Top 10 Tips for Negotiating Your Contract as a Physician
Negotiating your first - or fifth - contract can feel overwhelming. But it doesn’t have to be.
Whether you're stepping out of training or making a mid-career move, the contract table isn’t just about clauses and compensation. It’s about clarity. It’s about claiming what matters to you - on paper and in practice.
Contract negotiation is often not something taught in medical school or residency, but it is crucial to setting yourself up for future success.
Here are 10 tips to help you take control, ask the right questions, and walk away with a contract that reflects your value.
Healthcare Contract Negotiation Tips
1. Know Your Worth (And Own It)
Before you even open the contract, take a moment to ground yourself in your value. You’ve invested years into your training, often sacrificing sleep, relationships, and stability to get here. That dedication, expertise, and resilience are worth something – both to you and to any employer.
Use trusted resources and popular forums like:
MGMA Salary Reports (for benchmark compensation data by specialty and region)
Specialty-specific Facebook groups
Reddit (r/InternalMedicine or r/“your-specialty”)
Compare offers to industry standards and geographic norms. Know the going rate for your specialty, and don’t forget to consider benefits, work hours, and call expectations.
Pro tip: Verbal promises – no matter how sincere – won’t hold up unless they’re in writing. If it's important to you, make sure it’s in the contract. Clarity now prevents confusion (or conflict) later.
2. Don’t Skip the Homework
Research the employer – hospital, private practice, private equity group, or academic center. Things to think about:
What’s their reputation among current and former employees?
Are physicians happy there? What’s the turnover rate?
What are the patient volumes and expectations? Do you have a cap or quotas?
Is it a private practice, hospital system, private equity-owned group, or academic center – and how does that impact your autonomy and growth?
Who exactly will you be negotiating with – HR, a physician leader, or a practice manager?
Use Glassdoor, Google Reviews, or even your professional network to get the real story. The more you know, the more strategic you can be.
“Do your research before signing. Don’t be afraid to ask specific questions - especially ones that matter to your long-term satisfaction.
As a woman, I made a point to ask about how the group has supported other women. How was maternity leave handled? What happened to their call schedule and patient load during pregnancy and after?
I also asked about the partnership track: Is it truly available? What does it take to get there? When was someone last made a partner, and how often does it happen?
It’s also important to understand how the team functions - how patients are distributed, how overhead is split, and how calls are managed. These are the things that directly impact your day-to-day and your future, so don’t skip the hard questions.”
3. Get Clear on Your Priorities
Before negotiating, ask yourself: What truly matters to me?
Some ideas:
Competitive salary or loan repayment
Reasonable patient load
Protected time for research or teaching
Geographic location or proximity to family
A supportive culture or diverse leadership
Pick your top 2–3 priorities and stay grounded in them during negotiations. It’s easy to get distracted by shiny perks, but alignment with your values matters more in the long run. You’re not just negotiating a job – you’re shaping your lifestyle.
“For my first job after my fellowship, it was important for me to have a clear idea about how I would grow as a physician in the contract.
I tried to negotiate my first contract well, but there were still certain things that I didn’t negotiate for, and I didn’t completely understand the implications of the negotiation.”
4. Ask to See the Contract Early
It’s okay, and expected, to ask for time to review the contract. A rushed decision is never a good one. Employers who value you will respect that you want to do your due diligence.
Pro tip: Request the offer in writing and ask clarifying questions early. If the organization resists giving you time or access to documents, consider that a red flag.
5. Get Expert Eyes on It
Hire a contract attorney who specializes in physician agreements. This is one of the smartest investments you can make.
Potential red flags they may catch:
Vague or restrictive non-compete clauses
Ambiguous call schedules
Complicated RVU or bonus structures that don’t favor you
Clauses about intellectual property, termination, or malpractice tail coverage
Small edits now can save you from big regrets later.
If you're doing research or publishing, make sure your intellectual property rights are spelled out clearly—no gray areas, no surprises.
“I didn’t have an attorney review my first contract because I didn’t know I could - or should. I was told it was a ‘standard’ contract and that nothing could be changed, so I signed it as-is.
