Physician negotiating: Go get what you’re worth

Why physician negotiating matters more than you think

Negotiation isn’t just about “getting more.” It’s about aligning expectations so you don’t end up with the
clinical equivalent of buying a house and discovering the “charming vintage plumbing” is actually a waterfall in
the basement. A physician contract is a bundle of trade-offs: compensation, workload, call, support, autonomy,
metrics, and exit terms. If you don’t negotiate, you’re still making a choiceyou’re just letting someone else
make it for you.

Small contract terms can have big, compounding consequences

• A modest base salary gap can compound through raises, retirement contributions, and future offers.
• A vague bonus plan can look shiny on paper but quietly become “unattainable by design.”
• Call expectations can turn your “great work-life balance” into “I live at the hospital now.”
• Malpractice coverage details can cost you real money later (hello, tail coverage).
• Restrictive covenants can limit where you can work if the job turns out to be a bad fit.

The goal isn’t to “win” negotiations. The goal is a sustainable, fair deal that matches your clinical reality,
your life, and your long-term career plan.

Prep like a clinician: gather data before you “treat” the offer

Negotiation gets dramatically easier when it stops being emotional (“Do they like me?”) and becomes clinical
(“What does the evidence say?”). Your best leverage is preparation: benchmark data, clarity on priorities, and a
concrete plan for how you’ll present your ask.

Step 1: Know your market value (and define the right “market”)

“Physician salary” is not one number. It varies by specialty, region, practice type, call burden, productivity
model, and whether you’re employed, academic, private practice, or locums. Use multiple sources so you’re not
anchoring your value to a single survey.

• Specialty compensation surveys: Use reputable physician compensation reports and benchmarks as reference points.
• Federal wage data: Helpful for big-picture grounding, but often too broad for specialty-level negotiating.
• Academic settings: If you’re negotiating in academic medicine, look for academic-specific compensation context and equity discussions.

Step 2: Translate “I want more money” into a professional case

Employers negotiate all daywith payers, vendors, health systems, and recruiters. They expect physicians to do
the same. Your job is to make it easy for them to say yes by connecting your request to legitimate business
reasons:

• Local demand (hard-to-recruit specialty, coverage needs, service line growth)
• Your experience and differentiators (procedural mix, fellowship skills, language skills, leadership, quality initiatives)
• Productivity potential (realistic ramp, patient access, referral base, support staff)
• Risk reduction (stability, retention, reduced locums spend, improved coverage)

Step 3: Decide what matters most before you start trading

Negotiations are trades. If you don’t know your top priorities, you’ll trade away something important for
something shiny. Before the first counteroffer, list:

• Must-haves: Non-negotiable items (e.g., call cap, tail coverage, protected admin time).
• Nice-to-haves: Items you’ll trade for (e.g., extra CME, relocation, flexible schedule).
• Deal-breakers: The terms that make you walk away (e.g., punitive noncompete, unsafe workload, one-sided termination).

What to negotiate in a physician contract (hint: it’s not just base salary)

Strong physician negotiating often means optimizing the total package. Sometimes the employer has limited
flexibility on salary but more flexibility on bonus structure, call pay, support, schedule, or benefits. Here’s
where to focus.

Base salary and the compensation model

Ask how compensation is determined: straight salary, salary plus bonus, production-based, collections-based, or
work RVU-based. If productivity is involved, get the definitions and thresholds in writing.

• wRVU models: Clarify the conversion factor, threshold, ramp period, and whether wRVUs are “credited” fairly.
• Collections models: Understand payer mix, write-offs, and timingcollections lag can hurt you early.
• Quality/value metrics: Ask exactly which metrics, how measured, and how much they’re worth.

Practical rule: if someone can’t explain the bonus plan in under two minutes without using the phrase “it’s
complicated,” that’s not a planit’s a surprise waiting to happen.

Signing bonus, relocation, and loan repayment

Upfront incentives are common, especially in hard-to-staff roles. The key is understanding clawbacks:
how repayment works if you leave early, and whether it’s prorated. If the employer can’t move the base salary,
consider negotiating:

• Higher signing bonus with prorated repayment terms
• Relocation reimbursement (and what it covers)
• Student loan assistance (how it’s paid, tax implications, and service commitment)
• Earlier eligibility for productivity bonuses

Call pay and call expectations

Call can be the silent killer of a “good salary.” Two offers with the same base pay can feel wildly different
depending on call frequency, call intensity, and post-call expectations. Negotiate clarity:

• Call schedule (frequency, weekends/holidays, backup call)
• Compensation (stipend, per-shift, per-weekend, or included)
• Post-call day (protected time, clinic volume adjustments)
• Coverage resources (APP support, hospitalist coverage, anesthesia support, transfer policies)

Time: PTO, CME, and the “hidden” calendar

Physicians don’t just need time off. We need time to stay competent and licensed. Negotiate:

• PTO/vacation and how it’s scheduled
• CME days and CME stipend (and whether unused funds roll over)
• Paid licensing, DEA, board fees, and society dues
• Protected admin time (especially if metrics/documentation are heavy)

Malpractice coverage and tail insurance

Malpractice is not a line item you want to understand “eventually.” If you’re under claims-made coverage, tail
insurance can be a major expense when you leave. Your contract should specify:

• Claims-made vs occurrence coverage
• Who pays for tail (employer, you, or shared)
• When tail is triggered (termination, nonrenewal, retirement)

Noncompete clauses and restrictive covenants

Noncompetes are changing rapidly across states, and enforcement varies. The contract language matters: time
limits, geographic scope, specialty scope, and “workarounds” like liquidated damages or nonsolicitation terms.
If there’s a noncompete, consider negotiating:

• Shorter duration
• Smaller radius tied to actual practice site
• Carve-outs (telemedicine, academic work, moonlighting, specific facilities)
• Mutuality (if they terminate without cause, restrictions loosen)

Termination terms: the “exit ramp” you hope you won’t need

A common contract risk is one-sided termination. Without-cause termination clauses often require notice (e.g.,
60–90 days). Ensure the notice period is fair and that compensation terms during notice are clear.
Also clarify what happens to bonuses if you leave near the payout date.

• Without-cause termination: notice length, mutual rights, and whether you can still work/earn during notice
• For-cause termination: definitions, cure periods, due process
• Bonus payout language: ensure earned bonuses are paid even if employment ends before a calendar cutoff

Negotiation tactics that work in the real world

The best physician negotiating strategies are boring in the best way: calm, evidence-based, and collaborative.
Your goal is to make your counteroffer feel reasonable and well-supported.

Ask for the compensation range (and don’t volunteer a low anchor)

If asked for expectations early, redirect: “I’m sure you have a range budgeted for the rolecan you share it?”
Then respond with a data-backed range that fits your benchmarks and your priorities.

Use a “package” counteroffer, not a single-issue demand

Instead of only asking for a higher base salary, propose a balanced package:
“If base is fixed, can we adjust the wRVU threshold, add call pay, and increase CME?”
Employers often have different internal buckets for compensation vs benefits vs one-time incentives.

Make it easy to say yes: one page, clear bullets, friendly tone

A crisp written counteroffer keeps everyone honest and reduces “misunderstandings.” Keep it short:

• Thank them and reaffirm interest
• List 3–6 requested changes
• Add a sentence of rationale tied to data or role needs
• Offer flexibility: “Open to discussing options that work for both sides.”

Know your BATNA (your realistic alternative)

BATNA sounds fancy, but it’s simply: “What will I do if this doesn’t work out?” Another offer, locums, staying
put, or expanding your search. You don’t need to threatenjust knowing your alternative helps you negotiate
confidently and avoid desperation-signing.

Get the details in writing

If it’s not in the contract (or written addendum), it doesn’t exist. Verbal promisesespecially around patient
volumes, support staff, and scheduleshave a way of evaporating the moment you get your badge.

Special situations: new attendings, academics, and pay equity

If you’re a new attending: negotiate the ramp, not just the salary

Early-career physicians are often placed on productivity models with unrealistic expectations during the ramp-up.
Ask for a defined ramp period, adjusted targets, mentorship, and resources that actually allow productivity:
clinic templates, referral support, adequate MA/RN staffing, and reasonable documentation expectations.

If you’re in academics: negotiate mission support

Academic roles may trade some compensation for teaching, research, and institutional mission. That trade can be
fairbut only if protected time and expectations are explicit. Negotiate:

• Protected FTE for research/teaching/admin
• Startup support (if relevant), conference travel, and scholarly support
• Transparent compensation structure and equity practices

Pay equity is a negotiation issue, not a “later” issue

Persistent pay gaps have been documented across the profession. Negotiation won’t fix systemic problems alone,
but being informed helps you avoid being under-placed in a range. Use benchmark data, ask how pay is determined,
and request clarity on how experience and productivity affect pay progression.

Red flags that should slow you down (or send you running)

Some clauses are not “standard”they’re just common. Read with the skepticism you reserve for a sodium of 118
that “doesn’t look that bad.”

