When it comes to negotiating a contract for a physiatry job, one typical clause is the non-compete clause. It’s typically something that one would not think is negotiable but it’s worth trying. Perhaps you can negotiate the distance, the time limit, or the fine. Compromises are possible. It may take some skillful negotiation.
Most physiatry jobs have a non-compete clause in the contract. The monetary penalty associated with a non-compete usually ranges from $10,000 to $250,000. The geographic limitation may range from 5 miles to 100 miles of the practice/hospital. The larger limit relates to large hospital systems with many satellite offices. The length of the non-compete is from 1 – 3 years after leaving the entity. Some options if you leave a practice and have to wait until the non-compete is over are locum tenens work although you may need to get another state license or telemedicine.
Non-compete agreements are frequently challenged in legal cases. “Many states do not allow non-competes and some states have legislation in the works,” according to Jon Appino, Principal and Founder of Contract Diagnostics, a firm that helps physicians with contract reviews. Yet he still encourages doctors to check all local laws, explaining that even when a doctor hears that a non-compete is unenforceable, the contract may have predetermined damages that are tough to fight against. https://www.medicaleconomics.com/view/non-compete-clauses-what-physicians-need-know
Physiatry jobs vary based on so many factors. One of these factors is the compensation model. If it is your first PM&R job out of residency you probably won’t be able to choose the compensation model nor do you want to unless you are the rare exception that has some prior practice experience. It usually takes awhile for a new physical medicine and rehabilitation graduate to ramp up their productivity so a guaranteed salary if helpful. As an experienced physiatrist, even given guarantees from the new practice/hospital, you usually don’t know all the in’s and out’s of the new practice dynamics to ensure your success so a model with some certainty of income is the best. However, you might be able to negotiate the compensation model so it’s wise to select one that fits you, e.g., your productivity, your practice style, etc.
One form of compensation associated with a physiatry job is when the entity guarantees/loans a physiatrist “X” dollars a year and that these guarantees/loans are forgiven if, for example, you stay at the job for three years. What isn’t considered by some physiatrists is that there are income taxes due on these amounts. You may not pay tax on those amounts as received, but you will need to report the income and pay taxes on those dollars as they are forgiven.
Imagine if the total of practice support, educational loan repayment, relocation dollars, and signing bonus adds up to $450,000 (plus interest). The loans are to be forgiven over a three-year period following the end of the support period. The physiatrist is making $200,000 at the time forgiveness commences. This means that each year, for three years, the physiatrist’s taxable income will be reported as approximately $350,000 (this is $200,000 salary plus one-third of the $450,000 loan plus interest) and not just $200,000. https://www.physicianspractice.com/view/physician-recruitment-agreements-4-things-consider
On the flip side, practices should determine the buy-out arrangement as early as when they post a physiatry job and not wait until the associate leaves. Almost all medical groups have readily demonstrable value. Practices often believe they should vary the payout formula according to whether they have a new physiatry job because a physician’s departure is due to death, retirement, or disability, or if a physician retires “too young.” It is only fair to reward fully a departing PM&R partner who has participated in the group’s growth long enough to deserve a full payout, regardless of the reasons for the departure; after all, the physiciatrist is leaving behind essentially the same tangible and intangible values. An ongoing physical medicine and rehabilitation practice will almost always have the same patient loyalty and forecast for success, regardless of whether the departing physician dies, relocates, or retires. Such variations usually intend to penalize “inappropriate” departures to discourage partners from withdrawing voluntarily. But a practice’s success, to include successfully filling a physiatry job need, is usually tied inherently to the collegial, if not synergistic, interdependence of its physician members. Someone who no longer wishes to be in the group but who stays because of economic coercion will provide a negative influence on the continuing group practice. https://www.seak.com/wp-content/uploads/2014/09/LegalMistakesFinal.pdf
Physiatry groups that obtain life and/or disability insurance for their new PM&R physician when filling a physiatry job in amounts sufficient to fund buyout proceeds usually waste their money. It may be comforting to know that departures may have little economic effect on the remaining physicians, but this emotional comfort is often expensive and misplaced. First, even when the insurance is funded collectively by the group, a departing member will wind up paying for an allocated portion of his or her own insurance, which then benefits the group. The accounts receivable generated by that physician remain with the group. Thus, the doctor subsidizes his or her own insurance and provides a gift back to the remaining colleagues of the receivables and other intangible values he or she generated. Second, the practice’s receipt of insurance proceeds may trigger the alternative minimum tax under federal tax law, making this arrangement far less attractive. If the physicians try to avoid the agreement with a “cross-purchase” arrangement (by which the shareholders individually purchase policies on each other), this is a complicated process at best, and unwieldy when the group has more than two or three physicians. Third, insurance funds a departure only under certain circumstances. A life insurance policy will not fund a payout due to disability, nor will a disability policy fund a death payout. Neither will fund a retirement. The group may have to fund a payout regardless of insurance, so why not just structure the payout to be affordable and eliminate the insurance? On the other hand, sometimes a medical group has a physician whose drawing power, reputation, or influence is so great compared with that of the other physicians that the group is unsure whether it can survive that physician’s death or disability. In that case, insurance may be justified, to provide cash flow that would not necessarily be sustainable otherwise. https://www.seak.com/wp-content/uploads/2014/09/LegalMistakesFinal.pdf
Please visit www.farrhealthcare.com for a list of physiatry jobs.
