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Once you've determined what kind of practice you want to join, you need to develop a plan for joining the right practice. Consider the broad range of individuals and organizations that might be interested in hiring you or might know of prospective practices that have an employment opportunity available.

Making Contact
The Interview Process
Candidate Factors
Getting the Terms Spelled Out
Sample Employment Contract
Employment Contract Points
Summary of Contract Terms

Making Contact

Who should your list of contacts include? When you begin your search, your list of contact people should contain:

• Attending Physician—Ask them about their own practices, about friends' practices, and about former classmates looking for associates.
• ACC placement services and web searches
• Classified/Web Advertisements
• Hospital Administrators—These people are aware of practices that are recruiting additional doctors. Hospitals are also increasingly searching for physicians to bolster their staffs.
• Recruiters—These people earn a living recruiting physicians for practice opportunities and making successful physician matches.
• Colleagues and Friends—You and your colleagues will all interview with practices that might not be right for you but might be right for someone else.

To Do: In the Fall or Winter of your Final Training Year

• If you plan to join an existing practice, start by sending a cover letter and a copy of your CV, either as an initial contact or to follow-up after you've met a member of the practice. Send the cover letter and CV to the practice administrator or the physician responsible for the search.
• Schedule a phone interview. If someone has contacted you in response to your letter, schedule the phone conference as soon as possible. Before the actual telephone conference occurs, make a list of important facts about the prospective practice.
• Follow up the telephone interview with a some form of follow up, usually a thank-you note is a good idea. If you are interested in pursuing the practice, request an interview to meet the practice physicians and to see the practice in operation. Do not wait for them to call you; stay in touch. The first interview typically does not last more than three hours. Expect some kind of response from the practice within a period of two to three weeks, and if you don't hear from them, call yourself.

The Interview Process

• Confirm the date and time of your interview or meeting and any travel arrangements. Make sure you have accurate directions to the practice.
• Find out if the practice is planning to pay for part or all of your expenses.
• Prior to the interview, review your notes from your telephone conversation to reacquaint yourself with the particulars of the practice.
• Schedule meetings with all practice physicians relevant to the position, including the senior and associate physicians. The second interview is typically more in-depth and lasts at least a full day.
• Request an opportunity to see the physicians interacting with patients. This will give you a good feel for how busy the physicians really are, how they interact with the PAs, and so on.
• Tour the main practice office and the local community, if necessary
• Anticipate the questions you are most likely to be asked, and have some "standard" responses.
• Prepare a list of questions you would like to have answered about the practice.
• During the interview, allow the practice to lead with the focus of the questions. After the initial information has been gathered, the discussion should move on to more specific areas, like proposed salary, benefits, call schedule, and terms for co-ownership, if any.

Candidate Factors

What factors in a candidate is the prospective practice seeking?

• Generally the practice knows what type of cardiologist it needs (general, invasive, interventional, nuclear, etc) However, attractiveness in terms of training, experience, number of cases done, and amenability to practice demands, including interest in the actual office to which the candidate would most likely be assigned
• Ability to promote the practice either by means of specialized talents or reputation brought to the employer
• Personality and the ability to fit in with the other members of the practice are often crucial determinants; you don't usually have to join your best friends but most groups require some ability to get along favorably
• Board certification and/or fellowship status

