Interview with Ethan Nkana – Episode 339
In today's episode, Ethan Nkana explains how to negotiate a great contract, avoid burnout, and protect yourself legally.
Ethan's advice revolves around empowering physicians to advocate for their best interests, understand the nuances of their contracts, and seek professional assistance for optimal negotiations.
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A Crucial Step in Career Success
In this interview, Ethan Nkana, founder of the Rocky Mountain Physician Agency (RMPA), sheds light on the often-overlooked importance of negotiating your best employment contract. The conversation highlights the significant role contract negotiations play in a physician's career course. These negotiations have an enormous impact on overall job satisfaction, financial well-being, and work-life balance. Ethan's expertise, honed through years of working in hospitals, is presented as a valuable resource for physicians navigating this complex terrain.
Key Considerations in Physician Contract Negotiations
Ethan provides practical insights into the essential elements of physician contracts, guiding both new and experienced physicians. From compensation and restrictive covenants to job duties and support resources, the discussion offers a roadmap for physician employment agreements.
On this matter, we explore the top two or three critical elements that physicians should prioritize. These topics are demystified, with Ethan offering his valuable insights. Tail coverage for malpractice insurance and considerations for experienced physicians seeking contract renegotiation are also explored.
Ethan Nkana's Advice for New Graduates
It's a matter of asking, knowing how to ask, and what to ask for. For the first time attendings coming out, please do not feel as though you have to sign whatever is put in front of you… I want to encourage you, please advocate for yourselves, know what matters to you most, and ask for those things in your contract.
Summary
Ethan shared valuable insights into why you must fight for your best employment contract, and what to prioritize. He also reminds us that there are professionals like him who will serve as your agent to get you the best contract possible.
NOTE: Look below for a transcript of today's episode.
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Links for Today's Episode:
- Rocky Mountain Physician Agency
- Ethan Nkana's LinkedIn Profile
- Ethan Nkana's Phone Number: 720-471-0059
- More on Understanding Relative Value Units (RVUs) in Employment Agreements
- Physician Employment Agreements
- Get Ready for What Will Happen When You Quit Your Miserable Job – 213
- Root Causes of Physician Burnout – Interview with Dr. Dike Drummond – 028
- Dr. Debra Blaine's Coaching Services
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Podcast Editing & Production Services are provided by Oscar Hamilton
Transcription PNC Podcast Episode 339
Negotiate a Great Contract, Avoid Burnout, and Be Happy
- Interview with Ethan Nkana
John: Sometimes physicians can be their own worst enemies. We finish our training and agree to work for a large practice or a hospital system, and then two or three years later we're miserable. And we discover that our contract does not protect us from being mistreated or underpaid. My guest today is Ethan Nkana, and he's here today to help us avoid those issues. Welcome Ethan. I'm glad to have you here today.
Ethan Nkana: Thank you so much for having me, John. It is a delight to be here with you.
John: I don't know why I haven't talked to someone like you sooner. I've been doing this podcast for several years and I've always focused on nonclinical, but the reality is, for most physicians, they want to go clinical. And they may not want to do it forever, but heck, if they're going to work clinically, they shouldn't be subject to low salaries and being beat up and burned out after two years. I think some of what you're going to tell us today is going to help us avoid that. And I really do think, and I don't talk about this enough, but every physician that's going to be employed really has to have someone help them negotiate their contract. That's my opening for you. Take it from there. Tell us about your background and how you got into this.
Ethan Nkana: Yeah, spot on, John. And actually I want to touch on what you said a moment ago. So much of what I get to do in my job is education. And so, I think it's so important for doctors first to understand what is in your contract and the risks, the benefits and burdens, all of those things. During our conversation I don't want this to sound like a sales pitch for my business. I want to help doctors know how to do it for themselves so they don't need someone like me.
But I think you highlighted something that is extremely important about the relationship that doctors have with employers is often overestimated. And so, doctors have this fierce loyalty to employers, which they find out the hard way is not necessarily reciprocated. I'm glad that you and I get to talk today.
John: I'm going to say another prelude to this whole conversation for those that are listening, because I used to do negotiations on the hospital side for these physicians. I think when you're negotiating or you're having someone negotiate for you, you have to realize, the way you set this thing up and the document that you sign is going to be what you're going to live by for the next few years. And if it turns out there's big holes in it or there's things in there that just don't align with what you thought you were getting, you're going to be miserable. Again, that's just my admonition to those as we get going. Tell us how you got started and I did a little intro separate from this and I talked about how you go back to the legacy with your mom, but tell us about that and then how you got into this.
Ethan Nkana: Absolutely, and I think one of the cool things about what I get to do now is it's kind of the only thing I've ever done in my career. As you mentioned, my mom is an anesthesiologist. Coming out of college, she told me, you've got to get into healthcare, you're going to always have a job. What she didn't know is that I got laid off in 2019 and all of a sudden kind of found myself having this existential crisis.
And in the midst of that crisis, I had this question, "Why don't doctors have agents like professional athletes?" I started thinking about your training journeys as a physician, how that parallels with an athlete. Then you go pro and there's all of this money and athletes hire agents, but doctors tend to DIY it. And so, I founded RMPA - Rocky Mountain Physician Agency as an agency for physicians. And so, my job is similar to a talent agent, athletes, actors, you name it, my job is to negotiate and renegotiate physician contracts for the most money and best terms for my doctors.
John: Now that leads me to a question about that process. Do you usually get involved with their first contract or do you have a lot that are halfway through and now they're getting ready to re-up or renegotiate? Because I could figure that would be a whole different scenario.
Ethan Nkana: Yeah, we do actually quite a bit of both. We do first time attending, what we call rookie deals. Doctors who are coming out of residency and training. And we also negotiate deals for experienced doctors. As you mentioned, those are very different. The reason that for me, it's kind of like a fish in water is because the only thing I've done in my career is work in hospitals. From HR intern, which is my first job, supply chain, food and beverage, physician contracting, finance. If it's in a hospital, I've either done it or I know it.
And so, for me, it's really easy to kind of transition between, "Okay, I have a rookie doc who's going in their first contract. What are some of the things we want to prioritize?" But the cool thing about that though, John, is I get to see into the crystal ball of what attending doctors are concerned about. Then I get to say, "Hey, Dr. Jones, you might want to make sure that you lock in your call schedule, because that's the most common thing that experienced doctors call me about." It's kind of this cool dichotomy of getting to see doctors at the beginning of their career when it's all in front of you, and then I also get to work with doctors as they progress through their career, renegotiating their employment contracts.
