As physicians, many of you have outstanding clinical training and have learned the very best and the latest techniques on taking care of your patients. But many times in training, there's not as much time spent on the business side of medicine. So what we want to share today is some of our experience looking at the physician contracts and doing a comprehensive analysis. Basically, this is the type of information that the physicians, that the psychiatrists that we have on our current medical staff have said that they would like to share with you or they wish that someone would have shared with them when they were coming out of training and starting their practices. So we'll run through several different models and different scenarios for you. But as a frame of reference, HCA is a very large healthcare system. And just so you know my background, I have been in this environment for 22 years. So a lot of my healthcare knowledge comes from being in a pretty large healthcare system. It might be comparable to many of the academic systems that you might train in or you might be familiar with from your training, except that it's joined together across the country by central services such as the one my team provides. My team is the physician recruitment team that supports all these hospitals. And you can see as you look at the slide that there are several different states throughout Texas, Florida, Virginia, Tennessee, Colorado, Nevada, California, Utah, Idaho, and even over in England. So those are the states that we are most familiar with. And it's important to even understand that as you think about contracts, the state laws actually can change from state to state and affect some of the issues we're going to talk about. So one of the things that we recommend highly is that when you do get into the contracting stage of your job search, that you would look for an attorney who practices in the healthcare arena or the contract healthcare arena in the state that you'd like to practice in. You may be training in New Jersey, but you'd like to one day practice in Florida. You need someone who has Florida knowledge, because as I say, the state laws can be different from place to place. But with this array of 178 different hospitals, and we have behavioral services in almost all of these 45 different markets, and at the beginning of the year, we'll add a new one in North Carolina. We'll have the hospitals in Asheville and surrounding areas called Mission Health, somebody to join us. So with that kind of mass of hospitals, we've seen many of these different contracting situations over the years. And the good news for people in the behavioral health industry, for psychiatrists specifically, is that there is a huge shortage currently and one predicted. The MGMA, the Medical Group Management Association, is the group that really monitors pay rates and volume rates for all kinds of different specialties. And as we've considered their studies for the last five to seven years, every year the incomes that psychiatrists are seeing are going up, and the reason for that is because of the shortage. And we see that continuing, where by 2025, there should be a shortage of over 6,000 psychiatrists who will be able to provide care to patients. So the good news is that you will be in demand. The bad news is that there will be many different organizations trying to get you to work with them and come to them, and so you have to be aware of when you get into a situation, what does the contract mean, and how can you make sure that it's fair and reasonable to you, the doctor, who's spent so much time and money obtaining a fantastic clinical education. So looking at contracts, it's very important for you guys to understand that even though we advise you to have a colleague who is actually an attorney to support you, this is a legally binding agreement between a physician and another party, and it defines the relationship. So if something is discussed, but it's not mentioned in the contractual document, it may not be something that they plan to honor. And so you have to understand that the contracts are confusing. Most physicians do not have legal background and should not have legal background, but you should have someone who understands, who is a legal person to support you as you go through this process. The steps for contracting are pretty simple, but it's not as easy as it sounds. The first step is you, as the physician, need to read each contract. It's important that you read through the whole document. Now these documents are long. They're usually over 20 pages, and they can be very difficult to understand. So as you read it, I highly advise you to take, sometimes what they'll do, the organization in most cases will give you what they call a draft contract, a draft document that's just for you to look at and for your attorney to look at. And on that document, you can make notations and marks. So you can take a pen or a highlighter, however it is that you like to work, and you should really be circling or marking every single phrase or clause that you don't understand. Because when you get back together with the recruitment team or the doctors from the practice that's recruiting you and their legal people, you can ask those questions. At this point in the process, you've asked all kinds of questions, and they wouldn't be making a contractual offer to you unless they were very interested in bringing you into the market. So you understand the practice. You understand the practice dynamics. You understand the call. You understand the patient flow. You understand all of those particulars. Now it's time to understand the contractual requirements. So you want to read it, you want to understand it, and you want to get at least two expert opinions to support you. One would be someone, as I mentioned, who would be an attorney. The other would be someone who has financial background. Usually it's a certified financial planner or