Since then, I’ve had an attorney review every contract I’ve signed, and it’s made a huge difference. They catch inconsistencies, point out what’s missing, and suggest protections I hadn’t considered. Plus, having an attorney creates a buffer - it’s much easier to say, ‘my attorney recommended’ than to personally negotiate every point. I highly recommend getting legal support before signing anything.”
6. Break the Taboo Around Discussing Compensation
In training, we take what we’re given—because that’s how the system works. Salary is tied to your PGY level, and there’s no room to negotiate. So when it is time to advocate for more, it can feel uncomfortable—like asking is somehow too much.
But let’s be clear: talking about money isn’t greedy. It’s necessary.
“As I’ve gotten older and better at asking for things, I have asked for more money. How I approached it was by laying out my value and asking for what I’m worth. I said, ‘I have time to do more work and would like to do more, but I want more money to do so. This is what I need, can you do that?’ And they agreed.”
Ask mentors, colleagues, and friends about their salaries and perks – you never know where you may find an idea for something to negotiate. Things to think about:
Call pay: How does call pay work? Is it included in your salary or bonus pay? Is it given as a weekly, monthly, or yearly pay?
RVU structure: Do you transition from salary to RVUs? Is there a ramp-up period? Are you productivity-based from the start?
Bonuses: Are they attainable, or structured in a way that’s out of reach?
Knowledge is power – and transparency helps level the playing field.
7. Watch the Wording
Vague language is a liability. A contract that says “as needed” for call or “full-time hours” without specificity can lead to overwork and burnout.
Ask for:
Defined clinic hours
Specific number of patients per day (or per hour)
Clarified on-call schedules and response times
Administrative expectations (e.g., how quickly charts need to be closed)
Push for specificity and transparency. Ambiguity benefits the employer, not you.
“My contract for a W-2 employed position said they would only pay 50% of my malpractice coverage if I earned the practice less than $500,000 in revenue per year. I looked at the numbers quickly and calculated that I needed a net pay of $200-250k to reach that, which is an average doctor salary, so I signed.
Let me tell you, I didn’t make that much until my third or fourth year, because I didn’t have complete control over all aspects of how my practice was grown.”
8. Remember: Everything Is Negotiable
Negotiation isn’t conflict—it’s clarity. Most offers come with wiggle room, and asking for what you need doesn’t make you demanding, it makes you intentional. Be clear. Be kind. Be confident.
And remember: salary is just one piece. Sometimes the real value is in everything else they’re willing to offer like:
Signing bonus
Relocation allowance
Student loan repayment
CME funding and time
Malpractice insurance and tail coverage
Flexible start dates
Vacation time
Sick days
Parental leave
Days per week in clinic if outpatient
Flexible schedule and remote options
Administrative time for charting and inbox
Termination clause
Noncompete agreements
Pro tip: Even if your base salary is firm, employers often have more wiggle room in the benefits package.
And remember, just because you negotiated once doesn’t mean you can’t revisit terms later, especially after proving your value.
“Money is not the most important thing in that contract. A lot of the things that impact your happiness are other variables that potentially are negotiable - you don’t get what you don’t ask for.
You have to ask for the things that would improve your life and your happiness.”
9. Stay Professional, Even If You Decline
You might walk away from an offer – and that’s okay. Do it graciously. Medicine is a small world, and professionalism matters. Your dream job might be down the road with the same group or a colleague who remembers how you handled things.
10. Trust Your Gut (and Your Goals)
Finally, no contract is perfect, but it should feel like a step toward your bigger vision. The overall process should feel respectful, transparent, and aligned with your goals.
If something feels off, dig deeper. But If you’re feeling pressured, gaslit, or dismissed – that’s a red flag. A supportive, fair negotiation process often reflects a supportive workplace culture.
Trust yourself. You’ve trained hard, you’ve earned your seat at the table, and you deserve to build a life and career that works for you.
Final Thoughts
Negotiating a physician contract can feel intimidating, especially if you’re not used to advocating for yourself. But this is your moment. It’s not just about the next year or two – it’s about setting the tone for the next phase of your life.
So do the homework. Ask the questions. Have the conversation. And remember: advocacy isn’t just for your patients – it’s for you, too.