John: And I think it's implied, but I have to ask you directly. Given your experience, even prior to doing this and then starting the agency and now doing this, would you agree that if you really pay attention and you get the right contract, life is going to go a whole lot better? Or on the other hand, maybe you walk away from something. If you can't get to that contract, it means there's something wrong. Is that your experience?
Ethan Nkana: That is spot on, John. I think that often gets overlooked because psychologically we are so averse to change. And so, when doctors think about what it takes in order for them to advocate for their best interest, there's this big barrier, this big wall of change that they have to go through, or they have to think about scaling. And so, a big part of my job is the psychological part of helping doctors understand, "Yes, there's going to be change and it's going to be worth it." You're going to be happier, you're going to have less stress, you're going to have more support in your practice, you're going to be more fulfilled with your work, and then obviously make a bunch more money to do that.
John: Awesome. All right, obviously you're not going to be able to walk through like a typical 15 page contract or something and cover all, but all the bases. But tell us in your experience what are the top two or three issues and what are some of the pitfalls and maybe the things where you really have to step in and say, "This isn't worded right, or we really have to pay attention to this?" Just take it away and we'll learn as much as we can from you.
Ethan Nkana: Yeah, great question. I have what I call the big five, which are the five provisions that if I had 15 minutes, here's where my eyes would go. First and foremost, the compensation. We're all looking for that big sexy six figure number to see what's my annual salary. But don't forget about your bonuses. Your production bonuses, volume bonuses, signing bonus.
The second thing that I'm looking at is education loan debt assistance. I can count on one hand how many doctors I've talked to who do not come out of training with some type of debt, usually in the six figure range. And so, my responsibility is also to help make sure doctors can pay that down as quick as possible. Going back to what you mentioned a moment ago, which you teed up is doctors being happier. And one way doctors are happier is when they have less student loan debt hanging over their head and then they can use that money to fund the lifestyle they've worked so hard for. And so, I always will encourage doctors to ask for education loan debt assistance. Those can be big dollars anywhere from $25,000 to $50,000, and sometimes above that a year in addition to whatever you're putting into that.
The third is non-competes. You've probably heard of those. They're also called restrictive covenants. The primary difference in this between sports and doctors is that in sports, once your contract ends, you can go play for any team who's going to hire you. But for doctors, it's so much more restrictive. And I don't think people appreciate that. When a doctor finishes their contract, that's when the restriction ends. Let's say you do five years with an employer and then they say, "Nope, you got to get out of town because you can't practice within 20 miles." So, who's going to move 20 miles away and they can change your school district for your kids and your church and social network? I don't have to go into all that, but the non-compete can be really burdensome.
I'll give you a quick cheat code. The non-compete penalty should be paid by your new employer. I often hear doctors say, "Well, I can't go anywhere because of my non-compete." Don't worry about that, negotiate that into your new contract so that way you don't have to worry about that. They'll give it to you upfront as a bonus. They're going to forgive it over the period of your contract. And that way if your employer comes knocking on your door saying, "Hey, you owe us X thousands of dollars", cool, I have a check for my new employer to pay you. So you don't have to worry about getting sued.
The other thing I want to look at is your job duties and schedule. This is huge. This is the thing I often say if doctors got the resources and support they needed from employers, I would be out of a job. But the fact of the matter is, medicine is a business and doctors are a very important cog in a very large wheel. And so, understanding what your clinical contact hours, your patient contact hours are each week, what are your call expectations. And then I just had this issue last week, what happens to call when a doctor leaves? Do they have a support pool to cover that for you? Or do other remaining doctors have to take more call and now impinge upon your lifestyle?
And then lastly, it's your resources and support. You want to make sure you have adequate administrative, clinical, financial support in your contract so that way you can perform at the highest level. It's stressful enough the work that doctors do. Make sure that the hospital provides you with the resources to play at the highest level or to care for patients at the highest level.
John: Those cover a lot of areas. Let me ask you a question or two, maybe about two or three of those. The salary. What drives it? Is it surveys? Is it, "Look, I'm just going to get as high salary as I can. If they're really hurting, then they're going to pay a lot of money." What do you find works the best? And do you usually find that you can get more dollars than the physician actually anticipated?
Ethan Nkana: Absolutely. Every time we go into negotiation, we make our doctors more money. I was asked by a physician group last week, "Well, what happens when that doesn't happen?" The way I get paid is a percentage of my doctor's pay. So, if I don't make them more money, I don't get paid. Our batting average has to be a thousand in order for us to even stay alive. So, we always make our doctors more money.
I think the important thing for doctors to understand, I'm going to bookend this. The most important things that I think would be how busy you are as a physician. Let's take your specialty out. Your specialty is going to of course drive. Like a neurosurgeon, generally speaking, is never going to make less than a nephrologist. That's just never going to happen realistically. We'll leave that out of the conversation. Let's just talk about within your specialty how salaries might change a little bit.
The doctors who generally make the most money are going to be the busiest doctors. My job when I worked in hospitals was to quantify for my CEO how much money we're going to make off of Dr. Jurica based on how busy you are, the type of procedures you do, and then the other counterbalancing expenses, how much do you cost us as a hospital? And then the balance between that is what's called the ROI or return on investment. Doctors are seen literally as line items on financial statements, and I could quantify down to the dollar how valuable doctors were to our hospital. And so, that rule sets the bar as like the busiest doctors generally tend to make the most money.
The other major consideration is where you're practicing. Even if you're looking at two high cost areas, say New York and California, you cannot compare those. Because there's just so many nuances. Now, I'm not an expert in finance, but there's just so much nuance. You must look in similar geographic regions, but then even within that, the care setting you're in matters. Some doctors are in private practice, some doctors in academics, some are in safety nets, like county hospitals.
The general rule of thumb that the data shows is that the fewer layers between the insurance carrier and the patient, the higher pay for the doctor. Private practice, highest pay. Insurance pays the doctor, who pays the practice, and then the expenses get paid for the practice from there. Then as you get to the world that I was in, which is, and I only worked in nonprofit, so I never worked for a for-profit hospital. But those hospitals are looking at "Well, how can we bring on the most doctors of a particular specialty within a geographic area?" They call them service areas.
And so, the chess game that I get to play is how can I help shift doctors among health systems in a way that they have to pay doctors the most money to either acquire or retain them. And so, my job is to help doctors maximize the value of that compensation with your employer. We're looking at "I'm going to pull your stats. I'm going to pull how busy you are." In sports, how many touchdowns did you throw? How many points did you score? How many rebounds did you grab? I want to know how many procedures did you do? How busy are you? Because those are the things that are going to impact your compensation. I can tell you from experience if you come in with the latest and greatest MGMA report, your hospital or employer will find 18 different ways to invalidate that data. "Well, this is looking at private practice. This is looking at left-handed doctors." Just save yourself the time, save yourself the money.
