WEBVTT 00:00:46.089 --> 00:00:48.750 Welcome to Our Voices, Our Future, the podcast 00:00:48.750 --> 00:00:51.070 where we amplify the voices driving change in 00:00:51.070 --> 00:00:53.469 equity within medicine and beyond. Brought to 00:00:53.469 --> 00:00:55.670 you by the Gender Equity Task Force, a committee 00:00:55.670 --> 00:00:57.929 of the American Medical Women's Association. 00:00:58.469 --> 00:01:00.630 We're here to challenge norms, break barriers, 00:01:00.829 --> 00:01:03.570 and ignite conversations that matter. I'm Meenu 00:01:03.570 --> 00:01:06.129 Mnaney, and in each episode we'll bring you candid 00:01:06.129 --> 00:01:08.810 discussions with leaders, change makers, and 00:01:08.810 --> 00:01:10.930 advocates working to create a more inclusive 00:01:10.930 --> 00:01:13.900 and just world. No more silence, no more waiting. 00:01:14.079 --> 00:01:16.599 You're listening to our voices, our future. Let's 00:01:16.599 --> 00:01:19.519 get into it. Today, we're welcoming Mary Dunn, 00:01:19.680 --> 00:01:22.659 who is an attorney, practice manager at Juggernautha 00:01:22.659 --> 00:01:26.099 Neurosurgery, and a social media manager for 00:01:26.099 --> 00:01:28.239 Dr. Juggernautha as well. Thank you for being 00:01:28.239 --> 00:01:31.000 here, Mary. Thank you for having me. I'm excited 00:01:31.000 --> 00:01:35.099 to share with you all. Can you get us started 00:01:35.099 --> 00:01:36.859 by telling us a little bit about your background 00:01:36.859 --> 00:01:38.900 and what kind of motivated you to specialize 00:01:38.900 --> 00:01:41.939 in contract negotiations for physicians? Sure. 00:01:42.120 --> 00:01:44.579 So my background actually started out in real 00:01:44.579 --> 00:01:47.719 estate law. During undergrad, I worked for a 00:01:47.719 --> 00:01:50.640 local law firm that handled residential default 00:01:50.640 --> 00:01:53.239 services, which is basically loan modification, 00:01:53.439 --> 00:01:56.280 foreclosures, bankruptcies, representing banks. 00:01:56.739 --> 00:01:59.319 I clerked for them during law school. And then 00:01:59.319 --> 00:02:01.280 when I finished law school and passed the bar, 00:02:01.519 --> 00:02:04.739 I was hired as an associate attorney. So this 00:02:04.739 --> 00:02:06.799 was a really great opportunity for me because 00:02:06.799 --> 00:02:10.020 it put me in a courtroom almost every day. A 00:02:10.020 --> 00:02:12.879 lot of attorneys who just do contracts, they 00:02:12.879 --> 00:02:15.939 never step foot in a courtroom. So I knew that 00:02:15.939 --> 00:02:18.099 this was the time to get that experience because 00:02:18.099 --> 00:02:20.300 otherwise I might not ever get that experience 00:02:20.300 --> 00:02:24.060 in my career. And then as for my transition to 00:02:24.060 --> 00:02:26.479 healthcare, I kind of grew into it organically. 00:02:27.479 --> 00:02:30.240 I married a neurosurgeon and then I have a brother 00:02:30.240 --> 00:02:32.719 and a sister -in -law who are also physicians. 00:02:33.460 --> 00:02:35.680 So one of them is a hand surgeon and the other 00:02:35.680 --> 00:02:39.060 is an internist. So before my husband and I were 00:02:39.060 --> 00:02:41.740 even married, I started reviewing his contracts. 00:02:42.120 --> 00:02:44.319 And the thing about surgeons is they're in high 00:02:44.319 --> 00:02:46.659 demand. Hospitals are always looking to poach 00:02:46.659 --> 00:02:49.960 them and you receive offers for employment, not 00:02:49.960 --> 00:02:53.099 infrequently. So he was getting quite a number 00:02:53.099 --> 00:02:55.740 of contracts. So I started reviewing all of these 00:02:55.740 --> 00:02:58.939 contracts. And then we also started my husband's 00:02:58.939 --> 00:03:02.000 practice around the same time. So I really developed 00:03:02.000 --> 00:03:04.639 a passion for it. And then what started helping 00:03:04.639 --> 00:03:07.400 started us helping out family and friends occasionally 00:03:07.400 --> 00:03:10.180 grew into a full -time job as my husband started 00:03:10.180 --> 00:03:12.599 his practice and it grew and it continues to 00:03:12.599 --> 00:03:16.020 grow. I love that it's so organically like kind 00:03:16.020 --> 00:03:19.819 of just came to be. My next question is kind 00:03:19.819 --> 00:03:21.960 of about like why are contracts particularly 00:03:21.960 --> 00:03:24.240 important for female physicians entering into 00:03:24.240 --> 00:03:28.550 the medical field today? So my biggest message 00:03:28.550 --> 00:03:31.789 for all of you is to negotiate your contract 00:03:31.789 --> 00:03:35.169 upfront. with an attorney. You'll never have 00:03:35.169 --> 00:03:37.849 more bargaining power than you do at the time 00:03:37.849 --> 00:03:41.090 of your initial contract negotiation. So it not 00:03:41.090 --> 00:03:44.530 only dictates your current position, but it dictates 00:03:44.530 --> 00:03:47.009 your future positions as well. So for example, 00:03:47.009 --> 00:03:49.750 if you live in an area where non -competes are 00:03:49.750 --> 00:03:52.729 enforceable, then your current contract can dictate 00:03:52.729 --> 00:03:56.150 how far away your next job has to be. Or if you 00:03:56.150 --> 00:03:59.129 have a collections based compensation model, 00:03:59.409 --> 00:04:01.650 it can dictate the collections you'll continue 00:04:01.650 --> 00:04:04.659 to receive for work performed at your next job. 00:04:05.479 --> 00:04:10.080 I saw one contract somebody had and it was collections 00:04:10.080 --> 00:04:12.719 based. So they got a percent of their collections 00:04:12.719 --> 00:04:16.560 for their surgeries, but once they left the employment, 00:04:16.899 --> 00:04:19.579 they no longer were eligible to receive collections. 