Getting the Terms Spelled Out

• The Term—Your contract should clearly state the starting date for your employment with the practice. The term is important as a measuring point or salary and benefit increases.
• Termination—Your contract should have some kind of statement about how it can be terminated by either party. It should also state how much notice the practice must give you if it wants to discontinue your employment.
• Compensation—It is important to have salary terms stated clearly for each year you will be a practice employee. Annual increases, if applicable, must be spelled out in specific terms.
• Incentives and Bonuses—These are paid in addition to your base salary. Bonuses are generally offered to induce you to attract patients to the office, to work hard for the practice (and yourself), and as a reward for your financial contribution to the practice. Note that in cardiology, incentive bonuses tied to specific production are not very common. Generally, there are three types of bonuses:
  • Gross production—based on a percentage of the income you generate for the practice in excess of a predetermined amount.
  • Net income approach—to the extent that the net income of the practice exceeds a certain amount of the previous year's net income, then you are entitled to some portion of that excess.
  • Fully discretionary bonus—the practice has the right to determine, based upon the individual merit of the situation, whether or not a physician will earn a bonus. The most common bonuses in cardiology are tied to discretionary models and/or growth and profitability.
• Business expenses—A practice will typically pay some portion of the general business expenses that you can expect to incur, such as hospital staff fees, professional society dues, subscription journals, continuing medical education and related travel, portable phones, pagers, and computers, and all items necessary for you to practice. These expenses may be capped, subject to an annual limitation.
• Malpractice Insurance—There are two forms of malpractice insurance: "occurrence" and "claims made". An occurrence policy insures any actions that you do (or fail to do) as they may "occur". With a claims made policy, you are insuring against the day a claim is made against you. The costs are very different, and if you have a claims made policy, it is critical that you determine who pays the tail (the future risk of the claim being filed if the policy is terminated).
• Employee Fringe Benefits—The practice may offer fringe benefits to its physician-employees. Typically, some combination of the following are offered:
  • Payment of basic health and major medical insurance for you and your family (this is very common)
  • Group term life insurance (often only up to $50,000)
  • Payment or reimbursement for your disability insurance premiums (typically about half the time).
  • Coverage under the retirement plan of the practice (after a waiting period)
  • Moving and relocation expenses (less common)
  • Signing bonus, as an added incentive for you to agree to join the practice.
• Vacation and Leave of Absence—Typically, as a new physician, you are entitled to three to five weeks of paid leave vacation during the each twelve months of employment, and usually one additional week off in your second or third year of employment.
• Sick Pay—Know what time and compensation you will receive if you are absent for a particularly long period of time. Typically, at least 15-30 workdays of sick pay is offered. An absence is excess of what is allowed is usually without pay. Pregnancy-related leave is generally separately covered.
• Restrictive and Non-solicitation Covenants—A restrictive covenant is your agreement that you will not compete with your employer. As the competition for patients and payor contracts increases, restrictive covenants are becoming more prevalent. Unless you are practicing in a state that statutorily restricts such covenants, expect to see such a term.

The general law regarding restrictive covenants is that they must be reasonable in time, scope, and place, and they may not violate the public interest (such as informing non-competition with the only group in the area, which would effectively allow a monopoly, or deprive the area of the only interventional cardiologist).

A non-solicitation covenant states that if you depart from the practice for any reason (even if you are fired), you may not solicit any patient or member of any patient's household, any referral source or any employee from the practice. You are usually also prohibited from soliciting any patient contract or any practice business relationship (HMO, joint-venture arrangement) for some period of time (usually one to two years) following the termination of your employment.

There are three very different types of remedies to these terms. Generally there is the remedy of an injunction, whereby you simply agree that you not breach the covenants; if you then later breach them, the practice may go to court to enforce your agreement not to practice competitively to them.

With the alternative, there is a liquidated damages remedy; a pre-arranged financial settlement you agree to pay, which would not amount to a "penalty" if you do breach this promise to your employer. Depending on your status, amounts equal to 50% to 100% of your salary is an agreed liquidated damages and is therefore acceptable.

Lastly, there is the whole common law areas of remedy, where you are simply sued by your now-former employer for breaking your promise not to compete, and the "damages" (economic) are whatever the practice feels it suffered from your competition.

