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April 26, 2021

A Checklist to Help You Negotiate The Best Employment Contract

Employment contracts are complex and often difficult to navigate. This checklist is designed to help you consider all the right questions when reviewing any employment contract you receive. Review all the resources to make the best decision for your career and feel confident you're protected before you sign on the dotted line. 

Specific Considerations

Due Process

  • Does the group require you to agree to waive your medical staff protections/rights as part of signing a contract to work with the group at a site?
  • Does the group provide due process for "internal" company concerns?
  • Are all physicians on a medical staff, including emergency physicians, being afforded the same due process rights?

Fairness Issues and Due Process Considerations in Various Emergency Physician Relationships

ACEP Reaffirms Statement on Due Process Protections

Billing Transparency

  • Will you receive timely feedback on any performance-based measures used to determine compensation?
  • Is the compensation fair and equitable (does it take into account your experience, clinical and administrative services you may provide, the added value of your participation in the practice, market conditions, etc.)?
  • Will you receive a semi-annual report that itemizes all billings and collections done in your name, regardless of whether or not billing and collection is assigned to another entity within the limits of state and federal law?
  • Do you have the right to audit such billings, at any time without retribution?
  • Is there transparency in revenue and expenses associated with the practice, including management services?

Policy Statement: Compensation Arrangements for Emergency Physicians

Restrictive Covenant

  • Does the contract restrict your opportunities to moonlight or have a second job?
  • Does it require you to seek written permission before, for example, volunteering to provide care at the local marathon?
  • Is there a non-compete clause that restricts where you can work after you leave?
  • Is the restrictive covenant written in a vague way so that you cannot readily determine how much it limits your prospects? (ie: “cannot work within a 5-mile radius of any hospital contracted by your group”)

Force Majeure

  • Is your employer automatically released if an “act of nature” that prevents the employer from paying you? (This is becoming more common in physician contracts.)
  • If a force majeure clause is included as a basis for termination, does it provide the same notice period as other terminations?

Family Leave

  • Is FMLA available? (it may not be available with small groups)
  • Beyond FMLA, are you offered paid leave?
  • If no paid leave, are there alternatives such as low-interest loans? Are you able to “bank” paid sick leave for paternal leave?

FMLA v Paid Leave

Policy Statement: Family and Medical Leave

Termination Provisions

  • In which circumstances can the employer or employee terminate the contract?
  • Does the employer have the ability to terminate the contract without cause? And if so, do you have the same ability?
  • Are there protections in this instance - period of notice, severance pay?
  • Are the grounds specified as sufficient for “for cause” termination objective and reasonable (as opposed to “moral turpitude” or other such nebulous terms)?
  • Do you have the ability to terminate ‘for cause” in certain reasonable instances?
  • Can the employer terminate the contract before the employee begins working?
  • Is there a force majeure clause, which absolves one or both parties of some or all of their obligations in the event of a catastrophic event (e.g. pandemic)?

Malpractice Insurance

  • How is the malpractice policy structured and who is responsible for various premiums?
  • Are malpractice insurance limits reasonable?
  • Does the policy protect the physician against liability for APPs practicing under their direction?
  • Is the policy occurrence-based or claims made?
  • What are the provisions for purchasing “tail” coverage?
  • Is there a discovery clause?
  • Is there a consent to settlement clause?
  • What is the group’s malpractice claim history over the last 5 years?

Compensation

  • What is the base salary? How is it calculated (salary, RVU, quality metrics, patient satisfaction scores)?
  • Is there a pay difference between board eligible and board certified?
  • Does the salary include bonuses and under what conditions
  • Are health, vision, dental, disability covered and are these benefits fixed or subject to change after the contract is signed?
  • What other benefits are included?
  • What are the retirement contributions?
  • Is there profit-sharing?
  • What is covered for CME, licensure (state, DEA), board certification expenses, professional society dues?
  • Are your moving expenses covered?

2019–2020 Emergency Physician Compensation Report

Job Description & Obligations

  • What are your obligations and are they reasonable?
  • Are your clinical hours reasonable?
  • Do you have non-clinical obligations (e.g. teaching, research, departmental/committee meetings)?
  • Do you have call responsibilities?
  • Are you obligated to cover clinical emergencies outside the ED?
  • Are you required to obtain and maintain ABEM certification and are you required to maintain medical staff privileges?
  • What are your obligations in supervising and signing the charts of APPs providing patient care?
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