Jillian Vestal, JD – Contracts Beyond Salary: The Silent Architect of a Doctor’s Career

A doctor signs on for one clinic and later learns the employer can reassign them across town, legally, because of one clause they skimmed. Jillian Vestal, who specializes in doctor contracts, joins Dr. Michael Jerkins to break down the terms that quietly decide where you work, when you work, and where you’re allowed to go next.

She starts with the phrase that appears in nearly every agreement and protects almost nothing: “at the discretion of the employer.” It can hand over your location, your schedule, your call, and even your pay. Jillian separates a real salary review, where both sides revisit the number against survey data, from a vague clause that just lets the employer decide. She also dismantles the fear that hiring an attorney turns the negotiation combative, and the belief that a doctor can read the contract themselves. The work isn’t reading the words; it’s catching how provisions cross-reference and cancel each other out.

On money, she demystifies MGMA: why employers depend on it to justify pay as fair market value, and how an internal cap like a 60th percentile ceiling can be more conservative than the market supports. Her reframe is that “I want more” goes nowhere, while differentiation moves offers, whether that’s bilingual ability, niche training, or a skill that opens a service line. She also flags that anesthesiology has climbed the most over four years, and that pay is rising while productivity expectations largely aren’t.

Should doctor non-competes exist at all? Should doctors be using AI to review and negotiate their contracts? Are doctors negotiating the right pieces of their contract?

One theme anchors the conversation: the parts of a contract that shape a doctor’s life the most are rarely the parts they negotiate. Verbal promises don’t survive a dispute; the MGMA median isn’t the right target for a new attending, and the first contract is the cheapest one to get right.

Here are 5 main takeaways from our conversation with Jillian Vestal:

1. Don’t gloss over employer-discretion language

Jillian flags any clause that lets the employer decide your schedule, location, call, or pay as a major red flag. Even if the job posting sounds specific, the contract is what actually controls, and vague language can give the employer a lot more freedom than doctors realize.

2. Your first contract matters a lot

One of the biggest themes in the episode is that it’s much easier to negotiate before you sign than to fix things later. For residents and fellows especially, Jillian says the first contract is the best time to protect yourself, think through your exit strategy, and make sure the job really fits your goals.

3. MGMA is a tool, not a promise

The episode explains that MGMA benchmarks matter because employers use them, but they are not a guaranteed target salary for a new attending. What really matters is how you add value and whether the compensation model gives you a realistic path to grow into that pay.

4. Non-competes are still a serious issue

Jillian is very clear that non-competes don’t make sense in a field already dealing with doctor shortages and access problems. Even when they may not hold up in court, they can still pressure doctors through threat letters and create real-life stress around moving jobs or relocating families.

5. AI can help, but it can’t replace an attorney

AI may be useful for spotting questions or helping doctors prepare for review, but it can miss important exceptions or sound more confident than it should. The takeaway is that it’s a helpful starting point, not a substitute for actual legal review.

Transcript:

Jillian Vestal, JD:

I think it is very, very difficult to hear about the shortage of doctors, how much we need doctors, the issues with access to health care, just the issues with health in general. And then, on the flip side, say, “We just hired the specialist who, when they leave, can’t work within 50 miles of here.” I mean, it just doesn’t make sense. Again, from a policy standpoint, taking away the rights of the individual, the right… I mean, anything else just in terms of access, I think it’s absurd.

Dr. Michael Jerkins:

Welcome back to another episode of The Podcast for Doctors (By Doctors). I’m Dr. Michael Jerkins, and today we are joined by the one and only Jillian Vestal, who is a licensed attorney who specializes in doctor contracting. She helps doctors navigate employment agreements and some of the biggest decisions of their careers.

Jillian is a graduate of Harding University with a Juris Doctor from the University of Arkansas at Little Rock. And her background is very varied. That spans state government, public health, health care law, and she’s worked in the office of former Arkansas Governor Mike Beebe, the Arkansas Department of Health, and as in-house legal counsel for a health system. I mean, she’s done it all.