You should get a ballpark of what your salary should be. Doximity, Medscape, Merritt Hawkins, Physician Thrive. They all publish national and annual surveys on physician compensation. So you should have a ballpark of what you should be making. But if you think that that's going to help you in negotiation, you're just going to get laughed out of the room, unfortunately.
John: Now, one of the things that I remember that really drove physicians crazy in this process is the actual way that they're paid. And I'm sure it's changed since I was involved with this, which is more than 10 years ago. Well, they are going to be paid based on RVUs, number of patients seen, just a flat salary, some other goofy formula. Is that becoming any less complicated or do you still see all these different methods of trying to figure out how much you're going to actually take home?
Ethan Nkana: I'm convinced that the industry of law is made up so that people intentionally cannot understand it unless you go through this rigorous three year training program. Yes, it's extremely complex. Could a doctor understand it? Absolutely. But the time that it would take you, I was looking at a family medicine doctor's RVU bonus structure, and it was the wonkiest thing I'd ever seen. And I'll spare you the gore of how bad it is. But the point being, it's unlike anything else I've seen in the country. And so, this one organization has this bonus structure that's disadvantageous to the doctor and she has no recourse to change that. One, she didn't understand how it worked, which, how could you? It's so dense. And then secondarily, when I explained to her, "Hey, this is not in alignment with the industry standard and it's disadvantageous to you", how do you think she feels? It's miserable and it's unfortunate that we don't do a better job of making it plain.
I think what doctors appreciate about working with me, it's that I'm not a practicing attorney, I'm an agent. So, how I talk to you is different. How I interact with you is different. I'm not charging you when you call me. I get a bill from my attorney if I send him a text message or if I send him an email. Again, no disrespect, I have an attorney for my business, but it just seems like a really unsustainable way to add value for my doctors.
John: Well, let's take it one step further than what you described. Maybe you have someone who was in this job, they're unhappy and miserable, now you're helping them. They find out they can't understand the structure, they're never going to get a bonus because they don't really even know what to do to get the bonus. And the hospital is just not budging. To me, that's like, "I know it's tough, but maybe this is not the place you should be working. At the end of the day, we can find you a better job that's going to pay more and it's going to be more transparent." I would think physicians are in enough demand, that they would be able to within a reasonable distance, find a different job.
Ethan Nkana: Yeah. Where were you when I started this out, John? You are preaching exactly what I believe to be the reality for doctors is sometimes you need to go to grow. And I'm not saying that you should go into a contract negotiation, willing to cut ties. But the first question that I ask a doctor when we're getting ready to work together is let's say you present your employer with very reasonable requests and they say no to everything. What are you going to do? And if you say, "Well, Ethan, I'll just go back to work tomorrow and do what I got to do", cool, I'm not a good fit for you then. We work with doctors who say, "Ethan, I know that I'm worth more than that. I know that I deserve better. My patients deserve better, my family deserves better."
All right, here's what we're going to do for you. I'm not going to waste your time as a doctor or my time by talking to your employer until I have an offer for you from somewhere else for more money and better terms. And then I come back to your employer and say, "Hey, Dr. J is looking for a nice little salary bump, he needs an extra PA for his practice. We need you to make those changes for him going to this new contract." They're going to say what they always say, "Not interested. - Okay, cool. Just so you know, Dr. J has an offer across the street for more money and better support. If you're not willing to pay, he's going to walk. - Oh, hold on, hold on. We can have a conversation about this."
Because now they know the economics of Dr. J moving across the street. And what they count on is Dr. J doesn't know his economics, but I do. I know exactly what your work to this hospital and conversely I know how much it would mean at another hospital in your area if they had you working on their team.
John: Now you said something earlier about the non-compete and the fact that you know where you're going should be able to buy you out of that in some way. Now the contracts I've seen have actually never had a dollar amount attached to what that would be. They're just a threat. "We're going to take you to court. And it says here you can't work within 20 miles and you can't work for anyone under this other system." That makes me think, then your contract should always have a figure of how to buy that out. Is that kind of what you're saying?
Ethan Nkana: Exactly. Typically contracts will. I won't go off the deep end about the legality of non-competes and whether or not they're enforceable because there's lawyers who spend their entire careers researching and understanding that. And that's just not my world. For me, it's more a matter of practical implications. I want my doctors to be able to violate their non-compete with no penalty. That's my goal. I don't care about "Is this enforceable?" It doesn't matter. Well, I'm going to assume it is enforceable and get you a route around that. I think it's important for doctors to know that, exactly like you said, Dr. J, there should be a finite number in there. If there's not, it's not going to be harmful for you necessarily. But the point being, that's going to be the amount that you are going to need to cover if you violate your non-compete.
And then again, here's the cheat code. Tell your new employer, "Hey, I've got this tail that I need covered for me. Can you help?" They're going to say, "Cool, we'll pay you that bonus, but you have to work for us for three or four years" or something like that. So, you can get around it. And I've worked around non-competes with new employers. But it's just something that when I was a hospital exec, I used to scare doctors with non-competes. Well, you don't want to upset the CEO because they might come after you. You know that's in your non-compete area. And of course, it has a chilling effect and doctors won't try to. I had a general surgeon last week who didn't feel like she could make that move because of her non-compete, despite me explaining exactly how she can navigate that.
John: I could go on all day with questions about the contracts.
Ethan Nkana: Let's do it. I got all day.
John: Oh no, something else occurred to me. How hard should you push for a notice? I've seen notice from three months to six months to a year. And to me, if you're miserable and you're ready to go, I don't know, waiting a year, and maybe again that's another buyout, but where do those usually fall on your clients?
Ethan Nkana: My goal is usually 90 to 120 days. And the reason I say that is because that's your one runway to find a new job. Let's say if you want to leave, you give them 30 days or 90 days notice, there's no harm, no foul. You're able to go practice where you want. The more impactful situation for doctors or detrimental is when the employer says, "Hey Dr. J, we don't need you anymore." And then now what's my runway to making my next dollar? You don't have that stability. And God forbid, if you're a primary breadwinner for your home, that can be devastating for doctors.
So, it's super important to make sure that you have a nice little runway. Typically what you'll see is it'll say the hospital or employer will give the doctor 90 to 120 days notice, but we can tell you, you're done as of today. But they have to pay you that full runway amount. So, that's the other thing to think about is they can still let you go right away, but they still owe you that notice period amount of pay, which can be significant for you.
John: All right, one last quick one.
Ethan Nkana: Let's hear it.
