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Radiology Contract, Job Search Advice for Residents

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  • Radiology Contract, Job Search Advice for Residents

    Have been asked by the residents to put together a talk on contract negotiations. Many of them are being approached by radiology groups quite early on (R2 year and onward) and they would like some advice.

    What personal experiences have you had with jobs, contract negotiations that would be useful to them? General physician contracts and more-specific wisdom relevant to budding diagnostic and interventional radiologists would be very welcome!

    How much have you paid for contract review? Is it worth it to hire a service to negotiate for you or would an employer find that too aggressive?

  • #2
    I'd be weary of signing anything before R4 year unless you are location specific, or if it's a job that has a really really good reputation. A lot can change.

    If there is a non-compete, have it removed. If they're private (and you should really only be talking to true PP unless you have some reason to be in a location where that doesn't exist or if said PP is not good), then I would ask many questions about the interest to sell to PE, and if there could be any clause to reap some financial benefit should they sell to PE while an associate.

    As a trainee- learn EVERYTHING. Say yes and get comfortable. Each practice is different, and all the best jobs require you to do a little bit of everything with the higher end subspecialized stuff siphoned to you for whatever you did in your specialty. Be willing to physically be in a location.

    Practice ownership potential is preferred, especially if there is equity buy in. The earlier years are leaner than employment, but on the back end you're typically paid more and have more control over what can and can't be done in a department.

    Random things to think about- do they have mid-levels doing "light" procedures. How many places do you have to drive to. How good are there PACS. How many people haven't made partner

    I'm hospital employed. Most of the irks about my job are because of my employed status, rather than being a practice owner. Some of that satisfaction/dissatisfaction is dependent on your personality.

    Feel free to PM me about any rads stuff. There are many other good rads here who can weigh in. Stay away from auntminnie, if possible.

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    • #3
      Originally posted by Brains428 View Post
      I'd be weary of signing anything before R4 year unless you are location specific, or if it's a job that has a really really good reputation. A lot can change.

      If there is a non-compete, have it removed. If they're private (and you should really only be talking to true PP unless you have some reason to be in a location where that doesn't exist or if said PP is not good), then I would ask many questions about the interest to sell to PE, and if there could be any clause to reap some financial benefit should they sell to PE while an associate.

      As a trainee- learn EVERYTHING. Say yes and get comfortable. Each practice is different, and all the best jobs require you to do a little bit of everything with the higher end subspecialized stuff siphoned to you for whatever you did in your specialty. Be willing to physically be in a location.

      Practice ownership potential is preferred, especially if there is equity buy in. The earlier years are leaner than employment, but on the back end you're typically paid more and have more control over what can and can't be done in a department.

      Random things to think about- do they have mid-levels doing "light" procedures. How many places do you have to drive to. How good are there PACS. How many people haven't made partner

      I'm hospital employed. Most of the irks about my job are because of my employed status, rather than being a practice owner. Some of that satisfaction/dissatisfaction is dependent on your personality.

      Feel free to PM me about any rads stuff. There are many other good rads here who can weigh in. Stay away from auntminnie, if possible.
      Why stay away from auntminnie? Theres like 2 whole people who dont hate their lives!

      Comment


      • #4
        Look at the length and distance of the noncompete. One year is typical. More than one year is a red flag. Distance typically 5-25 miles. Look at potential areas you could still work during the noncompete. If the whole metro area you live in is blocked off that's a potential red flag.

        Most private groups have claims-made malpractice policies. Who pays the tail if you leave? Best would be for the group/company to cover. Otherwise negotiate the group/company pays if they let you go or don't renew. If you leave you pay. IR tail is roughly x2 of a DR and the amount increases over a period of 5 years that you have been in private practice.

        PE groups are not private practice. Some pitch they offer "partnership". I just roll my eyes.

        Mammo requirements for private rad groups can vary alot. Some groups require all rads to read mammo because of the logistics of managing diagnostic mammos and procedures. All new grads can read mammo. Many didn't think they have to and do not pay attention myself included. Echo above to learn all aspects of radiology so you have the background to become proficient. I went through a bunch of old ACR mammo CDs to relearn what I had forgotten after boards.

        IR rads who do only IR and don't do any DR work are limiting their work options. The new IR pathway is not a good choice if you want to have good DR skills. The pure IR jobs that exist are mostly in academic centers or in private practice groups with a large hospital with enough IR work. My group expects IR to do a significant amount of DR work. In exchange all partners earn an equal share.

