REPLAY: Do THIS BEFORE you sign your doctor contract!

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Forward slash docs outside the box . What's good everyone . Welcome back to another episode of Docs Outside the Box .

I am joined by Mr James Dockery , who is a proud HBCU graduate , graduated from North Carolina Central University in 1980 , and then went on to get his law degree JD from the UNC School of Law in 1983 , and also has a master's in law and privacy , as well as cybersecurity .

Has been spending over 23 years as a judge advocate in the US Air Force and is now considered basically a labor and employment expert with a great understanding of employment contracts as well as independent contractors , extensive trial experience , having tried over 100 jury trials . I didn't know that about you , james .

I did not know that you were a trial lawyer and , for the sake of this conversation , everyone . He has been working in the medical community , working with physicians , nurses as well as physician assistants since 1997 . Without further ado , I welcome James Dockery . James , welcome to Docs Outside the Box . How are you doing ?

So very , very excited to join you and to join your audience as well , to share some insight and perspectives of an attorney with over 40 some odd years of total experience and so excited .

We initially started working together at least you started working with Renee through the Student National Medical Association . You were actually an attorney on retainer , excuse me . I believe , and Renee has always been really instrumental with SNMA . I have been too , but really Renee has been instrumental with taking that student organization to another level .

And then the next step in our relationship was you negotiated our first contracts when we were employed , back in 2014 to 2017 .

And then me and Rene got this itch with going locums and you helped us craft contracts and helped us negotiate certain rates and I think you can see us going from I know there was some painful times when you saw how much you were asking to get paid and I'm sure you're like , why are these guys asking for so low ? To where we are at right now .

And I know it's been a long process , but you've been with us the entire process , the entire way , for over 10 years , which is what I love , because we built this relationship from the ground up and we continue to have this relationship .

And so , from that perspective , you know and there are times when , when I pick up the phone and call Renee , I have this issue I like to talk to you about , or I call me or you and say , hey , I'd like to talk to you about something and so , from that perspective , we built this relationship .

But that's also what I like about all of my physician clients as well is that that I tell them from the very beginning this isn't a one and done . We're . We're in this relationship for the long haul , and so , from that perspective , my plan is to work very hard for them and that we have a long-term goal .

That can be shifted , can be changed , but at the end of the day , we're working collaboratively to help the client achieve their long-term , their short-term as well as their long-term objectives , and you've also seen us grow into podcasting and social media .

There's going to be just multiple facets of this . So obviously I think we kind of let the cat out the bag as to what we're going to be talking about on this show , right ?

You know that your attorney should be someone that is responsive , somebody that you can pick up the phone and even with interesting and unique ideas to say , hmm , we're going to go from surgery to doing podcast . Let's talk about that , okay . Let's talk about that and let's understand , but my role is to help facilitate your goals and your objectives .

It's just kind of understood that your relationship with a hospital , your relationship with a residency program , just renews , right . And then you go into fellowship , you apply and then you get in and you may do an additional one to two years .

So the first time that a medical student , a resident , a doctor , may see like a contract , maybe right when they finish their training and they're looking for their first job why do they need a lawyer ? Why do you recommend that they have a lawyer to look at this contract ? They didn't need one before . Why do you think they need one now ?

And so , from that perspective , are you ready , willing and able to accept each and every word within that contract that was prepared by your future employer's lawyer ?

Because , quite frankly , that in and of itself means that you're already at a disadvantage when you're doing that , because their interest is not purely your interest , their interest is in their client's interest .

So you need someone on the other side to balance that out , to make certain that whatever is written in that contract , the terms and conditions within that contract you are comfortable with , you've had an opportunity to have a lawyer to have eyes on the agreement so that , at the end of the day , you're protected , your long-term as well as your short-term goals are

protected within that agreement .

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So I think a lot of docs . They don't think that that's negotiable or they don't think that that contract that they get , like there's like space in there . I think they just think here's the contract , sign it and that's it . So the ability to negotiate , or the ability to say I don't like this or this is good , that's commonplace right .

Are you comfortable with the compensation ? Are you comfortable with the time off ? In one instance we were able to negotiate for a client .

Repayment of student loans within that contract had never been thought of before , but we made the push and justified it appropriately with the company , with the hospital at the time was that it made sense for them to invest long-term in this particular physician to pay off their student loan debt .