someone who is a CPA or CFO or controller. That type of person could also be an aid to you as you look at the document. And I would even pay at least an attorney to support you in this process. They may have a rate that they would charge to consider a contract and look at a contract. They may have an hourly rate. Usually they'll do a flat rate that an attorney would charge you, and I would pay them for their expertise. It probably won't be more than $500 or so for them to take the time, an hour or two, to look at the contract and give you their opinion. How do you find an attorney or accountant? You can ask other physicians for a recommendation. Usually they will know people in the market who are good, offer good services. You can negotiate, like I say, a fixed amount before you start the engagement, and you have to know how this will affect your tax implications because these agreements, as I said, will have a lot of implications. When you look at a contract, there's several things to consider, and this slide just shows the key contract components. The parties, that's you and the other institution, be it a hospital system, a managed care group like Kaiser, or a large physician group, or maybe even a governmental group like the VA would be the one offering the contract to you. The term, that's another one that's really, really important. We'll touch on it again later, but the term is how long is this agreement for? What am I signing up for? Is it a 10-year, a 3-year, a 1-year, a 6-month? How long am I committing? Basically, that's the commitment period. The termination is another one that we'll talk about that's very, very important. There are several different contracts that you will sign or could sign in a situation. One is called an income guarantee. If you're not familiar with that, that is something that I'd recommend as a resident or fellow that you find out about because income guarantees are available to physicians that are coming into most markets. They have the ability to support a new resident coming into the market, and then basically they forgive any dollars that they loan you during the first year if you stay in the area for two or three more years. It's one year of support, and then three or four-year promise to stay. The employment agreement is more like the arrangement that the nursing staff or others have in the area, and that will be that you become an employee directly of the organization, be it a hospital, academic center, community hospital, whatever that may be. That is an area where we see more people in psychiatry going that direction, leaning that direction to want to be in the employee side, and we'll talk about why in a minute. If you join a local group, let's say there's a group of psychiatrists that offer services in the community to patients, then you would be signing a group employment contract with them, and possibly even a partnership agreement to become an owner in that business. There's also something called a PSA that might not be familiar to you, and some residents have asked me, is that a public service announcement? In our world, a PSA is a professional services agreement, and it can be in addition to these other agreements, and basically what it entails is it allows you to become maybe a medical director or to do call and different things. It's an agreement that outlines the duties of some special arrangement between the hospital and the physician, so it's a professional services agreement. Might be for certain hours or for certain responsibilities, and those require that you do a timesheet to make sure that that's properly done. If you want to stay in the academic realm, you probably would do an academic or research contract. Sometimes in the academic world, you would not receive a contract, you would just receive a letter, and that letter would give some of the details, but then the contract they would give you later, actually, after you come to the campus and sign on. There are managed care contracts that you'd want to sign, and these are very important for you to sign, because the government payers, Medicare and Medicaid are important, and many of our patients are covered by those, but the managed care contracts like Aetna, Cigna, Blue Cross, Blue Shield, Humana, those contracts offer more reimbursement for the patients that you take care of, and it's important that you can get that reimbursement for your services. You may also sign contracts with suppliers and vendors, and even personnel contracts, so there's a variety of different types of contracts, and the most common ones, like I've said, are the revenue guarantee, it's also called a net collectible, an income guarantee or a recruitment agreement, and the employment agreement. Now, the revenue guarantee is the first one that we'll touch on, and it's interesting, because many psychiatrists who are in training have never heard of this, and it's only available to physicians. This is compliant with the Star Clause, but there are certain things that have to be done to make sure it's compliant. It's got to be intended to entice someone to come into the area and provide needed services to the population. They can support you financially if you're willing to do that. They have to do a community needs study, so they may have to have done a study of who are the other psychiatrists in that community service area, and then what is the patient base? What's the population of patients? They might even consider patients that in-migrate from other patient areas. In short, there has to be a need for your specialty for you to qualify for one of these agreements. In this type of agreement, then, your income and overhead can be provided by the hospital, so that can include your monthly salary can be covered, a sign-on bonus, sometimes even moving relocation dollars. All of those could be part of this initial agreement, and provided by the hospital, and then it's forgiven over time. You can do that as a