Good Hospitalist Contract and Terms.

[danboy87]

I need some advice. I’m two years out of residency. My three-year contract as a hospitalist will be ending August 2021. I work as a hospital employee in the largest hospital system in the state.

When should I start asking for an extension/renegotiation of my contract? What things should I ask for? What should I watch out for?

Compared to what I’ve seen offered from other hospitals for hospitalist contracts, I feel like my current contract isn’t half bad. 250k to 260k max base salary. I've had colleagues, also right out of residency, get contracts with base salary start 310k. They cover ICU and do small procedure like CL placement. The hospital I work at has an open ICU but we don't manage vents. I can do CLs and intubate, ALCS, etc.

I get 6-11 dollars/per RVU (low I know) with average 4-5k RVU per year, up to 35k quality incentive bonus (average 80-90% captured per year). Anywhere from 16-20 patients a day. 1-2 admissions a day. +\- APP support.

I get along great with my bosses and enjoy my colleagues, so that’s a plus. I will of course be getting a lawyer to review my contract. The biggest problem I see in my current contract is a clause that they can change my salary pretty much at will. Apparently, this is getting pretty common with hospitalist contracts. Idk if anyone has been successful in negotiating this out of their contract. Any other advice would be greatly appreciated! Thanks to everyone in advance!

[Random1]

What is your expected wRVU ? - Average equals 4107
What is you reimbursement per w RVU?

If you want to work about average and make $240,000 per year, then you need to get $58 per rvu
I would not worry about base salary , because it usually figured into your rvu equation

[danboy87]

What is your expected wRVU ? - Average equals 4107
What is you reimbursement per w RVU?

If you want to work about average and make $240,000 per year, then you need to get $58 per rvu
I would not worry about base salary , because it usually figured into your rvu equation

My expected wRVU is 4000/year. My reimbursement is 4.5/wRVU now and increases 1.5/wRVU/per year for a max at 11/wRVU. This is if I stay on for 10 years total. My wRVU bonus is on top of my base salary, which is now 255k.

[Random1]

Your base salary is 255,000 which equates to 4000 rvus at a rate of 63.75 per rvu. But if you work harder , you only get 4.5 rvu for those services over 4000 ? That does no seem like it makes any sense, or is a bad contract , why would you work extra hard to get a tiny bonus.

Typically I would think that if you work over 4000 rvus , you should get 63.75 + 4.5 or 68.25 per rvu on the services over 4000 rvu in a year.

so if you would work for 4100 rvus , you should get your base of 255000 + 6825

[pulmdoc]

Location is everything when it comes to "fair" for income, and that goes double for hospitalists. Your salary+production seems pretty similar to what my hospitalist friends in central US are making (~275k base+production) for similar amounts of work. Covering truely critically ill patients (vents, drips etc) should pay more.

A three year contract seems somewhat unusual to me. What I have as an intensivist and have seen mostly is an "evergreen" contract where there is no fixed duration of employment, just procedures in place for termination from either side. Tradeoffs of flexibility vs stability.

Your employer should never have the power to unilaterally change your pay with no recourse and no way to leave. Otherwise, you are actually an indentured servant. However, in all negotiations leverage is everything; with the massive losses suffered during the recent shutdown, hospital systems said "you're taking a pay cut or a bunch of people are being laid off and the rest will do more work for the same pay" so doctors went along with it.

[danboy87]

Your base salary is 255,000 which equates to 4000 rvus at a rate of 63.75 per rvu. But if you work harder , you only get 4.5 rvu for those services over 4000 ? That does no seem like it makes any sense, or is a bad contract , why would you work extra hard to get a tiny bonus.

Typically I would think that if you work over 4000 rvus , you should get 63.75 + 4.5 or 68.25 per rvu on the services over 4000 rvu in a year.

so if you would work for 4100 rvus , you should get your base of 255000 + 6825

Ya, I had no clue what to negotiate as far as wRVU at the time. I had looked at some of my recently minted fellow attending contracts and they were all the same as mine. Now I'm seeing that my wRVU compensation is low.

[danboy87]

Location is everything when it comes to "fair" for income, and that goes double for hospitalists. Your salary+production seems pretty similar to what my hospitalist friends in central US are making (~275k base+production) for similar amounts of work. Covering truely critically ill patients (vents, drips etc) should pay more.

A three year contract seems somewhat unusual to me. What I have as an intensivist and have seen mostly is an "evergreen" contract where there is no fixed duration of employment, just procedures in place for termination from either side. Tradeoffs of flexibility vs stability.

Your employer should never have the power to unilaterally change your pay with no recourse and no way to leave. Otherwise, you are actually an indentured servant. However, in all negotiations leverage is everything; with the massive losses suffered during the recent shutdown, hospital systems said "you're taking a pay cut or a bunch of people are being laid off and the rest will do more work for the same pay" so doctors went along with it.

The three year contract was offered with a bonus of 10k per year. They flat out told me they were offering me this 2/2 wanting me to stay working at the hospital. I was talking about moving south to the state capital with my boss and he asking if I was moving and eventually planning switching jobs. He said he would hate to see me go. A lot of my colleagues also live to the south closer to the state capital. I wasn't planning on leaving, but it made me think that maybe I have more leverage than I thought. Or he is just being nice and/or playing mind games with me. haha

What would you recommend, as far as specifics, to have place in my contract if they will not take out the clause that they can change my pay? I was thinking how should I counter: If they change/reduce my pay, I'm free to leave with no consequence and get out of any non-compete clauses.

[Random1]

Do you know how productive you have been over the last 3 years in terms of RVUs/year ? You are in a much better position to negotiate a contract if you are a high performer vs a low performer in terms of work.

