Hi, my name is Jim Kelso, and I've been asked to do a presentation for the American Academy of Dermatology. It's usually focused on resident issues and the resident symposium. And today, that's what we're going to kick off with. So I am trying a Zoom recording for the first time, so please bear with me. I need to share my screen and get my slides up. Okay. All right. Let me go ahead and put on the slideshow. All right. So the talk today is about evaluating or providing information to help you evaluate the potential employment offer and an employment contract. So we're going to go over the terms and conditions or generalized terms and conditions with factors that you should be aware of. Okay. So why are contracts important? Contracts are important because they're going to define and manage the risk. They're going to define the relationship and try to put parameters around how both parties are going to work together. Contracts have to be binding. There has to be consideration to make the contract enforceable upon the other party. That consideration is typically bargained for in exchange. So in your case, as an employee, you're going to provide your labor in exchange for the compensation. So that's the consideration. If there's no consideration, there's no contract, and it's not binding and enforceable. So if you think about a gift or an advertisement, those are actually not contracts. And so you spend the first year of law school, definitely the first six months learning about what is a contract and what is not a contract, what's binding and what's not. Most importantly, contracts are used to manage the end of relationships. And a lot of times it's referred to as being around for the divorce, not the marriage. When we get into contracts, the first thing that comes up, the elephant in the room is compensation. So here we've got the general compensation data. In general, most people, the median, make about $457,000. The mean is a little bit higher, but the median is based on 45% of net collections. And that was the old school model. And private equity and different factors have really pushed that target down. So here we're at 45%, which is where we'd be of a million dollars. The collection data, the mean is a million dollars. The median is 985, basically a million dollars. So that's your 45%. So the question really becomes more on the right hand side, how do you get to a million dollars? So you get to a million dollars basically by seeing patients. And in dermatology, it's all about patient volume. So 35 patients a day, it's an average workload at 135, which is a very conservative estimate, dollars per patient encounter, four days per week, four weeks per month, 12 months, it's going to be 907. So that changes with a little bit of a couple little factors down toward the bottom on the right. $150 per patient encounter equals 1,000,008,000. 135 with 40 patients per encounter comes out to 1.036 million. And 150 at 40 patients per day comes out to 1.152. Different jurisdictions are going to be able to impact the $35 per patient encounter. So like in San Antonio, there's a variable in the reimbursement rate from CMS for CPT codes that includes a geographic area amount. And so that's called a GYPSI, and that can be higher based on different geographic areas. So like the GYPSI in New York is going to be different from the GYPSI in San Antonio, which would make this 135 a little bit higher. So if you're doing more cosmetics, that's going to increase this number as well. So in general, that's why, you know, 10 years ago, people would be employed by a practice, they may or may not have an opportunity to be an owner of the practice, and they would generally be offered a flat 45%. Those days are gone really because private equity has negatively impacted compensation for physicians in the long run. Now there's an alleged tradeoff, and we'll get to that, which is this slide. There are a lot of concerns about private equity. I've labeled this a note on private equity, but it's really kind of designed to help you understand the deal and the terms of what private equity is really offering and why the compensation is lower. So going back to the traditional model, which is my second bullet, most people would want to work for a practice where they become an owner because you get two things when you're an owner that are very valuable. I have a lot of young people say, well, I don't want all the headaches. You're going to have the headaches anyway, regardless of if you're an owner or not. Private equity is going to try to take those away, and we'll get to that. But the bottom line is you want to be an owner for two reasons. One, you have a vote on issues facing the employer, and then two, you get ancillary non-physician income. And so those are really two significant things that I think people lose sight of. So if there's four people in the group, you're going to be the fifth. You're going to have a 20% stake, and you're going to have a 20% of equity ownership and voting power, and you're going to have 20% of any ancillary income, spas, PAs, estheticians, laser services, whatever you can think of. So the goal of PE is to have 20% of the money that comes in from your labor go to Wall Street and the private equity investors. That's the goal. So the way that they do this is that they take the traditional model and they squeeze down the overhead, and they squeeze down the physician compensation. So if we go to the second bullet, what that really is kind of outlining is an eat what you kill model. In dermatology and most primary care practices, there's a 50% overhead cost. And if you're an owner of the practice, you get the rest, which ends up being 50%. So in an eat what you kill model, it's overhead, it's gross cash