Contracts and Disability: Understanding Your Rights and Protections as a Physician with Jon Appino

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Jon Appino is the founder of Contract Diagnostics – a consulting firm that specializes in getting physicians paid their worth.

At Wrenne, we are big fans of Contract Diagnostics, because one of the biggest issues in the healthcare industry is the fact that physicians just don’t know how valuable they are and that leads them to make suboptimal career decisions.

For this edition of the Finance For Physicians, however, we’re going to focus on a group of professionals that gets left out in most discussions:

Disabled physicians.

If you are one or know somebody who is, this is the podcast for you.

We’re going to dive deep into physician insurance policies for the disabled as well as talk about how to maximize your career growth even if you have a “debilitating” injury/disability.



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Physician Employment Contracts and Compensation with Jon Appino

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Full Episode Transcript:

Daniel: Jon, what’s up man? You’re looking a little under the weather there. You got a, you got a sling. You got, you got some scars. You’ve had a, a fun a couple weeks, huh? 

Jon Appino: Good to see you, sir. Yes. Yeah, man, I had an accident last week, an unplanned surgery and I still have a smile on my face.

I think the surgeon said a new friend called a metal plate and nine screws in my collarbone. I’m in a sling and I’ll, I haven’t seen the scar yet, but I will hear fairly shortly. And he said it would, he said it’s gonna be quite bigger than I initially thought it would be. 

Daniel: So, well, you have a cool scar to kind of show off in the future,

Jon Appino: I know. Now we I told my kids we’re taking names, but the plates, so if any of your listeners have suggestions for how to name the plate feel free to message In my son this morning, he’s. I was skiing with him he said Bert was a good name bet. So Bert, 

Daniel: we’ll have to think 

Jon Appino: about that. . Yeah. Anybody email Daniel and we’ll get the names on the list.

Daniel: Yeah. So we were gonna, so Jon’s contract focused his business and a lot of what he’s done is helping physicians with contracts and negotiations, stuff like that. And Jon’s been on before. And so we can link to, to those shows as well. But we were planning to talk about negotiating and how to ask for more money and, you know, Considering some of these other factors like time, which are super important for physicians, but I really, given your current state, I thought we could explore a scenario that has actually come up a few times with people we work with, and it does tie into some of what you do and contracts and negotiating and, and getting into some of these partnership deals.

So I think where this. Situation where, so Jon, you know, had an injury and was unable to work for definitely a few days as in his position, but if he was, we were just talking about before we hit record, if he were a surgeon, it probably would’ve been, you know, for example, a much longer time cuz he would’ve needed to use his hands.

But what he was sharing is, fortunately he doesn’t lie on his hands, particularly which is a good spot to be in, but a lot of you guys listening do. And so that’s important just to think about in general. But some of the situations we’ve seen come up. Handling or at least having the conversation around how it works in the event of disability or really just like time away.

we’ve worked with some multiple people actually that have had situations where they had to get away, whether it was for disability or other reasons. Personal issues could be where they had to like step back for an extended period of time. And in some of the cases it caused a little bit of, With small, especially with smaller practices and partnerships and ultimately resulted in some challenging situations I think potentially there could be some ways to mitigate that maybe on the front end by bringing up that as a potential circumstance.

I’m curious of your thoughts. 

Jon Appino: Yeah. I definitely think so, and I mean, you know, so I had a. Rockstar fracture to the clavicle and my collarbone, what the surgeon said in the plate, like I said, and I was out. I did, you know, surgery, obviously I was out for a couple of days and then woozy for a couple of days.

And then I’m now back. I’m a week out, but I’m still super slow. I need a little bit of breaks here and there because I tend to run I gas pretty easily compared to what I was before. But you know, even if I was a c. I don’t, I couldn’t do a full eight or nine hour schedule, you know, with patients, you know, every 20 minutes or 30 minutes.

I could hold an iPad with my hand. You know, I can poke on one with my left hand, but I can’t hold ’em with my right hand. So even a clinician, if I was a clinician, I don’t think I’d be back to work yet. Especially not like full-time. Let alone a surgeon, it would take me months to gain, regain full use, you know, pristine use of my arm, which is necessary for surgery.

But yeah, these are things that can definitely be discussed when you’re doing your due diligence around your employment contract. it’s important to know, first off, how the contract is defining disability. So termination is in every contract it should be, and termination for a reason of disability or death is usually in there as.

So if you can’t work, obviously if you pass away, the contract would end, but disability is often listed in there and it’s important to know how that’s defined because we’ve seen some contracts that define disability in 30 days you can’t do your job. Right. We’ve seen other contracts that say 90 days over a 12 month period.

