All right, everybody, thank you for coming. Welcome to your first job, searching, signing, and starting. My co-director is Seema Desai, he is our faculty for today. If you are a resident, fellow, medical student, early career physician, I think this is probably the most important lecture for you because these are going to be things that you will not learn in the books. Little bits of knowledge that will significantly impact your practice. First off, we have Dr. Seema Desai, superstar from Carolina's Rehab, she'll be talking about academic job considerations, a gentleman and a scholar, Dr. Jason Edwards, he'll be talking about contract basics and negotiation. The legend, Dr. Joseph Herrera, was originally set to be here but due to some personal issues he can't make it. But in our greatest hour of need, a hero has stepped in, Dr. David Gater, he'll talk about reimbursement models and hiring from the chair's perspective. I will not even attempt to read all of his titles. Another superstar, Dr. Samir Kapasi, he'll be talking about private practice. And Dr. Timothy Tu, I'll be talking about starting your job search. No disclosures. So these are things that we don't learn in residency. If you're lucky, you might get one lecture a year or sometimes you have to learn on the fly with whatever attending you're rotating with. So RVU, you might have heard that term, stands for relative value units. It puts a value on the things that we do. So follow up, clinic visits have a certain number, procedures have a certain number, surgeries, et cetera. So to put things into perspective, a standard new patient visit, which I just put as a level three, is 1.6 RVUs. A follow-up visit is 1.3 RVUs. It's about 20% less, but if you could see two follow-ups in the time that you see one new patient, you can almost double your productivity. As far as procedures, a blind knee injection gets 0.79 RVUs. If you throw on an ultrasound, you get 40% more at 1.1, but you can see that procedures actually reimburse less than clinic visits in terms of RVUs. So what are full-time equivalents or FTE? So essentially if you're working five days a week, two full sessions a day, a session being in the morning, 8 to 12, in the afternoon, 1 to 5, you are 1.0 FTEs. If you have a half day of administrative time, that goes down to 0.9 FTEs, and these are important because it affects your RVU targets or could affect your RVU targets and potentially the benefits you're eligible for. So for example, if your target for the year is 1,000 RVUs, your employer may say, hey, since you're only 0.9 FTEs, you only need to make 900, 0.9 times 1,000. On the other side, your employer may say you're 0.9 FTEs, but no one's paying for that 0.1, so you're still going to have to make 1,000 RVUs. As far as benefits, you can be part-time or full-time employed. Sometimes you need to meet a minimum threshold, and you can still be eligible for benefits. So for example, you may only work 0.6 FTEs, but still get the full-time benefits, and that varies by employer. Template, another term you might have heard. It does not mean the dot phrases you make in EPIC. It essentially means what is your schedule. So things to consider, the visit type, the duration. So I put NPV as a new patient visit, FUV as the follow-up, and PROC as the procedure. And I just put 30 minutes, 15 and 15, just to set an example. On the right side, you'll see four sample templates. Not mine, I just made them up. So in the first column, this particular physician decided he or she wanted to do 30 minutes, or the first 30 minutes of the hour for a new patient, and then two follow-up visits. Benefit for this is that, theoretically, when you see a follow-up, it's a much quicker visit. It allows you to catch up on your notes and not really fall behind. In the second column, the provider is starting off the session with four new patients in a row, and then a series of follow-up visits. Benefit for this is that the new patient visits, which take longer, you get rid of early on, and then you just go one after the other with the follow-up visits. A downside to this could be that you may not have time to finish some of your notes, and you'll be playing catch-up later on. In the third column, it's just procedures. So I have certain days where I only do procedures, and for me, that is most beneficial for my flow, so I'm not going from one mindset to another. In the fourth column, this particular physician has decided to do alternating visit types. So there's pros and cons for both a full session of procedures and mixing them up. If you're limited in resources, for example, you do EMGs, and you only have one EMG machine, it's probably difficult to do a bunch of EMGs in a row because you're going to have to clean the machine, turn the room over, et cetera. Whereas if you're mixing the visits while the machine is getting cleaned, while the room's getting turned over, you can see a clinic patient, and then by the time the machine is ready, you're also ready to see the patient. So whatever you decide, it's up to you. Just be aware of the implications. As far as billing, it's not about the money. We're not in medicine for the money, but it's about the money. So you need to learn billing because that's how you're going to get paid, all right? Again, not something that's necessarily taught so well in training. So I would highly recommend speaking with your attendings, see how they go about things, why they bill certain visits at a certain level, and just keep that in the back of your mind. When you start your first job, day one, they assume you already know how to do this. They're not going to teach you how. A good website is EM for Evaluation and Management, emuniversity.com. Free. Don't pay for their stuff, unless you want to. Where to look for jobs. So first and foremost, work your connections. Just like everything else in life, it's not what you know, it's who you know. So that student you rotated with when you were in third year and now you're both practicing physicians, reach out to them, see if they know anything. People you've met at conferences, reach