collections minus overhead. In dermatology, it just happens to hover around 50%. And so if you're an owner, you get 50%. If you're an owner, 50% goes to overhead. And most of the time, people are trying to manage that, but it's very difficult to get that 50% down. So private equity comes in and says, we're going to make your life easier because we're going to have shared savings. We're going to have professional management. We're going to have lower costs, and as a result, we're going to be able to put more money into marketing and get you more volume. So what they're trying to do is to trade off with ease of life versus ongoing compensation. So what most of them try to do is to get the 40% up to some threshold of 800 or $900,000 or a million dollars in net collections, and then it goes up to 45% at that point. But that 40% is what they're trying to do. So they knew that the traditional model was that most starting physicians would take 45%. So it's not like they're really trying to get the full 10% off the bat. They know that their delta with the new hire is a 5% delta, and if they can push it down, they will, and they're going to use that 10% to send to Wall Street. On the overhead, they're going to try to have shared savings with efficiencies of scale for billing, legal services, purchasing, practice management, EMR costs, all those kinds of things, and they're going to try to push the overhead down. The reality is that it's very difficult for them to push the 40% because there's just a lot of fixed costs. Most expensive fixed cost is labor, MAs, office managers, those types of folks. So when PE can't force down the 40%, what ends up happening at that point is that they put pressure on the physician to supervise mid-levels to make up the losses. So mid-levels can generate, if they're generating $800,000 or $900,000 in collections, for the practice, that's a profit somewhere between $200,000 and $250,000 per MP or PA. So in that model, the private equity is just keeping that profit, and they're going to send it on to Wall Street. So with your three TPOMs here, the deal is that you're going to lose 10% if you're a partner, and if you're at $1.25 million, that's $125,000 per year. Let's just say it's $100,000, it's a million, so you're losing $100,000 per year if you're a partner. If you do have any shared savings, you would lose that, although most practices really can't get below 50% anyway. So that one's kind of out. And then the other thing that you lose is if there are mid-levels in the group, that's a $250,000 to $200,000 loss revenue that you're missing out on. So if we go to conservative estimates of $100,000, and if there is a mid-level $200,000, that's a $300,000 delta that you're losing out on. Now, if there's multiple partners who are going to share that $200,000, that's obviously going to winnow that number down. But if we just go back to the top TPOM, that's a $100,000 loss that you could have had if you were in the practice as an owner. So 10-year period, that's a million dollars that you've lost. Now, PE is going to try to solve these concerns with you and make your life better. And the way that they do that is that they're targeting you to resolve burnout issues. However, PAs don't show up for work. There's going to be difficult patients. There's going to be difficult employees to deal with. And you're still going to have to attend the same billing and collection meetings and office management meetings. So in order for you to sign off on a lower compensation, you're going to have to determine whether or not the headaches and the quality of life is actually better, because that's really what private equity is offering. An easier lifestyle, an easier plug-and-play model, taking all the hassles and dealing with all the hassles for you. The reality is that that's very difficult to achieve. So that's your evaluation of a private equity deal, because your compensation is much different on a long-term basis. And oftentimes, they want to lock you up with a good signing bonus. I've seen $75,000 just today. And basically, over the two-year period where you'd have to pay that back, they know that they're going to recoup that in spades over a 5, 10, 15-year career. So moving on to just general issues related to contracts. And general kind of concerns when we're talking about contracting is that there's really three to four different types of entities that you could join. A sole proprietorship, which I would never recommend anyone join. That's going to be an unusual arrangement where a physician has elected to not open a hybrid entity and have limited liability. And the concern about a sole proprietorship is liability tracks through the social security number that tracks the money that goes into the practice. A business entity is going to have a social security number that's called an EIN. So you want to create a business entity in between you and liability to stop anyone from going into your personal bank account. And sole proprietorships are notoriously terrible on managing liability. Partnerships are an older model. Most employers are going to have some type of hybrid entity. The last bullet is really not very common in most jurisdictions because corporate practice in medicine is prohibited. And you do see it with not-for-profits and hospital systems typically. Now, I've got an asterisk here at the bottom. What ends up happening is that private equity is corporate medicine. And in most states, it should be limited. It's not limited because the PA will go out and hire or purchase a friendly PA or a friendly PLLC that the private equity firm controls in some manner. And that's really how private equity kind of gets around it. But ultimately, it really should be prohibited from a