• Co-ownership—Determine what co-ownership means in the practice. Typically it means gaining some ability to vote on corporate matters, sharing in financial risks and rewards, and generally having a say (or a vote) on management issues.
• Evaluation Criteria—The criteria against which you will be judged should be stayed in your agreement. Typical co-ownership criteria includes the following:
  • The commitment of your time and energy to contribute to the practice success § Your productivity, efficiency, and contribution to the bottom line
  • Your acceptance of the practice burdens and responsibilities
  • Your interest in the practice from an entrepreneurial standpoint
  • A demonstrated ability for you to work together with the other physicians and staff
  • Your becoming board certified in your cardiology and possibly if you are invasive or interventional, your lab privledges.
  • There may often be a minimum number of years (2-5) that you must be continuously employed by the practice
• Income Division Among Owners—If you receive anything less that your full income entitlement share, then you have a "buy-in" and your contract must explain all applicable terms.
• Goodwill—Goodwill is value inherent in the practice. It corresponds to the systems that are in place to see and treat patients, and the likelihood of patients' continued patronage. Due to health care changes, valuation has become more complex.
• Pay-out—If you are going to buy into a practice, know what you are buying. What are your rights as partner, and what will happen if you leave? Your pay-out should usually mirror your buy-in. In addition, if you buy in to goodwill, you should be bought out of it.
• Other Terms
  • Complete Understanding—In an increasing number of contracts, only the terms written in the contract control the terms of the arrangement; no other terms will apply. Therefore, if you are relying on a side letter not made part of the contract, you are out of luck.
  • Assignment—You may find that your contract may be assigned to a new party whom you do not want to join
• Cover Letter
• Full name, address, day and evening telephone numbers
• How you learned the practice is looking for an associate
• What makes you a good candidate for the position
• Your medical training status, and when you will be finished
• Your interest in following up with the practice
• A request for a telephone interview to learn more about the practice
• When you can be reached
• CV (Curriculum vitae) (link)
  • Full name and address
  • All of your medical training, where, when, and with whom
  • All awards that reflect well on your talents, even if not medically related
  • Any research or articles that you have published, contributed to, or collaborated with
  • Any special professional or non-professional interests you wish to pursue
  • Tailor your CV for the situation you want
• List
  • Practice name, telephone number
  • Person spoke to
  • Location(s) and specifically which office you are sought by
  • Size of group and average size over the past few years
  • Age of doctors in group
  • Situation and time when a physician last left
  • Subspecialties, by type and number
  • Why they are recruiting
  • Anticipated new doctor workload
  • Initial impression(s)
• Questions to be asked
  • How or why did you choose to pursue medicine as a career? Why cardiology?
  • Why do you like or dislike most about cardiology?
  • What are your long-term practice and personal goals?
  • Why do you think you would like to be in this type of practice setting?
  • How do you think you can contribute to this practice?
  • What is your general philosophy of practice?
  • What do you do in your free time?
  • Why you?
• Questions to have answered
  • Why are you looking for a new associate?
  • How long have you been recruiting?
  • Are your workload expectations for your associate(s) the same as for your senior physicians?
  • Who is the practice's primary competition?
  • What is a typical day/week like in this practice for the physicians?
  • How are practice decisions made?
  • How often do the owners meet?
  • What is the competitive environment like?
  • Does the practice use outside advisors?
  • I offer the following skills to you...how will your take advantage of this?

Employment Contract
Practice Name, P.C. Practice Address

Dr. New
[Home Address]

Dear ______________[first name]:

As I have discussed, this letter sets out our agreement for your employment. Your employment is, of course, contingent upon your obtaining active staff privileges at the Practice's local hospitals and all the appropriate licenses to practice medicine prior to your starting date.

If this letter meets with your approval, please sign and return it to us as soon as possible. Upon each of our signing, this informal, but legally binding, letter will determine the terms of our relationship.

1. Term—You will be an employee of _________________ (the "Practice") starting on or about ___________________________ and continuing thereafter until either you or we terminate our relationship. Either you or we may terminate your employment on ____________( ) days' notice to the other for any reason. If we terminate your employment under this notice, and you continue to work for the Practice during that time, your salary will continue for those ______________( ) days, or until you obtain other employment or practice, if that occurs sooner. Alternatively, we may require your immediate termination of employment with continued pay for such _____________ ( ) period.