So they don’t have to be consecutive, they don’t even have to be for the same ailment. So, you know, somebody could step away because of a rough pregnancy and be gone for two months. Have a shoulder injury like I do be gone for another three weeks, and then you get the flu and you’re out for a week.

You know, depending on how that’s looked at, it could be 90 total days out of a 12 month period, right? Now employers. For reasons to terminate physicians because they’re disabled, though they can’t work when they could. The PHY employer obviously wants to keep the physician there. But I do think to your point, it’s super important to discuss all these things on the front end.

And I think it’s important to talk about. I mean, look at the dynamics of the group, right? I mean, if you’re in a. OBGYN group and it’s, you know, there’s seven female partners in the group. You know, what’s the childbearing age? Are they all gonna start having children? If so, what does that mean for your schedule, right?

If you wanna have a child and step away, what does that mean for your schedule? In terms of how much call you’re taking? Yeah, if they are taking time away and stepping away because of, you know, births or cause of disabilities or something. Sometimes controllable, sometimes not. How does that impact you as far as your call schedule, as far as your clinic schedule?

And of course, does that mean you get paid more? Right? So all these things I think should be minimums that physicians discuss on the front end regarding their schedule and what happens if you or your colleagues are out. From a disability, we can, if you want, we can go back into compensation and production if you’re on a production only model and what happens if you’re not working for two, three months out of a year and draws and negative balances, we can go into 

Daniel: all that.

I think the paid time off is a good kind of segue to go that direction because it, you know, that’s like your choice to not. But you know, maybe cuz you’re hurt and maybe for a short period of time. But I’ve had that come up several times recently with families. We work with one-on-one. And one instance was this person was talking about how his hospitals and a little bit of hot water with the negotiations with their group, that they basically didn’t offer them any.

Paid time off or took it away during Covid and also took away the R V U based compensation or decided against implementing it, I think was exactly how it happened. Yeah. But either way they’re basically getting kind of stiff by the hospital, which the hospitals always, I mean, the hospitals are not looking out for interest most of the time.

But the ho that doesn’t surprise me much, but the hospital. . The part about P T O I think was, you know, crossing the line of the law and, you know, they didn’t do what they were legally supposed to do, so that’s gonna be something they’ll have some leverage on. But I think. The issue. And then another example a family we work with, this has all been in the past week mentioned PTO O and had said that since he’s earning, you know, quite a bit of RV use based compensation, it kind of doesn’t feel like a thing for him because most of his comp is di ends up being tied to the RVU based compensation, anyway.

So it’s more like he works when he works and he doesn’t when he doesn’t. So he ends up taking no time off, kind of in this current 

Jon Appino: state. Well, I mean, we see, you know, when we negotiate contracts for a physician we’re on the phone with employers a lot clarifying, you know, between the way a contract can be worded, right?

A contract can say you’ll have vacation time, you’ll have three weeks of vacation time, or it may say you’ll have PT o take time off, or it may say you’ll have. What’s one that we’ve seen? There’s a big employer that uses one, I think six, a available time off ato, right? Available time off. So you call them up and you know, we negotiate, oh, it’s not available.

What’s the time off policy? They say, well, they have available time off. They’re not paid. Right. So they have the availability to block themselves off on a schedule for up to so many weeks per year. But you know, they paid for it. Yeah. And you know, so again, it all comes back to that policy of the employer.

So if you are out of work for three days or for five days, or for three months or five months, what’s the policy? Is it to burn all of your vacation has paid? . And then is it to use short-term disability and is it to go unpaid? Is it to, if you don’t have PTO or any paid, I believe because you’re on production only, do you jump right into a.

A deficit. So if you’re on a draw, right, if you’re at 80% draw on a rough estimate, on a guaranteed pay per year, do they keep drawing at the 80%? And if they do, then what happens if you’re producing zero, but they’re still drawing you at 80% of what they think that you’ll do per year, will you generate a giant buck bucket?

So at the end of the year, what happens to the negative allocation of. You know, you generated 4,000 vus, but we paid you for 5,000. Now what? Right, right. That’s where there’s that delta. Right. So now do we have to pay that back? Do you have, do they have it taken out of your next 12 months paycheck? So there’s all kinds of things that can come with, you know this depending on how the contract is set up. Or depending on what’s in the policy and the procedures of the. 

Daniel: Yeah, so Jon’s a contract guy. He’s very focused on the contract. But also y’all do a good job at looking some of, looking at some of the other like non contractual things that are not exactly, I mean, maybe it comes up in the contract, but the contract is one thing.