00:04:19.740 --> 00:04:21.899 Now your collections usually take between 15 00:04:21.899 --> 00:04:25.399 and 45 days to come in after you do the case. 00:04:25.920 --> 00:04:29.000 So if you were to leave, all of your collections 00:04:29.000 --> 00:04:31.579 for the last 45 days for all that work you would 00:04:31.579 --> 00:04:34.379 never see. So you want to have a good negotiation, 00:04:34.579 --> 00:04:37.120 good contract lawyer, reviewer your contract 00:04:37.120 --> 00:04:40.920 upfront so that when you leave you have a favorable 00:04:40.920 --> 00:04:43.500 ending and you don't have to hire an attorney 00:04:43.500 --> 00:04:46.079 to fight it at that point. It's easier to just 00:04:46.079 --> 00:04:48.740 hire somebody upfront and negotiate it on the 00:04:48.740 --> 00:04:53.160 front end. So collections for people who might 00:04:53.160 --> 00:04:55.639 not know like what that term means is like it's 00:04:55.639 --> 00:04:58.339 not like services paid for like that you've already 00:04:58.339 --> 00:05:00.560 kind of done the work for, but you're getting 00:05:00.560 --> 00:05:03.100 it like later, the payment is later than the 00:05:03.100 --> 00:05:07.000 service. That's correct. So sometimes confused 00:05:07.000 --> 00:05:11.319 with an RVU based compensation model. RVU based 00:05:11.319 --> 00:05:14.480 is for how much work you do, irrespective of 00:05:14.480 --> 00:05:16.600 how much is collected for that. So maybe you 00:05:16.600 --> 00:05:18.860 did the surgery, but the patient didn't have 00:05:18.860 --> 00:05:21.879 insurance, you would still be paid under an RVU 00:05:21.879 --> 00:05:25.889 based modeling model. On the other hand, collections 00:05:25.889 --> 00:05:29.069 -based is how much you actually collect. So maybe 00:05:29.069 --> 00:05:31.850 you're only doing elective cases. Maybe everybody 00:05:31.850 --> 00:05:34.529 has insurance. So you're obviously going to be 00:05:34.529 --> 00:05:36.569 paid more for patients with better insurance 00:05:36.569 --> 00:05:39.709 than if they have a worse insurance. That's a 00:05:39.709 --> 00:05:43.069 collections -based model. So it takes anywhere 00:05:43.069 --> 00:05:46.689 between 15 and 45 days. on average, typically, 00:05:47.050 --> 00:05:49.350 to start getting the money in. Now, some cases 00:05:49.350 --> 00:05:52.610 are litigated. Maybe some claims have to be appealed. 00:05:52.810 --> 00:05:54.970 Maybe somebody didn't get an authorization and 00:05:54.970 --> 00:05:57.769 they have to go back and submit additional paperwork. 00:05:58.709 --> 00:06:01.750 Some insurances are conducting audits before 00:06:01.750 --> 00:06:05.470 they'll pay. So there is a lag in time if you're 00:06:05.470 --> 00:06:08.550 collections -based. So you might not get money 00:06:08.550 --> 00:06:11.029 right away when you're starting a collection 00:06:11.029 --> 00:06:12.910 space because you have to wait for the collections 00:06:12.910 --> 00:06:16.079 to come in. But then when you leave, you already 00:06:16.079 --> 00:06:18.480 have collections. So that money should continue 00:06:18.480 --> 00:06:21.100 for a little while. Okay, that's good to know. 00:06:21.259 --> 00:06:24.060 I had no idea that was a different like contract 00:06:24.060 --> 00:06:27.800 term that existed. You previously mentioned to 00:06:27.800 --> 00:06:30.560 get a lawyer to kind of help you negotiate that 00:06:30.560 --> 00:06:33.060 initial contract. So for like women that are 00:06:33.060 --> 00:06:35.860 kind of just like coming out of residency around 00:06:35.860 --> 00:06:39.120 like, how in advance should they seek out that 00:06:39.120 --> 00:06:41.350 counsel? like when they're looking is it like 00:06:41.350 --> 00:06:44.209 when they start their job search um is it once 00:06:44.209 --> 00:06:46.949 they have a interview and are ready about like 00:06:46.949 --> 00:06:48.850 in the negotiation stage like what does that 00:06:48.850 --> 00:06:50.529 kind of look like if you have any advice on that 00:06:50.529 --> 00:06:53.670 so we don't need a lawyer until you have a contract 00:06:53.670 --> 00:06:57.029 in your hand the lawyer will review the contract 00:06:57.029 --> 00:06:59.269 for you and you want to make sure that the lawyer 00:06:59.269 --> 00:07:02.660 specializes in health care law specifically because 00:07:02.660 --> 00:07:05.040 that way they have already probably worked with 00:07:05.040 --> 00:07:08.879 this hospital. Hospital CEOs turn over quickly. 