In our recent webinar “Transitioning From Training to Practice Successfully” we had a lot of great questions! So we wanted to give everyone a chance to view the webinar Q&A. Hopefully there will be something here to help you as you transition from training to practice!
“Can you negotiate contracts with big institutions such as Kaiser?”
That is a great, great question and the answer is, “Yes, you can.” Now, can you negotiate the same number of things into the degree that you would with a small private practice? No way! That's just totally different.
But I'm pretty close with Kaiser in the sense of, I go out annually and do a do an all-day seminar for their graduating residents on these topics. And I know them well, enough to say that, yes, they will listen to you.
Will they change a lot? Probably not. But even if you've signed a contract with them, if there's something in there that really gets under your skin and bothers you, talk to them. And whether they do it in the contract or in some kind of a context outside of the contract to make things better, they will listen to you.
So be sure that you don't just throw your hands up and say, “Whoever it is is too big, they're not going to listen to me,” we have found that generally, in almost every situation, to not be the case. A good question.
“What are your thoughts on public service loan forgiveness?”
My thoughts are, “We'll see.” And I think that would be true for any governmental program, right? I mean, you know, we're just entering this tenth year here where some people are starting to receive some payments from them, they're starting to pay off their loans.
Even if it's successful for the next for 2 or 3 years, I don't know that I'm confident that 10 years from now, or even 7 or 8 years from now, that it's still going to be operating and doing what it should.
So I'd say those of you who are relying on public service loan forgiveness to get rid of your debt here in 10 years, I would still pay maybe a little more than is required, just in case we get there and they renege on that and you're left having to pay it off.
You don't want to be stuck with a huge debt burden as if you haven't paid anything on it. So basically don't put all your eggs in one basket, especially when it comes to a program instituted by the government. So call me cynical, but I think that's being prepared; I think it's a good idea.
“Do I really need my own disability policy if my employer offers group disability coverage?”
Absolutely! Great question, I really appreciate that. Yes, if your employer offers coverage, that's pretty normal. And, like I said, you want to learn these things before you get disabled, not after.
Doctors call me and say, “Hey, why is my employer coverage only paying me 25% of my pay? They said 60%,” and I have to tell them about it not being own occupation, having maximums on their benefit, and taxes being taken out first.
When I tell them about all this, their first response is, “Well, I guess I should have gotten my own coverage to supplement it,” and that's exactly right. So even if you're getting coverage and it sounds pretty good, get a second opinion, let us show you how to match it up.
Make sure you get something to supplement it because all group insurance has deficiencies. And we're talking about your life income, we don't want to mess this up and under protect it.
“How do RVUs work?”
That's a great question. A lot of you may have bonuses or pay based on RVUs, or a Relative Value Unit. And that's just really the government's way of trying to figure out how to quantify what you do so they can make sure you're being paid fairly.
So it has to do with all sorts of things, but basically, you have some duty or procedure or something that you do is given some type of a multiplier.
And so let's say that they determined that the procedure that you're doing is worth $100, and let's say that it gets a an RVU factor of 2, then that means that, at the end of the day, it was worth $200 and that's what you should be reimbursed.
It doesn't happen exactly like that but an RVU is just a stab at trying to quantify, to monetize exactly what you do on a daily or hourly basis. So I hope that helps; we can go into more detail if you have specific questions about it, but that's kind of a 10,000 foot view of RVUs.
“Why do I need to get disability insurance before leaving residency if I'm not making an attending salary yet?”
I think that I already addressed this but I don't mind addressing it again. You have huge discounts available in training, massive discounts. And if you miss them, you're looking at paying 25%, 30%, sometimes even up to almost double what you would pay with your discount, depending on your situation.
And the nice thing is, even if you procrastinate and wait till last second, which again, no big deal, I would too, but you can actually learn about your options and apply for them but not pay for them until you're either closer to or into your attending position.
“I received an offer from an academic center, they said it will take one to two months before I can see the contract. Should I hold off on accepting until I see it?”
The general advice here would be yes. You don't want to sign anything necessarily and say that you're going to work there until you see the details in particulars of the contract.
I know that's tough coming out of training because you're saying, “Well, but what if it falls through and I don't get this position?”
But you may be better off in the long term not getting a position from an employer whose details you haven't seen yet. Because the worst thing to do would be to sign something and then get the details and find out you hosed yourself for the next three to five years with a really bad contract.
So I'd say be careful; you want to make sure you see everything you can before you sign it.
“I have had an advisor recommend Whole Life Insurance. What do you think?”
Thank you again for bringing that up. Whole Life Insurance is expensive. If you miss one single payment, most of the time, you lapse the policy, it triggers taxable gains, it is just not what it's cracked up to be.
