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PRESIDENT’S
MESSAGE

Advocating for Yourself:

Don’t shoot yourself in the employment contract!

By Adam Ratner, MD, 2019 BCMS President

It is the express mission of the Bexar County Medical Society contracts and hire an attorney
to advocate for you and your patients in Bexar County and to ad- with expertise in medical employ-
vocate together with TMA throughout the state. That said, there ment contract negotiation? Sim-
is only so much that organized medicine can do. You must also ple. It costs money from our own pockets, scarce personal time,
advocate for yourself! and many of us don’t think we can negotiate a favorable change in
The theme of the October 2019 issue of San Antonio Medicine was a contract anyway.
the corporate practice of medicine, dealing with its impact on us So, how much money is it worth to you to avoid a miserable
physicians and our patients. There are many powerful forces vying working environment which might ultimately cost several hundred
for the power and money inherent in the practice of medicine. With thousand dollars to escape?
both good and evil intentions, these forces are trying to control our Many physicians feel that we have no negotiating power and
working lives and practices as much as they can. would be unable to convince an employer to alter their employment
The initial and arguably the most important interaction many of contract. Certainly, if we begin with this negotiating attitude, we
us have with these powerful forces comes in the form of our em- won’t get far. The reality is that some employers will alter their con-
ployment contracts. These legal documents are typically created by tracts, and some won’t. Never forget that we, as physicians, have the
attorneys expert in employment law and reflect the cultures, values, ultimate power to simply walk away if we don’t like a contract. No
and motivations of the employers who offer them to us. one can force us to sign one against our will. This is truly our ulti-
An employment contract is truly a legal window into the culture mate power as individual physicians.
of a practice. Although most contracts understandably reflect the If a physician has only one job prospect and no other options, it
asymmetrical power between a corporate practice and an employed is harder to walk away from a bad contract. Most of us need to
physician, some contracts are more asymmetrical than others. It is make a living but still need to be able to walk away from a contract
one sign of a well-run practice for its employment contract to con- negotiation; we must seek out and cultivate multiple employment
tain provisions to protect itself whenever it can, within reason. options for ourselves prior to signing a contract. This takes time
That said, some physician employment contracts purposely in- and effort but usually pays off.
clude draconian provisions that may not even be legal and enforce- For more than a decade I’ve been teaching business of medicine
able. Why do otherwise intelligent physicians think that an employer courses to medical students, residents, fellows and practicing physi-
presenting such a poor contract would have any motivation to pro- cians. I’ve recently started asking those in my classes to take a short
vide an attractive working environment for its physicians? Further- and simple oath which I hope they will recall when it is their time
more, disentangling from one of these contracts might require a to evaluate and sign an employment agreement. You might want to
potentially costly and personally disruptive legal challenge for a vic- do the same.
tim physician, yet many of us routinely sign these instruments of “I promise that I will never sign an employment contract that I
servitude and bondage. have not read and understood in its entirety. I will seek wise and ex-
Many physicians are simply unwilling to take the time to read and perienced counsel as needed as the decision to sign such an agree-
understand the consequences of each provision in a contract. Most ment will likely impact me for the rest of my life.”
of us are clearly out of our areas of competence in interpreting
these documents. If confronted with a medical problem out of our Dr. Adam Ratner is President of the Bexar County Medical Society and
specialty, we routinely get a consult from an appropriate specialist serves as Professor and Assistant Dean of the University of the Incarnate
we trust. Why don’t we all do the same thing with our employment Word School of Osteopathic Medicine and Chair of The Patient Institute.

8 San Antonio Medicine • November 2019