That created great relationship between the physician as well as the hospital itself . So everything can in fact be negotiated . But there are also certain terms in which there are things in which you can't negotiate . But you go into these agreements with the mindset that everything is negotiable .

It almost felt like I was coming to the table , they were bringing me the menu and it was really just my job to decide if I was going to eat or not , whereas I think more people should look at it as well . I don't really like the broccoli . Can you give me something else ? Or I like this Great analogy .

And so , from that perspective , understand your value to the organization and also understand that , because you have value , you also have the ability to negotiate . You have the ability to to to your point to say I don't , I'm not particularly thrilled with a broccoli , but I can take asparagus instead , so to speak . Right .

Uh , and you have some incredible legal terms in there force majeure , you have that's legalese right , all that legalese is like okay , now if you went to medical school , in law school , you may get it Okay . And then there's always this , and I get to your point there's always this desire to say oh , I have a cousin who's a lawyer .

And so , from that perspective , one of the things that I do with each of my clients , I will walk them through each sentence of that agreement , you know , from the very beginning , and keep in mind this is between 16 and 20 pages long .

And so Walk them first through the agreement and say let's talk about this , let's identify what is those areas that I have some concerns with .

And so , from that perspective , one of the key components with regards to negotiating a contract , first of all , you want to read the contract and be very specific as to your interests one and then two , negotiating the contract is rather different , because now you are looking at as a physician , spending time talking to administrators , possibly lawyers and others , to

determine , to convey what you are really interested in and what you really want to do . That requires an additional set of skills because at that point in time it can become really very emotional . You're thinking wait a second . I believe I should have an extra $100,000 or that my- .

You can say , well , you know , that's my lawyer , that's that guy you know , continue to work with him , you know he's giving me advice , you maintain the relationship . At that point in time , let me and let the attorney be the bad guy in that regard .

And ultimately , more times than not , the parties can come together and recognize that there is value in bringing on this physician because of your skill , talent , expertise , and that the physician is also very much interested in working at this particular facility . Now , also , physicians need to be prepared to be able to walk away as well .

Be prepared to walk away because that whole meal might just not work very well , it might not be appetizing , and so , from that perspective , your value is in your ability to , or your attorney's ability to be able to negotiate effectively , but also understand your value to the point where you can just simply walk away .

But here's the biggest concern with regards to that If you're on the verge of renewing a contract , you have to be particularly careful , because the contract terms will specifically come to an end at a specific point . Now I have one particular point I want to raise . So , for instance , contract renewals .

I've reviewed a contract for a physician in which this language was used . This contract will automatically renew at the same terms and conditions , unless physician negotiates additional terms within 90 days of the termination date . Assume as the physician you're busy . you're doing surgery , you're doing a number of things you simply forget .

You know three years earlier that now you have this agreement Within that 90-day period of time . If you do not renegotiate , then you have effectively signed another contract under the same terms and conditions that you had three years prior to that . You have to be very careful . You have to be able to negotiate that within that period of time .

Otherwise you lose the ability to increase your compensation , you lose the ability to do any number of things increase your bonus structure , et cetera . So it becomes very , very important that as you're negotiating , or as your attorney is negotiating , to be mindful of clauses such as that .

One of the things that's important is that all too often , the devil is in the details . So you have to be very , very mindful of making certain that you're protecting all of your interests .

Once you provide that information to the client , that's the end , effectively , of that relationship for that particular period of time . Then the client basically establishes their own case to their employer or to the facility . On the other hand , where the attorney actually negotiates the work , that means more time , more effort .

It is more time working with either the lawyers or the hospital administrator . So from that perspective , it expands the amount of time in which the attorney is working on behalf of the client . So it is more time , more effort , greater negotiating opportunities . That just simply takes more time . So time is really the key component there .

It's going to be hard for me to just be like all right , let's take a chill pill . This is what they normally do . They possibly may offer something that is lower .

They may offer something that is not what you would normally expect , but the key things and I'm sure there's certain levels of engagement or activities of engagement that you know that you can walk into and you can take and tools that you can use , whereas me , as a physician , I don't have that , and I think you know one of them being like you know , the

person who talks to first or the person who says something first , or I mean , obviously , I'm sure one of them is trying not to be emotional about things , you know , and the reason I say that is because I tend to just say look , james , can you do not only the review , but can you also do the negotiations ?