There are many physiatry jobs to consider. Covid dampened the number of PM&R practice opportunities but as the pandemic eases so too has the job market. Inpatient physiatrists are in particular strong demand. Farr Healthcare, Inc. tries to make your practice search has worry-free as possible. We can help direct you to positions that are a good match and guide you through the process. Farr Healthcare also serves as your cheerleader to employers!
The physiatrist position falls under the broad category of physicians and surgeons, positions with exceptional job prospects. According to the U.S. Bureau of Labor Statistics, the projected employment for doctors and surgeons is expected to grow much faster than average through the year 2024. Board-certified physiatrists, who have an even better job outlook, also command higher salaries. Reference: https://careersinpsychology.org/physiatry-careers/
The PM&R practice search process starts with identifying practice opportunities of interest to you, talking with these entities and to the ultimate end of securing a job. You can count on it taking 6 months or more usually when one considers the time to meet the practice, get references, get a state license, get on the payor panels, etc.
With experience in physiatry recruitment for over 30 years, Farr Healthcare is able to help doctors to find practice opportunities and employers to find physiatrists. Not only are we able to find practice opportunities and physiatrists, we make every effort to make connections that are best-suited to both parties. We use our insight to ask hiring entities information to help discern what candidates are the best fit. We listen to physiatrists looking for work and ask questions to help identify what practice opportunities are the best for each individual. We aim to be customer-friendly!
We are always striving to be in front of as many physiatrists and rehab organizations as possible to ensure that each will respectively have enough practice opportunities and physiatrists when their time comes for a search. For example, we keep in touch with residency and fellowship programs.
According to the Association of Academic Physiatrists, there are over 10,000 board-certified physiatrists in the U.S., yet there is a growing patient base and needs in a variety of environments:
- Older adults are working longer: People are retiring later in life, and may incur on-the-job injuries that require PM&R treatment. By 2022, older males will compromise 27% and older females will make up 20% of the U.S. labor force.
- A number of areas in the U.S. currently have a shortage of rehabilitation services and/or physiatrists. Like other medical specialties, there is a geographic maldistribution of physiatrists. In certain geographic areas, no physiatric services are available.
- According to an article in McKnight’s, a medical industry publication, there is a growing need for physiatrists in sub-acute rehabilitation settings, such as skilled nursing facilities, due to shifts in payer level-of-care preferences. According to Dr. Gnatz: “Rehabilitation in the skilled nursing facility environment is rapidly emerging as the predominant level of inpatient rehabilitation care in the United States.”
- Physiatry’s greatest unmet need is in the number of academic physiatrists. PM&R residency programs continue to experience a shortage of academic talent to fill the growing number of chairperson and faculty positions.
Part of the PM&R practice search process is reference checking. Given the years of experience that Farr Healthcare has in physiatry recruitment, we have developed relationships with physiatrists that enable us to gain greater insights during our reference-checking process. With a reputation for honesty, we present to the employer thorough information about physiatry candidates.
Typically, an interview follows if the references are good. Here are some possible questions for the interview process according to https://www.betterteam.com:
- What process do you follow to locate and diagnose a patient’s source of pain?
Demonstrates broad medical expertise and the ability to diagnose various medical conditions.
- Describe a time when you collaborated with other medical professionals, such as a physical therapist, to develop a treatment plan for a patient. Was it successful?
Shows the ability to work with others.
- Describe your most successful medical case to date. What factors contributed to your success?
Proves work experience.
- How do you stay up to date with new treatments and advancements in physical medicine and rehabilitation?
Shows continuous training and professional development.
- How do you motivate patients that are feeling despondent? How do you deal with patients who refuse to cooperate with you?
Tests interpersonal skills.
Congratulations! You’ve been offered a physiatry job and received a contract. Now what? Most physiatrists pursue professional advice when a contract has been presented. There’s a reason for that. The contract is a vehicle to determine the terms of your PM&R work with a hospital or practice. It also governs what happens when you leave it.
A few legal practices are listed on my website under the Resources tab that I have met while at various conferences. I can not recommend any of these practices. You may have local lawyers to assist you. Of course, you want someone who has experience with physician contracts.
The physiatry contract you receive will no doubt have been crafted by the hiring entity’s attorney to protect their interests so it makes sense that you, too, should consult your attorney to safeguard your interests. You should consult a lawyer to make sure that their contract is not overreaching in what it requires of you and, if so, you will want to negotiate those points.
One of the key features of the PM&R contract is the compensation section. It spells out what you’ll receive, the terms of the finances, the calculation of the payment formula, etc. Hence, it is important that it is as clear as possible and as complete as possible. I might even suggest that an accountant review the financial part of your PM&R contract.
There are also practice management firms that will review doctor contracts. Some of them are listed on my website, again under the Resources tab. These practice management firms specialize in physiatry. Again, I have never used any of them personally so I can’t recommend any one of them.
Don’t forget to look at the Openings page on my website, www.farrhealthcare.com