But what I’ve also seen in my experience is many occasions where the employer or the. Breaks the contract and doesn’t follow it. And and not much happens because of it. It kind of like, nobody says anything. In every case, I can even think of nothing ultimately legally happened as a result of that.

And so to me that gets into the importance of like culture, like we kind of hit on earlier, like understanding what the culture is you’re getting into and. What those people value, I guess at the end of the day that you’re gonna be working with, are the people making the call calling the shots on who I would really wanna know who makes that call on, for example, pay time off or who makes the call and when I can decide to take vacation or not.

Or am I making the call? Do I have lots of auto autonomy to make my decisions? That would be preferable. Or is there this dude that doesn’t even understand how physicians work? Making that call an administrator or something. Yeah. Well, 

Jon Appino: I think that’s where it comes out to, like due diligence, right? I mean, when you look at the contract, you know, some employers will give you a contract and say it’s not negotiable, right?

Well, okay, but that isn’t it. You should have lots and lots and lots of questions to do, and that’s one of the things that we do at Contract Diagnostics is give the physician the tools, the frame, the how to go about asking those questions to your point. So you know if something happens.

how will they handle it? Right? What’s happened in the past and how have they dealt with it? Is there any flexibility in the policy? And if not, we need to see the policies. Right? So there’s lots of other ways that physicians can do due diligence when it comes to the contract. The contract terms are obviously very important.

And yeah, if the employer’s not following the contract terms, that’s definitely. Worthy of a discussion, right? I think if an employers follow the terms and a physician says nothing does nothing, the employer learns that broken window theory, right? Yeah. The employer learns, Hey, you know, Daniel’s not gonna say anything if we have ’em do an extra call or two here and there, and we’re not gonna pay him anything.

So, you know what? Let’s add two calls. Next, Qura, let’s add three calls next quarter. You know, the quality bonus that we had in last. Let’s take that away cuz we know that he’s, 

Daniel: we’ll see if he asks about 

Jon Appino: super. Yeah. You know, 

Daniel: that’s so shady. Yeah, but that’s where, but like it happens all 

Jon Appino: the time. It does.

And that’s why I was on the phone with a Alyssa, a physician earlier, and he was a general surgeon up in Oregon and he was using compensation Rx a product that you know about. You know what? We look at the compensation of physician. We give them data, we give him ideas and talking points with how to negotiate for more with their employer.

And, know, and he was asking me, he said, well, Jon, what if I ask for all these things? And they just say, no, it doesn’t work. Right. . first off, I think that we have, we had a very good plan. I think the employer will take some of his recommendations. But the other thing is, even if they say no, I’d say at least you’re on record with being one of those guys that’s gonna ask.

Yeah, that’s a good point. Right? Because if, you know, there’s so many physicians I talked with and I’ll say, look why are we on the phone? They’ll say, well, I haven’t had a raise in seven years. They’ll say, well, tell me about that. And they’ll say, you know, Jon, I like my job. I like my patients, I like my clinic, I like my colleagues.

I earn Okay. You know and and then they’ll, we’ll actually look at their numbers and they’re producing 75th percentile vus, and they’re earning 50th percentile. So we’ll call the Gap and they’ll have us do a negotiation. We’ll call their employer, and the employer’s like, oh yeah, Dr. Smith, fantastic gal.

She’s great with patients. Everyone loves that. We’re making so much money 

Daniel: off of her. Yeah. 

Jon Appino: And we’ll say, well, you know, Earning 75th or producing 75th and paid the medium. And even sometimes the employers will say, oh, really? Like they didn’t even know, because again, it’s, I hate to say the squeaky wheel gets the grease, you know?

But the physician we have a handful of physicians and every other year, They call us up and they say, I want you to renegotiate my contract. And their, their c e o knows that every single year that Dr. So-and-so is gonna have contract diagnostics call every other year, which means they know that they can’t point anything by the physician.

No. Right. They know that they’ve gotta, they’ve gotta treat the physician. With the best red carpet service because they know that every other year we’re gonna reach out, we’re gonna look at numbers, we’re gonna compare, and if something’s off, we’re gonna call ’em on it. So I think that every physician, every other year should raise their hand, go into the employer with data in which we have that contract diagnostics, and they should say, look, I want to talk about my pay.

I want to talk about the next steps. I want to talk about how we could modify things and tweak them with some things. So I think that’s good. And even if they say, We’re not ready to discuss it right now, doc. I think at least we’re on record, which I think is very valuable. 

Daniel: Yeah. So, I want to talk a little bit more about your service that you’ve mentioned and we’ve worked together on this and maybe some of you listen in and have even gone through it, but I think it’s a valuable service.

