#Team YOLO or #TeamInvest? Which side are you on when it comes to money?

Each year I try to read several books that will not only teach me something I didn’t know but will also challenge my views on a variety of topics, especially money. One of the books I just finished reading is “Die with Zero” by Bill Perkins. I have to say, this book has made me reevaluate my entire life.

As many of you know, I’m a planner. I’m also a frugal person who tries not to spend too much money, especially on material things. One of my life goals is to amass a great deal of wealth that I can use to retire early, give to my friends and family, travel the world, and donate to companies and organizations that make the world a better place. In order to do that, my initial plan was to work a lot over the next 10 years, get paid a high salary, and invest a large percentage of that money to increase my net worth. To put it simply, I was going to work a lot, make a lot, and invest a lot so that I could build wealth as soon as possible.

Bill Perkins in his book “Die with Zero” made me rethink that entire plan.

I still plan to amass wealth but the way I do that has definitely changed.

One of my biggest takeaways from the book was that instead of structuring my life to maximize my wealth, I should instead structure my life to maximize fulfillment. That means discovering what makes me happy and creating a life that allows me to have more of the experiences I enjoy. It means realizing that some experiences like international travel, late-night outings, or active outdoor activities are better had at certain points in my life (ie. When I am young and healthy). While this may sound basic, it caused me to rethink my life plan. Through this book I learned that I shouldn’t use my youth delaying gratification and sacrificing for my older self (at last not as much as I had planned). Instead, I can be fiscally responsible, but I should also try to enjoy life more along the way. In other words, I need to make sure I’m not delaying gratification too much.  Some experiences are best had when I am young and healthy so if I keep delaying, I may never get to have them (at least not in the way I desire).

Let me give you an example. One of the things I’ve wanted to do is go to China to climb the Great Wall. I keep telling myself I’ll go eventually, but I’m about to turn 32 and I still haven’t done it. This book has helped me see that if I keep delaying going to China, I may eventually be too busy to go (once I have kids) or too to enjoy the experience the way I imagined (if I delay the trip until late middle age or retirement). A trip to China wasn’t the only thing I was delaying. There were also experiences I kept putting off. One of them is going to Coachella with my friends. This book made me realize that If I keep delaying it then I may soon miss out on the ability to do this. Why? Because at some point I will get married and have children so leaving my newborn at home to spend all day at a festival in the desert won’t be as appealing. My point? Some experiences are better had when I’m young so delaying them may cause me to miss out on the experience entirely. 

And this brings me to the balance question.

What is the right amount to work vs play? What is the right amount to spend vs save? Yes, we should all try to live in the moment and maximize happiness with incredible experiences but shouldn’t we also save for the future and for a rainy day and invest for retirement? What is the right amount to allocate to each side and how do you know when you’ve gone too far in one direction vs another?

I have friends who spend almost everything they get, fail to save anything, and rack up tons of debt that they may never be able to repay. I have other friends who save so much of what they earn that they deprive themselves of incredibly meaningful experiences they may never be able to have again.

One friend accrued over $10,000 in credit card by buying designer bags and living in fancy apartments she couldn’t afford. Another friend missed out on his best friend’s wedding because he was too busy at his job to take the time off work.

Neither is ideal.

So when I think about this phase of my life (and you think about this phase of your life), we are all left wondering about the right balance. We don’t want to squander our youth and good health working way too much to amass more money than we truly need. But we also don’t want to spend too much too soon and fail to have the money we need to take care of our families, pay our bills, and invest for the future. What should we do?

The optimal balance may vary from person to person. It may also differ for each of us during certain phases of our lives. Perhaps when I’m younger I can invest a little less to have more money to travel and enjoy life before kids. Maybe when I start having kids, I travel a little less and spend more time/money investing for their future and spend more quality time at home. Then when my kids get older, I cut back on investing once more to have more memorable family vacations and gatherings with friends.

My point? It’s quite possible that our savings/investing rate may fluctuate throughout our lives. It’s also likely that the balance of work life and personal life may change as well. Our job right now is to start thinking about what that optimal balance looks like during the next year or two. For me, this will probably mean working part-time and making a little less money than I could in order to travel more, spend quality time with my aging parents, and cross some things off my bucket list. It may also mean that instead of investing a large portion of my income, I instead invest a reasonable amount (15% to 20%) and give myself the freedom and flexibility to enjoy the rest of the money in ways that maximize my overall life fulfillment.

