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Mr.

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Harwood, I'm Dave Usam,

0:02

and I am a neuroradiologist at the Johns Hopkins

0:06

University School of Medicine.

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I was wondering if I could ask you some questions,

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um, from your talk.

0:12

Um, first of all, you know, a lot of the first employment

0:17

contracts are from trainees

0:19

who are relatively inexperienced in this type of material

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that you've just, uh, discussed,

0:25

and I'm sure that they don't wanna start off on a wrong foot

0:29

with an employer by challenging some of the existing,

0:34

um, provisions in a contract.

0:37

How do you balance the employee

0:39

and employer relationship with, uh, making sure that, uh,

0:44

they're not gonna be taken by the employer, so to speak?

0:47

Yeah, so I think it's a, it's a evolved process

0:50

that we've worked on through the years.

0:52

Um, we get the employment agreement, we go

0:55

through it in detail with the physician.

0:58

We talk about the areas of, of heightened

1:01

or material importance.

1:03

We try to determine what issues are really critical

1:05

for the employee, um, issues

1:08

that may not be addressed in the employment agreement

1:10

that have been discussed.

1:12

Uh, and we try to sort of pull together, um, our comments,

1:17

um, to the employment agreement that are material.

1:19

We don't try to, uh, attack every single page

1:23

and every single provision in the employment agreement

1:25

because we understand and appreciate,

1:27

because we're on both sides

1:28

of this issue representing employers as well,

1:30

that the practice has a form that it wants to use,

1:33

that all physicians are typically subject to the same form,

1:36

and it's unlikely that they're gonna be willing to change,

1:39

uh, or materially change all the

1:41

provisions in the employment agreement.

1:43

So it's, it starts with being sort

1:44

of understanding the agreement itself,

1:46

understanding what's market, um,

1:49

and trying to balance between

1:51

provisions in the employment agreement

1:53

that are outta market are not consistent with conversations

1:55

that have been had, uh, and,

1:57

and issues that really kind of, we feel important

1:59

that we need to press on

2:00

because it's important to the physician

2:03

or it's something that we see as a particular issue

2:05

with a given practice.

2:07

I know that the physicians are often, you know,

2:09

concerned about sending over a laundry list.

2:12

And the way that I've kind

2:13

of developed my practice is I prepare the list

2:17

and then I let the physician send my list to the employer

2:20

and let them know that a lot

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of this is coming from the lawyer

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and let the conversation if there needs to be between lawyer

2:27

and lawyer or lawyer and business person

2:29

to get the physician out of the middle of it so that,

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you know, I'm, I'm, I'm the quote unquote bad guy here.

2:35

I'm representing them. It's my job.

2:37

Um, but I'm also here to, to be an advocate, um,

2:40

for the physician.

2:42

But I wanna do that respectfully.

2:43

I understand this, I understand this space very well.

2:45

It's part, it's my practice every day.

2:47

Um, so I know what to, to ask for and what not to ask for.

2:51

I think when you go into a negotiation like this

2:54

to like treat it like it's war

2:55

or to treat it like you need a victory,

2:57

that's a bad outcome, um, from the get go.

3:01

And I guess, um, to

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what extent would you say in the market

3:06

that physicians coming out of training are utilizing, um,

3:10

employment lawyers as opposed to reading it

3:14

through the Gadi gup and just signing on the line?

3:16

What's, what's the, uh, penetration?

3:21

I, I think it's a mi I think it's a mixed bag.

3:23

Um, I, I think it's probably, you know,

3:26

less than 50% are are doing it in some cases

3:29

because, um, the employers told them,

3:32

well, we, you know, it's fine.

3:33

You can work with a lawyer,

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but we don't change our employment agreement.

3:36

Um, you know, we're seeing more

3:38

and more people try to turn to Google

3:40

or chat GPT to, to try to understand it.

3:43

Those are both very imperfect, uh, tools right now.

3:47

Candidly, I think what we've seen produced by chat GPT

3:50

and other kind of AI products, um, is not in line

3:55

with maybe the way that we would handle a lot of issues.

3:57

They kind of spit out information that's not,

4:00

that may not be accurate or may not be actually helpful.

4:03

Um, I actually came across something very recently where,

4:06

um, somebody produced a list of issues presented by Jet GBT.

4:09

Um, there were 15 issues.

4:11

I would say 11 of the 15 were actually counter, um,

4:14

to the other party's interest.

