Bhavin Patel, MD

By now, if you’re a final-year resident, you should be thinking about your plans for when you finish your residency. Before you begin the job search in earnest, it’s a good idea to create or update your curriculum vitae, or CV. You might be thinking, “That’s easy. I haven’t done anything yet!” That might be the case, but in reality, you probably have done more than you realize.

Whether you are just starting out or need to freshen a rough draft, here are some recommendations for creating a CV.

Brainstorm

The first step is to capture all the things you have done. Start by taking a sheet of paper and making columns with the following headings: licensure/documents, honors and awards, presentations/publications, research activities, committees, teaching, community service, and special skills. List each of the things you’ve done in each category.

Don’t be modest. You have to sell yourself. No item is too small for consideration for your CV at this stage. Get together with other people in your residency class and brainstorm together. They might help you think of certain activities that you have not already thought about. Here are some key points to keep in mind as you brainstorm each section:

• Licensure/documents: If you haven’t obtained a license in the state where you want to practice, now is the time to do it. Make sure advanced cardiac life support (ACLS) and BLS are current. If you haven’t taken your board exam, mention that you are board-eligible and include the date you plan to take the exam.
Once you’ve created your first CV, you will need to develop a system to update and maintain the document. The easiest way to do this is to keep a “career folder” on your desktop or in a filing cabinet. This will help you catalog all the extra things you’ve done throughout your career.
• Honors and awards: You don’t have to receive a trophy at a fancy awards ceremony to fill out this section. Did you ever receive a letter from the department chair, program director, or clerkship director giving you a special commendation? Such recognition might be worth a mention.
• Presentations and publications: If you have been published, include the citation here. Many residents present posters at regional meetings; this information should go in your CV. Have you given a presentation for “Morning Report” or a “Morbidity and Mortality Conference”? If so, these count as presentations, too. Many residents have written Web-based materials. Cite these as well.
• Teaching: Consider all the activities you perform for medical students. Have you given the students any prepared lectures? Have you been a preceptor for their physical exam labs? Have you provided mentorship for a student? Significant time spent mentoring also should be reflected on a resident’s CV.
• Research: QI projects generally count as HM research projects.
• Committees: Think about all the meetings you’ve attended and determine if any of them count as providing services to the residency or hospital.
• Special skills: Proficiency in thoracocentesis or lumbar puncture procedures qualifies for this section. If you speak a second (or third, fourth, etc.) language, include it here.

Rough Draft = First Attempt

Now that you have gathered your information, it’s time to organize it. Web-based resources and templates are plentiful, and many can help you write the CV. If you are applying for an academic position, you will need to keep a detailed CV. If you are not applying for an academic position, it is best to keep your CV at no more than two pages in length; however, you might want to keep a comprehensive (and lengthier) version on file.

Maintain a Career Folder

Once you’ve created your first CV, you will need to develop a system to update and maintain the document. The easiest way to do this is to keep a “career folder” on your desktop or in a filing cabinet. This will help you catalog all the extra things you’ve done throughout your career.

Write notes to yourself, with the date and time spent on certain activities. Then, at regular intervals, document them on your CV. It’s best to update your CV every six months.

The career file also can be used to keep evaluations, letters from patients, or anything else that exemplifies your accomplishments at work. Having a system for organizing your achievements will help you negotiate a raise and assist with future promotions or tenure.

Cover Letter

A cover letter should be no more than three to four paragraphs in length. Keep it simple and to the point. Briefly state how you heard about the job opening and why you are interested in the job.

Take a paragraph to identify the skills and experience you have to offer the HM group. The final paragraph should be used to explain how you intend to follow up and the best way you can be reached (phone, e-mail, etc.) to arrange an interview.