00:07:08.980 --> 00:07:10.959 So maybe they worked with them at another hospital. 00:07:11.040 --> 00:07:12.860 Maybe they worked with them at this hospital. 00:07:13.180 --> 00:07:15.779 So they have those relationships already. They 00:07:15.779 --> 00:07:19.199 have already know what this hospital is giving 00:07:19.199 --> 00:07:22.740 to other. um similar providers in your area and 00:07:22.740 --> 00:07:25.680 they know what other competing hospitals are 00:07:25.680 --> 00:07:28.459 giving to other similar physicians and maybe 00:07:28.459 --> 00:07:30.939 they know just in the larger network of health 00:07:30.939 --> 00:07:33.980 care systems what's being offered so it's a it's 00:07:33.980 --> 00:07:37.699 a huge advantage to have an attorney who has 00:07:37.699 --> 00:07:40.920 negotiated contracts like this before who knows 00:07:40.920 --> 00:07:43.660 what you're worth who knows how much money there 00:07:43.660 --> 00:07:47.610 is in the budget um i can say for for us as an 00:07:47.610 --> 00:07:50.129 employer of different providers of different 00:07:50.129 --> 00:07:52.829 types, I know what my margins are. I know what 00:07:52.829 --> 00:07:55.430 I can afford to pay somebody. I know what my 00:07:55.430 --> 00:07:58.350 max is. So a good health care attorney will also 00:07:58.350 --> 00:08:00.910 have a lot of that same information. They know 00:08:00.910 --> 00:08:03.449 what they can get for you better than you do. 00:08:05.269 --> 00:08:07.670 So what are some common pitfalls that you see 00:08:07.670 --> 00:08:10.269 like female physicians that like they encounter 00:08:10.269 --> 00:08:12.529 during contract negotiations and how can they 00:08:12.529 --> 00:08:16.550 avoid them? So things that I see in contracts 00:08:16.550 --> 00:08:19.910 that you want to make sure you have your lawyer 00:08:19.910 --> 00:08:25.389 work on for you, one is call. So how many physicians 00:08:25.389 --> 00:08:28.670 share the call responsibility and how is the 00:08:28.670 --> 00:08:32.669 call split? So this also gets into hospital bylaws 00:08:32.669 --> 00:08:35.970 because sometimes the hospital bylaws will say 00:08:35.970 --> 00:08:41.009 it gets shared among however many surgeons, neurosurgeons, 00:08:41.110 --> 00:08:43.399 let's say for example. have privileges here. 00:08:43.659 --> 00:08:46.159 So then if there are three neurosurgeons there, 00:08:46.639 --> 00:08:49.600 it has to be split three ways. So sometimes you 00:08:49.600 --> 00:08:52.200 split it pro rata, where you each take 10 days. 00:08:52.440 --> 00:08:54.460 Sometimes it doesn't have to be shared equally. 00:08:55.419 --> 00:08:58.600 One thing that I see is if it's shared pro rata, 00:08:59.080 --> 00:09:03.620 who decides? And are the weekends and holidays 00:09:03.620 --> 00:09:06.789 also split equally? Because otherwise, what you 00:09:06.789 --> 00:09:10.049 run into is the new person or the young person 00:09:10.049 --> 00:09:13.029 gets all the weekends in the holidays. So you 00:09:13.029 --> 00:09:16.230 want to make sure that it's split in a way that's 00:09:16.230 --> 00:09:18.730 fair. And you also want to know who decides. 00:09:19.149 --> 00:09:22.549 So is it a competitor who's deciding? Is it somebody 00:09:22.549 --> 00:09:24.350 within your group who makes the call schedule? 00:09:24.629 --> 00:09:26.909 You kind of want to know who's making the schedule, 00:09:27.049 --> 00:09:29.070 who's making these decisions, and can you work 00:09:29.070 --> 00:09:33.059 with them? Another thing I see is hospitals will 00:09:33.059 --> 00:09:37.000 often pay more for holiday calls, sometimes weekend 00:09:37.000 --> 00:09:40.379 call, but typically holiday call. So if you are 00:09:40.379 --> 00:09:42.879 taking holidays, if you are taking weekends, 00:09:42.899 --> 00:09:46.320 or if you take extras, how much do you get paid? 00:09:46.639 --> 00:09:49.379 And the amount that you get paid extra for call 00:09:49.379 --> 00:09:52.519 in for specialty call like this varies and it's 00:09:52.519 --> 00:09:54.559 negotiable. So you want to negotiate that in 00:09:54.559 --> 00:09:57.879 your contract. Also in your contract bonuses. 00:09:58.519 --> 00:10:01.110 So you want to make sure that you get bonuses 00:10:01.110 --> 00:10:03.769 that you're entitled to and that hospitals typically 00:10:03.769 --> 00:10:07.389 pay and the amounts of bonuses are also negotiable. 00:10:07.870 --> 00:10:11.169 So have your lawyer negotiate whatever they offer. 00:10:11.389 --> 00:10:13.750 There's probably some wiggle room for negotiation. 00:10:14.169 --> 00:10:17.269 So typically you'll have a signing bonus. So 00:10:17.269 --> 00:10:19.830 you want to expect that. You can also look for 00:10:19.830 --> 00:10:22.830 productivity bonuses, maybe a year end bonus. 00:10:23.149 --> 00:10:25.950 Sometimes if you stay there for over a certain 00:10:25.950 --> 00:10:29.000 amount of time, you'll get a retention bonus. 