out. Job fairs are also great. So every society, when they have their annual assembly, will have a job fair. But you can also go to a general job fair. For example, websites or companies like CareerMD will have a general job fair for all specialties, but usually physiatry will have its own section. Search engines are important. You can go to each individual society's website and check their career center. Different journals. So not just the PM&R ones. Search for New England Journal. If you're in pain or you do EMGs, maybe check some neurosurgery societies or journals. If you're sports medicine, check some orthopedic ones. Monster.com and Deed.com, they're not necessarily geared for healthcare, but there are still jobs that are only advertised on those platforms. And if you're interested in the VA, USAJOBS is the website for you. Cold calling, I don't necessarily recommend picking up the phone and calling someone, hey, you got a job. But you can send an email, cover letter is recommended with an up-to-date CV. You can use a recruiter, but make note, you will get hounded. You don't have to respond, but they will call you nonstop. A downside to a recruiter is that they will take a cut out of whatever signing bonus, but they do a lot of the legwork. Also you have to know your worth. So this is the MGMA data. Don't ask me how I obtained it. I put on the left different specialties that are related to ours. And you can see the median for each. So if you are not in the median, if you're below it, you are not being valued appropriately. Or maybe you are and the system does not have the resources, but just know what you're worth. You can do pros and cons for whatever situation you're in. Finding a balance. So when you're looking for a job or considering different opportunities, you need to consider lifestyle, location, and lucrativeness. That is a word. I verified it. I looked it up. I did not believe it. But it is. In general, if you can get two of them, great. And remember, happiness is relative. So taking location, for example, say there's a job in New York City. For person A, that might be ideal. Big town, lots of other stuff to do, may or may not be close to family. But person B might think that particular job, no matter how wonderful the responsibilities are, is actually a nightmare because it's in New York City. Maybe that person wants to be out in nature. So we're more rural or suburban. So lifestyle is different for everyone. Location is different for everyone. Money is probably the common denominator. Licensure, just consider it's called FCVS. It's basically a website that helps consolidate all your credentials, and it will facilitate your application for licensure across the nation. CME, you're going to have to keep track of it. I like to rename my files, like on the bottom here, where it has my name, the year, what the CME is from, and how many credits it is, so that I can see how many credits I have without actually opening up the file. And online transcripts, there's the AAP Menara website, which has the online learning portal. You can upload your CME certificates, and it will keep track and report to the board on your behalf. Logs. Sorry, I got to talk really fast. I use logs to keep track of all my visit types, every single encounter, what I bill, what tests I order, what procedures I do, who I refer to, et cetera. And I find it's helpful because I can get a percentage, am I overbilling one type, am I ordering tons of one test, am I referring to ortho like way too often, but also it helps me follow up with things. So if I want to know, oh, hey, who did I do that SI joint injection on in December? I can just search for the SI joints that I did in December and find it that way, because it can be hard to just search random patients in your schedule. Financial considerations. So how much to save? COVID was a good example. A lot of people lost their jobs or got pay cuts. The general rule of thumb is you should have six months worth of savings, because worst case scenario, you lose your job, it can take a long time for credentialing. You might sign a contract and wait another six months before you actually start. So six months of savings. Max out your Roth IRA. If you are not yet making attending money, then you're probably eligible for a Roth IRA. Max it out, because once you're attending, unless you're incorporated, yada, yada, yada, you're not going to be eligible. Family insurance. Rates are lower when you're in training. Look into that. Live like a resident. Maybe you can blow your first paycheck on whatever you want, maybe, but live like a resident and then you will accumulate wealth. You want to think long-term. FSA. So it's basically a debit card pre-tax that you can use to pay for health-related expenses like copayments. What I just found, I have a four-year-old girl, is nighttime diapers are covered by the FSA. I didn't know that. And an employer match. So your retirement fund, some employers will match your contribution. Make sure you contribute enough to at least meet that. Taking points. Use your network. People you've worked with in the past or just chatted with, don't be afraid to reach out. Be your own advocate. Know your worth. Know your value. Know what you want. And fight for yourself. And just try to decide what's most important, because you don't want to be switching jobs frequently. Ideally, one and done. Not always the case. Usually not the case. But the more you know going into it, the better off you'll be. So next is going to be Dr. Seema Desai, and she'll be talking about academic jobs. All right, so I'm going to be talking to everyone today about the academic job considerations for signing your first job. I will have some overlap with what Dr. Tu had to say. I have no disclosures. So how is the academic system structured? Like Dr. Chu said, it's not about the money, but it is about the money. So it's important to know how you're actually going to get paid. Are you actually going to have a salary? Do you have some sort of salary guarantee? Like the first two years, they may guarantee, okay, you're