EP16 - Mastering Physician Contracts: Fair Pay & Work-Life Balance

In every operating room, in every ward, in every clinic, and every team meeting, a silent battle brews. Conflict, negotiation, identity. Welcome to the Scalpel and Sword podcast, where I, Dr. Lee Sharma, physician and conflict analyst, Explore the hidden negotiations behind modern medicine. Let's trade burnout for boundaries and learn the art of healing with precision and power. Hello and welcome, my peaceful warriors. Welcome to the Scalpel and Sword podcast. I am your host, Dr. Lee Sharma, physician and conflict analyst, and I am so excited to have on the podcast today Kyle Clawson. Kyle is the CEO of Resolve, which is a company that is completely and utterly dedicated to helping physicians with contract negotiation, salary negotiation. They are endorsed by over 50 state medical societies and also nationally. Kyle is a speaker all over the country with regards to physician contracts and negotiation. His spouse is a physician, and I gotta love it. I tell you, when people put their dog in their bio, it's It's like, I'm already a kindred spirit if you've got your dog in there. You've got a Bernedoodle named Murphy. So I love that.

He's the star of the house. You know, you gotta include him.

Aren't they all though? The fur babies are always the star. But Kyle, welcome to the podcast.

Appreciate you having me on.

Thank you for being here. So how long ago did you found Resolve and what was your impetus in starting this company?

Yeah, Resolve's been around for about 15 years now. So the reason it was formed, it was actually formed by a physician who was doing these business of medicine talks to residents and just understanding that there's very little training around compensation and contracts and all the things that go into getting your first job. And that's where it started. It's come obviously quite a long ways, like most companies in the last 15 years, it's evolved. And we utilize a lot of technology now that we didn't back in 2010, but it started from a physician and that's the core of what we do is try to empower physicians in this very specific niche.

That's so great. I always like to share my age. I'd finished training in the '90s, and I remember the rite of passage when you were getting your first job is you took your contract to the attorney, and that was kind of a process. And you went to the attorney and they looked at your contract and they made recommendations, and once you got it approved and once you got it taken care of, you went out to dinner or celebrated because at that point you knew you were locked into your job. But these were not attorneys that necessarily specialized in physician contracts or reimbursement. They may have been contract attorneys, but not necessarily in the space of medicine. What makes medical contract negotiation a different animal?

Well, I think it's like any area of the law really, or any area of medicine. If you want to be subspecialized, you want to be really good at what you're doing and seeing the market at a very high level. And the more volume you have, the better advice you can give. And so I think it's not necessarily unique to medical contracts. It's unique to every topic, but because we focus here, right, all day, every day, you know, we can tell you the last time a certain employer had a contract come through and maybe what those terms were or what their in-house counsel likes to do with language or what they don't like to do. And I think nothing against a local attorney, right? That's maybe next to the residency program that you were at. I think they can do a good job as well. I just think their access to the market and the high-level picture is sometimes limited. And so that's the part of the value that we bring is that expertise on a national level.

Yeah. And I think that's a great perspective that not only are you familiar with physician contracts, you're familiar with the people with whom you are negotiating. You probably have seen multiple contracts come through from a single entity. And so you've got experience with how that language works and how their in-house counsel works. And that's a very interesting perspective that maybe somebody who does contract law, but not necessarily what you're doing, Very, very, very different. I think it's also interesting, one of the things that I thought was interesting on your website when I was preparing for this was even though 80% of us right now are employed, there's still 20% of physicians that are in independent practice, and those physicians still have the burden of contract negotiation. In terms of what's coming in, what you're looking at Resolve, now that we've got so many physicians that are employed, what shifts have you seen in contracts and sort of contract language and negotiation?