corporate practice in medicine standpoint. So when you're going into looking at jobs, there's really three options. You can create your own practice as a sole physician, solo practice. I would say do that. It's not very difficult. It is daunting. But there's a lot of rewards. It's a project plan. You guys are all smart people. You guys are all smart people. And you'd be instantly busy on your own because patients like having a physician who is engaged. When you're in a private equity practice, you may or may not be engaged depending on your personality or the setup or whether or not you're happy where you are. That could be true for a traditional practice as well. If you're going to be an employee of an existing practice, there's really two different types of models that you're going to be in. You're either going to be a simple base salary with no equity ownership option, or you're going to be in a traditional practice where you're going to be allowed to purchase an ownership option down the road. Obviously, for me, for you, that's what I want. If you were my brother or my sister, I want you to become an owner of a practice because you finally are in control of your professional life. Another note on private equity is sometimes they'll say, we do provide equity option, equity ownership. We're going to let you buy $200,000 worth of shares at $1 per share. But what they don't really tell you is in a corporate standpoint, there's probably four trillion shares that are outstanding and your $200,000 of shares is minuscule compared to other ownership interests. The last thing that you could do is to join an existing group. Sometimes you see this with a multi-specialty group where you join as an independent contractor. In that model, you have a standalone business and you manage your own individual taxes and benefits. Some practices or some individuals don't like that model. They would prefer people to just operate as a sole proprietorship, but that creates the liability concern. There's a lot of DYI type people, white code investors. Those folks don't like setting up a business entity. I would say set one up in Texas. There aren't a whole lot of ongoing yearly costs to have a business entity and you do get the liability protection. That may be something that you'd want to consider if you're going in as an independent contractor. But the way that that model works is that really if you had $450,000 in income, and it should be $450,000 across the board. For the employee salary over here on the right, just let's consider that to be $450,000. So here, if you have $450,000 in income to your business, any write-off or business expense is going to reduce your taxable income. So if you have taxes, benefits, you want to go to Maui DERM, you don't care, you're going to spend $20,000 on your CME and take an awesome family vacation. You're going to fund a 401k. If you have a spouse that doesn't work and you're going to have them work at your practice and do administrative stuff on the side, you can fund their 401k. So all those expenses are going to be business write-offs and if you were to have, as an argument, let's say $150,000 in business expenses, your taxable income is reduced to $300,000. It's probably going to be really difficult to get to $150,000 in business expenses, but I'm just showing you how that analysis works because you very well could have $75,000 or $50,000 for sure. If you had to pay for your own malpractice, it could even be that for sure. So on the employee side, if we forget the $375,000 and just go to $450,000, all you have your standard deduction. And if you had a $20,000 standard deduction, which has been watered down by recent changes to the tax rules, you'd be paying taxes on $430,000 and that's kind of the rub there. But you have to have enough business expenses to make it worthwhile. Okay. Pre-employment considerations, choose a job that suits you or the type of practice that suits you. Understand that compensation and benefits are going to change for solo and small practices. They're going to have less benefits. They're going to have a smaller signing bonus. Academics is going to have less compensation, but better benefits. Know the job market for your geographic area. Sometimes there are special perks for going to underserved areas. And then also there can be special restrictions. If you think about very popular places to live, think about like in Austin, Texas, as an example, it's going to take you 24 to 36 months to build an appropriate patient base. That's going to be a pretty significant restriction on patient volume in the geographic area. The special perks would be things like a hospital recruitment agreement, which is the second bullet from the bottom. If it's difficult to recruit physicians to the area because it's underserved, the hospital can guarantee income for a year and help you start your practice. And then lastly, you have to appreciate state income taxes. The issues most often negotiated are obviously compensation and incentive and performance bonuses. There's a big push to try to get that number as close to 45% as possible. That's harder to do now because private equity has changed the market. And so private practices that used to offer 45% now know that private equity has busted people down and they can offer a lower amount too. And so it's really kind of hurt the industry or the specialty across the board. The work schedule and the call schedule requirements are typically negotiated as well as the practice location. These two kind of go hand in hand. If you're going to be at multiple practice locations or multiple clinics throughout your work week, you want your schedule to match the location. The location should be defined in your contract and changes should