Tell me, what is your optimal balance of work and play? How do you determine what amount to spend vs save? Is there anything you’d like to change over the next year?

6 Large Expenses to Plan for as a Young Doctor:

If you’re heading into your last year of residency as a young doctor, congrats! Medical training is tough and you’re almost done. As you celebrate and start reserving your vacation weeks, don’t forget about some large expenses that may be coming your way. As a former senior resident who just started fellowship, there were quite a few large expenses I had that I wasn’t fully prepared for. I ended up having to make some extra money on the side in order to cover all the costs. Learn from my mistakes and plan ahead for these large expenses that may be coming your way:

1. Board Certification Exam

As you finish your residency, you will become eligible to take the board certification exam for your specialty. While some specialties like Ob/Gyn and Surgery have oral components that may take a lot longer to study or qualify for, almost all specialties require you to pass a written exam. In case you weren’t aware, that written exam isn’t cheap. I’m in family medicine and I paid around $1300. Yep, you read that right $1300. And yes, I had to pay the full cost before I was able to schedule the exam. Be sure to look up how much the board exam costs for your field. For some specialties and subspecialties it may cost over $2,000.

2. Full Physician Medical License

Residents in training usually practice medicine and see patients with a post-graduate training license. Once you finish residency, (whether you decide to do a fellowship or not) you are usually required to get a full physician license. This is not a national license. It is a state license which means you must have a full medical license in each state you practice medicine. Unfortunately, the cost of a full medical license isn’t cheap. I paid at least $500 in application fees for my initial Georgia license. Then I paid $230 a couple years later to renew it. Because I am doing a fellowship in California, I needed to pay for an initial California medical license along with the application fee which was around $1200. I also had to pay to get official fingerprints, medical transcripts, and USMLE scores sent to the state medical board. These costs were not cheap either. If you have already signed an attending contract, you may be able to get some of these expenses paid for by your new employer. Try to negotiate that into the contract or plan ahead so you have the money available for it.

3. DEA License

If you’re like me, you may be surprised to learn that getting a full physician license in each state you practice in, isn’t sufficient. You also need a license to prescribe medication, otherwise known as a Drug Enforcement Administration (DEA) license. The cost of this license isn’t cheap. I paid $888 for mine. If you’re a physician in training at a state institution or residency you may be able to get this fee waived, but there’s a caveat. Technically speaking, you need a DEA license for each state in which you practice medicine and you may have to pay for it yourself if your employer does not provide funds for this cost. I have a DEA license associated with my Georgia medical license and another DEA license associated with my California medical license. These costs can add up quickly.

4. Moving Expenses

Whether you are moving to a different state for fellowship or starting your attending job in a new area, most doctors-in-training move after they finish residency. In case it’s been a while since you moved, let me catch you up to speed: it’s expensive. I moved to California from Georgia and this cross-country move was not cheap. Simply traveling to California to look at apartments was costly. The cost of moving my clothes, transporting household goods, and shipping my car was expensive as well. Plus, there are other moving costs to consider too. You may need a new driver’s license and car registration which can lead to additional expenses and insurance fees. You may also need furniture or kitchen appliances. Once you account for these costs, you can easily spend $2,000 to $4,000 if not more.

5. Housing Costs 

Many people finish residency and want to buy a home. We have so much delayed gratification in training that we finally want to accomplish the ultimate sign of adulting: homeownership. Unless you’ve been living under a rock, you know that inflation is through the roof and housing prices have increased over the last couple years. Many people are offering over the asking price and paying with cash which has made it more difficult and costly to find the home you desire. Be prepared. For those of us who plan to rent for another year, things may not be as good on our end either. Rent prices have gone up tremendously and many places still require a rather large security deposit. Whether you decide to rent or buy, beware that your housing costs may be higher than you anticipated.

