Non-competes, control

[Horners]

Any employed or job seeking psychiatrists out there feeling the same thing I’m feeling? Every employer wants to own you. Control what you do with your time, know where else you’re working etc…

I’m fairly new in the job search and I’ve found myself incredibly stressed out with this feeling that every employer wants to control what I do with my time.

I find this incredibly frustrating. Am I simply one of these people destined to own their own practice? The control employers want to have on me feels very uncomfortable.

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[forchinet121]

Work 1099 and they have no control

 

[JKinSC]

Work 1099 and they have no control

This is why God made private practice...

 

[troutscout]

The only way it changes (outside of contacting your legislators and advocating for a ban on healthcare professional non competes) is to put a line in the sand and refuse to work anywhere that requires them and be willing to walk - while letting them know that removing the non compete is a non negotiable issue for you. We need more physicians willing and able to do that.

 

[SubzDoc]

I have often wondered what a potential employer would say if I told them I want a per-occurrence insurance policy and no non-competes or minimum contract length but, in turn, they can keep the signing bonus.

 

[Mad Jack]

Any employed or job seeking psychiatrists out there feeling the same thing I’m feeling? Every employer wants to own you. Control what you do with your time, know where else you’re working etc…

I’m fairly new in the job search and I’ve found myself incredibly stressed out with this feeling that every employer wants to control what I do with my time.

I find this incredibly frustrating. Am I simply one of these people destined to own their own practice? The control employers want to have on me feels very uncomfortable.

One of my first questions when discussing an offer is if there is a noncompete. If the answer is yes, my answer is it isn't a job for me. It seems I'm not alone and many local hospital systems have noncompetes for every specialty except psychiatry for this reason.

 

[G Sheb]

Welcome to W2 employment...
Those 'benefits' aren't coming free. We just had this discussion in another thread...

 

[hebel]

I agree with the overall feeling. I think this gradual transition of doctors from being treated as professionals to being treated as employees is one of the factors leading to dissatisfaction with the profession.

As to the non-competes, I am 2 for 2 in getting the employer to make significant changes to their non-compete. They often write broad non-competes, despite fearing a rather specific scenario. I start by asking what they are concerned about. From there, we can usually change the language to prevent their concern(s) while making the non-compete effectively non-applicable to any of my hypothetical future plans.

 

[WisNeuro]

If they want you bad enough, they'll change it. Wife (non-psych physician) just switched jobs, asked for a change in the non-compete, they changed it immediately with zero pushback. Never hurts to ask, and if it's unreasonable, just play hardball. Plenty of jobs out there,

 

[TexasPhysician]

Being against non-competes is like being against benzodiazepines. They have both appropriate and inappropriate uses.

Say you work for a company that has 15 locations in DFW. It would be inappropriate to say you can’t work within 15 miles of any company location for 2 years. You’d have to move.

Compare that to a private practice with 1 location in DFW. That practice could have contracts with private entities that you wouldn’t have ever known about. I find it very reasonable to maintain a non-compete of 10 miles from 1 location with a buy-out clause. Otherwise you could open up shop next door and poach every contract with no consequences. That would be quite detrimental to the private practice.

 

[Merovinge]

I definitely see big box shops pushing these very hard and getting into large legal battles to enforce them, even when there is not a huge financial malus to them as a form of control. There's been some pretty famous litigation in two different cities I have practiced in related to them. Certainly don't ignore them and hope they aren't enforced. There are plenty of employers without non-competes or without illogical non-competes, I would not give in if staying local is important for your family. You and your family come first.

 

[dl2dp2]

Compare that to a private practice with 1 location in DFW. That practice could have contracts with private entities that you wouldn’t have ever known about. I find it very reasonable to maintain a non-compete of 10 miles from 1 location with a buy-out clause. Otherwise you could open up shop next door and poach every contract with no consequences. That would be quite detrimental to the private practice.

This kind of situation is very rare though. Very often the practice's non-compete would extend beyond these kinds of a narrow set of circumstances. For example, typically if you are hired under a 1 location practice that takes insurance, the noncompete would include having a side cash practice during non-work hours.