Yeah. I mean, that demographic or that breakdown is right. I mean, it's most residents now are going to go out into an employed setting, right? Meaning they're going to work for a health system. They're not going to have the opportunity to buy in and have equity ownership, but every resident comes out as an employee to start with. Right. I mean, even if you go into private practice, you're not a partner from day one. And so contractually, you've got to know what that means. You've got to protect yourself. And certainly the shift for systems and academic centers, even private practice, I mean, all of them, their footprint has grown, right? Because there's been a lot of consolidation. And so what that means is that the employment side of it, I think, is getting more and more polished. I think some of the documents are getting more verbose and they're heavier and they're considering all these circumstances that maybe they didn't 10 years ago. And we've had COVID happen in the last, you know, 10 years and that's caused issues. And so I think the language is not getting simpler. I guess I'll put it that way.

Yeah, it's interesting you talk about how these contracts have gotten weightier and heavier. There's just more consideration that kind of goes into this process. And it's maybe more so for employed physicians, but also in these bigger systems. What are some things that you specifically try to educate, like people say coming out of residency, going into private practice, or if they're going into, let's take employed physicians, what kind of things do you specifically try to look for in those contracts?

Well, we always want to start out with making sure the document fits that individual. So it feels to me like every client has different needs and they all come in with things that were told to them throughout the interview process of how much call they're going to take, or what locations they're going to work at, or if there's tail coverage or if there's not. I mean, they've been told a lot and we never know what that conversation has been, right? They come to us at the end of the process usually. And so step number one is making sure the document reflects what they think they're getting into. And oftentimes it doesn't. And I think that's where we then have to start to work through, well, what are priorities for you? What are deal breakers for you and what aren't? And try to narrow that list down as much as we can because we do want to go through any negotiation, right, in good faith. And we want to make sure we're hitting on things that matter and not wasting time on things that don't. But trying to customize, I think, is the most important thing that I would say. Systems in every employer, right, in healthcare and otherwise, they want to have standardized documents. They want to have the same thing for everyone. It just doesn't work very well from where I sit in medicine. And we try to accomplish that as much as we can for our clients.

I think that's such a great point. I did an interview about a month and a half ago with one of my former medical students that is now in private practice, and we were talking about her process of negotiation. And one of the things that you just touched on that she also verbalized was how important it was for her to have a clear understanding of what she wanted. You know, in terms of walking into that negotiation, it wasn't just a matter of walking in with a contract and giving it to a professional like you and saying, okay, look at this contract. It was actually understanding these are the things that are important to me. And so sharing that with you as you're looking, reviewing that contract makes you a better, you know, and more informed person to look at that because they have to know what they're actually after. One of the things that you also mentioned was this discussion of expectations. And I think call is a great place to look at that. I was watching an interview that you had done where you were talking about, and I hate to say this, a very common situation where a physician is walking into an employment situation where maybe they were told they were taking 1 in 7 or 1 in 8. And then people leave or people retire and all of a sudden you're told you're taking 1 in 4 and 1 in 5 and there's nothing in the contract that covers that. How do you help physicians prepare for those kinds of situations?

Well, what we ultimately would like to do is to make sure the contract protects them to whatever level of call they're comfortable with. So the call pool is currently like 1 in 7 in your example. And they say, hey, I'm willing to help out a little bit, right? If somebody leaves or there's a car accident, somebody becomes disabled, those things that happen. But I never want to take more than 1 in 5, right? Well, then we'd like to have language that says calls capped at 1 in 5. And it doesn't mean that the system or the employer is not going to need coverage. They will. But it means go out and find locum coverage, right? Don't make the current pool of physicians that they're— do that and cover that. And so that's step 1 is how much do you want to take? Step 2 is when do I want to start to get paid more? If I'm supposed to take 1 in 7 call and I'm taking 1 in 5, And maybe I'm young and single and I want to make as much money as I can. Well, that's great, but I still want to be paid for that extra call that I'm taking. So there's 2 components of what's important to people, frequency and then pay.