Interview Tips

A well-written CV can lead to several interview offers. Here are some important tips to help you obtain that all-important job offer:

• Have a clear vision. It’s important to know what you are looking for. Having clear goals will help you know exactly the kind of job you want and avoid wasting time and energy.
• Set aside time for a phone interview. You can learn a lot about an HM program during this time; give the interviewer a chance to learn about you, too. Use this step to screen out those places you really want to visit in person.
• Show up on time. Give yourself enough time to reach your destination, park, and find the meeting location. If possible, take a test drive a day or two before.
• Remember, your appearance matters. Dress professionally in conservative business attire. Furthermore, always act professional. Avoid negative talk about past attendings or employers. If you are going out for lunch, avoid ordering alcohol.
• Write down questions to ask. This will give you more clarity and ensure that all of your questions regarding the prospective job are answered.
• Show interest in the program. Ask appropriate questions, even if you have all the information you need. Don’t leave without asking about the next steps in the hiring process.
• Talk about money last. Contrary to popular belief, it’s OK to bring up the topic of money during an interview. Just don’t make it your first—and only—question.
• Check out the town. Bring your spouse or partner to explore a prospective relocation site. Look into housing, schools, your potential commute, and recreational activities. TH

Dr. Garcia is assistant professor in the division of hospital medicine at the University of Texas Health Sciences Center at San Antonio. Dr. Patel is a hospitalist at HPMG Regions Hospital and assistant professor of medicine at the University of Minnesota in St. Paul.

Image Source: CHAGIN/ISTOCKPHOTO.COM

By now, if you’re a final-year resident, you should be thinking about your plans for when you finish your residency. Before you begin the job search in earnest, it’s a good idea to create or update your curriculum vitae, or CV. You might be thinking, “That’s easy. I haven’t done anything yet!” That might be the case, but in reality, you probably have done more than you realize.

Whether you are just starting out or need to freshen a rough draft, here are some recommendations for creating a CV.

Brainstorm

The first step is to capture all the things you have done. Start by taking a sheet of paper and making columns with the following headings: licensure/documents, honors and awards, presentations/publications, research activities, committees, teaching, community service, and special skills. List each of the things you’ve done in each category.

Don’t be modest. You have to sell yourself. No item is too small for consideration for your CV at this stage. Get together with other people in your residency class and brainstorm together. They might help you think of certain activities that you have not already thought about. Here are some key points to keep in mind as you brainstorm each section:

• Licensure/documents: If you haven’t obtained a license in the state where you want to practice, now is the time to do it. Make sure advanced cardiac life support (ACLS) and BLS are current. If you haven’t taken your board exam, mention that you are board-eligible and include the date you plan to take the exam.
Once you’ve created your first CV, you will need to develop a system to update and maintain the document. The easiest way to do this is to keep a “career folder” on your desktop or in a filing cabinet. This will help you catalog all the extra things you’ve done throughout your career.
• Honors and awards: You don’t have to receive a trophy at a fancy awards ceremony to fill out this section. Did you ever receive a letter from the department chair, program director, or clerkship director giving you a special commendation? Such recognition might be worth a mention.
• Presentations and publications: If you have been published, include the citation here. Many residents present posters at regional meetings; this information should go in your CV. Have you given a presentation for “Morning Report” or a “Morbidity and Mortality Conference”? If so, these count as presentations, too. Many residents have written Web-based materials. Cite these as well.
• Teaching: Consider all the activities you perform for medical students. Have you given the students any prepared lectures? Have you been a preceptor for their physical exam labs? Have you provided mentorship for a student? Significant time spent mentoring also should be reflected on a resident’s CV.
• Research: QI projects generally count as HM research projects.
• Committees: Think about all the meetings you’ve attended and determine if any of them count as providing services to the residency or hospital.
• Special skills: Proficiency in thoracocentesis or lumbar puncture procedures qualifies for this section. If you speak a second (or third, fourth, etc.) language, include it here.

Rough Draft = First Attempt

Now that you have gathered your information, it’s time to organize it. Web-based resources and templates are plentiful, and many can help you write the CV. If you are applying for an academic position, you will need to keep a detailed CV. If you are not applying for an academic position, it is best to keep your CV at no more than two pages in length; however, you might want to keep a comprehensive (and lengthier) version on file.