There's fundamentally a tension between the non-ownership employees and the owner. A restrictive covenant is an awkward way to do it and it essentially puts a "tax" on productivity. But often large systems have a power due to considerations with overhead, etc.

 

[comp1]

I totally disagree with comparing them to benzos in general. They're more like Xanax. The appropriate use is so rare and the abuse is so extreme. There is a reason they are banned in multiple states. Like with Xanax, just don't. You're better than that and anyone that won't negotiate on this is likely to be bizarrely controlling in other areas and just not worth it. Residency seriously does not prepare us for valuing ourselves appropriately...

 

[Sushirolls]

non competes with Big Box shops are like get out of jail free cards.
If some one may need to sue them, they'll be used to wiggle out of things.
It's a non-cash type of currency.

They are enforced in many states.

 

[VA Hopeful Dr]

I totally disagree with comparing them to benzos in general. They're more like Xanax. The appropriate use is so rare and the abuse is so extreme. There is a reason they are banned in multiple states. Like with Xanax, just don't. You're better than that and anyone that won't negotiate on this is likely to be bizarrely controlling in other areas and just not worth it. Residency seriously does not prepare us for valuing ourselves appropriately...

So you have a successful private practice. You bring someone on. After 6 months they quit and open up a practice literally next door to yours. I doubt you'd be OK with that.

The non-competes I've had (FP not psych) basically prevented me from going to the main competitor for 1 year. I was free to start my own practice or join a PP group in the same town, but I'd have to go 15 miles if I wanted to work for Big Box competitor. I've never found that unreasonable.

 

[whopper]

I just signed a contact today with a non-compete but it was written in a way in which I don't see myself getting screwed. It basically said if I left the agency I couldn't practice at the same exact location in a competing manner within 2 years. Given it's the "same-exact" and not within a radius I felt fine with it.

Read the fine print.

 

[Sushirolls]

There are also non-solicitation clauses. Those can be considered in lieu of geography.

 

[nexus73]

Non-compete in psych only makes sense to me if it's a private practice bringing someone from out of the area, with costs of recruiting, time and guidance to build up a practice, then have some leverage to prevent the person from being there 18 months, then moving outside and being a direct competitor.

Large health systems, multispecialty groups, don't make sense to me at all, for psych non-compete. These systems are probably barely making money on psych, or could be losing money on psych. Why do you care if a doctor leaves to start a private practice next door. If anything it improves access for the health system PCPs to refer patients to psych, which many places they have no one to refer out to.

At the opposite end of the admin/physician love spectrum, like vascular surgeon or ortho...they don't want these guys leaving and start an ASC down the road and taking all the well insured patients, and docs drop hospital privileges and no longer cover call. That's a disaster for a health system.

 

[PikminOC]

I have often wondered what a potential employer would say if I told them I want a per-occurrence insurance policy and no non-competes or minimum contract length but, in turn, they can keep the signing bonus.

They have a big group that gives out the insurance. Doubtful they would give you occurrence based.

 

[Candidate2017]

Any employed or job seeking psychiatrists out there feeling the same thing I’m feeling? Every employer wants to own you. Control what you do with your time, know where else you’re working etc…

As a licensed physician, you are required by your state board and state/federal laws to act as a professional. This means you are required to act within the standard of care, exercise independent judgment, and are personally liable for not adhering to the standard of care.

However, when you are employed, The Man expects you to behave like an employee (i.e., do as you are told and make a profit for the organization) without regard to your license or your professional obligation. This is in direct conflict with practicing medicine as a professional. The Man, as a businessman, profits from your labor but transfers all the malpractice risks to you.

 

[Candidate2017]

I agree with the overall feeling. I think this gradual transition of doctors from being treated as professionals to being treated as employees is one of the factors leading to dissatisfaction with the profession.

Doctors are treated like employees because they signed on to be... employees. And then are surprised when they get told what to do by someone with a business degree or nursing degree.