John: Tail coverage was always something... I was on the other side, again, I was pushing that you have to pay as much as we could get you to pay, and then the contracts we'd shoot for, all of it or have a reducing amount based on how long you've been there. But do you get contracts where you just say, "Look, it's a cost of doing business, I can't work if I don't have insurance, I'm not going to pay it." Do some institutions accept that these days?
Ethan Nkana: What I tend to see across the country is kind of two primary approaches. The default I would say is the employer is going to pay for tail coverage in some of these large healthcare systems. The exception to that is when I see private practices, that's where I tend to see more of the doctor has to cover 100% or the large majority of the tail coverage. And by no means is that a rule or research. That's just kind of my anecdotal observations. What I shoot for, for my doctors in any setting is employer covers 100% of tail insurance. I won't get into the intricacies of occurrence based first claim space, but just know if you need tail coverage insurance, there's kind of the primary default, which is your employer should pay that.
The other approaches I see is, the other bookend is the doctor pays the whole thing. But in private practice, what I'll sometimes see is the employer will cover more tail the longer the doctor's there. So, let's say the employer will cover 50% tail, but after two years they'll cover 100% tail coverage. The sensitive, weird thing about that is you're talking about when you end the relationship, but it's super important to talk about that because it's not something you want to have to find out the hard way that is disadvantageous to you.
John: Yeah. And the thing that I remind physicians about it, particularly if they're looking at their first contract, the tail is very low when you've never seen a patient since you're training. It's only when you've been in practice for a while where it can skyrocket. Eventually if you're an ortho or OB or whatever, it's going to be enormous. We had one guy at our hospital, he just walked away. He didn't pay it and he wasn't going to pay it. And I think the hospital had to protect itself by paying it even though it wasn't in his contract. I wouldn't recommend that approach.
Ethan Nkana: Yeah, likewise, I would not tell you "Walk away and not pay." Yeah. But that is one way to take the most aggressive approach. It's like, "Man, I'm not going to do it. What are you going to do?"
John: Yeah. All right, we are going to run out of time here. I want you to spend a little time, again, talking to us about your company. It's RMPA. rmpa.co is the URL for Rocky Mountain Physician Agency. Tell us more about that.
Ethan Nkana: Yeah. I think the cool thing about what I get to do for doctors is I'm not a traditional law firm or attorney. While my background is I'm trained as a lawyer, I have an MBA, I spent my entire career working in hospitals. And so, what that's allowed me to do is create an industry where we represent doctors the same way agents negotiate talent deals like artists, musicians, movie actors, professional athletes are the common one for me. And so, the cool thing about my work is I get to see doctors at the beginning of their career and help them negotiate a really strong foundation. And at the same time, attendings come to me and say, "Hey, I don't want to get screwed on another contract. Can you help me make sure that I get the best deal in this next contract?"Or physician groups will come to me and say, "Ethan, there's four of us, 10 of us, 20 of us. We have crummy contracts, crummy conditions, but we don't know how to get the attention of our employer." And so, that's where I come in and say, "Look, you get back to doing what you do best, which is taking care of patients, and I'm going to represent your interests to make sure that we address all of your concerns."
And as you know. Dr. J, doctors are not a monolith. If you have 10 doctors in a group, it's not 10 doctors who are all prioritizing the same things. Some of you are going to be in different stages of your career, so you may value different components of your contract, your job, or your lifestyle. And my job is to help take those priorities and interpret them in a way that your employer can understand and make sure they're in your contract for you.
John: Now, you alluded to this earlier, but we didn't get into detail about it. But basically when you're engaged, your plan is to put the onus of the payment on the employer, which is most of us have not gone that route. That would tell me that maybe there's a timing issue here. We're not going to bring you in at the last minute. When would be the best time for either a new physician coming out of residency, fellowship or someone who sees their contract up for renewal in a year or six months? When would be the best time to talk to you?
Ethan Nkana: Yeah, good question. I would start by saying if you are an experienced doctor, you should renegotiate now. Unless you've negotiated in the last six months, nine months, 12 months, you should renegotiate your contract now. Because the chances are you probably haven't had a salary raise in the last 2, 3, 5 years, which means you're taking a pay cut. So, experienced attendings, I would say call me first. And I only say that because as we were talking about, I think we're recording this Dr. J, but we're not a good fit for every doctor. I'll be the first one to say, "Hey, if you are a doctor who only wants to work in this specific hospital or setting and you're not willing to consider your options", I'll be the first to tell you we are not a good fit and we're not going to meet your expectations.
The doctors who are a good fit for us are the doctors who understand that they deserve better. And they call me and they say, "Ethan, I'm frustrated. I'm frustrated with my practice, with not having enough support, with not having enough resources. My staff is not supported." Those are the conversations we can help talk you through. You just want us to give you the answers to the test. We'll be happy to do that. And in fact, we do that. We'll be with University of Michigan next week doing a workshop for them on how to go from training to your first job and make the most out of it. My view of it is call us first. Send us a note first and we'll help you help lay out the roadmap for you.
But I say for experienced attendings, you should renegotiate now. And I know it's going to feel awkward. "Well, my contract is not up." Renegotiate now. If you wait until it's up, you're going to be too late and the hospital is going to slow play you, which they love to do. And then if you're a first time attending, I say that the appropriate time to start looking for your job is about nine to 12 months from when you're finishing training. Typically you'll finish training June, July timeframe. So, nine to 12 months before that is when you should really in earnest kind of get the job search started and then looking to sign a deal in the spring so that way you can do the onboarding, HR, drug tests, all of that. And then potentially you might relocate. So, you'll need to consider that as well.
John: The people I talk to are usually pretty miserable. And so, have you ever been involved with someone who says, "Look, I am in the middle of my contract. It may be a three year contract, or maybe I'm early, it's been a year. I need to renegotiate it now, as you said." But have you had it where they said, "I am going to invoke my need to give my notice. I'm going to give my 60, 90 whatever, 120 days notice and it's not because I want to leave, it's because I just want to talk to you about getting a better contract." The employers, do they respond okay to that?
Ethan Nkana: Yeah, that's a really interesting perspective. I haven't considered that before. I haven't seen that exact situation. I always tell my doctors, whether they work with me or not, get a safety net first. Before you go to your employer and invoke your notice or say, "Hey, I'm going to leave", get an offer first or get some interest first because that will allow you to have, one, some confidence because you can actually back up what you're saying. But secondarily, it gives you a soft landing spot. In case you need it, you really need out, you'd have a landing spot that would allow you to have an uninterrupted livelihood and an ability to make a living. So, if you do put in your notice, I would say go get an offer first.
John: Makes sense. All right, one more time, what's the website and maybe the phone number if you want to give us that too?