Maintain a Career Folder

Once you’ve created your first CV, you will need to develop a system to update and maintain the document. The easiest way to do this is to keep a “career folder” on your desktop or in a filing cabinet. This will help you catalog all the extra things you’ve done throughout your career.

Write notes to yourself, with the date and time spent on certain activities. Then, at regular intervals, document them on your CV. It’s best to update your CV every six months.

The career file also can be used to keep evaluations, letters from patients, or anything else that exemplifies your accomplishments at work. Having a system for organizing your achievements will help you negotiate a raise and assist with future promotions or tenure.

Cover Letter

A cover letter should be no more than three to four paragraphs in length. Keep it simple and to the point. Briefly state how you heard about the job opening and why you are interested in the job.

Take a paragraph to identify the skills and experience you have to offer the HM group. The final paragraph should be used to explain how you intend to follow up and the best way you can be reached (phone, e-mail, etc.) to arrange an interview.

Interview Tips

A well-written CV can lead to several interview offers. Here are some important tips to help you obtain that all-important job offer:

• Have a clear vision. It’s important to know what you are looking for. Having clear goals will help you know exactly the kind of job you want and avoid wasting time and energy.
• Set aside time for a phone interview. You can learn a lot about an HM program during this time; give the interviewer a chance to learn about you, too. Use this step to screen out those places you really want to visit in person.
• Show up on time. Give yourself enough time to reach your destination, park, and find the meeting location. If possible, take a test drive a day or two before.
• Remember, your appearance matters. Dress professionally in conservative business attire. Furthermore, always act professional. Avoid negative talk about past attendings or employers. If you are going out for lunch, avoid ordering alcohol.
• Write down questions to ask. This will give you more clarity and ensure that all of your questions regarding the prospective job are answered.
• Show interest in the program. Ask appropriate questions, even if you have all the information you need. Don’t leave without asking about the next steps in the hiring process.
• Talk about money last. Contrary to popular belief, it’s OK to bring up the topic of money during an interview. Just don’t make it your first—and only—question.
• Check out the town. Bring your spouse or partner to explore a prospective relocation site. Look into housing, schools, your potential commute, and recreational activities. TH

Dr. Garcia is assistant professor in the division of hospital medicine at the University of Texas Health Sciences Center at San Antonio. Dr. Patel is a hospitalist at HPMG Regions Hospital and assistant professor of medicine at the University of Minnesota in St. Paul.

Image Source: CHAGIN/ISTOCKPHOTO.COM

By now, if you’re a final-year resident, you should be thinking about your plans for when you finish your residency. Before you begin the job search in earnest, it’s a good idea to create or update your curriculum vitae, or CV. You might be thinking, “That’s easy. I haven’t done anything yet!” That might be the case, but in reality, you probably have done more than you realize.

Whether you are just starting out or need to freshen a rough draft, here are some recommendations for creating a CV.

Brainstorm

The first step is to capture all the things you have done. Start by taking a sheet of paper and making columns with the following headings: licensure/documents, honors and awards, presentations/publications, research activities, committees, teaching, community service, and special skills. List each of the things you’ve done in each category.

Don’t be modest. You have to sell yourself. No item is too small for consideration for your CV at this stage. Get together with other people in your residency class and brainstorm together. They might help you think of certain activities that you have not already thought about. Here are some key points to keep in mind as you brainstorm each section:

• Licensure/documents: If you haven’t obtained a license in the state where you want to practice, now is the time to do it. Make sure advanced cardiac life support (ACLS) and BLS are current. If you haven’t taken your board exam, mention that you are board-eligible and include the date you plan to take the exam.
Once you’ve created your first CV, you will need to develop a system to update and maintain the document. The easiest way to do this is to keep a “career folder” on your desktop or in a filing cabinet. This will help you catalog all the extra things you’ve done throughout your career.
• Honors and awards: You don’t have to receive a trophy at a fancy awards ceremony to fill out this section. Did you ever receive a letter from the department chair, program director, or clerkship director giving you a special commendation? Such recognition might be worth a mention.
• Presentations and publications: If you have been published, include the citation here. Many residents present posters at regional meetings; this information should go in your CV. Have you given a presentation for “Morning Report” or a “Morbidity and Mortality Conference”? If so, these count as presentations, too. Many residents have written Web-based materials. Cite these as well.
• Teaching: Consider all the activities you perform for medical students. Have you given the students any prepared lectures? Have you been a preceptor for their physical exam labs? Have you provided mentorship for a student? Significant time spent mentoring also should be reflected on a resident’s CV.
• Research: QI projects generally count as HM research projects.
• Committees: Think about all the meetings you’ve attended and determine if any of them count as providing services to the residency or hospital.
• Special skills: Proficiency in thoracocentesis or lumbar puncture procedures qualifies for this section. If you speak a second (or third, fourth, etc.) language, include it here.

Rough Draft = First Attempt

Now that you have gathered your information, it’s time to organize it. Web-based resources and templates are plentiful, and many can help you write the CV. If you are applying for an academic position, you will need to keep a detailed CV. If you are not applying for an academic position, it is best to keep your CV at no more than two pages in length; however, you might want to keep a comprehensive (and lengthier) version on file.

Maintain a Career Folder

Once you’ve created your first CV, you will need to develop a system to update and maintain the document. The easiest way to do this is to keep a “career folder” on your desktop or in a filing cabinet. This will help you catalog all the extra things you’ve done throughout your career.

Write notes to yourself, with the date and time spent on certain activities. Then, at regular intervals, document them on your CV. It’s best to update your CV every six months.

The career file also can be used to keep evaluations, letters from patients, or anything else that exemplifies your accomplishments at work. Having a system for organizing your achievements will help you negotiate a raise and assist with future promotions or tenure.

Cover Letter

A cover letter should be no more than three to four paragraphs in length. Keep it simple and to the point. Briefly state how you heard about the job opening and why you are interested in the job.

Take a paragraph to identify the skills and experience you have to offer the HM group. The final paragraph should be used to explain how you intend to follow up and the best way you can be reached (phone, e-mail, etc.) to arrange an interview.

Interview Tips

A well-written CV can lead to several interview offers. Here are some important tips to help you obtain that all-important job offer:

• Have a clear vision. It’s important to know what you are looking for. Having clear goals will help you know exactly the kind of job you want and avoid wasting time and energy.
• Set aside time for a phone interview. You can learn a lot about an HM program during this time; give the interviewer a chance to learn about you, too. Use this step to screen out those places you really want to visit in person.
• Show up on time. Give yourself enough time to reach your destination, park, and find the meeting location. If possible, take a test drive a day or two before.
• Remember, your appearance matters. Dress professionally in conservative business attire. Furthermore, always act professional. Avoid negative talk about past attendings or employers. If you are going out for lunch, avoid ordering alcohol.
• Write down questions to ask. This will give you more clarity and ensure that all of your questions regarding the prospective job are answered.
• Show interest in the program. Ask appropriate questions, even if you have all the information you need. Don’t leave without asking about the next steps in the hiring process.
• Talk about money last. Contrary to popular belief, it’s OK to bring up the topic of money during an interview. Just don’t make it your first—and only—question.
• Check out the town. Bring your spouse or partner to explore a prospective relocation site. Look into housing, schools, your potential commute, and recreational activities. TH

Dr. Garcia is assistant professor in the division of hospital medicine at the University of Texas Health Sciences Center at San Antonio. Dr. Patel is a hospitalist at HPMG Regions Hospital and assistant professor of medicine at the University of Minnesota in St. Paul.

Image Source: CHAGIN/ISTOCKPHOTO.COM

Got a job offer? Congratulations! The hard part of finding your first job after residency is complete. This also is a time to sit down and think about what’s important to you, as you want the details of your job to be stated in a contract. Here are some tips about contract negotiation.