[pulmdoc]

I will ask around to see what ballpark wRVU pay my friends are getting. All have a high base (~90% total comp) so $6/wRVU isnt necessarily bad. What matters most is the total comp for the work done. Would you rather have a $250k base +(6x4000) bonus, or no base and $60/wRVU on 4000 wRVU? The first option pays $34k more.

The key question rather than duration of contract is how "locked in" each side is to staying. Ideally, the power dynamic should be equal, where if the employer can terminate easily, the employee can terminate easily and vice versa. My specific contract is really a perpetual 90 day contract; I can walk away without cause with a 90 day notice, and I can be let go without cause with 90 day notice. The upside to that uncertainty is that I have no non-compete clause, so if I was let go I could go work for a competitor immediately. This gives me many more employment options than if I was locked out of an employment market.

It's my opinion that employed physicians (especially hospital-based physicians like ED, hospitalist, anesthesia, intensivist without patient panels) should never accept a non-compete clause as a condition of employment without major tradeoffs in their favor. Exclusivity (agreeing not to work for competitors at the same time) is less of a red line, but it depends on the specifics (an ED doctor contracted at hospital A who picks up 1 shift/month at hospital B is different than a hospitalist who is supposed to be admitting at hospital A and B on the same day).

[IMinMS]

I’m also starting out as a hospitalist and opted for the higher guaranteed base report with lower wRVU productivity bonus (county government hospital and starting first job so I thought it was likely my wRVU totals might be lower than when I’m a few years in). Still pretty happy with my contract. Something I saw at two separate hospital systems (albeit in the same urban market) when I was interviewing was lower pay per wRVU based on experience. I expect a first year hospitalist would be less efficient but that would seemingly bear itself out in lower wRVUs generated so the reduced pay rate I was seeing (say $30/wRVU vs $60/wRVU for someone a few years out) seems like a double whammy. Has anyone else seen this/is that standard in other contracts?

[hightower]

I need some advice. I’m two years out of residency. My three-year contract as a hospitalist will be ending August 2021. I work as a hospital employee in the largest hospital system in the state.

When should I start asking for an extension/renegotiation of my contract? What things should I ask for? What should I watch out for?

Compared to what I’ve seen offered from other hospitals for hospitalist contracts, I feel like my current contract isn’t half bad. 250k to 260k max base salary. I've had colleagues, also right out of residency, get contracts with base salary start 310k. They cover ICU and do small procedure like CL placement. The hospital I work at has an open ICU but we don't manage vents. I can do CLs and intubate, ALCS, etc.

I get 6-11 dollars/per RVU (low I know) with average 4-5k RVU per year, up to 35k quality incentive bonus (average 80-90% captured per year). Anywhere from 16-20 patients a day. 1-2 admissions a day. +\- APP support.

I get along great with my bosses and enjoy my colleagues, so that’s a plus. I will of course be getting a lawyer to review my contract. The biggest problem I see in my current contract is a clause that they can change my salary pretty much at will. Apparently, this is getting pretty common with hospitalist contracts. Idk if anyone has been successful in negotiating this out of their contract. Any other advice would be greatly appreciated! Thanks to everyone in advance!

Your contract is about as good as it gets in the hospitalist world. I’ve been working as a Hospitalist for about 10 years now.

If there’s one thing that I’ve learned it’s that there’s no such thing as individuals in a group having any success negotiating anything on that contract. Though a group offers you an individual contract, keep in mind that they offer the exact same thing to everyone in the group. Unless all docs in the group get together and negotiate as one, you have zero power. They can just say “well 15 of your other colleagues signed the contract with these terms, why won’t you?” And trust me, most of your colleagues will quickly and blindly sign it. Your only choice is to accept it or decline it. Unless you work in a rural hospital where they are truly desperate for staff, they have zero incentive to negotiate with you. As a young newly graduated doc, they make you feel all special at first. But once you’ve been in the group a while, you will find they truly prefer the younger docs because they know they will comply with any and all demands and accept any and all terms in their uniform contracts.

My first couple of years were great too. Then I started to learn what the 3 yr contract renewals were all about (controlling the doctors and maximizing corporate profit). If any member of the group gets in the way, they simply get rid of you.

I’ve seen countless older docs (like me, 7-10 years out of residency) pushed out of groups when they don’t like the new rules or terms of employment. They dont have to even offer you a new contract. If you dont prove to be a good, compliant, productive spoke in the corporate wheel, they will simply not offer you a new contract. The best thing you can do if you really like your group and your hospital, is try to insert yourself in a leadership/administrative role. Those are the only docs I’ve seen last in a group long term.
Come back to this thread in 6-7 years and re-read my post and you’ll see how right I am. Best of luck. My advice is to save aggressively and become FI as quickly as possible (and pay off your student loans asap).

[Tim]

“I get along great with my bosses and enjoy my colleagues, so that’s a plus. ”
The best contract is one you never need to look at.
Comp, job, location. You mentioned one clause with the ability to change compensation. As long as that releases any non competes, probably doesn’t make sense to push too hard. You seem content with all the three factors. I would at some point simply ask your bosses how contract renewals are handled. They control the timing unless you seriously have reasons to change.

[danboy87]

Thank you everyone for giving your input. I emailed my boss over the weekend to discuss possibly renewing/revising my contract for next year and this was his response: “Are you back Tuesday? Want to meet then? Hoping we can also discuss how to keep you. Thanks.” I’m hoping this is promising. I’ll keep you guys posted on if there is any offer coming soon or what was said. This will be interesting.

[danboy87]

The hospitalist program director wants me to stay and was worried I was leaving when I reached out to him. Meeting will be in two weeks to decide next contract details.

[danboy87]

A little late on the follow up. Met with higher ups. They said that the new wRVU bonus/incentive may work. Need to come up with a formal proposal. They weren't budging on anything else.