I currently have or have had the following relevant financial relations to disclose: -Ownership Interest in a Commercial Interest: Bristol Myer

Transcription

1 I currently have or have had the following relevant financial relations to disclose: -Ownership Interest in a Commercial Interest: Bristol Myer Squibb, Novacure, Novartis - Honorarium/Feed Paid: Medical Mutual

2 I do not intend to discuss an off label use of a product during this activity.

3 Recent studies have found that 70% of all graduating residents will change jobs in their first 2 to 3 years of training. 50% of Hematology / Oncology Fellows change jobs in the first 2 years out of fellowship. The Hematology / Oncology employment environment is dramatically changing and fellowship programs provide little training on how to navigate this process.

4 You have dedicated the last 10 years of your life to becoming an Oncologist. You sacrificed blood, sweat, and tears to get here. don t mess it up now! Prepare! Understand: ú Who are you negotiating with? ú What you are negotiating for? ú Where you want to be(personally and professionally) in 10 years?

5 Interpersonal conflict Financial Issues Lack of decision-making capacity Inadequate referrals Partnership determination Staff Support Family issues Vukmir J; Physician Contract Guidebook 2014

6 INTERPERSONAL CONFLICT FINANCIAL ISSUES (These 2 are the noted to be the MOST important!!!)

7 Whoever wrote the contract took care of themselves Neil Hamilton

8 Universities Private Practices Hospital Employment Models Hybrids (Physician Service Agreements, etc)

9 WHEN YOU GET THE CONTRACT - GET THE LAWYER Contracts are becoming increasingly complicated in regards to: ú Non-compete clauses ú Restrictive covenants ú Termination policies Serves as the point person for negotiations and avoids conflict Can give insights to your ask

10 Moving expenses Loan Repayment Programs (regional) Personal Marketing Support Staff Signing Bonus Can be affected if you used a recruiter (choose how you use a recruiter carefully)

11 Fair Market Value The concept of Fair Market Reviews and Commercial Reasonableness comes from the section of the Social Security Act known as Stark II rules This means the arrangement between physicians and hospitals must not have anything to do with referrals that hospitals can generate from the relationship. The measure of these arrangements is the commercial reasonableness or fair market value. This data often comes from MGMA, Sullivan Cotter & Associates, Consultants D Clark. Medical Economics 2012

12 Relative Value Units: RVUs are a method for calculating the volume of work or effort expended by a physician in treating patients. This is how the value of a physician services is currently determined and is closely tied to how well we document and bill.

13 Private Practice Base Salary Buy-in (Time? Money? Know what you are buying!) Time to Partnership Partnership Structure (Democratic? Tiered?)

14 Hospitals Salary: ú Base salary ú Performance/Quality metrics ú RVUs (Upper and lower limits) Vacation CME Days per Week Terms for termination and contract renewal

15 Universities: Salary Protected Research Time Teaching Responsibility Continuing Medical Education Funds Alternate Income Streams Moving towards performance metrics like RVUs ú What is reasonable? What percent of your time is in clinic? ú Is your time protected for research?

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17 You will be inundated with cash! Banks will offer you ridiculous loans based on your income Remember you are a decade behind in saving for retirement and your children s educations. Be frugal your first few years and you can make this deficit up quickly. The most expensive potential mistake you can make your first 2-3 years out is to buy a very expensive house (a very common mistake doctors make). The costs in taxes, insurance, maintenance, etc will drain most of your discretionary income.

18 If you want something and can justify how it can help the University, Practice, or Hospital ASK FOR IT When negotiating with hospitals, see if you can use the same lawyer as the other employed physicians they can help guide you through the process and ensure that everyone is getting as similar deal. Many contracts have auto-renewal terms if you do not renegotiate. Make sure that certain elements like per RVU reimbursement, CME, cost-of-living increases are indexed or you will have to renegotiate your contract every 2 years.

19 Interpersonal conflict Financial Issues Lack of decision-making capacity Inadequate referrals Partnership determination Staff Support Family issues Vukmir J; Physician Contract Guidebook 2014

20 MGMA 2016 Provider Compensation and Production Report (most Universities can get you an updated copy on an interlibrary loan). Your Money Ratios$ by Charles Farrell The Millionaire Next Door by Thomas Stanley Quantifying the personal financial impact of a career choice in academic hematology/oncology (AHO) M. Palmeri; 2011 ASCO Annual Meeting Poster Session