New job? Ask 4 questions before signing on

An attorney offers tips on contract negotiation.

No one purposely takes the wrong job or chooses an uncomfortable working environment, but bad fits do happen. To make them less likely to happen to you, pay close attention to your employment contract before you sign it. Ask yourself—and your prospective employers—the following questions.

Who is the employer?

The typical employment arrangement involves either the hospital (or an affiliate) in which the hospitalist directly provides services, or a private group that contracts to provide hospitalist services. In either situation, termination clauses are an important consideration. If you're working directly for the hospital, it's imperative to understand the situations in which you can be terminated for cause (and what cure options, if any, are available) and the timelines for a without-cause termination. If your contract does offer a cure option, or the opportunity to correct deficits and avoid termination, a timeline of 10 to 15 days is generally reasonable. For without-cause terminations, 60 to 90 days is a common standard.

It's traumatic enough to be terminated by an employer, but it's perhaps even more disconcerting and disheartening to be terminated because the hospital has ended its contractual relationship with your group. If you'll be working for a group, you should know whether the group has the exclusive contractual relationship with the hospital, and, if so, when that arrangement is up for renewal or can otherwise be terminated by either party.

Are duties clearly defined?

Every employment contract should delineate the rights and responsibilities of an employee. This is particularly true for a hospitalist who does not have an established and repeat patient base and may not have a full-time supervisor on site if the hospital has outsourced the hospitalist functions.

To ensure that the hospitalist and the employer have the proper expectations, the hospitalist's duties should be delineated clearly. Your contract should spell out whether you'll cover unassigned patients who present in the emergency department. Ask whether you will be coordinating inpatient care for patients with an assigned physician, and address whether this responsibility applies to every physician with admitting privileges, or only to certain physicians or groups.

Also define the expected hours of responsibility. Depending upon the number of hospitalists in the employment situation, the expected hours of work and responsibilities may be different. Will you work a 7 a.m. to 5 p.m. shift four days a week, or work 7 p.m. to 7 a.m. three days a week? How are weekend and holiday responsibilities delineated?

Many hospitalists believe they'll have a better quality of life because they don't have responsibilities outside their shift coverage. This impression can quickly be erased if you are shortstaffed and working longer and more than anticipated.

Are there bonus opportunities?

A hospitalist's employment contract, whether with a private employer or directly for a hospital or its affiliate, may include bonus incentives. Ensure that you'll have regular access to the hospital and/or employer's books and records to measure potential bonus opportunities. You should understand the mechanics of the bonus and whether the bonus is actually attainable or even within one person's control. For example, bonuses paid to an entire team can be adversely impacted if one member performs poorly.

Also, a bonus based upon revenue collection for the hospitalist's services may not be the best or most appropriate measuring tool. A hospitalist can't accept or reject the care of a patient due to payer status. If your hospital serves a large uninsured or underinsured community, you could be penalized for poor payment. You'll similarly be penalized if your hospital or the employer has inefficient billing and collections.

When does the contract end?

Hospitalists who might want to remain in the community after leaving the hospital's employment, especially if they have a spouse who works in the community or children in local schools, should be aware of their contracts' noncompete clauses. Hospitalists shouldn't sign away the right to work wherever they want when moving from one job to another. This is particularly true if the hospitalist would like to switch to an outpatient internal medicine practice.

The potential of moving to a direct competitor of the current employing hospital should have no bearing on contract negotiations. It's very unlikely that an admitting physician places a patient in one hospital versus another because a particular hospitalist works there. The same principle applies to direct hires and those hired through groups, so make sure the employing group is not bound by a noncompete provision.

As long as hospitals remain under economic pressure to keep lengths of stay as short as medically necessary and consumers continue to focus on quality and continuity of care, hospitalist positions will flourish. But although the job market is robust, it's still important to understand your own short- and long-term goals and those of your prospective employer. If they match, the arrangement will be a good fit.