So this range is really helpful because she has a rare vantage point where she’s sat on both sides of the doctor and employment table. She’s reviewed and negotiated everything from employment agreements and compensation agreements to call coverage and professional services contracts.

She uses that experience to help doctors spot risks, understand the fine print, and negotiate with confidence. Her practical, relationship-centered approach helps doctors advocate for themselves while also building lasting partnerships with the organizations they join.

Welcome back to The Podcast for Doctors (By Doctors), Jillian.

JV: It’s good to see you.

MJ: I am well. I always feel like I learn a lot about contracts when I talk to you, and hopefully people listening do as well. So, excited to catch up and hear some of your hot takes and words of wisdom.

JV: I can promise… I’m not sure about words of wisdom.

MJ: Maybe both. We’ll plan on both. We’ll see. I’m curious, just to jump right in: since you’ve read more doctor contracts than most doctors ever will, what is a clause that most doctors gloss over that makes you want to reach through the page and just, like, stop?

JV: There are definitely a few. I would say clauses that say, “At the discretion of the employer,” whatever that is, whether it’s the schedule, the location, certainly in the compensation. Any of those things where the employer is just getting to decide, right? They will make all the decisions. They’re going to tell you when you’re coming to work, where you’re going to work, when you’re going to take call. Those are really concerning.

And I talk with a lot of doctors who will say, “Well, yeah, but the job posting said it was going to be at this clinic. I interviewed at this clinic, I toured this clinic, this is where they need somebody. They showed me an office at this clinic.” But the contract says I’m going to work at this clinic and other clinics at the discretion of the employer. And what that means is, if another clinic opens up, or if it doesn’t work out at this clinic, or whatever else happens, they can send you there.

And that doesn’t mean that they necessarily will, but it means that they can. So it’s always something to kind of think through and to be sure that you’re comfortable with it. And a lot of employers will say, “No, no, no, no, no, we’ll never do that.” But frankly, a lot of them will say, “Yeah, we may.” You know, I mean, a lot of them will own up to it.

And it’s something that you really want to be cautious about.

MJ: What are some of the more odd things you’ve seen employers try to put in there, saying at the employer’s discretion, that they try to sneak by the physician? I know location is one, and call schedule, but those are, I guess, pretty standard. They try to dictate the terms, but are there other things that we should be looking out for too?

JV: Yeah, I don’t know if this is necessarily something that they’re trying to sneak by, but I’ve seen it a few times that the compensation is going to be at their discretion. You know, it’ll say, the contract will say something like, “Year one, you’re going to be paid X, and following years, you’ll be paid a reasonable amount at the discretion of the employer,” or something along those lines.

And there are doctors who are like, “Well, is that okay? Kind of, you know, is that not what contracts say essentially?”

And obviously, no, that’s not something that I would recommend signing. Now, it may be a situation where your contract says you’re signing really far in advance. And so, three or four years or five years from now, the two parties are going to meet, and you’re going to look at various survey data, and you’re going to come together and jointly discuss and mutually determine a reasonable amount. Okay.

I’d much rather see a specific number, but that process is fine. But if it’s just something where they’re telling you, “Hey, we’re just going to come up with a number,” yeah, that’s concerning.

MJ: Yeah. “Reasonable compensation at the discretion of the employer.” That’s fine. Whatever is reasonable. That’s what’s interesting, right? Obviously, we’re not trained on contract law. We’re not necessarily trained on how to negotiate or read a contract. So I’m curious, when you engage with a doctor who’s actually like, “A contract attorney? Maybe I should talk to one of these.” What’s the biggest misconception out there that doctors have on what a contract attorney actually does?

JV: I’d say there are a few. Number one, I think that there’s an assumption that it has to be adversarial. That when there’s an attorney involved, you know, we’re pounding desks and shaking our fingers in people’s faces. Not always, a lot of the time.