Because I think , from my temperament and doing things in between cases or with how busy I am , I don't think I'll be speaking from an area of strength .

You know , and so identify the sweet spot and say , okay , let's negotiate at a higher level , you know , because again , this is about negotiating where the facility will have one perspective you have a perspective in terms of what actually works for you , the client , in this particular case .

Then let's have something that is not outrageous , but terms and conditions that is difficult to say no to . Then you can negotiate down to your sweet spot .

So let's say , for example , like you say , your sweet spot is I'm going to make a number of $50 an hour , right , you're saying that you should go a little bit higher , knowing that there may be some space to come down exactly to your sweet spot . Is that what you're saying ?

Keep in mind , I've tried over 100 cases .

So it's a matter of negotiating while selling as well , because I want to be able to put you in a position to where I can say Dr X has these skills , qualities and abilities and deserves this amount of compensation or whatever we're negotiating at , and as a result of that , you need to pay him or her this requisite amount of money , either for locums or for

base salary or if it is an independent contractor , what does that actually look like ? But it's a matter of negotiating . It is utilizing those trial advocacy skills that would convince a jury to do exactly what I want them to do , what we would want them to do .

There are so many different factors . All too often most attorneys will charge either a flat fee or an hourly rate . Hourly rates can range from $300 an hour up to $700 , $800 an hour , depending upon that particular attorney's value of their time . An attorney's stock and trade is their time .

For the most part , I like using a flat fee approach in large measure because then I'm not looking at the clock , nor is the client looking at the clock , so we're not rushing through it .

We're not saying , oh , there are four hours , we've spent four hours on this document already and now I'm at roughly a thousand dollars as an example , just using it as an example . But the flat fee allows us to avoid this watching the clock and it gives me a sense , and the client a sense , that we're both vested in this matter .

Let's sort of work together to make it the best way .

I have my answer . I know why I want pay these fees . Why should they pay for a lawyer to help them negotiate something ? I have my answer . I know why I want to do it , so I'll let you give your answer . But I'm really interested to see how you convince a resident , or even a young attending , to get a lawyer .

You have much more training and education than any professional athlete , and almost every professional athlete will have someone negotiating the deal for them . You are much more valuable in society in general than any professional athlete will ever be .

As I mentioned early on , we've negotiated bonus structures , we've negotiated additional compensation , we've negotiated repayment of student loans all the kinds of things that are outside of the original contract , and so here's another major component to that .

One of the things that you really want to be very cautious of is the various termination clauses within the contract . Are you terminated for cause ?

You're a member of an OBGYN practice group in Dallas and you want to start your own practice down the street . You built a great client base and you want to be able to do that . That non-compete says no , we do not want you to take our patients , we do not want you to take our patients with you because it's a revenue stream .

And so , from that perspective , what companies I use companies , but what practice groups and hospitals will do is to say you are limited for a period of time in terms of practicing in this particular area .

Most states frown upon non-compete agreements Now , and there are some instances where they are , in fact , valid , but they need to be very narrowly focused and very narrowly created , and so that's part of the role that the lawyer plays in this is to make sure that that non-compete is valid .

I represented a client where there was a non-compete in which the client could not practice law in the state of Texas . That's crazy . That's crazy .

Agreement with the hope that somebody would not take it to a lawyer to review . Now let's assume . Let's then assume then that that physician did not come to a lawyer at the front end and pay a couple of thousand dollars for that legal fee on the front end . On the back end , to get that non-compete agreement would have been 10 times that amount .

To get that non-compete agreement overturned in court would be 10 times that amount .

So there's that , and it's also some of the tax implications with regards to whether or not you're going to be an employee or you're going to be an independent contractor , and so some of those actually factor into the process . And then if you're going to do locums , for instance , then are you going to be locums as an employee ?

You're going to be locums as an independent contractor ?

But they're considered to be an independent contractor and the reason why we know this is like a lot of them will write this in the group . They're like yeah , you know , I said that I wanted to be an independent contractor and they said A , b , c , d and I'm like well , they can't tell you what your schedule is supposed to be .