not be permitted without the mutual agreement of the parties. Practice location changes can hurt you in three ways. One, if you have a terrible commute, you want to be able to agree to that or reject it. Two, if you have to rebuild your patient base, that can hurt your compensation. And then three, it can extend the scope of your non-compete. Equity ownership, if you are going to be in a traditional model where you get to buy into the practice, typically there's not a whole lot of negotiations, but it is very important to confirm several aspects of this. One, you want to make sure the buy-in price is reasonable and the valuation is reasonable. So often if you're joining a historical practice that allows people to buy in, you want to find out what the historical valuation has been and how long it's taken to pay that value back. So if you're making 450 as an employee and you're going to be making 650 as a partner and it's going to take you three years to buy down the buy-in price, I think that's pretty reasonable. That's something that you'll have to consider and you'll have to evaluate with your team. Equal ownership percentage is often the most valuable thing. So if you're going to be that fifth person in a four-member group, you want to make sure you're going to get 20% of the equity ownership. We already talked about the special note on private equity. They may give you some shares in the company, but that's really not true equity ownership. You don't have a controlling stake. You want to have control and that's why you want to buy into a smaller group. Oftentimes you'd probably do better with your money in the market than in the private equity group anyway. Restrictive covenants. Here the non-compete typically is one year and 10 miles. The old two years and 20 or 25 miles is kind of going away and I really fight for a smaller time period because most people can do something for one year and then rejoin or develop a practice in the area. Non-solicitation provisions are very common. Not a whole lot to say there. The average leave allowance falls between, well it's really four weeks. It's one week of CME and four weeks of leave and that's pretty standard. Signing bonuses for traditional practice could be between 10 to 25,000 as averages. Private equity can be much higher. It's almost what you can get them to give you up front. I had an old boss who used to say, if you give the employee an option to take a bonus over a raise, they almost always take the bonus and it's the silliest thing in the world because you really want the raise. That's really what private equity is doing is that they're giving you a big bonus, but you're not getting the raise to 45%. It's a one-time thing that they're going to recoup over time for sure. The relocation allowance, that typically falls between $7,500 and $10,000. The benefits, you just need a benefit summary to understand what those benefits are going to be. Retirement accounts, they're really not negotiable. You just want to make sure that there is one. The CME allowance is typically that one week of leave plus an expense allowance that falls generally between $3,000 and $5,000. On malpractice coverage, most jurisdictions across the country are $1 million, $3 million. Then the big issue is whether or not it's an occurrence-based policy or a claims-made policy. Occurrence-based basically means, and insurance people would roll over if they heard me say it this way, but TAIL is prepaid with an occurrence-based policy. It's much more expensive, but you don't have to worry about TAIL on the backend. A lot of times in the Northeast where TAIL can be extremely expensive along with malpractice, you can negotiate occurrence-based policies. The rest of the country mainly has claims-made because it's cheaper and then the younger physician has to eat the cost of TAIL. In some agreements, you can get TAIL paid for by the employer in private equity because they do have those shared savings and they do have a lot of physicians that work for them. They typically can get leveraged to have TAIL prepaid as part of their benefit package. There are some states that do have lower coverage limits. Texas has had very good tort reform, so has Florida. The minimums there fall within $200 to $250 and $600 and $750 respectively. That can be lower than that $1 million, $3 million. Indemnification clauses are a little bit difficult to outline, but basically what they mean is that if you do something that drags the employer into a lawsuit, the employer wants you to defend them, protect them, pay for the damages, do everything it takes to make the employer whole. If you get drug into a lawsuit as a result of what the employer has done, you would like the same, but oftentimes the employer only wants a one-way indemnification where the employee is indemnifying the employer. Issues from indemnification that could be caused on both sides, billing fraud, sexual harassment, HIPAA breaches, data breaches, identity theft, those kind of non-malpractice related issues. A piece of equipment falls on a patient or injures a patient because it wasn't maintained. That's typically on the employer. Types of compensation and bonuses. We've talked about this a little bit. The straight production is that eat what you kill model. It's generally gross cash collections, which is netted. The net collections definition is gross cash collections, less or net refunds, chargebacks, or other adjustments. In dermatology, it's also net or less the cost of cosmetics. Then if you're in a traditional practice, you're going to have the cost of overhead. Overhead is typically divided into two columns. It's net cash receipts or gross cash, less refunds, chargebacks, other adjustments, net of or less individual expenses, and