Get It in Writing

Just as in practice, where we are always told, “it didn’t happen if it’s not documented in the chart,” the same holds true for your workplace contract. This is the time to prioritize what elements are important to you in order to have a satisfying and rewarding career, both professionally and financially. If a particular aspect of your employment agreement is important to you, be it salary, schedule, or malpractice insurance coverage, be sure its stated in writing in your contract. Verbal statements from your employer, such as “we’ll discuss this after you start your job,” should raise a red flag.

Know What Is Negotiable

Some residents are relieved just to secure their first job offer and they immediately accept the initial offer as-is, without attempting to negotiate. Although it’s probably unreasonable to negotiate everything, after you read the initial contract, if anything important is not to your satisfaction, it is practical to have a discussion with your employer. Employers expect this of their hires and, if done politely and professionally, this is a time to build bridges with your future supervisor. Moreover, they begin to better understand your needs and you theirs.

You may find it helpful to talk to associates in the group about what parts of their contracts were negotiable. For example, particularly in academic settings, you may find salary and benefits are not negotiable; however, other benefits, such as office space or protected research time, may be negotiable. Basically, the best time to negotiate is the “honeymoon” period, right after a job offer has been made, as the employer will be doing its best to entice a prospective employee.

Consider a Legal Opinion

In general, the more complex your contract, the more important it will be to solicit the help of an attorney experienced in healthcare. Even if your contract is very simple, contains a standardized salary and benefit structure, has no restrictive covenants, and partnership is not an issue, it may be helpful to have your contract reviewed by an attorney. Understand what is written in your contract and, if there is any doubt, hire a lawyer.

Ultimately, you will be signing the contract, not your lawyer, so be sure you understand what is in it and don’t get mired in “legalese.” Some firms offer third-party contract negotiation; they will assign an attorney to step in as an intermediary. Then again, most experts recommend against hiring a third-party negotiator, as this may increase the distance between you and your employer at a time probably best spent getting to know each other.

Maintain a Keen Eye

Specifics to look for in your new contract:

Work requirements. The employment agreement should visibly define your job responsibilities. Things to look for in your contract include the obligations of the physician, number of shifts or hours or weeks per year you are expected to work, call responsibilities, a census cap (if applicable), allotted vacation time, and continuing medical education time.

Compensation. The contract clearly should delineate how you will be paid. Some hospitalists are compensated solely via a salary; others are paid based on billing/productivity, while the majority are paid based on a combination of these methods (a base salary plus incentives). Be sure you understand the incentive and/or bonus structure of your salary. Practices basing incentives on physician productivity will incorporate your own billing practices and often is measured in relative value units (RVUs). In some settings, group incentives are based on quality targets set by the administration, such as the Joint Commission on the Accreditation of Healthcare Organi-­zations (JCAHO) core measure compliance, dictation timeliness, or patient/primary care physician satisfaction.

Benefits. In addition to your salary, you should see that your benefits are spelled out. The obvious benefits include medical, dental, and vision insurance, as well as a retirement savings plan. As discussed in the July 2008 issue of The Hospitalist, as demand for hospitalists continues to exceed supply, look for signing bonuses, coverage of relocation expenses, and the possibility of student loan payoff. Other important benefits include coverage of professional dues, CME allocation, and licensing and board examination fees.

Malpractice Insurance. This can be a complicated topic. In general, there are two major classes of malpractice insurance: an occurrence policy and a claims-made policy. In respect to an occurrence policy, any malpractice incident arising while the coverage was in place, regardless of when the claim was filed, will be covered even after you have stopped practicing under that policy. A claims-made policy, on the other hand, protects physicians for any covered claim, if they are insured when the claim is made. It does not cover malpractice claims filed after the physician cancels the malpractice policy, even if the claim is about an event that occurred while the physician was insured.

If you are offered a claims-made policy, require your employer to add tail coverage, which covers you after leaving the practice for any events occurred during employment. If you are unclear about any part of the group’s malpractice coverage, consider seeking legal advice.

Restrictive covenants. These are non-compete clauses often setting geographic and time restrictions of where and when a physician can practice in the event they leave the group. Though you never know what the future holds, this becomes relevant if you were to change jobs and work at an adjacent local facility or one in a nearby county. In general, hospitalists rarely carry a panel of patients, so an employer probably should not be concerned about hospitalists taking patients with them if/when they leave the practice. Be cautious of restrictive covenants found in your contract.