Watch for these common contract hazards

• Unclear bonus terms: No definition of metrics, timing, or payout rules.
• Accelerated termination after you give notice: You give 90 days; they walk you out in 7.
• Overly broad noncompete: Huge radius, long duration, vague specialty scope.
• One-sided “without cause” terms: They can terminate easily; you can’t.
• Support-staff ambiguity: Productivity expectations without staffing or access to rooms/equipment.
• Repayment traps: Signing bonus clawbacks that aren’t prorated or are tied to vague “for cause” triggers.

If something feels off, it’s worth getting a physician-focused contract review. A few hundred to a few thousand
dollars can prevent far more expensive problems later.

How to negotiate without burning bridges

The fear is real: “If I negotiate, they’ll rescind the offer.” In most cases, professional negotiation is
expectedespecially if you’re respectful, specific, and reasonable. Here’s a tone that works:

• Warm: “I’m excited about the role and the team.”
• Clear: “I’d like to revisit a few terms to ensure the package matches the role’s scope.”
• Data-based: “Based on specialty benchmarks and call expectations…”
• Collaborative: “Here are a couple options that could work for both sides.”

You can be kind and still be firm. You do it every day when you tell a patient, “I hear you… and also, we’re not
prescribing antibiotics for a viral cold.”

Experiences from the trenches: what physicians commonly learn the hard way (and how to learn it the easy way)

The stories below are composites based on common physician negotiating scenarios (names and details changed).
The point isn’t dramait’s pattern recognition. If you can spot the pattern, you can negotiate around it.

1) The “great salary” that quietly required a second job: call overload

A new attending saw a strong base salary and signed quickly. Two months in, reality arrived with a pager.
Call wasn’t “1:6” in spirit; it was “1:6” on paper and “whenever the universe feels mischievous” in practice.
The fix wasn’t just call payit was negotiating a call cap, defining what counts as call, adding
backup coverage, and protecting a post-call recovery period. The lesson: call is compensation,
whether they pay you for it or you pay with your sleep.

2) The bonus plan that disappeared like a parking spot on rounding day

Another physician had a contract with a “potential” bonus tied to productivity. The problem was the threshold:
it assumed a full panel from day one, but scheduling bottlenecks and limited room availability made that
impossible. After a contract review, their counteroffer focused on ramp-up language: lower
thresholds in year one, guaranteed support staffing, and a written commitment to clinic access. Suddenly the
“potential” bonus became an achievable bonus. The lesson: negotiate the system that
enables productivity, not just the payout.

3) The signing bonus that turned into a trap: clawbacks without proration

A signing bonus helped with moving costs, but the repayment clause required paying it all back if the physician
left before two yearsno proration. When family circumstances changed, the physician faced a painful choice:
stay unhappy or pay a big exit fee. In a later negotiation, they insisted on prorated repayment,
clear “for cause” definitions, and repayment terms that matched real life (because life loves plot twists).
The lesson: negotiate clawbacks with the same seriousness you give anticoagulationdetails matter.

4) The noncompete that blocked the “escape route”

A physician accepted a job near family, only to discover the noncompete covered multiple counties and effectively
forced a move if things didn’t work out. In the next offer, the physician negotiated a smaller radius tied to
the primary practice site, a shorter duration, and a carve-out if the employer terminated without cause.
The lesson: you’re not planning to leave on day one, but you’re negotiating to avoid being trapped on day 600.

5) The “supportive team” that didn’t include… actual support staff

One physician negotiated salary successfully but didn’t ask about staffing. The job required high throughput,
yet the MA/RN support was thin, and prior authorizations multiplied like gremlins. The result: longer days,
less patient satisfaction, and an early burnout spiral. In a future negotiation, they added language about
staffing ratios, scribes (or documentation support), and protected admin time. The lesson: the fastest way to
increase your effective compensation is to protect your time and your workflow.

How these experiences translate into a smarter negotiation playbook

• Define the workload: Patient volumes, call, weekends, and admin tasks should be concrete.
• Define the math: wRVUs, collections, and bonus formulas must be transparent and realistic.
• Define the supports: Staffing, scheduling access, and resources should match expectations.
• Define the exit: Noncompetes, termination, and tail coverage should be survivable.
• Negotiate like a professional: Calm, data-driven, and collaborativeno theatrics required.

Physician negotiating is not a personality trait. It’s a skill. And like any skill in medicine, you improve it
with reps, feedback, and a refusal to accept “That’s just how it is” as a final diagnosis.