Post-Residency And Fellowship: Getting Into Gear For The Job Search And Contract Review

As the new year approaches, third-year residents and fellows are hopefully well into their job searches as they prepare for post-training life. At this point, these young podiatrists have: 

• figured out geographically where they want to live and work;

• analyzed the area in question for job opportunities;

• reviewed available resources to see where potential jobs are currently being advertised or created a target outreach list of prospective employers;

• up-to-date, finalized resumes and cover letters, have letters of recommendations in the works and have secured professional references among various attendings from training; and

• started license application(s) for the state(s) in which they hope to practice.

More information on these steps can be found on the “Life After Residency – Job Search” section on my website www.footankleresource.com .

Further, I would expect many of you have already begun to dive deeper into the job search process, having reached out to potential employers, gone on interviews or even received a contract to review. It behooves you to take all the necessary steps to make sure you get a contract that: 

• you thoroughly understand;

• has all of the points you negotiated in written format (just like medical records, "if it’s not written down, it didn't happen"); and

• you are comfortable and confident in signing.

To achieve the aforementioned related points about the employment agreement, I would like to offer some advice.

Have the contract reviewed by the necessary entities. This includes several people such as a contract lawyer who specializes in medical/physician employment agreements. This lawyer will review the contract so you can understand some of the legal verbiage typically unfamiliar to doctors and also clarify various legal-medical contract matters with which he or she is familiar.

Remember, lawyers are good at explaining the legal wording of the contract and general points of physician contracts.

Podiatric physicians (i.e., attendings, colleagues) who have both signed and created their own contracts are also likely to have reviewed many over their career. Seeking a review from such a podiatrist may also add a different dimension of understanding to the process.

While most of us will have a lawyer review the contract, I also advise having a podiatrist do this as well, whether he or she is an attending, residency/fellowship director, a co-resident or friend who went through the process and has some experience. There are many contract points that are specific for a podiatry employment agreement. Some lawyers may not be familiar with these points, do not understand them or are unaware of key points that should be in the contract due to a lack of knowledge of podiatry.

It is not the lawyer’s fault as he or she is not expected to know everything about every medical profession and how contract points may differ in specific situations. An example of this is whether the contract makes mention of where durable medical equipment (DME) or orthotic revenue is directed. Does this revenue go to the employer, the practice, the partners or the employee’s collections toward bonus? I often see this point missed or unclear in reviewing past contracts, which can make a big difference in the employee’s bottom line collection and ability to achieve bonus (and how much).

Additionally, many of us have family or friends in the medical field or law profession. Alternately, we may know people in the business world who have experience in consulting and negotiating. Learning some of their skills, strategies and practices can come in handy later on in the process. The more eyes you have on your employment agreement, the better.

This last point regarding contract review may be somewhat controversial or make you uneasy. However, I hear this point made across different medical and professional disciplines. In my opinion, do not be afraid to discuss salary (i.e., base salary, collection thresholds, percent bonus, ancillary revenue, etc.) and other contract points with your colleagues. Each job and location will garner different figures. However, knowing what others are getting (for better or worse) may help you realize if you are getting a fair deal or may help you (or a friend) negotiate a better contract. 

Transparency among peers will only help the profession and hopefully advance salary levels for everyone. Remember, do not compare contracts as apples to apples as there is a lot that goes into each agreement. Influencing factors may include location (state, rural, urban), practice model (podiatry, orthopaedic, hospital-employed), etc.

Final Notes

The costs of missing something in a first contract can haunt you for years and be difficult to change down the line. I hear countless times that contract review by outside entities actually gained things in the contract outweighing the costs of the lawyer and second party review fees. This could be a higher base salary, improved bonus percentages, a sign-on bonus (getting or increasing one), more vacation days, CME days, CME reimbursement and other more intricate items within the contract tied to compensation.

The employment agreement is the foundation of which your time with your future employer will be dictated from, good, bad or indifferent. You will only negotiate your first contract with your employer once. Therefore, it behooves you to take all the necessary steps to make sure you get the contract you want with full understanding of the agreement.

Dr. Hood is a fellowship-trained foot and ankle surgeon. Follow him on Twitter at @crhoodjrdpm and Instagram at @crhoodjrdpm. Also check out his website www.footankleresource.com, which contains information on student/resident/new practitioner transitioning as well as links to academic and educational resources found throughout the Internet related to foot and ankle medicine.