But most of the conversations either that I have with employers or that I encourage doctors to have with employers are not anywhere near that. We’re all on the same team. We want good doctors to end up in the jobs that they want to be in so that they can serve communities and help patients and be in communities that need them. That’s what we’re all after.

So asking good questions and making sure that contracts are right and meet the goals of the doctors is not an adversarial process by nature. Now, it may get there, right? I mean, we may not be able to get where we want to be without pushing a little harder.

So that’s kind of the first step: people get a little bit uncomfortable. “Are they going to be mad if I get an attorney involved? Are they going to be upset with me?” Like, no. That’s certainly the first part of it.

The second, and I say this with all due respect, I think that there is sometimes an assumption that they can do what I can do, right? It’s just a document. You’re just reading. How hard could it possibly be?

And fair to an extent, right? But there’s a lot more to it, typically, than that. Should it be very straightforward and very easy? Yeah, I guess it probably should in a perfect world. The documents rarely are. The language is heavy and it is very dense, and there is a lot to parse through.

And I have had a doctor pull out and say, “Well, but this section says X.” And, you know, you have to go eight sections above, eight lines above where the sentence starts and look at that opening clause and say, “Well, yeah, but this is what they’re talking about here.” So that’s why it means something different.

So sometimes there is a bit of convincing that this is something that they need. And that’s especially, I think, true in a community of people who are extremely intelligent, extremely knowledgeable, extremely well educated, and used to being at the very top of their field. So I think that’s part of it too.

And then I think there is also sometimes a little, kind of the flip side of that, is there’s another group of folks who think I’m going to have a magic wand and can go, “Okay, we’ll just give you a $50,000 signing bonus,” you know.

And so then kind of having to say too, like, well, we can’t make them do anything, right? We’re going to look and we’re going to see what we think ideally this should look like, and we’re going to be reasonable about this, and we’re going to make the strongest case for it and the strongest argument, and we’re going to go to them in the most reasonable way.

But ultimately, they’re going to have to agree to it as well. So, you know, just having an understanding of what the process is is often a big part of what I have to help doctors understand.

MJ: Makes sense. And obviously we’re very confident people. We do a lot of things well. I mean, we do everything well. And so the confidence-to-confidence ratio doesn’t always match up with the different tasks in our life.

And, you know, part of it is maybe different for the experienced doctor who’s worked and been in practice for a while versus the folks who are just out of residency or fellowship, or even dental school, vet school. It’s their first one, maybe, to ever see.

And that’s like prime time for people to screw up or not sign a contract that’s actually in their best interest. So if you could just give every graduating resident, fellow, dental student, vet student one piece of contract advice, what would that advice be?

JV: So I see two camps in those scenarios. The two camps are the folks who go in guns blazing. They’re coming out of training. They are extremely confident. They know what they’re doing. They know what they want. And they don’t see the need for somebody else to come in and advocate for them or to come in and help them navigate.

I would still encourage them to have somebody take a look at it. It is a relatively small price with a relatively large potential payoff. Even if that payoff is just peace of mind, even if it’s just knowing, “This is what I’ve signed.”

A lot of what we do in a contract review is looking at exit strategy. So even if it’s something that we are just talking about, “Hey, in two or three years, when you want to get out of this, what’s that going to look like?” Let’s talk about that exit strategy today, because I can tell you the best time to negotiate that is right now, before you sign it. It’s worth it. It’s worth it to have that conversation today. You haven’t done this. This is the time.

Now, the other end of the spectrum that I see are the folks who are used to being the residents. They’re used to saying yes, I’ll do it, to whatever they’re asked to do. They don’t ask questions. They put their head down, they do the work, and that’s it.

And so with those people, I’m having to say, “You can ask for more. You can ask questions at all. It’s okay to not just accept this at face value. You can tell them what you want. You have choice.”

MJ: You have choice. Wow. Crazy, isn’t it?