00:10:29.639 --> 00:10:32.159 Sometimes if you do all of your charting in a 00:10:32.159 --> 00:10:35.200 timely manner, you'll get a bonus for that. If 00:10:35.200 --> 00:10:37.480 you're relocating to work there, you should look 00:10:37.480 --> 00:10:40.120 for a relocation bonus. And if the amount is 00:10:40.120 --> 00:10:45.279 not enough, ask for more. So not only are the 00:10:45.279 --> 00:10:48.279 bonuses negotiable, the amounts are negotiable, 00:10:48.379 --> 00:10:51.240 but also the terms of the bonuses. So sometimes 00:10:51.240 --> 00:10:54.049 if they offer you a relocation bonus, but you 00:10:54.049 --> 00:10:56.549 don't stay the term of your contract, they might 00:10:56.549 --> 00:10:58.509 want you to pay that back, or they might want 00:10:58.509 --> 00:11:00.750 you to pay back your signing bonus. So you want 00:11:00.750 --> 00:11:03.269 to make sure that the terms of the bonuses are 00:11:03.269 --> 00:11:06.789 also favorable to you. If you're moving to a 00:11:06.789 --> 00:11:09.090 new place, for example, it might not work out. 00:11:09.429 --> 00:11:11.090 Make sure you're not going to be on the hook 00:11:11.090 --> 00:11:13.570 to repay a whole bunch of bonuses when you leave. 00:11:14.549 --> 00:11:18.629 Another area that you need to watch out for is 00:11:18.629 --> 00:11:22.389 your malpractice insurance. So the contract will 00:11:22.389 --> 00:11:24.950 state the amount of malpractice insurance that 00:11:24.950 --> 00:11:28.269 they'll provide for you. So this amount is negotiable. 00:11:28.309 --> 00:11:30.870 So this gets back again to the importance of 00:11:30.870 --> 00:11:33.870 having a good healthcare attorney because they'll 00:11:33.870 --> 00:11:37.590 know how much insurance you need for your specialty 00:11:37.590 --> 00:11:41.350 and in your geographic area. For example, I live 00:11:41.350 --> 00:11:47.639 in Detroit. You need more malpractice insurance 00:11:47.639 --> 00:11:52.360 in Detroit than you do in a more rural area where 00:11:52.360 --> 00:11:54.879 people are less litigious, maybe the claim amounts 00:11:54.879 --> 00:11:57.620 are smaller. So your healthcare attorney can 00:11:57.620 --> 00:12:00.259 make sure that the amount of insurance that they're 00:12:00.259 --> 00:12:03.779 providing is sufficient for where you're practicing 00:12:03.779 --> 00:12:07.679 and what your specialty is. It will also state 00:12:07.679 --> 00:12:12.139 whether it's claims -based or occurrence -based 00:12:12.139 --> 00:12:16.990 malpractice. two totally different types of malpractice. 00:12:17.250 --> 00:12:21.590 A current space provides lasting coverage for 00:12:21.590 --> 00:12:25.610 your past acts. So while you're working at hospital 00:12:25.610 --> 00:12:30.110 A, maybe something happens. You later leave and 00:12:30.110 --> 00:12:33.230 work for hospital B. So that insurance from hospital 00:12:33.230 --> 00:12:35.950 A is canceled. However, if you have a current 00:12:35.950 --> 00:12:38.029 space, you would still be covered for all the 00:12:38.029 --> 00:12:41.639 work that you did there. If you have claims based, 00:12:41.759 --> 00:12:45.419 it's a cheaper policy, but it only covers you 00:12:45.419 --> 00:12:49.600 while you have the policy active. So if you leave 00:12:49.600 --> 00:12:52.720 and then somebody files a claim, you don't have 00:12:52.720 --> 00:12:56.279 that insurance anymore. So if your contract has 00:12:56.279 --> 00:13:00.460 claims based, then you need to purchase a tail 00:13:00.460 --> 00:13:05.470 and a tail will cover that. So if the contract 00:13:05.470 --> 00:13:08.090 has claims -based insurance for you, the contract 00:13:08.090 --> 00:13:12.049 should also say they'll pay your tail. If for 00:13:12.049 --> 00:13:16.009 some reason you already have your contract and 00:13:16.009 --> 00:13:18.690 it doesn't make them pay for a tail, then what 00:13:18.690 --> 00:13:21.970 you need to do when you go to your next job is 00:13:21.970 --> 00:13:25.309 you ask the next job to pick up a no's. So the 00:13:25.309 --> 00:13:28.649 no's would then cover those past acts from the 00:13:28.649 --> 00:13:31.679 old job. So this is another piece where it's 00:13:31.679 --> 00:13:33.600 really important to have a healthcare attorney 00:13:33.600 --> 00:13:36.940 work this out for you because you don't want 00:13:36.940 --> 00:13:39.440 to be in a situation where you leave a job and 00:13:39.440 --> 00:13:41.700 you have no coverage for a claim that's filed 00:13:41.700 --> 00:13:44.919 at your old job. No, that makes sense. That's 00:13:44.919 --> 00:13:48.659 a lot of little details. It's a lot. Yeah. And 00:13:48.659 --> 00:13:50.899 it's really, I see the importance of having someone 00:13:50.899 --> 00:13:53.080 to kind of look through it. Even if you even 00:13:53.080 --> 00:13:55.220 have a little bit of like experience or knowledge, 00:13:55.320 --> 00:13:56.980 I think having just a second set of eyes that 00:13:56.980 --> 00:13:59.159 is doing this on a daily basis, I can see how 00:13:59.159 --> 00:14:01.559 useful that will be. It's much more nuanced, 00:14:01.659 --> 00:14:05.940 I think, than people realize. One other thing 00:14:05.940 --> 00:14:10.000 that I'm seeing, background checks. So I'm seeing 00:14:10.000 --> 00:14:14.000 where an employer wants to perform a background 00:14:14.000 --> 00:14:17.179 check, the actual language, this is an actual 00:14:18.020 --> 00:14:21.440 contract that they want to consult with any third 00:14:21.440 --> 00:14:25.460 party who may have info on you, including otherwise 00:14:25.460 --> 00:14:28.639 privileged or confidential information. So this 00:14:28.639 --> 00:14:31.379 would allow the hospital to go to anyone, your 00:14:31.379 --> 00:14:35.220 neighbor, your Facebook friend, your doctor, 00:14:36.279 --> 00:14:38.539 anyone and get any information, even if it's 00:14:38.539 --> 00:14:40.799 privileged or confidential. So you want your 00:14:40.799 --> 00:14:44.480 attorney to negotiate a background check that 00:14:44.480 --> 00:14:47.220 doesn't include them. talking to anyone you've 00:14:47.220 --> 00:14:49.700 ever met about anything, however private and 00:14:49.700 --> 00:14:52.960 unrelated to your work it might be. Maybe they 00:14:52.960 --> 00:14:55.360 can query the data bank, maybe they can check 00:14:55.360 --> 00:14:58.200 references that you provide, but it's not an 00:14:58.200 --> 00:15:00.460 unlimited phishing expedition. So again, you 00:15:00.460 --> 00:15:02.899 want to be careful what you sign and have someone 00:15:02.899 --> 00:15:05.019 look at it for you to make sure you're not signing 00:15:05.019 --> 00:15:10.980 your life away. In your experience, how can women 00:15:10.980 --> 00:15:13.440 in medicine effectively communicate their worth 00:15:13.440 --> 00:15:16.659 and value during negotiations? especially first 00:15:16.659 --> 00:15:19.299 time contract negotiations, I feel like, because 00:15:19.299 --> 00:15:21.720 I feel like residency interviews and like residency, 00:15:21.720 --> 00:15:23.620 we don't get as much say, but like our first 00:15:23.620 --> 00:15:27.059 attending job that we go out to, what is some 00:15:27.059 --> 00:15:30.019 advice you have? So I've already said this, I 00:15:30.019 --> 00:15:31.799 feel like I don't want to keep repeating it, 00:15:31.980 --> 00:15:35.980 but hire a good attorney. In Michigan, there 00:15:35.980 --> 00:15:40.039 are two, there were two lawsuits. So one of them 00:15:40.039 --> 00:15:44.279 was brought by a group of NPs who are mainly 00:15:44.279 --> 00:15:49.360 women. against U of M stating that PAs, the physician 00:15:49.360 --> 00:15:52.200 assistants, were making more than them. Now, 00:15:52.480 --> 00:15:55.340 the NPs were saying they're mostly women and 00:15:55.340 --> 00:15:58.039 they were saying the PAs were mostly men. And 00:15:58.039 --> 00:16:00.639 the PAs and the NPs did largely the same work, 00:16:00.840 --> 00:16:02.879 their reimbursements were the same. And so there 00:16:02.879 --> 00:16:04.460 shouldn't have been such a disparity between 00:16:04.460 --> 00:16:06.919 the incomes of the NPs and the PAs. They were 00:16:06.919 --> 00:16:10.799 actually successful. And then this past April, 00:16:11.740 --> 00:16:15.809 female PAs at U of M brought in action against 00:16:15.809 --> 00:16:19.490 U of M, stating the male PAs were making on average 00:16:19.490 --> 00:16:23.850 $9 ,000 more. than the females. So that obviously 00:16:23.850 --> 00:16:26.889 is still pending. It was just filed. But I think 00:16:26.889 --> 00:16:29.250 this gets back to the importance of having an 00:16:29.250 --> 00:16:31.570 attorney review this for you, because they'll 00:16:31.570 --> 00:16:33.870 know how much the men are making. They'll have 00:16:33.870 --> 00:16:36.830 worked on the contracts for men and women. They'll 00:16:36.830 --> 00:16:38.809 have worked on other mid -level contracts for 00:16:38.809 --> 00:16:40.889 the university. They'll know how much other people 00:16:40.889 --> 00:16:43.990 are getting. So your point of biggest bargaining 00:16:43.990 --> 00:16:47.799 power. It's before you start during the contract 00:16:47.799 --> 00:16:50.440 negotiations. Once you have a contract and you're 00:16:50.440 --> 00:16:52.860 earning less, they're not gonna just say, sure, 00:16:52.919 --> 00:16:54.799 I'll pay you more. You're gonna have to hire 00:16:54.799 --> 00:16:58.419 a lawyer, sue them. It takes years. If it's successful, 00:16:58.419 --> 00:17:00.820 maybe, maybe not. And then you're still gonna 00:17:00.820 --> 00:17:03.279 have to pay your attorney fees. It's really not 00:17:03.279 --> 00:17:05.359 that helpful. It's more about making the point 00:17:05.359 --> 00:17:07.740 at that point. So you really wanna hire a good 00:17:07.740 --> 00:17:10.240 healthcare attorney upfront. Have them work this 00:17:10.240 --> 00:17:11.940 out for you so you don't have to worry about 00:17:11.940 --> 00:17:16.319 it. I think it's about information and being 00:17:16.319 --> 00:17:21.619 preemptive rather than reactionary. What legal 00:17:21.619 --> 00:17:24.779 protections exist for female physicians regarding 00:17:24.779 --> 00:17:27.640 pay equity, discrimination, and contract negotiations? 