Ethan Nkana: Yeah. The phone number is (720) 471-0059. My email address is ethan@rmpa.co. And then we're on Instagram and LinkedIn. We're also starting our new business YouTube page, where we have given a bunch of free tips on how doctors can advocate for themselves in contract negotiations.
John: Very good. Any other last thoughts or advice for us before I let you go? I'd say let's talk about the new grads that are coming out. Just any other things you want to leave before we get out of here?
Ethan Nkana: I think one of the most common misconceptions about first time attendings is that they do not have the ability to negotiate. And I want to be the first one, hopefully, to break that myth. Every one of the doctors that we work with makes more money in their contracts. It's a matter of asking, knowing how to ask and what to ask for. For the first time attendings coming out, please do not feel as though you have to sign whatever is put in front of you. I said a thousand times as a healthcare executive, "It's a standard contract, you can't change anything." And guess what? Doctors didn't change anything. I want to encourage you, please advocate for yourselves, know what matters to you most and ask for those things in your contract.
John: Excellent advice. I really appreciate that. Well, I guess that's all we have time for today. Ethan, I'll have to have you come back someday but this has been fantastic. I've learned a lot. With that, I'll say goodbye.
Ethan Nkana: That's been a blast. Thanks Dr. J.
John: Bye-bye.
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Transcription PNC Podcast Episode 339
Negotiate a Great Contract, Avoid Burnout, and Be Happy
- Interview with Ethan Nkana
John: Sometimes physicians can be their own worst enemies. We finish our training and agree to work for a large practice or a hospital system, and then two or three years later we're miserable. And we discover that our contract does not protect us from being mistreated or underpaid. My guest today is Ethan Nkana, and he's here today to help us avoid those issues. Welcome Ethan. I'm glad to have you here today.
Ethan Nkana: Thank you so much for having me, John. It is a delight to be here with you.
John: I don't know why I haven't talked to someone like you sooner. I've been doing this podcast for several years and I've always focused on nonclinical, but the reality is, for most physicians, they want to go clinical. And they may not want to do it forever, but heck, if they're going to work clinically, they shouldn't be subject to low salaries and being beat up and burned out after two years. I think some of what you're going to tell us today is going to help us avoid that. And I really do think, and I don't talk about this enough, but every physician that's going to be employed really has to have someone help them negotiate their contract. That's my opening for you. Take it from there. Tell us about your background and how you got into this.
Ethan Nkana: Yeah, spot on, John. And actually I want to touch on what you said a moment ago. So much of what I get to do in my job is education. And so, I think it's so important for doctors first to understand what is in your contract and the risks, the benefits and burdens, all of those things. During our conversation I don't want this to sound like a sales pitch for my business. I want to help doctors know how to do it for themselves so they don't need someone like me.
But I think you highlighted something that is extremely important about the relationship that doctors have with employers is often overestimated. And so, doctors have this fierce loyalty to employers, which they find out the hard way is not necessarily reciprocated. I'm glad that you and I get to talk today.
John: I'm going to say another prelude to this whole conversation for those that are listening, because I used to do negotiations on the hospital side for these physicians. I think when you're negotiating or you're having someone negotiate for you, you have to realize, the way you set this thing up and the document that you sign is going to be what you're going to live by for the next few years. And if it turns out there's big holes in it or there's things in there that just don't align with what you thought you were getting, you're going to be miserable. Again, that's just my admonition to those as we get going. Tell us how you got started and I did a little intro separate from this and I talked about how you go back to the legacy with your mom, but tell us about that and then how you got into this.
Ethan Nkana: Absolutely, and I think one of the cool things about what I get to do now is it's kind of the only thing I've ever done in my career. As you mentioned, my mom is an anesthesiologist. Coming out of college, she told me, you've got to get into healthcare, you're going to always have a job. What she didn't know is that I got laid off in 2019 and all of a sudden kind of found myself having this existential crisis.
And in the midst of that crisis, I had this question, "Why don't doctors have agents like professional athletes?" I started thinking about your training journeys as a physician, how that parallels with an athlete. Then you go pro and there's all of this money and athletes hire agents, but doctors tend to DIY it. And so, I founded RMPA - Rocky Mountain Physician Agency as an agency for physicians. And so, my job is similar to a talent agent, athletes, actors, you name it, my job is to negotiate and renegotiate physician contracts for the most money and best terms for my doctors.
John: Now that leads me to a question about that process. Do you usually get involved with their first contract or do you have a lot that are halfway through and now they're getting ready to re-up or renegotiate? Because I could figure that would be a whole different scenario.
Ethan Nkana: Yeah, we do actually quite a bit of both. We do first time attending, what we call rookie deals. Doctors who are coming out of residency and training. And we also negotiate deals for experienced doctors. As you mentioned, those are very different. The reason that for me, it's kind of like a fish in water is because the only thing I've done in my career is work in hospitals. From HR intern, which is my first job, supply chain, food and beverage, physician contracting, finance. If it's in a hospital, I've either done it or I know it.
And so, for me, it's really easy to kind of transition between, "Okay, I have a rookie doc who's going in their first contract. What are some of the things we want to prioritize?" But the cool thing about that though, John, is I get to see into the crystal ball of what attending doctors are concerned about. Then I get to say, "Hey, Dr. Jones, you might want to make sure that you lock in your call schedule, because that's the most common thing that experienced doctors call me about." It's kind of this cool dichotomy of getting to see doctors at the beginning of their career when it's all in front of you, and then I also get to work with doctors as they progress through their career, renegotiating their employment contracts.
John: And I think it's implied, but I have to ask you directly. Given your experience, even prior to doing this and then starting the agency and now doing this, would you agree that if you really pay attention and you get the right contract, life is going to go a whole lot better? Or on the other hand, maybe you walk away from something. If you can't get to that contract, it means there's something wrong. Is that your experience?
Ethan Nkana: That is spot on, John. I think that often gets overlooked because psychologically we are so averse to change. And so, when doctors think about what it takes in order for them to advocate for their best interest, there's this big barrier, this big wall of change that they have to go through, or they have to think about scaling. And so, a big part of my job is the psychological part of helping doctors understand, "Yes, there's going to be change and it's going to be worth it." You're going to be happier, you're going to have less stress, you're going to have more support in your practice, you're going to be more fulfilled with your work, and then obviously make a bunch more money to do that.
John: Awesome. All right, obviously you're not going to be able to walk through like a typical 15 page contract or something and cover all, but all the bases. But tell us in your experience what are the top two or three issues and what are some of the pitfalls and maybe the things where you really have to step in and say, "This isn't worded right, or we really have to pay attention to this?" Just take it away and we'll learn as much as we can from you.
