Welcome to Our Voices, Our Future, the podcast
where we amplify the voices driving change in
equity within medicine and beyond. Brought to
you by the Gender Equity Task Force, a committee
of the American Medical Women's Association.
We're here to challenge norms, break barriers,
and ignite conversations that matter. I'm Meenu
Mnaney, and in each episode we'll bring you candid
discussions with leaders, change makers, and
advocates working to create a more inclusive
and just world. No more silence, no more waiting.
You're listening to our voices, our future. Let's
get into it. Today, we're welcoming Mary Dunn,
who is an attorney, practice manager at Juggernautha
Neurosurgery, and a social media manager for
Dr. Juggernautha as well. Thank you for being
here, Mary. Thank you for having me. I'm excited
to share with you all. Can you get us started
by telling us a little bit about your background
and what kind of motivated you to specialize
in contract negotiations for physicians? Sure.
So my background actually started out in real
estate law. During undergrad, I worked for a
local law firm that handled residential default
services, which is basically loan modification,
foreclosures, bankruptcies, representing banks.
I clerked for them during law school. And then
when I finished law school and passed the bar,
I was hired as an associate attorney. So this
was a really great opportunity for me because
it put me in a courtroom almost every day. A
lot of attorneys who just do contracts, they
never step foot in a courtroom. So I knew that
this was the time to get that experience because
otherwise I might not ever get that experience
in my career. And then as for my transition to
healthcare, I kind of grew into it organically.
I married a neurosurgeon and then I have a brother
and a sister -in -law who are also physicians.
So one of them is a hand surgeon and the other
is an internist. So before my husband and I were
even married, I started reviewing his contracts.
And the thing about surgeons is they're in high
demand. Hospitals are always looking to poach
them and you receive offers for employment, not
infrequently. So he was getting quite a number
of contracts. So I started reviewing all of these
contracts. And then we also started my husband's
practice around the same time. So I really developed
a passion for it. And then what started helping
started us helping out family and friends occasionally
grew into a full -time job as my husband started
his practice and it grew and it continues to
grow. I love that it's so organically like kind
of just came to be. My next question is kind
of about like why are contracts particularly
important for female physicians entering into
the medical field today? So my biggest message
for all of you is to negotiate your contract
upfront. with an attorney. You'll never have
more bargaining power than you do at the time
of your initial contract negotiation. So it not
only dictates your current position, but it dictates
your future positions as well. So for example,
if you live in an area where non -competes are
enforceable, then your current contract can dictate
how far away your next job has to be. Or if you
have a collections based compensation model,
it can dictate the collections you'll continue
to receive for work performed at your next job.
I saw one contract somebody had and it was collections
based. So they got a percent of their collections
for their surgeries, but once they left the employment,
they no longer were eligible to receive collections.
Now your collections usually take between 15
and 45 days to come in after you do the case.
So if you were to leave, all of your collections
for the last 45 days for all that work you would
never see. So you want to have a good negotiation,
good contract lawyer, reviewer your contract
upfront so that when you leave you have a favorable
ending and you don't have to hire an attorney
to fight it at that point. It's easier to just
hire somebody upfront and negotiate it on the
front end. So collections for people who might
not know like what that term means is like it's
not like services paid for like that you've already
kind of done the work for, but you're getting
it like later, the payment is later than the
service. That's correct. So sometimes confused
with an RVU based compensation model. RVU based
is for how much work you do, irrespective of
how much is collected for that. So maybe you
did the surgery, but the patient didn't have
insurance, you would still be paid under an RVU
based modeling model. On the other hand, collections
-based is how much you actually collect. So maybe
you're only doing elective cases. Maybe everybody
has insurance. So you're obviously going to be
paid more for patients with better insurance
than if they have a worse insurance. That's a
collections -based model. So it takes anywhere
between 15 and 45 days. on average, typically,
to start getting the money in. Now, some cases
are litigated. Maybe some claims have to be appealed.
Maybe somebody didn't get an authorization and
they have to go back and submit additional paperwork.
Some insurances are conducting audits before
they'll pay. So there is a lag in time if you're
collections -based. So you might not get money
right away when you're starting a collection
space because you have to wait for the collections
to come in. But then when you leave, you already
have collections. So that money should continue
for a little while. Okay, that's good to know.
I had no idea that was a different like contract
term that existed. You previously mentioned to
get a lawyer to kind of help you negotiate that
initial contract. So for like women that are
kind of just like coming out of residency around
like, how in advance should they seek out that
counsel? like when they're looking is it like
when they start their job search um is it once
they have a interview and are ready about like
in the negotiation stage like what does that
kind of look like if you have any advice on that
so we don't need a lawyer until you have a contract
in your hand the lawyer will review the contract
for you and you want to make sure that the lawyer
specializes in health care law specifically because
that way they have already probably worked with
this hospital. Hospital CEOs turn over quickly.