JV: Yeah. And a lot of them, especially if it’s someone who is looking at a contract from the institution where they’ve trained. And so they’re having to go to their attending who they are currently working with and say, “Hey, this signing bonus isn’t going to do it. I’m going to need more.” Or, “I want you to put in here, I’m only going to work seven nights of call a month.”

MJ: I’ve had that experience. It’s weird. Awkward. Yeah.

JV: I’m sure. I can’t imagine going to a law professor and being like, “Hey, I’m not going to…” It would be extremely odd. I can’t imagine.

MJ: Especially when you want to work there too. So it’s like, “I don’t really want to make them mad,” and it’s weird because I know them and they’ve trained me. So there’s a lot of awkward pitfalls there.

JV: So I give a lot of pep talks, right? I give a lot of, you know, “This is your value. This is what you’re worth.” They know who you are. You are a known entity to them. A known entity in the world of hiring doctors is invaluable. So don’t undersell what you’re bringing to the table.

So those are kind of the two that I see coming out of training, whether that’s medical, dental, vet.

Like you said, doctors who have been in practice for a while, they typically know what they don’t know. They’ve seen some things go bad. They know where they need somebody and where they don’t. It’s a completely different process, completely different ballgame.

But a lot of times with the new docs, it’s either telling them, “Hey, you’re worth this,” or saying, “Hey, come back here. We need to slow down a minute.”

MJ: Yeah. You talked about compensation. And I didn’t really know much about this in residency, but certainly learned about it afterwards, is in the medical side, MGMA being a huge benchmark that a lot of specialties, not all, but most specialties follow to understand how you’re getting paid. And it comes out once a year.

So recently, the MGMA data for physician compensation came out. What are some of the biggest takeaways that you’ve had or you’ve seen from the numbers? And why should we care about it?

JV: There’s a lot of reasons to care about it. So I’ll start with that. You should care about it because employers care about it. That’s the first piece of it.

And if you’ll let me, I want to start even kind of further back than that because I talk with a lot of doctors who, frankly, don’t know what MGMA is. And they really don’t have an understanding for why it’s even important in the world of medicine, in the world of contracts.

So the federal government regulates how doctors are paid. There’s a lot of federal money tied up in health care. So 30, 40 years ago, there was a lot of kind of bad dealings. And so there were some regulations.

And the regulations that came out of it say a lot of things. And physician compensation has to be within the fair market value, and it has to be commercially reasonable, among other things.

In the infinite wisdom of the federal government, they then did not really define what those terms mean.

So, of course, there has been case law, and there have been opinions, and there have been all of these things coming out of it. But it made employers realize we need to have some methodology to say, “This is what our compensation is based on,” other than just, “This is what we feel like,” or, “This is how much we liked this person.”

And so these external sources like the MGMA, which is a group that puts out a survey and then produces a report, have become really, really valuable because it gives employers something outside of themselves to say, “Hey, this is what the market says. So this is what we’re going to pay.”

So it’s within the fair market. It has to be reasonable because this survey is telling us that all of these other doctors are making around about this same number.

So when doctors hear things like, “Well, we can’t pay you more than this because it would be over the 60th percentile and we would have compliance issues,” what that means is that internally, they’ve created a methodology that says, “We’re not going to go over this particular number because we feel like that could trigger something,” and that’s going to be our own stopping point.

MJ: Trigger something that’s kind of made up potentially.

JV: That’s right. Because nobody really knows what that number is. And even if that number is 60% for one doctor, well, it could be—or the 60th percentile for one doctor—it could be the 75th percentile for another doctor, because that other doctor could produce more, or that other doctor could have been around longer, or be the medical director. Right? There are all of these other things to take into account, but it’s easier if we just say, “Here’s our number.”

So doctors need to understand the world that they’re working within. And if you’re going to get an employer to go over that rule that they have in place, you’re going to have to have a good reason. You’re going to have to come to the table with something more than, “Well, I wanted more,” or, “This other hospital’s paying me more,” because they may have a whole different methodology that says the 75th percentile is where their trigger is going to be.