Furthermore, we may immediately terminate your employment upon written notice to you at any time if you cease to be fully licensed to practice medicine in _____________, if you should die or become permanently disabled, or if there is other cause for your termination.

For purposes of this Paragraph 1 "permanently disabled" shall mean that you are unable, due to illness or injury, to perform your normal duties for the Practice on a full-time basis for the next six (6) months, as certified by an independent physician selected by the Practice in its sole discretion. (You agree to submit to such examination if requested by the Practice.) "Permanently disabled" shall also mean that you are in fact absent from the Practice due to illness or injury for a total of six (6) months in any twelve (12) month period.

2. Duties—As an employee, you will be involved full-time in our practice of Cardiology and you will not take any outside employment without prior written approval. You agree that the Practice will have the right to designate your working hours and locations, and the fees for your services. You further agree to comply with Practice policies, whether written or established by prior course of conduct. [We will share calls on an equal basis.]

In addition to routine practice, you will be encouraged and expected to develop new sources of patients and to work actively to expand the Practice's geographic and patient base.

3. Compensation
a. Base Salary. Your base salary for the initial twelve (12) months of employment will be _________________________ Thousand Dollars ($___,000), payable according to the Practice's normal payroll periods. For the next twelve (12) month period (starting ________, 200_, your annual base salary will increase to _______________________ Thousand Dollars ($__0,000). For the next twelve (12) month period (starting ________, 200_, your annual base salary will increase to _______________________ Thousand Dollars ($__0,000).

b. Incentive Bonus. Upon completion of each 12-month period of employment, you will be entitled to a bonus based on my evaluation of the following factors:

• Your maintenance of a superior level of clinical knowledge and expertise;
• Your productivity and efficiency in handling patient matters;
• Your willingness and effectiveness in promoting the Practice and yourself, and your attracting new patient and/or referral sources to the Practice;
• Your acceptance of Practice burdens and responsibilities;
• Your interest in the Practice from an entrepreneurial standpoint;
• Your acceptance by patients, physicians, office staff and hospital personnel; and
• Your successful attainment of board certification in __________________when you become eligible.

The amount of this bonus will be between $2,000 and $10,000 as determined by us in our sole discretion based on our evaluation of the factors above. This bonus will be paid to you within thirty (30) days of the end of the bonus period.

c. Taxes. All applicable employment taxes (e.g., FICA, FUTA, state unemployment taxes, etc.) will be withheld by the Practice from all wages and bonuses paid to you.

4. Business Expenses—During your salaried employment, the Practice will pay the cost of your professional liability insurance coverage in the legally required amounts, except as otherwise provided below with respect to "tail" coverage. The Practice will also pay:

• your state licensing fees, and your hospital staff fees at ______________________;
• professional journal subscriptions requested by you, subject to my prior approval;
• your professional education expenses (including airfare, hotels and meals) up to an aggregate maximum reimbursement of $___________ for each 12-month period of employment;
• your documented business telephone and pager calls; and
• your documented moving expenses up to $_______.

Other Practice-related expenses such as entertainment or additional education costs will be paid by you without reimbursement by the Practice, except as otherwise approved by the Practice in advance.

If your employment with the Practice should end at any time and for any reason, you agree that any malpractice premium paid by the Practice for you which covers a period after your termination will be deemed the property of the Practice, and you will direct the Practice's insurer to terminate your coverage and refund the prepaid premium directly to the Practice. If for any reason the insurer fails to so refund the prepaid premium, then you will immediately pay to the Practice an amount equal to the prepaid premium. You will then be entitled to a refund or continued coverage from the insurer. If (a) the Practice does not receive the insurer's refund, and (b) you fail to reimburse the Practice for the prepaid premium, the Practice will have the right to deduct such cost from any remaining salary or bonus payments due to you.