6.Celebratory Vacation

Residency is hard. We were on call for over 24 hours at a time, worked nights and weekends while missing out on time with our families, and were drastically underpaid for the work we did. Finishing this training is quite an accomplishment and you deserve to celebrate. If you’re like most people, you will want to take a break before you start working as an attending. Most people take at least 6 weeks off to refresh and recharge and one of the most popular things to do during that time is travel. Go to Greece, Belize, Europe, Hawaii, or whatever bucket list location tickles your fancy. This may be one of the only times in your life where you have an extended time off without work obligations so take advantage of it. Just be aware that these vacations aren’t cheap. They can cost thousands of dollars and usually require you to save for them ahead of time.

My point? The end of residency or fellowship can be exciting, but it can also be quite costly. Expenses tend to add up quick. If you’re not careful, you can find yourself charging way more things on your credit card than you ever imagined. Be sure to plan ahead.

7 Benefits to Make Sure You Have in Your Contract

It’s that time of the year again. Graduating med students have started their first jobs, existing residents have been promoted to a new post-graduate level, and experienced attendings are in the midst of contract renewals. As you continue working, make sure you get the pay and the benefits that you deserve. Be sure to check for these 7 things as you enter the next phase of your career:

1. Look for a salary increase and cost-of-living adjustment. Within this past year inflation has skyrocketed. The price of homes, cars, food, and other items has increased dramatically. In order to keep up with the rising cost of goods, you should receive a cost-of-living adjustment to your pay. This will help you maintain your buying power and standard-of-living over time. A cost-of-living adjustment is automatic in most jobs, but it is not always included in physician contracts. If you haven’t noticed a cost-of-living adjustment to your base pay, reach out to your human resources department to inquire about it. Be sure to negotiate that in your next contract if it is not in your current one.

2. Enroll in health insurance for yourself and your family. Health insurance is something we all need. Although we may live healthy lifestyles, we cannot predict the future. We don’t know if we’ll get sick, get in an accident, or be diagnosed with an illness that requires specialized care. In order to reduce the financial burden of these unexpected costs, we need health insurance. Health insurance can be quite expensive but, most, if not all, of the cost is usually covered by your employer. Be sure to clarify this and ensure that you’ve enrolled. If you have a spouse, children, or other family members that you support, ask about the monthly cost of adding them onto your health insurance plan. Inquire about vision and dental insurance as well. These additions tend to be quite affordable but usually require separate insurance policies that you can get through your employer.

3. Make Health Care FSA and Dependent Care FSA contributions. A Health Care FSA is a flexible spending account. Money in this account is used to pay for out-of-pocket health care expenses like the cost of prescription drugs, surgeries, fertility treatments, and doctor’s visits. While you can pay for these expenses with money from your regular checking or savings account, you may want to consider using a Health Care FSA instead. Why? Because any money you put in this account is exempt from federal, state, and FICA taxes (which could save you hundreds if not thousands of dollars each year).

A Dependent Care FSA is very similar. Instead of using the money in this account for out-of-pocket healthcare expenses, the money in a Dependent Care FSA is used to pay for childcare expenses or nursing home expenses you may have to spend on your children, aging parents, or other dependents. You can put a couple thousand dollars into a Health Care FSA each year and up to $5,000 (per household) into a Dependent Care FSA each year. Any money you contribute is protected from taxes. Just be sure to only put in the amount you will use because any unused money does not roll over to the next year.

4. Contribute a percentage of your pay to retirement accounts and see if you get a match. Another benefit to clarify is retirement. Most organizations will have a 401K (if you work for a for-profit business) or a 403b (if you work for a non-profit organization). You can contribute to these investment accounts with pre-tax dollars and stack money for your retirement over time. Doing so not only allows you to start building wealth but it also helps you to save thousands of dollars in taxes each year. The max amount you can contribute each year changes but is currently at $20,500. Some organizations also have a 457b account, which is similar to a 401K, and gives you a chance to stuff an additional $20,000 in pre-tax dollars into investment accounts each year. Using this account allows you to build even more wealth and save even more money in taxes.

Along with contributing your own money in these accounts, many organizations also offer a retirement match. This is when they incentivize you to invest money for your own retirement by giving you extra money to do so. Oftentimes, they will match what you contribute to retirement up to a certain percentage of your salary. This can result in $10,000 to $20,000 (or more) dollars each year that your organization puts inside of your own personal retirement account. This retirement match is a free benefit you may be eligible for after your first full year of working at that organization so don’t hesitate to ask about it and utilize it. It could net you thousands of extra dollars per year, expediting your ability to reach financial freedom.