So that’s why the MGMA matters. That’s why it’s important. You’re not going to win the argument of like, “Hey, the 60th percentile shouldn’t be where your trigger is.” They don’t care. They don’t care what you think it should be there.

So you need to know how you are differentiated, right? If you’re bilingual and they have a patient population that would be better served by that, you need to tell them that. Right? You need to bring that to the table.

If you are trained in a particular area that’s going to broaden their service line, tell them. Right? If you can do things that they’re not currently offering, that’s where you’re going to move the needle on something like that.

So big picture, that’s the MGMA. That’s why I think it matters. That’s why I think doctors need to know how to work within it.

What I have seen this year within the MGMA, there’s a pretty consistent increase over the course of various specialties, which is not unusual. It’s fairly uncommon for specialties to go down. It happens, but it’s not something that happens that often.

If a specialty goes down, it’s usually because there was a big spike and it’s sort of correcting itself.

And this year, I would say, is fairly typical. I wouldn’t say that there’s a lot that is too unusual here. I would say you want to be aware of the productivity numbers as well.

Because what I have seen is that at times the compensation numbers are going up, but the productivity numbers are actually staying the same. And so that’s actually really good. It means you’re doing roughly the same amount of work, but you’re going to get paid a little bit more, which is great. I mean, that’s what we’d like to see.

So no huge surprises, I would say, this year in terms of MGMA. No big leaps, but definitely just some consistent growth.

MJ: What specialty have you seen have the biggest increase in compensation this year?

JV: Over the last four years, actually, when we kind of take a step back, the specialty that’s risen the most is anesthesiology. In the last four years, it has increased 18%.

From the 2025 report to the 2026 report, it went from total compensation of $498,000 to $590,000.

Now, a lot of things are taken into account in those numbers. Certainly, the amount of work, where they’re doing it, the need—also shortage is a factor there too. When we see fewer of that specialty, often the numbers rise.

That’s why we saw a few years ago psychiatry numbers went way up. There was a huge need, and they were kind of the hot specialty in terms of recruitment. So that may be why we’re seeing that here.

And kind of continuing on that, you know, we continue to see primary care going up. That’s been at about a 10% increase over the last four years, which I think is not shocking given the need that we continue to see there as well.

But anesthesiology was the biggest jump.

MJ: Hmm, interesting. I know people obviously pay attention to the compensation piece, but also a lot of doctors are paying attention to non-competes. That’s probably the thing when I talk to colleagues that comes up the most often about their contracts. I’m curious, what do you think about non-competes? Should they be illegal? Is this one of those things that should just be totally gone from our contracts altogether?

JV: As a lawyer, I rarely give my opinion about things, but I will say yes, I think that they should be. I think it is very, very difficult to hear about the shortage of doctors, how much we need doctors, the issues with access to health care, just the issues with health in general. And then, on the flip side, say, “We just hired the specialist who, when they leave, can’t work within 50 miles of…” I mean, it just doesn’t make sense.

Again, from a policy standpoint, taking away the rights of the individual, the right… I mean, anything else just in terms of the access, I think it’s absurd.

MJ: Totally agree. I mean, there’s so many horror stories. And sometimes it’s like a terrible contract, but then they can’t enforce it. But maybe they can’t enforce it, but they threaten to enforce it, which then changes the doctor’s decision, moving their family and all of these really huge impacts on their life over some contract that maybe wasn’t even enforceable.

So, another reason why you should have an attorney. But I’m curious, where do you see this going on non-competes? Like, in a couple of years, are we going to see these unchanged, or are non-competes going to be banned? Is there going to be more limitations? Where are you seeing the trends for that?

JV: I think we’re going to see them more limited, which is what we’ve seen the last few years. I don’t think we’ll see them altogether banned.

A couple of years ago, there was some movement to ban them at the national level. That has sort of died. Now, that could certainly change, right? Right now, different states have various efforts, and that’s happening sort of piecemeal.