going to get paid X amount of money for the first year and a half or two years. And then the RVU model, you may actually have a mixed model where you have a base salary and then an RVU on top of that. So it's really important going in, you do your homework, you figure out how much you are supposed to be compensated. So the AAP Menar has a compensation outline online. The AAMC also has a compensation that actually goes over what physiatrists make. So getting access to this is very important. So you actually can figure out what's your actual worth. Benefits, again, kind of highlighting what Dr. Chu said, health insurance. So FSAs, HSAs, very important, lots of lingo that you need to learn and read about. Retirement, again, very important. You need to know if you're getting a 401k versus a 403b versus a 457. They are all a little bit different. And knowing whether the hospital you work for is actually going to match. They may only match you if you work full-time. If you work part-time, you may not get a match at all. And every hospital system and academic system is different. Some places will actually even help you get life insurance if you already don't have it and may get it somewhat of a discount. Disability insurance, the same way. I do recommend getting it as a resident, though, because that's going to save you a lot more money than if you try to get it when you're in attending. But some hospitals do provide that short-term disability that you may need, as well as long-term. But usually not as much bang for your buck as when you're in a resident. CME days, really important to know how many CME days you're going to get, because I get to come to CME conferences because I have CME days. And how much funding is actually allocated for your CME. So whether it's books, conferences, other sorts of things that you may need as part of, you know, renewing your licensure, some of those do fall under CME. Vacation days, important that we all get some rest and R&R, so how many vacation days are you getting? But kind of the more important part about vacation is who's actually covering you while you're away? Are you actually going to have to find your own coverage? Are you and your colleague going to need to balance not both being at a conference at the same time and that sort of thing? So there's three kind of primary tracks in academia, and every academic institution does vary on what type of tracks they may offer, but these are the three most common. So the clinical track typically just involves patient care, service line functions. You may teach maybe a lecture or two a year, but not a ton of teaching, but you may have some administrative work. So you may need to be on a couple committees and maybe be on the falls committee or, you know, patient safety, those type of things. The research track is someone who's probably wants to have a heavier career in research or maybe wants a good balance of both. So it's really important with the research track, you ask about how much protected time are you going to have to actually do your research, because you're likely not going to be able to have a full clinical schedule and do the research too. You're going to need some time to do your research. Again, it's important to ask how many publications maybe per year are they expecting out of you? Are there a certain amount of grant proposals they want you to achieve every year? And so that sometimes may actually be tied to your salary too, depending on the institution. Educational is probably the most popular one that a lot of us pursue. Again, important to ask protected time. If you are teaching a lot, you may actually need some time to make sure you're getting great PowerPoints or maybe even educating yourself on how to actually teach millennials better and that sort of thing. What are the teaching expectations? Are you expected to teach medical students, residents, and fellows, or are you just teaching medical students and residents? I personally do teach all three. I teach medical students, residents, and fellows. So I always have to adjust the level of education that I'm teaching to each group. How many lectures per year are you doing? Are you doing lectures for the residents, as well as the medical school, as well as maybe the fellowship program? So important to know how much work you're going to be putting in. And then some departments, including my own, we have educational RVUs, which means like you get RVUs for doing more educational things, whether it be interviewing residents or helping with mock orals, those sort of things. And that actually sometimes will go towards your salary, may not, but some places it may be part of what you're doing. Promotions, we all want to get promoted. So it's really important to know how do you actually move up the ranks? How do you go from assistant professor to associate to full professor? And what's the timeline for that? Does it take 10 years to go from assistant to associate or associate to full? And what are the qualifications? Every institution actually has a pretty in-depth list of what they want to see in order to promote you. But it's also important to ask your department, like, how does that process work? What's the typical timeline in the department? What do they expect of you? A lot of this does involve having a research component to your career and making sure you are getting publications. Maybe you're not connected directly to a medical school and you want to be adjunct faculty. So you can also do that and ask about it. If that's something you're interested in, a lot of times you just have to reach out to the school itself and see how that would work in the process of getting you to be adjunct. And then faculty development programs, how do you move up in the ranks? You have leadership skills. How do you get leadership skills? Well, they don't just come naturally to most of us. So these faculty development programs usually help you build leadership skills, kind of teach you how to become a better leader, and that subsequently helps you move up. Your CV, very important in academia, but really anywhere