5. Check for disability insurance and life insurance. Most jobs will offer long-term disability insurance. This means they will pay you a certain portion of your salary (up to a certain amount) each year, if you were to get disabled and were unable to work. This is a great benefit that is usually free for most people. Unfortunately, it may not be enough. You will likely need to take out your own independent, specialty-specific, own-occupation disability insurance that you can get through an independent insurance agent. (The benefit given by your job is nice but insufficient to meet most people expenses). Along with disability insurance, your job may also offer life insurance. This is a benefit that pays a certain amount of money to your family if you were to die. Similar to disability insurance, this benefit is often free and can be a great addition but is usually insufficient. Most people will need to purchase their own term-life insurance policy and long-term disability insurance policy through an independent insurance agent.

6. Reexamine your malpractice insurance. As a physician, lawsuits aren’t uncommon. Patients may sue for all kinds of reasons, and regardless of whether it was your fault or not, hiring an attorney to defend you can be expensive. All doctors need malpractice insurance. Thankfully, this is usually given to you by your job. Just clarify what it covers and what type of policy you have. If you have an occurrence policy (which is the most protective) then great! If you have a claims-made policy (which is less protective), make sure that they also offer you tail insurance (which will protect you against lawsuits that are filed even after you leave the organization). Unlike life insurance and disability insurance, the malpractice insurance you get from your job should be sufficient. Just be sure to clarify which type you have, what it covers, and ensure you are protected from lawsuits even after you leave the organization.

7. See if you have access to any perks (tuition assistance, mortgage assistance, or discount tickets). Some jobs offer even more perks and incentives than money and insurance. For example, if you work for a large health system that is affiliated with a university, they may offer tuition assistance for yourself and your kids. After you have worked at the organization for a set amount of time, they will pay part of the cost for you to take courses at the university. Many jobs will also pay a portion of the cost for your children if they choose to pursue a degree there. Other jobs have even offered mortgage reimbursement. This is when they pay up to 10% of the cost of a mortgage for physicians who chose to join the organization and stay in the area for a certain number of years. Some jobs may not have the funds to do tuition assistance or mortgage assistance but may be able to offer other perks such as reduced costs for attorney fees to help you set up a living will or trust fund for your family. Others may even offer discount tickets for community events, concerts, and professional sports in your area. Ask your human resources department which perks you may be eligible for.

To summarize, don’t let another year go by without looking at your contract and double checking your benefits. You could be missing out on tens of thousands of dollars each year. Check and see what you’re eligible for and don’t forget to negotiate for what you want.

How to give money to your family without going broke

Realize you can’t do it all

You’re a nice person. You want to help others. You love your family and friends. But let’s face it. You can’t do it all. You cannot put everyone else’s needs above your own. Although this is something we know, it can be hard to put into practice. You are successful. You’ve done well for yourself. And other people count on you. But you have to realize you can’t be everything to everyone. You cannot give all you have away leaving nothing for yourself. You cannot put the livelihood of yourself and your immediate family in jeopardy because of your generosity to more distant family members or friends. You cannot continue to give away endless amounts of money to others before paying off your own debts and obligations.  As the airplane stewards say “put your own oxygen mask on first before trying to help someone else”

Decide how much you can afford to GIVE away

There’s an old adage that says “Never loan money to family that you expect to get back.” In other words, when it comes to family, loaning money isn’t wise. Either give the money away with no strings attached or do nothing at all. Loaning money creates unnecessary tension that could destroy loving relationships and families. Give away what you can and make peace with the rest. While some people cannot fathom the thought of financing the livelihoods of their extended family, others consider it as natural as brushing their teeth. Whether you view it as an important tradition with tremendous value or a rare occurrence, decide what you are willing to give. Look at your monthly income and expenses. Decide a reasonable amount you can actually afford to give away each month. Is it $50 or $100 or perhaps $500?