About a year ago, Texas enforced a new law that doctor non-competes can be one year, five miles. In a state the size of Texas, that’s pretty significant. You know, five miles is not huge there.

Obviously, we’ve got a handful of states that just don’t have them at all for any worker. There are states that are saying you can’t have them for primary care doctors. There are states that have, just in the last year or so, banned them completely for doctors. You know, there are things happening kind of at the state level. I think we’ll continue to see that.

There are states where they are alive and well, but—and I think you touched on this, and this is something that I talk with doctors about a lot—there are sort of two forces at play.

There’s what I would call legal enforcement, which is what we’re talking about. Is there a law that says you can even do this? Right? Could you even file a lawsuit and try to enforce this? Is the contract that says there’s a non-compete, is that enforceable?

The other is what I’m going to call market enforcement, because, frankly, what we’re seeing is a lot of judges are not in favor of a non-compete. If an employer files a lawsuit, doesn’t settle, gets all the way to court—this is not legal advice, no one take it as such—if we see an employer get all the way through that process, they’re not typically that successful.

Especially these huge, far-reaching, “You can’t work within 50 miles of all 73 of our clinics” kind of thing. Those are not typically going anywhere. And we don’t see a lot of employers trying.

What we see employers doing is, when a doctor leaves, giving them a letter that says, “Hey, don’t forget, this is your non-compete,” sending maybe a letter to their new employer saying, “Hey, don’t forget Dr. Jerkins has a non-compete. And if you send him to work at Clinic X, he will be in violation of said non-compete. And it will be within our right to sue you for $2 million,” or whatever.

And maybe even send a follow-up. And if I’m the new CEO who has just hired you, I might go, “I don’t know, y’all. Is Dr. Jerkins worth this? Do I want this headache?”

Now, maybe me, the new CEO, knows that I didn’t enforce the non-compete when the other guy left. And so there, you know, maybe this is all just a big—I don’t want to say scam, but, you know, maybe it is.

But are they going to go after you in court and are they going to try to scare you and your new employer? Are they going to try to go after you in court? Probably not, is my best guess. Will they send you some scary letters? Yeah, maybe.

And so that’s sort of—and you need to get an attorney. That’s absolutely right. And again, I’m not telling you, like, just disregard it. It doesn’t matter, because it does, and they could. But there are sort of two different ways to use that against you.

And so, again, do I think that judges are going to say you can’t work within the state of Kentucky anywhere you want? No, probably not. But can they make it tough for you? Yeah, they can.

MJ: That’s when you get an attorney.

MJ: So this is interesting to think about because as many people might be listening to this who got a scary letter from an employer or former employer about a non-compete, they may or may not—I’m just guessing—have put that into their favorite LLM and asked the LLM to give them legal advice.

So I’m really curious on your take. Do you think AI is making doctors better at reviewing their own contracts and handling their own legal matters?

JV: So I’m going to answer that question with a question.

MJ: Oh boy. Okay. Can’t wait.

JV: Do you think AI is making patients better at reviewing their own medical situation?

MJ: In some ways, yes. Okay, in some ways. I can’t say that it’s 100%. I am all about patients being more informed and empowered with complex data they might not understand. Now, it might lead them to the wrong conclusions, it might make them overconfident in the wrong positions, but ultimately, I think the ideal scenario is where the patient has as much information as they can get and as much understanding as they can get.

But they partner with their health care provider who can help them navigate. Okay, this is where that makes a lot of sense, and I didn’t think about that, but that’s a good point this brought up. Or, hey, here’s where it was completely wrong and I would totally ignore that.

That’s what I would say the model should be in the medical space.

JV: I 100% agree with you if you took out “patient” and put in “client” or “customer” or whoever you want it. Yeah, that’s what I’m seeing.

I think it’s obviously a great tool. I mean, I think we all are finding that just in our lives in various places, right? I mean, it can provide some really interesting information. Yeah, it’s great.

