I get it
I understand the potential pitfalls physicians and groups face. Many (if not most) of the issues aren't strictly legal in nature: They arise from the day-to-day realities of practice. You need an attorney who understands more than just the contract. You need an attorney who understands your practice and what it’s like to be a physician today. I’m not here to fix grammar and other inconsequential errors in the deal documents with no real insight into what the terms mean for your practice; I’m here to make sure you don’t get stuck reading films off-hours as a radiologist or doing q2 call as an OB without your consent and extra pay. I’m focused on the things that matter to you.
phYSICIAN EMployment agreements
Healthcare in the United States is in a state of flux. More doctors than ever before find themselves employed by hospitals and groups rather than as owners or equity partners in a practice. With this shift, compensation models and expectations have changed; so, too, have most doctors' relationships with their practices. The physician employment agreement defines that relationship, determining whether you work for the practice or the practice works for you. I take pride in clearly explaining your employment agreement and negotiating it so that it works for you.
Physician COMPENSATION Structures
Modern physician compensation structures can be confusing, sometimes intentionally so. Between salary, guarantee, RVU and other incentive-based pay structures, as well as hybrid models, the way your total compensation is determined can be complicated. I understand the systems and will let you know if yours is fair. After all, you've earned it.
Practice BUY-Ins and m&A
Becoming an equity owner in a practice is an accomplishment that you should be proud of; it bring both rewards (financial and otherwise) and potential risks. Whether you’re going to be the group’s 30th “partner,” signing the same purchase and stockholders agreements as the other partners, or you’re in the process of negotiating a tailored transaction where you become the only other equity holder with a view to purchasing the practice upon the founding partner’s retirement, I’m here to help with services geared towards your unique situation. Similarly, if you’re purchasing a practice outright or selling your practice, I’m here to move the transaction forward and protect your interests.
Group Service Agreements
Renegotiating an existing service agreement with a healthcare facility can be tricky. Physicians and the hospital have invested enormous time, money, and energy in the relationship. Still, certain points often need to be reassessed and tweaked to make the relationship work better going forward. Negotiating a contract with a new facility often raises similar issues, but in a different context: Expansion offers opportunity for increased profits and visibility for the group, but also raises concerns about over-extension and administrative headaches. In either situation, I’m focused on finding common ground and getting an agreement in place that fits your strategic plan.
CLEAR FEES & EASY BILLING
With a straightforward, flat-fee structure, you’ll know exactly what I charge for the help you want, whether it's full-service or more limited assistance. I invoice electronically and accept checks, debit and credit cards - whatever method works best for you.
The following clients are illustrative of those represented:
Acupuncture and Wellness Practice in California (service agreement negotiations with health system)
Anesthesiologist in California (independent contractor agreement negotiations with private practice)
Anesthesiologist in Michigan (employment contract negotiations with private practice)
Anesthesiologist in Washington (employment contract negotiations with private practice; privileges resignation negotiations)
Cardiothoracic Surgery Group in Florida (employment agreement drafting for hire of first non-partner physician)
Colorectal Surgeon in Kentucky (employment contract negotiations with private practice)
Colorectal Surgeon in Nevada (employment contract negotiations with private practice)
Emergency Medicine Physician in California (employment contract negotiations with private practice)
Family Practice Physician in California (employment agreement negotiations with combined academic and private practice)
Family Practice Physician in Florida (employment agreement drafting in anticipation of purchasing practice)
Urgent Care Physician in Florida (employment contract negotiations with private practice)
Family Practice Physician in Tennessee (employment contract negotiations with private practice where physician responsible for practice overhead and losses)
Family Practice Physician in New York (employment termination counselling)
Family Practice Physician in Indiana (employment termination counselling)
Gastroenterologist in California (hospital support agreement negotiations for establishment of private practice)
General Surgeon in New Mexico (employment contract negotiations with private practice)
General Surgeon in Tennessee (hospital recruitment agreement and employment termination counselling)
Hematology-Oncology Physician in California (employment contract negotiations with private practice)
Infectious Disease Physician in Pennsylvania (employment contract negotiations with private practice)
Interventional Cardiologist in Arizona and California (counsel and entity formation for transitioning to a multi-state practice)
Interventional Radiologist in New Jersey (employment and partnership contract negotiations with private practice)
Interventional Radiologist in Pennsylvania (employment contract negotiations with health system)
Management Services Organization (MSO) and Practice Consultancy in Nevada (general counsel)
Musculoskeletal Radiologist in New York (employment and partnership contract negotiations with private practice)
Neuroradiologist in Pennsylvania (employment contract negotiations with health system)
Obstetrician/Gynecologist in California (employment contract renegotiations subsequent to client inadvertently renewing contract on prior terms)
Obstetrician/Gynecologist in California (employment contract negotiations with combined academic and private practice)
Obstetrician/Gynecologist in California (employment contract renegotiations with private practice)