Create a Family Savings Account

I find that having a set amount in your head may not be enough. When it comes to family many of us don’t stick to our boundaries or budgets as much. One way to avoid overspending is to create a family savings account. Deposit money into this account each month with the amount you can afford to give away. As family needs come up, you can pull money from this account to assist your family. This allows you to save for the financial needs of your family without having to assist with large purchases last minute. Make a rule that the money you give to your family will no longer come from your bank account directly. It will now come only from this family savings account. Each month you can make a deposit into this account to build up reserves for any financial requests/needs of your family may have in the future.

Set expectations and boundaries

Let your family know that this account cannot be over drafted. This means that once the money is out and the balance goes to zero, they must wait for the reserves to build up again before more money is given away. This allows you only give away what you can afford each month without being bombarded with last minute requests that you didn’t plan for. It creates boundaries and allows you to set expectations around what you can give away without jeopardizing your own financial goals and obligations. You get to be generous to your family and still take care of yourself. It’s a win-win.

8 Questions to Ask Before You Join a New Practice

The following article is tailored for medical doctors but certain aspects may be applicable for young professionals in other fields.

Starting a new job can be nerve-wrecking and exciting. Along with negotiating salary and benefits, you should also ask about a few other factors to make sure you know what you are getting into. Here are 8 questions to ask before you join a new medical practice.

1. Why are you hiring? Some practices are hiring because they are growing. Other practices are hiring because people are quitting. What is the case at this location? Are people getting promoted which creates new openings? Or, have multiple people decided to leave the practice for one reason or another? Don’t just take their word for it. Ask to speak to a couple of the physicians at that practice. Find out what they like about the place they work and also ask what they would like changed. Speaking to other physicians will help you get an idea of what working there would be like. You want to go into your new job with your eyes wide open.  

2. What is the turnover rate of staff? Reliable support staff is key for a good work environment and quality of life. Find out what it is like at this practice. Have most doctors had their support staff for years or is there frequent turnover? How many medical assistants and nurses are there per doctor? Is there someone to assist with portal messages, medication refills, and patient forms? Many doctors get burned out due to lack of support and increasing administrative tasks so be sure that you understand the workload and have reliable support needed to get it done. The recruiter may not know this information offhand so reach out to the nurse manager or clinic manager, if needed.

3. Am I expected to supervise or work alongside mid-level providers? There has been an influx of physician assistants and nurse practitioners in the medical field. Are they hired at your hospital or clinic? If so, what is their role? Some practices have the mid-level discuss every patient with the physician. At other places, the mid-levels seem to practice independently. Find out how they are utilized where you are. Also find out if you are expected to supervise them. If you are, realize that you are now taking on more medical liability. Is the practice compensating you more for this risk? If you are expected to review their charts, are you given more admin time to accomplish this goal? Make sure you clarify this BEFORE you sign the contract.

4. What happens if I leave? No one goes into a marriage, expecting to get divorced. Nevertheless, break ups happen, especially when it comes to jobs. It is much easier to discuss terms ahead of time so make sure you ask. Inquire about the notification policy. Who do you need to tell and how far in advance must this be done? Also clarify if there is any money you will have to repay if you leave before a certain time frame? Are you expected to payback the full sign-on bonus or just a part of it? Also ask about malpractice and health insurance coverage. How does malpractice work if you leave? How long do you keep your health benefits? Lastly, clarify any rules or stipulations. Is there a non-compete or are you able to take a job nearby if you desire? Make sure you have all of these terms in writing in a place that is easily accessible.

5. Am I able to work part-time? Not every practice or healthcare system has kept up with the times or is structured in a way to handle part-time workers. Make sure you ask. Just because you plan to work full-time now, does not mean you won’t want to cut back to part time at some point in the future. Will this practice accommodate that? If so, what would be the pay difference? If you work part time are you still eligible for health insurance benefits? Will you have to repay part of your sign on bonus? Will you be given a different productivity threshold to reach? Understand the rules in place for part time workers and get a sense for how accommodating they will or won’t be with this schedule change if you were to desire it in the future.