Ethan Nkana: Yeah, great question. I have what I call the big five, which are the five provisions that if I had 15 minutes, here's where my eyes would go. First and foremost, the compensation. We're all looking for that big sexy six figure number to see what's my annual salary. But don't forget about your bonuses. Your production bonuses, volume bonuses, signing bonus.
The second thing that I'm looking at is education loan debt assistance. I can count on one hand how many doctors I've talked to who do not come out of training with some type of debt, usually in the six figure range. And so, my responsibility is also to help make sure doctors can pay that down as quick as possible. Going back to what you mentioned a moment ago, which you teed up is doctors being happier. And one way doctors are happier is when they have less student loan debt hanging over their head and then they can use that money to fund the lifestyle they've worked so hard for. And so, I always will encourage doctors to ask for education loan debt assistance. Those can be big dollars anywhere from $25,000 to $50,000, and sometimes above that a year in addition to whatever you're putting into that.
The third is non-competes. You've probably heard of those. They're also called restrictive covenants. The primary difference in this between sports and doctors is that in sports, once your contract ends, you can go play for any team who's going to hire you. But for doctors, it's so much more restrictive. And I don't think people appreciate that. When a doctor finishes their contract, that's when the restriction ends. Let's say you do five years with an employer and then they say, "Nope, you got to get out of town because you can't practice within 20 miles." So, who's going to move 20 miles away and they can change your school district for your kids and your church and social network? I don't have to go into all that, but the non-compete can be really burdensome.
I'll give you a quick cheat code. The non-compete penalty should be paid by your new employer. I often hear doctors say, "Well, I can't go anywhere because of my non-compete." Don't worry about that, negotiate that into your new contract so that way you don't have to worry about that. They'll give it to you upfront as a bonus. They're going to forgive it over the period of your contract. And that way if your employer comes knocking on your door saying, "Hey, you owe us X thousands of dollars", cool, I have a check for my new employer to pay you. So you don't have to worry about getting sued.
The other thing I want to look at is your job duties and schedule. This is huge. This is the thing I often say if doctors got the resources and support they needed from employers, I would be out of a job. But the fact of the matter is, medicine is a business and doctors are a very important cog in a very large wheel. And so, understanding what your clinical contact hours, your patient contact hours are each week, what are your call expectations. And then I just had this issue last week, what happens to call when a doctor leaves? Do they have a support pool to cover that for you? Or do other remaining doctors have to take more call and now impinge upon your lifestyle?
And then lastly, it's your resources and support. You want to make sure you have adequate administrative, clinical, financial support in your contract so that way you can perform at the highest level. It's stressful enough the work that doctors do. Make sure that the hospital provides you with the resources to play at the highest level or to care for patients at the highest level.
John: Those cover a lot of areas. Let me ask you a question or two, maybe about two or three of those. The salary. What drives it? Is it surveys? Is it, "Look, I'm just going to get as high salary as I can. If they're really hurting, then they're going to pay a lot of money." What do you find works the best? And do you usually find that you can get more dollars than the physician actually anticipated?
Ethan Nkana: Absolutely. Every time we go into negotiation, we make our doctors more money. I was asked by a physician group last week, "Well, what happens when that doesn't happen?" The way I get paid is a percentage of my doctor's pay. So, if I don't make them more money, I don't get paid. Our batting average has to be a thousand in order for us to even stay alive. So, we always make our doctors more money.
I think the important thing for doctors to understand, I'm going to bookend this. The most important things that I think would be how busy you are as a physician. Let's take your specialty out. Your specialty is going to of course drive. Like a neurosurgeon, generally speaking, is never going to make less than a nephrologist. That's just never going to happen realistically. We'll leave that out of the conversation. Let's just talk about within your specialty how salaries might change a little bit.
The doctors who generally make the most money are going to be the busiest doctors. My job when I worked in hospitals was to quantify for my CEO how much money we're going to make off of Dr. Jurica based on how busy you are, the type of procedures you do, and then the other counterbalancing expenses, how much do you cost us as a hospital? And then the balance between that is what's called the ROI or return on investment. Doctors are seen literally as line items on financial statements, and I could quantify down to the dollar how valuable doctors were to our hospital. And so, that rule sets the bar as like the busiest doctors generally tend to make the most money.
The other major consideration is where you're practicing. Even if you're looking at two high cost areas, say New York and California, you cannot compare those. Because there's just so many nuances. Now, I'm not an expert in finance, but there's just so much nuance. You must look in similar geographic regions, but then even within that, the care setting you're in matters. Some doctors are in private practice, some doctors in academics, some are in safety nets, like county hospitals.
The general rule of thumb that the data shows is that the fewer layers between the insurance carrier and the patient, the higher pay for the doctor. Private practice, highest pay. Insurance pays the doctor, who pays the practice, and then the expenses get paid for the practice from there. Then as you get to the world that I was in, which is, and I only worked in nonprofit, so I never worked for a for-profit hospital. But those hospitals are looking at "Well, how can we bring on the most doctors of a particular specialty within a geographic area?" They call them service areas.
And so, the chess game that I get to play is how can I help shift doctors among health systems in a way that they have to pay doctors the most money to either acquire or retain them. And so, my job is to help doctors maximize the value of that compensation with your employer. We're looking at "I'm going to pull your stats. I'm going to pull how busy you are." In sports, how many touchdowns did you throw? How many points did you score? How many rebounds did you grab? I want to know how many procedures did you do? How busy are you? Because those are the things that are going to impact your compensation. I can tell you from experience if you come in with the latest and greatest MGMA report, your hospital or employer will find 18 different ways to invalidate that data. "Well, this is looking at private practice. This is looking at left-handed doctors." Just save yourself the time, save yourself the money.
You should get a ballpark of what your salary should be. Doximity, Medscape, Merritt Hawkins, Physician Thrive. They all publish national and annual surveys on physician compensation. So you should have a ballpark of what you should be making. But if you think that that's going to help you in negotiation, you're just going to get laughed out of the room, unfortunately.
John: Now, one of the things that I remember that really drove physicians crazy in this process is the actual way that they're paid. And I'm sure it's changed since I was involved with this, which is more than 10 years ago. Well, they are going to be paid based on RVUs, number of patients seen, just a flat salary, some other goofy formula. Is that becoming any less complicated or do you still see all these different methods of trying to figure out how much you're going to actually take home?
Ethan Nkana: I'm convinced that the industry of law is made up so that people intentionally cannot understand it unless you go through this rigorous three year training program. Yes, it's extremely complex. Could a doctor understand it? Absolutely. But the time that it would take you, I was looking at a family medicine doctor's RVU bonus structure, and it was the wonkiest thing I'd ever seen. And I'll spare you the gore of how bad it is. But the point being, it's unlike anything else I've seen in the country. And so, this one organization has this bonus structure that's disadvantageous to the doctor and she has no recourse to change that. One, she didn't understand how it worked, which, how could you? It's so dense. And then secondarily, when I explained to her, "Hey, this is not in alignment with the industry standard and it's disadvantageous to you", how do you think she feels? It's miserable and it's unfortunate that we don't do a better job of making it plain.