They can't you know all these different things that you have that you're describing . These are like Makes you an employee .

So , from the hospital perspective , they really should make certain that you're truly an independent contractor and not an employee , because then that opens them up to even greater liability because they're failing to pay the necessary taxes , withholding taxes on this doc or nurse or physician assistant .

So it becomes very important that , as you look at that agreement , make certain that the visions that indicate that you're an employee are stricken from that document .

This is the lawyer that I should be going with versus this is the lawyer that .

We are limited in terms of the number of lawyers that might be within a particular family and in all likelihood you're going to help them out .

So from that perspective , it's tough to turn down a family member , but resist the temptation to go with somebody who is purely a criminal lawyer or a real estate lawyer or somebody who does divorce work , to do your contract ?

because the contracts you know , the legal community has become really very specialized in many , many respects , and so you really want to know what's your background in terms of employment law , what's your background in terms of negotiating contracts , what's your background in terms of , more specifically , doing work for the medical community ? Because even that is unique .

I've been working with physicians and physician practices for over 20 years and so from that perspective , you really want somebody who really understands the nuances of the healthcare facility , the healthcare practice .

And I'm not a physician , but I've worked with physicians in many , many instances over the years , and so I goofed that up and said I'm not a lawyer , I'm not a physician , I may play one on television , but I'm very definitely a lawyer . Have you had to fire ? But I'm very definitely a lawyer .

We just cannot collaborate together to go down a path that would either worsen the physician's position or put my law license in jeopardy .

I ended up hiring you and you actually got me an $80,000 swing with my contract , with my salary Well , actually , with a combination of salary and student loan payback contract with my salary Well , actually , we have a combination of salary and student loan payback , so we were able to go up about $50,000 on my salary and then you were able to help me get an

additional $30,000 of student loan repayback so 10 per year and I was really grateful for that , because there were certain things , like you said , that were important outside of just the salary , and I think nowadays people are starting to really understand the concept of golden handcuffs .

There were certain things , like you said , that were important outside of just the salary , and I think nowadays people are starting to really understand the concept of golden handcuffs and oftentimes , those golden handcuffs which can be a what do you call it , I'm sorry which could be a what's the word I want to use ? It's a . What is it ?

A bonus , these bonuses , they're actually loans , right ? Let's talk about that real quick . Is there any way that you can get a sign-on bonus without it being a loan ?

But I've seen recently where practice groups or hospitals are tying it to just that , that they equate it as a loan and that if you fail to get to a certain point , or either within the terms of the contract or you fail to produce in terms of the number of hours , the number of patients seen , et cetera I haven't seen that one .

That's bad they can take that money , they can actually take that money back . In that regard , those kinds of agreements , quite frankly , those kinds of practice groups and practice areas I tell clients just to stay away from , because that to me , is a sham in that regard .

And so from that perspective , it becomes very important that a signing bonus is just that , a signing bonus . Now the other component where bonuses become really important is called either an incentive bonus , and I call those the invisible bonus structure , because it looks good , it looks like oh , wow .

At the end of the year , if I do X , Y and Z and I meet these parameters , I will take home an additional $100,000 .

But the problem with that is nobody gets it because the threshold limit is so incredibly high that unless you're going to work literally 15 hours a day , almost six or seven days a week , you're just simply not going to be able to generate that kind of service for that particular entity to get the bonus .

There's nothing in the contract that says well , every three months or every six months , we will check the RVUs to do this , or we will have a coder an independent coder come in and look at X , y and Z to show that you are reaching these numbers .

So it becomes , like you said , this imaginary bonus , right If you hit this certain production line but nobody's checking for it anyway .

I've seen one contractor where they will retroactively take money from you . Yeah , again , where they will take money from you because you fail to maintain that same level .

And so , from that perspective , there are just some agreements that are just in and of themselves , just untenable , just in and of themselves , just untenable , and that physicians need to be fully aware of when they are that sometimes that , going back to that devil in the details , they need to be fully , fully aware that just because it looks good on his face ,

that may not necessarily be what you ultimately receive at the end of the year . So just be very very cautious .

I heard that 10 years ago and I know that more so now . Definitely in the Northeast and , I think , definitely in the West Coast , you see a lot of hospitals that are merging together .