6. What is the patient panel and insurance payer mix? Patient panel and insurance mix can drastically impact the revenue of the practice and your own personal satisfaction so be sure to ask about it. What are the patient demographics? Do you serve a diverse group of patients (in terms of gender, race/ethnicity, economic status, etc)? What percent of billing does the practice get paid for on average? Is this practice located in an underserved community with lots of Medicaid patients? Or, does the practice serve a more affluent population that tends to have private insurance? The type of insurance patients’ have will impact clinic reimbursements and your overall pay.

7. What are the clinic policies? Get a feel for the operations and interworking’s of your clinic. Is there a late policy for patients? Who handles forms like FMLA, prior authorizations, and work/school clearances? Also, understand how holidays work. Is your clinic open or closed for certain ones? Is there a chance you could be on-call? Make sure you understand how time-off works. Do you have to ask for it months in advance? Do you have to take it in 1-week chunks or can you request each day as needed? These are some of the intangible factors that can heavily influence your qualify of life.

8. How are bonuses structured? You deserve to be paid well for the work you do and rewarded for the efficiency you provide. Be sure to understand how bonuses work and clarify which milestones are required. For example, if you get a sign-on bonus find out if you get all the money up front when you sign the contract or if you have to wait until you start working. Also clarify if it is given in a lump sum or dispersed evenly over time? Along with the sign-on bonus, ask about productivity bonuses. Usually this is extra money you get for hitting a certain RVU target. Figure out what that RVU target is and whether or not it is feasible for you to reach. Healthcare systems may even have additional bonuses based on the practice revenue or patient satisfaction scores so ask about those as well. Lastly, inquire about a longevity bonus or a reward for staying with the same organization for a certain length of time. Is there some sort of reward for your loyalty in terms of an increased retirement match, a higher bonus, tuition reimbursement for your kids, a partnership promotion, or a cost of living adjustment? Their answer may be “no,” but it certainly doesn’t hurt to ask or negotiate something like that into your contract.

How to Get Money for Moving Expenses

It’s late spring. This means lots of med students and physicians are preparing to start new jobs or hoping to advance forward in their current one. This is an exciting time, but it can be stressful as well, especially when it comes to finances. Gathering money for moving expenses, housing costs, as well as basic living expenses can be quite daunting. As someone who is moving across the country to start a fellowship myself, I completely understand the sentiment. When people ask me about ways to get money for all these expenses here are the 4 things I tell them:

1.     Moonlighting. As a physician one of the things we know how to do is work. Moonlighting is when we as doctors work extra shifts for added pay. Some people work in the hospital, others work in the urgent care, some even take call from home. Each employer has their own set of rules or stipulations regarding moonlighting but if your program allows it, working a little extra to cover the cost of moving expenses can be a great way to earn extra cash. 

2.     Uber/Lyft/Doordash/Amazon. Some folks, especially med students may not have the credentials to moonlight or work extra shifts. If that’s the case for you, there are other options to consider. You can try driving for Uber or Lyft or even sign up for food and package delivery services like Amazon and Doordash. While these jobs may not be the highest paying, the flexible hours may be a great fit for your busy schedule. 

3.     Monetize your talents. I’m a huge fan of having multiple income streams and encourage all young professionals to do so as well. Perhaps there’s a skill you have that other people would pay you to learn? For example, some of my friends are good at tennis and charge others for tennis lessons. I also have friends who are great at cooking and charge their friends for meal preps or who are great at photography and charge others for headshots. Can you think of a skill you have that you can monetize? If so, let your med school classmates or co-residents know and get started!

4.     Get a side hustle. Side hustles can be great. They are jobs that we do for others or passion projects that we make money from. For example, some people have started a blog or podcast and charged companies for ads. Other people do some consulting on the side. Some folks make money from social media or act as ambassadors for other companies. Think of ways to leverage what you know or who you know in order to bring in some extra cash.

5.     Personal Loans. When all else fails and you need some money quickly, you can always consider a loan. I’m not a huge fan of taking out debt you don’t need, but even I had to borrow money at some point, especially when I was waiting on my first residency paycheck. Moving can be expensive and trying to get money for housing and living expenses can require cash that you may not have on hand. As long as you don’t take out more than you need, getting a personal loan at a low interest rate can be quite beneficial. While there are several companies that may offer relocation loans, Doc2Doc is a company for physicians by physicians that offers loans at low interest rates to graduating med students and physicians. If you have a pressing need for cash, these types of personal loans can be a great option as well.