Ownership/Partnership. In some private groups, partnership will be offered after a preliminary employment period, usually one to two years. Look for your contract to state when and how partnership might be offered, and what the criteria to join are. This also is the time to ask others in the group to get a sense of how many associates are offered partnership and when this might happen.

Allowable Activities. Look for any restrictions regarding your activities outside normal clinical duties, such as teaching, research, or consulting for other firms. If such restrictions are in your contract, there may be specifications about whether income from such activities is yours or whether it is shared with the rest of the practice. TH

Bryan Huang, MD, assistant clinical professor, division of hospital medicine, University of California-San Diego Department of Medicine, Bhavin Patel, MD, hospitalist at Regions Hospital, HealthPartners Medical Group, St. Paul, Minn., Bijo Chacko, MD, hospitalist program medical director, Preferred Health Partners, New York City, and chair of SHM’s Young Physician Committee.

Got a job offer? Congratulations! The hard part of finding your first job after residency is complete. This also is a time to sit down and think about what’s important to you, as you want the details of your job to be stated in a contract. Here are some tips about contract negotiation.

Get It in Writing

Just as in practice, where we are always told, “it didn’t happen if it’s not documented in the chart,” the same holds true for your workplace contract. This is the time to prioritize what elements are important to you in order to have a satisfying and rewarding career, both professionally and financially. If a particular aspect of your employment agreement is important to you, be it salary, schedule, or malpractice insurance coverage, be sure its stated in writing in your contract. Verbal statements from your employer, such as “we’ll discuss this after you start your job,” should raise a red flag.

Know What Is Negotiable

Some residents are relieved just to secure their first job offer and they immediately accept the initial offer as-is, without attempting to negotiate. Although it’s probably unreasonable to negotiate everything, after you read the initial contract, if anything important is not to your satisfaction, it is practical to have a discussion with your employer. Employers expect this of their hires and, if done politely and professionally, this is a time to build bridges with your future supervisor. Moreover, they begin to better understand your needs and you theirs.

You may find it helpful to talk to associates in the group about what parts of their contracts were negotiable. For example, particularly in academic settings, you may find salary and benefits are not negotiable; however, other benefits, such as office space or protected research time, may be negotiable. Basically, the best time to negotiate is the “honeymoon” period, right after a job offer has been made, as the employer will be doing its best to entice a prospective employee.

Consider a Legal Opinion

In general, the more complex your contract, the more important it will be to solicit the help of an attorney experienced in healthcare. Even if your contract is very simple, contains a standardized salary and benefit structure, has no restrictive covenants, and partnership is not an issue, it may be helpful to have your contract reviewed by an attorney. Understand what is written in your contract and, if there is any doubt, hire a lawyer.

Ultimately, you will be signing the contract, not your lawyer, so be sure you understand what is in it and don’t get mired in “legalese.” Some firms offer third-party contract negotiation; they will assign an attorney to step in as an intermediary. Then again, most experts recommend against hiring a third-party negotiator, as this may increase the distance between you and your employer at a time probably best spent getting to know each other.

Maintain a Keen Eye

Specifics to look for in your new contract:

Work requirements. The employment agreement should visibly define your job responsibilities. Things to look for in your contract include the obligations of the physician, number of shifts or hours or weeks per year you are expected to work, call responsibilities, a census cap (if applicable), allotted vacation time, and continuing medical education time.

Compensation. The contract clearly should delineate how you will be paid. Some hospitalists are compensated solely via a salary; others are paid based on billing/productivity, while the majority are paid based on a combination of these methods (a base salary plus incentives). Be sure you understand the incentive and/or bonus structure of your salary. Practices basing incentives on physician productivity will incorporate your own billing practices and often is measured in relative value units (RVUs). In some settings, group incentives are based on quality targets set by the administration, such as the Joint Commission on the Accreditation of Healthcare Organi-­zations (JCAHO) core measure compliance, dictation timeliness, or patient/primary care physician satisfaction.