private practice physician, so you can join a private practice, or you could be a solo physician. Either way, you would be eligible to receive this kind of support. The hospital can provide assistance for new physicians establishing a practice in their community, but the agreement has to be in writing. You have to be relocating to the community, or been in practice less than one year out of fellowship or residency. There is no obligation to refer patients to the hospital. You take your patients, if they need to be hospitalized, to wherever you feel is the best clinical option for them. The star flaws are very specific, that they cannot, this agreement does not force you to change the way you might practice for your patients. You might also sign that agreement with the group, if you're joining a group, and it can only cover the new expenses related to a new physician coming in, the new rent, the new personnel, and the new expenses. This is an example of a map that shows the community need for an area. Basically this is a natural area where I am here, but basically what they'll do is study where patients migrate to, what zip codes they come from, and in that way, they'll be able to establish the patient base, and then they have standards and benchmarks that say how many psychiatrists are needed to care for that size patient base, and that's an actual sample of a community need study, the executive summary there. So typically in this arrangement, it's a one-year support, two or three-year promise to stay. So in the example I'm going to show you, there's a $330,000 physician salary in the first year, there's overhead for the physician to come, expenses related to the practice of medicine, $150,000, so the total contract is for $480,000. Now, when a physician starts their practice, this is typical of psychiatrists and typical of other specialties as well, in the first month, there will probably not be very many collections, if any at all, in terms of the collections for taking care of the patients. You'll see, you might have appointments, patients are wanting to see you, or you'll see them through the emergency department sometimes or even at the hospital, and you'll be able to submit bills for those, for taking care of those patients, but for them to actually be collected through the payers, that takes a while. And that is why this hospital subsidy, this income guarantee, is nice, because even if you don't have any revenue from the practice of medicine, you still are covered through the hospital subsidy in the first month, for example, zero collections, but you get $40,000 through the subsidy, and then on through the month, as you collect more for caring for the patients, you receive less of the subsidy until the ninth month, when you really don't need it any longer at all. So out of the total $480,000 in this example, then $180,000 was actually used by the physician coming into the market. After that first year is over, then, the commitment is to stay in the community and continue caring for patients, and so there's a forgiveness period. And in that time, the loan that is taken, or the $180,000 that was given in the first year, can be forgiven. In this case, over 36 months, it would be $5,000 forgiven every month that you stay in the community. If someone stays for the full 36 months, that whole amount that was given to you would be forgiven. You would not pay that loan back. If someone was to leave the community, and let's say they're practicing in Tampa, for example, they change their mind, they move to Tulsa, Oklahoma, then they would have to pay back whatever is not forgiven in this arrangement. So it's very important to find an area if you're going to do an income guarantee that you want to be in and want to stay in for at least the first four years. When you do that, then, in the year that these amounts are forgiven, there'll be a 1099 consequence from a tax perspective. It's not bad, but it's just to be aware of that. Other things to be aware of on a revenue guarantee or income guarantee. They do also offer or can offer a sign-on bonus, as I mentioned before, student loan repayment. I know that's very popular with many of our residents. Startup expenses, relocation allowance, marketing, and legal and accounting can all be reimbursed through that income guarantee. More and more, the psychiatrists that we talk to coming out of training are asking us about the employment option. In other words, can the hospital, can the practice straight up employ the psychiatrist? And that is an option just as well, but there are different laws surrounding those contracts. So let me share with you what to be aware of here. The hospital, the managed care organization, they can employ you, but they do not need to do a community need study as was needed for the income guarantee. The income, your benefits, your malpractice insurance, which is very important to have, are provided by the employer. The practice management, the billing, the coding, the collections, all of those things are taken care of also by the employer in this arrangement. So for physicians who feel like they really want to spend their time practicing, they don't want to do anything administratively, this is a great option to be employed. It's not just HCA that does this, other hospital systems do this, or you might call it being a faculty member in an academic setting as well. But more and more, we see residents and fellows asking about this option for several reasons listed here. Now, as I mentioned before, in this employment agreement, there's a couple of really important things. The term, how long is the agreement for? Three years? Five years? We feel like those are normal timeframes. Enough time for you to get started and get a feel for it, but not a forever type of arrangement. These things should be spelled out in the contract components. And then termination clause, and this one's very important. Let's say, for example, that you come