It’s compensation Rx, right, Jon? That’s what you call it. Yeah. Yeah. And so it’s kind of like a Easy way to kind of get some good data on your side and potentially breach. Have an op, you know, identify an opportunity to start to breach the conversation of like, maybe I should be doing some negotiating or at, you know, worst to kind of verify you’re in a good spot and whatnot.

And it’s relatively low cost. If you’re working with us like one-on-one through the planning firm, you can talk to us about like helping to facilitate that sort of service. But I think it’s a valuable thing to start to prompt that discussion regularly. I come across physicians all the time that have been in kind of like that.

You know, comfortable state, I guess you would call it, where for many, many years where they’re probably below market, whether it’s, and I look at the whole picture, whether it’s like dollar per hour. Or you know, or vacation time, or they’re overworked and underpaid, or a combination of both, or they’re even like mistreated and there’s all kinds of factors to it.

But I think this is a good early step to like, start to, you know, get some data on your side because that data is helpful. You wanna tell us a little bit more about it? what are we talking about here? Yeah. 

Jon Appino: So we. You know, we’ve been doing physician contract reviews at contract diagnostics for over 12 years.

We’ve helped, you know, tens of thousands of physicians and their families navigate the process between, I have a contract here. I don’t know what it says. And you know, even if I do know what it says, And I don’t know how to negotiate it. And even if I want to negotiate, I dunno how to or what to ask for.

So we’ve helped tens of thousands of physicians go through that process and every year we just kept thinking and, you know, and because of that we captured some really, really good data. Now we have MGMA and other data sets, but we have our internal raw database as well, which, If you think about, it’s very valuable because the ma, all the big national databases, m gmma, Sullivan, coter, you know, A M G A A A M C, everything, right?

They’re all aggregated on an annual basis. It then takes months, right, to pre-pop the data, analyze it, report it out, and then publish it. So right now it’s okay to stamp this if we need to. I think it’s March, mid-March of 2023. Okay. Yeah. So the last current updated mg, if we use M G M A dataset that we have is the 2022 dataset.

Typically comes out in May or June every year. Okay, so we have the 2022 data set. That’s what we’re using right now. It’s with all the, it’s with the gold standard, but the 2022 data set is based on 2021 data. So the 2021 year comes to conclusion. They 

Daniel: then, what’s inflation been since then? Paid survey

Jon Appino: Now you’re the financial guy, right? I know it’s been over, I mean, we’re already 

Daniel: like 15% 

Jon Appino: off. Yeah. And so, you know, so that’s the problem. But our data at Contract Diagnostics is updated real time. So if we worked with a hospitalist today in Chicago, Our database reflects a hospitalist in Chicago as of today.

Right. Which MGMA is looking at a hospitalist and what they earned back in the year 2021. And how they reported it, which has all these other asterisks and everything else. Not in Chicago. It’s based on a regional, so you got Chicago and St. Louis and Springfield and you know, and, small town Kansas and South Dakota included the same data set.

What we do with Compensation RX is we provide compensation data so we can give the big survey data and we can give our internal database to a position that says, I’m in this market with this setup. So I’m a private practitioner and a group of five I take call this much. Here’s all my factors. We can customize a data set to them and give it to them, but it’s one thing to have numbers, right?

I can go online, I can look at numbers anywhere. It’s one thing to have a number, but it’s another thing to set context. So it’s almost like if somebody said, Hey, Daniel, from a financial perspective I’m gonna retire in five years. How much money should I have saved up? And you don’t know what my lifestyle.

you don’t know what my health is, right? So you have a lot of questions before you say, Jon, you should have 2 million or 5 million or 10 million saved up to, to take money from, right? Am I gonna pay for my kids’ college? Do I have a mortgage on my house? Do I travel a lot. Do I take a lot of prescriptions, pills?

I mean, you know, there’s lot do I give to charity? There’s lots of questions that a financial advisor would give me. Before they just said, you should have 5 million. And the same thing here. So you can look at the data and say a cardiologist in Springfield or in Illinois or in the Midwest should make X dollars.

But to put a story around it is what we feel matters. So that’s why we get on the phone with every physician who uses this product with the dataset and we talk to ’em about their situation. How much call are you taking? I mentioned a surgeon earlier today. He was taking five calls. Right. So the data sets don’t take into account you’re taking five calls a month or 12 calls a month.

It just says, here’s the average surgeon pay. Right? So we take all those things into account and then we customize a plan for the physician to go back to their employer. And this is one of those we talked earlier about. The tens of thousands of families we’ve helped who have a contract navigate it. This is for not those people.