shared overhead expenses if you're in an eat what you kill model. The flat sum is for academics and some private practices. Flat sum with performance bonus or quality bonus is large employers, some small employers. Typically, there's no quality bonus for a smaller employer. If you're with a large employer, you also could be paid off of a work RVU based compensation model. The MGMA data for 2019 reported $67.24 per work RVU. If you think about an average dollar per patient encounter of $135, that's going to be a 99213 with a destruction code of the 17,000 or the 11,000 cryosurgeries. That could expand the total dollars, but that would be $85 from CMS for the 99213, and then more money for the destruction depending on what happens there. That's going to average out your 135 because a 99212 with no additional services is going to be like $67. The average comes in. If you think 50% overhead, 50% to the physician, the practice is keeping $68 and the physician's getting $67, that's probably about 50%. If you're in that model, it's typically just straight dollar per work RVU. Percentage of collections, which is typically how dermatologists are paid, 45% of net collections. That's where cosmetics and refunds and chargebacks are netted out of the gross cash collected. Then you can also have a draw-based compensation plan, which gets a little bit more complicated. A draw-based compensation plan is where the employer is going to have an expected production based on other people in the group, and the parties are going to come together and say, yeah, I expect that you will generate $450,000 in compensation based on our compensation plan. We are going to prepay you, and we're going to hold back 20% or 15%, so they're going to pay you 80% or 85%. Maybe they'll pay you 400%, and then they'll crunch the numbers quarterly and then do a year in reconciliation to make sure you've hit your targets. If the volume isn't there and you don't hit your target, you're going to have a deficit. If your volume is there and you have hit your target, the patient volume is going to warrant a bonus. In a draw-based compensation model, you can have deficits, and if no one shows up to be seen, you could really be handcuffed by a pretty significant deficit, so you have to watch that, because if you quit, you have to pay the deficit back. The percentage of supervised advanced practice providers, MPs and PAs, in private practice, it's typically between 8% and 10%. In private equity, it's 2% to 3%, and so that's something that you'd want to negotiate as well. Okay, we're getting into the red flags, and if you have an agreement that has any type of liquidated damages, it's a bad agreement because the message is sent that they have a difficult time retaining people, and that's why you're going to have liquidated damages, because you're going to leave early and they're going to want you to pay damages. Deficit tracking, anything where they don't have patient volume that is sustainable, if you have really predictable patient volume, you really don't need any type of deficit tracking. If the practice is healthy and they're going to be able to get you busy pretty quickly, there shouldn't be any deficit tracking, so it's almost like dating a member of the opposite sex who's really overly controlling or overly concerned with what's happening. It's kind of like, why are they that way? Something weird's going on here. Repayment of startup costs, that is a traditional issue where people don't want to stay at the employer, so they're going to make you pay for the startup costs because it's the revolving door. That should be part of what they're keeping. If you're in a practice where you're getting 45% and they're keeping 55%, that's part of the 55%. That's a cost shift. So the next bullet is cost shift. If you have to pay for your own benefits, your own taxes, your own malpractice, your own CME, those are cost shifts. As an example, I got an agreement the other day where the girl was going to get 50%, but then when you looked at what was netted out of the percentage, also removed from the percentage definition was benefits, CME, malpractice, and that's a cost shift. So in essence, she had a 45% contract because if you think about benefits, malpractice, and all those costs, if you're at $30,000, $40,000, $50,000 at a million bucks, 1% equals $10,000. So she lost her 5%. So that 5% of that $50,000 over a 10-year period is a half million bucks. It's a big deal. That's a college fund for your kids. It's something to really fight for. A fixed term greater than one year, anytime the employer wants to lock you in without allowing you to terminate without cause is a problem. So you always want to be able to terminate at any moment after giving 90 days notice. If anything changes from that, it's designed to lock you in and be a barrier from your separation. So private equity doesn't want you to leave, and they're going to require 180 day notice on average, which is way too long. If you do terminate without cause and the employer's allowed to accelerate your termination date, that's a problem. Non-discrimination based on payment, that typically means that there's less money in the system. I kind of went real quickly over the acceleration issue. So let's go back to that real quick. If you give your 90 days notice and the employer can immediately accelerate your termination date, you really don't have 90 days notice. So there's a problem with that because you may be short-sighted and may not be able to start work at a new employer because it normally takes 90 days to get credentialed. So you've done what you were supposed to do, and then you got screwed because the employer doesn't want you around. No, they should have to pay you through that notice