Yeah. I also think that's a really great way of making sure that physicians don't get in that situation because it's not something you think about. Oh, they told me I'm taking 1 in 7, and then you make this assumption that that's never going to change. And that's just not the nature of any workforce really, but especially in medicine, that workforce is always shifting. So helping physicians prepare for that eventuality contractually, I think, is huge. A big thing you also mentioned is the idea of appropriately being reimbursed. If you're doing the extra work, are you getting extra pay for that extra work? And there's also going to be times— this is one of the things that, as I was looking at Resolve, I thought was really cool— is that you also help physicians negotiate reimbursement. And in many times, getting a reimbursement that's appropriate for what they're doing and what their geography is. Is that something that a lot of physicians come to Resolve for?

I think so. I think sometimes there's almost this line in the sand of people only care about the dollars, right? Or they only care about everything else, right? The language and the risk and all the softer points. And we would prefer that they pay attention to all of it, honestly, and that they negotiate all that in good faith. And so one of the things that's unique about us, because we see thousands and thousands of contracts every year, is we can give you a lot of those insights. What are people being paid per worker over you, right? What are starting offers? Kind of that market intelligence that you need in addition to some of the survey information that you're going to want access to. So most employers use MGMA or Sullivan Cotter or some combination of those. You do get access to MGMA information as well on our site. And so it's hopefully getting you as much information as possible to really get you the best outcome, which is what we're after. Yeah.

One of the phrases that you just used, which I think is so important for any negotiation or any conflict management, is in good faith. The idea that everybody's coming to the table With true transparency, not just for what they want, but what their expectations are communally. But we're not pulling our punches. We're not trying to do anything down and dirty. We're actually really trying to get a good working relationship contractually between the employer, the practice, and the physician. And this transparency that you're providing people, I think, with having national data, MGMA data, things like that, where you can look at, okay, this is what a pediatrician makes in the Southeast, and this is appropriate to ask for. I think that's really huge. And also, I think a lot of physicians tend to be conflict avoidant. You know, they don't want to deal with a conflict. And so, I think one of the great things about Resolve is they feel like they have an ally walking into that negotiation. They feel like they're not going in there alone. Do you feel like you have physicians that sometimes, because they are conflict avoidant, are just, I don't want to get into it. I want this, but I don't really want to get—

do you—

is that some characteristic that you see? Yeah.

Probably more common than— it's probably the majority rule that physicians are usually a little bit risk-averse. They don't like conflict. They sometimes don't want to offend anybody, right, throughout the process. And they don't want to come across as being greedy, right? Because we know the compensation numbers are higher than normal, right? Or higher than average. But what we try to focus on is value. And so we know healthcare is almost one-fifth of our GDP, right? We know that the numbers in healthcare are huge, right? And we know that physicians provide almost all of that revenue generation to your license, right? And so we know that you've gotta be a big part of that pie and a big part of that equation. And so when we go in good faith, what that means is we're not trying to ask for 90th or 100th percentile numbers, right? All the time. And we hope that the employer's not offering 10th percentile numbers either. It's kind of this range in the middle and we're negotiating between that range. And I think if you do that, it's, that's kind of the definition of good faith to me.

Oh, absolutely. One of the things that you also talked about, and we talk a lot, and especially on the podcast, I feel like we focus on residents and residents going into training and then young doctors going into private practice. But there's lots of other parts of this sort of process and clients that are coming in and physicians that are either retiring, selling a practice, actually making that transition. That's something else I'm sure that you see a lot of people who are trying to either sell a practice or bring in a partner. As sticky a process, I guess we would say, as doctors coming into practice?