So maybe they worked with them at another hospital.
Maybe they worked with them at this hospital.
So they have those relationships already. They
have already know what this hospital is giving
to other. um similar providers in your area and
they know what other competing hospitals are
giving to other similar physicians and maybe
they know just in the larger network of health
care systems what's being offered so it's a it's
a huge advantage to have an attorney who has
negotiated contracts like this before who knows
what you're worth who knows how much money there
is in the budget um i can say for for us as an
employer of different providers of different
types, I know what my margins are. I know what
I can afford to pay somebody. I know what my
max is. So a good health care attorney will also
have a lot of that same information. They know
what they can get for you better than you do.
So what are some common pitfalls that you see
like female physicians that like they encounter
during contract negotiations and how can they
avoid them? So things that I see in contracts
that you want to make sure you have your lawyer
work on for you, one is call. So how many physicians
share the call responsibility and how is the
call split? So this also gets into hospital bylaws
because sometimes the hospital bylaws will say
it gets shared among however many surgeons, neurosurgeons,
let's say for example. have privileges here.
So then if there are three neurosurgeons there,
it has to be split three ways. So sometimes you
split it pro rata, where you each take 10 days.
Sometimes it doesn't have to be shared equally.
One thing that I see is if it's shared pro rata,
who decides? And are the weekends and holidays
also split equally? Because otherwise, what you
run into is the new person or the young person
gets all the weekends in the holidays. So you
want to make sure that it's split in a way that's
fair. And you also want to know who decides.
So is it a competitor who's deciding? Is it somebody
within your group who makes the call schedule?
You kind of want to know who's making the schedule,
who's making these decisions, and can you work
with them? Another thing I see is hospitals will
often pay more for holiday calls, sometimes weekend
call, but typically holiday call. So if you are
taking holidays, if you are taking weekends,
or if you take extras, how much do you get paid?
And the amount that you get paid extra for call
in for specialty call like this varies and it's
negotiable. So you want to negotiate that in
your contract. Also in your contract bonuses.
So you want to make sure that you get bonuses
that you're entitled to and that hospitals typically
pay and the amounts of bonuses are also negotiable.
So have your lawyer negotiate whatever they offer.
There's probably some wiggle room for negotiation.
So typically you'll have a signing bonus. So
you want to expect that. You can also look for
productivity bonuses, maybe a year end bonus.
Sometimes if you stay there for over a certain
amount of time, you'll get a retention bonus.
Sometimes if you do all of your charting in a
timely manner, you'll get a bonus for that. If
you're relocating to work there, you should look
for a relocation bonus. And if the amount is
not enough, ask for more. So not only are the
bonuses negotiable, the amounts are negotiable,
but also the terms of the bonuses. So sometimes
if they offer you a relocation bonus, but you
don't stay the term of your contract, they might
want you to pay that back, or they might want
you to pay back your signing bonus. So you want
to make sure that the terms of the bonuses are
also favorable to you. If you're moving to a
new place, for example, it might not work out.
Make sure you're not going to be on the hook
to repay a whole bunch of bonuses when you leave.
Another area that you need to watch out for is
your malpractice insurance. So the contract will
state the amount of malpractice insurance that
they'll provide for you. So this amount is negotiable.
So this gets back again to the importance of
having a good healthcare attorney because they'll
know how much insurance you need for your specialty
and in your geographic area. For example, I live
in Detroit. You need more malpractice insurance
in Detroit than you do in a more rural area where
people are less litigious, maybe the claim amounts
are smaller. So your healthcare attorney can
make sure that the amount of insurance that they're
providing is sufficient for where you're practicing
and what your specialty is. It will also state
whether it's claims -based or occurrence -based
malpractice. two totally different types of malpractice.
