contract terms to alter, how to phrase the terms, and
help to identify red flags.
Likewise, you should expect transparency and clarity from the practice with which you are negotiating.
Be sure to read the entire contract and ask detailed
questions if you have any concerns. If you find a provision objectionable, ask the organization to remove it.
Think twice before agreeing to terms that sound suspicious, even if the practice insists that they will never be
enforced. Once the surgeon has signed the contract, he
or she will have no recourse if there is a disagreement.
Ask for copies of corporate bylaws and partnership
agreements, as these documents may contain elements
that will affect your practice. For example, a partnership
agreement may allow more established partners to take
call less frequently or have more vacation, resulting in
an increased workload for newer surgeons. 5 Also, the
financial documents of the group and hospital should
be reviewed, as their finances may affect your future
earning potential. 8
It is important that the surgeon fully understand
the leadership structure of the organization. Physician
satisfaction in the workplace is heavily influenced by
the efficiency of the immediate work environment,
the schedule flexibility and autonomy granted by the
leadership, and the workload requirements. 4
Additionally, you may be expected to standardize aspects of your practice, such as referral patterns.
Be aware that compensation may be different in an
integrated practice than in a typical group practice, so
educate yourself on the exact stipulations of the compensation plan. 9 Success in a large organization is driven
more by collaboration than the “deficit-based” thinking that rules the clinical setting. 10 If the institution’s
leaders value collaboration, they will more likely listen
to your concerns, and you may be better able to make
beneficial changes once you begin your practice.
Tone refers to how you present yourself to potential
Effective communication with colleagues
employers or group partners. Everyone appreciates
someone who is pleasant, hard-working, and has good
decision-making ability, so avoid exuding “the surgical
personality” in your negotiations. 11 Keep an amiable
tone at all times, especially when discussing the finer
points of the contract or when discussing a point in
the contract with which you don’t agree. How you
interact initially will set the stage for interactions later
in your career.
Communication breakdowns between the provider
and the patient, the provider and the family members, or both are reported as the second-most common
cause of inpatient surgical errors resulting in patient
injury. 12 It is a well-documented fact that limiting communication breakdowns could substantially decrease
complications, delays in care, and overall morbidity
of the surgical patient. 13, 14 Effective communication
increases patient satisfaction and improves health outcomes, while poor communication is linked to patient
complaints and liability claims. 15
One of the most important skills for effective
communication is the ability to manage one’s own
emotions and to perceive the emotions of others—also
known as emotional intelligence. The surgeon’s ability to identify and manage his or her emotions as well
as the ability to understand the emotions of patients,
family members, and colleagues is fundamental to the
successful provision of optimal patient care. Finding
ways to train surgeons and residents with the aim of
improving their emotional intelligence is a growing
field of research in medical education, although its
value has been demonstrated in the business community for many years. 16
Interpersonal attributes such as trust are known
to contribute to the success of interpersonal communication between surgeons, both in the emergent and
nonemergent hospital setting. 17 Building a foundation of trustworthiness in interpersonal relationships
with colleagues can be a complex, laborious process.
Seniority and a proven track record are often synonymous with increased trust in the surgical setting. 17