Even though you can use it if you have a contract and you wanna know if it’s paid fairly, but this is for the other 900,000 to other physicians out there who have a job, who are in a job, and maybe they haven’t had a raise. I think the data shows 42% of physicians haven’t had a merit increase in four.

Right. So you start to take all those things into account. It’s for all those other physicians. So for under $300, they can get access to the data, our proprietary data, and have a 30 minute call with us to have suggestions and solutions based on a customizable approach to your, the physicians, you know, specific situation.

So we take their data, we take their story, we take the hospital, we take their partners, we take the fluidity of their group, we take everything into account and say, These are five or seven or 12 different ideas that you could go through and ask. So it’s a fantastic product. And the guy I talked with this morning in the surgeon in Oregon, he said, you know, Jonny goes, I think I’m paid fairly, but it’s been four years and I figured for 300 bucks, what the hell?

I’d get the numbers, you know? And I think that’s a great frame to have. So I think it’s relatively inexpensive. Yeah. It’s like an hour worth of work. Yeah, it’s almo, I mean, yeah. And for 300 bucks to do every other year, every third year, I think’s something that most physicians should participate in on a fairly routine basis.


Daniel: And that’s, we’ve seen big gaps come up too. Like on occasion there’s pretty big gaps identified. In their actual compensation versus what is competitive market wise. So that’s a great way to kind of start to tee up this idea of maybe negotiating your employment for like an ex, especially for somebody that’s in an existing setup.

I’m curious if there are, I mean, let’s say you get this Go through this process and you have more data on your side and you, you know, it’s not quite how the ideal should be. Like you’re underpaid or maybe not getting enough vacation or how do you like breach the subject? Like how I’m thinking of like, let’s go with personality types.

So like, let’s go with softer spoken not so aggressive. 

Jon Appino: Yeah. That’s the great thing is we customize the approach. So, you know, You’re the sweet little pediatrician that doesn’t know how to bring 

Daniel: it up. Why is the pediatrician gotta be the sweet one? . Yeah. Pediatricians are sweet. 

Jon Appino: Yeah. Yeah.

It’s, I mean, I love, it’s funny, if you look at, like, we have that negotiation package with our contract review and it’s our most expensive package, and we have an awful lot of pediatricians that use it. Yeah. Oh, it’s valuable. Less because, but they use it because, you know, you know, we’ll say, look, you should really ask for $5,000.

Right. And a surgeon will say, 5,000, I’m gonna ask for 50,000 . You know? And, and a pediatrician will say 5,000. Oh, Jon, I could never do that. Yeah. You know, I don’t know how to say that. You know, so again, that’s what I love. As we get to that, that, again, the data’s the data, but we get to individually customize our approach, which is what makes it so fun for us and so valuable for the position.

So how do we think that should come up? Well, if it’s difficult, if you don’t do it on a routine basis right now, if you do it every other year, then they just expect it from you, right? I think that every physician should look at when their contract started and when it renews or when it ends, and they should backdate three or four months from that period and send an email to their employer that says, Hey, I’m reviewing the terms of my contract.

I wanna sit down with you and talk about how things have gone over the past two years or three years, or if it’s been longer. Fill the blank. Right. I’d like to discuss, you know, overall the contract, the setup, the compensation, my productions, and gather some feedback from you on what we, what I could do to be more efficient.

And I think you, you bring it up in two different ways. One, it’s, you want to talk with them to get feedback, right. Are there things that you’re doing that you could be doing better? Maybe there’s referral patterns that you could be making that would be more beneficial to your patients and your colleagues.

Maybe there’s an efficiency in a clinic that you could do, that you could tweak, that you could see an extra couple of patients a day. Maybe there’s other, I, you know, other things like leadership opportunities that you wanna discuss with them. Maybe there’s something as small, like, I’d like to have access, better access to an ultrasound.

Daniel: But you’re kind of put in the frame of like, what’s, how can I help you partner? Yeah. I think like, how do I help you? Cuz a lot of people approach that and they’re like, how can you help me? Yeah. And they’re very, 

Jon Appino: I think if you, yeah, I think if you just send ’em an email and you say, dear boss, in essence right, I want $50,000 in a bonus.

I want right $4 more on my RBU’s and I want to get paid extra 500 bucks. Awesome. Yeah. Said, I don’t think that’s a good frame to have, right? And that’s where I think like a personalized approach is beneficial. Because whether you are the cardiac surgeon that started five programs and you know, you.