00:17:29.059 --> 00:17:34.000 So in Michigan, there's a lot that the mid -levels 00:17:34.000 --> 00:17:36.680 that you have added. for filing under a Michigan 00:17:36.680 --> 00:17:38.519 law. So it would depend on the state that you're 00:17:38.519 --> 00:17:41.339 in and what legal protections they have. But 00:17:41.339 --> 00:17:43.339 again, if you're already at the point of having 00:17:43.339 --> 00:17:47.240 to hire an attorney and sue, it's not technically 00:17:47.240 --> 00:17:50.359 too late, but the best time to negotiate it and 00:17:50.359 --> 00:17:52.720 figure that out is at the time that you're offered 00:17:52.720 --> 00:17:56.599 the contract. I think if we take one thing away 00:17:56.599 --> 00:17:59.559 from our conversation is hire a lawyer at the 00:17:59.559 --> 00:18:01.660 start of the contract. An experienced healthcare 00:18:01.660 --> 00:18:05.200 attorney is gonna be your best friend. And I 00:18:05.200 --> 00:18:07.079 think that's important, especially for people 00:18:07.079 --> 00:18:10.119 starting out to learn that, because I feel like 00:18:10.119 --> 00:18:12.759 if you don't hear it, I don't think you would 00:18:12.759 --> 00:18:16.240 know to do it. I think a lot of people try to 00:18:16.240 --> 00:18:19.259 read the contract themselves, and you don't know 00:18:19.259 --> 00:18:21.400 what you don't know. You don't know what other 00:18:21.400 --> 00:18:23.059 people are getting offered. You don't realize 00:18:23.059 --> 00:18:27.420 how bad your contract might be. Next question 00:18:27.420 --> 00:18:29.940 is going to be more about support networks. How 00:18:29.940 --> 00:18:31.779 important do you think support networks are just 00:18:31.779 --> 00:18:34.759 mentorship or professional organizations? are 00:18:34.759 --> 00:18:38.140 in negotiation, like in negotiating contracts 00:18:38.140 --> 00:18:41.359 and what resources would you recommend for these 00:18:41.359 --> 00:18:45.940 groups and like anyone in general? So I think 00:18:45.940 --> 00:18:49.460 this can't be emphasized enough. Having a strong 00:18:49.460 --> 00:18:51.680 support network will help you understand what 00:18:51.680 --> 00:18:54.000 others are being offered for similar services. 00:18:54.440 --> 00:18:56.779 how much call they're having to take, how many 00:18:56.779 --> 00:18:59.400 weekends and holidays, what type of bonuses they're 00:18:59.400 --> 00:19:01.500 receiving, and all the important contract terms 00:19:01.500 --> 00:19:04.119 that you'll want to negotiate for. So like having 00:19:04.119 --> 00:19:07.160 an attorney who also has that information, speaking 00:19:07.160 --> 00:19:09.759 with other providers will also give you more 00:19:09.759 --> 00:19:11.880 insight into what other people are getting in 00:19:11.880 --> 00:19:14.440 their contracts. So it's helpful to know what 00:19:14.440 --> 00:19:17.000 these same hospital systems are offering to others. 00:19:17.440 --> 00:19:20.119 And if you have mentorship available at your 00:19:20.119 --> 00:19:22.900 program, utilize it. If you're on social media, 00:19:23.220 --> 00:19:25.259 connect with other doctors, both within your 00:19:25.259 --> 00:19:28.480 specialty and in other specialties. We've been 00:19:28.480 --> 00:19:32.779 on social media actively for a little over a 00:19:32.779 --> 00:19:35.720 year now, and our network has grown so much. 00:19:36.359 --> 00:19:38.640 So where before we maybe just knew people within 00:19:38.640 --> 00:19:41.519 our own state or within our own region, now we've 00:19:41.519 --> 00:19:43.500 connected with people all over the country and 00:19:43.500 --> 00:19:46.500 all over the world. So it's helpful not just 00:19:46.500 --> 00:19:50.759 in terms of connection, but also job opportunities, 00:19:51.380 --> 00:19:53.220 seeing what other people are getting in other 00:19:53.220 --> 00:19:57.460 areas. It helps in so many bigger ways to connect 00:19:57.460 --> 00:20:00.880 with other people. So you may need a job one 00:20:00.880 --> 00:20:03.140 day or they may need a job one day. You may be 00:20:03.140 --> 00:20:05.599 an employer yourself one day if you go into private 00:20:05.599 --> 00:20:09.200 practice and the larger your network is, the 00:20:09.200 --> 00:20:15.019 more people you have to talk to. I think social 00:20:15.019 --> 00:20:17.339 media has helped that a lot of ways of like increasing 00:20:17.339 --> 00:20:19.940 your community and conversations and building 00:20:19.940 --> 00:20:22.279 that. I think that's a positive of social media 00:20:22.279 --> 00:20:24.920 and like I think this day and age. So it's really 00:20:24.920 --> 00:20:28.180 great to hear. And I love that advice about expanding 00:20:28.180 --> 00:20:32.000 your network. It might not need to be in person, 00:20:32.500 --> 00:20:35.359 but I think you need to expand your network. 