Well, it might be stickier actually, or more complex. So if you're selling a practice, you're being bought out by a health system or private equity or whoever the buyer is. You know, there's a lot that goes into that because you're not only selling your revenue stream, but you're probably going to become an employee, right, of that new entity for at least a short period of time. They don't want you to just walk off and have the patients leave because that's the big value. So Yeah, I think it's all of the corporate documentation that has to go along with it on top of a new employment setting that you're looking at. And sometimes the value of the practice is split between those documents. So yeah, certainly something that you're going to want to be careful of, that you're going to want to think through, not only short-term is this good for me, but also how long am I going to practice and what does that look like 3 or 4 years down the road? I think if you're, I'll say 65, right, in selling your practice, it's probably a much different discussion than if you're 40, right? And you're selling your practice because you're likely going to have more years to sit in that new system. So definitely complex, definitely adds another layer to the conversation and certainly something that's happened a lot over the last 5 to 10 years.

Especially, I'm sure with the rise of private equity, I'm seeing, I'm sure you're seeing that a whole lot more.

Yeah.

Also too, like this idea of bringing in other physicians into this practice situation. Let's say I'm, for example, I'm a solo practice owner. So if I was ever to bring in somebody else, it's almost like getting married. You would definitely, I would be very conscientious about bringing somebody into something that you had been with and with something that were very near and dear to your heart. Do you find that often, and I'm sure you do, just by virtue of the fact this is what you specialize in, that there are so many things that doctors don't think about going into these kinds of negotiations?

Well, you mentioned the word marriage and I'm going to use that Loosely, but we often kind of joke that if you're a family law attorney, you talk about the divorce with the marriage. And if you're in this setting, you really have to think about how do we break up if this doesn't work? And that's a hard conversation to have because you're trying to be excited and, hey, I'm bringing in somebody that's new and this is going to be great. We're going to be partners. But I think that's probably the part that gets overlooked the most is, hey, 5 years from now, my spouse gets a new job and we just need to move, right? It's everything's going great, but we have depart, what does that look like? Or what happens if there's substance abuse from one of us? And, you know, it's you or me or somebody's an alcoholic and they've got drug issues. Like, what does that look like if we need to break up? Or if we want to sell out to private equity, right? There might be different paths through that process on how the relationship ends and the valuations could be different and our purchase price formula might be different. And so, yeah, I think it's really, really important to think about the full picture And all the possible solutions, even if they're not fun to think about upfront, because it's going to make your life a lot easier in the event those things do arise later on.

I think that's so brilliant. The awareness of, especially as people are coming into those agreements, this stuff might happen. We have the best of intentions. We are very optimistic, but the world is the world and life is life. We just don't know. And so it's so much better on the front end to have something set up if this breakup happens for whatever reason, that we actually know how we're going to handle it. I would almost say that even though it's hard probably to have that conversation with your physicians with whom you're writing these contracts and reviewing the contracts for, the fact that you are building that sort of awareness in them, conflict happens. We're not going to be happy 100% of the time. This is how we're going to handle it if. I almost wonder if when you have those conversations with doctors that they walk away from those conversations and maybe, I'm not going to say necessarily less conflict, but probably better able to handle it because you've made them think about it a little bit.

Yeah, you hope so. The idea is that if you're going to a physician and they specialize in something, they're going to give you a lot of information, right? And even things that you haven't thought about yet. And then you walk away going, oh, okay, well now I can make a better decision for myself because I have the full picture. It's the same way for us. We've seen a lot, right? And crazy examples that have come up. And so we're always bringing those into the table to say, hey, what if this, what if that, what if the other thing happens? And then physicians are really good at making decisions once you have all of the information. And so we feel like that's our job is to give you as much of that information as we can and then let you decide how do you want to attack this? And then we'll help you, right? With tools and language and contracts to get you there. But our clients are more than capable once they know everything.

Absolutely. You had mentioned that the physician that founded this company initially started out by giving talks to residency programs. So your company is 15 years old, so those talks started in the 2010s. So there's this whole generation of doctors that came out and are currently practicing that never got that kind of business education. And I'm cheerfully— I will admit that I was one of those, that the idea of any talk of contract negotiation, salary negotiation, any kind of business acumen was just not something that was given to us. They gave us a residency training and they kicked us out and they said, go, go, go. And most of the education that I've gotten has been through talking with people like you. My husband is very business-minded, so I've gotten my education in different ways. Do you see a difference between these younger physicians coming out in practice and maybe some of the people of the '90s and early 2000s who weren't as fortunate to have that kind of business education?

