Your employment contract

It's tempting to give new employers the benefit of the doubt. After all, they had the good sense to hire you. Isn't it reasonable to assume that they'll treat you fairly? Maybe, but that doesn't mean you shouldn't read your employment contract carefully, make sure you understand all of its provisions, and, if necessary, let a lawyer have a peek.

In any contract negotiation, employers are primarily concerned with protecting their own interests, says Andrew M. Knoll, MD, JD, a former hospitalist who's now a healthcare attorney with the Syracuse, New York, firm of Scolaro, Shulman, Cohen, Fetter & Burstein. That's not surprising, and in some ways it's even fair, Knoll adds: The employer is going to pay you a salary, at least for a time, whether you're productive or not. Still, the current demand for hospitalists exceeds the supply, so that should give you some negotiating leverage.

Hospitalist employment contracts generally cover a two- or three-year period. Key provisions include:

Work schedule. There isn't much room for negotiation here, either, especially if you're joining a group that rotates shifts. For example, if everyone in the group works 12 hours for seven days, and then is off for seven days, individualized schedules aren't practical. Exceptions might be made for part-time hospitalists, says Knoll, but full-timers have to get with the program.

Vacation and sick leave. The more your schedule resembles that of an outpatient physician, the greater the likelihood that you'll get paid vacation days. Few seven days on, seven days off programs offer paid vacation because so much time off is built into the schedule. "Seven on, seven off is very much like emergency medicine," says Knoll. "You get paid only when you work."

You might be able to negotiate a bit of sick leave, however. Knoll recommends asking for at least five days.

Signing bonus. Unlike starting salary, these are usually negotiable because a bonus is a one-time thing. "When you're at the end of a negotiation and the practice has decided it wants you, they'd rather invest a few thousand dollars in a bonus than restart the recruitment process," Knoll says. If your new job requires you to relocate, aim for a contract that indicates the employer will finance your move. "Anything of substantive value should be in the contract," says Knoll.

Liability insurance. Most employers pay for hospitalists' malpractice insurance. If it's a claims-made policy-one in which the insurer pays only for claims that are filed during your employment period-you want the hospital to pick up the tab for all or a good portion of the tail coverage. Tail is a one-time payment, but it can be as high as $50,000. During a contract negotiation, Knoll advises calling the insurance carrier to find out what it currently charges for tail coverage. "That could change," he says, "you can use the information you have to negotiate accordingly."