period if they want to remove you early. Going down to non-competes, one year, 10 miles, pretty average. If it's worse than that, you need to really look into that. That's a potential red flag. Unilateral changes to your compensation or practice location, that kind of speaks to itself. Work or call schedules that don't match prior statements, big problem there. The employer should provide you billing and collection data monthly. That's going to be a check and balance that you're being paid appropriately. So anyone that doesn't provide you transparency on billing and collection data, that's a problem. And then lastly, if the contract is oddly formatted, super weird. Anyone who's going to have a contract for a million dollars per year needs to have professional agreements in place and needs to have thought through these issues specifically. When reviewing offers, know what's important to you. Prepare and ask questions during the interview. Super important. If equity ownership is important, ask what the shareholder salaries are, how long it takes to buy in, what the buy-in price is. Have those follow-up discussions so they know that you're involved and interested. It's just like a marriage. Somebody has to take care of the poop diaper and somebody has to take care of the vomit. Normally spouses don't do both. One does one and one does the other. So somebody has to turn the lights off at the end of the day. You know, is that worth $50,000 a year? I would say it is worth $50,000. It's a light switch. You're leaving anyway. Plus, when you do have kids, that's going to be a huge amount of money to take off issues like college funds. It's massive. Okay, for complicated bonuses, ask to see the bonus calculation. A spreadsheet is super valuable to evaluate what's actually happening and what's being removed from your compensation. The agreement needs to contain what was promised. You've got to respect deadlines and offer letters. Super important. If the deadline passes, the offer is expired. It's automatically been revoked. The employer does not have to honor it anymore. If you make red line changes to an offer, that's technically a counter-offer and the employer can revoke their initial offer because you no longer have accepted it. So those are things that you need to be cognizant of. If you go in there guns blazing because you really don't want to work at private equity, well, if it's too aggressive of changes, they may just withdraw the offer. If you're uneasy, have someone help you review the agreement so your changes are appropriate. Why negotiate? Biggest slide in here and the middle bullet or this third bullet is the one that probably should be highlighted in red. You know, don't be afraid to negotiate. You're interviewing the employer. It's not about what you get from the negotiations. It's about how the employer handles a difficult interaction with you and that interaction is going to be very insightful into how the employer manages their business. So understanding what that process is is going to be very important. Hiring people who know the business is important. If you don't like the back and forth, have your attorney insulate you from those negotiations so you have some distance. When you do hire an attorney, find someone you trust. They're going to be part of your team just like your accountant. It can be very important. Issues are going to come up over your career. Your attorney should have experience in the healthcare industry so they can evaluate the terms of the deal. Hopefully they'll be a member of the American Health Lawyers Association. And I wanted to add a note on attorney's fees. You know, here it's either attorneys charge either flat rate hourly or percentage. Attorneys who manage contracts are transactional attorneys and they charge an hourly rate usually in quarter hour increments. If any business partner wants to charge you a percentage of your contract or your compensation, that is a major red flag and the only entity or business partner that should do that is a billing company. I started doing this because there was a person that I knew that had someone help them negotiate their contract and the attorney took a huge percent from their contract and it was like $15,000 and I was like, that is absolutely unethical. So attorneys shouldn't charge that way and you need to understand that only a billing company typically gets a percentage of your collections. And that wraps up the discussion. I know that there's going to be a Zoom meeting in a couple weeks and I'm happy to talk about things. Big issue items that have come up recently are the without cause termination in the face of COVID, guaranteed salaries in the face of COVID, force majeure clauses that have been added to the agreements. I've seen another clause by a private equity company recently that was entitled frustrations to the agreement. So if the terms of the agreement that were originally contemplated were not still in effect, the employer can change the deal with five days notice, which was ridiculous, but that's what you get with private equity. And so basically it renders the contract really unenforceable. So why are they even signing a contract with you? So anyway, I know that there'll be other contractual issues or concerns that'll come up and I'm happy to discuss those in person when we have our Zoom meeting in a couple of weeks. So I hope you found this helpful. I went relatively quickly because it's a Zoom thing. This thing can get kind of boring. I wanted to get to the meat of the issues and I hope that you found this helpful. Okay, take care. Bye.

employment contracts

compensation in dermatology

private equity impact

physician ownership

restrictive covenants

compensation models

COVID-19 pandemic