I think what doctors appreciate about working with me, it's that I'm not a practicing attorney, I'm an agent. So, how I talk to you is different. How I interact with you is different. I'm not charging you when you call me. I get a bill from my attorney if I send him a text message or if I send him an email. Again, no disrespect, I have an attorney for my business, but it just seems like a really unsustainable way to add value for my doctors.
John: Well, let's take it one step further than what you described. Maybe you have someone who was in this job, they're unhappy and miserable, now you're helping them. They find out they can't understand the structure, they're never going to get a bonus because they don't really even know what to do to get the bonus. And the hospital is just not budging. To me, that's like, "I know it's tough, but maybe this is not the place you should be working. At the end of the day, we can find you a better job that's going to pay more and it's going to be more transparent." I would think physicians are in enough demand, that they would be able to within a reasonable distance, find a different job.
Ethan Nkana: Yeah. Where were you when I started this out, John? You are preaching exactly what I believe to be the reality for doctors is sometimes you need to go to grow. And I'm not saying that you should go into a contract negotiation, willing to cut ties. But the first question that I ask a doctor when we're getting ready to work together is let's say you present your employer with very reasonable requests and they say no to everything. What are you going to do? And if you say, "Well, Ethan, I'll just go back to work tomorrow and do what I got to do", cool, I'm not a good fit for you then. We work with doctors who say, "Ethan, I know that I'm worth more than that. I know that I deserve better. My patients deserve better, my family deserves better."
All right, here's what we're going to do for you. I'm not going to waste your time as a doctor or my time by talking to your employer until I have an offer for you from somewhere else for more money and better terms. And then I come back to your employer and say, "Hey, Dr. J is looking for a nice little salary bump, he needs an extra PA for his practice. We need you to make those changes for him going to this new contract." They're going to say what they always say, "Not interested. - Okay, cool. Just so you know, Dr. J has an offer across the street for more money and better support. If you're not willing to pay, he's going to walk. - Oh, hold on, hold on. We can have a conversation about this."
Because now they know the economics of Dr. J moving across the street. And what they count on is Dr. J doesn't know his economics, but I do. I know exactly what your work to this hospital and conversely I know how much it would mean at another hospital in your area if they had you working on their team.
John: Now you said something earlier about the non-compete and the fact that you know where you're going should be able to buy you out of that in some way. Now the contracts I've seen have actually never had a dollar amount attached to what that would be. They're just a threat. "We're going to take you to court. And it says here you can't work within 20 miles and you can't work for anyone under this other system." That makes me think, then your contract should always have a figure of how to buy that out. Is that kind of what you're saying?
Ethan Nkana: Exactly. Typically contracts will. I won't go off the deep end about the legality of non-competes and whether or not they're enforceable because there's lawyers who spend their entire careers researching and understanding that. And that's just not my world. For me, it's more a matter of practical implications. I want my doctors to be able to violate their non-compete with no penalty. That's my goal. I don't care about "Is this enforceable?" It doesn't matter. Well, I'm going to assume it is enforceable and get you a route around that. I think it's important for doctors to know that, exactly like you said, Dr. J, there should be a finite number in there. If there's not, it's not going to be harmful for you necessarily. But the point being, that's going to be the amount that you are going to need to cover if you violate your non-compete.
And then again, here's the cheat code. Tell your new employer, "Hey, I've got this tail that I need covered for me. Can you help?" They're going to say, "Cool, we'll pay you that bonus, but you have to work for us for three or four years" or something like that. So, you can get around it. And I've worked around non-competes with new employers. But it's just something that when I was a hospital exec, I used to scare doctors with non-competes. Well, you don't want to upset the CEO because they might come after you. You know that's in your non-compete area. And of course, it has a chilling effect and doctors won't try to. I had a general surgeon last week who didn't feel like she could make that move because of her non-compete, despite me explaining exactly how she can navigate that.
John: I could go on all day with questions about the contracts.
Ethan Nkana: Let's do it. I got all day.
John: Oh no, something else occurred to me. How hard should you push for a notice? I've seen notice from three months to six months to a year. And to me, if you're miserable and you're ready to go, I don't know, waiting a year, and maybe again that's another buyout, but where do those usually fall on your clients?
Ethan Nkana: My goal is usually 90 to 120 days. And the reason I say that is because that's your one runway to find a new job. Let's say if you want to leave, you give them 30 days or 90 days notice, there's no harm, no foul. You're able to go practice where you want. The more impactful situation for doctors or detrimental is when the employer says, "Hey Dr. J, we don't need you anymore." And then now what's my runway to making my next dollar? You don't have that stability. And God forbid, if you're a primary breadwinner for your home, that can be devastating for doctors.
So, it's super important to make sure that you have a nice little runway. Typically what you'll see is it'll say the hospital or employer will give the doctor 90 to 120 days notice, but we can tell you, you're done as of today. But they have to pay you that full runway amount. So, that's the other thing to think about is they can still let you go right away, but they still owe you that notice period amount of pay, which can be significant for you.
John: All right, one last quick one.
Ethan Nkana: Let's hear it.
John: Tail coverage was always something... I was on the other side, again, I was pushing that you have to pay as much as we could get you to pay, and then the contracts we'd shoot for, all of it or have a reducing amount based on how long you've been there. But do you get contracts where you just say, "Look, it's a cost of doing business, I can't work if I don't have insurance, I'm not going to pay it." Do some institutions accept that these days?
Ethan Nkana: What I tend to see across the country is kind of two primary approaches. The default I would say is the employer is going to pay for tail coverage in some of these large healthcare systems. The exception to that is when I see private practices, that's where I tend to see more of the doctor has to cover 100% or the large majority of the tail coverage. And by no means is that a rule or research. That's just kind of my anecdotal observations. What I shoot for, for my doctors in any setting is employer covers 100% of tail insurance. I won't get into the intricacies of occurrence based first claim space, but just know if you need tail coverage insurance, there's kind of the primary default, which is your employer should pay that.
The other approaches I see is, the other bookend is the doctor pays the whole thing. But in private practice, what I'll sometimes see is the employer will cover more tail the longer the doctor's there. So, let's say the employer will cover 50% tail, but after two years they'll cover 100% tail coverage. The sensitive, weird thing about that is you're talking about when you end the relationship, but it's super important to talk about that because it's not something you want to have to find out the hard way that is disadvantageous to you.