4:16

Uh, and because Chad GPT didn't understand really kind

4:19

of the angle that you were trying to attack, um, I think

4:23

that, um, you know, effective use

4:25

of counsel is very important.

4:27

It doesn't have to be, and you can work with the qualified,

4:31

uh, knowledgeable healthcare lawyer on your employment

4:33

agreement without incurring a substantial expense.

4:36

You should be working with somebody that's not,

4:38

that's not gonna charge you, you know, for every, um,

4:42

single minute of every single second of their day.

4:46

Um, these are not, these are not type of arrangements that,

4:49

that, at least from my practice, uh, I do these more to

4:52

as an accommodation, um, for people that I know

4:55

that I've worked with that refer people onto me.

4:58

Um, and I'm trying

4:59

to develop a lasting relationship with those individuals.

5:02

And I know that if I overcharge on the review

5:05

of a physician employment agreement,

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I will never hear from them again.

5:08

I will never hear from their colleagues again.

5:10

I will never hear from their friends again.

5:12

Um, so I think that it's just really smart

5:14

to be a savvy consumer, uh,

5:16

and work with people that know what they're doing.

5:19

Okay. Um, I was interested in talking to you about

5:24

teleradiology and geographical non-competes.

5:29

A lot of times these teleradiology groups are in multiple,

5:32

multiple states in multiple, uh, locations in a state, uh,

5:37

and to be subject to a potential geographic

5:41

non-compete in a certain radius around so much

5:44

of the country, um, it becomes, um,

5:49

I would imagine scary i, in your practice,

5:51

do the teleradiology groups have such geographical,

5:56

non-competes, or is that, um, not typical?

6:00

Um, I, I think it varies depending upon the platform.

6:03

Um, I think that there's, right now, um, it's a little bit

6:07

of a buyer's market.

6:08

And what I mean by that is

6:09

that the teleradiology companies cannot find radiologists

6:14

fast enough to help them achieve their growth metrics

6:17

or to achieve and be able to provide services

6:20

to all their client current clients.

6:23

Uh, and so I think that the physicians have leverage in this

6:26

market right now to push back on these, um,

6:30

on these restrictive covenants, particularly the ones

6:33

that are so broad.

6:35

Um, you know, I think some of the arguments

6:37

that we've used are, look, I I reside in California.

6:41

Uh, California will not enforce a non-compete in the

6:43

employment context against really anybody

6:46

but specifically physicians.

6:47

I'm not gonna subject myself

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to a non-compete period, end of story.

6:51

Um, I think most of the, the, the practices I work

6:55

with are more concerned about, uh,

6:57

or the platforms that I've worked are more concerned about

7:00

soliciting the relationships.

7:02

They don't want you to be going

7:03

after their hospital clients trying to steal away that work.

7:07

They're not necessarily

7:08

as concerned about you leaving the platform

7:10

and moving somewhere else, but they are very concerned about

7:13

soliciting those hospital, hospital relationships

7:16

and making sure that those are protected.

7:18

And that to me is probably the right focal point.

7:21

If I was, you know, kind of running a platform,

7:23

I'd be more worried about my relationships with my customers

7:26

and less worried about trying to put in place a non-compete

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that's likely unenforceable very expensive to try

7:33

to go enforce, uh,

7:34

and something I'm unlikely to go try to enforce.

7:37

Okay. And can you give us just, um, typical values

7:42

for notification of termination?

7:45

I, I think it's across the board.

7:47

I, I, I think from my perspective, uh, I'm,

7:50

I'm thinking about this more from the employee perspective

7:52

right now as opposed to the employer.

7:54

I think 90 days is really kind of

7:56

what you would expect to see.

7:58

Um, from the employer perspective, I'm seeing more 180, um,

8:02

because it is, there is such an acute shortage of,

8:05

of physicians that are out there in the market.

8:07

Uh, and because it's such a difficult burden to schedule,

8:12

uh, and you're having to schedule so far in advance

8:14

that 90 days may not be enough.

8:17

Um, beyond 180 days,

8:19

I think it becomes burdensome on all parties.

8:22

Um, and I think from the physician perspective, it's,

8:26

it's really difficult to become engaged

8:28

and do what you're doing when you know you've got two steps

8:31

out the door, but you've got another

8:33

180 days to go to make it.

8:36

Um, I don't think that's beneficial

8:37

to either the employer or the employee.