In addition, we agree that upon your termination of employment with the Practice for any reason, the Practice will purchase "tail" coverage for you. You agree to reimburse the Practice such tail cost, or if you fail to so reimburse the Practice, you agree that the Practice will have the right to deduct such cost from any remaining salary or bonus payments owed to you.

5. Fringe Benefits—During your salaried employment, you will be entitled to certain fringe benefits in accordance with the Practice's insurance policies and benefit plans, as they may be amended from time to time (subject to your being accepted for insurance at standard premiums by the Practice's insurers). These currently include basic health and major medical insurance for you and your family, [disability coverage for a portion of your earnings, and group term life insurance protection of $50,000.]

The Practice also maintains a tax-qualified retirement plan. You will be eligible to participate in this plan after an initial waiting period.

6. Vacation/CME—During your first 12 months of employment, you will be entitled to four (4) weeks of vacation and paid professional/education leave. After you have completed 12 months of employment, these allowances will increase to five (5) weeks of vacation and paid professional/education leave per 12-month period of employment.

Arrangements for all such absences must, of course, be made in advance to ensure that the Practice is properly covered. Unused vacation or seminar leave cannot be carried over to succeeding calendar years, nor will you receive compensation for time not taken, either during or upon termination of employment.

7. Disability (Sick) Leave—During your salaried employment, in case of your absence due to illness or injury, your full base salary as described above will continue for a period not exceeding fifteen (15) business days per twelve (12) month period of employment, plus any unused vacation time. Absence in excess of such fifteen (15) business days will be without pay. Paid sick leave is provided only if required and thus not compensated or carried over from year to year if unused. [Medically-necessary pregnancy-related leave (pregnancy, miscarriage, childbirth and recovery, etc.) is treated as absence due to disability.]

8. Leave of Absence—Any leave of absence (any absence not provided for in Paragraphs 6 or 7) is subject to approval and will be without pay. Approved leave may be granted after consideration of all relevant factors, including the essential nature of the requested leave and the burdens to the Practice that would result from your absence.

9. No Ownership Interest—During your employment, unless you become an equity owner/shareholder, you will not be required to contribute any money toward the Practice's equipment or operations, but likewise your work gives you no financial or ownership interest in the Practice's accounts receivable, furniture, equipment, leasehold, patient charts and records, or the like. All remuneration earned during your employment from any medically related activities (including patient care, hospital positions, lecturing, teaching, writing, insurance or legal consultation, etc.) belongs to the Practice, and you will promptly turn over any such amount you receive.

You agree that all charts and records for patients seen by you are the property of the Practice and will not be removed by you from the Practice during your employment or upon your termination. All patient and referrer lists are also the property of the Practice and will not be removed from the Practice or copied by you.

10. Restrictive Covenant—In the course of inviting you to join my Practice of ______________, and in your employment, you will be introduced to and have made available to you all of the Practice's contacts and referring doctor relationships, ongoing patient flow, hospital sources, business and professional relationships and the like. You acknowledge that, since you have not been in private practice in the _______________ area previously, you currently have no established patient following in the _________________ area, nor do you currently have any substantial experience in the "business" of private medical practice.

We have discussed how termination of your employment for any reason or in any manner, followed by your practicing cardiology or any of its disciplines in the Practice's drawing area, would cause you to take many of the sources of the Practice's success with you to the ongoing Practice's detriment. The Practice would have established you in a situation that makes you a very strong competitor for the Practice's current and potential sources. This is particularly true given that you would not have been able to secure privileges at ______________________ (and therefore practice in _____________ at all) without the Practice's assistance. You acknowledge that we would not have helped you secure such privileges without the protection offered by this covenant.

You therefore agree that, during your employment and for a period of two (2) years after your employment ends (for any reason), you will not render any __________________ services in any capacity (e.g., employee, shareholder, independent contractor) within a _____ (__) air mile radius of any office or place of business of the Practice which exists on the date of your termination. This includes (i.e. restricts) your practice at any hospital within such ______ (__) mile radius. You and we agree that the ______ (__) miles radius is a reasonable protection for our practice, which currently draws patients beyond the ____ mile radius, throughout __________ County.