Nothing is free. But most doctors don't blink twice before giving up their hard earned right to exercise professional judgment in exchange for a W-2 paycheck, signon bonus, 401(k), paid vacation days, health insurance, not having to worry about running a practice, etc.

 

[AD04]

It's really about power. Do you need the job more than the job needs you? In my contract, I don't have non-compete. But I don't mind signing non-compete for the right compensation. And if there is non-compete, if you have good relationship, it may be waived in the future if you leave. This isn't black or white.

With that being said, you can tell a lot by the other party by the initial contract you get. If it is full of restrictions and non-competes and indemnification clauses, it's likely not a good place to work.

 

[allantois]

This is what happens when lawyers and business people get into healthcare

 

[G Sheb]

This is what happens when lawyers and business people get into healthcare

But this is also why doctors get paid 300k+.
We’re part of the business system. It’s why we make so much money and also why we’re little cogs in the machine. The two are very much related and that’s why I’m skeptical about the romanticization of the past.

Frankly I find that with contractor or even W2 PRN work, you turn the tables. They need us and so the power dynamic is not so much in their favor anymore when you don’t sign your name for control.

 

[TexasPhysician]

I totally disagree with comparing them to benzos in general. They're more like Xanax. The appropriate use is so rare and the abuse is so extreme. There is a reason they are banned in multiple states. Like with Xanax, just don't. You're better than that and anyone that won't negotiate on this is likely to be bizarrely controlling in other areas and just not worth it. Residency seriously does not prepare us for valuing ourselves appropriately...

Let’s look at it another way. If I see a contract without a non-compete/non solicitation, my first thought is that this practice doesn’t have an attorney reviewing its business or ignores their recommendations. Red flag #1. Also, a practice that has nothing to protect that they are doing better than the competition is not a place I want to work. Red flag #2. I believe that I do good work, and I want to be with a group that is doing things better than the run of the mill practice.

I would straight walk if a contract doesn’t include such a non-compete clause. That said, Im also not moving forward unless the clause is reasonable or negotiable to a degree.

Like benzos, these clauses are both good and bad depending on their use.

 

[Geraltofrivia]

I agree with the overall feeling. I think this gradual transition of doctors from being treated as professionals to being treated as employees is one of the factors leading to dissatisfaction with the profession.

As to the non-competes, I am 2 for 2 in getting the employer to make significant changes to their non-compete. They often write broad non-competes, despite fearing a rather specific scenario. I start by asking what they are concerned about. From there, we can usually change the language to prevent their concern(s) while making the non-compete effectively non-applicable to any of my hypothetical future plans.

Could you talk through some less experienced people how to do this?

 

[Horners]

Let’s look at it another way. If I see a contract without a non-compete/non solicitation, my first thought is that this practice doesn’t have an attorney reviewing its business or ignores their recommendations. Red flag #1. Also, a practice that has nothing to protect that they are doing better than the competition is not a place I want to work. Red flag #2. I believe that I do good work, and I want to be with a group that is doing things better than the run of the mill practice.

I would straight walk if a contract doesn’t include such a non-compete clause. That said, Im also not moving forward unless the clause is reasonable or negotiable to a degree.

Like benzos, these clauses are both good and bad depending on their use.

This is an interesting view that you would walk if it DIDN’T have one. Seems like the more appropriate metaphor is more like a double edged sword.

Either way, I was able to negotiate down the noncompete to more reasonable terms. I think one thing I’m really having trouble with is recognizing my own value and being able to throw that weight around correctly and being able to dodge the pushback and bullying from employers.

How do you, TP, and the rest of you manage this sort of transition into attendinghood?

Thanks

 

[Candidate2017]

Could you talk through some less experienced people how to do this?

Are you a psychiatrist? If so, use your magical powers and words.

If you don't have psych magic mojo, just pretend your potential employer is a new eval with the chief complaint of, "My Xanax." Then be pleasantly surprised that your potential employer is mostly rational, not belligerent, and actually willing to somewhat listen to you and work with you.