A little bit. So I'm going to frame your situation and a lot of our clients that have been out, I'm going to say between 10 and 20 Somewhere in that timeframe, their school of hard knocks where they may have gone through a contract and they didn't pay attention to it because they didn't have any training on it. And then they had a bad outcome or life happened. And those clients will come into us and they fully grasp what they're getting. I mean, they're fully appreciative of like, yes, this is important. And they're able to prioritize things very well. Sometimes I almost think when the younger residents who may have more information right now, they think, yeah, there's these issues, but it'll never happen. Like these problems will never come up. And then 5 years later, they're like, oh man, I really should have paid more attention to that paragraph. So that's the biggest distinction for me. I think there's obviously more information out there. There's these podcasts and videos and all these great things, but I still think sometimes getting physicians to act on it and to actually take that next step, sometimes it's hard. It's kind of like people going to, I don't know, their annual well check, right? Is they don't do it even though they know they should. Sometimes it feels like that to us on the law side.

That's such a great insight because I do think sometimes as physicians we get into this mindset of, well, we've been through medical school, we've been through residency, we should know how to do this. And I'm not necessarily going to say it's a pride thing, but I think it's one of those things that sometimes you don't really recognize that there is help available and you should take the help. Because, you know, you had briefly talked about this idea of specialization. We're good in our own specialty. We're good in our little sandbox. But that doesn't mean we know everything in the next sandbox. And so, we definitely need to ask for help. But the other thing I think that you touched on was you've seen so many situations, you have seen so many different, just unusual situations that you're much better able to prepare physicians, residents for what that contract should look like once you know what their priorities are.

Right.

I also really think it's cool that as you are working with these eventualities with these residents and physicians, That you are making sure that they've thought about what they want and what they need before they walk into that. I think that's so important. As you're seeing the rise of unions, and this is one of those things that I think we're seeing more of, you know, as we're getting into this newer generation, are you seeing contract language about unionization for any of these residents? Is that something you're seeing more of?

The unions that are representing residents, we don't dabble in that at all. So we're working with them with training. So that's kind of—

Right.

Half the question, but there are folks that are going into situations where either their current employment is moving towards a union, right? Or they're entering into contracts that the union is helping out with already. I think it's roughly 8 to 10%. That's the statistic that's out there of the number of physicians across the country that are in a union. So it's still very much the minority position. Um, I think they can be helpful. I think there's also potential for them to be problematic because we feel that physicians are so unique on an individual level that it's hard to say, let's create a rule that applies to 300 doctors, right? Or 300 positions because some of them want to take call more than others and some want to take less and some want to maximize compensation and some want work-life balance. We've had clients that have been a part of unions that really like them. We've had clients that have been part of unions that really didn't feel like they were doing a good job. So I think it's probably too early for us to have a strong opinion on that. I think it just depends on the person and where they're at.

I wonder if that's a trend you're going to see more of as maybe you see that increase. It'll be interesting to see how that's reflected in contracts and how the larger entities are going to perceive that. One of the things that I think you also do at Resolve that is really an interesting concept to me is the concept of renegotiation, is the idea that you have physicians that are at some point in their careers going to want to renegotiate a contract. What are the common sort of impetus for people to come in and want to do that?

It's usually one of two things. It's either one, they've been taking too much call, right? And something with the job isn't working well for them. And rather than leaving or burning out or something, they're trying to fix it. So I think a really good idea, right, is try to fix the solution if you can, get to a solution if you can. The other side is that they just feel like they're underpaid. They haven't gotten a raise in 10 years. Nothing's happened. They're under contract. Everything seems to be going well, but they're just curious, right, on what is—

Mm-hmm.

current data say for my specialty? And so we've unfortunately had some clients come through where they haven't looked at their contract in 10 years and they're severely underpaid, right? Where it's like their conversion factor should be 75 or 80 and it's at 60 and they're producing 10,000+ work RVUs a year. And so you can do the math on that. They're short a big number for 10 years, right?

