Physician Contracts: The Fine Print
January 1, 1970
After years of medical training, it’s time to find a job. Learn more about physician compensation and how to evaluate your offer.
Though it varies by specialty, physician pay is typically built around one (or a combination) of three models:
Shift-based models are reserved mainly for specialties such as emergency medicine and hospitalists, while compensation packages for primary care physicians trend toward production and salary-based structures. And, in many cases, production and salary models are combined.
For example, suppose you are a primary care physician starting work right out of residency. You may be offered a base salary during your ramp-up period, followed by a hybrid salary/production model that would kick in once you’ve established a large enough patient panel.
Salary and shift-based models are pretty self-explanatory, but production-based pay is not so straightforward.
A production-based compensation model is built around a standard unit of measurement — most commonly, a work relative value unit (wRVU). In this model, a number value, or RVU, is assigned to standard procedures. Employers then place a dollar value on each RVU worked.
Many compensation models are also increasingly including value-based pay incentives to reward physicians for good patient outcomes.
Learn more about wRVUs, how they are calculated and how they influence your pay.
Understanding compensation basics is a start, but there’s more to know before you can be sure your offer is fair and right for you.
Erik Steen, a Senior Compensation Consultant with Providence Health System, says his background in health care finance and compensation plan design worked to his advantage when his wife, an OB/GYN, began searching for a post-residency position.
While he had reviewed enough contracts to understand what was reasonable, he says you don’t have to be a physician compensation expert to advocate for yourself and feel comfortable signing on the dotted line.
Steen offers the following five tips for resident physicians:
“One of the best ways to know you have a fair offer is to have multiple offers in front of you,” says Steen, who emphasizes the value of comparison shopping.
Getting multiple offers from similar organizations across one region is best for accuracy. But you can also evaluate an offer's upside potential by comparing it to others from different types of employers.
Beyond comparison, there are other ways to evaluate offers for fairness.
“Look at nationally published survey data,” says Steen. “There are several organizations that publish annual surveys on physician compensation. This data isn’t perfect, but it can serve as a nice benchmark.”
Because access to nationally published data comes at a cost, Steen recommends checking with your residency program, as they may already subscribe to these resources.
Steen also points to online physician community forums as great real-world resources.
Though physician compensation works differently than other jobs, Steen says physicians may have strong negotiating power. While most employment offers aren’t going to change, there are some things you can attempt to negotiate in your favor. These include:
“If there’s something you want, it doesn’t hurt to ask,” says Steen. “For many employers, the answer may be ‘no,’ but there’s nothing wrong with advocating for yourself.”
Your pay—no matter how it’s structured—is one part of your total compensation package. Indirect compensation like time off, benefits, retirement plans and continuing medical education support can also add value to your offer.
“Don’t just look at the dollars you’ll be paid and assume that offer is best,” says Steen. “It’s important to understand indirect compensation and fringe benefits and how they contribute to the complete package.”
According to Steen, other things to consider are restrictions medical groups place on how you can practice. For example, there may be limitations on the types of procedures you can perform or how you can schedule your time.
Your contract will provide much of what you need to know about your compensation package, but it could leave some questions unanswered.
“For example,” says Steen, “if your contract says you get a one-year or two-year salary guarantee, then switch to the group’s compensation plan, you want to be sure you know what that means. It’s not unreasonable to ask for more details.”
Beyond asking more about the plan itself, Steen suggests asking:
Additional considerations that aren’t necessarily listed in a job contract, but that can impact your satisfaction and long-term success — particularly in a production-based pay model — include:
Getting an offer is exciting, but it’s important to remember that by accepting an offer, you are also signing a legal contract.
From non-compete clauses to sign-on bonus payback terms, many parts of an offer can have future implications that you’ll want to be fully aware of.
If your offer includes language you don’t understand, or if you want help developing a strategy to negotiate, Steen suggests seeking a contract lawyer's advice.
“It may be a few hundred dollars, but this is an area where money is well spent if it means getting qualified eyes on what will be a binding contract that impacts your future.”
Your job search may start up to a year before your residency ends. Use this time to get all your questions answered and set yourself up for success.
Provider Solutions & Development offers holistic career coaching for every stage of your career journey, from residency to retirement. We provide complimentary resources, one-on-one career navigation, toolkits, seminars and training.