Post-Training Mistakes Residents and Other Professionals Make: Part II by Clark Gaither, MD, MRO, FAAFP

This is the second post in a series on common mistakes I have seen residents and other professionals make just out of training, mistakes with long-term, often severe, consequences. The first post-training mistake I covered in my last post was the debt trap. In this post I’ll cover the second arena where mistakes are commonly made, employment agreements and job interviews.

Here are six simple tips to follow when preparing to execute an employment agreement or when appearing for a job interview:

Read before signing: First and foremost, NEVER, EVER sign an employment agreement without reading it in its entirety and understanding it completely. You would not believe how frequently this most important step is omitted. In addition, I believe it is good practice to have an attorney review an employment agreement before executing it. It will be money well spent. A whole lot of heartache can be prevented later over production quotas, workload, hours/days of work, time off, scope of practice, non-compete clauses, administrative responsibilities, and more. No matter what you might have been told during an interview, if it isn’t in your employment agreement, it isn’t enforceable. If it is in your employment agreement, it is enforceable. In an interview you might be assured you will not be expected to take on any administrative duties, given management responsibilities, or moved to different practice locations, but buried in the employment agreement might be a clause stating “unless absolutely necessary.” What is and isn’t necessary would, of course, be determined by your employer.

Negotiate: An employment agreement should be the beginning of a negotiation. If I were told an employment agreement cannot be changed, that I would either have to accept it or leave it, that is not an agreement I would personally want to sign or a place where I would want to be employed. Consider production quotas. If you were to randomly assemble twenty people together, you wouldn’t expect each of them to move at the same speed, even if they had identical training. This is an obvious problem with one-size-fits-all employment agreements. Some people need more detail, move at a slower pace, and take more time to make decisions. Employment agreements should contain allowances for the different speeds and comfort levels at which people work and be paid accordingly. In consultation with an attorney, you are allowed to propose changes to an employment agreement which will either be accepted or rejected by a potential employer. Bottom line—if an agreement is not a good fit for you and you are having a hard time getting reasonable accommodations, you might want to consider moving on to your next employment opportunity.

Early out: Your employment agreement should have a 90- to 180-day escape clause where you can walk away from your employer or they can walk away from you if things do not work out. Two- or three-year agreements without an escape clause other than being fired should not be acceptable. Just remember, though, if you were given a sign-on bonus or moving expenses, your employer will most likely want those funds returned, unless your agreement specifies otherwise.

Equitable clauses: Your employment agreement should contain equitable clauses for both you and the employer. For instance, if you must provide written notice of separation from your employer, your employer should also provide written notice of termination. Termination without notice would be unfair if you are held to a different standard.

Disagreements: If your employer asks you to do something which is not in the best interest of the patient, client, or customer and, in your opinion, puts individuals at risk for harm, what then are your options? Are options for settling such disputes spelled out in your employment agreement? If not, they should be. If you are in the workplace and you see behaviors, protocols, procedures, or activities which have the potential to cause harm, could possibly result in inferior products or services, or are outright wrong, how are these situations to be handled? Is there a mechanism or algorithm for addressing these kinds of issues? Along these lines, always present your arguments for needed or necessary change in writing. Email is the best route for communication because there is always a digital trail which can be followed. Conversations disappear into the ether. They are more open to interpretation, misunderstandings, and selective memory and are therefore not an acceptable means of notification or documentation.

Ask questions: Such as, what is your provider/employee turnover rate? High workforce turnover rates are an unmistakable sign of instability and are symptomatic of underlying problems.

Employment agreements

Make sure to read thoroughly before signing an employment agreement.

Where turnover rates are high, rates of job-related burnout (JRB) are usually high as well. High JRB rates are associated with a negative impact on one or more of the following domains—work overload, lack of control, insufficient reward, breakdown of community, absence of fairness, and conflicting values. If these are being so negatively impacted to a point where employees are jumping ship, the last thing you should want to do is climb on board. Have you performed customer satisfaction surveys? If so, what do they show? If the answer is no, satisfaction surveys have not been done, that’s a problem. If they have been done but you are told the results are confidential and for internal purposes only, that is also a problem. Can you provide me with a list of employees I might speak with about your organization? Ask as many employees as possible to speak frankly (background information only and without attribution) about their level of job satisfaction. You want to obtain a general sense of how the employees feel about their job/employer. Alternatively, an organization’s cafeteria is a more open and anonymous place to strike up such conversations with employees. If mostly sour or derogatory themes emerge, consider them very seriously. What is your group’s or organization’s three biggest challenges going forward and what are you doing to address them? Does the interviewer or employee have reasonable, thoughtful answers? Are there opportunities for educational enrichment activities? Support for lifelong learning is a very positive stance to take for any organization. What community outreach programs or activities does your organization support? If you are service oriented, you want to seek out an employer with a similar philosophy and ethics. If you sense the bottom line is all that matters, then you would be better served, serve others better, and be much happier elsewhere. To that end, ask for and read the mission, vision, and values statements of the organization to make sure their values are in alignment with yours.

As you finish training and actually begin your career by entering the workforce, no doubt with unbridled energy and enthusiasm for what comes next, the last thing you want are problems which will slow you down and eat up resources. Following these six simple suggestions will save time and prevent costly mistakes.