Yeah.

And then it's, they're pretty frustrated. We've had some on the other side of the coin where we do look at comp and we're like, yeah, the organization's been updating that fairly frequently. So you're okay on that part, but maybe let's get you that Scribe or that APP support that you want, or more admin time for charting or whatever it is. Let's try to make the quality of life better because we, again, want you to be there. And systems and employers want that too. I mean, they don't want to have to, you know, recruit and retain is really hard, right? It's expensive. There's not enough physicians in the country. And so to replace you is a really big number. So they almost always universally, they'd rather save a relationship with So we encourage anybody that's in a contract to take a look at it, have it reviewed, make sure it's okay. It might be, account might be fine, it might need an adjustment, but at least you can have that peace of mind.

I love how when you were talking about that, because I think so often when we talk about contracts, we talk about physician employment and what that contract looks like. And you mentioned it, I think the 2 most common denominators that make people go look are money and call.

Mm-hmm. Yep.

But it's really also quality of life. When you talk about being able to negotiate a scribe or negotiate an extra employee to do X, being able to make that day in your practice look like what you want it to look like, and the fact that you can actually use contract negotiation to do that. But the other thing I think you do, because it's all you do, is you are giving physicians such solid comparative data. You look at other people in the same situation. It's like, this is what X is doing, and what you want and what this other physician wants may look a little different, but that physician's experience can help to inform yours. And so this is— I'm going to help you achieve what that work should look like. I also think it's really interesting because when you talk about the fact that it's hard to replace physicians, sometimes we don't think of ourselves that way. Sometimes we don't really see ourselves as being a valuable commodity. I would say one of the biggest things I tell when I have especially young female medical students that are going into residency, it's like, you must remember that you are a commodity. You are valuable, as especially, and you know, all physicians are, but I think there are some patients who seek out female physicians preferentially. That if they've gone to the effort to educate you and train you, there are patients who will seek you out. And as a result, it's much more to their benefit to keep you. And so they're going to work to keep you. So if you're walking into a contract negotiation with very solid data about what you should be getting, or if you're able to say to somebody, X physician negotiated a scribe or an extra workup or something like that, those are things that you can ask for and don't feel bad about asking. So a lot of times, do you think physicians feel bad about asking?

Yes. And it's not all of them, but I would say 70%. We don't track that data, so I don't know for sure, but It feels like 7 out of 10 come in going, ooh, you know, I'm getting this. If I'm coming from residency to the real world, right, my income is going to jump 6 to 10 times, right? I mean, it's a big number, right? And so they automatically feel like, wow, am I really worth that much? Well, the answer one is yes, or they wouldn't be paying it to you, right? And then 2, it almost trickles down to everything else. It's like, well, because of the increase in income, I shouldn't ask for all these other things that are important to me. I think female physicians for sure, right? I mean, we know now that it's about 50% of med schools are female, right? So the split is becoming more even. So the workforce will shift to being hopefully 50/50 soon. But yeah, there are patients that will seek out Spanish speakers or there are patients that'll seek out females, right? And so you have to know not only what your specialty brings and what your billing and what your collections are going to be from that, but also that your practice might ramp up quicker, right? Or you may have higher volumes because of other—

Mm-hmm.

things about your demographic or soft skills that you have. So I just think it's important to know all those things and to know what the employer has for options too. I mean, if they've got 10 applicants for a job, your leverage is less than if they have one. And nationally, we know there's a shortage, but there might be certain markets, right? And smaller micro markets where supply's not in your favor. And I think it's also important to know that.