 

[TheRightMedication]

I have no credentials to present other than my personal experience in negotiations. Advice to follow none the less -

First of all, unless you're an especially skilled psychopath and / or narcissist, this isn't a get-all-the-loot-you-can session. It's a negotiation. If you are able to make a case for your value, people will listen. If you just want more goodies, most people will see through that.

It's capitalism - everyone can win! Help make sure you both win.

Now that your hearts in the right place, you can apply all the pressure you have. That's also part of the fun of capitalism, there can be a bit of friendly competition as you both win together. Someone will win more.

If you want to win you need leverage, meaning you need a BATNA - Best Alternative to a Negotiated Agreement. Ideally you have multiple job offers, or the financial freedom to be unemployed for a long while.

If you don't have a BATNA, I'm not sure what leverage you have.

Moving on to items to negotiate for. Especially early in your career, I strongly recommend you not make money primary. Think about what the job is going to do for your skills, reputation, and growth in 5 or ten years. Can you do good work there, be happy and not overworked, and grow? If not, that extra money is very, very expensive.

TLDR - you negotiate with actual leverage, not some kind of skill or guile. And be careful what you wish for.

 

[confused_doc]

Let’s look at it another way. If I see a contract without a non-compete/non solicitation, my first thought is that this practice doesn’t have an attorney reviewing its business or ignores their recommendations. Red flag #1. Also, a practice that has nothing to protect that they are doing better than the competition is not a place I want to work. Red flag #2. I believe that I do good work, and I want to be with a group that is doing things better than the run of the mill practice.

I would straight walk if a contract doesn’t include such a non-compete clause. That said, Im also not moving forward unless the clause is reasonable or negotiable to a degree.

Like benzos, these clauses are both good and bad depending on their use.

I think this is one of the dumbest things I've ever heard. I guess it's now pretty easy to see why physicians have lost so much power in the healthcare system.

 

[TexasPhysician]

I think this is one of the dumbest things I've ever heard. I guess it's now pretty easy to see why physicians have lost so much power in the healthcare system.

Physicians have lost power at the table because of our inability to move together with force politically. I actively volunteer my time to help with that.

If I had to name another primary area that leads to our abuse, it is neglecting to hire strong legal minds to review our contracts and provide recommendations. I’ve seen friends lose $200k+/year over not having a good contract.

Next would be poor negotiation skills. I’d gladly accept a non-compete with a certain radius for a much more lucrative job. I’d also give up my right to create a competing start-up for 1 year to see the blueprints of a major mover in the field. If you accept others to give up everything for nothing, you are going to be forever stuck with jobs I wouldn’t want.

Then there is one sided indemnity agreements that can lead to you being responsible for tens of millions in potential damages if something negative occurs.

Psychiatrists and physicians in general gladly get paid pennies to supervise midlevels. Friend of mine lost his license to that. Some jobs push you to supervise without training you how to do so or allocating time/money to it.

Add many more higher risk items before finally getting to basic non-competes.

I routinely negotiate non-competes just fine without holding myself or others back depending on the side of the table I’m sitting. These are relatively simple clauses which can be selectively used for certain tasks, have buy-outs, role limited, limited distances, etc.

I can read a business to business contract, and the quality of legal work that went into the contract tells me how much negotiating power I have. A crap legal job, and I’ll ask for a lot more. The quality of legal work says a lot about who you are meeting with.

We all should have respect for/utilize good legal work, be able to identify major issues, understand where/how to negotiate, and plan our futures (not jump into whatever job comes available).

 

[randomdoc1]

I think from an employer's standpoint it probably has more to do with money than actually controlling someone. Non-competes stem from concern a physician will leave, set up shop and take the "customers." Providers at my office, we don't do non-compete. But we do have a non-solicitation. So we're just saying, we're not cool if someone comes here and tries to advertise another place under this roof and same goes for trying to recruit employees out of this office. Now if a patient decides to follow a provider, I'm not gonna start beef with that, I'm cool with it. If someone leaves, they can set up shop next door technically and there's nothing I can do. And if someone does solicit, I'd basically have to sue the person to enforce the contract. So from an employer's standpoint, it darn well better be worth the money and trouble, most of the time it is not. As far as why employers want to know other places employees are working, we kind of want to see what we are up against as well. Are we offering something competitive? It can also be an area to discuss areas that need clear boundaries both ways. For example, never hurts to discuss with an employee that you can't technically render services under randomdoc1's clinic name while you are physically located in another clinic and bill as such. There's a whole bunch of legal and insurance hoopla involved.