8:39

And I think that if you provide, you know,

8:41

the 180 days notice, that's, that's substantial notice

8:46

to provide replacement coverage, scheduling,

8:49

and everything else you need to do.

8:50

Um, but I know from my perspective on the employee side,

8:53

I'm pushing for 90 days.

8:55

Okay. Also, give us a, a typical range of years

9:00

to partnership or years to ownership.

9:01

What, what should the physician be expecting?

9:05

Yeah, I, I still continue to see two to three years, um,

9:08

as the period of time for in private practice.

9:11

Okay.

9:13

One more question. Um, you know, when you talk about

9:18

bonuses, for example, um,

9:22

last quarter bonus is often paid

9:26

beyond the last quarter.

9:27

And you got into this briefly.

9:29

Um, you know, I, I'll give you my,

9:31

my personal perspective here.

9:32

We are in academic medicine

9:34

and Johns Hopkins has a reputation for not being the,

9:37

the best in compensation.

9:39

And we have end of year bonus for your academic work

9:42

that typically arrives September 30th.

9:45

And we have people who leave Hopkins June 30th as part

9:49

of the academic year,

9:52

and they go off to private practice

9:54

where they're making twice as much

9:55

as they were making at Hopkins.

9:57

And yet we are obligated to pay them an end of year bonus

10:03

in September, um, when they're no longer an employee.

10:07

So, and same thing with, you know, end

10:09

of year productivity bonus, you know, the,

10:11

the year ends for academia.

10:13

June 30th, we get our end

10:14

of year productivity bonus usually, you know, a month later.

10:18

What is the general consensus about these end

10:23

of employment, continuing paying people bonuses

10:26

after they've left your program?

10:28

I, I, I, I think there's really kind of two perspectives.

10:31

I think from the employee perspective, um,

10:35

if I've met the criteria that needs to be satisfied in order

10:38

to earn a bonus, I should be paid by bonus.

10:42

The employer perspective is, it's as much about performance

10:46

as it is about retention.

10:48

And I wanna put as many, you know, using the carrot

10:51

and stick approach, I wanna put in many

10:53

tools as I have available.

10:55

I wanna put things in place that entice the physician

10:58

or require the physician to stay longer.

11:00

Um, and so I talked on this briefly about, you know, whether

11:03

or not you have to remain employed on the date

11:06

that the bonus is paid versus being Remi being employed

11:09

through the bonus measurement period.

11:12

And I, I, you know, I see this all across many different,

11:16

I mean, both academic medicine, private practice,

11:19

the private equity platforms, I think private equity,

11:21

you're gonna see in almost all instances you've gotta be

11:24

employed on the day the bonus is paid,

11:27

um, because they want retention.

11:28

Um, private practice, it really depends on, you know, kind

11:32

of historically what the practice has done.

11:35

And in some cases, the practices have just not had large

11:38

turnover and it's not been something that's been addressed.

11:41

And in academic medicine, I would say that it's really,

11:45

you know, kind of more favorable to the physicians

11:47

because in part, you know, you've made the point about the,

11:50

the discrepancy between private practice

11:52

and academic medicine in terms

11:54

of the salary and compensation.

11:56

It's a recruitment tool. Uh, it's a retention tool.

11:59

I I, I'm gonna pay people, you know, if they've earned it

12:02

and they've, they've earned their bonus, I'm gonna pay it.

12:04

That's what I typically see.

12:06

I see that with like the chain hospital companies too,

12:08

you know, that it's, uh, you know, you can negotiate so

12:12

that if you've been employed

12:13

through the bonus measurement period,

12:15

you're gonna get your bonus whether you're there

12:17

or not at the, when it's paid.

12:20

And I, and I think from the, I think from just the,

12:21

the last comment I'll make is that maybe the,

12:23

it is the employee perspective a little bit more, which is

12:26

I can't control, you know, how long it takes you

12:29

to actually make the payment.

12:32

Um, and I can't control if you decide to wait

12:34

until the very last day, you know,

12:37

before you're required to make the payment for tax purposes

12:40

that you decide to do that.

12:41

That's pretty unfair to me.

12:43

If I've earned it, you know, you've gotten the benefit

12:45

of my production and my services, I should get paid.

12:50

Thank you very much for your perspective

12:51

and for this wonderful lecture.

12:54

Yeah, thank you for the opportunity. I.