• Contract Review
/

Preventive Medicine: Physician Contract Negotiation

Evan Winter

Fifty percent of physicians leave their first practice within the first two years of employment. That’s a staggering statistic, especially to physicians in training. They work incredibly long hours, making a fraction of an attending’s salary, for years, all while holding onto hundreds of thousands in student loans. Then graduation comes, and they secure an attending position with pay and benefits that finally allow them to live a little more comfortably and start paying off their debt. But it’s not that simple. A huge pay raise may look extremely attractive to a newly attending physician, but there are many more aspects of an employment contract that factor into job satisfaction for the long term. If a contract is properly negotiated from the start, physicians can avoid becoming one of the many who quickly become unsatisfied with their job.

Make a Plan

Before starting a job search, and definitely before signing a contract, a physician should strongly consider their ideal employment situation and where they want to be in the future. A sizable starting salary is great, but as many older attendings will say, it is far from everything needed to be happy. Physicians should be thinking about an overall career plan and attempting to answer some key questions which will help them stick to that plan. Where do they want to live? How fast will they pay down debt? How much time are they willing to spend on call? 

Once at least some of those questions have been answered, it is advisable to connect with someone who knows the physician job market from a business and legal perspective. Medical school and training teach physicians all about practicing medicine, but little to nothing about the business side of it. This leaves many feeling like they are flying blind when it comes to determining fair market value for a position and negotiating a contract. Fortunately, there are agencies and lawyers who specialize in physician employment contracts, and once one is chosen, there are a number of main contract points they will suggest paying considerable attention to.

Type of Work and Call Hours

To be satisfied with a position for a long time, physicians should be involved in the type of work they actually want to be doing and working hours that fit with their desired schedule. They should be sure to question contract language which has them performing “duties specified by the employer,” so they don’t end up being required to complete a broad range of tasks they wouldn’t have signed up for. This is especially true for specialists, who should have it put in writing that they will perform their specialty. 

Often, as it is in residency, younger employees will also be served with a contract requiring them to work longer hours, weekends, holidays, etc. This can be negotiable and should at the very least be negotiated to resemble the requirements of other newer employees. Similar to the scope of work, language such as “hours defined by employer” should be avoided so a physician is not on call at all sorts of unspecified times. This combination of proper workload and scheduling can help tremendously in creating a work-life balance and preventing burnout.

Advancement and Bonuses

After the groundwork is set concerning tasks and schedule, physicians must think of opportunities for advancement. In the case of private practice, this means understanding how and when a physician can start becoming a partner or shareholder. These days, employers outlining a path to partnership within a contract is not always the case. Physicians should negotiate for a contract clause which clearly specifies whether that path is available, when it is available, and how to get there. 

Another way physicians can incentivize themselves and level up their career is via bonuses. Signing bonuses are always a plus, but end-of-year bonuses can be especially valuable. They can help make up for parts of a job that a doctor is unable to control, such as any lulls in workload and subsequent lack of production-based pay. Bonus types and amounts can vary wildly, and they tend to be highly negotiable.

Benefits

Last, but not least, a benefits package, like many other parts of a contract, is often pitched to physicians as “standard.” However, doctors would do well to make sure their benefits are anything but standard. There are many moving pieces to a benefits package, and they should be manipulated to fit a physician’s lifestyle. This is an area where referring back to the initial career plan can be extremely useful. Physicians should consider benefits such as student loan repayment, retirement savings, malpractice insurance, and more that will help them stay on their desired path and reach the common goals of paying off debt and establishing greater financial stability. Without a benefits package that protects a physician and their family both physically and financially, they may need to pursue other employment opportunities sooner or later.

Everything is Negotiable

For physicians, properly negotiating a contract sets the foundation for a more fulfilling, stable career from the day they sign on. Making the ask and negotiating for the most desirable terms of employment before even beginning work will cultivate a better relationship with an employer and help prevent any unexpected complications in the future. Contract negotiation can be made easier by securing multiple offers and obtaining knowledge of the job market for the physician’s specialty and location. Therefore, a physician acquires greater leverage in negotiations, and with enough leverage everything is negotiable.