that you keep an up-to-date CV. Every like two months, I go through and update my CV because every time you give a lecture, whether it's nationally, regionally, locally, you want to add it to your CV. Anything you publish, you need to add. So if you're not doing it often enough, you're going to leave stuff off. And that's actually what helps you also get promoted, is making sure that CV has everything that you've done on that. Expectations. So what are your expectations from the chair that you're interviewing with? Dr. Gator will kind of speak more to this, so I'm not going to really touch on it, but it is important that you ask that when you're interviewing. What's really the purpose of bringing you on as a new hire? Are you building a new program? Are you expanding the consult service? Are you building or making the inpatient service larger by bringing in a new service? Are you making more outpatient continuity? It's important to really figure out like what is the framework for what are you going to be doing? Marketing is another important thing, depending on whether you're doing primarily inpatient or outpatient, like where are your patient referrals coming from? Are you going to need to go out and do lunch and learn sessions with many different departments? Or are these referrals just coming into you because there's so many and there's maybe a backlog of patients that need to be seen? Support. What type of support is the department going to help you with? Are you going to have internal mentorship, even within your department, so that you can move up the ranks? Skillsets. It's very important to know like what are your strengths, what are you bringing to the table, but also what are your limitations? You don't want to say yes to everything. It's important that you do say yes, but it's important to know when you need to say no too, so that you're not taking so much on your plate that you're drowning in your first career. COVID. Another big thing. How did COVID actually impact the department and how did that change their practices? I know myself, I never knew about telehealth before COVID, but now I use telehealth a bunch in my outpatient clinic and has really changed the way I do some of my outpatient practices. So important to ask maybe even how much telehealth are you going to be doing, which wasn't a question I would have asked when I was hired. And then quickly, just my job search journey. I personally limited myself to the Southeast region because I wanted to be closer to family and then I only wanted to be at academic centers. So to me, that basically limited the amount of places I was going to apply because of just the nature of wanting to be closer to my family. I also wanted a really established program. I knew I didn't want to build a program from the bottom up. And so I wanted to join a place that already had at least some of that in place. And the resources I used, I used a ton of resources. I used AAPM and our job fair, the AAP, I used to Google alerts, I networked with all my previous attendings, program directors, people from residency, alumni, and kind of what Dr. Chu said, really stay true to yourself. This is your first job. So it's important to be open to learning and growing and know that it's not the end of the world, that if it's your first job and you're not super happy with it, you can always learn from that opportunity and try something else. But if you can stay at your first job, it's great. If you have any questions, you can reach out to me and I'll pass this off to Dr. Samir Kapasi, who's going to talk to you guys about the opposite of what I do, which is private practice. I'm ready to share my screen here. There we go. I think I shared the correct screen. Wonderful. All right. So I am going to be talking about private practice considerations today. And here we go. That's me. I am in an orthopedics practice, and obviously I'm not an orthopedic surgeon. You might see a few of our people wander in and out behind me because we do shared offices. I'm also on faculty at Tufts Medical Center. Why did that happen? Let's go back here. Yeah, I'm also on faculty at Tufts Medical Center. And then I am also a private practitioner who recently came out of multiple practices to settle in on one. I started my time at Tufts in PM&R. And then I did a fellowship in spine over the Newham Baptist, which is our orthopedic hospital locally. I joined a spine super group after that that had been started at Newham Baptist. And then I moved on to a boutique practice. Then I decided that I wanted to be a part of a bunch of different practices and just see a boatload of patients. And so I did that. Oops, I'm advancing without me wanting to. During that time, I was seeing SNF patients as well through these guys. And I was seeing patients one day a week at Tufts. And now I resigned from my time over at Tufts and I exclusively see patients over at Edgewood Orthopedics, which is where I've kind of ended up. So who are you? You are a fresh or soon to be minted graduate who wants autonomy. You deserve it. You want longer term financial benefit. You may not have that in the short term, in the initial part of your career as you establish your practice, but you will have it later. So let's talk about hospital versus private practice. In a hospital, you have an established staff, EMR, established referrals, you use hospital equipment and computers, your hospital credentials you with different insurances. There's an ease of use for ordering tests and imaging, things like that. You're more or less paid regardless of volume. There will be some level of bonusing based on production. And there's a huge potential for mentorship and leadership. In private practice, theoretically, you build your staff, you buy your EMR, you build a referral base, you buy your own equipment and computers, you're responsible for credentialing, you integrate with your hospital to order different tests and imaging, and you are directly volume dependent. Is there a potential for mentorship and leadership? That's what I'm doing right now. I am working with Tufts and