So if you want life insurance, either go the really cheap term route and rent it for a certain period of time.
Or if you want to try and get your money back and have something to build some money over time and that’ll last for your entire career or a lifetime, then look more towards Index Universal Life; you'll get a much better situation, I think.
“Is there any utility in having multiple disability insurance coverages?”
Good question. For those of you who are making a lot of money, each disability policy has a maximum on it that may be anywhere from $15,000 to $20,000 a month.
If you're going to be making enough money that, on top of any group insurance from your employer and that amount of coverage, you still want more coverage, you can have multiple policies and it will let you go up to higher amounts like $30,000 between the two policies.
So I guess there is some utility, but you need to be in a higher income earning specialty to do that. And it needs to be a situation where you're going to want more than $15,000 or $20,000 a month because you can get up to that level of coverage from one policy.
“When is the best time to get disability insurance?”
I think a lot of you are asking that question, probably because you feel the time pressure. And here's the thing, if you're going to go to each individual company and check them out, that's going to take you forever.
The six companies that do this kind of coverage are Principal, Standard, Ameritas, MassMutual, Guardian and Ohio National. So if you're a doctor getting disability insurance, you want to make sure you get it from one of those 6 companies.
And if you don't, even if it's from the AMA or Northwestern Mutual or anywhere else, it is not going to be that true own-specialty or own-occupation coverage.
Now, if you go to try to get quotes separately from those six companies, it's going to take you forever to get them on your own and you're not going to get discounts.
But because we work with doctors nationwide, not only are we going to pool that together into one report so that not only do you have all six options side by side, but we can get the highest levels of discounts for you.
“I’ve applied for disability through two different companies and been denied due to job-related stress or anxiety documented in my medical records. Are there any options for me?”
Just know that each company treats every single medical situation differently. And I can tell you that, even with anxiety or stress issues, even if you've been on antidepressants or things like that, there can still be options for you to get very good discounted own-occupation disability insurance.
So I wouldn't necessarily let past results or any medical conditions or any medications you're taking keep you from doing this. You still want to learn about your options and your discounts.
And more than likely, you will have at least one very good discounted option. So don't let that stop you from going ahead and chatting with us about it.
“How can I find a financial advisor I can actually trust?”
What I can tell you is this, every financial advisor wants to work with doctors. The problem is that most of them are not qualified to work with you, they don't work with doctors very much, they might have 10 doctors who are clients.
I had an advisor brag to me the other day that he'd worked with 10 doctors during his 30-year career; he thought that was great. You want to find the ones who have worked with a lot of doctors and you want to find the ones who charge fair fees and the ones who are going to be honest with you about things and not be biased by an insurance company.
So I'd say if you’re working with a financial adviser and they can only recommend one type of investment or insurance policy, that's not a good situation. If they haven't worked with many doctors, that's probably not a good situation.
And trust is something that's built over time. So start small. Work with them on some life insurance, work with them on some small investments, and see how that goes.
If you think we know what we're talking about, we can certainly recommend financial advisers for you. We can actually recommend physician contract attorneys and we can recommend CPAs for taxes. So we can kind of be a hub for you. If you don't know who to trust but you trust us, which a lot of doctors do, we can certainly point you in directions of people we trust and kind of vicariously give you trust in that way. Otherwise, you're kind of on your own, and I agree that it's really, really tough; hopefully I gave you some helpful thoughts.
“How much time is needed for an attorney to review a contract?”
Typically, it might take a week to 2 weeks, depending on this complexity. And just know, even if you've signed your contract, getting a real legitimate physician contract attorney to review it and educate you on what's in it, what's not, what should you maybe talk with the employer about, is still very, very, very valuable.
And, again, we have people we can recommend who work with physicians specifically. So keep that in mind if you're still interested in having that contract looked at; we certainly can point you to somebody.
“How do I negotiate a sign-on bonus if they're asking for you to pay it back if you leave early?”
Just know that most sign-on bonuses, signing bonuses, commencement bonuses, most of them do have a repayment obligation with them.
Your income can have a repayment obligation on it. I've told the horror story many times about an orthopedic surgeon who received a contract for $500,000, got to his practice for his first year, didn't work a lot due to some issues and ended up owing $300,000 back to the practice at the end of his first year out of training.
So make sure that you’re aware of any repayment obligations. Negotiate that out of there if you can. But if you can't, make sure that you're working your way into it. So if they give you a $20,000 signing bonus, and if you leave within 2 years, they're going to make you pay it all back, maybe make it where it steps down.
If you make it through one year, now it's only $10,000, and by the end of the second year, then it goes away; or something like that. Make sure that it's prorated and steps down.