Oh my goodness. Yes. I think it's really cool that you see that as well. 'Cause I think in my work, I definitely see that physicians don't really wanna engage, especially in a negotiation or conflict process. Number one, because I think the process scares them. But number two, it is that sense of, I shouldn't be asking, I shouldn't be asking, I don't want to rock the boat, I don't want to make trouble. Instead of owning the fact, no, no, no, these are things that you've worked for, these are things that you should have, and it's totally okay to ask. And especially if you have the power and the data to negotiate, I think that's so powerful. So, I think it's interesting that you see the same thing, but I'm also really hopeful that because companies like Resolve exist, And that as the awareness of your company increases, that people will make use of those services. That's really what I hope will happen. And I think that's going to make for happier doctors. I mean, I think that's the thing. When doctors feel like they are recognized and fairly reimbursed and can build a workplace environment that really reflects what their priorities are, they're much more likely to stay where they are. They're going to be better providers. They're going to have happier patients. I mean, it really does travel the whole way around. If you could say, so you have a physician who they're wanting to come in, they're wanting to renegotiate a contract. Is there any one piece of advice you give them before that process starts?

Well, if you're going to renegotiate, we always think that you should have access to your data so we know historically what you've been doing, because the employer is certainly going to look back on that and we want to make sure we're doing that as well. So it's not only your contract that we want to take a peek at and understand, but it's also What have you done? How long have you been there? How long do you plan to stay there?

Right?

Are there any things that are unique about you? Right? So we're kind of just collecting all that information. I mean, like an H&P, right? Like you're just getting all the background information. You can know what advice to give. I think that's probably more important in a renegotiation as opposed to a resident who has no history, right? It's, you're coming out of training, right? We know what that profile looks like. So that would be the one thing is do your homework upfront, try to collect that information if you can. So you're ready to have those conversations.

Yeah, I think that's such a great point because I do think unfortunately there's a lot of us that don't know. We don't know what our charges are. We don't know what our RVUs are. You know, if we're trying to think about a renegotiation, we really don't know what we're pulling down. And as a result, it makes it much harder to approach that process. Do you have any words of wisdom for residents that are looking to look at that first contract and getting out into practice for the first time?

Yeah. So your first contract is sometimes your most important one because it's going to set the tone for every renewal or every renegotiation that you have. And so I would say definitely don't sell yourself short in the first contract. If you want to be in a certain location, which is almost always the case, right? We know that physicians pick their job based on geography usually. And so if you need to be in Miami or Denver or whatever city, go out and talk to all the practices, right? If you can, there's probably some upper limit on that depending on specialty, but you should hopefully have 3 or 4 really good offers, right? In that area. So you can then have that leverage and have that side-by-side data to know what you're getting into and try to make that informed decision about long-term, what does this look like for me? And hopefully different practice types too, right? I don't think it hurts to have one private practice and one employed and kind of see what that trajectory looks like so you can make again that decision. Because oftentimes comp and autonomy are at conflict with each other, right? It's like the more freedom you get, the more ownership you get, the less guarantee you get upfront. And so That doesn't mean long-term over 10 years they don't end up matching each other. It just means what are your, what's your risk tolerance early on?

Absolutely. And also too, I think it's a really great thing because there are still independent private practices. That path might look different because then you're talking about a path to partnership. And so is that something that you are interested in being more of the captain of the ship as opposed to someone who's coming in and working? And I think as Maybe physicians are getting more educated about business models. I'm hoping they're going to be less afraid to go into that private practice because I feel like that's a motivation for a lot of doctors who just said, I just want to practice medicine and I really don't want to have any role in any kind of management. I think you're seeing physicians who are more willing to engage in that process of management, and therefore they want to be on that ownership track. Most physicians, or I guess a lot of physicians, tend to not stay with their first job too. A lot of times that first job is not their last job. They may spend 5 years at that job and find, okay, maybe this is not what I'm looking for. And so they're having to move on. And I think because of that, like you said, that first contract is so important because that's their foray into their first profession in their professional life. And I think that's really, really big that you're making a good point of that. That contract means a lot because it's their first. I'm sure a lot of doctors who are also looking for partnership that are going on that track as well and having to negotiate what that looks like.

