How do I lock the schedule in writing before I sign?

Get the schedule, the call burden, and the coverage ratio in the contract, not in an email. Verbal promises about hiring evaporate. If they will not write it down, that tells you everything.

A staffing shortage has a way of becoming your schedule. The group tells you it is a 40 hour week with one weekend a month, and then six months in you are covering late rooms three nights a week because two people quit and the replacements never materialized. The version of the job you were sold lives in the brochure. The version you will work lives in the contract. Put it in the contract.

The three things to get in writing

1. The schedule. Not "full time." The actual shape of it: sites, rooms or cases per day, normal start and end times, and how many late rooms per week count as normal. A contract that says you work at "sites as assigned" assigns you everywhere, forever.

2. The call burden. In house versus home call, how often, what post call looks like, and which services count. Anesthesia call is not one thing. OB call, trauma call, and late room coverage are different burdens with different frequencies, and groups price them differently. Get the frequency in numbers: one in how many, weekend frequency, holiday rotation. A verbal "call is light" is worth nothing. "One in eight in house call with a post call day off" is worth something.

3. The coverage ratio. How many rooms you run and under what model. A day medically directing four rooms with two CRNAs out sick is not the same job as directing two. The contract should state your usual supervision or direction ratio and what happens when staffing drops below it. If the ratio is not in the contract, the ratio is whatever the schedule needs that day.

Why emails and verbal promises fail

Three reasons. First, the recruiter does not work for you. The recruiter's job is to fill the slot, and the recruiter may not even work for the group a year from now. An email from someone who has left cannot fix your schedule.

Second, promises about hiring are the fastest evaporating sentences in medicine. "We are hiring three more physicians" is easy to say in March and easy to forget by September. Groups that are short staffed stay short staffed. Price the job as it exists today, with the schedule you can enforce.

Third, an email is not part of the agreement. When there is a dispute, the contract controls. If the schedule terms are not in the contract or an attached exhibit, you have an anecdote, not a term.

The language to ask for

You do not need to write like a lawyer. You need numbers. Send the group something like this:

• Maximum sites per week: two, with at least 30 days notice before a new site is added to my rotation
• Late room coverage: no more than two late rooms per week as part of base schedule. Additional late rooms compensated at the call rate
• Call frequency: in house call no more than one in eight, with the post call day off
• Coverage ratio: medical direction at no more than 1 to 3 under normal staffing. When staffing drops, rooms are closed before the ratio is exceeded

Attach it as an exhibit or schedule to the contract, not as a side letter. The exact form matters less than the location. It has to be inside the agreement.

What a refusal means

If the group says the schedule cannot be in the contract because "it changes too much," listen to what that sentence means. It means the schedule changes too much. They are telling you the brochure version is not enforceable, and they are choosing not to enforce it.

Some groups will agree to an addendum or exhibit, or a written call stipend schedule while keeping the day to day flexible. Those are reasonable middle grounds. What is not reasonable is nothing. A group that will not put a single number next to its call burden has a call burden it does not want to commit to. Believe the refusal.

A comparison: enforceable versus verbal