Talk to my agent: Some physicians let others arrange the job

In 2001, Duke University basketball player Shane Battier moved on to the NBA and hired an agent to handle his contract negotiations. Around the same time, Duke University psychiatry resident Omar Manejwala, MD, moved on to the pro ranks and, like Battier, hired an agent to handle his contract negotiations.

It might seem strange that a physician would have an agent handle job-hunting and contract negotiations. But the increasingly complicated nature of employer and partnership contracts has more doctors retaining outside help -- for an hourly fee, or a base rate of 4% to 10% of the first year's salary.

While no numbers exist as to how many doctors are hiring agents, many individuals and law firms are advertising themselves as physicians agents on Web sites and pitching their wares at seminars on medical school campuses.

The agents offer not only to help you get a fair salary but also to eliminate contract language that might be unfriendly to you.

Dr. Manejwala enthusiastically recommends hiring an agent, as he did to get his first two post-residency positions. For his current post -- associate medical director at the William J. Farley Center, a substance abuse rehabilitation center in Williamsburg, Va. -- he said his agent was able to get a noncompete clause eliminated from his contract, among other details.

"It turns out salary ended up being one of the least important variables," Dr. Manejwala said. The agent "justified his fee in both my cases multiple times over."

But hiring an agent is no guarantee of getting what you want -- or that getting what you want will be worth the price you might pay both in dollars and in good will with your employer. With no official certification for the field, anybody can put up a shingle and call himself or herself an agent.

And some critics of physicians using an agent say the trend is further evidence of medicine becoming more like any other business.

"Athletes do it because there's so much money at stake," said Peter Conrad, PhD, Harry Coplan Professor of Social Sciences at Brandeis University in Waltham, Mass. "I don't see too many physicians signing multimillion-dollar contracts. It puts the money in the contract out in front of what the goals should be. There's something not quite right about it."

What an agent does

By general legal definition, an agent is a person or firm retained specifically for the purpose of acting on the client's behalf in a fiduciary relationship.

If you have given an attorney power to negotiate a contract on your behalf, that attorney is acting as your agent. But an attorney who is reviewing your contract and giving you advice on what you should ask to have changed is not acting as an agent, because the attorney is not engaged in the actual contract negotiation. An agent does not have to be attorney, however.

Physician agents say they are needed because the employers doctors are dealing with have their own outside paid help when it comes to drawing up contracts and studying candidates, the latter through employer-paid search firms. It's only fair, they say, that physicians get the same help.

"It's important to remember the employer contract was drafted by the employer to maximize their advantage," said Brad Jones, president of Medicord, a Charlottesville, Va.-based physician agency. He represents Dr. Manejwala.

Michael Z. Stern, an attorney in Austin, Texas, said pairing an agent with a physician makes sense given that employment contracts can range anywhere from a one-page letter to a 50-page document -- and either one can be vague. "The point is not to necessarily bargain for better working conditions," he said. "It's to make [the contract] more explicit so that everyone knows what's expected."

Agents say they also can broach sticky subjects, such as starting salary and practice stability. "An agent removes the personal and emotional aspect from the contract negotiation," said James Steele, president of the Synerge Agency, a physician representation agency in San Antonio.

Agents say the relationship doesn't start with the contract. For example, Jones says he gets to know his clients' personal and career goals and then works to secure anywhere between two and four job offers. Once a contract is presented, he drafts a comprehensive list of the contract highlights and reviews them with his client.

Then an informational meeting is set up with the potential employer where the agent asks the kind of questions that an interviewing physician may want to know but might not want to ask; for example, the salaries of other physicians in the practice or the practice's financial statements over the past three years.

"I always ask employers for a list of everyone who's left in the last five years," Jones said. "If you want to know the downside of a relationship, that's where you start."

Jones said the entire process can span nearly six months.

Do it yourself

But have things changed so much, have the tables against doctors in employer contract negotiations turned so much, that physicians need to retain the health care equivalent of Drew Rosenhaus or Michael Ovitz? Plenty of experts say physicians should approach the idea of an agent with great caution.

The emergence of physician agents is so new that organized medicine does not have specific ethical guidelines regarding them.

And some experts say that, merely as a business proposition, agents might not be worth what they're charging.

Ken Hertz, an Alexandria, La.-based senior consultant with the Medical Group Management Assn., said there is nothing agents can do that physicians cannot do when it comes to contract negotiation. If physicians need help, there are less expensive ways to go, he said.

"You could get an attorney to look at your contract for $500 to $1,000," Hertz said. "It could cost thousands of dollars to hire an agent. And how much more are they going to get you? They're not going to get you $100,000 in CME."

Though Steele says the organizations he has negotiated with have appreciated his services on behalf of doctors, Hertz said he's not so sure. Doctors could face the same fate as Jim Ringo, the Green Bay Packers center who in the early 1960s was among the first players to hire an agent. The oft-told story about Ringo is that he told the legendary Vince Lombardi to talk to his agent about a new deal. Lombardi left the room, then came back and told the agent he was talking to the wrong guy, because "Jim Ringo has just been traded to the Philadelphia Eagles."

"I've got to think that there are certainly organizations out there that, should a doctor show up with an agent, the hospital or practice would say, thanks, but maybe we'll find somebody else," Hertz said.

Agents need scrutiny, too

If a physician is interested in hiring an agent, Hertz said that doctor must put the agent through the same analysis he expects the agent to put into each deal. Does the agent's style represent you? How aggressive do you want the agent to be?

"Do you want to be seen as so aggressive financially that you bleed the practice? Nobody wants to do that," Hertz said. "You have to make sure if you get someone to negotiate the contract you've got to be very clear about how you want that handled, and you need to define some boundaries.

"I think you've got to build these relationships based on trust and mutual respect. It's got to work for the practice and the doctor."

Dr. Manejwala said he believes his agent, Jones, did just that. "This was a nice way to get a fair deal but also maintain a fair relationship," he said.

Regardless of anyone's trepidation, agents are confident theirs is a growth industry. "There may be a lot more people out there like me five years from now," Steele said.