Yeah, no, we do. Private practice isn't dead. We always joke about that, that even if it's a minority, there's still people that really want to have control. They want to buy into the surgery center. They want to hire their own staff and run all that stuff the way they want to, have their work schedule, you know, not dictated by an administrator or somebody else. And so I think the pendulum will swing, right? I mean, it's gone heavy employment. I think it will eventually come back, like everything else, right? We tend to find the middle eventually. And so I don't think it's dead. I think it's certainly a good option. I think there are certain specialties that really benefit from being in private practice and certain specialties that don't necessarily fall as traditionally into the health system model or the employed model. So yeah, I think when you're negotiating with private practice, it's a little bit different. It's hopefully a colleague and a business partner that you're talking to, not a CEO or administrator or recruiter that might not be there in 3 years. And so you've got to treat those conversations slightly different. I think it's really important for Physicians understand finance, you know, at some levels, like how to read a profit and loss statement and what a balance sheet means and those other important items that go into it where you're never going to have to do that if you work for HCA or, you know, large health systems. So definitely differences there. And I think both can be very good, right, for individual physicians. It just again depends on kind of what they want.

I'm hoping too. And as you said, I agree with you. I think that pendulum is starting to swing back. You're going to see more physicians want to be in an ownership situation. I think as you start to see physicians get more, you're going to see more, you know, physicians with MBAs and JDs, you're going to see them engage more with that and actually educating other physicians in those areas. And you're going to see more physicians willing to take that responsibility.

Yeah, I would agree. I think there's so much more information right out there right now. And people are starting that they may have gone into employment and decided, hey, it's not for me. And they're coming back out of it. So yeah, I think the data should Skew back a little bit in the next few years.

I agree. Absolutely. Kyle, if people want to find Resolve, if they are interested in getting any kind of contract or negotiation help, how would they find you?

Yeah, I mean, resolve.com is the easiest way. Go to the website, they can check that out. You mentioned that there's a lot of endorsement of the idea, right, of what we're doing. And so there's certainly state medical organizations, there's your national societies, right? Well, it should have information from us on there as well. So I mean, you hopefully will find us in a lot of different spots, but the website It would be where you'd go to create an account, start that process of getting access to the data and doing those things to empower yourself. So that's the best way to do it.

One of the things, and I just want to close with this because I loved this so much, when I got your bio, it said one of the things that you're passionate about is helping physicians to level the playing field, that you really want physicians to have the tools, the knowledge, and the power to actually negotiate The work-life reimbursement that they should have. And I love it that you're doing the work, and I think the work that you're doing is so helpful and so important. And I really kind of hope that as companies like Resolve gain more prominence, that physicians will start to feel less conflict avoidant, that they'll actually feel like they can engage in the process. Conflict isn't always a bad thing. Conflict can actually yield better and bigger things if we're willing to engage. So I really appreciate the work that you're doing. Well, thank you. Very kind. We love doing it, and that's what we do all day. Sounds good. Well, Kyle, thank you for your time. Thank you for being on the podcast. It's been great. Thanks for having me. Awesome. Peaceful warriors, thank you so much for being with us on Scalpel and Sword. Please join us next time, but until then, be at peace. Every episode is an invitation. To speak, to negotiate, to choose. I'm Dr. Lee Sharma. Join the dialogue by subscribing to Scalpel and Sword. Until next time, peaceful warriors, may your choices be sharp and your voice be even sharper. This podcast is a reflection of lived experience and research in conflict resolution. The Scalpel and Sword is not intended as medical or legal guidance. For personal matters, please consult a qualified professional.