00:20:37.980 --> 00:20:40.200 If female physicians face discrimination, like 00:20:40.200 --> 00:20:43.460 we talked about the case with Michigan, during 00:20:43.460 --> 00:20:46.900 the negotiation process, what steps would you 00:20:46.900 --> 00:20:52.599 recommend someone take to address that? So I 00:20:52.599 --> 00:20:55.940 would say you can go to the hospital or the employer, 00:20:56.460 --> 00:21:00.869 but frankly, If you've signed a contract, you 00:21:00.869 --> 00:21:02.730 could have had an attorney review it for you. 00:21:02.730 --> 00:21:05.470 You don't have a lot of bargaining power. So 00:21:05.470 --> 00:21:09.470 your best time to avoid this and to make sure 00:21:09.470 --> 00:21:11.910 that you're not the victim of discrimination 00:21:11.910 --> 00:21:14.470 is right at the beginning when they offer your 00:21:14.470 --> 00:21:17.529 contract before you sign it. If you've already 00:21:17.529 --> 00:21:20.750 signed it, you can still hire an attorney. But 00:21:20.750 --> 00:21:24.589 in the cases I described, they had a group. The 00:21:24.589 --> 00:21:27.730 first case with the NPs versus the PAs, they 00:21:27.730 --> 00:21:31.930 had 30 NPs who experienced the same thing. In 00:21:31.930 --> 00:21:34.210 the case that was just brought in April with 00:21:34.210 --> 00:21:37.349 the female PAs versus the male PAs, there are 00:21:37.349 --> 00:21:42.609 300 of them. So yes, it happens. But if enough 00:21:42.609 --> 00:21:45.430 people are hiring attorneys, then they'll have 00:21:45.430 --> 00:21:49.829 better contracts. So your success is really only 00:21:49.829 --> 00:21:52.269 going to be if other people are experiencing 00:21:52.269 --> 00:21:54.789 the same thing. If maybe your contract's just 00:21:54.789 --> 00:21:57.430 a little bit worse, what attorney is going to 00:21:57.430 --> 00:21:59.609 take that case? Because this would be a contingent 00:21:59.609 --> 00:22:01.849 fee case. They'll take a fee at the end when 00:22:01.849 --> 00:22:04.450 they're successful. You're not paying them on 00:22:04.450 --> 00:22:07.309 an hourly basis. So it's going to be really hard 00:22:07.309 --> 00:22:10.369 to get an attorney to take your case on a contingent 00:22:10.369 --> 00:22:14.049 fee. if maybe it's not that egregious, or maybe 00:22:14.049 --> 00:22:17.150 you're not making that much less than other people. 00:22:17.509 --> 00:22:20.849 So your best bet is to hire an attorney from 00:22:20.849 --> 00:22:23.349 day one the minute you get your contract, have 00:22:23.349 --> 00:22:25.869 them give you a good contract, and then at least 00:22:25.869 --> 00:22:30.569 you are protected. That makes perfect sense, 00:22:30.769 --> 00:22:34.059 I think, especially the whole conversation of 00:22:34.059 --> 00:22:36.559 being prepared. I think that's the theme I've 00:22:36.559 --> 00:22:38.380 gotten from our conversation today, is being 00:22:38.380 --> 00:22:41.220 prepared. When we go into these rooms, when we're 00:22:41.220 --> 00:22:43.660 negotiating, I think it's better to be prepared 00:22:43.660 --> 00:22:50.740 before than to try to figure out after. And I 00:22:50.740 --> 00:22:52.319 guess my last question, we kind of touched on 00:22:52.319 --> 00:22:54.819 this a lot throughout our conversation today, 00:22:55.359 --> 00:22:58.200 was advice you would give to female physicians 00:22:58.200 --> 00:23:00.440 preparing for their first contract negotiation. 00:23:01.620 --> 00:23:05.279 Just being prepared in knowing what you want 00:23:05.279 --> 00:23:08.519 and holding firm until you got it obviously within 00:23:08.519 --> 00:23:12.460 reason For example, if you know, maybe you're 00:23:12.460 --> 00:23:14.259 gonna get married and want to be able to have 00:23:14.259 --> 00:23:18.359 kids What is your maternity leave look like in 00:23:18.359 --> 00:23:21.660 your contract? Can you negotiate? Maybe you'll 00:23:21.660 --> 00:23:24.240 have a certain amount of PTO. Maybe you have 00:23:24.240 --> 00:23:27.059 maternity leave, but maybe you can negotiate 00:23:27.059 --> 00:23:29.160 in a year if you have a child, maybe you get 00:23:29.160 --> 00:23:31.900 an extra two weeks on top of whatever you would 00:23:31.900 --> 00:23:35.019 normally get. All of that's negotiable. If you 00:23:35.019 --> 00:23:38.480 have a spouse who's also in medicine, maybe that 00:23:38.480 --> 00:23:40.740 non -compete is really important to you because 00:23:40.740 --> 00:23:44.299 if you choose to leave your job, he shouldn't 00:23:44.299 --> 00:23:48.259 have to leave his job too to ride out a non -compete. 00:23:48.660 --> 00:23:51.579 Maybe you have to go so far away. So maybe that 00:23:51.579 --> 00:23:53.740 non -compete is really important to you. So if 00:23:53.740 --> 00:23:56.180 you choose to leave, he doesn't have to leave. 