we are sorry, I'm working with Tufts and I'm seeing residents three times a week every other month. Leadership wise, you can have leadership in your local community, ACOs and hospitals while maintaining your faculty levels. So moving on, group versus private practices. Oftentimes in groups, there are buy-ins for partnership, there's an already established referral base that's been set up by your predecessors, there's an established EMR and staff that you don't have to worry about, you have the ability to function in multiple hospital systems and your group credentials you. You hit the ground running, and maybe you're salaried initially, and as time progresses, that changes to where you have a lot more sway in terms of production. And depending on the size of your practice, you can sway reimbursement. In a solo practice, there's certainly a high initial cost. You build your own referral base, you kiss babies, you shake hands, you bring donuts to different staff members, you buy your own EMR, you hire your own staff, and you also have the ability to function in multiple hospital systems. Ultimately, you credential you, you can facilitate this through credentialing services, and you have a lot of free time initially. You can use that free time for a number of different things, like marketing yourself on whatever social media. Ultimately, if you do not work, you're not going to get paid. So is there an ability to sway reimbursement? Not unless you're the only show in town, or you're doing things like PRP, or stem cells, or prolotherapy, things that aren't typically covered. So where should you end up? My feeling is absolutely private practice. Throughout my career, over the last 10 years, I've been in private practice, and for me, it's a no-brainer. You've been thought to think independently, you've been thought to maintain an independent frame of mind. Everything that you're going to do is computer-based. Accessibility is super high value, and you will have that accessibility as a private practitioner initially, and that's going to be seen by the primary care physicians. Right now, real estate is pretty cheap and healthcare has gone through this huge evolution with telehealth. So you can see patients from your house rather than from anywhere else. So where do you begin? You can establish your business plan. You can decide what you want to do, where you're gonna find start your startup funds, family savings, small business loans. You can decide whether you want to be part of an academic center or rent space or find your own spot to own. And ultimately at the beginning of all of this, you wanna stay conservative. You want to, I think Tim said something earlier, for as long as you can, you want to maintain that savings. You want to rock the resident or fellow salary as long as you feel like you can. And stay lean, you wanna outsource as much as you can for as long as you need to. And this is done even in larger practices. Right now I'm part of a growing orthopedics practice where we just reached over a hundred employees and there's still things that we outsource. Well, because other people can do it better. Why focus on things that your practice can't do as well? Initially you're going to end up wasting money in doing that. So initially when you set up a practice, you are going to most likely set up an S-core. This allows for pass through income. You work with the, you go to the IRS website. I have the website listed up here. And you can go through their section on forming a corporation. You will get, if I think that the way they were doing it was that if it's during office hours, which is the typical nine to five, you get your EIN initially and instantly. And then you have to go to establish your corporate identity in your state. And some states like Massachusetts, where I am, have special rules and require authorization for setting up medical clinics or delivering medical care. You open up your bank account after that with all of this information. You find your startup capital. You find your business loan, your small business loan. You beg, borrow, steal from family or friends because you'll be able to quickly return the capital. You'll get up on your feet relatively quickly. I think a little faster than you think you will. As time progresses, before you hang your shingle, you want to apply to your local ACOs, your local hospital systems and be admitted. You want to find a credentialing service. There are multiple that are available online that will do the legwork for you. So you don't have to do it. You're going to have to have an EMR. And there are a bunch that are really wonderful. There's Athena, which has got a lower startup cost and can do your billing for you. There's Epic, which is a high startup and maintenance cost, but it's really well integrated into hospital systems. My current practice, we use Centricity, also super expensive, but we're moving to Epic, also super expensive, but the hospital is going to be giving us some ability to pay for it as well. So we don't have to pay for all of it. There's OpenEMR, which is a little clunky, but it's free. So you don't have to pay for anything. Then you find your location to lease or buy. There are a bunch of different websites to do that and just drive around the location where you want to end up because you'll inevitably see places that are up for sale or up for lease that you wouldn't see otherwise. The other thing that I have looked at before is talking to physical therapists and seeing whether I can rent space in their spots. Talk to other physicians to see whether you can rent space in their spots sometime during the week. You can hire staff or you don't have to hire staff. You can use services that can give you virtual staff, like virtual phone trees. So you get all your messaging information. You have people that are elsewhere who can man your phone tree. I know of systems that work with groups in the Philippines, groups in India, groups in Ireland that will create a phone tree for them. You can supply them with information to be able to triage your patients. You can