Physician Contract Negotiations and Contract Review
(Compensation databases, terms to negotiate, contract lawyers, & red flags)
One thing we don’t do a great job of in training is preparing physicians for contract negotiations. There’s not enough salary transparency, and it’s easy for physicians to get taken advantage of. In our communities, we want to empower physicians to know their worth, and part of that requires knowing what to look out for in contracts, salary data, other aspects of compensation you need to negotiate aside from just salary, and negotiation skills. Also, remember that if it’s not in the contract, you won’t have a leg to stand on if something is contested, so push to get it included! This page is intended to give you resources and answer frequently asked questions.
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Contract Negotiation and Review Resources
Please Note: In order to access these databases, you must join our Physician Side Gigs Facebook group, which is free but only open to physicians.
Thousands of datapoints, not just about salary, but also about vacation time, benefits, hours worked, admin/academic time, signing and relocation bonuses, partnership options, and more.
This lists information about rates physicians are getting by location and specialty, details of locums gigs, experiences with different locums companies, as well as miscellaneous things like tips for maximizing points rewards.
This database lists by specialty, location, and employer/practice type whether you are paid for call and how much, whether mandatory, what the call schedule is like, if call is in house or from home and how often people go in, how you are paid when you come in, etc.
Physician Contract Review Resources
If you need your contract reviewed by an attorney, we have an contract attorney database, with local attorneys organized by state. If you don't find a local attorney, we have an advertising relationship with Resolve, with discount code PHYSICIANS10 for 10% off! They are a national company that specializes in physician contracts so they're very familiar with compensation data, partnership agreements, things to look out with for call compensation, liability insurance, noncompetes, etc. They've been highly reviewed (you can see reviews on their site) both online and by members of our group. That site lists the different packages - if you're on a phone you may have to scroll on the first package to see the others.
Additional Contracts Educational Resources
We have links to previous events on various aspects of contract negotiations on our free educational virtual events page.
If you haven't read Never Split the Difference, it's a great read to get you into the negotiating mindset that is good for all aspects of life, not just jobs!
How Do I Know If My Physician Employment Offer is Good?
You should get as much information from others as possible. Talk to prior co-residents from years before you, talk to your mentors, talk to others in your field (you can ask on our physician Facebook groups) and try and look at as much compensation data as possible. We have a good amount of data on our salary and negotiation database, but you should also look at MGMA and other available databases. If you are in academics, look at the AAMC database. If you are looking at a VA job, you can check on FedsDataCenter.com. Often times your contract attorney or hospital libraries will have access to this data.
Also note that the best offer is the one that works for you, because the whole package is important, and not all compensation is salary. Benefits packages, PTO, the ability to become a partner and share in other revenue streams, and opportunities to access student loan repayment programs have a huge monetary value, for example. Additionally, just looking at compensation is deceptive, because you need something that provides the professional career and lifestyle that you want. For some people, salary is very important, while for others, it’s working with a certain patient demographic, getting to work in research or with residents, having part time options, getting a certain benefit package or good health insurance, having more autonomy, etc. Don’t take a job just because it pays the best or because it’s the most prestigious. Sit down and write down what things are important to you and what things are dealbreakers, and look at all jobs in this context. Negotiate for the things that matter to you.
What Is Negotiable and What Parts of My Physician Contract Should I Pay Particular Attention To?
We most commonly see people talking about the salary being offered and wRVUs, but contracts have so many more terms than that (see the next paragraph). Put simply, everything is negotiable, and you should pick the things that are most meaningful to you. If you don’t care about having a CME fund because you’re happy doing online free CME, then don’t waste your time negotiating that. It may be more important to you that you are able to end your day at 4:30 or that you have protected time for research, or even that you have a convenient parking spot. Think about the things that make you happy and focus there.
That said, aside from salaries and wRVUs, these are the things that we most often see people negotiate about or factoring into their compensation package.
For some people, having some cash upfront can be very important to defray the costs of moving, time off between jobs, and other expenses, particularly when transitioning between training and their first physician job. Some things to keep in mind here:
This is a one time event, and if it gets in the way of you being able to ask for other things that will impact your happiness long term, you should shift your focus elsewhere. It’s better to get $5000 more on your base salary that you will get yearly rather than a one time bonus of $10,000.
You will be taxed on this, so set aside the money.
Many sign on and relocation bonuses come with strings attached, and you may have to pay them back if you don’t stay with a practice for a certain period of time, so ensure this is in line with your plan.
Vacation Time/Sick Time/Other PTO
Having the ability to take time off for vacation, sick leave, maternity or paternity leave, CME, or otherwise can be a valuable part of the compensation package. For many, this has a value above an extra few thousand dollars, and may be something worth negotiating for more of if an employer is not budging on salary. You’re also not taxed on that time, whereas you’re taxed on salary, so the monetary value to you may be more than you think. As an added perk, it’ll likely make you a better and more refreshed physician, which may contribute to your productivity and patient satisfaction scores and actually result in more revenue.