Benefits. In addition to your salary, you should see that your benefits are spelled out. The obvious benefits include medical, dental, and vision insurance, as well as a retirement savings plan. As discussed in the July 2008 issue of The Hospitalist, as demand for hospitalists continues to exceed supply, look for signing bonuses, coverage of relocation expenses, and the possibility of student loan payoff. Other important benefits include coverage of professional dues, CME allocation, and licensing and board examination fees.

Malpractice Insurance. This can be a complicated topic. In general, there are two major classes of malpractice insurance: an occurrence policy and a claims-made policy. In respect to an occurrence policy, any malpractice incident arising while the coverage was in place, regardless of when the claim was filed, will be covered even after you have stopped practicing under that policy. A claims-made policy, on the other hand, protects physicians for any covered claim, if they are insured when the claim is made. It does not cover malpractice claims filed after the physician cancels the malpractice policy, even if the claim is about an event that occurred while the physician was insured.

If you are offered a claims-made policy, require your employer to add tail coverage, which covers you after leaving the practice for any events occurred during employment. If you are unclear about any part of the group’s malpractice coverage, consider seeking legal advice.

Restrictive covenants. These are non-compete clauses often setting geographic and time restrictions of where and when a physician can practice in the event they leave the group. Though you never know what the future holds, this becomes relevant if you were to change jobs and work at an adjacent local facility or one in a nearby county. In general, hospitalists rarely carry a panel of patients, so an employer probably should not be concerned about hospitalists taking patients with them if/when they leave the practice. Be cautious of restrictive covenants found in your contract.

Ownership/Partnership. In some private groups, partnership will be offered after a preliminary employment period, usually one to two years. Look for your contract to state when and how partnership might be offered, and what the criteria to join are. This also is the time to ask others in the group to get a sense of how many associates are offered partnership and when this might happen.

Allowable Activities. Look for any restrictions regarding your activities outside normal clinical duties, such as teaching, research, or consulting for other firms. If such restrictions are in your contract, there may be specifications about whether income from such activities is yours or whether it is shared with the rest of the practice. TH

Bryan Huang, MD, assistant clinical professor, division of hospital medicine, University of California-San Diego Department of Medicine, Bhavin Patel, MD, hospitalist at Regions Hospital, HealthPartners Medical Group, St. Paul, Minn., Bijo Chacko, MD, hospitalist program medical director, Preferred Health Partners, New York City, and chair of SHM’s Young Physician Committee.

Got a job offer? Congratulations! The hard part of finding your first job after residency is complete. This also is a time to sit down and think about what’s important to you, as you want the details of your job to be stated in a contract. Here are some tips about contract negotiation.

Get It in Writing

Just as in practice, where we are always told, “it didn’t happen if it’s not documented in the chart,” the same holds true for your workplace contract. This is the time to prioritize what elements are important to you in order to have a satisfying and rewarding career, both professionally and financially. If a particular aspect of your employment agreement is important to you, be it salary, schedule, or malpractice insurance coverage, be sure its stated in writing in your contract. Verbal statements from your employer, such as “we’ll discuss this after you start your job,” should raise a red flag.

Know What Is Negotiable

Some residents are relieved just to secure their first job offer and they immediately accept the initial offer as-is, without attempting to negotiate. Although it’s probably unreasonable to negotiate everything, after you read the initial contract, if anything important is not to your satisfaction, it is practical to have a discussion with your employer. Employers expect this of their hires and, if done politely and professionally, this is a time to build bridges with your future supervisor. Moreover, they begin to better understand your needs and you theirs.

You may find it helpful to talk to associates in the group about what parts of their contracts were negotiable. For example, particularly in academic settings, you may find salary and benefits are not negotiable; however, other benefits, such as office space or protected research time, may be negotiable. Basically, the best time to negotiate is the “honeymoon” period, right after a job offer has been made, as the employer will be doing its best to entice a prospective employee.