figure out your telehealth platform. The one that I use currently is DoxyME. I have a love-hate relationship with it. I also use Doximity if DoxyME fails. I sometimes will use Zoom as well. That's given to me through Tufts. Don't tell anybody that I'm still using it because I don't want them to take it away from me because it's still pretty wonderful. And I think there was a question on marketing earlier, advocacy. Yeah, market the heck out of your practice. You have, at the beginning of your time, you're gonna have the ability to say hi to a bunch of people, unless you're a part of a big practice that's gonna make you hit the ground running. You're going to be able to see primary care physicians. But do simple things like give them a call afterwards or stop in their office and say, I saw this patient and this is how I felt about it. A couple of weeks ago, I had a patient that I kind of wanted to talk to the primary care about and the primary care happened to be upstairs from me in the same building. So I said, you know what? Let me take a trip upstairs to talk to that primary care. I haven't missed a single patient from that primary care since. I've been his lead referral since then. You can do simple things like Facebook sites, Instagram. A lot of folks are doing TikTok now. I have a lot of plastic surgery friends who are doing TikTok things. A lot of ER friends who are on TikTok. I think PM&R is the next field that can move into stuff like this. There's a lot of explanation for what we do and how you can help people that you can put up there and people can seek you out through these different platforms. It's certainly a brave new world in terms of the digital side of things and where we can move forward for marketing our practice. And ultimately when you're done with all of this or when you've been moving through all of this, you can hang your shingle. You're ready to go. You know, pat on your back. You will do awesome. I'm sure of that. And next on our docket, we have Jason Edwards who will be giving us information on contract basics and negotiations. And let me see if I can stop my video. Thanks, Dr. Capasi. All right, so I am Jason Edwards. I'm the Medical Director of the Brain Injury Rehabilitation Program at New York Presbyterian and Brooklyn Methodist Hospital with appointments at Cornell and Columbia. Today, we're gonna cover some of the basics of contract review and negotiation. So at this point, you've received a phone call, you've been offered the position and you're waiting for the written offer. If you haven't done already, this is a good time to go back to some of what Dr. Tu talked about earlier and really sitting down and determining what is important to you. Is it work-life balance? Is it compensation? Is it the best of the best in terms of support services to make sure that you're offering world-class care to your patients? This is really gonna vary for every person. So it's important to take some time and really dig through that. And I should have said before I started that I have nothing to disclose. So when we talk about, once the contract arrives, sorry guys, I'm having a little trouble with my PowerPoint. Let me try to stop share. Okay, sorry about that. So before we begin, let's talk a little bit about what a contract is. So many people associate a lot of negative connotations with the idea of a contract. I want to assure you that it's not all bad. A contract defines the relationship between the employer and the employee. It helps to avoid misunderstandings and help to delineate the employee's position, including compensation, your work hours, your work duties, what locations you're responsible for covering, what support services are in place and what benefits you may get among other things. So some of the important things to consider, compensation and benefits, duties and responsibilities, restrictive covenants, termination provisions, professional liability insurance and then the negotiation itself. So we're going to start with compensation and benefits. So the contract should clearly delineate the compensation structure, the amount of compensation. This should include any incentive pay or income guarantees. It should also include a complete list of all benefits that you'll receive unless this is provided in a supplemental document, which is commonly the case. Benefits can include health, dental, vision insurance, life insurance, disability insurance, malpractice, your amount of vacation days, sick and personal leave, CME funds, relocation expenses and potential options for student loan repayment among other things. Sorry, everybody, I'm having a little trouble with my PowerPoint. Next, we're talking about duties and responsibilities. The contract should clearly detail your specific duties and responsibilities. This generally will include details of your work hours, workload, what days you're working, call responsibilities, locations covered as well as the workspace. Restrictive covenants. These include non-compete clauses, which are a way for an employer to protect their interest if and when the employee terminates the contract. A non-compete typically limit the geographic region in which a physician can practice for a set period of time. In cases where the physician works at several sites, this clause may limit practicing within a certain radius of any practice location. So you have to be careful, particularly in the more dense regions in the countries as this could be quite restrictive and actually lock you out of a significant area. A non-solicitation clause may also be included. This may prohibit offering to hire employees from the system upon leaving to solicit prior patients or to contact referring physicians within the system. Termination provisions. Usually, I mean, obviously this is not the focus of negotiations, right? You just got the job. Termination provisions are still an important point to consider. In general, contracts address termination for cause and termination without cause. For cause permits the practice to terminate the physician with little or no notice for things like restrictions