What you need to know about non-compete clauses in your work contract:

The following post is part of a series on physician contracts

Non-competes are restrictive clauses that are found within many physician contracts. Unfortunately, they can drastically impact where a doctor is able to work and how they practice medicine. Before you sign any contract, look to see if it contains a non-compete clause and make sure you understand all the nuances around it.

What are non-compete clauses? Non competes are stipulations in contracts that prevent you from “competing” with your current employer by working for one of their competitors if you were to leave your job. They prevent you from working for a competing organization or health system within a certain radius for a particular time frame to prevent you from taking away any business form your current employer. For example, if you are a psychiatrist who decides to work for a large health system, the non-compete clause in your contract may state that if you leave your current job then you cannot practice psychiatry within a 20-mile radius of that employer for the first 2 years after you leave.

Why do they exist? Non-competes exist because employers have discovered that many patients like their doctors. In fact, patients tend to be more attached to their doctor than to the health center or clinic that they go to. Because of this, if patients find out that their doctor is leaving the current practice or hospital to work at another location nearby, the patient may follow the doctor to his or her new location. Health centers and hospitals don’t want to lose patients, so many of them put terms in place, like a non-compete clause, to prevent doctors from leaving the practice, taking patients with them, and becoming their direct competitors.

Why don’t doctors like them? It is rare for a doctor to work at one place for the entirety of their career. They may want to switch jobs for an increase in pay, more work/life balance, a change in family priorities, a job promotion, etc. Non-compete clauses restrict this. If a physician is already settled in a city that they love, non-competes clauses may require them to move to an entirely different location in order to continue to practice their specialty. If a non-compete states they can’t work within a certain radius for a certain length of a time, then a physician may not be able to take a better job in the same city and may be forced to move away or have a long work commute in order to avoid being sued for violating this clause. Many doctors feel as though non-compete clauses keep them stuck in jobs they may not like, getting paid less than they are worth.

What can doctors do to change it? Many doctors have encouraged others to refuse to sign contracts that contain non-compete clauses. They argue that no other profession tends to have this sort of restrictive language in its contracts and believe if physicians collectively refused to sign contracts with these clauses then the clauses would be removed entirely. Other doctors disagree. They feel as though trying to eliminate noncompete clauses altogether is a lost cause and instead encourage doctors to negotiate better terms. They suggest shortening the length of time in the non-competes, lessening the radius, or having the clause eliminated altogether for doctors who have not yet built up their patient practice or who have worked for their employer for a certain length of time.

My point? Be aware that non-competes clauses exist and try to eliminate them out of your future contract. If you cannot remove the non-compete clause, then be sure to negotiate more favorable terms.

8 Things to Negotiate Besides Salary

The following article is focuses mainly on physician contract negotiation

Whether we are considering a new job or up for review at our current place of employment, there are several things we should negotiate. Many of us focus solely on salary, but there are other things we should be sure to negotiate as well:

1. Benefits and Insurance: One of the first things to consider besides salary is benefits. For physicians and other young professionals with college degrees, student loan forgiveness may be one of the top things to look at. Some jobs offer direct loan forgiveness. Other jobs qualify for federal loan forgiveness through the public service loan forgiveness program. Be sure to see if either is offered at your job. Along with loan forgiveness, also look at retirement matching. Retirement matching is when your employer gives you extra “free” money to invest in your work retirement accounts. They may “match” the amount of money you invest up to a certain amount, which can add up to tens of thousands of dollars per year. I’ve seen some jobs in which the salary was $10-$15K less than another place but the retirement matching was so good that it more than made up for it. Another benefit to look at is malpractice insurance. Ensure that your job covers you if a patient or client tries to sue and that the insurance in place will cover you for claims made while you work for the organization AND even after you leave.

2. Sign-on bonus: One of the initial bonuses doctors get when they sign their first attending physician contract is a sign-on bonus. There are many nuances involved with a sign on bonus that doctors should be aware of but in general, a sign-on bonus is a 4 to 6 figure amount of money that many businesses provide to newly hired doctors. It can be given in one lump sum or in smaller installments. It is usually structured as a loan that gets “forgiven” after you work at the company for a certain period of time. This free money can be great, but the first amount they mention is unlikely to be their best offer. Ask for more.

