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There is no contract that will accomplish indeterminate goals. Successful contracts require that both sides define optimum realistic goals, seek an opportunity that will meet those goals, and then negotiate a contract that accomplishes those goals.*

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Individual practitioners generally enter into contractual relationships with hospitals and emergency physician groups.1 There are many components to negotiating a successful contract. This chapter addresses the pertinent contractual issues between physician and hospital or groups. These include

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  • Evaluation of the position
  • Contract necessity
  • The negotiation process
  • Role of legal counsel
  • Letter of intent
  • Key contract clauses
  • Pearls and pitfalls

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*Editor's note: Sample language is used several times in this chapter. Its only intent is to familiarize the reader with the types of language that may be used to convey contractual intent. The sample language is not meant to be definitive, complete, or used in a contract by the reader. Before accepting any contract language, the reader should consult advisers with expertise in contract law in the state in which the contract is to be executed.

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Prior to entering a negotiation, practitioners should gain a thorough and realistic understanding of the position that they are considering and compare the information gleaned to their predetermined goals. (Appendix 85-1 at the end of this chapter contains 21 questions that may be utilized by the job seeker to consider a position being contemplated.) There are many opportunities to gain information well in advance of the contractual discussion. Methods of gaining information are discussed next.

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ED Observation

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The considering practitioner can spend time in the ED reviewing the operations during different shifts to observe processes such as

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  • Organization of care
  • Interaction of staff
  • Process of admission and discharge
  • Relations with non-ED medical staff

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Communication with Key Stakeholders

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Invaluable information can be discerned by speaking with staff members, group members, and administrators who currently interact with the ED. Asking key questions will help to ascertain the level of respect for the ED and the plans for future growth and resources. See Appendix 85-1 for “key questions” 8 (relationship with administration), 12 (relationship with nursing), 14 (relationship with medical staff), and 16 (relationship among group members). It may be quite valuable to speak with a practitioner who has left the group to determine the reason for departure.

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Responsibilities of Individual Practitioners

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“Key questions” 18 to 21 review specific responsibilities of the practitioners. It is important to clearly understand the scheduling process and its fairness, the expectations for administrative, committee, and outreach responsibilities, and productivity (RVU and patient per hour) expectations, and so on.

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Professional Growth Opportunities

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While many graduating residents approach a new job with an attitude of “I just want to settle in, hone my skills, make a decent salary ...

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