the fear of losing your job.
As a new physician moving from residency or fellowship into attendinghood, or simply considering a career shift, the journey can be both exhilarating and daunting. There’s the excitement of embarking on your first “real” position, at last earning a paycheck that mirrors the years of hard work you’ve devoted. However, that excitement is often coupled with stress: about discovering the right environment, navigating unfamiliar systems, and negotiating a contract you might not completely grasp.
Among all these new duties, your initial job contract may appear to be just another box to check off. Yet, it is, in fact, one of the most crucial documents in your professional life. It will influence your salary, your workload, your independence, and most significantly, your overall well-being.
Some trainees receive structured preparation in reviewing and negotiating contracts, yet many do not. Consequently, numerous physicians enter the workforce ill-equipped to advocate for themselves. To demonstrate this, let’s examine two distinctly different experiences in their first jobs.
Dr. Cynthia Chen-Joea:
When I finalized my first attending contract, I was unaware of what I didn’t know.
I was simply thrilled to have landed my dream position—the highest paying faculty role that I was presented with. I perceived it as fair compensation, with wonderful hours and flexibility, and I was eager to collaborate with others who shared my passion for teaching residents. Like numerous physicians, I genuinely felt that medicine was a vocation, not merely a job. I wasn’t meant to focus too heavily on finances or nuances. After all, I had dedicated over a decade to my training—wasn’t this the payoff?
I presumed I had sufficient knowledge of negotiation to ask all the requisite questions, which was certainly more than many of my peers.
However, what I did not grasp and understand would only come to light over five years later.
I didn’t recognize my worth.
I didn’t acknowledge my significance to the program and institution.
And I didn’t comprehend that I lacked negotiation skills.
It cost me clarity, leverage, and tranquility.
Dr. Peter Baum:
I gained a reputation for going the extra mile for my patients, to such an extent that self-sacrifice caused me to experience burnout during residency.
When I received my first job offer, I was thrilled by a opportunity that appeared to align with my values, allowing me to maintain my well-being. But when the salary offered fell short of my expectations, I reached out to a mentor for advice on navigating the situation and attempted to negotiate.
After several discussions, I successfully negotiated a salary that matched the local employment market standards and importantly, met my financial requirements as a newly minted attending starting a family in an area with a high cost of living.
Eventually, my family and I had to relocate multiple times due to my wife’s career demands and professional growth. The skills I acquired in that initial negotiation equipped me for success in my following contract negotiations, and I ensured I advocated for my worth throughout.
Through our roles as physician coaches, we’ve assisted numerous doctors grappling with feelings of being stuck, burned out, and disenchanted—but often, their discontent traces back to the very contract they agreed to on day one.
That’s why we firmly uphold this belief:
Acquiring negotiation skills for your contract is among the most vital career competencies you can foster as a physician.
And no—it’s not exclusive to the “business-minded” individuals.
Why physicians are reluctant to negotiate
The majority of physicians never learn how to negotiate. We are trained to save lives, make diagnoses, document endlessly, and get by on minimal sleep. But if it’s time to defend ourselves—to analyze a non-compete clause or challenge our base salary? Cue the selflessness and feelings of inadequacy.
Many of us grew up within systems—medical and otherwise—that celebrated compliance and penalized assertiveness. We’ve been conditioned to adhere to rules without questioning them. When we do voice our concerns, we often face reprimands or second-guess our decisions.
Am I being too obstinate? Too assertive? What if they withdraw the offer? Is this the value they attribute to me?
Compounded by a culture that frequently venerates self-sacrifice and depicts medicine as a calling rather than a profession, the result is a concoction of shame, silence, and missed opportunities.
However, here’s the reality: Negotiating doesn’t signify greed. It indicates that you are well-informed. It’s not about being confrontational—it’s about fostering clarity and alignment. A robust contract not only safeguards you, but also assures that you can fully attend to your patients without perpetually running on empty. This implies that you won’t be rushing from one patient to another, mentally tallying how many more charts need to be completed after hours. It signifies that you’re not silently brooding over pay disparities or feeling imprisoned in a toxic work atmosphere with the anxiety of job loss.