Imagine being recruited to several employers around the country who wine and dine you guys. They set you up at nice hotels and serve you the best steak and seafood in town. They even pay for the kiddos to fly out with you.

Congratulations, this is real life for post-training.

Before you get to reap in the rewards of a post-training job, hands-down, no excuses — you absolutely need to educate yourself on contracts.

Your first contract will set precedence for all of the other contracts in your life. Your DrSpouse spends hours of training, but need to spend just a few hours on what would dictate his career that you guys worked hard for.

The book I read to help me and my husband is called The Final Hurdle was written Hursch, which was highly recommended to me by several in the physician finance industry.

Hursch’s logo has the caduceus and the scale

What is the book about and who the heck is Hursch?

Mr. Dennis Hursch is a healthcare attorney who specializes in working with physicians. He has been practicing law since 1982.

Hirsch has a super sweet history with doctors. He dedicates this book to doctors who saved his miracle baby who is now his grown daughter.

His mission is to help the young resident — YOUR DR SPOUSE — who is interviewing for his first job. As that young resident’s spouse, you are just as important in the decision-making as the resident himself, which makes this book recommended reading for both of you.

Your Dr spouse unlikely had any negotiation training

Our DrSpouses are very well-educated. Your house has piles of books, binders, USMLE, board study guides, and medical journals you’ve accumulated.

But soon, on top of the kitchen table, is a crucial document that determines your working conditions for the next 20 to 30 years of your working life.

These pieces of paper cumulate everything you guys worked so hard for.

How do you know if everything in it is fair and with tight definitions that won’t screw you over later?

You really don’t.

Your DrSpouse probably had no training on business skills like negotiation or understanding contracts.

To me, that’s an affront to physician education.

No wonder so many physicians face the debilitating effects of burnout. Having no preparation to deal with the nuances of your employer is a recipe for burnout in the making.

Fresh out of training, you’re tired of the tunnel and you just want to start making money right away.

So, it’s natural to blow off your contract. You will likely focus on only some numbers like compensation and work schedule while flipping through the contract.

But there is so much more to a contract than that.

On top of that, employers like to say, “We will send you our standard contract, which we have all signed,” alluding to the fact nothing can be negotiated. This happens a lot, especially for academic positions.

And that’s how they get you in situations that are unfair.

Why this book is a game changer

Hursch explains how what is in the contract can screw you over, what he usually has successfully been able to negotiate, and what he normally sees or doesn’t see.

Style of the book

The book has 116 pages, which can be read in under two hours cover-to-cover.

To be honest, there is nothing that will make me fall asleep faster than law talk. (Those who went into law, we salute you.)

But Hursch uses easy, fun language. He also pokes at the fun dynamics between doctors and lawyers, two well-educated professional fields that are well-misunderstood by people on the outside.

He even makes a funny footnote, mentioning a hypothetical company called “Mutual of Podunk.*” And then he writes:

 “*I am pretty sure that there isn’t an insurance company called Mutual of Podunk. If there is, I humbly apologize for any offense taken. I am sure it is a wonderful company, where caring people do their best to change the world for the better.”

I was able to keep focused on the book even with three little kids.

I think I proved my point.

What does the book cover?

The book has eight chapters and goes through what you need to know about physician employment contracts.

Hursch covers these:

  1. Compensation benefits
  • Is there a sign-on bonus?
  • Do you or the employer determine if or how disabled you are before you get disability benefits?
  1. Restrictive covenants
  • How can you minimize the impact of a restrictive covenant — such as geographical area as well as the time that the restriction — if things don’t work out and you still want to make a living at this particular location?
  • Do the restrictions apply only to your new office, or to every location where your new employer has offices?
  1. Call coverage
  • How call is divided and patient contact hours?
  • Who owns the medical records if you have a new employer and one of your patients wants to be continued to be seen by you?
  • Can your employer can assign you to work other offices that may be super far from where you live?
  1. Defining what is expected of you
  • What are the patient contact hours expectations?
  • What is flexible and what is firm in your contract?
  1. Terms of the agreement
  • Are there issues with hospital and managed care credentialing and how to work around them?
  • What are the grounds for termination?
  • What are the “without cause” termination issues?
  1. Other issues in agreements to watch out for
  1. Malpractice insurance (lots of horror stories here)
  • What are the types of coverage and the significance if you leave?
  • What are the needs for “tail coverage”?
  • How to minimize the devasting cost of “tail coverage”?
  1. Private practice issues
  • What is the time to ownership?
  • What are the concerns with “guaranteed” ownership?
  • What is the cost of the buy-in?
  • What are the methodologies for determining the buy-in?
  • What are the provisions that are vital in regard to future ownership?

