Urologists negotiating employment, payer, or other contracts often feel like they’re navigating unknown, hazardous terrain.
Thomas Stringer, MD, associate professor and associate chairman of urology at University of Florida, Gainesville, often reviews residents’ employment contracts. He recalls a recent hospital contract, where he urged the resident to seek clarification in key areas. But the resident wanted the job so much, he felt uncomfortable asking questions and potentially turning off the employer.
That’s a mistake, according to Dr. Stringer.
“This [contract] is your conditions of employment. You really need to define what those are so you can feel satisfied once you sign the thing. I think physicians tend to be pretty anxious about negotiating on their own behalf,” he said.
Dr. Stringer, who for 7 years directed the course, “Physician Contract Negotiation: Employment and Ownership in the Current Economic Climate,” at AUA annual meetings, says urologists are increasingly called upon to negotiate important and binding documents, like employment contracts.
“More and more physicians, in general, are employed. In the year 2000, almost 60% of all physicians were shareholders in their practices. Currently, that’s closer to 30% of all physicians,” Dr. Stringer said. “Our data suggests that the number of employed urologists is going up, and that’s according to AUA Census data. Fifty-one percent of urologists were employed in 2015; now it’s 56%. But there’s an age differential. According to the AUA Census, among urologists under age 45, 72% are employed.”
In fact, urologists can be employed by hospitals, health systems, academic institutions, independent practices, and the government.
“You even need an employment contract if you’re self-employed,” Dr. Stringer said.
Every entity has its own interests in mind when employing physicians. Sometimes, the interest is largely profit-driven. For example, private equity firms are a relatively new physician employer. Private equity firms have been buying physician group practices, including, in 2016, the purchase of Chesapeake Urology by Audax Private Equity.
“The goal of the private equity purchase is to scale up the business, build a portfolio, and sell it again in an average of 3 to 5 years,” Dr. Stringer said.
Urologists need to represent themselves to ensure employers meet their employment goals and interests. It’s critical especially for female physicians to negotiate well for themselves, according to Michele G. Cyr, MD, MACP, senior associate dean for academic affairs in biology and medicine and professor of medicine and medical science at Brown University, Providence, RI.
In 2017, the national gender gap for physicians increased compared to 2016 as female doctors earned 27.7% less ($105,000) than male doctors, according to Doximity’s second annual Physician Compensation Report, released March 14, 2018. There’s no medical specialty in which female doctors earn more than male doctors, and women earn less than men in all of the top 50 metro areas, according to Doximity.
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