A current space provides lasting coverage for
your past acts. So while you're working at hospital
A, maybe something happens. You later leave and
work for hospital B. So that insurance from hospital
A is canceled. However, if you have a current
space, you would still be covered for all the
work that you did there. If you have claims based,
it's a cheaper policy, but it only covers you
while you have the policy active. So if you leave
and then somebody files a claim, you don't have
that insurance anymore. So if your contract has
claims based, then you need to purchase a tail
and a tail will cover that. So if the contract
has claims -based insurance for you, the contract
should also say they'll pay your tail. If for
some reason you already have your contract and
it doesn't make them pay for a tail, then what
you need to do when you go to your next job is
you ask the next job to pick up a no's. So the
no's would then cover those past acts from the
old job. So this is another piece where it's
really important to have a healthcare attorney
work this out for you because you don't want
to be in a situation where you leave a job and
you have no coverage for a claim that's filed
at your old job. No, that makes sense. That's
a lot of little details. It's a lot. Yeah. And
it's really, I see the importance of having someone
to kind of look through it. Even if you even
have a little bit of like experience or knowledge,
I think having just a second set of eyes that
is doing this on a daily basis, I can see how
useful that will be. It's much more nuanced,
I think, than people realize. One other thing
that I'm seeing, background checks. So I'm seeing
where an employer wants to perform a background
check, the actual language, this is an actual
contract that they want to consult with any third
party who may have info on you, including otherwise
privileged or confidential information. So this
would allow the hospital to go to anyone, your
neighbor, your Facebook friend, your doctor,
anyone and get any information, even if it's
privileged or confidential. So you want your
attorney to negotiate a background check that
doesn't include them. talking to anyone you've
ever met about anything, however private and
unrelated to your work it might be. Maybe they
can query the data bank, maybe they can check
references that you provide, but it's not an
unlimited phishing expedition. So again, you
want to be careful what you sign and have someone
look at it for you to make sure you're not signing
your life away. In your experience, how can women
in medicine effectively communicate their worth
and value during negotiations? especially first
time contract negotiations, I feel like, because
I feel like residency interviews and like residency,
we don't get as much say, but like our first
attending job that we go out to, what is some
advice you have? So I've already said this, I
feel like I don't want to keep repeating it,
but hire a good attorney. In Michigan, there
are two, there were two lawsuits. So one of them
was brought by a group of NPs who are mainly
women. against U of M stating that PAs, the physician
assistants, were making more than them. Now,
the NPs were saying they're mostly women and
they were saying the PAs were mostly men. And
the PAs and the NPs did largely the same work,
their reimbursements were the same. And so there
shouldn't have been such a disparity between
the incomes of the NPs and the PAs. They were
actually successful. And then this past April,
female PAs at U of M brought in action against
U of M, stating the male PAs were making on average
$9 ,000 more. than the females. So that obviously
is still pending. It was just filed. But I think
this gets back to the importance of having an
attorney review this for you, because they'll
know how much the men are making. They'll have
worked on the contracts for men and women. They'll
have worked on other mid -level contracts for
the university. They'll know how much other people
are getting. So your point of biggest bargaining
power. It's before you start during the contract
negotiations. Once you have a contract and you're
earning less, they're not gonna just say, sure,
I'll pay you more. You're gonna have to hire
a lawyer, sue them. It takes years. If it's successful,
maybe, maybe not. And then you're still gonna
have to pay your attorney fees. It's really not
that helpful. It's more about making the point
at that point. So you really wanna hire a good
healthcare attorney upfront. Have them work this
out for you so you don't have to worry about
it. I think it's about information and being
preemptive rather than reactionary. What legal
protections exist for female physicians regarding
pay equity, discrimination, and contract negotiations?
So in Michigan, there's a lot that the mid -levels
that you have added. for filing under a Michigan
law. So it would depend on the state that you're
in and what legal protections they have. But
again, if you're already at the point of having
to hire an attorney and sue, it's not technically
too late, but the best time to negotiate it and
figure that out is at the time that you're offered
the contract. I think if we take one thing away
from our conversation is hire a lawyer at the
start of the contract. An experienced healthcare
attorney is gonna be your best friend. And I
think that's important, especially for people
starting out to learn that, because I feel like
if you don't hear it, I don't think you would
know to do it. I think a lot of people try to
read the contract themselves, and you don't know
what you don't know. You don't know what other
people are getting offered. You don't realize
how bad your contract might be. Next question
is going to be more about support networks. How
important do you think support networks are just
mentorship or professional organizations? are
in negotiation, like in negotiating contracts
and what resources would you recommend for these
groups and like anyone in general? So I think
this can't be emphasized enough. Having a strong
support network will help you understand what
others are being offered for similar services.
how much call they're having to take, how many
weekends and holidays, what type of bonuses they're
receiving, and all the important contract terms
that you'll want to negotiate for. So like having
an attorney who also has that information, speaking
with other providers will also give you more
insight into what other people are getting in
their contracts. So it's helpful to know what
these same hospital systems are offering to others.
And if you have mentorship available at your
program, utilize it. If you're on social media,
connect with other doctors, both within your
specialty and in other specialties. We've been
on social media actively for a little over a
year now, and our network has grown so much.
So where before we maybe just knew people within
our own state or within our own region, now we've
connected with people all over the country and
all over the world. So it's helpful not just
in terms of connection, but also job opportunities,
seeing what other people are getting in other
areas. It helps in so many bigger ways to connect
with other people. So you may need a job one
day or they may need a job one day. You may be
an employer yourself one day if you go into private
practice and the larger your network is, the
more people you have to talk to. I think social
media has helped that a lot of ways of like increasing
your community and conversations and building
that. I think that's a positive of social media
and like I think this day and age. So it's really
great to hear. And I love that advice about expanding
your network. It might not need to be in person,
but I think you need to expand your network.
