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Continuity Clinic Notebook:

 Chapter V: Other Aspects of Private Pediatrics

Chapter 3 Index

A. The Business of Private Practice
--Interviewing for Private Practice

  

Negotiating Contracts for Pediatric Practice

Introduction: The first decision you must make is to decide what kind of practice you want to enter.  If you are limited to certain parts of the state, that clearly will determine a lot of other issues about your contract.  If not so limited, there are a number of possibilities:     

  1. Solo - (usually in rural areas) - either with or without shared night and weekend call
  2. Small single specialty group (1-3 doctors) - usually in suburban/rural areas
  3. Large single specialty group (> 4 doctors)
  4. HMO - free standing type of building
  5. Multispecialty group - usually in urban areas
  6. Hospital owned small or large single specialty or multispecialty group - usually in larger cities
  7. Others including combinations of above

Evaluation of different types of practices:
A. General Issues: Ranking May Be Biased

  Solo Small Large HMO Multi Hospital Owned
1. Control 4 + 3+ 2+ 1+ 1+ 1+
2. Benefits 1+ 2+ 3+ 3+ 3+ 3+
3. Patient free to choose 4+ 3+ 2+ 1+ 2+ 1+
4. Time Off 1+ 2+ 3+ 4+ 3+ 3+
5. Feeling of being appreciated 4+ 3+ 3+ 2+ 3+ 3+
6. Learning – keeping up 1+ 2+ 3+ 3+ 3+ 3+
7. Administrative time 1+ 1+ 2+ 4+ 3+ 4+
8. Hospital responsibilities 1+ 1+ 1+ 4+ 2+ 2+
9. Community Involvement 4+ 4+ 3+ 1+ 3+ 2+

B. Signing and Evaluating Contracts with Different types of practices:

  Solo Small Large HMO Multi Hospital Owned
1. Well thought out 1+ 1+ 2+ 4+ 4+ 4+
*2. Negotiable 4+ 4+ 3+ 1+ 2+ 2+
3. Lowest turnover (opinion) 4+ (least) 3+ 2+ 2+ 2+ 3+

*Benefits delineated below; N.B. Always Have A Lawyer Look at Your Contract

I. Non-monetary Benefits:

1. Time Off:

a. workweek: what is usual schedule?  Many practices now give 1 day off/week
- What is the weekend schedule and night call schedule?  Do not accept a job where you are working more than the other partners.

b. CME time: usually one week first year, two weeks after that. 
- allowance: usual would be between $1500-$3000

c. Vacation: usual would be two weeks first year, 3 weeks next year, 4 weeks thereafter

d. Sick leave/ Pregnancy Leave - are these specified?

e. Part-time issues: does the group have part-time MDs? How are they treated?

2. Office Mechanics: - have own nurse; office efficiency; phone calls made by you or by nurse; facility modernized and functional; administrative support; laboratory support.  How much time must you spend on office administration issues; what is ER support, night and weekend phone coverage?

3. Peer Group: ages and interests of other doctors; compatibility in terms of interests, etc

4. Hospital Affiliations: how many, and how often must you travel to different ones? Committee requirements, attend C-Sections at all hospitals; what is nursing like in those hospitals

5. Reputation of group in community: go ask in grocery stores, gas stations etc.

6. Is there a non-compete clause - how many miles for how long a period of time?

7. Nurse Triage Lines at nights and weekends?

II. Monetary Benefits: Consider Only Total Economic Package:

1. Getting There: relocation allowance (up to $5000); pediatric board allowance; interest free loans - offered more by hospitals; signing bonus - up to $10000 in rural communities

2. Salary: Starting ranges from $80-$120,000 depending on location: more in rural areas.  Get in writing the amount you will be paid the second year, third year, etc.

3. Insurance: Never accept the “usual and customary” phrase.  Have them specify amounts!

a. malpractice - what is coverage (usual: 1 million/3 million); will group pay the tail insurance if you leave (up to $5000 - 6000)

b. health - what is deductible?  Some are $100; others up to $4000 - can get expensive.

c. disability - for younger people this is key: should have about 1/2 to 2/3 your salary.
There are two ways of handling this:
- if group pays, then income is not taxable to you
- if you pay your own, then income would not be taxable if collected

d. life - how much is being offered: some offer the amount equal to your salary, others are much higher.

4. Pension/Profit Plan Once a Partner: can be up to 15% of salary

5. Journals, Dues - local and AAP; AMA

6. Other: car allowance, gas allowance, and dental allowance

7. What is the buy-in for the practice to become a partner: two very different issues:

a. buying stock to become a partner; what are the terms?  how much money up front?

b. investing in the real estate of the partnership.  Be careful!  Have pros evaluate for you.

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Department of Pediatrics  |  Medical College of Georgia
 Please email comments, suggestions or questions to:
John T.  Benjamin M.D.,  jbenj@mcg.edu

February 27, 2004