on the physician's license, failure to maintain clinical privileges or misconduct among other things. Termination without cause requires no specific reason. And this may or may not come with a notice of requirements such as like a 30 or 60 day notice. The notice of course is helpful as that gives you some lead time to find a new position. Professional liability insurance. This is an important point. The contract should indicate whether the practice will maintain professional liability insurance on the physician's behalf. Policies often fall under two categories, either claims made or occurrence policies. Your claims made protect the physician from claims while the policy is in effect. But without extended reporting, which is referred to as tail insurance, a claims made policy doesn't cover any claim made after the policy ends. So if the event occurred while you had the policy, policy ends, you've left, moved on to a new job and then a person files a lawsuit, you are not covered at that point. Unless the institution has some sort of other agreement where they continue to cover you, but you need to be very clear on that if that's the case. With occurrence coverage, the policy covers claims made for events that occurred during the policy period, regardless of when they're reported. Obviously this is gonna be the more expensive option. So a lot of times you will see claims made, but it's an important distinction because it determines whether you need tail coverage if you leave the practice. In claims made, there's something else called nose coverage where you can actually transfer the start date of an existing policy to a new insurance carrier so that the new policy period extends back, eliminating the need for tail insurance. In general, this is the more cost-effective option, but it gets tricky when you're crossing state lines. You definitely need to look into that with an attorney. So let's talk about negotiation. The prospect of this is for many people very stressful. It's not something we're trained to do, but some of the most commonly negotiated items include your salary, relocation expenses, bonuses, and paid time off. But before you negotiate, again, make sure that you determine what is important to you. Is it the quality of support services, the salary, work-life balance, potential for career advancement, potential for research and what sorts of research support is in place? What you negotiate is going to depend on your individual priorities. If you only plan to stay in a reason a few years, a non-compete may not be a big issue. But if you're determined that that's where you're going to settle down for the rest of your life, it could be a deal breaker. Realize that not everything can be negotiated. It can be helpful to make a list of your needs and what your deal breakers are. Define the minimum you are willing to accept and also determining your best alternative to a negotiated agreement, often called the BATNA. So basically, what is your next best option? And this is helpful in negotiation as it not only lays out alternatives if the negotiations fall through, but it also provides some negotiating power. With any verbal agreements, make sure to get them in writing. Depending on your level of comfort, it may be useful to have an outside consultant or attorney review the contract. Ask your former graduates from your programs who they've used. Often, a couple people that the program use consistently. And many of these firms will have that comparative compensation data to help determine if the offer is competitive. And some of these, we'll actually break it down by early career physiatrists. It'll give you a better idea. And then I think I mentioned in the chat earlier, the AAPMNR Physician Compensation Survey Report is also a helpful resource. Lastly, when asking for more, always have a justification. Be able to say why, whether it's asking, whether it's based off of comparative compensation data or whether it's needs to fulfill the role. Get a good idea of what they expect out of you. And if you need something to make that happen, then you have an argument when you go back and say, no, I actually, I need this. And with that, I'm gonna turn it over to Dr. Gater, who's the professor and chair of PMNR at the University of Miami Miller School of Medicine. And I need you to stop sharing your screen, Dr. Edwards. Yes. Okay, we'll try this again. No pressure batting clean up after such great presentations. I want to just talk through briefly some of the reimbursement models, I have no financial disclosures moving forward. So I'll talk through those payment models, talk about a little bit of the barriers and challenges that you may encounter and then you've already had a discussion on negotiation so I'll keep that brief. There are materials available to you, Merritt Hawkins you can access this for free and they talk you through different recruiting incentives, this is something you should know about as you're starting forward. You could also get a similar type of compensation productivity survey report from Sullivan Cotter but that's going to cost you a little bit. The bottom line is most of you are going to start off with the base pay and then some idea of incentives and that varies somewhat. The Merritt Hawkins 2021 review showed that just over 60% of individuals who are starting out will have a salary and a bonus that they're looking at. About 35% will only have a salary without incentives and fewer and fewer folks over the years are provided an income guarantee. Interest of time, I'm going to slip forward. So we've mentioned MGMA, that's the Medical Group Management Association, Sullivan Cotter is more of a private practice type of group so both of these have more to do with private practice. AAMC is used a lot for the academic institutions. The bottom line is this is the type of information you can get from each of these. The provider compensation based on number of years in practice and or what rank are you in an academic institution. What is the additional academic compensation, in other words, will we provide you some