American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Contract Negotiation: Areas of Contention

Many promising physicians and surgeons make the mistake of believing their new employment is a “dream job” only to discover that some of the most important details of the job were lost in the proverbial fine print. I’ve compiled five examples of what can go wrong when an employment contract is not carefully reviewed.

  1. On call services. Physicians often disagree with each other on the coverage of emergent cases. Over the years, call has evolved to include which types of patients are cared for by which teams in a medical center, as well as which patients can be transferred into a hospital system. Ideally, a contract should include a thorough discussion of what specific conditions are covered while on call and, critically, what is the upper limit of your call responsibilities. This final point is most important when you find yourself as one of only a very few specialists in a medical center that requires excessive numbers of call days to fill gaps in the staffing.
  2. Away time. This may seem like a small point but it can become very important. Surgeons need time away from work. A contract should include a clear number of weeks or days without clinical responsibilities where no communication (electronic or otherwise) is required. Typical contracts include weeks of vacation and a separate allocation for continuing medical education and conferences.
  3. Expenses. Every surgeon incurs expenses. These can include dues, donations to physician communities, digital resources, conference attendance, and other fee-based activities. A contract should guarantee which of these expenses are paid for in a transparent manner.
  4. Percentage effort. Each weekday represents 20 percent of a standard workweek. This means that each half day during the week is 10 percent of a surgeon’s time. The contract should define precisely which amount of time is dedicated to what type of work. Typical contracts include a percentage dedicated to academic and/or administrative duties in proportion to the amount of weekly time needed for those activities.
  5. Non-compete clauses. Contracts can sometimes require specific information about what happens when a physician leaves a practice or hospital system. Though difficult to actually enforce, these clauses cause a fair amount of difficulty for surgeons who want to leave a hospital for a competing job. Non-compete clauses usually require a surgeon to work in a specific location, often prohibitively a long distance away from the current position. In general, these clauses must be considered carefully as they can limit where you practice in the future.

Contract evaluation is a complex business. Several resources are available to the ACS community for the purposes of contract negotiation. The overall goal is to have a smooth transition into a new practice experience.