So I have the con and I'd like to thank Arnold for putting this together, thanks for your work as the head of the Government Relations Committee, and thanks for inviting us to Long Beach. So I'm going to talk about restrictive covenants protect my new physicians, my new programs, and training. And I don't have any disclosures, well, except for the fact that I recently served a two-year non-compete when I decided to move. So I know a fair amount about this. I'm going to talk about three things. How did this anti-competitive tsunami about non-competes, how did that begin? And Arnold's talked a little bit about that. The legal tenets of basically protecting legitimate business interests. That's where non-competes come from. And then finally I'm going to have some fun with what does a reasonable non-compete look like? You've seen this already, you see why this happened, but this drove everybody from private practice into being a hospital employee over about 12 or 15 years. The government did this to us. Okay, everybody needs to know that. The government did this to us. All of us are employees. And then the White House executive order from July of 2021 on promoting competition in the American economy. Okay, it basically says, it's only about a 21-page document, you should read it. It basically says that a fair and open competitive market has long been the cornerstone in the American economy and that monopolies are bad. So we also heard, and Hari talked about this, we heard from a lot of interventional cardiologists and cardiologists that they're getting caught in these non-compete traps. And these are the articles that were published and there's Hari and I, we worked long and hard on this. But let's talk about something we can all relate to. Let's talk about a person. Let's talk about an interventional fellow who's finished his interventional fellowship. He's got two kids. His spouse is from a small town in Florida, about two hours from any major urban area. And there's a large hospital there with 300 beds with 25 cardiologists, and he's got half a million dollars in debt, he or she. Well, there's no hiring at this one big hospital. So there's a smaller group in town that's going to build an ASC. I think this is very timely, right? Lots of people are building ASCs. They need that fourth interventionalist so they can cover both the hospital and the ASC, and they're a well-known group. So you like them, they like you, so you sign a contract. It's a good contract. You get a two-year guarantee. They're going to pay off your loans in two years. You can be a partner in a couple years and make big money. You're going to be able to buy into the ASC. Okay, they're going to introduce you to all the referral lines. But you have to sign this non-compete agreement for two years and 15 miles. You talk to the wife's family doctor, I mean, family lawyer, and they say, okay, sign it. Oh, happy day, until two years later, when actually the practice is a you-know-what show, okay? Now the hospital needs another interventionalist now, and you consult the family lawyer again. He goes, not so fast, like game day. You signed a non-compete agreement. You agreed to this non-compete agreement. That third word is agreement. A contract is a handshake where both parties are equally uncomfortable, and he signed it. So where is this person now? Okay, he's got a huge referral base. He wants to stay in town, and his spouse wants to stay in town. They now have three kids, no school debt, fiscally sound, and the hospital is going to give him basically an RVU kind of contract. But what did the group lose? Not only did they lose the money they invested in this person, and it's about a million dollars over two years, but he now, or she now, has all the trade secrets about how they get their referrals, and that's what the hospital wants. Okay? So you become a million dollar business investment, okay? And you know all the trade secrets. So you be the judge. What would Judge Judy say, okay? Here you are in a state that has non-competes, okay? You signed the agreement. You know all the trade secrets, and the hospital wants that, right? It's unlikely, too, that the hospital will pay your legal bills for fighting against your old group. So this is apparently what Judge Judy says. I had to look this up on the internet. You say no, I say yes, I win. I'm the judge. That's what would happen. That's what would happen in Florida or Georgia. So what's the state right now? Well, Hari, I gave you credit that you were going to get this finished in New York. You sloth. I mean, come on, man. Can't you do better? But Wisconsin and Maryland, okay, now they got rid of non-competes, but that's the minority. Basically, about 15 states have where you cannot have a non-compete with a physician. The other 37, either from common law or statute, you can have a non-compete. So what are reasonable non-competes? Let's have some fun with this. I hate this billboard, but I see it every day on the way to work. I'm a Florida Gator, and that's a Georgia Bulldog, and I hate Morgan & Morgan, but size matters in non-competes. Ten cardiologists leaving a 20 billion dollar company is very different than one cardiologist leaving a 15-person group. Location matters. Rural patients are hurt when doctors are run out of town, right? Okay. Risk matters. If a small practice is risking a huge piece of their capital, they need to be protected. Business secrets matter, and if you're a small practice or a medium-sized practice, and you're up against an 800-pound gorilla, you need to be protected. And then finally, age matters. And this is what really bothers us a lot, is that young interventional cardiologists and cardiologists are being screwed, okay, by big business. And this is happening to lots of people, and you're going to hear about that. So in summary, most states have non-competes. The FTC ruling is going to be tied up in court for a long time, and this is a state's rights issue, just like you're licensed to practice in whatever state you practice. It's not portable, even with a compact, right? It's a state's rights issue. Many believe this will actually end up in the Supreme Court, okay? The legal tenets, know your state, know the law, know the risk you're taking, know the financial risk you're taking, know the financial risk the hospital's taking. Try to understand that, and we need to protect these younger interventional cardiologists. I mean, what do you all think? Who would have won that case in the real life thing? I'm telling you, the hospital wouldn't win that one. And then government control. We need to be involved. Advocate for change, or be on the menu. Everybody in this room should be donated to SkyPak, because that's the only way we're going to change things. Thank you very much.

non-compete agreements

physicians

government regulations

healthcare industry

younger physicians