Similarly, you agree that the two (2) years length of the restriction is reasonable because of (i) the long lead time needed to find a replacement physician (newly trained urologists complete their residencies in June, and are therefore only available to start work at one time during the year); (ii) the time required to secure hospital privileges for the replacement doctor, which involves extensive paperwork and approvals; (iii) the time needed to credential the new doctor with the Practice's payors; (iv) training time, once on the job; and (v) time to integrate the doctor into our practice and establish him or her with patients and referrers, all of which would be undermined by your active competition during this time.

You agree that this restriction applies if your employment ends at any time and for any reason (even if we were to ask you to leave) until and unless a succeeding written agreement no longer contains this restriction. You agree that no alleged breach of this agreement shall be a defense to enforcement of this non-compete provision or the non-solicitation provision below.

You further agree that the Practice is empowered to enforce your promise by obtaining an injunction in court (without the necessity of posting any bond). If the Practice does obtain such an injunction, then whatever portion of the two (2) year period has not expired as of the date the covenant was first violated will begin to run from the date of the final court decision on the claim for injunctive relief.

You expressly agree that if you violate this restrictive covenant, even a grant of injunctive relief may not fully compensate the Practice for the damage suffered from your competitive actions while you were in breach of the covenant, and that, therefore, in addition to seeking an injunction, the Practice may pursue any other available remedies including, but not limited to recovery of money damages, as compensation for the period in which you competed in violation of this restrictive covenant. You specifically agree that the Practice will have the right to reimbursement from you for reasonable attorney's fees and court costs incurred in enforcing this covenant.

11. Non-solicitation Covenant—Recognizing that your duty to the Practice as your employer extends beyond your employment, you agree that, if your employment ends for any reason or in any manner, whether or not you practice within the non-compete area described above, you will in no event, directly or indirectly: (i) solicit for treatment any former or existing patient (or member of any patient's household) of the Practice, or attempt to influence such individual to terminate his or her relationship with the Practice; (ii) employ in your new practice any employee of the Practice; (iii) induce or attempt to influence any hospital, other health care facility, any physician or any other professional with a referring relationship with the Practice to terminate that relationship; or (iv) solicit any patient service contractual arrangement of the Practice, all for a period of two (2) years immediately following the end of your employment.

You agree that, if you violate this non-solicitation promise, the Practice will be entitled to money damages in an amount established by the court as compensation to the Practice for these actions, together with my legal costs and other expenses for enforcing this provision, which you agree to reimburse to the Practice.

* * *

__________[first name], we hope this letter agreement meets with your approval, and we look forward to working with you. If you agree to these terms and agree that they shall be legally binding upon you and the Practice, please sign three copies of this letter agreement. We will then return one fully executed copy to you for your personal records. We will each then have copies signed by the other, to evidence our agreement.

To discuss any part of this agreement further, please call me at your earliest convenience.

Sincerely, _________________________, P.C.

By: ____________________________
[Senior doctor, M.D.]
President

Agreed and accepted this day of , 2000. ____________________________
[Junior doctor, M.D.]

General Contract Points

• When in doubt about the meaning or the intent of a term in an agreement, ask. If necessary, have the clause revised.
• Never sign a contract with ambiguous language or based on verbal assurances that are contrary to the stated contract language.
• Deal directly with the practice representative to discuss the contract terms. Avoid negotiating with the practice's lawyer.
• Have a lawyer or consultant familiar with these types of contracts review your arrangement to help determine if your contract is fair, reasonable, and complete.
• Pay attention to the practice's negotiating style. Are they being reasonable or heavy-handed? Does this style of negotiation leave you to believe that other problems may develop? Is there information that the practice has not fully disclosed?

Summary of Contract Terms

Contact membership@acc.org; 800-253-4636, ext. 5603; 202-375-6000, ext. 5603

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