If female physicians face discrimination, like
we talked about the case with Michigan, during
the negotiation process, what steps would you
recommend someone take to address that? So I
would say you can go to the hospital or the employer,
but frankly, If you've signed a contract, you
could have had an attorney review it for you.
You don't have a lot of bargaining power. So
your best time to avoid this and to make sure
that you're not the victim of discrimination
is right at the beginning when they offer your
contract before you sign it. If you've already
signed it, you can still hire an attorney. But
in the cases I described, they had a group. The
first case with the NPs versus the PAs, they
had 30 NPs who experienced the same thing. In
the case that was just brought in April with
the female PAs versus the male PAs, there are
300 of them. So yes, it happens. But if enough
people are hiring attorneys, then they'll have
better contracts. So your success is really only
going to be if other people are experiencing
the same thing. If maybe your contract's just
a little bit worse, what attorney is going to
take that case? Because this would be a contingent
fee case. They'll take a fee at the end when
they're successful. You're not paying them on
an hourly basis. So it's going to be really hard
to get an attorney to take your case on a contingent
fee. if maybe it's not that egregious, or maybe
you're not making that much less than other people.
So your best bet is to hire an attorney from
day one the minute you get your contract, have
them give you a good contract, and then at least
you are protected. That makes perfect sense,
I think, especially the whole conversation of
being prepared. I think that's the theme I've
gotten from our conversation today, is being
prepared. When we go into these rooms, when we're
negotiating, I think it's better to be prepared
before than to try to figure out after. And I
guess my last question, we kind of touched on
this a lot throughout our conversation today,
was advice you would give to female physicians
preparing for their first contract negotiation.
Just being prepared in knowing what you want
and holding firm until you got it obviously within
reason For example, if you know, maybe you're
gonna get married and want to be able to have
kids What is your maternity leave look like in
your contract? Can you negotiate? Maybe you'll
have a certain amount of PTO. Maybe you have
maternity leave, but maybe you can negotiate
in a year if you have a child, maybe you get
an extra two weeks on top of whatever you would
normally get. All of that's negotiable. If you
have a spouse who's also in medicine, maybe that
non -compete is really important to you because
if you choose to leave your job, he shouldn't
have to leave his job too to ride out a non -compete.
Maybe you have to go so far away. So maybe that
non -compete is really important to you. So if
you choose to leave, he doesn't have to leave.
And then he'll have in his contract, if he leaves,
he doesn't have to leave the area either. So
know what's important to you. Know what your
needs are from the outset. So you're prepared.
You let your attorney know what your concerns
are and what things are most important. And then
they can structure the negotiations around that
so that you have what you need. You're protected
during your contract and after you leave. Are
there any like resources that you would recommend
for people like to kind of kind of know those
what terms exist in a contract especially like
a physician contract before they go speak to
an attorney like where they like online or books
anything that you recommend that physicians read
in terms of contracts um in terms of contracts
uh aside from reading law books i'm not really
sure um I would say talk to other physicians
and see what things were important to them and
what they were able to get in their contract.
You can do that before you even have a contract
in your hand. Once you've got a contract in your
hand, you can still talk to other competing groups
or competing hospitals. And you have a contract,
so maybe you can negotiate to get something a
little bit better. But before you sign anything,
make sure you have a contract attorney review
it, a health care contract attorney. in any changes
that you need, have them go to the administration
and make those changes on your behalf. How do
you find a health care contract attorney? Is
it just Googling health care contract attorney,
or is there more word of mouth? For someone who
has no idea, what would you recommend they do?
I think word of mouth is huge here. um you can
google and you'll you'll get a bunch of options
but you don't really know who's good and who's
not good um so i think this is where you can
lean on your mentors and in your associations
to speak with your peers your mentors maybe your
professors and see who they've used um because
generally most people will use the same few healthcare
attorneys in a given area and you want to make
sure you're with someone who does a lot of these
contracts because they'll know the people at
the hospitals, they'll know the contracts, they'll
be familiar with the area. Salaries vary greatly
depending on where you're located. So you want
someone to know kind of that nuanced information
of what you should be getting. Maybe if you move
practice 50 miles away, your salary will look
like this. You want all of that information.
So I would say this is where word of mouth is
huge because you want someone who knows your
industry, who knows your location, and who's
done a lot of these. Lovely. Thank you so much
for that advice. Thank you for having me. So
that's a wrap on this episode of Our Voices Our
Future. We hope today's conversation inspired
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