Consider a Legal Opinion

In general, the more complex your contract, the more important it will be to solicit the help of an attorney experienced in healthcare. Even if your contract is very simple, contains a standardized salary and benefit structure, has no restrictive covenants, and partnership is not an issue, it may be helpful to have your contract reviewed by an attorney. Understand what is written in your contract and, if there is any doubt, hire a lawyer.

Ultimately, you will be signing the contract, not your lawyer, so be sure you understand what is in it and don’t get mired in “legalese.” Some firms offer third-party contract negotiation; they will assign an attorney to step in as an intermediary. Then again, most experts recommend against hiring a third-party negotiator, as this may increase the distance between you and your employer at a time probably best spent getting to know each other.

Maintain a Keen Eye

Specifics to look for in your new contract:

Work requirements. The employment agreement should visibly define your job responsibilities. Things to look for in your contract include the obligations of the physician, number of shifts or hours or weeks per year you are expected to work, call responsibilities, a census cap (if applicable), allotted vacation time, and continuing medical education time.

Compensation. The contract clearly should delineate how you will be paid. Some hospitalists are compensated solely via a salary; others are paid based on billing/productivity, while the majority are paid based on a combination of these methods (a base salary plus incentives). Be sure you understand the incentive and/or bonus structure of your salary. Practices basing incentives on physician productivity will incorporate your own billing practices and often is measured in relative value units (RVUs). In some settings, group incentives are based on quality targets set by the administration, such as the Joint Commission on the Accreditation of Healthcare Organi-­zations (JCAHO) core measure compliance, dictation timeliness, or patient/primary care physician satisfaction.

Benefits. In addition to your salary, you should see that your benefits are spelled out. The obvious benefits include medical, dental, and vision insurance, as well as a retirement savings plan. As discussed in the July 2008 issue of The Hospitalist, as demand for hospitalists continues to exceed supply, look for signing bonuses, coverage of relocation expenses, and the possibility of student loan payoff. Other important benefits include coverage of professional dues, CME allocation, and licensing and board examination fees.

Malpractice Insurance. This can be a complicated topic. In general, there are two major classes of malpractice insurance: an occurrence policy and a claims-made policy. In respect to an occurrence policy, any malpractice incident arising while the coverage was in place, regardless of when the claim was filed, will be covered even after you have stopped practicing under that policy. A claims-made policy, on the other hand, protects physicians for any covered claim, if they are insured when the claim is made. It does not cover malpractice claims filed after the physician cancels the malpractice policy, even if the claim is about an event that occurred while the physician was insured.

If you are offered a claims-made policy, require your employer to add tail coverage, which covers you after leaving the practice for any events occurred during employment. If you are unclear about any part of the group’s malpractice coverage, consider seeking legal advice.

Restrictive covenants. These are non-compete clauses often setting geographic and time restrictions of where and when a physician can practice in the event they leave the group. Though you never know what the future holds, this becomes relevant if you were to change jobs and work at an adjacent local facility or one in a nearby county. In general, hospitalists rarely carry a panel of patients, so an employer probably should not be concerned about hospitalists taking patients with them if/when they leave the practice. Be cautious of restrictive covenants found in your contract.

Ownership/Partnership. In some private groups, partnership will be offered after a preliminary employment period, usually one to two years. Look for your contract to state when and how partnership might be offered, and what the criteria to join are. This also is the time to ask others in the group to get a sense of how many associates are offered partnership and when this might happen.

Allowable Activities. Look for any restrictions regarding your activities outside normal clinical duties, such as teaching, research, or consulting for other firms. If such restrictions are in your contract, there may be specifications about whether income from such activities is yours or whether it is shared with the rest of the practice. TH

Bryan Huang, MD, assistant clinical professor, division of hospital medicine, University of California-San Diego Department of Medicine, Bhavin Patel, MD, hospitalist at Regions Hospital, HealthPartners Medical Group, St. Paul, Minn., Bijo Chacko, MD, hospitalist program medical director, Preferred Health Partners, New York City, and chair of SHM’s Young Physician Committee.