John: Yeah. And the thing that I remind physicians about it, particularly if they're looking at their first contract, the tail is very low when you've never seen a patient since you're training. It's only when you've been in practice for a while where it can skyrocket. Eventually if you're an ortho or OB or whatever, it's going to be enormous. We had one guy at our hospital, he just walked away. He didn't pay it and he wasn't going to pay it. And I think the hospital had to protect itself by paying it even though it wasn't in his contract. I wouldn't recommend that approach.
Ethan Nkana: Yeah, likewise, I would not tell you "Walk away and not pay." Yeah. But that is one way to take the most aggressive approach. It's like, "Man, I'm not going to do it. What are you going to do?"
John: Yeah. All right, we are going to run out of time here. I want you to spend a little time, again, talking to us about your company. It's RMPA. rmpa.co is the URL for Rocky Mountain Physician Agency. Tell us more about that.
Ethan Nkana: Yeah. I think the cool thing about what I get to do for doctors is I'm not a traditional law firm or attorney. While my background is I'm trained as a lawyer, I have an MBA, I spent my entire career working in hospitals. And so, what that's allowed me to do is create an industry where we represent doctors the same way agents negotiate talent deals like artists, musicians, movie actors, professional athletes are the common one for me. And so, the cool thing about my work is I get to see doctors at the beginning of their career and help them negotiate a really strong foundation. And at the same time, attendings come to me and say, "Hey, I don't want to get screwed on another contract. Can you help me make sure that I get the best deal in this next contract?"Or physician groups will come to me and say, "Ethan, there's four of us, 10 of us, 20 of us. We have crummy contracts, crummy conditions, but we don't know how to get the attention of our employer." And so, that's where I come in and say, "Look, you get back to doing what you do best, which is taking care of patients, and I'm going to represent your interests to make sure that we address all of your concerns."
And as you know. Dr. J, doctors are not a monolith. If you have 10 doctors in a group, it's not 10 doctors who are all prioritizing the same things. Some of you are going to be in different stages of your career, so you may value different components of your contract, your job, or your lifestyle. And my job is to help take those priorities and interpret them in a way that your employer can understand and make sure they're in your contract for you.
John: Now, you alluded to this earlier, but we didn't get into detail about it. But basically when you're engaged, your plan is to put the onus of the payment on the employer, which is most of us have not gone that route. That would tell me that maybe there's a timing issue here. We're not going to bring you in at the last minute. When would be the best time for either a new physician coming out of residency, fellowship or someone who sees their contract up for renewal in a year or six months? When would be the best time to talk to you?
Ethan Nkana: Yeah, good question. I would start by saying if you are an experienced doctor, you should renegotiate now. Unless you've negotiated in the last six months, nine months, 12 months, you should renegotiate your contract now. Because the chances are you probably haven't had a salary raise in the last 2, 3, 5 years, which means you're taking a pay cut. So, experienced attendings, I would say call me first. And I only say that because as we were talking about, I think we're recording this Dr. J, but we're not a good fit for every doctor. I'll be the first one to say, "Hey, if you are a doctor who only wants to work in this specific hospital or setting and you're not willing to consider your options", I'll be the first to tell you we are not a good fit and we're not going to meet your expectations.
The doctors who are a good fit for us are the doctors who understand that they deserve better. And they call me and they say, "Ethan, I'm frustrated. I'm frustrated with my practice, with not having enough support, with not having enough resources. My staff is not supported." Those are the conversations we can help talk you through. You just want us to give you the answers to the test. We'll be happy to do that. And in fact, we do that. We'll be with University of Michigan next week doing a workshop for them on how to go from training to your first job and make the most out of it. My view of it is call us first. Send us a note first and we'll help you help lay out the roadmap for you.
But I say for experienced attendings, you should renegotiate now. And I know it's going to feel awkward. "Well, my contract is not up." Renegotiate now. If you wait until it's up, you're going to be too late and the hospital is going to slow play you, which they love to do. And then if you're a first time attending, I say that the appropriate time to start looking for your job is about nine to 12 months from when you're finishing training. Typically you'll finish training June, July timeframe. So, nine to 12 months before that is when you should really in earnest kind of get the job search started and then looking to sign a deal in the spring so that way you can do the onboarding, HR, drug tests, all of that. And then potentially you might relocate. So, you'll need to consider that as well.
John: The people I talk to are usually pretty miserable. And so, have you ever been involved with someone who says, "Look, I am in the middle of my contract. It may be a three year contract, or maybe I'm early, it's been a year. I need to renegotiate it now, as you said." But have you had it where they said, "I am going to invoke my need to give my notice. I'm going to give my 60, 90 whatever, 120 days notice and it's not because I want to leave, it's because I just want to talk to you about getting a better contract." The employers, do they respond okay to that?
Ethan Nkana: Yeah, that's a really interesting perspective. I haven't considered that before. I haven't seen that exact situation. I always tell my doctors, whether they work with me or not, get a safety net first. Before you go to your employer and invoke your notice or say, "Hey, I'm going to leave", get an offer first or get some interest first because that will allow you to have, one, some confidence because you can actually back up what you're saying. But secondarily, it gives you a soft landing spot. In case you need it, you really need out, you'd have a landing spot that would allow you to have an uninterrupted livelihood and an ability to make a living. So, if you do put in your notice, I would say go get an offer first.
John: Makes sense. All right, one more time, what's the website and maybe the phone number if you want to give us that too?
Ethan Nkana: Yeah. The phone number is (720) 471-0059. My email address is ethan@rmpa.co. And then we're on Instagram and LinkedIn. We're also starting our new business YouTube page, where we have given a bunch of free tips on how doctors can advocate for themselves in contract negotiations.
John: Very good. Any other last thoughts or advice for us before I let you go? I'd say let's talk about the new grads that are coming out. Just any other things you want to leave before we get out of here?
Ethan Nkana: I think one of the most common misconceptions about first time attendings is that they do not have the ability to negotiate. And I want to be the first one, hopefully, to break that myth. Every one of the doctors that we work with makes more money in their contracts. It's a matter of asking, knowing how to ask and what to ask for. For the first time attendings coming out, please do not feel as though you have to sign whatever is put in front of you. I said a thousand times as a healthcare executive, "It's a standard contract, you can't change anything." And guess what? Doctors didn't change anything. I want to encourage you, please advocate for yourselves, know what matters to you most and ask for those things in your contract.
John: Excellent advice. I really appreciate that. Well, I guess that's all we have time for today. Ethan, I'll have to have you come back someday but this has been fantastic. I've learned a lot. With that, I'll say goodbye.
Ethan Nkana: That's been a blast. Thanks Dr. J.
John: Bye-bye.
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