Changing jobs as a hospitalist can mean new opportunities, new challenges, greater job satisfaction, and possibly (hopefully) a bigger paycheck.

But if it’s been a while, a refresher on the ins and outs of contract negotiation could be helpful.

Get a Second Opinion

Hospitalists can certainly choose to review contracts on their own. However, a second set of eyes could be helpful, especially if you don’t have much previous experience in this area.

“My very first piece of advice is to get someone else involved,” said Jillian Vestal, JD, an attorney who specializes in physician contracts and serves as head of legal services for Panacea Financial. “Doctors are so well trained and well educated in their field. But unfortunately, contracts are not something that they get a lot of training about.”

An attorney who is a health law specialist can be a particularly useful resource, according to Elizabeth Snelson, Esq., the author of the AMA Physicians’ Guide to Hospital Employment Contracts (AMA membership required to access).

“It’s advisable when a physician is having a contract reviewed by healthcare counsel in the state where they’re going to be practicing because there are nuances in health law that don’t apply in other areas of the law,” added Elizabeth Greene, JD, an attorney with Mirick, a law firm based in central Massachusetts.

If you need recommendations, you can contact the local medical society or the relevant state medical association. If that’s not an option, you might consult your program director if they have some prior experience in navigating employment contracts, Vestal said.

Don’t Rely Solely on AI

Should you use AI to help you review your contract? Vestal suggested viewing AI as a helpful starting point, but it should not replace a comprehensive legal review.

“As is true across many industries, AI can be an incredibly valuable tool for helping physicians, and professionals in general, better understand complex concepts and identify potential areas of concern,” Vestal said. “That said, I would not recommend relying exclusively on an AI model for contract advice, any more than a physician would recommend relying exclusively on that same model for medical advice.”

Clarify Supervisory Requirements and Compensation Details

Snelson, who serves as legal counsel for the Medical Staff PLLC, noted that more hospitalists may be required to supervise the growing number of hospital-employed nurse practitioners and physician assistants.

“But it’s an additional kind of responsibility, for which there could be legal exposure,” she said. “If part of their duties are to supervise, their contract should say that…and make sure that all the duties are stipulated.”

Vestal suggested also clarifying expectations and definition of terms such as “full time,” including how many shifts constitute “full time” employment. “Those details may be left out, and that can leave a doctor open to a lot of risk,” she said.

According to David Glaser, JD, an attorney with the health law group of the firm Fredrikson in Minneapolis, physicians should also take care to understand the compensation model that they would be expected to work under.

While many physicians work under a salary model, others work under a productivity model, and a growing number are working under a hybrid model that includes elements of both, according to a recent policy research paper on physician compensation models from the American Medical Association.

Other details to verify might include any requirements to serve on or chair committees or quality-improvement initiatives.

Verify the Specifics of Your Malpractice Coverage

Determine if you will be covered by an occurrence-based malpractice insurance policy or a claims-made policy.

Occurrence-based policies tend to be more expensive than claims-made policies, but experts typically recommend having tail coverage to supplement a claims-made policy. Tail coverage covers you if any malpractice claims are filed based on incidents from your previous job after you leave it and take a new job at a different hospital with a new insurance carrier.

However, a contract may or may not specifically include that tail coverage, and it’s important not to assume that it’s included. “The risk is that if it’s not documented, it’s not included, and then the physician, when they depart, will be responsible for the tail coverage,” Greene said.

If the contract doesn’t specifically include tail coverage, Greene recommended asking for it to be covered, too. “If a physician is terminated without cause by a hospital, I would want the hospital to bear the cost of the tail coverage that is commensurate with the coverage that was provided,” she said.

Find Out if There’s a Noncompete

It may feel a little strange to be considering a future exit strategy before starting a new job, but experts say that it’s important. In fact, Glaser suggested that it’s one of the most important issues to consider.

For example, does your state allow noncompete agreements? Some do, and some don’t, according to Vestal, who called the national situation on noncompete agreements for physicians “a hodgepodge.” Some states have started limiting noncompetes, whereas others have not moved in that direction.

“It’s sort of a moving target,” she said. “It really depends on what state you’re in.”

But don’t assume that your employer has kept up with state law in this area, especially if it’s recently changed. Know the law so that you know what you can be legally asked to do. Also you can always ask for the noncompete agreement to be removed.

“I think narrowing the noncompete is going to be more successful than just taking it out or saying, ‘Get rid of this. I don’t want it at all,’” said Vestal. “But you can start there.”

Don’t Forget the Importance of a Good Fit

Glaser said he encourages physicians to also keep the big picture in mind when negotiating a contract for employment. “Ultimately, I think the contract matters less than the fit,” he said. “If you are working for a bad boss, a good contract is not going to save you.”

One way to determine if the job (and workplace) will be a good fit is to talk to some previous employees of your future employer. LinkedIn may be able to uncover some connections to help.

“Find out where they went and why,” Glaser said. “And if no one has left in the last 3 years or so, that’s a huge positive.”

Review Everything Before You Sign on the Dotted Line

When the time to sign on the dotted line arrives, don’t just pick up the pen.

“Review the document that you are going to sign, and if you have any questions or lack familiarity with any of the terms, engaged qualified counsel to advise you,” Greene said. “It’s a complex area, and as a physician, you’re not expected to understand all the legal nuances of the agreement.”

She continued, “[b]ut if you are signing your name to a document and it’s going to control your livelihood, understanding that document and the rights and responsibilities that you have would be advised.”

The experts cited in this article had no relevant disclosures.