A job offer coming out of residency is a professional milestone, marking a big boost in pay and prestige. The final hurdle is sealing the best deal. Learn how to make the most of the time from offer to signed contract. The AMA offers advice on employment-contract matters and other issues relevant to your physician career.
One of those resources is a six-part interview series featured on “AMA Making the Rounds,” a podcast about negotiating an employment contract. The interview, with Wes Cleveland, senior attorney for the AMA Advocacy Resource Center, covers issues such as compensation, liability insurance and restrictive covenants.
Think of your career as if “you have started off on your own one-yard line and you have driven 99 yards down and you are ready to score. You don’t want to fumble the ball right at the end,” Cleveland said in one episode, underscoring the importance of specialized legal help.
By the time the offer arrives, there will likely have been a substantial courtship—in-depth interviews and a site visit. Being satisfied with those counts. Also, you should have completed a substantial amount of your own research about the potential employer. But what follows is just as important.
When they get serious, seek help fast
Offer provisions in contracts vary, but there are some fundamentals that apply in a wide range of situations.
Expect a serious offer to come on paper. It may be a one- or two-page letter of intent or a full contract that can run two dozen pages or more. A letter of intent will sketch out the key points—especially compensation—while a contract can get into a sometimes bewildering level of detail. A letter of intent may also contain a months-long “standstill” agreement, blocking you from negotiating with other potential employers.
A signed contract will finalize a deal, but be cautious about signing some letters of intent. Usually they are not binding, but some are, and the legal effect of your signing a letter of intent can vary by state.
Binding letters of intent can lock in pay and other provisions. However, even if a letter of intent is not binding, it is still likely to affect your negotiations.
Dive deeper:
- What I wish I knew in residency about being an employed physician
- What doctors must know about their first employment contract
- In transition to practice, know these 8 steps for evaluating jobs
- To know whether physician job pays enough, assess goals, values
Get a lawyer. Budget a few thousand dollars for a knowledgeable attorney to review any letter of intent and contract. This is best done by a lawyer who specializes in physician contract language and who practices in the same state as the potential employer. An experienced lawyer in this field can provide additional value to you too.
“I can't tell you how many very smart, very well-read, highly educated physicians sign a contract that says horrible stuff, and they just don't understand that it's horrible,” said Elizabeth A. Snelson, president of Legal Counsel for the Medical Staff PLLC, which specializes in working with medical staffs, medical societies and medical staff professionals. “This is a new age in the practice of medicine.”
Snelson is the author of the AMA Physicians’ Guide to Hospital Employment Contracts (PDF), free for AMA members, which provides expert guidance to physicians contemplating, entering into or working under employment contracts with hospitals or related entities.
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“Or they think they talked about it with the employer and it will all work out. They don't understand that it doesn't matter what you talked about—the only thing that matters, legally, is the contract. A jury will look at this incredibly overeducated human and think, ‘How could you not know? It's right there on paper!’”
Attorneys may also have insights on the local market or a prospective employer’s negotiating style or workplace culture. They also might have access to costly salary surveys that aren’t practical for employment candidates to obtain. One way to find a specialist lawyer is to contact your state medical society.
Don’t fear attempting to negotiate. Employers should not be put off by attempts to negotiate. However, potential employers may differ widely in their willingness to negotiate. Large, institutional employers may be less flexible than smaller, less bureaucratic organizations. You simply will not know until you try. Do not be afraid to ask for what you want.
Still, some physicians may be uncomfortable trying to negotiate. The same specialist lawyer reviewing the contracts will often be available to negotiate. It will cost extra, but can often be worth it, depending on your comfort level.
Be confident—that’s where research comes in handy—but be reasonable and realistic. The key issue is to understand local conditions—does their offer meet, beat or fail to measure up to the rest of the market?
Have half a dozen things to negotiate about. Compensation will nearly always be at the top of your list, but Cleveland recommended to “ask for more things than you really want.” That way, in trying to get extras that matter most to you—like flexible time or CME funding—“you can give those other things away.”
Explore all six episodes of the “AMA Making the Rounds” podcast series on employment contracts:
“Know Before You Sign”
- In this episode, Wes Cleveland provides tips on what to consider before you begin the contracting process.
“Letters of Intent”
- What are letters of intent? And when should you retain an attorney during the contracting process?
“Compensation”
- It’s all about money. Or is it? Cleveland describes what to look for in compensation and benefit packages.
“Restrictive Covenants and Termination Clauses”
- What are letters of intent? And when should you retain an attorney during the contracting process?
“Duties and Liability Insurance”
- You may not know it, but you can negotiate your duties as part of your employment contract. And don’t forget to think about liability insurance! Wes Cleveland provides the details.
“Interviews and Negotiations: What to Do (and Avoid)”
- What are letters of intent? And when should you retain an attorney during the contracting process?
Learn more with the AMA about understanding employment contracts.
More broadly, the AMA Transitioning to Practice series has guidance and resources on deciding where to practice, negotiating an employment contract, managing work-life balance, and other essential tips about starting in practice.