 

[TexasPhysician]

I think from an employer's standpoint it probably has more to do with money than actually controlling someone. Non-competes stem from concern a physician will leave, set up shop and take the "customers." Providers at my office, we don't do non-compete. But we do have a non-solicitation. So we're just saying, we're not cool if someone comes here and tries to advertise another place under this roof and same goes for trying to recruit employees out of this office. Now if a patient decides to follow a provider, I'm not gonna start beef with that, I'm cool with it. If someone leaves, they can set up shop next door technically and there's nothing I can do. And if someone does solicit, I'd basically have to sue the person to enforce the contract. So from an employer's standpoint, it darn well better be worth the money and trouble, most of the time it is not. As far as why employers want to know other places employees are working, we kind of want to see what we are up against as well. Are we offering something competitive? It can also be an area to discuss areas that need clear boundaries both ways. For example, never hurts to discuss with an employee that you can't technically render services under randomdoc1's clinic name while you are physically located in another clinic and bill as such. There's a whole bunch of legal and insurance hoopla involved.

Your location may be unique, but what if that person literally took up shop next door? Their name next to yours would notify patients where he/she went, and it wouldn’t be considered soliciting.

 

[the5thelement]

Time is your most precious commodity. Literally the only thing which you will never get back. We trade our youth and energy for the medical degree , then work for peanuts through residency and then end up as waging for the rest of our lives. Take that control back. I never sign any contract which has any thing which i deem exploitative.

 

[comp1]

These contracts are bad for doctors and bad for patients. If we can't advocate for ourselves, we can at least advocate for patients. Unfortunately I have to second the extremely strong disagreement with TexasPhysician's comment. It's definitely NOT an indication of a good place to work and it IS an indication of a location that wants a very high degree of control over your practice. If the reason for that control desire is money, that doesn't really make things better. It definitely doesn't somehow indicate they are going to advocate for you or patients better in other areas. They are going to advocate for themselves in other areas.

 

[randomdoc1]

Your location may be unique, but what if that person literally took up shop next door? Their name next to yours would notify patients where he/she went, and it wouldn’t be considered soliciting.

Then I'd give them a housewarming plant. lol! Yes, a person can do that. But thank goodness we have no shortage of referrals. Wouldn't be financially worth it for me to sue. I think I'd be up for neighborly competition but maybe I'm getting a little over confident. fyi, I opened shop literally across the street from my former employer (we can see each other from our office windows--kinda creepy). I did not mean it that way, it was literally the only place that would rent to a mental health clinic. Our geographic area is...unique.

Another thing, insurance contracts. The vast majority of this clinic's money is insurance reimbursements. Insurance companies are less generous granting contracts to small/new practices now. And the rates in the start are sh_t. It sounds evil, but in a way it does protect my clinic from competition. I'm not saying it should be that way, but it's a fight climbing your way around through insurance land. So let's say a psychiatrist here wants to start their own shop. Well, half their panel is Optum and I've negotiated 3.5 years to competitive rates. If they branch off, they will take a 50% pay cut per capita on those patients as an in network provider. They can opt for self pay, but if a patient can see a psychiatrist at this office for $20 versus $200, a lot will choose the former. Some of the big payers here, are now telling psychiatrists they won't grant a contract for their commercial plans unless they agree to take medicaid too. Again, a physician can opt to stay OON to avoid the low rates, but if a patient can see an in network provider here for a $20 copay versus hundreds for self pay....yea, it's messy. That's all I have to say about healthcare.

