weatherby Healthcare or Contract Diagnostics, that contact information is here, or you can reply to our email after the show. So have a great night everyone. Thanks so much.

Dr. Kathryn Sarnoski: Thanks for inviting us, and thank you everyone for spending the evening with us. Reach out with any questions; we’re here for you.

Madison Wood: Thanks so much.

About the author

Gerry Carpenter

Gerry Carpenter is the managing editor for CHG Healthcare. He is a 20-year marketing veteran who loves to write, edit, and play with words. He enjoys visiting new places, speaks fluent French, and is slowly learning Portuguese and Japanese.