into employment, you join a new group, it's a hospital in New Jersey, and it's where you're from, and you really wanted to work there, and then you find out that you need to move your family for health reasons or for other reasons to another part of the country. The termination clause tells how much time you have to give in notice before you leave. It makes sense for both sides, the physician and the employer, for there to be a termination clause. Because if you need to leave, they will need to backfill you so that they can still take care of the patients. And so we see 90 days or 120 days being a normal timeframe in this area. Now, let's say the other thing is true. The hospital is not doing well, or they have too many psychiatrists, or they don't like the way that you practice, or you're not seeing enough patients, and they want to terminate you. They must also give you 90 to 100 days notice if the termination clause says that. And if they don't do that, then they would just simply write you a check for that amount, which might be nice in case you have to find a new practice, that you do have the support to do that. So when you look at these contracts, there are several different kinds of basically compensation. Many times there's a base component, especially in the psychiatry area. There can be a production component that I'll talk about, and it can be related to the collections It can be related to number of patients seen. There can be a combination between the base and production methods. But there's also something that you should be aware of, and it's called the RVU method. And this is very, very popular with physicians and psychiatrists across the country, because the RVU method is different in the way that it compensates a psychiatrist, in that there are RVU metrics assigned by the Center for Medicare Services to any activity that you would do with a patient, whether it was a consult, whether it was a, you know, whatever that type of activity would be, there's always an RVU value to that. So physicians tend to like the RVU model, because if you saw the patient, you chart the RVUs, you get credit for that work. In some of the other production models, it depends on the collections received from the patient or from the payers, in which case, if there's not a good payment, there's less remuneration for the physician. So these are the models that we normally see, and these are also the models that are the most popular. Many times, in the first year, even if it's going to become a production model, in the first year, because you're getting a runway to start a new practice, they will have what they call a salary floor or a base. In this example on the slide, I'm showing you a base of 300,000. So that means that the first year, you would not do worse than 300,000. And if certain metrics are met, you may do more than that. They may have bonuses related to the RVUs, or they may have bonuses related to the quality, or they may have bonuses related to the patient satisfaction surveys. Year two, then, shows a drop in the floor. Does that mean you make less? No. It usually means that your patient base is such that by the other method, the RVU method, you will actually make more than the floor, and even more than the floor from the first year. They're usually pretty confident of that. In year three, in many cases, we see that these arrangements move to full production, or an RVU type of program, where it's based on the production you did the previous year. That would be the expectation. And then those would be the types of, that would be the way that you could, if you're more productive, earn more than the floor, if you will. So it's important to understand these questions. And when you get to this level, and they've given you a draft agreement to talk with, and you ask your attorney, it's important to understand some of these questions. What is included in the costs that are assigned to me? Is it a set list that is included in the contract? In other words, in every practice, there's going to be rent, there's going to be malpractice coverage, there's going to be employee costs, there's going to be costs for those that assist in the care of your patients. And so all those things you have to understand, how are those costs assigned to you in the productivity area? So these are questions that appear on the slide today that I would ask when you get to this point in the arrangement. I would not ask these early on in the interview process. I would wait until they've actually given you a draft contract, until you're at the offer stage talking about these types of issues. Now to further share more about the RVU model, I would say here that this is a good way to get a better understanding. And again, many of you have heard the term work RVUs, or WRVUs, or RVUs. This is another way to look at that. The physician, based on the value attributed to each professional service by CMS, will have a certain number of RVUs. In this example, it's 8,000. But for every RVU, there's a dollar conversion factor. And that will be based on the managed care payers, the number of other physicians in the area, all kinds of factors. And that is something that you, the physician, can and should ask about and negotiate. In this setting, there's 8,000 RVUs. $50 conversion factor means physician compensation is $400,000. It's a very simple, straightforward way for the physician to know that their compensation is pretty straightforward. The less complicated these plans are, the better for you. So the question is, how do you deal with the physician? If you're joining a partnership or a group, these are the things you have to consider. And it's very fair to ask these questions. How is this group structured? What is the corporate structure? Is it an S-Corp? What is the corporate structure? Is it a PLC? What type of thing? Who owns the group? Do the physicians own it? Does someone else own it? Does the academic center own it? Areas