00:23:56.299 --> 00:23:59.140 And then he'll have in his contract, if he leaves, 00:23:59.599 --> 00:24:01.900 he doesn't have to leave the area either. So 00:24:01.900 --> 00:24:04.940 know what's important to you. Know what your 00:24:04.940 --> 00:24:07.940 needs are from the outset. So you're prepared. 00:24:08.220 --> 00:24:10.079 You let your attorney know what your concerns 00:24:10.079 --> 00:24:12.539 are and what things are most important. And then 00:24:12.539 --> 00:24:17.319 they can structure the negotiations around that 00:24:17.319 --> 00:24:19.779 so that you have what you need. You're protected 00:24:19.779 --> 00:24:23.769 during your contract and after you leave. Are 00:24:23.769 --> 00:24:26.190 there any like resources that you would recommend 00:24:26.190 --> 00:24:29.329 for people like to kind of kind of know those 00:24:29.329 --> 00:24:31.750 what terms exist in a contract especially like 00:24:31.750 --> 00:24:34.210 a physician contract before they go speak to 00:24:34.210 --> 00:24:36.650 an attorney like where they like online or books 00:24:36.650 --> 00:24:39.730 anything that you recommend that physicians read 00:24:39.730 --> 00:24:43.490 in terms of contracts um in terms of contracts 00:24:43.490 --> 00:24:47.269 uh aside from reading law books i'm not really 00:24:47.269 --> 00:24:50.910 sure um I would say talk to other physicians 00:24:50.910 --> 00:24:53.130 and see what things were important to them and 00:24:53.130 --> 00:24:55.089 what they were able to get in their contract. 00:24:55.569 --> 00:24:58.150 You can do that before you even have a contract 00:24:58.150 --> 00:25:01.210 in your hand. Once you've got a contract in your 00:25:01.210 --> 00:25:05.630 hand, you can still talk to other competing groups 00:25:05.630 --> 00:25:08.490 or competing hospitals. And you have a contract, 00:25:08.509 --> 00:25:10.450 so maybe you can negotiate to get something a 00:25:10.450 --> 00:25:13.490 little bit better. But before you sign anything, 00:25:13.750 --> 00:25:15.529 make sure you have a contract attorney review 00:25:15.529 --> 00:25:18.990 it, a health care contract attorney. in any changes 00:25:18.990 --> 00:25:21.369 that you need, have them go to the administration 00:25:21.369 --> 00:25:25.789 and make those changes on your behalf. How do 00:25:25.789 --> 00:25:29.150 you find a health care contract attorney? Is 00:25:29.150 --> 00:25:31.490 it just Googling health care contract attorney, 00:25:31.730 --> 00:25:36.750 or is there more word of mouth? For someone who 00:25:36.750 --> 00:25:38.750 has no idea, what would you recommend they do? 00:25:39.210 --> 00:25:42.920 I think word of mouth is huge here. um you can 00:25:42.920 --> 00:25:45.259 google and you'll you'll get a bunch of options 00:25:45.259 --> 00:25:48.839 but you don't really know who's good and who's 00:25:48.839 --> 00:25:51.279 not good um so i think this is where you can 00:25:51.279 --> 00:25:53.819 lean on your mentors and in your associations 00:25:53.819 --> 00:25:56.480 to speak with your peers your mentors maybe your 00:25:56.480 --> 00:25:59.440 professors and see who they've used um because 00:25:59.440 --> 00:26:03.849 generally most people will use the same few healthcare 00:26:03.849 --> 00:26:06.390 attorneys in a given area and you want to make 00:26:06.390 --> 00:26:09.190 sure you're with someone who does a lot of these 00:26:09.190 --> 00:26:11.569 contracts because they'll know the people at 00:26:11.569 --> 00:26:13.549 the hospitals, they'll know the contracts, they'll 00:26:13.549 --> 00:26:18.089 be familiar with the area. Salaries vary greatly 00:26:18.089 --> 00:26:20.690 depending on where you're located. So you want 00:26:20.690 --> 00:26:23.390 someone to know kind of that nuanced information 00:26:23.390 --> 00:26:25.730 of what you should be getting. Maybe if you move 00:26:25.880 --> 00:26:28.619 practice 50 miles away, your salary will look 00:26:28.619 --> 00:26:30.920 like this. You want all of that information. 00:26:31.279 --> 00:26:33.380 So I would say this is where word of mouth is 00:26:33.380 --> 00:26:36.279 huge because you want someone who knows your 00:26:36.279 --> 00:26:38.940 industry, who knows your location, and who's 00:26:38.940 --> 00:26:42.519 done a lot of these. Lovely. Thank you so much 00:26:42.519 --> 00:26:46.420 for that advice. Thank you for having me. So 00:26:46.420 --> 00:26:49.000 that's a wrap on this episode of Our Voices Our 00:26:49.000 --> 00:26:51.380 Future. We hope today's conversation inspired 00:26:51.380 --> 00:26:53.940 you, challenged you, and reminded you of the 00:26:53.940 --> 00:26:56.259 power of raising your voice. The fight for equity 00:26:56.259 --> 00:26:58.339 doesn't stop here. Join us in this movement. 00:26:58.680 --> 00:27:00.859 Subscribe wherever you get your podcasts. And 00:27:00.859 --> 00:27:02.759 if you love this episode, share it with someone 00:27:02.759 --> 00:27:05.599 who needs to hear it. Until next time, stay bold, 00:27:05.859 --> 00:27:07.880 stay vocal, and keep the conversation going. 00:27:08.279 --> 00:27:09.720 This is Our Voices Our Future.