Physicians are often in the job market at the start of a new year. Third-year fellows could be finalizing their employment offers and accepting their top choices; established physicians with 90 – 180-day resignation notification clauses could be working on a job change that accommodates a family move during the summer between school terms; or perhaps the COVID-19 pandemic could have you reconsidering your current employment situation and you want a change in scenery.

Regardless of your circumstance, this can either be a stressful or exciting time depending on how you approach it and how prepared you are. However, physicians generally have little or no experience in the job hunting and negotiating process.

Fortunately, there are some excellent resources available to you that can help you avoid the potential pitfalls of choosing the wrong position or accepting a poorly designed employment agreement. Four of these are linked below:

• Physician Employment Contracts: Strategies for Avoiding Pitfalls
• How to Evaluate, Accept, Reject, or Negotiate a Job Offer
• Checklist: Evaluating Prospective Employers
• Noncompete Negotiations: Push Back Now to Protect Yourself Later

A Google search for "Physician Employment Offers" has over 39 million sites to review so there is no lack of information available. Despite all this advice, too many physicians end up disenchanted with the organization they choose or the terms of the contract they agree to.

Below are my thoughts on ways to optimize your chance of success:

1. My first rule of thumb is to remember that job satisfaction is generally driven more by the culture and work environment than by compensation. If your compensation is great, you are happy one day every two weeks (payday). However, if the culture sucks, you are unhappy every day, including payday.
2. I believe you need at least three other people on your team to help you objectively look at job options and make the best choice. They are:
   
   
   • Your spouse or significant other. I learned through the years that, often, I was recruiting the spouse and hiring the physician together for the most likely long-term satisfaction and fit.
   • A mentor or other trusted (and knowledgeable and objective) physician who will offer you the unbiased truth – not just what you want to hear.
   • An attorney experienced in physician employment agreements. Not someone motivated to suggest hundreds of document changes (which often is not going to happen and will just cost you legal fees) but rather a pragmatic legal counsel who can differentiate with what is clearly unwarranted language or contract terms that are vague and need clarification.

3. 2020 aside, the job market for cardiologists moving forward is strongly tilted in the physician's favor in terms of supply and demand. As helpless as it can feel to have the hiring decision out of your control, the fact is you never have more leverage than when you receive a job offer. The urgent need to recruit cardiologists gives you the opportunity to counter a job offer – albeit within reason. Although some organizations seem stuck on only paying the nth percentile of Medical Group Management Association or a similar survey, areas open for discussion can be signing bonuses, unique CME allowances, etc. If you are viewed as a great candidate, a progressive organization will almost always accommodate some unique requests to land you as a hire. At the same time, most organizations do want to maintain a degree of consistency between their employment agreements, so a totally unique deal is generally unattainable. As a result, you need to be careful about what you ask for in your counter and ideally have some logic of market basis to back up your request. A great example of a reasonable request is to make sure that your health insurance and other benefits start on your first day vs. having to go without coverage or pay COBRA. If they say no, ask the hiring organization to pay your COBRA. Again, a small price to pay for getting their ideal candidate.
4. Like any major decision, do not be scared to walk away if it just does not feel right. Also, do not be held hostage to artificial deadlines. Just because they tell you they need a decision by a certain date does not mean that must be your deadline.
5. Interview the organization just as hard as they are interviewing you. Insist that you get to meet (or virtually talk to) as many of the key people as possible. You will want to talk to other recent physician hires to get their perspectives, talk to the staff you will be working with regularly, talk to referring physicians, etc. You need to diagnose the organization just like you would a new unfamiliar patient to learn whether they are healthy (culture-wise) or not. Go on their website and Facebook pages to see how they present themselves and what patients have to say.
6. Although I contend that the culture is more important than compensation, the fact is the compensation model often drives the culture. Is the compensation model based 100% on productivity? If so, does this create internal competition for wRVUs and result in a "practice" rather than a "group." Ask for examples of how teamwork routinely happens or does not happen. These days, compensation is often structured with an income guarantee for a period – say two years – and you will want to know what happens in year three. Therefore, you want to talk to recent hires who have gone past the income guarantee period. Did they maintain, increase or lose compensation at that point? An area which is having a larger aspect (sometimes exceeding 20%) of compensation are "quality metrics." You will want to understand the history of this aspect of compensation. Are the metrics reasonable? Attainable? Measurable? Are they group or individual?
7. Do not be over reliant on the recruiter. Many can be extremely helpful. But at the same time, there is often an inherent conflict of interest in that they are paid if you accept the job, so they basically are working for the hiring organization whether they are internal or external. View them as a resource and lean on them to help you get all your questions answered and interview needs met.

The last topic I want to cover is the time between when you accept a job and when you start, especially the potential risk of a job offer being rescinded. As is often the case with physicians, there can be quite a bit of time between when you "accepted" the job offer, and even signed an employment agreement, to when you start your first day.

Unfortunately, there are examples of cardiologists whose offer was rescinded during that time solely through a decision by the employer. Maybe it was a downturn in their financial situation, or a change in ownership (or leadership) but be aware that it can, and occasionally does, happen.

This article offers some legal explanation for such a circumstance. The key is to remember that most employment offers are "at will" and the offer itself can be terminated. This is one reason to have an experienced attorney involved in your job process from the beginning. It is just as important to stay connected to the hiring organization throughout the period from you resigning from your current position to starting your new one. In actuality, this will likely happen because you will be applying for new hospital privileges, getting credentialed into new insurance contracts, etc. But it is always in your best interest to identify your key physician or administrative leader contact and regularly stay in touch with them. If they are not responding, that may be a sign of trouble.

This article was authored by Larry Sobal, MBA, MHA, chief executive officer of the Heart and Vascular Institute of Wisconsin.