that I've seen lately, there have been hybrids, where the physicians who are faculty members also have their own independent group or independent practice that they are able to be a part of. So they own that group. What's the time frame? Can I do a, will I buy in? How is it paid? All of those things are important if you're thinking about joining a local physician group and understanding that. The partnership agreement can also be very important because it's going to have several different types of provisions, buy in, buy out, and liquidation provisions. Hopefully, you won't ever need those provisions, but they should exist in a partnership agreement because you might be buying into the value. And if you would ever leave, they'd have to buy you out. It also should outline some of the call coverage arrangements and the management duties. And they definitely should be able to show you, either in the partnership agreement or accompanying document, the vacation, the illness, the disability, and leave and absence policies. And these are very important for young residents because many of you will have situations where you're out of the office or you need to be out of the office for family, for disability, for different things, including family leave. The partnership agreement should explain how the mechanism for settling disputes, and it should also explain the physician's liability for lawsuits and purchasing policies within the group. Now, when you're joining the employment arena, if you're coming into an arena like that, there has to be something called FMV. If you haven't heard of that acronym before, FMV stands for fair market value. In the employment arrangement that exists for academic institutions and hospitals that employ doctors, those doctors have to be employed at a fair market value level. So what is the going rate? In other words, for someone who does psychiatry or child and adolescent psychiatry or geropsych, those different things, what is the going rate? That is something that you would need to know. So understand this topic. I'm going to show you an example of a practice and what it looks like. In the top picture, there are three physicians that actually own and operate a practice. Let's say it's a psychiatry practice. When you have the valuators look at this practice, they look at the fixtures, the furniture, the equipment, supplies involved, and the accounts receivable based on the patients that have been seen. In this case, the practice is valued at $1 million total for everything these doctors have put into the practice. If a fourth person or a new person is to then join that practice, the normal thing that they would do is have a buy-in amount of one fourth of the amount of the total value of the practice. That way, everyone has an equal share and the new person would have paid for what the previous people put together. In contract, just so you know the limitations, the revenue guarantee sets a salary ceiling if you have a payback contract. The employment contract usually has a salary floor. You can go from a revenue guarantee or an income guarantee to employment, but you can't go from employment to an income guarantee because you would not be moving into the area for the first time. In these agreements, it's also very important if you've ever heard the words non-compete, this becomes very important for physicians and psychiatrists to understand. Non-compete and restrictive covenants are the same exact thing and it basically means the physician cannot practice in the same area if they are to leave the current practice. There's a specified geographic area or given amount of time that you cannot practice. Now, those restrictions have to be reasonable in terms of the time, the scope, and the distance. Another term that's used when we're talking about restrictive covenants is liquidated damages, which is amount of money that can be paid to the group to allow you to leave and stay in the area. But these are important provisions. If they exist in a contract that you look at, you've gotta make sure you understand them, you've gotta make sure they're reasonable, you can live with them if you decide, for some reason, that you have to leave that practice. The types of malpractice insurance are also very important, too, and these are something that many psychiatrists are aware of, need to be aware of. In terms of claims made, this covers the policy, if there are any alleged acts of malpractice that take place, and I report it to the carrier during the policy period. If that's the case, you are required to get tail coverage in case occurrences come after you've left that practice. Occurrence-based is for anything that can occur while the policy is in effect, regardless of when the claim is paid. So usually, these policies are more expensive, but it's not important that you have a tail because you're covered from the occurrence. When you think about compensation, it's important for the physicians to understand that these are derived based on salary studies. As I mentioned before, you see on this slide, the MGMA, that stands for the Medical Group Management Association. These people are the practice managers. They are the ones who turn in information from across the country, and then this organization, the association, basically takes all that information and synthesizes it to a salary survey that is used, and this is really the gold standard that's used at the MGMA. They may also use the AAMC. They may use information from salary.com, and they may be able to get information from the APA, but most organizations will try to have something that says this is the median, this is the 25th percentile, this is the 15th percentile, this is the 70th percentile. They'll want to have some kind of salary like that, some kind of survey to help them, and you can get a hold of those if you know someone who's with the MGMA. We happen to be members, so if you ever need that information, you contact