Do I think it should be relied upon for legal advice? No, no more than I think it should be relied upon for medical advice.

I have worked with doctors who have put their contracts into an AI model and have used that to formulate questions to bring to the contract review. And it’s extremely helpful.

It’s always great for me when they’re really upfront about it, right? Like, “Hey, ChatGPT said X, Y, and Z. What do you think about that?”

Or any other source, like, “My program director said X,” right? I mean, just tell me kind of where this came from.

But yeah, I think it’s great. I will tell you, in the handful of times that’s happened—again, the handful of times that it’s been specifically cited. I’m certain it has happened many more times—but in those handful of times, there have been some things they’ve said that it’s like, “Yeah, that’s a valid point, and here’s how I would address it,” right?

Because they’re not getting necessarily responses or remedies to those things. It may be pointing out, like, “Hey, you’ve got a non-compete that says X.” It’s not necessarily telling them, “Here are some alternatives,” or, “Here are some things to think through.”

There have also been a handful of times that it’s missed some things. And the AI model has maybe pointed out a non-compete or pointed out something about an exit strategy, and it didn’t catch a couple of pages later the exceptions that were mentioned or, you know, the clause that kind of modified that.

So, again—

MJ: It can be overconfident, right?

JV: Yeah.

MJ: And that’s the thing that’s a little scary. Like, from medical training, it’s scary when a trainee is overconfident and can’t necessarily admit, “Okay, yeah, you’re right. I probably should have thought about that more, maybe asked more clarifying questions.”

Or then it goes to, okay, well, when they are overconfident and maybe they are more prescriptive on what to do, who is liable? Right? You know, that’s obviously a legal question, but also we ethically—question, I think, especially in health care. Who’s liable for this when there is a mistake made, or they’re not clear on, “This isn’t medical advice”?

And I think this is like a little bit of a rabbit trail. I think where we’ll see more and more of this in health care is especially in the pediatrics realm, because if you look at pediatric health care, a lot of it isn’t necessarily evidence-based in the classic sense of there’s double-blinded, placebo-controlled trials on every single pediatric disease process or medical decision, because there’s not as many studies on the pediatric side as there are on the adult side.

So therefore, you’re going into more of the art of medicine, training-based, academic-based training for the pediatricians. But when that’s automated and there’s a limited evidence base that that LLM is drawing from or making decisions, like, okay, well, now what? Who’s liable for this?

Sorry for the diatribe, but I think the same thing probably applies to legal advice as well, I would guess.

JV: And I would assume that this exists more in terms of pediatric medicine, but is it drawing from everybody with a blog and a home remedy and everybody who has an opinion about what contract law should look like and about what a non-compete should be?

And again, I think it’s an incredible resource. And I think, like, what a time, right? Like, it’s fascinating.

But I think, like anything else, it has an appropriate use and an appropriate time and place. And I recognize you and I sitting here and saying this to one another, but there are still such things as experts in fields and highly trained individuals.

And, you know, if you’re looking to plan a road trip and want to know the best places to stop for barbecue along the route, like, yeah, it’s awesome. If you’re trying to decide the contract to sign for your job or how to treat your child’s fever, it doesn’t seem like maybe to do those with the same tool.

MJ: Yeah. I mean, the same thing is, like, we’ve had great software and ability for basically computer-driven piloting of airplanes. It doesn’t mean we don’t train humans to do that or still have humans on board, right?

I mean, that’s, I think, a good analogy too of what we’re talking about with that level of expertise and training in this kind of specialized knowledge-based services, like legal and health care advice.

But I know we’re coming close to the end, and we have a section where we do rapid fire. It’s really not ever rapid.

JV: Yeah, I’m too wordy to do rapid fire, but I’ll try.

MJ: No, no. I am as well. So I will say a statement and you tell me if you think that statement is true or false. And then, you know, a little about why.

Okay. So true or false: A verbal promise from your future employer is worth the paper it’s printed on.

JV: False.

