Ins and Outs of Negotiating a Private Practice Job Paul E. Wallner, DO, FACR, FAOCR, FASTRO, FACRO Senior Vice President for Medical Affairs 21st Century Oncology, LLC Associate Executive Director for Radiation Oncology The American Board of Radiology

Practice Experience Academic Private practice Federal government Corporate employee Not recruiting and not representing either 21st Century Oncology or the ABR

Wallner’s “Rules” of the “Game”

Relax and try to enjoy the experience! Rule #1 Relax and try to enjoy the experience!

If the “perfect” job did exist, I would be an applicant! Rule #2 If the “perfect” job did exist, I would be an applicant!

Rule #6 Make no assumptions!

Rule #7 Bay-area ethnocentrism works: if you live in the Bay-area and are ready to retire!

Initiating the Job Search Timing – it’s never too soon! Look in a mirror – consider your goals and needs Cast a wide net Get the word out – Chair, Program Director, faculty, friends, contacts Muster your resources – update your resume Avoid “cold call” recruiters Sign nothing! Role of rotations? Due diligence is critical

Post-training Opportunities Academic Government (Federal and State) Private Practice Solo, Group, Partnership, “Corporate” Corporate (non-clinical)

Private Practice Definition Source: Merriam-Webster On-Line “a professional business (such as that of a lawyer or doctor) that is not controlled or paid for by the government or a larger company (such as a hospital)” Source: Merriam-Webster On-Line “the work of a professional health care  provider who is independent of economic or  policy control by professional peers except for licensing and other legal restrictions. Source: Mosby Medical Dictionary

Location Consider your nuclear and extended family Consider non-work opportunities Consider your “fit” into a community Consider cost of living Consider schools Consider opportunities for spending Consider the practice and practice environment Fantasy might be better than reality

Business Relationships Employee - without partnership opportunity Large corporation model Ideal for part-time employment Employee – with partnership opportunity Don’t expect guarantees and be aware of past history Partner Understand the risk versus benefit ratio Understand the legal implications Partnership is not (necessarily) the Holy Grail Owner/operator Sub-contractor

Contracts (general considerations) Get local legal advice – YOUR OWN! Make no assumptions! Everything is not necessarily negotiable Oral commitments are not necessarily binding

Contracts (specific considerations) Term (length) Financial Terms Benefits Termination Non-compete/ restrictive covenant Coverage Future relationship Residency requirements Board certification requirements Dispute resolution

Term (length) Initial contract is typically for one year Beware of long contract terms Review roll-over language carefully Salary increases Bonus (incentive) increases Vacation increases Expense reimbursement increases Change in benefits

Financial Terms Salary Incentives Total package value Are goals measurable and attainable Who controls attainability Payment schedule Non-clinical activities Total package value Increase at roll-over

Benefits (Employee versus sub-contractor) Pension/ 401(k) – contribution(s), vesting Profit-sharing - vesting Insurance – health, life, AD&D, general liability, umbrella Automobile Meetings Journals Memberships Medical/other licenses Medical liability insurance

Termination Notice period For cause Not for cause (employee at will) Specify Remediation details and period Multi-site group issue Not for cause (employee at will) Restrictive covenant waiver Payment of money owed

Restrictive Covenant (non-competition) Types: non-competition, non-solicitation Review local laws and decisions “Rule of reasonableness” – physician/patient harm Specific practice prohibitions Hospital privileges – co-terminus? Distance Specific mileage County Proximity to practice Medicare region Term Typically 18-24 months

Coverage/Call Frequency Distance – especially for multi-site practices Back-up – for unfamiliar issues

Future Relationship Length of subsequent contracts Partnership potential Precise nature of partnership Partnership valuation Buy-in Buy-out (departure versus death) Asset potential

Partnership: The Holy (or holey?) Grail? Understand exactly what you are getting into! Understand all details of this particular partnership Types of Partnerships General Limited

Partnership Issues Consider both cultural and financial aspects Review existing partnership documents Get everything in writing Consider the issues as you would any financial transaction Consider risks and benefits The offer is great for the ego, BUT remember, this is just a business transaction

Partnership Considerations Long-term implications to you and your family (divesting can make a divorce look easy) “Buy-in” periods and amounts Partnership “culture” How are differences handled How are decisions made – “entrenched leadership”

Financial Issues of Partnership Average income: trailing 5+/- years Accounts receivable History, patient base, payer base, procedure mix, 90-day aging Overhead and debt load Look for shadow employees and costs Goodwill Real Estate and equipment optional or required Review of the practice environment

Board Certification Requirements Typically three years from anniversary of eligibility or hire Current meaning of “Board Eligibility” Hospital rules/regulations Managed care relationships/contracts

Dispute Resolution Method Costs Venue Litigation versus arbitration Specify details Costs Venue

Transition Considerations Relocation expenses – fixed, total, timed Rent versus buy Health care coverage – COBRA payment Revenue stream issues – household budgets State licensure issues Hospital privileges

Questions?