Obstetrician/Gynecologist in Florida (employment contract renegotiations with private practice; physician recruitment agreement negotiations with hospital system)
Obstetrician/Gynecologist in Utah (employment agreement negotiations with health system)
Obstetrician/Gynecologist in Washington (employment contract negotiations with private practice)
Oral Surgeon in California (practice acquisition via asset and partnership interest purchase)
Orthopedic Surgeon in California (employment contract renegotiations with private practice)
Orthopedic Surgeon in New York and New Jersey (employment contract negotiations with private practice)
Pediatric Cardiologist in California (employment contract negotiations with private practice)
Pediatrician in Virginia (employment contract renegotiations with hospital-owned group)
Podiatrist in California (practice entity formation and purchase acquisition via asset purchase)
Psychiatrist in Alaska (employment contract negotiations with private practice)
Psychiatrist in California (employment contract negotiations for telepsychiatry practice with private practice)
Psychiatrist in California (partnership dissociation negotiations and establishment of new practice)
Psychiatrist in Massachusetts (counsel in connection with administrative role change)
Psychiatrist in Utah (employment contract negotiations with health system)
Pulmonology and Intensive Care Group in California (group negotiations with umbrella private practice)
Radiologist in New York (employment contract renegotiations with private practice)
Radiologist in Pennsylvania (employment agreement negotiations with health system)
Urologist in New York (employment contract negotiations with private practice)
Urologist in Virginia (employment contract negotiations with private practice)
Urologist in South Dakota (employment agreement negotiations with health system)
DOES YOUR PRACTICE WORK FOR YOU?
Ask yourself, would you be protected in the following situation? My friend Emily* wasn't.
Emily knew she didn’t want to go to work anymore. It wasn't the patients; she'd do anything for them. But the partners who hired her were another story. As the alarm blares after another busy call night, just thinking about the partners lecturing her again about her low productivity when they force her to take all the bad cases makes Emily sick to her stomach. Literally nauseated.
Two and half years ago, things were looking bright. Emily had recently married, and she and her husband, John, were in a U-Haul, heading from Manhattan to her first "real job" back home in Indiana. Residency was finally in the rearview, and she was beyond excited to be on the way to the respect (and paycheck!) of being an attending. Everything was falling into place.
It was great being back home outside of Indianapolis. The new house she and John bought was great. It actually had a back yard! Emily was excited and relieved that all the time she spent getting to this point was paying off. John was ecstatic. He loved his new engineering job in Indy, and their lifestyle reminded him of his suburban Long Island childhood. A year later, Emily knew she had made the right decision: A baby was on the way and being close to her mom and sister would be a godsend. Things were perfect.
Sure, there was the commute into Indy, but it was short and the traffic usually wasn’t too bad. Plus, since John worked close to the hospital, they were usually able to ride in together. Emily didn’t get the best cases, but she was the new doctor, fresh out of training. Residency had toughened her, so she wasn't particularly concerned when the partners weren’t always friendly. She knew she'd have to pay her dues and prove herself. Things were good and were only going to get better.
That was a year ago. Now, as Emily cinches her scrub bottoms tight and gets ready to rush back to the hospital, she realizes that the little things that bothered her weren't trivial: They were warning signs. She's exhausted, mentally and physically. She came off her guarantee, and now the partners have her out of the OR and in the office assigned to cases that don't count much towards production. GYN surgery is what she loves about being a doctor. Being out of the OR is making her feel stale and underutilized. She's gone above and beyond to be a team player, working harder than ever and proving herself as a strong new physician. The current situation is unfulfilling and unsatisfying. It's frustrating.
Then there are the financial ramifications: Emily is on track to make 24% of what she did last year. Thankfully, John's been promoted, and his increased pay helps fill the gap. Otherwise, how would they make the mortgage and student loan payments, not to mention pay for daycare? Emily left residency envisioning a clear path for herself, and now she feels lost.
The worst part is that even though she's working like crazy making nothing, the partners are getting more abusive and trying to milk her for more and more. Too late to do any good, Emily discovers the group burned through 4 new doctors in the 6 years before she joined the practice. No junior physician has been asked to join as a partner since the group was formed by the current partners, who all became friends during residency. She's definitely the outsider. And now when she applies to other jobs around Indy, Emily gets the feeling her current practice is blackballing her. It’s great being back home, but she's going to have to move to find another job …
This is her life: her profession, her family, her future. Is this what she's worked so hard for? Frustration and dissatisfaction? She feels used, hurt. It's not fair.
How does she keep this from happening at her next job? She feels powerless. She's done all the right things, everything she's supposed to do to be successful. How could this happen? How does she move forward? How does she protect herself and her family?
*This situation is based on the experience of a friend, an OB/GYN. Names and other identifying details have been changed to protect her privacy, but the events happened as described. To get another job, the physician had to sell her home, her husband had to change jobs, and they had to relocate two hours away from friends and family. Her story is one of the reasons I started helping physicians. Read more about the events leading up Emily accepting the group's offer (under My Story).
The deal terms matter. I'm here to help.