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

Contracting for Surgeons Looking for Jobs

Completion of formal surgical training is a very exciting and challenging time in a young surgeon’s life. Most of us have spent a decade and a half deeply engaged in study of biology, anatomy, and pathophysiology, while at the same time becoming technically proficient surgeons. However, this difficult journey often leaves us unprepared for the business and legal aspects of getting our first job. For the past two years, the Ohio Chapter of the American College of Surgeons (ACS) has devoted a portion of our annual meeting to resident issues, and one of the most requested topics is negotiating the first contract.

Margaret Dunn, MD, FACS, has given the presentation, “Negotiating Your First Contract,” the past two years at the Ohio Annual Meeting. The presentation begins with an overview of the contents included in most contracts. Most residents understand the basic terms of the contract such as duration, call requirements, and base salary. The presentation puts more emphasis on the complex portions of the contract.

First, compensation may not be as straightforward as most residents would expect. Compensation includes much more than just a base salary in most physician contracts. A base salary may be guaranteed, but it is usually only guaranteed for a limited period of time. Understanding productivity bonuses can also be quite challenging, as the most common way to define productivity, billed RVUs, are often not discussed with residents. Furthermore, call pay, sign-on bonuses, and quality bonuses may be part of the overall compensation. All of these possible components of compensation should be considered rather than comparing base salary alone.

Second, the benefits should be clearly defined in any contract. Benefits can vary extensively and can greatly contribute to overall compensation. Benefits typically include health insurance and disability insurance, but life insurance and contributions to retirement plans may also be included. Also, included in benefits may be compensation for Continuing Medical Education, travel to meetings, and journal subscriptions. Other benefits include paid time off, malpractice insurance, and possibly moving expenses and a cell phone.

Next, the contract should define expectations of the employee, including call requirements, administrative duties, and research requirements. Depending on the type of position, expectations may be very different. Office expenses and staffing may be part of the contract. Also, residents should understand how they will get patients and if there are restrictions on referral patterns.

Finally, the presentation focuses on understanding the termination portion of the contract. This part is one that many residents do not consider until too late, when their first job is not working out. Understanding the for-cause and not-for-cause clauses of the contract is very important, as is understanding the potential costs that may be associated with early termination of the contract. Also, depending on the state, restrictive covenants within the contract may limit the surgeon’s options for a new position.

More detailed information regarding contracts can be obtained from the ACS Handbook. Residents are encouraged to ask questions and seek legal advice before signing any contract.