We're going to talk about special contractual issues for women's physicians. A little bit of housekeeping here. Just you're all muted. Note that you have to take that pre-test now in order to get your CME, and there's questions there where you can send to, and again, to take CME you have to take the pre-test and there's information there about where you can send to get your CME credit. Quick disclaimer, I'm an attorney, so you know you need to have big disclaimers. The biggest thing in here is that nothing in this presentation should be construed as legal advice. This is all very generic, general stuff, so if you have a specific question, you should probably reach out to legal counsel. Tell you a little bit about myself. I started really working for physicians a little bit after my first daughter was born. She had a very serious congestive heart failure and a lot of other heart issues, and we had so many nights where the physicians stayed up all night by our bed that I kind of realized these people are approaching superhuman and I want to do what I can for them. So slowly over the years I started moving my practice and now I really just work exclusively for physicians. I don't think I'll ever be able to repay the debt that I have, but at the same time I do what I want to for physicians. I'll pause there. I hope you can cut out that WhatsApp thing that popped up. So anyway, today we're going to talk about special contractual issues for female physicians. I think I would like to start off by saying there shouldn't be a webinar on this. There shouldn't be any special contractual issues for female physicians. You're a physician. It shouldn't make any difference. So in an ideal world I would say there are none. Thank you. Have a good day. Unfortunately, you're probably aware that in fact there are special contractual issues that you do face, right or wrong, and as a woman there are things that you need to protect yourself against. So one of the first things that you have to look at is what I call the oldest line in the book. This is our standard contract. Now you really can't blame recruiters and employers for using this line because it works an awful lot of times. Many many people will hear that line and say, oh, if it's a standard contract, I guess there's no sense looking at it. I'll have to sign it. There may be a kernel of truth in that. The recruiter may very well say, I can't make changes and that could very well be the honest truth. Very likely the recruiter can't make changes. So if you get that line, it's important to just say, well, who could I talk to that could change the agreement? And many times, virtually always, there is somebody that can change the agreement. You're also likely to hear that everyone gets this contract and that's probably also true. Everyone probably does get that contract to start with. That doesn't mean that everybody signed that contract. It means that's the first thing we send to everybody. One obvious example is a family practitioner is going to have different compensation provisions than a cardiothoracic surgeon. So not everyone gets the exact contract that you got. Compensation provisions are always tailored for the different specialties. Now the question that kind of has to be on your mind is, are they also tailored especially for men? Luckily, there's ways you can kind of figure that out. Before we get into that, I think it's important to talk about why you even need to worry about this. This to me is a stunning, stunning slide. Merritt Hawkins, you may be familiar with. It's a very respected, perhaps one of the top physician recruiting firms in the nation. And it was hired by the Maryland Medical Society to see if there are any pay discrepancies between males and females. And this may not be a shock to any of you, but the Merritt Hawkins survey showed that there's a difference in pre-tax income of 49.6% overall between male physicians and female physicians. Now a couple of things I want to point out here. These are based on 2020 tax returns, not 1920 tax returns. The other thing is the survey says it factored in things like part-time and site of service. So there's no obvious reason why there'd be these discrepancies other than just pure discrimination. I mean, you could see somebody saying, well, female physicians tend to work part-time and so they make less. Again, according to Merritt Hawkins, which is a very reputable company, all of that was factored in. So I think you can assume that in Maryland in 2020, these are actual numbers of discrepancies. Primary care physicians over 41%, surgical diagnostic and other 33.5% difference between male physicians. And the one that kind of surprised me was private practice, where I tend to think of everybody really working hard and sharing income more. Even there, male physicians made 30.9% more than females. So that's an interesting fact, but what can you do about it? Well, luckily there are benchmarks out there. The ones I use, there's other ones. I like Medical Group Management Association or MGMA benchmarks. They tell you things like salary, sign-on bonus, relocation allowance, vacation, CME and other benefits. If there's a discrepancy between the offer and those benchmarks, I think you are owed an explanation of why. It's important to remember, too, that these benchmarks can be usually narrowed down to the type of employer, so hospital versus physician practice, and also geographical area. So again, if you are way off a benchmark, I think there needs to be an explanation. The honest explanation may be that's what we pay the men, but hopefully the employer can give you a little better explanation