Clarify if federal holidays count in your PTO time.
Clarify if you may have other responsibilities during your PTO, such as checking results, responding to patient outreach, call responsibilities.
See if unused PTO carries over, and what the procedure is for getting PTO approved. You do not want to be in a scenario where you are told you can’t use PTO because of staffing needs, especially if PTO doesn’t roll over.
Maternity and Paternity leave are complicated. Clarify if that time off is paid, and even if it’s not, understand how it affects your productivity expectations and bonuses or call schedules. Your ideal situation would prorate these measures/requirements to reflect the time off.
While you are often not able to negotiate these as they tend to be standard to all employees, you want to be aware of what options you have and be able to factor them into comparisons with other job offers, as they are a major part of your compensation package. Consider:
Retirement plans: Is there employer matching of contributions? What options are available - 401k/403b/457, Roth options for 401k/403b, profit sharing plans, defined benefit or cash balance pension plans?
Health insurance: What is the qualify of the plan? How much of the cost of the plan is shouldered by the employer? If there is a high deductible, is there an option for contributing to an HSA or an FSA?
Dependent care flexible spending accounts: These could be of benefit for those paying for childcare for young children or who have healthcare .
Life insurance and disability insurance: Although we prefer independent policies that move with you if you switch jobs and pay out benefits in post tax dollars, additional insurance provided by your employer still has value!
Fringe benefits such as legal or financial benefits
CME or academic funds
Productivity Bonus Structures
Bonuses can be a large portion of your compensation, and sometimes even greater than your base pay, so it’s very important to understand and negotiate the terms. Know what you have to do to fulfill your base salary requirements and move on to the bonus terms. Know exactly what numbers qualify to be included in those thresholds (collections? Collections - expenses? RVU minimums?) and ask for examples of other physicians so you can get a sense for how much you can reasonably expect to make with any given workload.
Tip: Make sure that the conditions in which they don’t give you your bonus are spelled out. Ideally, you don’t want there to be a discretionary component that allows them to deny you a bonus because there’s a pandemic, because your boss doesn’t like you, or because you said no to a duty that wasn’t in your contract.
Terms of Separation
You have to plan for what happens when you separate. Hopefully this is your forever job, but you want to make sure the terms of separation are fair.
Conditions of Termination
Things to check for in conditions of termination:
Can you leave before the contract is up?
How much notice is required if you want to leave?
Under what grounds can they terminate your contract early?
How much notice do they have to give you?
Make sure you have some job security and that if you are doing your job correctly, they can’t just terminate you because their budget changes or they found another candidate who does the job for cheaper than you.
Noncompetes can make it really hard to leave a bad job if you are tied to an area. If possible, get this eliminated. If not, make sure it’s reasonable, and limited to a certain mile radius of only the office you practice at (not an entire hospital system or every location of the practice). Make sure it’s as short as possible.
If they terminate you without cause, you really shouldn’t have a noncompete. They’ve already decided they don’t need you, but shouldn’t have the ability to preclude you from having another job at a competitor or starting your own practice in this case.
Learn more on our dedicated negotiating noncompete agreements page.
There are primarily two kinds of malpractice coverage - occurrence based or claims made. Occurrence based is what most people had during training, which states that if the malpractice suit concerns an incident that happened while you were covered by their malpractice, the malpractice company will cover it. Claims made, on the other hand, will only cover you while you hold that policy. This means when you leave this job, you will need tail insurance (or nose coverage from your new job) to cover you if somebody files a lawsuit after you leave. Tail insurance is expensive. Try to have it included. Usually there will be some terms attached to it, like how long you worked there, whether you decided to leave or they terminated you, etc.
Learn more about tail insurance.
Schedules and Call Schedules
Things to consider when evaluating the schedule:
How long are your work days?
How are schedules made?
Are there weekend requirements or after hours requirements?
Are certain shifts/roles easier than others and how are those distributed?
There’s a lot to be negotiated in regards to call, not just with frequency. Look for the following:
Are you paid for call?
Is there a different rate if you are called in versus just holding the pager?
What are the actual call responsibilities?
What you need to come in for?
Are you required you live within a certain radius of the hospital?
How are weekends and holidays distributed?
Do senior members of the group have different terms than you? Read this clause carefully.
Tip: Many contracts intentionally do not spell out how often the physician is required to be on call. Some will just state that they will be on call as often as others in the group or other similar vague language. While that seems fair, you may not find call burdensome when there are 6 people in the call schedule, but what happens if 2 quit and one is out on maternity leave? If you can, make sure that your contract states the maximal frequency you can be on call.