3. Productivity Increases: Along with a sign-on bonus, it is also important to inquire about productivity bonuses. Most places want you to be as efficient as possible since increased efficiency leads to increased profits. If you’re actively increasing the business’s revenue because of your efficiency, then you should get a share of the profits. Be sure to negotiate this ahead of time and be aware that the amount they offer may differ for people in certain specialties. Some places will pay you a flat salary until you hit a certain work productivity threshold. Other places will pay you based on productivity from the onset. There are even businesses that offer a set monthly pay but provide annual or semiannual bonuses to employees based on the total company revenue. The exact structure of the productivity bonus can differ. Make sure you understand what other folks in your profession are getting so you can ensure you are being compensated adequately for the efficiency you provide.

4. Vacation and Personal Leave: Whether you love your job or not, everyone needs periodic breaks to step away and recharge. Do not forget to negotiate paid vacation time. While 3 weeks may be standard at most places, who says you have to settle for average? Why not ask for more? Aim for 4 weeks or negotiate additional vacation time after you have been with the organization for a certain length of time. Many jobs like to lump vacation time and sick time together as “personal time off” but try to keep this separate if you can. If you or a loved one gets sick or diagnosed with an illness, you shouldn’t have to use all of your vacation time dealing with medical issues. See if you can get at least 5 days of sick time in addition to your vacation time. If you’re a parent or plan to be, be sure to ask about parental leave for the birth or adoption of a child. Although FMLA holds your job while you are out, you may not get paid during that time. Negotiating paid family leave is vital.

5. Work Schedule Flexibility and Expectations: Along with personal time off, it’s also important that you negotiate a healthy work schedule that allows you to be productive without causing you to burn out. Perhaps you decrease the frequency you are on call? Maybe you negotiate a 4-day work week. Or perhaps you consider starting and/or ending work a little earlier or later some days to accommodate your family needs. You have the power to create the work schedule you desire. Figure out what type of work schedule you want and negotiate for it. If you can articulate how you will maintain productivity with your desired schedule, employers will be more likely to consider your requests.

6. Automatic increases: I am amazed by the number of physicians and other young professionals who don’t get automatic raises each year at their job. Because of inflation, things get more expensive each year. If you don’t get a cost-of-living adjustment to account for inflation, then you may actually be losing money year after year. Cost-of-living adjustments may not be standard at many places, so be sure to negotiate that in the contract if you don’t see it. It may also be wise to negotiate general productivity targets or a longevity increase. The goal is to get an automatic increase in pay after working for the organization for a certain length of time, like 3 years, as well as an automatic increase for bringing in “X” amount of revenue for the company. These types of automatic increases help you continue to be paid your worth over time and ensure that people hired after you don’t start off making more than you.

7. Licensing and Continual Education: As physicians, this is an important expense to inquire about. State medical licenses (to practice medicine), DEA licenses (to prescribe medicine), and board certifications (to maintain your medical credentials) can cost thousands of dollars in fees. It’s standard that the business pays for these expenses so if you don’t see it in the contract, ask for it to be added. Along with getting these fees covered, most medical societies require you to stay up to date on new medical treatments by doing a certain amount of continual medical education (CME) each year. Ensure that your job provides you with an adequate amount of CME funds to attend conferences and programming that provide these CME credits.

8. Autonomy (Intellectual property and non-compete clause): A surprising number of physicians do not have autonomy over their work. Don’t let that be you. Ensure that your intellectual property (ideas, products, or services that you create) are yours and not the job you work for. Be sure that you have the freedom to do other projects and work at other places outside of your job should you choose to do so. Lastly, watch out for non-compete clauses. These phrases in contracts prevent you from doing similar work at a nearby organization if you were to leave your current job. As you can imagine, they can cause a huge problem because they may require you to uproot your entire family or drastically increase your work commute if you were to quit your job since these non-compete clauses prevent you from getting another job at a different location in the same city. Try to avoid non-competes if you can.

Was this helpful? Do you plan to negotiate these things in your physician contract? Are there other things you plan to add?