degree of compensation to cover your expenses for CME, to cover other types of medical license, etc. If you are taking a position that includes a medical directorship, there is a portion of that that will contribute to your compensation and then typically they will provide ranges of sign-on bonuses and moving allowances and then again you've had a pretty good discussion about benefits from Dr. Desai so I'm going to jump forward. When I look at incentives, now there are some particularly private practice and hospital models where it's solely based on RVUs and that type of thing. In academic situations, there are a number of other things that may be considered and so certainly your clinical productivity, that's going to be benchmarked according to your type of practice and your allocated efforts. So if 90% of your effort is clinical, then your RVU target is going to be higher but if you have a medical directorship, for example, or you're a program director, for example, that would cut off 10% or maybe another 10% so now that you're down to maybe 70% and that's what we would use to determine your target. I take into account these other things and depending upon how this is put together in your particular contract, you need to have some idea of, you know, what are the expectations with regard to on-call coverage, are there penalties for not getting my notes done in a timely way. In academic situations, we look for local, regional, national, and international recognition and that's going to contribute some points to essentially the educational RVUs that Dr. Desai talked about. Scholarship, those of you who are doing research, you're going to have to meet a portion of your salary with grants and there's a higher expectation for manuscripts. So most assistant professors, and I'll talk briefly through the kind of trajectory, although again this was already discussed, you need to know if you're going to be on a clinical educator tract, you're going to require somewhere between 6 and 10 manuscripts. Those don't have to be research papers. A lot of times those can be case reports, etc., but your chair and mentor should be meeting with you periodically. So with my new faculty, I meet with them once or twice a month depending upon what their needs are and we'll talk through that a little bit more. These other things are part of the package, basically, that I'm looking at. And so, again, this has been described, but you typically in an academic setting are going to be scored on your clinical productivity, your educational productivity, the clinical research and scholarly work that you put forward, and then your community outreach. And that allocated effort is going to be important as you put things together. So I ask our faculty to put together SMART goals in each of those areas. SMART goals are specific, measurable, attainable, relevant, and time-limited as we go forward. And so just to kind of finish out some things that have already been shared, as you're looking for your first job, know yourself and your priorities, know the market, know your worth, understand the cost of living considerations in a particular community is going to be much different in the coasts than it is in the Midwest, for example. Certainly ask for advice from your colleagues and mentors and be willing to look beyond the money. There's much more to life than that and often tell my mentees, I mean, you got four aspects of life that you need to consider, intellectual, emotional, physical, and spiritual, and all of those need to be taken into account as you make these decisions. So I was trying to get through this relatively quickly so we might have a few minutes left for additional questions. There's my contact information if you'd like to reach out to me with additional questions and I'll take a look at the chat and stop sharing, or at least try to stop sharing. I'm not hearing anything, so if there are questions out there, they must be just in the chat. So I think one of the big questions there was, and we're trying our best to go through and answer them, but I think the main concern about new grads with contract negotiation is that they just feel they have minimal leverage, and so they'd be interested to know if any of the panel just have tips on how they were either able to acquire more benefits or salary with their first job and what to really use as leverage. Some of the answers already in the chat were just using facts, comparing what the actual national average is to what you're being offered, supply and demand, and then having just a justifiable way or reason that you're asking, and asking, obviously, in a very respectful manner and not necessarily demanding it. I just want to address what Anthony Tran just said, that he'd be happy just to have a job. I think that that's part of the problem. Some of us just want a job, but if you do that, if you're not looking at the finer details, you may be worse off because you're going to encounter situations that you won't be happy with, and you're just going to continue to search and actually delay your success. I'm going to echo what Tim says there. You know your worth, ultimately. You finished a residency and or a fellowship. You are a commodity, and you are something that will produce. It's your job to be able to argue for your benefits and how much you make. It's the workplace's job to certainly reimburse you an adequate amount, but they're happier reimbursing you an adequate amount rather than what you're looking for. I've looked at academic jobs before, and I've gone back and forth in contract negotiations with them, so it's possible. It's doable. Don't feel like just because it's a big institution, they're going to say, no, this is as it is. You can have some room for movement. All right, well, I think that wraps up the session. If people have questions, they can always reach out to us on Twitter or email or LinkedIn, all the social media outlets there. Thank you, everyone.

job contract

negotiating

priorities

compensation

support services

research

market standards

base salary

termination provisions

job offer