 

[dl2dp2]

I’d gladly accept a non-compete with a certain radius for a much more lucrative job. I’d also give up my right to create a competing start-up for 1 year to see the blueprints of a major mover in the field. If you accept others to give up everything for nothing, you are going to be forever stuck with jobs I wouldn’t want.

This is exactly it. In several instances where people accepted fairly restrictive non-competes, the baseline compensation is higher. It's a different model. Some people like the warm blanket of being employed. If you don't, you obviously wouldn't want to be restricted. The ceiling is higher for the latter, but the risk is also higher.

One of the lessons I've learned in my years is that it's actually NOT at all trivial to run a lucrative practice. Most people don't make it... It's very interesting.

 

[comp1]

These contracts are bad for doctors and bad for patients. If we can't advocate for ourselves, we can at least advocate for patients. Unfortunately I have to second the extremely strong disagreement with TexasPhysician's comment. It's definitely NOT an indication of a good place to work and it IS an indication of a location that wants a very high degree of control over your practice. If the reason for that control desire is money, that doesn't really make things better. It definitely doesn't somehow indicate they are going to advocate for you or patients better in other areas. They are going to advocate for themselves in other areas.

 

[TexasPhysician]

These contracts are bad for doctors and bad for patients. If we can't advocate for ourselves, we can at least advocate for patients. Unfortunately I have to second the extremely strong disagreement with TexasPhysician's comment. It's definitely NOT an indication of a good place to work and it IS an indication of a location that wants a very high degree of control over your practice. If the reason for that control desire is money, that doesn't really make things better. It definitely doesn't somehow indicate they are going to advocate for you or patients better in other areas. They are going to advocate for themselves in other areas.

A good place to work will involve good contracts. A good place to work will negotiate non-competes to a mutually agreeable level. The problem I have is non-competes that restrict the ability to work. I have a hard time believing that almost any employee is noticeably harmed by a 5 mile non-compete in a big city. The only good reason to breach that is to take business from the employer. San Antonio or wherever has dozens of jobs outside of every 5 miles that don’t include moving. It’s the 15 miles from every affiliated clinic that is a problem.

Same goes for buy-outs. I pay 60k+ more than other clinics per year in my area. If you want to break my small non-compete, returning part of the generous extra pay by buying out the non-compete to set up shop next door is fair game in my opinion. You’d still make out better, but I’m less harmed by spending $ on advertising and filling hours.

It’s crazy to believe that higher salaries and great caseloads will come from clinics that do nothing special that needs no protecting.

Now if we are talking the local Medicaid clinic, there is no reason for a non-compete.

 

[AD04]

Psychiatrists and physicians in general gladly get paid pennies to supervise midlevels. Friend of mine lost his license to that. Some jobs push you to supervise without training you how to do so or allocating time/money to it.

Would you explain what happened? What does your friend do for work now?

I’d also give up my right to create a competing start-up for 1 year to see the blueprints of a major mover in the field.

I did this for my first job to learn how a private practice was run. I was quite underwhelmed. The better use of your time is to work a lucrative job and pay for good mentors if you don't have any from your current job. For example, if I was starting an insurance-based private practice and with goals of growing it, I would reach out to @randomdoc1 and propose an offer.

Another thing, insurance contracts. The vast majority of this clinic's money is insurance reimbursements. Insurance companies are less generous granting contracts to small/new practices now. And the rates in the start are sh_t.

Does this mean you're always expanding / recruiting? I'm sure getting bigger gives your more negotiating power.

 

[allantois]

You don’t see attorneys or bankers signing non-competes/ it’s to keep the sheep in line. What even is the point of a 5 mile non compete? If it’s not community mental health, any other patient can travel extra 5 miles. Non-solicitation clause should be sufficient. These non competes absolutely are bad for patients just as all other lawyer/big business involvement in healthcare

 

[TexasPhysician]

You don’t see attorneys or bankers signing non-competes/ it’s to keep the sheep in line. What even is the point of a 5 mile non compete? If it’s not community mental health, any other patient can travel extra 5 miles. Non-solicitation clause should be sufficient. These non competes absolutely are bad for patients just as all other lawyer/big business involvement in healthcare

Yes you do see attorneys signing them. Executives? Yes they sign them too. Want to start a franchise? You’ll sign one. Involved in a start-up? You’ll sign one. If anything, some of these include the inability to work in the same sector anywhere in the USA.