You are 68 years old and you wanna refresh your contract at the last institution that you’re hoping to retire from. I think that’s a different story than is the pediatrician who didn’t make partner last year and they don’t know why and they didn’t get a raise and their contract maybe even expired six months ago and they don’t know how to go, where to talk about it.

Yeah, so those are the things that we specialize in is helping the physician understand the situation, what’s fair, right? And again, sometimes a surgeon will say, I want $50,000. And we’ll say, I encourage you to ask. But 30,000, I can sit here and put a case together for my 30,000 is a good number to ask for.

If somebody says, why would I give you 50? I can’t put that case together because of the story and the data. But if you wanna ask for 50, go right ahead. When you go, I think there’s a reasonable pushing. It’s not reeling them back as well. 

Daniel: There’s like a reasonable range. You can go over that and it can actually, you know how they say like, you know, no harm in asking.

But I kind of disagree with that. Like, there is some harm if you get too aggressive and you go too high, it can cause a little bit of negative reaction. Especially if they’re like, I wouldn’t even give you any raise. And you’re asking for a massive raise. I mean, so you have to, it. The, that’s where the, I think third party, you know, second set of eyes can help is.

You know, putting some objectivity behind it and saying, 

Jon Appino: you know, yeah, well, and I and, but that’s where it also matters. It’s almost like, You know, I had surgery last week and I had to go in and get, like, I had to do some pre-work, right? I had to go get blood drawn to make sure that I wasn’t gonna bleed out.

My blood pressure was okay. I had to have an x-ray, I had to do a what do you call it? Ekg, I think, you know, to make sure my heart was healthy enough to go undergo anesthesia and surgery and everything. So you had to go. It’s like, okay, you have to kind of see where you are and then. Take that step.

Right? And I think if you just go in and say, look, I want 20 grand more. Okay. Why? I think if you can go in there and say, look, I am producing 500 RBU’s per month. My partners on average are producing 430, and the median for M GMA is, you know, 4, 410. I am producing at this, but I’m getting paid at that. I’m doing more call than on average.

I’m doing this. These are the reasons that I would like to request this, right? And obviously it helps if you’re a hyper producer. We have people that call us up and they’ll say, Jon, I’m making X dollars per year and I’m producing Y vus, and I’ll be honest with them. And I’ll say, look, I think you got a good deal.

They’ll say, well, but I want more money. And again, to your point, like maybe it’s like you can ask, but I’d much rather to have you ask for these three things because they make more sense and they’re reasonable. I don’t want the employer to look at you as some unreasonable person who’s demanding and you haven’t earned it.

Because if I’m that employer, I can look back at you and say, look, why would I pay you more? You’re producing at the 40th percentile. Why would I pay you? The 70th percentile. You know, and if, well my colleague makes this, well yeah, your colleague’s producing a lot more than you are taking a lot more call or has 20 years of experience or speaks a second language or has an advanced fellowship under their belt.

So I think that’s why the story matters and you can’t just look at numbers and say, the averages this, therefore I get this. I think that’s why the story matters, which is what we do. Taking into account with Cop R and our contract review 

Daniel: packages, of course. Is it worth getting an offer at another place just to have some like comparison?

Jon Appino: touchy situation. So I, not that I don’t like that. I, again, I think it depends on the story can be you’re in a small town. Yeah, can be. But again, if your employer knows that you’re out interviewing and now all of a sudden your partners know you’re out interviewing and then you decide to stay, it can, that can have downtime effects.

Daniel: Yeah. That’s why the whole story, you’re right. I mean, the whole story’s super important because if, or maybe they’re like we don’t totally vibe with you. , but maybe you wanted to stay there but you were just doing it only for the money and they could see that as like a, this dude’s 50 50 and we’re just gonna go ahead and cut ties cuz we have somebody else.

I mean like it could go negative. Yeah. It’s kinda like asking for way too much money. 

Jon Appino: Yeah, I’m the employer. Why would I invest in you if I know you’re gonna be kicking tires and looking at other opportunities? Right? Yeah. I want people in my organization that want to be here. Yeah. I wanna give the red carpet treatment to those who I think want to be here.

Right. Ideally you’re saying I want to be, maybe you’re not one of those people, so Yeah. I think that’s, Now, I do think, again, it’s not that it’s not an effective strategy, right? I think it’s always good to be searching job boards. I think it’s always good to be keeping your nose out there smelling what’s going on as far as, you know, competitors, colleagues, other markets, et cetera.

I think that’s a very, very important thing to do. But, you know, depending on the situation, would I be interviewing across town knowing that you’re likely gonna see somebody that you know on. It’s likely gonna make it out into the, you know, into the community that you know that Dr. So-and-so was interviewing at competitor A.