Administrative or Academic Time
If you want protected time for certain activities, or want to be able to work virtually for these duties, negotiate this into your contract.
Tip: It should be spelled out in your contract, or there’s a good chance the expectation will be that those activities will come out of your personal time. As everyone struggles to squeeze more out with less resources, academic or administrative time that may be being offered without being included in the contract is often the first to go.
If you are joining a private practice group because of the opportunity for partnership, you want as much transparency into the partnership process as possible before devoting a few years of your life as an employee. Learn more on our assessing a partnership opportunity page.
Tip: In today’s world, thinking about the potential for a private equity buyout is prudent. Unfortunately we’ve heard lots of cases of people being a few months from partnerships after years, and then having the company sold to private equity and getting nothing for their sweat equity. See if you can negotiate some terms regarding this in.
Be careful about what is spelled out in your employment contract in regards to what you can be asked to do. With the increase in other members of the healthcare team, it may be expected that you oversee the work of others, which you may or may not want to do. This could be a significant time requirement on your time, or depending on how it is structured, result in liability for you or implications for your medical license, and you should decide what you are comfortable with, and how much you should be compensated for relevant activity.
People forget to ask about this, but many employers have restrictions on what you can do outside of work. If you think you want to do some side gigs like moonlighting, consulting, device development, expert witness, or otherwise, you don’t want them to either decline your ability to do so or want a share of the money you generate. Ask for a clause that says that as long as it doesn’t interfere with your duties at your job, you are allowed to do what you want in your free time.
Student Loan Repayment
For many physicians, student loans are a huge burden, and people often pick jobs based on companies that either qualify for federal loan forgiveness programs or programs from their employers. Some practices will offer to pay off a portion of your student loan if you work with them for a certain time, or a certain amount every year for a certain number of years, almost as a retention bonus. If this is important to you, ask for it!
You might be told certain things are non-negotiable. Try to negotiate anyway. If you don’t ask, you won’t get. Saying that something is “a standard contract” is a great negotiating tactic by employers that sends a not so subtle message to you to not try to negotiate. If they really want you, they’re not likely going to rescind their offer just because you tried to advocate for yourself (and if they do, that’s a huge red flag!).
Also, while there may be some things that are the same for everyone in some groups (salary, benefits, termination clauses, for example), there are many other things that can be customized about your contract, as we outlined above. Those aspects may have even greater of a value to you than another few thousand dollars, so if they’re hard and fast on the salary after asking once, try moving on to negotiating for something else if you’re getting the sense that you’re not likely to get the salary substantially increased at that point.
Red Flags In Contract and Negotiations
While everyone’s dealbreakers will vary, there are certain things we feel strongly about looking at. Make sure that the employer is willing to commit to things like the conditions under which your contract can be terminated, what your exact job responsibilities are (including supervision of other healthcare professionals), and a reasonable noncompete clause.
Additionally, if they aren’t willing to put something in the contract but ask you to trust them, be weary. If it’s not in the contract it’s not enforceable. Your future boss could be amazing, but they could also change jobs and the new person may not honor what they said to you. Get it all in writing.
In general, if you feel there is not a good faith effort to accommodate your requests, and the overriding sentiment is that you should feel privileged to work for them, pay attention to that spidey sense. The way you are treated during a contract negotiation sets the stage for how they will treat you as an employee.
Getting a Physician Contract Reviewed
With very few exceptions (for example, a VA job doesn’t have a contract, so there’s not much to review there, although you can negotiate salary), we think everyone should have their contract reviewed by a contract attorney. It is worth the money.
That said, even for “standard” contracts like those often offered at academic centers, you want to go into them eyes wide open. The fact is that you are a physician and you don’t know what you don’t know. The other side has likely put a LOT of time and energy into making sure the contract is favorable to them. Having a second set of eyes on the contract that can spot red flags and can advocate on your behalf, or explain to you why certain clauses are concerning or that you should at least understand the risk behind, is valuable.
You’ve put so many years and dollars into ~a decade of education to get to this point, and being cheap about this last step doesn’t make sense. Even one mistake avoided, a small negotiated increase in payment per RVU, or getting out of a restrictive clause will pay off with dividends in terms of mental energy, compensation, and legal fees later. Even if nothing is changed, the peace of mind in knowing there were no red flags and that you understand your contract well is well worth paying for.
If you need someone to review your contracts, we have a 10% discount with our advertisers at Resolve with code PHYSICIANS10. Hundreds of our members have used them. They are a national company that specializes in physician contracts so they're very familiar with compensation data, partnership agreements, things to look out with for call compensation, liability insurance, noncompetes, etc etc. They've been highly reviewed (you can see reviews on their site) both online and by members of our group. That site lists the different packages - if you're on a phone you may have to scroll on the first package to see the others.
We also have a contract attorney database, with local attorneys organized by state.