Let’s take 1 issue. Many patients find psychiatrists through Google Maps or other Maps to find a psychiatrist near them. Some even forget the name of their clinic and use maps to figure it out. So I search “psychiatrist” and Google Maps will show me some nearby clinics. If there are 3 psychiatric clinics in the same building, it is very common for only the most Google optimized clinic to show up. It isn’t aesthetically pleasing to try and show 4 clinics in 1 spot over 4 clinics evenly spread out over the map. Better user experience. A few miles down the road, a weakly optimized clinic will show up over a stronger one in the same building as the strongest one.

So an employee could learn exactly how I attract patients, poach my contracts, set-up shop in the same building, pay tens of thousands to get better SEO, and severely damage my ability to grow. Patients would not benefit as they wouldn’t easily find my clinic on maps for directions or to know I exist to make a phone call and schedule.

This creates a Google optimized war which increases patient acquisition costs and the end result is us both increasing cash prices to deal with this. One of us will give up eventually and move away. The patients then suffer.

 

[Stagg737]

You don’t see attorneys or bankers signing non-competes/ it’s to keep the sheep in line. What even is the point of a 5 mile non compete? If it’s not community mental health, any other patient can travel extra 5 miles. Non-solicitation clause should be sufficient. These non competes absolutely are bad for patients just as all other lawyer/big business involvement in healthcare

Yea, this is wrong. I worked in a few industries before med school and had to sign a non-compete in several of them, the most egregious ironically being in fast food. I can echo what Texas said in the post above as my wife works in advertising and previously worked in marketing doing SEO for physician groups. In an area with many practices, it can be easy to completely screw over a previous employer if they don't protect themselves and I also saw this happen with a large group of orthopods I used to work with. I can give specific examples if you'd like.

 

[randomdoc1]

Does this mean you're always expanding / recruiting? I'm sure getting bigger gives your more negotiating power.

I sure am! And yes, having more people gives you more negotiating power. Other things that factor into it:
-does your place offer a service in higher need? (e.g. treat chronically mentally ill, child adolescent providers, substance use treatment, outreach to rural areas, etc.)
-do you have good outcome data (they like hearing about saving money)

I know this thread is about employers and control, although as physicians in any capacity, we have so many little factors we can fine tune to our favor. You can use these chips as well for negotiating as an employee of course. It's all about, what does this person/clinic offer me/us? Can we work symbiotically?

Other neat tricks I learned-->
--continue to foster those relationships whether you are a clinic owner or employee. Business 101. I've LinkedIn friended network managers and of course kept things professional (I also post regularly on LinkedIn so your presence is more consistently in their feed and you become a familiar face). Be friendly, approachable, but also firm, specific and consistent. I like to think it's helped in edging better rates that otherwise may not have happened. I remember once a network manager asked me off the record about what FDA approved treatment options existed for a certain psychiatric disorder. This person said it was about their child. I linked to a few resources and of course, was firm in saying this is what I know is available and it is not an endorsement for or against and they must consult with their provider. It was kind of an odd place as I was not the one to initiate that conversation. They were quite grateful. I remember another time, an insurance was not budging on the rate and I told the network manager I appreciated their efforts and can tell it was not their decision. Later on, we did get the rate up. So....yea.
--1-2 insurances continued to offer me sh_t rates. But we're in a hard bind where it's hard to drop them too. So I told them, fine, you offer us that, we're not taking anymore of your new referrals. You can technically be open to in house referrals only without violating the insurance contract. I told them maybe we'll grant their members better access if they change their tune first. Give sh_t rates, get sh_t service lol. I think the lesson of the story is, contracts whether with employers or insurance (although in the big scheme that's kind of like...my employer), there's things you can nudge around!