Yeah. So that may be okay and it may not be right, but I think it’s, I, you know, but again, it can also be an effective strategy if you’re getting paid less and you request more and they say the answer is no. I think you can say, okay, you may force me to look at other options. 

Daniel: Right. Well, it could be, 

Jon Appino: you could have a good story, at least know that you’re only looking.

You know, you feel like you’re underpaid based on market value. Yeah. And you’re only looking to be paid at market value. Now again, some institutions, they have a good brand, right? You have a national brand that everybody knows and everyone wants to work at. They may say, look, we don’t have to pay you more because we can replace you.

So, right, so you have to be careful. Go ahead, Lee. Sorry. Again, I think the answer is yes to all the above, but I do think the story matters based on each individual 

Daniel: situation. I think something that’s coming up more and more that I’m seeing is it kind of goes in with the burnout and frustration and physicians with the system.

But people are more and more, I’m hearing physicians say like, I don’t really need or want more money. I need more time or space. Or even just like the system is terrible, like, I need some solutions. Like they’re not solving these problems that I’m bringing up. So like, whether it’s time away or like problems in the system, how would you suggest like dealing with those.

Jon Appino: So I just read an article yesterday, by the way, on, you know how physicians are starting to look at things a little bit different. It’s not all about more money. More money, more work. More work, right? We’re starting to see more job share opportunities here at different employers. We are seeing burnout.

Burnout, I still think is something that employers say they don’t necessarily do, but we are seeing some employers put policies in place for burnout. Yeah. What was the question again? Around, 

Daniel: around, yeah. I mean, how do you ask like, so let’s say I’m working somewhere and I’ll just paint the picture my employer, yeah.

I’m frustrated. Yeah. And maybe I can’t put a pin on it other than one other than the system. It’s just I’m not doing healthcare. I wanted to, and my company, maybe they have a burnout policy, but it’s like I go see a burnout guru that tells me I need to meditate and take a break and I’m good and it’s all Yeah.

Kind of put on me. And that’s pretty annoying. But like, ultimately I’m like, this system is frustrating. I’m not sure why, but I. For starters, I need to take some time away cuz I am spending too much time in the system that I’m extremely frustrated with. Like, I think primary question I’m asking is like, a lot of what we talked about is like, how do I get more pay?

But like what if I’m going to the employer and saying, how do I work less? And I’ve had lots of people bring that up to their employers and the employers are like, we got nothing. You’re on, it’s on you. And they put it right back on the. And they make ’em feel guilty sometimes too. They’re like, you gotta, you know, we need you.

Like, the people need you. The patients need you. Yeah. And that’s wrong, but that’s 

Jon Appino: how it happens. Hopefully. Agree. Yeah. You know, I, I think it’s important to have that discussion on the front end of every employment opportunity. Right. So as you’re interviewing, I think it’s always important to bring those things up.

Right. How do you handle requests for part. Right. If I decided to go part-time in the future, what changes for benefits? Is my compensation literally changed? Or is it like in a linear fashion or is there a different factor that goes into it? How do you prorate call? If I’m doing 0.8, do I take 0.8 with a call?

Or do you always have every physician take equal amount divided by the group? So I think those are important to say on the front end. Now, if you’re in a position, how do you bring that up? Again? I think I, I hate to say it just depends, right? It depends on the lot it I. I think it, I think the one thing I think that we would both agree on is that transparency and open communication is always a good thing.

So if you are a physician or in any job, you’re an accountant at the county seat, right? I think if you want to work something different, I think sitting back in your job doing nothing about it, not saying anything because you don’t know how to say it or who to say it to, I think is a bad. I think that’s where lots of burnout comes from that.

So people look up 10 years down the road and go, jeepers creepers. I just spent 10 years here working my tail off, miserable for money that I didn’t want, nor do I need, or maybe you’re not even paid fairly. Maybe you’re paid fantastically. , but you regret that 10 years head down working without saying anything.

So I think it’s always worthy of a conversation. Yeah. What’s, and bring it up for that. I think everyone has a different way, right? I prefer an email to somebody. Say, Hey, I’d, I, there’s a couple of things I’d like to bring up to you around p c. When can we meet? And I like live conversations, right.

I don’t like emails. People can take ’em wrong. Right. Well team it up with an email is good. Yeah, but I, yeah, I think something, but you gotta 

Daniel: draw the line at like, Hey, I’d like to talk. 

Jon Appino: Yeah. I would like to discuss my future with the group and the clinical schedule I’m currently 

Daniel: expected to have.