myself or Louis Joseph, but you can do research. When it comes to the compensation, it might be important for you to know what do first-year residents typically earn in terms of their schedule? What is the typical amount for someone who's further along in practice, and if it's a specialty within the psychiatry area, how does that affect the possibilities? Those surveys, like I say, are available, so it's not like residency or fellowship when it's just a flat number and everybody's the same. Those things can be negotiated, it can be discussed, and it's important that you know your benchmarks and consider the total compensation package. Consider the benefits. There's a cost to your employer providing benefits for you, and if they provide health benefits and disability benefits and vision benefits and dental benefits that you and your family can take advantage of and they provide that, then that is additional dollars that are beneficial to you that you need to consider in terms of your calculation. In any of these cases, you wanna consider the role and percentage of productivity. If you work harder than the other colleagues, will you be compensated for that? If you see more patients, if you do more procedures, if you do more consults, will you be compensated for that? Supply and demand is really gonna affect these different scenarios, so there are different surveys for different parts of the country. If you're going to a rural area versus a suburban area, a lot of times there will be higher levels of compensation. If you're going to an extremely urban area, where again, it's difficult to get candidates to go, that can also affect compensation. When you look at the MGMA data for psychiatry, you can see that the first year typically is in the 25th percentile range, and that's in the $217,000 range. These numbers are available to psychiatrists, again, through the presentation. The mean here shows that the average is in the 280s, the median is 267. The number of RVUs is here as well, and you can see the different geographic areas will have a different number because again, of the number of physicians in those areas and the number of the way that the managed care payers reimburse for different services. So the eastern median is actually lower than the other medians because they have more doctors in that area and they have less compensation. And again, I mentioned this a minute ago, but just to touch on it again, malpractice can be a very important consideration for you. Health, dental, and vision, paid vacation, holidays, sick time. Your CME, you'll need to do CME to maintain your license and your credential, and to do that, you have to have time off and you have to have some dollars. So they may cover that, they may cover up to a certain amount, they may cover for you to go to the APA or state organizations. And if so, you have to take advantage of that. Disability insurance, that's a very important thing for physicians to have, you wanna make sure that you've got that. Dues and subscriptions, licensures, your laptop, your phone, tablet, all of those things may be things that are included in even retirement benefits in the package. All right, so negotiation. Is it okay to negotiate? On certain things, yes, you do have the right to negotiate, but you have to understand that you have to do so reasonably. Make sure that you're operating from facts. You don't wanna negotiate and say, hey, I like that salary, but I really need a Mercedes and it should be a three class. That's not factual. You want it to be something based on information that's factual. For example, you might say, I agree with the salary offer, however, I was hoping because we have to move and because I have to get COBRA for a few weeks to make sure I have family insurance coverage and that costs a few thousand dollars, and I've got also dollars that I'm gonna have to use for new, for my down payment on my new place, those sorts of things. So that is why I would like to negotiate something additional. So there's a way to do it that's appropriate and humble, and you have to remember that these contracts are built by the other side, and they sometimes can be amended. Sometimes they can't be amended. So make sure you listen to the other side. Make sure you get everything in writing. When something is negotiated, make sure that that comes back in writing, either through an email or an addendum to the contract. When you want to negotiate, you have to determine who the real decision maker is. Sometimes it's a physician who started the practice. Sometimes all of that rests with the practice management leadership, maybe the CEO or the CMO or whoever. Never be the first one to give a number. You may say, having looked at the surveys that I just showed you, hey, I'd like to be at the 25th percentile, I'd like to be at 207, and the whole time they were thinking we probably should go to 225 for you because of some extraordinary circumstances. If they do make you an offer, always sleep on it. Always ask, can I have some time to think about this before accepting an offer? Never take the first offer. That may cause them to make additional offers without you even asking for it. But don't ask for things that aren't, like I say, relevant to your practice situation, like the car or different things. Ask for things that are meaningful to you, to your family, as you go through the process. These are a couple things to watch out for. Don't say, I'm just a doctor, I don't know anything about business. They have been in the business of healthcare. They'll know a lot about it. You, through having the opportunity to ask questions and to go through a seminar like this, now know a lot about these situations. I'm going to be honest with you. That kind of sounds like, well, you haven't been so far, so probably don't say that. Take it or leave it. You don't want to get to that point because if they can't make a change, that will cause them to feel like you're