for that. So there's a couple of things that female physicians, I think, need to be especially more cognizant of than males, and that's at the interview process itself. Now if you think about it, part of the interview process is getting to know each other, and obviously an interviewer is going to want to make a personal connection with you. The interviewer probably isn't a lawyer either and probably doesn't have a real good handle on what's discriminatory or what isn't. Still in all, you should be aware that there are questions about your status that legally can't be asked in a job interview. And there's a few of these. If you think about them, I think they're kind of intuitive that these are things that would separate, potentially, a female physician from a male physician. Although they're not obvious. Are you married? I mean, I can see you and I talking and getting to know each other. That's probably a question I could innocently ask. But in fact, a question about marital status is legally considered discriminatory. Another thing, again, you and I getting to know each other, do you have any kids? Seems harmless enough, but let's face it, females tend to be more involved in child care than males are. So you've got to wonder if they would ask a male physician, do you have any kids? And if a male physician said yes, it probably wouldn't have the same implications that it does when a female says. And the really loaded that hopefully most people would be smart enough not to ask is, do you want to have a family? If you think about it, for a male to say, yeah, there's not going to be long pregnancy leaves, there's not going to be any of that. So, but for a female, you want to have a family, you definitely are going to need some time off. So all of those questions are going to be treated as discrimination by the EEOC. That's the federal bureaucracy that handles discrimination. And again, if you think about it, pregnancy of a male physician's spouse is not going to have a really material impact on that physician's schedule. If a female gets pregnant, that is going to have a material impact. And it's equally obvious that a female physician is going to need more time off to have a baby. The male physician may want to be there when the baby's delivered, maybe want to stick around for a day or two afterwards. But a female physician has a much bigger time commitment in having a baby. I should warn you that if you're talking about maybe a small physician practice, this federal law only applies if the employer has 15 or more employees. So incredibly enough, if we've got 10 employees, I probably can ask you if you intend to have a family, and I probably can decide not to hire you because I'm going to have to give you more time off. But nowadays, most entities do have 15 employees. So this should be good information for everybody. I wanted you to see this interpretation. This is the EEOC's interpretation of the Civil Rights Act of 1964. You cannot be discriminated against because you have the capability to become pregnant. That applies to job benefits or job opportunities. Again, we can't say, look, we've got a male that is just as well qualified, and I know he won't be taking pregnancy leave. So no hard feelings. We're not hiring you. That is absolutely against the law in the United States. Same deal with benefits. Here's something else I wanted you to see, and this was pulled directly from the EEOC website. It is any inquiries based on pregnancies or pregnancies is considered prima facie. It's actual evidence of pregnancy discrimination. So it doesn't so much matter if maybe we decided that because the male physician is coming for, you know, is in his third position and has a lot more experience. If we asked you the questions about pregnancy discrimination, it's considered strong evidence that the reason we didn't hire you was because you were female and had the ability to become pregnant. Another thing you kind of have to watch is and kind of read between the lines, I think more than a male physician does, is little statements like we all work well together. Well, that sounds great. You know, collegial approach. That's exactly what everybody wants. But is it another way of saying, hey, this is an old boys network. So all those good old boys get together fine. And it might be. I actually had a situation where I represented a female physician who was just not getting the same kind of schedules that the males were in a lot of things. And it was strongly hinted that she probably wasn't partnership material. So she had me involved. I sent a letter to the supervisor. The supervisor pulled her into a meeting, said, look, I don't want to talk to the attorney. Let's you and I work this out. And as you might imagine, that meeting got pretty emotional, as it would for any physician speaking about their future. However, at one point in the meeting, the supervisor asked her why she was, and I'll quote here, so sensitive and emotional. Because obviously, a male physician would just be cool, calm and rational when speaking about his future at a firm. That same employer was talking to another female physician. And and again, it was kind of saying, we don't think your partnership material. It's funny how the women in that practice just didn't seem to be partnership material. I told her she wasn't partnership material. She got very upset and he asked her if she was menstruating. So, you know, we all work together can be good. It can also, again, be signs of an old boy network that that you have to be aware of. So it's very important that you confirm the culture. One way I suggest doing this is to ask about the