MJ: So, I shouldn’t believe all the future employers that just tell me verbal promises and don’t put them in the contract. Is that what you’re suggesting?

JV: I’m not saying you can’t believe them, but it’s not worthwhile.

MJ: Just trust but verify.

JV: That’s right. That’s right. Here’s my scenario: What happens if the person who told you that, who you really like, leaves in two years? Like, think through that scenario.

And here’s my other rule of thumb, and this is not short: If it’s something that is make-or-break for you, if you’re like, “I will not take this job if I don’t take somebody’s verbal promise on that,” if you’re like, “I don’t really care if I work in this clinic or that clinic, it doesn’t matter,” then yeah, okay, fine.

But if it’s a deal breaker, get it in writing.

MJ: Get it in writing. All right. True or false? The MGMA median is the right target salary for a brand-new attending.

False. Why is that?

JV: Right. I think it’s, you know, who’s to say? And normally, that target, that median, is going to be something that we hope that you’ll get to within a couple of years when you kind of get a practice up and running. So I don’t anticipate that you’re going to be there right out of the gate.

MJ: And it goes back to production too, right? So, like, how much are you actually producing and things.

JV: Absolutely. And now I’m more concerned with, does the model that you’re getting allow you to get there to that total?

MJ: That’s a great point. True or false: You should never sign a doctor contract without an attorney reviewing it first.

True. True. I kind of suspected you would say that.

JV: I’m not saying me, necessarily.

MJ: No, I know. I agree, by the way. I totally and wholeheartedly agree.

And I think I’ve told this story on this podcast, but when my first attending contract came up, I didn’t know that there were contract attorneys until a co-resident told me, and I didn’t know how they worked.

So I had this phone call, and then I am an internist by nature, so I emailed little questions constantly for like three weeks. And then I got my first bill at the end of the month, and it was a very not-great bill, especially when I was a resident at the time.

Anyway, I figured that out. That’s why—

JV: I don’t bill by the hour. I would just like to make that statement.

MJ: Don’t bill by the hour. I love that. Just do it by the job, make it affordable, make it value-added. Love it.

All right. Last true or false: You can always renegotiate later. So the first contract doesn’t really matter.

False. Very false.

JV: It’s a lot easier to do it at the beginning.

MJ: Measure twice, cut once. Is that the—is that it?

There you go.

So, all right. We always ask this to every single guest, but what is one thing that you’ve recently changed your mind or changed your opinion about?

JV: That’s really hard. And not because I haven’t changed my mind or opinion about many things. I think I’m going to actually say two.

One is the use of AI, that I do think that there is certainly a use for it within the world of contract review. I would say that for a while I thought there probably was not a place.

I do think that, as we discussed, it can be used and used well, used in a really informative way in the scope of a larger review process.

So I would say that’s something because I probably would have said before, like, “Don’t even bother.” So I would say that.

The other, and this kind of is maybe a little bit more long-term: I had high hopes that non-competes for doctors were really going to become a thing of the past. I thought that that’s where we were headed, and it just does not—it seems to have lost all momentum.

So I think, unfortunately, we’re stuck with them for a bit longer.

MJ: Well, hopefully you change your mind about that here in a couple of years. Who knows?

JV: Yeah, I mean, I hope. I hope that I do.

MJ: Well, this has been very informative. I appreciate your help and the way you help our community of doctors and advocate for us. Where can listeners find you? Where can they find more information about you or your services?

JV: On our website, which is panacea.legal. There is more information there. You can sign up for a free 15-minute consultation with me if you just want a little bit more information and want to learn about our process, or want to talk through your situation and figure out maybe which type of review would be the best, or anything like that.

My email address is there too. It’s [email protected], so feel free to reach out that way.

I love what I do. I love to help doctors kind of navigate the process, and getting to see them through and getting to a place that they are happy and in the place they want to be is always fun for me. So would love to help.

MJ: Well, thank you for your time, Jillian. I appreciate you being here, and we will talk soon.

MJ:

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