driving a harder bargain than maybe you should. You can say, I have another offer, but you have to be truthful about that. The points to remember here, this contract is always drawn up by them. The practice, they're paying a legal team to make these documents, help them. Basically, the document is designed to avoid problems that might have come up in previous situations. So you always have to read the entire document yourself. Ask for clarification, as I said before, if you don't understand things. Statements like may, or to the extent possible, under certain circumstances, if you see those living in a contract, they may not be something that they actually will deliver on. They may say, you may have a chance for a bonus. Well, that doesn't really define how that bonus will be earned. So that should be more, it should be more explained more further than that. Do not pay for goodwill to join a group that used to be a common practice in the medical industry, and that's no longer relevant. And always obtain the services of a competent attorney and accountant, and look for someone specializing in healthcare. The final thing we would say to you, and this is something that we always feel as we talk about contracts, and RVUs, and MGMA, and all these things, fair market value, all those things are important, but you have to assess the big picture. And when I say that, what I mean is, will this opportunity allow me to grow professionally? Will it bring me closer to my ultimate career objectives? You have trained as a medical student, as a resident, as a fellow, for years now to get to this point. And so you want to be in a career that's gonna be satisfying to you, that's gonna allow you to do the things you wanna do. Are the hours required, are they acceptable for your family situation? In many cases, in years past, physicians worked unbelievable amounts of hours, especially in the psychiatry area, because there's both inpatient and outpatient work to do. And they can really cause a problem with your work-life balance. So if there are certain things that you as a family, or you as an individual, wanna make sure you hold the line and watch the time you spend, then you have to make sure that the hours required are acceptable. And you have to know what those hours are. What are the call hours? What are the weekend hours? What are the evening hours? And what are the hours for regular practice? Are the incentives offered? Are they attainable? Will they motivate me? Or will they just cause me to be unhappy? Those are things you have to ask. You have to ask yourself these questions. And do my prospective colleagues, will they be people I enjoy working with? Will they be people I enjoy being around with? If you can't answer yes to that, I would say that's probably a consideration that you don't take that offer, even if the offer is above the median. Life is too short to be with people that you don't wanna be with, and work with them on a daily basis. So be with people that you wanna be with and enjoy working with. There are several resources that are available to you that I'll mention. If you're looking for an attorney, there's a resource called martindale.com that lists attorneys by state and by specialty. So that's always helpful. If you're looking for budgeting information, there's the American Association of Medical Colleges has information. The APA has a huge reservoir of information for residents and fellows, and that is why today we're making this podcast so that you can have this type of information available to you. MGMA also has the information on the salary surveys that have been done across the psychiatry area and for all specialties, really. So those are good to have. There are opportunities with HCA. HCA is currently looking for psychiatrists across the country. We need, I think right now, over 60 openings exist in several of our states all across the country. If you would happen to be interested in one of those, we also do have residents. If you have someone who's going to be matching into their residency, we have resident spots now available in several of our hospitals throughout the different parts of the country. But you can go to this website. It's called practicewithus.com. If you wanted to know about our openings, you could easily search them, and it might be a good practice for you to do so because you could also compare these listings to other opportunity listings just to see how complete is the listing. Does it tell you enough about the job? Does it answer some of your questions to tell you enough to see if you're interested? You can search psychiatry and see all of those openings. We also do have a program that's available for residents specifically for psychiatrists, and it's called the Earn While You Learn Stipend Program. What it means is we wanna support residents who wanna work in our area one day. And so even if you're still in training, we'll commit to a monthly stipend amount for you now, so on the order of two, three, $4,000 a month. If you'll commit to come into one of our markets and be on our medical staff for two years after you finish training. So you have to be in one of our areas. If you're sure that you're going to Florida or sure you're going to Texas or Kansas City or Nashville, you could actually apply for the stipend. Now, the application process is pretty rigorous. We ask for program director support for you. We ask for recommendations. We have our psychiatry experts look at your background and determine, and then we have a committee that will basically decide which applications get accepted. But we do offer this for psychiatrists. We probably have right now 10 or 12 psychiatrists who will be graduating in 2019, 2020, and 2021 that are receiving this support from HCA and plan to work in one of our markets one day.

physician contracts

income guarantees

employment agreements

compensation

non-compete clauses

malpractice insurance

negotiation

career goals