How this book can change your life

If your DrSpouse is not looking for a job, this book will be boring. It just won’t apply to your situation.

But if he’s actively interviewing, this book is a gem.

It’s like prune juice. It doesn’t taste good and you don’t need to drink it all the time. But if you can’t go, you really need it.

The best parts of the book that are invaluable

There are three parts that is worth the cost of the book:

  1. The most important chapter in the book is the last one (Chapter 8) called, “Private Practice Issues.” It is chockful of info that I would have otherwise no clue about. I personally never seen this section explained elsewhere on the internet.
  2. The second most important chapter in the book is Chapter 7, “Malpractice Insurance.” If I could name one thing that most physicians get caught off-guard about, it’s who is covering tail insurance or how to negotiate it if it’s not included.
  3. Third, there is a checklist at the back of the book with questions you need to absolutely know going into a contract. These were great for preparing my husband for his negotiations.

For these sections alone, you should read this book.

You should get the book even if you’re going to hire an attorney anyway

Here’s why.

If you were optimizing your situation as the potential new hire, you would ask about these issues before the contract is written and before you hire a contract lawyer.

You would not use the book to replace a contract attorney, but to give your attorney a better canvas to work with.

Once the contract is already drafted, your attorney is much more limited as to how much can be negotiated at that point.

My theory why many physicians think that contracts in academia are non-negotiable is that they give one that’s already drafted. At that point, not many physicians even try.

However, Hursch has been able to negotiate parts in even the most “standard” of academic contracts that were supposedly non-negotiable.

Secondly, you need to really understand what is on contracts, specifically, on your contract.

Your attorney (whoever you choose) may or may not do a good job explaining everything. But this book will.

One key advice you can takeaway

One of the book’s key advice on how to approach contract negotiation is to act like the dumb doc. It’s not meant to be offensive, but is a charade that will give you the upper hand in the negotiation.

Have your DrSpouse act like a dumb doc who needs to check back before you can meet again buys time so you can be prepared with accurate information to discuss.

It’s just like a good US President who doesn’t send our troops without intelligence.

If your DrSpouse makes snap commitments, it will be harder to backpeddle on a point he has already conceded to.

Acting as the dumb doc doesn’t compromise your DrSpouse’s reputation as a leader. Instead, it shows you don’t rush into decisions, are flexible and creative about coming to solutions, and checks facts beforehand.

The dumb doc always gets the best contracts.


Hursch takes you through three stages:

  1. You’re on the fence about hiring an attorney, wondering if you can get away with using a law clerk, your program director with tons of experience doing this, or signing the “standard” contract as is.
  2. You realize there are areas in your contract that are not very clear, and it would totally screw you guys over, working your DrSpouse like a hamster in a cage and killing your dreams.
  3. You won’t ever contemplate signing a contract without a healthcare attorney to review. (That’s me, and how I feel.)

Ultimately, Hursch wants you to hire him as your attorney to review your employment agreement. He can perform reviews in all 50 states.

Just like there are specialists in all fields of medicine, he wants you to read his book and realize he specializes in healthcare employment contract review — a match for your needs. He feels best qualified to do this job for you.

Real, honest review

This isn’t really a criticism, but a comment. It’s currently a sticker shock at its listed price of $70 on Amazon.

I think this is fair compared to the price of USMLE and other board study guides we have bought throughout training. You need to think of it as a textbook, not a fiction novel.

If your DrSpouse can negotiate or come across as a stronger candidate as a result of this book, which I think he will, this book is worth three times as much.

Still, $70 isn’t chump change on a residency or fellowship budget. At the end of training, you will hemorrhage money to pay for licensing, boards, and moving.

You will be like:

“Great, just another expense.”

I get it, you need the book the most when you are broke!

I wish it was cheaper, but maybe your DrSpouse’s program can buy it for you and then store it in the lounge.

In summary

You need to be trained on understanding contracts. And you need this training before you interview.

If the contract is already on paper, there is little room for negotiation. It’s pretty much a done deal.

Whoever you choose as your attorney, it’s important it is to work with one who concentrates his or her practice on physician employment agreements. Do not go with a law clerk, your program director, or just any attorney.

Money is tight in the final months before finally earning a big paycheck. But don’t skimp in this area. Your first contract will set precedence for all of the other contracts in your life.

Get the book to understand and optimize your contract before it’s drafted, and get a healthcare attorney to review your contract once it is written.