How rookie doctors crush their first contract


There are few things in a doctor’s life more exciting and overwhelming at the same time than finding your first job out of training and *gulp* negotiating your first employment contract. For many people, not just doctors, talking about how much money you’ll make can feel incredibly uncomfortable. You might feel overwhelmed or anxious about the process, making you want to sign the first contract that’s put in front of you as quickly as you can. During the job search, you must challenge yourself to lean into the discomfort of contract negotiation with the same courage, despite the uncertainty, that led you through medical school and residency.

Here’s what doctors don’t talk about enough – you’re not the only doctor feeling this way. It’s natural for doctors to be stressed, overwhelmed, and avoidant when searching for a job and negotiating your first contract. During training, you were never taught how to find the best jobs or what the “right” salary is for your specialty, geography, and care setting. It’s only human to feel uncertain through this process – even experienced doctors get butterflies negotiating their contracts. This blog will give you the only tips you’ll ever need to negotiate the best contract for you out of training.

Tip #1: Be willing to walk away

First and foremost, because of doctors’ financial value to hospitals and practices, you do have the power to ask for what is important to you in your practice and lifestyle in your contract. Doctors’ superpower in contract discussions is your ability to walk away from the offer. Here’s how to put yourself into the strongest position. During your job search, don’t put all your eggs in one basket. It’s a common misconception that first-time attendees do not have the power or leverage to make changes to a job offer. This causes doctors to leave hundreds of thousands of dollars on the negotiating table, causing you to trail behind your peers, financially. To have true power and influence in a contract negotiation, you must get more than one job offer. Having multiple, strong job offers will give you the confidence you need to negotiate the best deal for you rather than being underpaid for your skills, training, and contributions to the practice.

Pro tip: It’s important, but challenging, to sync up the timing of the offers so that you can negotiate multiple offers at the same time. When employers pressure you to sign a contract quickly, it’s completely appropriate to ask for more time (5 days – 6 weeks).

Tip #2: Do your homework

There are plenty of resources available to help you understand what salary range you should expect based on your geographic region, specialty, sub-specialty, care setting, employment/ownership status, and leadership responsibilities. We rely on the usual suspects like the Medical Group Management Association (MGMA), Medscape, Doximity, Physicians Thrive, and Merritt Hawkins. Beware: While MGMA is the gold standard and used by many health care systems across the country, it’s not free.

Pro tip: Many doctors make the mistake of asking their doctor friends or attendings how much they should be paid. This strategy is ill-advised and results in doctors leaving a ton of money on the table. Let the data be your guide.

Tip #3: Pay the debt down STAT

Who could forget about the mountain of medical education loan debt bogging you down? In 2019, the Association of American Medical Colleges reported that physicians finish training with $200,000, on average, in medical education loan debt. This debt can be a barrier to living the doctor lifestyle that you’ve worked so hard for. Don’t drag this chain of debt any longer than you need to. Here are three strategies we use to help doctors pay down their 6-figure student loan debt balance.

Government pays: Public Service Loan Forgiveness (PSLF). Enroll in the PSLF program to have your student loan balance erased after ten years of payments (120 on-time payments). This applies to doctors who work for organizations classified as 501(c)(3) non-profit organizations. This doesn’t mean that you need to take a vow of poverty to enroll in PSLF. Many faith-based, academic, and community hospitals are non-profits, making them eligible for PSLF enrollment.

Employer pays: education loan debt assistance. Employers can provide financial support, up to $100K—$300K, for physicians to pay down their medical education loan debt. Doctors must ask for education loan debt assistance, as it’s not usually offered upfront. This contribution from your employer could cut years off your paydown timeline.

Doctor pays: Increase the base salary. If all else fails, negotiate for an increase in your base salary guarantee and direct that income toward paying down your debt. Physicians must be proactive in the negotiation of your first employment contract, especially the base salary. Don’t be afraid to speak up and advocate for your value.

Pro tip: These three strategies can be used together to pay off your debt balance and get you to live the doctor’s lifestyle as quickly as possible.

You got this.

Negotiating your contract will be stressful, but it will be worth it. Lean into the discomfort, uncertainty, and maybe even a bit of fear. First-time attendings must understand your value to hospitals and practices. Medicine is a business, and it’s now your responsibility to proactively negotiate your employment contracts, making sure you get the pay you deserve so that you’re focused on taking the best care of your patients and aren’t being underpaid compared to your partners and peers.

Ethan A. Nkana is an attorney.


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