Negotiating a Contract
In the recent climate of the surgical profession, there is a growing risk of unemployment or underemployment for new General Surgeons in Ontario. Complicating matters is a growing supply of General Surgeons, not only generated within the province but also more competition coming from surgeons transferring from other provinces or international medical graduates. Before competing for that position, take the time to evaluate the skills that you have to offer the profession; in turn, consider the lifestyle/professional goals/objectives/workload/ remuneration that you want from your specialty. You will have to negotiate for some aspects but realistically concede on others.
A key message from the Canadian Medical Association when negotiating a contract: "When evaluating a practice opportunity, remember that you may be able to negotiate income, service obligations, financial obligations and benefits. Ask questions, do your research and be knowledgeable about the market value of the compensation, as well as the obligations of any position you consider." Ask yourself the following questions:
- What potential income or billing level should I expect?
- What will my clinical and academic responsibilities be in the position?
- What will my financial obligations be to the practice, group or department?
- What benefits are available?
- What other requirements, duties or responsibilities will the position demand?
Income & Remuneration
Learn expected level of income and gross billings before going into an interview. Ask colleagues, program director, head of your department, etc.. The OMA might have data in this regard readily available for members also.
If the position is in a group, association or department, what will the new physician’s responsibilities be? What workload will be expected? What will the on-call responsibilities be? For university appointments, will there be expectations in terms of publications in peer-related journals? What are the clinical/teaching/research responsibilities? Who has to submit the research applications? Who hires/pays for office administration? Is the term indefinite or specified otherwise? What is the departure clause and potential penalties?
Will this be a sole proprietorship or will you be part of a partnership, group or department? Will you be sharing the costs (i.e. lease/mortgage, admin, office expenses, insurance, etc.)? Ask a lawyer to check a group agreement to ensure fairness and equity and understand potential liabilities of a group. How about decision making - how is it done and do you have an equal vote?
Depending on your jurisdiction, the MOHLTC might offer an added incentive program (alternative payment plan) in addition to your fee for service billings. Many hospitals and communities also offer financial incentives such as moving cost remuneration, signing bonuses or relocation allowances, to attract certain specialists. Other benefits could include insurance, holidays, CME time, payment of professional dues, pension plans, car allowance/parking, start-up loans, etc.
How much OR/endoscopy time will you be given? Is the procedure room appropriately staffed? Who is in charge of lining up surgical assistants? Is office space available? Do you select/hire support staff or will it be assigned? If you will be doing research, who will provide the research staff/equipment? Is there parental/sick leave?
These arrangements in the past had been informally/verbally arranged, but in a litigious world, it's becoming more formal with contracts. However brief the locum is, a physician is essentially agreeing to assume the responsibilities and practice style of the host doctor - not necessarily the way you usually do things. Are there particular procedural skills required (i.e. endoscopy, C-sections, etc.)? Learn the expected pace, hours, call committment, patient volume/demographic, experience of staff, type/availability of support associates, etc. Will you have to line up surgical assistants or will it be done by the hospital? If the former, ask for a list of surgeons you can approach. When are your office days/OR days/endoscopy days? Do you have to cover more than one hospital/clinic? Ask to speak with the office staff who will be booking appointments/managing patient files. If it's a long placement, who will be informing the patients of the change? Who will be enforcing the office policies - you or the office staff? Do you have the option of not filling any of these obligations for the short term? Are you going to be comfortable with the scheduling? If you sign on, pull sample charts to get a feel of the host surgeon's style of charting and how much description he/she expects. Is there a guaranteed daily stipend in addition to fee-for-service? Will you be able to claim 100% of FFS? Read the fine print and don't make assumptions. For more information, refer to CMA Module 11.*
IMPORTANT NOTE: Always have a lawyer (employment/business) review any contract before you sign it.
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