Yeah. Long emails usually don’t go well. 

Jon Appino: Yep. Let me know what’s available on Friday. Right. Yeah. I think that would be something. And then they know, Hey, Jon wants to talk about his clinical. Or Jon wants to talk about his auto-renewing contract, or Jon wants to talk about his call pay. I think it’s important to, to do that.

And if they reply back with like, sure. What’s going on, I would not get into that conversation. I’ve heard, I’ve, I could tell you and I could do 25 podcasts on horror stories around email communications with employers. Right. Yeah. I mean, same thing with you. I know. I mean, it’s something that we don’t suggest.

I think starting it out though, you know, thanks in advance for your time. I mean, being very cordial, you know, I mean, I think all those things are important, but I think a live conversation if you’re at the employer is super 

Daniel: important. Yeah. And we can, I would love to get into, in another conversation all a little bit more, Tactics for that actual conversation.

I think that would be really cool to kind of talk about what that conversation looks like and then different tactics for having the conversation. Cuz there’s a lot of different You know, helpful tips, I think that you can put in your back pocket as you approach that conversation. I also wanted to throw out, I know we’re wrapping up, getting close to the end and, and gonna wrap up soon, but I also wanted to throw out, like, make sure to send us questions.

Jon’s like a wealth of knowledge in regards to contrast and negotiation. So if y’all have questions I wanna put Jon on the hot seat and get some of these questions out there and really like drill into it. Please send me questions that you have, even if it’s like on your specific contract. We can dig into things.

I’ll put my email in the show notes for you to kind of, you’ll see that right away. But yeah, definitely let us know questions that you have. Related to any of this type stuff. And then what else did you throw out? You wanted to get name suggestions for your, metal 

Jon Appino: please. Suggestions. So, yeah, name suggestions to the point.

Bart’s already been suggested, so you don’t need to email that one in unless it’s a vote for the name bart. And then, yeah. Any questions, any suggestions, any ideas around anything? If it’s, you know, future topics for podcasts, if it’s, answer a question on this, if it’s an. I mean cheaper. We talked all day.

We didn’t even talk about the update to non-compete agreements. Right. Oh gosh. Which is coming up time. So there’s all kinds of stuff. Right. What does the Medicaid rule for this year already mean for physician pay? Right. What is, there’s so many things that we could get into, right? How do you know which data set is most applicable to you?

Right. How do you. , you know, what if your contract expired? What if you haven’t had a raise in five years? There’s all kinds of, you know, different ways that we could, 

Daniel: we can take it a bunch of different directions. So we need you guys to tell us where you want us to go with it, cuz you know, otherwise, we’ll, we can, you know, come up with stuff all day long.

Jon and I could talk for Yeah. Hours and hours and hours on end, but we would rather talk about the things you guys have on your mind. Please run 

Jon Appino: those question. And the thing is, you know is anybody can always go to contract and send up a free 15 minute console. We have a button on our page, there’s no strings attached.

You need to put an email address in because we send you a reminder email and of course a phone number. But we never market anything to you. We don’t call you and say buy something from us. 15 minute free consult. If it’s, Hey, tell me about this. If it’s, Hey, can you give a talk to my medical residency program?

If it’s, Hey, can you come talk to our state association? If it’s, you know, my contract expired four months ago and I’m still at the job and they haven’t said anything, what do I do? All the above. It’s a free consult. There’s really not a lot of, we don’t review documents, but there’s not a lot of rules.

If you, I can send a link to you, Daniel, and you can always send that out to your folks as well. I’ll put in the show notes, I’ll put that, show 

Daniel: notes, all that kinda stuff. Yeah. I’ll link to the contract, the compensation Rx. Service that we talked about at the very beginning, and then I’ll link to the general website and then I’ll throw my email in there so you can throw out questions through that as well.

Jon, it’s been fun, man. I’m sorry you got injured and hopefully you have a speedy 

Jon Appino: recovery there, . I will, I, sorry too. It sucks. I’d love to cook and I can’t cook. I love to ride bike and I can’t ride bike. I love to live. You’re right-handed too, right? ? I’m right-handed and I can, so, but I can talk on podcasts all day and.

Still have a smile and I always have a smile because, it’s just I love doing this stuff and hanging out with you guys. So, yeah. Whether I’ve got a sling on or no sling on whether the plate stays in or comes out, all those things are irrelevant. Contract diagnostics will be here to help rent, financial, and all the folks listening out there with any questions they have on their contracts and compensations schedules.

So give us a call. Thank 

Daniel: you, Jon. All right, man. 

Jon Appino: Anytime luck. I look forward to the next round.