So the wiggle room , or what appears to be the ability to get maybe one hospital in one region to compete with another hospital , maybe in a close region , that's not there anymore . So what do you do in those situations ? Do you have room ? When they say it's a standard contract ?

Do I just trust them and say , okay , well , let me just sign it down the line and move on ?

And so , from what I mean by doing your homework Because , again , if you are tied to a particular region of the country , if you're tied to a particular city , or you're tied to a particular locale , your bargaining position is significantly impacted in that regard , the ability to be able to say I'm going to do something different , or if you have the ability to

say , well , I'm going to wait and do locums . I'm going to do other kinds of contract work instead , then you're not held to . This is our contract and it becomes a take it or leave it .

I take the position , and I encourage clients to take the position , that you are a very valuable commodity and that they really want you much more than they are ready , willing and able to admit . But just be prepared to make some tough and hard decisions that will ultimately serve you very , very well .

Is it always true that once you sign it , that's it , Like everything is legally binded ? Because I know you .

You mentioned very briefly like there's an opportunity , for example , to fight restrictive covenants as a clinician work or if , if knee dark or works in any other capacity outside of this hospital and earns any type of income as a physician or using his clinical knowledge , that that income belongs to that hospital . Do you remember that ?

And we got that and we got that taken out right . But if someone signs that , go ahead . Go ahead ,

please .

And I use that term servitude , but I could very easily use that term of slavery ended a long time ago and so from that point of view , it is no . There are certain instances where it is just onus face illegal and you bring that to the hospital or the practice group's attention and they don't want that kind of a fight .

They don't want to spend hundreds of thousands of dollars hiring lawyers in order to defend something that , on its face , is actually illegal . And so , from that perspective , again keep in mind , this contract was created for the benefit of the practice group or the benefit of the hospital .

That's why it was created , and so all the more reason why physicians and people in the medical community must have someone on the front end to look at those agreements , because they're not created for their benefit , they're created for the employer's benefit .

And if you're not willing to fight or if you're not willing to know , if you don't have the wherewithal to get someone to review this and say you need to get this taken out of the contract , they may be willing to forfeit all that money . I know of one of the residents that I worked with .

I won't say what level they are , but I know one of the residents that happened to him . He was at a hospital , he was working , he was employed and during the time off at a hospital he was working , he was employed and during the time off he would go and do locums and he was doing well .

And somehow his home hospital found out and I don't know if he decided not to fight it . I don't know if he just said I just want to make it go away , but he told me he forfeited like a significant amount of some six figure amount and I'm like , wait what .

You should have talked to someone about this and I just that brings me back to what I saw in my conscience . I'm like , actually this is a lot more common than I thought it was . Actually , I thought I was just like this had to be some type of remnant or some type of thing that just was unique to me . You know .

And so from that perspective , that kind of that old adage that you know , you need to have a family physician or someone that you can actually talk to . You also need that family attorney as well .

That person can pick up the phone and call and you've called me and we've talked on Sundays , we've talked on Saturdays , and so I've always taken the position that with a client- James , this hospital is acting crazy .

And if that attorney isn't that available , you need to find another attorney .

And so , from that perspective , it just because I'm the mouthpiece for the client and I'm the person that's going to do what is your sweet spot , Going back to that same position that we took even with you years ago . What is your sweet spot and where do you want to end ?

And if it's important to get at a client over the last five years or so , it was important for him , for that client to have his student loans paid off . That was important . And so , from that perspective , we negotiated a deal to where it had an incredible salary but that the hospital was genuinely interested in keeping this particular physician .

They paid off his student loans . They paid off his student loans . So from that perspective , it becomes what is ? And paying off ?

This was literally a masterclass into contract negotiations and understanding what your interests are in comparison to what the hospital or maybe your private practice interests are . So , james , how do people get in contact with you ? How do they ask questions if they want to take things further , past this podcast episode ?

We're giving you the power to really take the next step and have the life , as well as the career , that you want . So , james Dockery , thank you so much for jumping on Docs Outside the Box . Once again , everybody , we're going to have his contact information in the show notes . He is the truth .

Please take this podcast episode to heart and share this with other people who may be getting towards the end of their residency or may be going into a contract negotiation and may need some help . So , james , thanks again for your help on this show .

I'll catch you on the next one , peace .