possibility of a leadership position or becoming an owner. I would love to tell you I've never heard stories about this, but several times I've had a female physician tell me that the interviewer was surprised and said something like we've never had a woman stick around long enough to become a leader. Obviously, if you hear something like that, maybe you should consider getting out of that place. Maybe they really do have a problem. And in defense of them, they may not know it. I mean, us good old boys never get pregnant. We don't think about pregnancy leave. Why should we? And now one physician is coming in and making a stink about it. Maybe we view that physician as a troublemaker. So again, it's really important that you confirm the culture. There are some ways you can do that. One way is to check third party rating sites. I like rate your health care employer, ryhe.org. I really like them because they were formed by a family medicine physician in Pennsylvania, and he has a really good sense of what's important to physicians. Again, I don't think it's the be all end all. It's just been started a few years ago, so the data can be a bit sparse. But if you can check on third party sites, that's usually a good idea. The really golden idea is to speak to other women physicians at the employers. Now, the fact that there are no other women physicians is not necessarily a warning sign. I mean, obviously, the first woman gets hired somewhere at every practice or every hospital or department. So I don't think you need to view that as absolutely a big problem. But at the same time, it is a warning sign. I think it means that maybe you should be looking especially cautiously at that employer. I think the bottom line here is you don't want to be a trailblazer unless you know, maybe you do want to be a trailblazer. But unless you do, I think you may want to go someplace that has other women physicians there and definitely don't assume that you can change the culture. The culture is what it is, and maybe they're reasonable. Maybe they're not. But you really want to spend a couple of years of your career making that determination. Another thing you can look at are disability policies and the procedures for disability. In particular, the thing I'd like to know is are there any specific maternity leave policies? The answer may be no, and that might not be a bad thing. But even if you're not really interested in ever having a baby, those policies or lack thereof might tell you quite a bit about how women are treated in the organization. So I think asking about maternity leave is a good thing just to sort of get a general sense of what's going on at the practice. Again, the law in the United States is that an employer has to treat a pregnancy as any other medical condition. So if I hurt my back and they say, OK, you'll be out for six weeks, they can't say, well, pregnancy is different. We're not going to give you six weeks of leave. Pregnancy is a medical condition, and they have to treat it at least as well as any other medical condition. So to me, the most important thing here is that you have to protect yourself and make sure that these people really do respect you and will treat you as well as they would treat a male physician. Unfortunately, you really can't assume that that's going to be the case. By poking around a little bit, you might find out. But it's important that you get into the right frame of mind when you're signing a contract. I know you didn't get to where you are in life by not being super competitive. Maybe in high school, certainly in college, certainly in med school, perhaps in the residency and fellowship. Your career is extremely competitive. And to get where you got, you had to be a competitor. And I understand that. What you need to understand is once they give you the job or offer you the job, you aren't competing anymore. You're now the prize. So for whatever reason, that employer wants to hire you. So it's very important you don't sell yourself short and stand up for your rights. As I said, it's unfortunate that there's any need for this webinar at all. But until discrimination against women ends, you by you, I mean, women physicians need to be especially vigilant in protecting their rights. Here's a few resources that are out there to help you in this regard. I think the fact that you're here, you probably know the value of your AOA membership. But there's a lot of things out there that can help you in navigating a new position. And thank you. If you have any questions of me, you can reach me at pahealthlaw.com. And just as a reminder, to get CME credit, you have to complete the post-test and evaluation. And the link for that is there. Thank you and good luck. I guess that's it. Great job. Thank you. Sure. I appreciate it. I saw that an AOA or a WhatsApp message popped up on the screen. Will you be able to get that out of the recording? I'll see what I can do. But you couldn't read it. It was small. Oh, good. Because it was pretty devastating. It was my wife telling me her sister is an alcoholic. That's not something we want to put out there. All right. Yeah, let's not throw that out there. Yes, I will work on getting it out. Okay. Thank you so much. Yes. And we're going to get this up on the website. And then we're going to shoot a special email out to all the female physicians. So the residents as well as the physicians. Great. Well, I hope it's helpful. Yes. Always good. Thank you, Dennis. Appreciate it. Take care. Yeah, I hope you feel better. Thank you. Bye.

female physicians

contractual challenges

pay disparity

negotiation

workplace culture

employment support