        When you interview talk to at least one associate in the group. Better yet have a friend already in the group. Understand the work expectations. We make the associates available to talk with prospective new associates.

        Know how the buy-in process works. What being a partner means- equal share of profit and time off? Or is it a tiered partnership?

        Most major points of a contract (salary, time off, call responsibility) are not negotiable. If you give associates differing contract terms they talk and get upset. That said depending on how badly a group needs an associate's expertise a highly desired associate could strike a better bargain.

        Comment


        • #5
          Read every line of a contract. Consider using yours to outline the sections and the reason they are in there. It is only "boiler plate" until there is a dispute.
          Need to have conversations with current and former associates and former partners if possible.
          Get a contract review, not only for negotiation but making sure you have a complete understanding of the terms and conditions.
          Consider getting one of the contract review vendors to possibly make a brief presentation.
          The best negotiating tool is a competing offer. Consider timing your job search from a time standpoint to have competing offers in the same timeframe.
          Last edited by Tim; 05-07-2022, 07:56 AM.

          Comment


          • #6
            Not that this shouldn't be obvious- but be a good co-resident to your class and other classes. Also be a good resident in general. The best jobs you'll be able to get will be through the connections you've made that people that know and like you. I don't think anyone will actively throw you under the bus if they see you apply unless you're truly pathologic, but if there is an opening in a good practice, your former colleagues will call you first.

            The best jobs never make the ACR board. They're all filled via word of mouth.

            Comment


            • #7
              I am a spouse, but can speak to some of it. I need to have my husband write up something about the parts I can’t speak to and post it on here. There are so few good resources out there.

              —We paid $500/hour to have the initial employment contract reviewed and will be paying $550/hour shortly for a partnership contract review. We spent $1000 on the initial review and it was money well spent. The key is to try and understand as much as possible in your own and come up with a list of areas you want answers on vs shoving an unread contract at a lawyer and racking up a bill. Find a lawyer familiar with healthcare in the state you intend to practice in. They should have an idea of how "normal" or "fair" the contract is. It doesn't mean you can change anything, but it means you can gauge the situation more accurately.

              —Pay specific attention to benefits. They vary wildly. We didn’t ask enough about the 401k situation because we were used to setups common to a large organization and that led to a big disappointment later. (In our case: we discovered a "profit sharing 401k" does not mean that an employer will be contributing anything beyond the setup of the accounts to your retirement.) Same with health insurance. In a small group, that can be a huge expense. They should be able to give you the plan for the current year.

              —Ask about wRVU expectations. It might not mean much to a new grad, but if the practice is tracking them and basing compensation off them in any way, you need to know up front.

              --Ask schedule/vacation/call specifics. Do they cover nights internally? If so, how many weeks a year will you be on nights? How does call work? Is vacation taken on a rotating schedule with no choice on which weeks you are off, or can you request specific weeks off? Do you have to request an entire week or can it be done in shorter increments?

              Comment


              • #8
                Would be weird to sign something R2. Dip your toe in the water sure but over 3 years until you would start. Landscape of the practice can change pretty dramatically in that time, staffing needs, new leadership, hospital position can change, etc. Also not sure your attendings that work with you even really know you well enough to make a recommendation or not, depending on size of program.

                Be wary of big numbers. They don't happen for no reason so to earn them you will either a) work a ton b) live in middle of BFE where no one else wants to c) both of above. People fall in love with a big number and are like " I can make a zillion dollars at this practice in Illinois" and they think of chicago, when in reality its like rural illinois where no one wants to live, you are reading everything while doing fluro and light IR and basically miserable.

                Vacation is also a sliding scale. You can work super hard when you are on and have a million weeks of vacation when off( ie barebones staffing), or be overstaffed and have as much vacation as a VA worker. I tend to think answer is somewhere in middle which usually is like 10 weeks vacation (which is still a metric ton for all other jobs not radiology).

                As mentioned above, call and partner tiers are very important. Are all the partners the same class or are there different classes(general red flag).

                If they want to read mammo or not. What % of their subspecialty will they be reading.

                If going to pay someone for contract review, it should be someone local that has worked with that group before. It will be way more time and cost efficient rather than having a rando contract attorney review it. In my n of 2, contract review has been quite overrated(easy way to blow a couple K) and stuff was generally pretty boiler plate but each situation is YMMV.

                If buy in is for hard assets(scanners) or just "goodwill" ie the contract, ie nearly meaningless.

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